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NO 0-7 hr 8 - 28 hr 29hr-1thn

URUT JENIS PENYAKIT


B L B L B L
L P L P L P L P L P L
1 3 4 5 6 7 8 9 10 11 12 13 14
5 PRAKTUR
6 ESRD
8 PETEREGIUM
9 TUMOR MAMAE
### LYMPOMA
### VERTILIGO
### OMA
21 HIPERTIROID
22 HP 26
23 DYSPEPSI
24 TIA
### ARTRTIS
#REF! PRAKTURNASAL
#REF! LYM COLLI
30 HEPATITIS
31 SLE
32 BO
33 GLUKOMA
34 HEMATOMA
35 BRONCHITIS
36 CESTPAIN
37 DEPRESI
38 ASMA
#REF! ICTERUS 1
41 PRESBIAKUTIS
42 SERUMEN
44 ITP
47 CA CERVIK
48 HIL
49 NS
50 DSFC
51 FAM
52 PPOK
RHINITIS
TINEA KAPITIS
HAEMAPTAC
TRAUMA PD MATA
URTIKARIA
H 52
SELULITIS
DEBRIDEMENT
MYOMA
TB
NEUROSA
CRF
SKIZOPRENA

R68
-1thn 1 - 4 th 5-9 th 10-14
L B L B L B
P L P L P L P L P L
15 16 17 18 19 20 21 22 23 24
1

1
1 1
1
1
JUMLAH KASUS BARU MENURUT GOLONGAN UMUR

10-14 th 15-19 th 20-44 th


B L B L B L
P L P L P L P L P L
25 26 27 28 29 30 31 32 33 34

1 1
1

1
2
1
1 1
3

1
1
1 1

1
44 th 45-54 th 55-59 th 60-69
L B L B L B
P L P L P L P L P L
35 36 37 38 39 40 41 42 43 44

2 2
1 1
1

1 1
2 1

3 1

1 1
1

1 1 1

1 2

1
1
1

1 1
1
1
1
60-69 th >- 70 th kasus baru

B L B L L P JML

P L P L P L P
45 46 47 48 49 50 51 49 50 51
1 0 1
0 2 2
0 0 0
0 0 0
0 1 1
1 1 0 1
0 1 1
0 1 1
0 0 0
2 2 0 2
1 0 0 0
1 0 1
1 0 0 0
0 0 0
0 2 2
0 0 0
0 1 1
1 0 0 0
0 1 1
2 0 2
1 0 3 3
0 2 2
1 0 0 0
1 0 1
1 0 1 1
0 0 0
0 0 0
0 1 1
1 0 1
0 0 0
1 1 0 0 0
0 1 1
0 0 0
2 0 2
0 1 1
1 0 1
1 0 1
1 0 1
1 0 0 0
1 0 0 0
1 0 1 1
0 1 1
0 0 0
0 0 0
0 0 0
1 0 0 0
14 20 34
2 8 10
16 28 44
kasus lama
peserta
L P JML kasus total
gakin

52 53 54 55 56
0 0 0 1
0 2 2 4
0 2 2 2
0 1 1 1 1
0 0 0 1 13
0 0 0 1
1 0 1 2 9
0 0 0 1 6
1 1 2 2
1 2 3 5
0 1 1 1 18
0 3 3 4 3
0 1 1 1 14
0 2 2 2
0 2 2 4
0 1 1 1
0 0 0 1
1 0 1 1 15
0 0 0 1
0 0 0 2 16
0 2 2 5
0 0 0 2
4 3 7 7
0 0 0 1
0 0 0 1
0 1 1 1
0 1 1 1
0 0 0 1 2
1 0 1 2
1 1 2 2
0 2 2 2
0 0 0 1 11
1 0 1 1
0 1 1 3 17
0 0 0 1 7
0 0 0 1
0 0 0 1
0 0 0 1
0 1 1 1
1 1 2 2
0 0 0 1
0 0 0 1
1 1 2 2
0 1 1 1
0 1 1 1 12
2 1 3 3
15 35 50 84
0 10 10 20
15 45 60 104
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN APRIL TAHUN 2013

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM 1 2 16 26 45
2 DISPEPSIA 4 3 8 2 17
3 DEPRESI 0 0 4 0 4
4 PSIKOMATIS INSOMNIA 1 1 0 0 2
5 ANXIETAS 0 0 2 0 2
6 IMPAKSI 1 2 1 2 6
7 ACNE 0 0 0 1 1
8 PROLAPS UTERI 0 0 0 1 1
9 PROSTAT HIPERPLASIA 1 0 0 1 2
10 RA 2 2 1 5 10
11 HIL 0 1 1 0 2
12 DERMATITIS 0 1 4 2 7
13 CANASOFARINX 1 0 0 0 1
14 ISK 0 3 0 1 4
15 KISTA OVARIUM 0 0 0 1 1
16 SINUSITIS 0 0 0 1 1
17 ANEMIA HAEMORAGIC 0 1 0 0 1
18 PTERIGIUM 0 3 0 0 3
19 CHEPALGIA 0 0 0 1 1
20 APENDIKSITIS 0 0 0 1 1
21 CHEST PAIN 0 0 0 1 1
22 MOLA HIDATIDOSA 0 0 0 4 4
23 ASHD 0 0 8 3 11
24 MYOPIA 1 4 0 2 7
25 ANEMIA GRAVIDARIUM 0 1 0 0 1
26 ESRD 0 1 3 1 5
27 EPILEPSI 0 0 7 2 9
28 POST STROKE 0 0 3 2 5
29 CA MAMAE 0 0 0 1 1
30 CAD 0 0 2 3 5
31 PPOK 0 0 1 0 1
32 KATARAK 2 2 3 2 9
33 PULPITIS 2 4 0 0 6
34 OBS FEBRIS SUSP TYPOID 1 0 0 0 1
35 DISLIPIDEMIA 0 1 2 2 5
36 TUMOR PARU 0 0 1 0 1
37 SUSP DBD 5 1 2 0 8
38 ASHMA 0 0 0 2 2
39 CEREBRAL PALSI 0 0 1 2 3
40 HERNIA 0 0 0 1 1
41 SERVICITIS 0 0 1 0 1
42 THALASEMIA 0 0 2 5 7
43 PSEUDOPILIA 0 0 0 1 1
44 HT 0 0 2 0 2
45 FAM 0 1 0 0 1
46 RUPTUR TENDON 0 1 0 0 1
47 OMP 0 0 0 1 1
48 RETINOBLASTOMA 0 0 1 0 1
49 VERUCA 0 2 0 0 2
50 OA GEUNE 0 1 1 2 4
51 LYMPADENOPATI 0 1 0 1 2
52 CA CERVIK 0 0 0 3 3
53 TYROID 0 0 1 0 1
54 EVAN'S SYNDROM 0 0 1 0 1
55 HERPES 0 0 1 0 1
56 SOL 0 0 1 0 1
57 NS 1 0 0 0 1
58 GLAUKOMA 0 0 0 1 1
59 HT DG GRAVIDA 0 0 1 1 2
60 HAEMOROID EKSTERNA 1 0 0 0 1
61 CHEPALGIA 0 0 2 1 3
62 TRAUMA KEPALA 0 1 1 1 3
63 FLAUR ALLBUS 1 0 0 0 1
64 PALPITASI CARDIS TB 1 0 2 1 4
65 GRAV DG STRUMA 0 0 0 1 1
66 IVB 0 0 0 1 1
67 HAEMOROID 0 0 0 1 1
68 MYOMA UTERI 0 1 0 0 1
69 HYPERTYROID 0 1 0 3 4
70 ABSES EC GP 2 0 0 0 2
71 FATAL DISTRESS 0 1 0 0 1
72 CERUMENT DALAM 0 2 0 1 3
73 SEROTINUS 0 2 0 1 3
74 VULNUS DIGITI 3 DEXTRA 1 0 0 0 1
75 FEB 0 1 0 1 2
76 LBP 0 0 1 1 2
77 BRONCHITIS 2 0 1 0 3
78 VITILIGO 0 1 0 0 1
79 DECOM 1 0 0 0 1
80 OSTEOPOROSIS 0 0 1 0 1
81 MENINGITIS TB 1 0 0 0 1
82 DILATED CARDIOMIOPATI 2 0 0 1 3
83 HEPATITIS 1 0 0 1 2
84 CORPUS ALINEUM 1 0 0 0 1
85 GOUT 1 1 0 0 2
86 STRUMA 0 0 0 1 1
87 OMA 0 1 0 1 2
88 CARDIOMYOPATI 0 1 0 2 3
89 SLE 0 0 0 1 1
90 POST BGM + TB 1 0 0 0 1
91 STOMATITIS 0 1 0 0 1
92 RAD LUMBAL 0 0 0 1 1
93 KONJUNGTIVITIS 0 0 0 1 1
94 SKIZOPRENIA 0 1 0 0 1
95 IKTERRUS 2 0 0 1 3
JUMLAH 41 54 90 111 296

Mengetahui, Sumedang, April 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN APRIL TAHUN 2012

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM E14 7 9 32 39 87
2 Hypertensi I10 2 4 12 17 35
3 POST STROKE 5 2 3 9 19
4 Dermatitis L30 4 3 3 3 13
5 ISRD 0 5 4 3 12
6 Presbiopia 2 4 0 3 9
7 THALASEMIA 1 1 2 4 8
8 Epilepsi G 40 0 0 4 4 8
9 katarak H 25 2 3 0 3 8
10 Pulpitis 0 2 3 2 7
11 ASHD 1 1 3 2 7
12 Tukak Lambung K 29 0 0 1 5 6
13 HEPATITIS 0 2 2 1 5

14
TB PARU dengan
Hemaptoe 0 2 2 1 5
15 Myopia 0 1 1 3 5
16 Struma 0 0 2 3 5
17 Serotinus 0 4 0 1 5

18
Fibro Adenoma
Mamae 0 1 1 3 5
19 Gout M10 1 2 4 1 8
20 Ortopedi 0 0 1 4 5
21 Lipoma 1 0 0 3 4
22 Chestpain 0 2 1 1 4

23 Hiperkolesterolemia
1 1 1 1 4
24 Tinitus 0 1 2 1 4
25 Sinusitis 2 1 1 0 4
26 Hemodialisa 0 0 2 2 4
27 Skizoprenia 0 1 0 2 3
28 Sellulitis 1 1 1 0 3
29 Asma J 45 1 2 0 0 3
30 Dispepsia 0 0 1 1 2
31 Myoma Uteri 0 1 0 1 2
32 POST Operasi 0 0 0 2 2
33 Omp 0 1 0 1 2
34
Obs. febris dengan
suspek DBD 2 0 0 0 2
35 Peterigium 1 0 0 0 1
36 Varices 1 0 0 0 1
37 Abortus 0 1 0 0 1
38 Trauma 0 1 0 0 1

39
Gravida dengan letak
sungsang 0 1 0 0 1

40
Cikatrik pada Sklera
sinistra 1 0 0 0 1
41 Pneumonia 0 0 0 1 1
42 bronhitis 0 0 0 1 1
43 Nephrotik Sindrome 0 1 0 0 1
44 BPH 1 0 0 0 1
45 TYPOID Fiver 0 0 0 1 1
Gastro Enteritis akut
46 dengan dehidrasi
berat 1 0 0 0 1

47
Glomerulonephritis
akut 1 0 0 0 1
48 osteoporosis 0 0 0 1 1

49
Decompensatio
Cordis 0 0 1 0 1
50 OMK 1 0 0 0 1
40 61 90 130 321

Mengetahui, Sumedang, 06 Juni 2012


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Edi Karyadi Ena Marlena Sanusi


NIP. 19590918 198603 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN MEI TAHUN 2012

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM E14 0 3 20 26 49
2 HT I10 2 8 10 21 41
3 ASHD 0 0 8 9 17
4 POST STROKE 2 0 6 9 17
5 KATARAK H 25 1 3 3 5 12
6 GANTI KACA MATA 2 2 2 4 10
7 RA 1 1 3 9 14

8 Gravida dengan partus lama 0 2 0 3 5

Gravida dengan letak sungsang 2 2 4


9
10 Tukak Lambung K 29 1 1 4 3 9
11 Neuritis M792 0 1 2 6 9
12 EPILEPSI G 40 0 0 4 5 9
13 Decompensatio 1 3 2 2 8
14 Dermatits alergica L 30 1 2 3 1 7
15 BPH 2 0 5 0 7
16 ASMA J 45 0 0 4 3 7
17 DIslipidemia 1 2 3 1 7
18 Ginggivitis 1 3 2 0 6
19 STRUMA 0 0 2 4 6
20 THALASEMIA 0 0 1 5 6
21 Kista Ovarium 0 1 0 4 5
22 Obs. Febris dengan suspek DBD 1 3 1 0 5
23 Dyspepsia 2 0 1 2 5
24 Chest pain 0 3 0 2 5
25 ESRD 0 2 0 2 4
26 HEPATITIS 0 2 0 2 4
27 Skizoprenia 0 0 2 1 3
28 Rhinitis Alergica 2 0 0 1 3
29 Lymphadenitis polli 0 0 0 2 2
30 Pyteregium 0 0 0 2 2
31 OMA 0 1 1 0 2
32 BRONCHITIS 2 0 0 0 2
33 DEPRESI 0 2 0 0 2
34 Hernia Inguinalis lateralis 1 0 1 0 2
35 Nefrotik Sindrom 0 0 1 1 2
36 DSFC 0 0 0 2 2
37 SELULITIS 0 0 1 1 2
38 Hemaptoe 0 0 1 1 2
39 Fraktur Tibia Femoralis Dextra 1 0 0 0 1
40 Tumor Mamae Sinistra 0 0 0 1 1
41 LYMPOMA 0 1 0 0 1
42 Vitiligo 1 0 0 0 1
43 HIPERTIROID 0 1 0 0 1
44 TIA 0 0 0 1 1
45 Fraktur Nasalis 0 0 0 1 1
46 SLE 0 0 0 1 1
47 BO 0 1 0 0 1
48 GLUKOMA 0 0 1 0 1
49 HEMATOMA 0 1 0 0 1
50 ICTERUS 1 0 0 0 1
51 Presbiakusis 0 1 0 0 1
52 OMK 0 0 0 1 1
53 ITP 0 0 0 1 1
54 CA CERVIK 0 1 0 0 1
55 Fibro Adenoma Mamae 0 1 0 0 1
56 PPOK 0 0 1 0 1
57 TINEA KAPITIS 0 1 0 0 1
58 HAEMAPTAC 1 0 0 0 1
59 Trauma pada palpebra Sinistra 1 0 0 0 1
60 URTIKARIA 1 0 0 0 1
61 Pterigium 0 0 0 1 1
62 DEBRIDEMENT 0 1 0 0 1
63 Myoma Uteri 0 1 0 0 1
64 Kecemasan 0 0 0 1 1
65 Cronik Renal Failure 0 0 0 1 1

JUMLAH 29 57 95 150 331


Mengetahui, Sumedang, 06 Juni 2012
a/n Kepala UPTD Puskesmas Cimalaka Pembuat Laporan
Ka Subag TU

Edi Karyadi Ena Marlena Sanusi


NIP. 19590918 198603 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN JUNI TAHUN 2012

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM E14 2 1 18 40 61
2 HYPERTENSI I10 1 0 11 8 20
3 ASHD 1 0 9 2 12
4 KATARAK H25 1 4 1 4 10
5 DERMATITIS L30 3 1 4 1 9
6 HIL 3 0 5 0 8
7 RA 0 5 1 1 7
8 EPILEPSI G40 0 3 2 2 7
9 SKIZOPRENIA 1 2 1 2 6
10 THALASEMIA 0 0 1 4 5
11 TINITUS 2 1 1 1 5
12 TB DENGAN HAEMAPTOE 1 0 2 2 5
13 POST STROKE 0 0 1 4 5
14 KONJUNGTIVITIS 3 2 0 0 5
15 NEURITIS 0 0 2 3 5
16 PRESBIOP 0 0 1 4 5
17 STRUMA 0 1 0 4 5
18 ULKUS PEPTIKUM 1 1 1 2 5
19 GOUT M10 0 1 0 3 4
20 OSTEOPOROSIS 1 0 2 1 4
21 IKTERUS 2 1 1 0 4
22 CEPHALGIA 0 0 1 3 4
23 NS 0 1 3 0 4
24 NEROMYALGIA 0 0 2 2 4
25 DISLIPIDEMIA 1 2 0 1 4
26 HEPATITIS 0 2 0 2 4
27 OSTEO ARTRITIS 1 1 1 0 3
28 AMI 0 0 3 0 3
29 ESRD 0 0 3 0 3
30 GRAVIDA DENGAN PROTEIN + 3 0 2 0 1 3
31 LYMPADENOPATI 0 2 0 1 3
32 INFAKSI 1 1 0 1 3

33 OBS.FEBRIS DENGAN TYPOID 1 1 1 0 3


34 PULPITIS 1 2 0 0 3

35 MASTITIS 0 2 0 0 2
36 KATARAK KONGENITAL 1 0 1 0 2
37 PTERIGIUM 0 1 0 1 2

38 FAM 0 2 0 0 2

39 VERUKA PADA JARI 1 0 0 1 2


40 PANORAMIK 0 2 0 0 2

41 PROLAPS UTERI 0 1 0 1 2

42 CA CERVIK 0 1 0 1 2

43 ABORTUS INCOMPLITUS 0 2 0 0 2

44 SNAKE QITE 2 0 0 0 2
45 ABSES HATI 0 0 1 0 1

46 MYOMA UTERI 0 1 0 0 1

47 TUKAK LAMBUNG 0 1 0 0 1

48 DEBRIDEMENT 0 1 0 0 1
49 KELOID DI PUTTING KA-KI 0 1 0 0 1
50 RATENTIO PLASENTA 0 0 1 0 1
51 COMONCOLD 0 1 0 0 1

52 POST OP 0 0 0 1 1

53 POST SC 0 0 0 1 1

54 HAEMOROID 1 0 0 0 1

55 LBP 0 0 1 0 1

56 TUMOR WILLMS 0 0 1 0 1

57 INFEKSI KPD 0 1 0 0 1

58 IN ERUPSI 0 0 0 1 1

59 PTERIGIUM OD 0 0 1 0 1

60 FRAKTUR TIBIA SIN 0 0 0 1 1

61 ECZEMA 0 1 0 0 1

62 RADIAK LUMBAL 0 0 0 1 1

63 ATRALBIA 0 0 1 0 1

64 ASPHYXIA 1 0 0 0 1

65 MIOPYA 0 1 0 0 1

66 SU + KPD 0 1 0 0 1

67 TINEA 1 0 0 0 1

68 TIROTOSITAS 0 1 0 0 1

69 GRAVIDA HT 0 1 0 0 1

70 PLACENTA PRAVIA 0 0 0 1 1

71 IUFD 0 1 0 0 1
72 OMP 0 1 0 0 1
73 CHESTPAIN 1 0 0 0 1
74 SNNT 0 0 1 0 1
75 FLOUR ALBUS 0 1 0 0 1
76 DCFC 0 0 0 1 1
77 ISPA 0 0 1 0 1
78 BPH 1 0 0 0 1
79 PSEDOPHILIA 0 0 0 1 1
JUMLAH 36 62 87 111 296

Mengetahui, Sumedang, 04 Juli 2012


Plt Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Edi Karyadi Ena Marlena Sanusi


NIP. 19590918 198603 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN JULI TAHUN 2012

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM E14 4 5 27 28 64
2 ASHD 5 2 15 11 33
3 HYPERTENSI 2 2 9 18 31
4 POST STROKE 3 2 15 10 30
5 DYSPEPSI K30 2 0 2 14 18
6 BPH 5 0 4 3 12
7 DISLIPEDEMIA 0 3 5 4 12
8 KATARAK H26 0 0 5 5 10
9 GANTI KACA MATA 0 0 5 5 10
10 DERMATITIS L30 0 2 3 4 9
11 DECOM 1 1 4 3 9
12 SERUMEN DALAM 3 4 0 0 7
13 CRF 0 1 2 4 7
14 RHINITIS 1 3 3 0 7
15 FRAKTUR FEMUR 0 1 5 0 6
16 INFAKSI 3 1 2 0 6
17 FAM 0 0 0 6 6
18 MYOPI 0 3 1 2 6
19 EPILEPSI G40 0 0 1 4 5
20 THALASEMIA 0 0 0 5 5
21 NS 1 0 2 1 4
22 TINITUS 0 0 2 2 4
23 GLAUCOMA 1 1 0 2 4
24 PULPITIS 1 1 1 1 4
25 ESRD 1 0 0 2 3
26 ULLUS DIABETIC 0 1 0 2 3
27 PPOK 0 0 3 0 3
28 SLE 0 0 1 2 3
29 HNP 0 0 0 3 3
30 ASMA J45 0 0 2 1 3
31 AB IMINEN 0 2 0 0 2
32 CLAVUS 0 2 0 0 2
33 SELULITIS 0 0 1 1 2
34 ISPA J06 1 1 0 0 2
35 HYPERTIROID 0 2 0 0 2
36 TUMOR COLON 0 1 0 1 2
37 STRUMA 0 0 0 2 2
38 TUMOR TONSIL 0 1 0 0 1
39 GLAUKOMA ABSOLUT 1 0 0 0 1
40 TUMOR PALPEBRA 0 0 0 1 1
41 SEROTINUS 0 1 0 0 1
42 PLASENTA PRAVIA 0 1 0 0 1
43 KPD 0 0 1 0 1
44 HIPERKERATOSIS 0 1 0 0 1
45 PROLAP UTERI 0 1 0 0 1
46 ASFIKSIA 0 1 0 0 1
47 KET 0 1 0 0 1
48 HEMATEMESIS 1 0 0 0 1
49 PTERIGIUM 0 1 0 0 1
50 URTIKARIA 0 1 0 0 1
51 CHEST PAIN 0 0 0 0 0
JUMLAH 36 50 121 147 354

Mengetahui, Sumedang, 6 AGUSTUS 2012


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN JANUARI TAHUN 2014

NO ICD X BARU LAMA JUMLAH


DIAGNOSA
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 ESRD 0 0 2 1 3
2 KONTROL CKD 0 0 0 1 1
3 DIABETES MELITUS 0 0 21 56 77
4 ASHD 0 0 11 9 20
5 CICATRIX 0 1 1 2 4
6 NEUROSA 0 0 0 1 1
7 HIPERNTENSI 0 0 6 22 28
8 SUSP CORPUS ALINEUM 0 0 1 0 1
9 SUSP TB BATUK 0 2 0 1 3
10 SUSP KATARAK MATUR ODS 0 3 0 4 7
11 SUSP DBD RL (+) 0 1 0 0 1
12 REFRAKSI ANOMALI 0 0 0 3 3
13 PRESBIOPI 0 0 1 0 1
14 KATARAK 0 0 1 3 4
15 HNP 1 1 0 0 2
16 DERMATITIS 0 0 0 1 1
17 ASMA BRONHIALE 0 0 0 1 1
18 SUSP MYOPIA 1 0 0 1 2
19 G2 P1 AO GRAV 41 MG 0 1 0 0 1
20 DIARE 0 0 1 0 1
21 SUSP KAWASAKI DESEASE 0 0 1 0 1
22 CKD 0 0 1 0 1
23 TIA 0 0 1 0 1
24 SERUMEN 0 0 0 1 1
25 HIL DEXTRA 0 0 0 1 1
26 POST STROKE 0 0 5 5 10
27 DISLIPIDEMIA 0 0 0 6 6
28 TUMOR PARU KIRI 0 0 0 1 1
29 CHEPALGIA 0 0 0 5 5
30 KONTROL SELLULITIS 0 0 0 1 1
31 AUTISME 0 0 1 0 1
32 MYALGIA 0 0 5 2 7
33 KONTROL POS OF FRAKTUR MANDIBULA CIKATRIK 0 0 0 1 1
34 MENINGOENCEPHACELE 0 0 1 0 1
35 CALCANUS 0 0 0 1 1
36 ANEMIA 0 0 0 1 1
37 ENCEPHALOPATI 0 0 0 1 1
38 STROKE 0 0 2 1 3
39 ANEMIA APILASTIK 0 0 1 0 1
40 SERUMEN DALAM TELINGA KIRI 0 0 0 1 1
41 KONTROL THYROID 0 0 0 1 1
42 KATARAK OD 0 0 1 0 1
43 KONTROL POST KLL 0 0 1 0 1
44 KONTROL EPILEPSI 0 0 1 0 1

PERIODONTITIS APICALIS ETCAUSA GANGREN


45 PULPA 46 1 0 0 0 1
46 SUSP BENJOLAN DI REGIO 1 0 1 0 0 1
47 POST TAMBAHAN SEMNETARA GIGI 35 D RSU 0 1 0 0 1
48 KISTA OVARIUM 0 0 0 1 1
49 POST OP HIPERTYROID 0 0 0 1 1
50 ANEMIA APLASTIK 0 0 0 1 1
51 SUSP MYOPIA 1 0 0 0 1
52 SUSP HF 0 1 0 0 1
53 SUSP DISLOKASI ARTIKULATIO 0 0 0 2 2
54 KONTROL THALASEMIA 0 0 3 4 7
55 TRAUMA DADA KIRI 0 0 0 1 1
56 KONTROL POST OP KATARAK 0 0 0 1 1
57 POST CYTECTOMY 0 1 0 0 1
58 AB IMINEN 0 1 0 0 1
59 CRF 1 0 0 0 1
60 RA 0 0 1 0 1
61 KONTROL HIPERTIROID 0 0 1 1 2
62 KONTROL POST OP KATARAK 0 0 1 2 3
63 KONTROL PSIKOSA AKUT 0 0 0 1 1
64 STRUMA 0 0 2 0 2
65 SCEBUN 0 0 1 0 1
66 APP AKUT 0 0 0 1 1
67 KONTROL STROKE INFARK 0 0 2 0 2
68 SELULIT 0 0 0 1 1
69 SUSP TRAUMA OS TERKENA SHUTTLE COCK 0 0 1 0 1
70 G1 PO AO INFARK 34 MG DG GEMELI 0 0 0 1 1
71 SEROSIS HEPATITIS 0 0 1 0 1
PERIODONTITIS APICALIS ETCAUSA GANGREN
72 PULPA 36 1 0 0 0 1
73 NEUROMYALGIA 0 0 0 1 1
74 SUSP ADRENITIS 0 0 0 1 1
75 KONTROL GASTRITIS 0 0 0 1 1
76 SUSP FAM 0 0 0 1 1
77 SPA 0 0 1 0 1
78 SUSP FARINGITIS 0 0 1 1 2
79 SUNGSANG 0 0 0 1 1
80 G3 P1 A1 GRAV 9-10 MG 0 0 0 1 1
81 AB IMINEN 0 0 0 1 1
82 KONTROL CHD 0 0 1 0 1
83 EPILEPSI 0 0 2 5 7
84 KONTROL BPH 0 0 1 0 1
85 DISPEPSIA 0 0 0 1 1
86 KONTROL SPONDILITIS LUMBAL 0 0 0 1 1
87 KONTROL DCFC 0 0 0 1 1
88 KONTROL STROKE INFARK 0 0 1 0 1
89 KONTROL ASHMA BRONCHIALE 0 0 1 0 1
90 KONTROL GOUT 0 0 0 1 1
91 G3 P1 A1 0 1 0 0 1
92 SUSP TYPOID 0 0 1 0 1
93 KONTROL POST OF KATARAK 0 0 1 0 1
94 LYMP COLLI 0 0 1 0 1
95 SKIZOPRENIA 0 0 1 0 1
96 KONTROL PSIKOSA AKUT 0 0 2 0 2
97 CA NASOPARING 0 0 1 0 1
98 RECUREN APHTONS STOMATITIS DI LIDAH SEBELAH KIRI 0 0 1 0 1
99 KONTROL TB GAGAL 0 0 0 1 1
100 GLAUKOMA 0 0 0 1 1
101 SUSP HI DEXTRA 0 0 1 0 1
102 NH 0 1 0 0 1
103 SUSP HEPATITIS 1 0 0 0 1
104 KONTROL PARKINSON 0 0 0 1 1
105 SUSP METIOMENORAGE 0 0 0 1 1
106 IVB 0 0 2 0 2
107 PSIKOSA AKUT 0 0 1 1 2
108 POST OP PRAKTUR MANDIBULA BILATERAL 0 0 0 1 1
109 POST KLL KONTROL 0 0 1 0 1
110 DECOM CORDIS 0 0 1 1 2
111 TRIGEMINAL NEURALGIA 0 0 1 1 2
112 CARDIOMEGALI 0 0 1 0 1
113 SUSP VERUC JARI III KAKI 1 0 0 0 1
114 KONTROL EAKANEUS 0 0 0 1 1
115 GANTI KACA MATA 0 0 1 0 1
116 CAD 0 0 1 1 2
117 TYROID 0 0 0 1 1
118 GII PO A1 SUSP GEMELI 0 1 0 0 1
119 HEMODIALISA 1 0 0 0 1
120 POST OP SSNT 0 0 1 0 1
121 OBS FEBRIS 1 0 0 0 1
122 CELULITIS 0 0 0 1 1
123 GP 53 PRO RO 0 1 0 0 1
124 UP IUD LL 0 0 0 1 1
125 MIOP 0 0 0 1 1
126 RIWAYATA KANDILOMA 0 0 0 1 1
127 CA CERVIC 0 0 0 1 1
128 IMPAKSI 28 0 0 0 1 1
129 CARDIOMIOPATI 0 0 1 0 1
130 SUSP GAGAL JANTUNG 0 0 0 1 1
131 THALASEMIA 0 0 1 1 2
132 BANGKITAN EPILEPSI 0 0 1 0 1
133 KONTROL NEURALGIA 0 0 0 1 1
134 KONTROL PSEUDOPILIA 0 0 0 1 1
135 CHD 0 0 0 1 1
136 AKUT ABD 0 0 1 0 1
137 SUSP DYSPEPSIA 0 0 0 1 1
138 SUSP PLEGMON 0 0 0 1 1
139 SUSP STRUMA 0 0 0 1 1
140 CONGENITAL DISONDER 0 0 0 1 1
141 SUSP PARKINSON 0 0 2 0 2
142 SUSP MYOPIA VOD 0 0 1 0 1
143 ENDONTULOUS 0 0 0 1 1
144 GASTRITIS 0 0 1 0 1
145 KONTROL KEJANG 0 0 0 1 1
146 ANXIETAS 0 0 1 0 1
147 EVO 42 - 43 MG 0 0 0 1 1
148 SUSP KELOID 0 0 0 1 1
149 SUSP PRESBIOP 0 0 0 1 1
150 GR 45 0 0 0 1 1
151 CAD 0 0 1 0 1
152 OBS FEBRIS 0 0 0 0 0
JUMLAH 10 18 116 202 346
Mengetahui, Sumedang, 19 PEBUARI 2014
Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

EDI KARYADI. S.I.P Ena Marlena Sanusi


NIP. 19590918 198604 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN PEBRUARI TAHUN 2013

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 Trigeminus 0 0 0 1 1
2 DERMATITIS 1 2 0 1 4
3 BPH 1 0 0 0 1
PACTURIEN ATERM DG
4 ASMA 0 1 0 0 1
5 IMPAKSI 0 2 0 2 4
6 GLAUKOMA 1 0 0 1 2
7 SEROTINUS 0 2 0 0 2
8 HP 26 0 1 0 0 1
9 HP LANJUT 0 0 0 1 1
10 GP 16 0 1 0 0 1
11 GOUT 0 5 0 0 5
12 DC FC 0 0 1 0 1
13 HEAD INJURY 0 0 0 1 1
14 MYOP 0 0 0 1 1
15 BRONCHITIS 0 0 0 1 1
16 HYPERTIROID 0 0 0 1 1
17 BBLR 1 1 0 0 2
18 TB PARU 0 0 0 0 0
19 TUMOR COLON 0 0 0 1 1
20 GANGLION 1 0 0 0 1
21 TUMOR RENAL SIN 0 1 0 0 1
22 CEPHALGIA 0 1 5 1 7
23 HEPATITIS 0 1 0 0 1
24 HERPES 0 1 0 0 1
25 PSIKOSA 0 0 1 1 2
26 CA MAMAE DEXTRA 0 0 0 2 2
27 ISPA 0 0 0 1 1
28 PULPITIS 37 0 0 1 1 2
29 PPOK 0 0 1 0 1
30 AB COMPLITE 0 1 0 0 1
31 ASHD 0 0 17 2 19
32 POST STROKE 0 0 5 7 12
33 KATARAK 0 2 2 3 7
34 FAM 0 1 0 0 1
35 EVAN'S SYNDROM 0 0 2 0 2
36 DYSPEPSIA 8 0 18 8 34
37 TINITUS 1 1 0 2 4
38 LYPMPCOLLI 1 0 1 1 3
39 OMP 0 1 1 1 3
40 CA NASOPHARING 1 0 0 0 1
41 DISLIPIDEMIA 3 0 3 11 17
42 STRUMA 0 0 0 3 3
43 NEUROSA 0 1 0 1 2
44 ANEMIA 0 1 0 0 1
45 TUMOR PRANKEAS 0 0 1 0 1
46 RA 2 5 4 9 20

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
47 POST OP APP 0 0 0 1 1
48 PTERIGIUM 1 2 0 1 4
49 OBS FEBRIS SUSP DBD 3 2 3 0 8
50 THALASEMIA 0 0 3 2 5
51 DM 5 12 13 26 56
52 EPILEPSI 1 1 1 4 7
53 HT 1 1 6 3 11
54 POST TE 0 0 0 1 1
55 CKD 0 0 1 0 1
56 ICTERIK 1 0 0 0 1
57 NS 0 1 0 0 1
58 ESRD 0 0 2 2 4
59 GANTI KACA MATA 0 1 0 1 2
60 ISK 0 0 0 1 1
61 HP 12 0 2 0 0 2
62 GRAV DG HYPERTIROID 0 1 0 0 1
63 KARDIOMIOPATI 0 1 0 0 1
64 SERUMEN DALAM 2 1 0 0 3
65 CA KGB 0 0 1 0 1
66 RETINOBLASTOMA OD 0 0 1 0 1
67 NEPROLITHIASIS 0 0 0 1 1
JUMLAH 35 57 94 108 294

Mengetahui, Sumedang, Maret 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN APRIL TAHUN 2013

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 Trigeminus 0 0 0 1 1
2 DERMATITIS 2 2 0 1 5
3 BPH 1 0 0 0 1
PACTURIEN ATERM DG
4 ASMA 0 1 0 0 1
5 IMPAKSI 2 2 0 2 6
6 GLAUKOMA 1 0 0 1 2
7 SEROTINUS 0 2 0 0 2
8 HP 26 1 1 0 0 2
9 HP LANJUT 0 0 0 1 1
10 GP 16 0 1 0 0 1
11 GOUT 0 5 0 6 11
12 DC FC 0 0 1 0 1
13 HEAD INJURY 0 0 0 1 1
14 MYOP 0 0 0 1 1
15 BRONCHITIS 0 0 0 1 1
16 HYPERTIROID 0 0 0 1 1
17 BBLR 1 1 0 0 2
18 TB PARU 0 0 0 0 0
19 TUMOR COLON 0 0 0 1 1
20 GANGLION 1 0 0 0 1
21 TUMOR RENAL SIN 0 1 0 0 1
22 CEPHALGIA 0 1 5 1 7
23 HEPATITIS 0 1 0 0 1
24 HERPES 0 1 0 0 1
25 PSIKOSA 0 0 1 1 2
26 CA MAMAE DEXTRA 0 0 0 2 2
27 ISPA 0 0 0 1 1
28 PULPITIS 37 0 0 1 1 2
29 PPOK 0 0 1 0 1
30 AB COMPLITE 0 1 0 0 1
31 ASHD 0 0 17 2 19
32 POST STROKE 1 0 6 7 14
33 KATARAK 0 2 2 3 7
34 FAM 0 1 0 0 1
35 EVAN'S SYNDROM 0 0 2 0 2
36 DYSPEPSIA 8 0 21 8 37
37 TINITUS 1 1 0 2 4
38 LYPMPCOLLI 1 0 1 1 3
39 OMP 0 1 1 1 3
40 CA NASOPHARING 1 0 0 0 1
41 DISLIPIDEMIA 3 0 3 11 17
42 STRUMA 0 0 0 3 3
43 NEUROSA 0 1 0 1 2
44 ANEMIA 0 1 0 0 1
45 TUMOR PRANKEAS 0 0 1 0 1
46 RA 2 7 4 9 22
47 POST OP APP 0 0 0 1 1
48 PTERIGIUM 1 2 0 1 4
49 OBS FEBRIS SUSP DBD 1 2 1 2 6
50 THALASEMIA 0 0 3 2 5
51 DM 5 10 11 23 49
52 EPILEPSI 1 1 1 4 7
53 HT 1 2 4 3 10
54 POST TE 0 0 0 1 1
55 CKD 0 0 1 0 1
56 ICTERIK 1 0 0 0 1
57 NS 0 1 0 0 1
58 ESRD 0 1 3 2 6
59 GANTI KACA MATA 0 1 0 1 2
60 ISK 0 0 0 1 1
61 HP 12 1 1 0 2 4
62 GRAV DG HYPERTIROID 0 1 0 0 1
63 KARDIOMIOPATI 0 1 0 0 1
64 SERUMEN DALAM 0 2 1 1 4
65 CA KGB 0 0 1 0 1
66 RETINOBLASTOMA OD 0 0 1 0 1
67 NEPROLITHIASIS 0 0 0 1 1
JUMLAH 37 59 94 116 306

Mengetahui, Sumedang, April 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN APRIL TAHUN 2013

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM 1 2 16 26 45
2 DISPEPSIA 4 3 8 2 17
3 DEPRESI 0 0 4 0 4
4 PSIKOMATIS INSOMNIA 1 1 0 0 2
5 ANXIETAS 0 0 2 0 2
6 IMPAKSI 1 2 1 2 6
7 ACNE 0 0 0 1 1
8 PROLAPS UTERI 0 0 0 1 1
9 PROSTAT HIPERPLASIA 1 0 0 1 2
10 RA 2 2 1 5 10
11 HIL 0 1 1 0 2
12 DERMATITIS 0 1 4 2 7
13 CANASOFARINX 1 0 0 0 1
14 ISK 0 3 0 1 4
15 KISTA OVARIUM 0 0 0 1 1
16 SINUSITIS 0 0 0 1 1
17 ANEMIA HAEMORAGIC 0 1 0 0 1
18 PTERIGIUM 0 3 0 0 3
19 CHEPALGIA 0 0 0 1 1
20 APENDIKSITIS 0 0 0 1 1
21 CHEST PAIN 0 0 0 1 1
22 MOLA HIDATIDOSA 0 0 0 4 4
23 ASHD 0 0 8 3 11
24 MYOPIA 1 4 0 2 7
25 ANEMIA GRAVIDARIUM 0 1 0 0 1
26 ESRD 0 1 3 1 5
27 EPILEPSI 0 0 7 2 9
28 POST STROKE 0 0 3 2 5
29 CA MAMAE 0 0 0 1 1
30 CAD 0 0 2 3 5
31 PPOK 0 0 1 0 1
32 KATARAK 2 2 3 2 9
33 PULPITIS 2 4 0 0 6
34 OBS FEBRIS SUSP TYPOID 1 0 0 0 1
35 DISLIPIDEMIA 0 1 2 2 5
36 TUMOR PARU 0 0 1 0 1
37 SUSP DBD 5 1 2 0 8
38 ASHMA 0 0 0 2 2
39 CEREBRAL PALSI 0 0 1 2 3
40 HERNIA 0 0 0 1 1
41 SERVICITIS 0 0 1 0 1
42 THALASEMIA 0 0 2 5 7
43 PSEUDOPILIA 0 0 0 1 1
44 HT 0 0 2 0 2
45 FAM 0 1 0 0 1
46 RUPTUR TENDON 0 1 0 0 1
47 OMP 0 0 0 1 1
48 RETINOBLASTOMA 0 0 1 0 1
49 VERUCA 0 2 0 0 2
50 OA GEUNE 0 1 1 2 4
51 LYMPADENOPATI 0 1 0 1 2
52 CA CERVIK 0 0 0 3 3
53 TYROID 0 0 1 0 1
54 EVAN'S SYNDROM 0 0 1 0 1
55 HERPES 0 0 1 0 1
56 SOL 0 0 1 0 1
57 NS 1 0 0 0 1
58 GLAUKOMA 0 0 0 1 1
59 HT DG GRAVIDA 0 0 1 1 2
60 HAEMOROID EKSTERNA 1 0 0 0 1
61 CHEPALGIA 0 0 2 1 3
62 TRAUMA KEPALA 0 1 1 1 3
63 FLAUR ALLBUS 1 0 0 0 1
64 PALPITASI CARDIS TB 1 0 2 1 4
65 GRAV DG STRUMA 0 0 0 1 1
66 IVB 0 0 0 1 1
67 HAEMOROID 0 0 0 1 1
68 MYOMA UTERI 0 1 0 0 1
69 HYPERTYROID 0 1 0 3 4
70 ABSES EC GP 2 0 0 0 2
71 FATAL DISTRESS 0 1 0 0 1
72 CERUMENT DALAM 0 2 0 1 3
73 SEROTINUS 0 2 0 1 3
74 VULNUS DIGITI 3 DEXTRA 1 0 0 0 1
75 FEB 0 1 0 1 2
76 LBP 0 0 1 1 2
77 BRONCHITIS 2 0 1 0 3
78 VITILIGO 0 1 0 0 1
79 DECOM 1 0 0 0 1
80 OSTEOPOROSIS 0 0 1 0 1
81 MENINGITIS TB 1 0 0 0 1
82 DILATED CARDIOMIOPATI 2 0 0 1 3
83 HEPATITIS 1 0 0 1 2
84 CORPUS ALINEUM 1 0 0 0 1
85 GOUT 1 1 0 0 2
86 STRUMA 0 0 0 1 1
87 OMA 0 1 0 1 2
88 CARDIOMYOPATI 0 1 0 2 3
89 SLE 0 0 0 1 1
90 POST BGM + TB 1 0 0 0 1
91 STOMATITIS 0 1 0 0 1
92 RAD LUMBAL 0 0 0 1 1
93 KONJUNGTIVITIS 0 0 0 1 1
94 SKIZOPRENIA 0 1 0 0 1
95 IKTERRUS 2 0 0 1 3
JUMLAH 41 54 90 111 296

Mengetahui, Sumedang, April 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN MEI TAHUN 2013

NO BARU LAMA
DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 Other Artritis #REF! #REF! #REF! #REF! #REF!
2 LBP #REF! #REF! #REF! #REF! #REF!
3 HISPRUNG #REF! #REF! #REF! #REF! #REF!
4 SUSP HERNIA SINISTRA #REF! #REF! #REF! #REF! #REF!
5 SUSP ASHMA #REF! #REF! #REF! #REF! #REF!
6 CEREBRAL PALSY #REF! #REF! #REF! #REF! #REF!
7 KARDIOMYOPATI #REF! #REF! #REF! #REF! #REF!
8 PULPA POLIP #REF! #REF! #REF! #REF! #REF!
9 SUSP DHF #REF! #REF! #REF! #REF! #REF!
10 SUSP HIPEREMI PULPA LANJUT 21 #REF! #REF! #REF! #REF! #REF!
11 HIPERTENSI #REF! #REF! #REF! #REF! #REF!
12 DIABETES MELITUS #REF! #REF! #REF! #REF! #REF!
13 KONTROL HYPERKOLESTEROL #REF! #REF! #REF! #REF! #REF!
14 AUTISME #REF! #REF! #REF! #REF! #REF!
15 ACNE #REF! #REF! #REF! #REF! #REF!
16 KONTROL OSTEOPOROSIS #REF! #REF! #REF! #REF! #REF!
17 SKIZOPREN KRONIK #REF! #REF! #REF! #REF! #REF!
18 KONTROL STROKE #REF! #REF! #REF! #REF! #REF!
19 KONTROL EPILEPSI #REF! #REF! #REF! #REF! #REF!
20 SUSP PRESBIOPI #REF! #REF! #REF! #REF! #REF!
21 PULPITIS 28,38 #REF! #REF! #REF! #REF! #REF!
22 KONTROL OA GENUE #REF! #REF! #REF! #REF! #REF!
23 CORPUS ALINEUM ARBITA DEXTRA #REF! #REF! #REF! #REF! #REF!
24 SUSP CONJUNGTIVITIS ALLERGIAN #REF! #REF! #REF! #REF! #REF!
25 KONTROL INSUFFISIENSI BERTEBRA BASILER #REF! #REF! #REF! #REF! #REF!
26 KPNTROL CRD #REF! #REF! #REF! #REF! #REF!
27 NS #REF! #REF! #REF! #REF! #REF!
28 SUSP DISPEPSIA #REF! #REF! #REF! #REF! #REF!
29 SUSP LBP #REF! #REF! #REF! #REF! #REF!
30 THALASEMIA #REF! #REF! #REF! #REF! #REF!
31 END STAGE RENAL DESEASE) #REF! #REF! #REF! #REF! #REF!
32 KONTROL PARKINSON #REF! #REF! #REF! #REF! #REF!
33 RETINOBLASTOMA #REF! #REF! #REF! #REF! #REF!
34 CEPHALGIA #REF! #REF! #REF! #REF! #REF!
35 CRONIK RENAL DESEASE #REF! #REF! #REF! #REF! #REF!
36 GANTI KACA MATA #REF! #REF! #REF! #REF! #REF!
37 SUSP HIPERTIROID #REF! #REF! #REF! #REF! #REF!
38 SUSP VERTIGO #REF! #REF! #REF! #REF! #REF!
39 CERUMEN #REF! #REF! #REF! #REF! #REF!
40 EVANS SYNDROM #REF! #REF! #REF! #REF! #REF!
41 DECOMP NEUROPATI #REF! #REF! #REF! #REF! #REF!
42 POST PENGOBATAN TB + RIWAYAT JANTUNG #REF! #REF! #REF! #REF! #REF!
43 HIPEREMI 22 #REF! #REF! #REF! #REF! #REF!
44 SUSP SERVIC CITYS #REF! #REF! #REF! #REF! #REF!
45 SUSP TINEA CAPITIS #REF! #REF! #REF! #REF! #REF!
46 GOUT ARTRITIS #REF! #REF! #REF! #REF! #REF!
47 DERMATITIS #REF! #REF! #REF! #REF! #REF!
48 TRAUMA TUMPUL OS TERTUSUK KAYU #REF! #REF! #REF! #REF! #REF!
49 SUSP STRUMA #REF! #REF! #REF! #REF! #REF!
50 SUSP OMP #REF! #REF! #REF! #REF! #REF!
51 SUSP ULKUS PADA IBU JARI #REF! #REF! #REF! #REF! #REF!
52 DISLIPIDEMIA #REF! #REF! #REF! #REF! #REF!
53 KATARAK CONGENITAL #REF! #REF! #REF! #REF! #REF!
54 SUSP KATARAK MATUR OD +OS #REF! #REF! #REF! #REF! #REF!
55 HERNIA SEROTALIS #REF! #REF! #REF! #REF! #REF!
56 IMPAKSI #REF! #REF! #REF! #REF! #REF!
57 G3 P2 AB INCOMPLET #REF! #REF! #REF! #REF! #REF!
58 NUMERALIS #REF! #REF! #REF! #REF! #REF!
59 CHEST PAIN #REF! #REF! #REF! #REF! #REF!
60 TRAUMA KEPALA #REF! #REF! #REF! #REF! #REF!
61 CARDIOMEGALI #REF! #REF! #REF! #REF! #REF!
62 ASAM URAT #REF! #REF! #REF! #REF! #REF!
63 PSIKOSA AKUT #REF! #REF! #REF! #REF! #REF!
64 EKSEMA #REF! #REF! #REF! #REF! #REF!
65 GP 36 #REF! #REF! #REF! #REF! #REF!
66 MYOPHIA #REF! #REF! #REF! #REF! #REF!
67 MYALGIA #REF! #REF! #REF! #REF! #REF!
68 GASTROENTERITIS #REF! #REF! #REF! #REF! #REF!
69 HORDEOLUM INTERNA #REF! #REF! #REF! #REF! #REF!
70 DERMATITIS ALERGI #REF! #REF! #REF! #REF! #REF!
71 CONGENITAL HAND I UNITED DIGIL #REF! #REF! #REF! #REF! #REF!
72 TRANSIENCE ISCEMIC ATTACK #REF! #REF! #REF! #REF! #REF!
73 SUSP TUMOR MAMAE SINISTRA #REF! #REF! #REF! #REF! #REF!
74 SUSP LIPOMA #REF! #REF! #REF! #REF! #REF!
75 CAD #REF! #REF! #REF! #REF! #REF!
76 SUSP HAEMOROID #REF! #REF! #REF! #REF! #REF!
77 SUSP ANGINA PECTORIS #REF! #REF! #REF! #REF! #REF!
78 DEPREPSI #REF! #REF! #REF! #REF! #REF!
79 SUSP ABSES #REF! #REF! #REF! #REF! #REF!
80 POST OP LIPOMA #REF! #REF! #REF! #REF! #REF!
81 BATUK + G1 P1 A1 #REF! #REF! #REF! #REF! #REF!
82 OBSTIVASI + ASHMA #REF! #REF! #REF! #REF! #REF!
83 SUGESTIF MYOMA UTERI #REF! #REF! #REF! #REF! #REF!
84 G2 P1 A0 40 MG #REF! #REF! #REF! #REF! #REF!
85 SUSP OMP #REF! #REF! #REF! #REF! #REF!
86 HT + ASHD #REF! #REF! #REF! #REF! #REF!
87 SUSP PRESENSIAL TUMOR #REF! #REF! #REF! #REF! #REF!
88 SUSP DBD #REF! #REF! #REF! #REF! #REF!
89 ANXIETAS #REF! #REF! #REF! #REF! #REF!
90 POSP OF ENPLAQUE MENINGIUMA #REF! #REF! #REF! #REF! #REF!
91 EPILEPSI #REF! #REF! #REF! #REF! #REF!
92 KATARAK MATUR #REF! #REF! #REF! #REF! #REF!
93 SUSP TUMOR #REF! #REF! #REF! #REF! #REF!
94 POS SC #REF! #REF! #REF! #REF! #REF!
95 CHD #REF! #REF! #REF! #REF! #REF!
96 KONTROL TUMOR PARU SINISTRA #REF! #REF! #REF! #REF! #REF!
97 BPH #REF! #REF! #REF! #REF! #REF!
98 GASTRITIS + DIABTES MELITUS #REF! #REF! #REF! #REF!
99 TINITUS TELINGA KANAN #REF! #REF! #REF! #REF!
100 SUSP ANEMIA + MELENA #REF! #REF! #REF! #REF!
101 IMPAKSI 88 #REF! #REF! #REF! #REF!
102 G8 P7 A0 LETAK SUNGSANG #REF! #REF! #REF! #REF!
103 DEPRESI #REF! #REF! #REF! #REF!
104 HIPERTIROID #REF! #REF! #REF! #REF!
105 G1 PO AO 3 MG SUSP PRE EKLAMSI BERAT #REF! #REF! #REF! #REF!
106 SPACE OCCUPYNG LESSION #REF! #REF! #REF! #REF!
G2 P1 AO GRAV 31 MG DENGAN HIPERTENSI
107 #REF! #REF! #REF! #REF!
108 SUGERT MYOMA UTERI #REF! #REF! #REF! #REF!
109 G2 P1 AO SUSP SEROTIN #REF! #REF! #REF! #REF!
110 KISTA OVARIUM #REF! #REF! #REF! #REF!
111 SUSP SINUSITIS #REF! #REF! #REF! #REF!
112 KATARAK #REF! #REF! #REF! #REF!
113 EFUSI FLEURA #REF! #REF! #REF! #REF!
114 ASHD DCT + TB PARU #REF! #REF! #REF! #REF!
115 LIMPADENOPATI #REF! #REF! #REF! #REF!
116 BATUK LAMA KONTROL #REF! #REF! #REF! #REF!
117 PULPITIS 47 #REF! #REF! #REF! #REF!
118 SUSP TB ( BTA NEGATIP) #REF! #REF! #REF! #REF!
119 BRONCHITIS #REF! #REF! #REF! #REF!
120 ABORTUS IMINEN #REF! #REF! #REF! #REF!
121 SUSP VERIKOKEL #REF! #REF! #REF! #REF!
122 PTERIGIUM #REF! #REF! #REF! #REF!
123 PERIODONTITIS APIKALIS CKAUSA GANGREN
PULPA 46 #REF! #REF! #REF! #REF!
124 TUMOR PARU #REF! #REF! #REF! #REF!
125 SUSP FEBRIS TYPOID #REF! #REF! #REF! #REF!
126 KONTROL CLAVUS #REF! #REF! #REF! #REF!
127 GLAUKOMA #REF! #REF! #REF! #REF!
128 CONGESTIVE RENAL FAILURE #REF! #REF! #REF! #REF!
129 DELATED CARDIOMIOPATI #REF! #REF! #REF! #REF!
130 EPILEPSI #REF! #REF! #REF! #REF!
131 CA NASOFARING #REF! #REF! #REF! #REF!
132 KONTROL PS A1 PARUS PRENDUST DCFC #REF! #REF! #REF! #REF!
133 KONTROL ASHD #REF! #REF! #REF! #REF!
134 DISLOKASI TMJ #REF! #REF! #REF! #REF!
135 GOUT #REF! #REF! #REF! #REF!
136 ANEMIA #REF! #REF! #REF! #REF!
137 OBS FEBRIS #REF! #REF! #REF! #REF!
138 POST OP KATARAK #REF! #REF! #REF! #REF!
139 PUPITIS 38 (IMPAKSI) #REF! #REF! #REF! #REF!
140 KONTROL ASHMA #REF! #REF! #REF! #REF!
141 ASHD #REF! #REF! #REF! #REF!
142 PALPITASI CURDIS TB #REF! #REF! #REF! #REF!
143 KONTROL MYALGIA #REF! #REF! #REF! #REF!
144 KONTROL SPACE OCCUPYNG LESSION #REF! #REF! #REF! #REF!
145 STROKE #REF! #REF! #REF! #REF!
146 KONTROL GLAUKOMA #REF! #REF! #REF! #REF!
147 SUSP DISLOKASI PERGELANGAN TANGAN #REF! #REF! #REF! #REF!
148 KONTROL POST CRANIOTOMI #REF! #REF! #REF! #REF!
149 CA CERVIK #REF! #REF! #REF! #REF!
150 STRUMA #REF! #REF! #REF! #REF!
151 OSTEOPOROSIS #REF! #REF! #REF! #REF!
#REF! #REF! #REF! #REF!
L #REF! #REF!

.
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN JUNI TAHUN 2013
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 Other Artritis 0 1 0 1 2
2 LBP 0 0 1 0 1
3 HISPRUNG 0 1 0 0 1
4 SUSP HERNIA SINISTRA 1 0 0 0 1
5 SUSP ASHMA 1 0 0 0 1
6 CEREBRAL PALSY 1 0 0 0 1
7 KARDIOMYOPATI 0 0 1 0 1
8 PULPA POLIP 0 0 0 1 1
9 SUSP DHF 1 0 0 0 1
10 SUSP HIPEREMI PULPA LANJUT 21 1 0 0 0 1
11 HIPERTENSI 0 0 1 6 7
12 DIABETES MELITUS 1 0 11 20 32
13 KONTROL HYPERKOLESTEROL 0 0 0 1 1
14 AUTISME 1 0 0 0 1
15 ACNE 0 1 0 0 1
16 KONTROL OSTEOPOROSIS 0 0 1 0 1
17 SKIZOPREN KRONIK 0 0 0 1 1
18 KONTROL STROKE 0 0 3 6 9
19 KONTROL EPILEPSI 1 0 3 0 4
20 SUSP PRESBIOPI 0 0 1 2 3
21 PULPITIS 28,38 0 1 1 1 3
22 KONTROL OA GENUE 0 1 0 0 1
23 CORPUS ALINEUM ARBITA DEXTRA 1 0 0 0 1
24 SUSP CONJUNGTIVITIS ALLERGIAN 0 1 0 0 1
25 KONTROL INSUFFISIENSI BERTEBRA BASILER 0 0 1 0 1
26 KPNTROL CRD 0 0 0 1 1
27 NS 0 0 0 1 1
28 SUSP DISPEPSIA 0 1 4 4 9
29 SUSP LBP 1 0 0 0 1
30 THALASEMIA 1 0 0 1 2
31 END STAGE RENAL DESEASE) 0 0 3 0 3
32 KONTROL PARKINSON 0 0 0 1 1
33 RETINOBLASTOMA 0 0 1 0 1
34 CEPHALGIA 0 0 1 4 5
35 CRONIK RENAL DESEASE 0 0 1 0 1
36 GANTI KACA MATA 0 0 0 1 1
37 SUSP HIPERTIROID 0 1 0 0 1
38 SUSP VERTIGO 0 0 1 0 1
39 CERUMEN 0 0 0 2 2
40 EVANS SYNDROM 0 0 1 0 1
41 DECOMP NEUROPATI 0 0 0 1 1
42 POST PENGOBATAN TB + RIWAYAT JANTUNG 0 0 1 0 1
43 HIPEREMI 22 0 0 1 0 1
44 SUSP SERVIC CITYS 0 1 0 0 1
45 SUSP TINEA CAPITIS 0 1 0 0 1
46 GOUT ARTRITIS 0 0 0 1 1
47 DERMATITIS 0 0 1 1 2
48 TRAUMA TUMPUL OS TERTUSUK KAYU 1 0 0 0 1
49 SUSP STRUMA 0 0 0 2 2
50 SUSP OMP 0 0 1 0 1
51 SUSP ULKUS PADA IBU JARI 1 0 0 0 1
52 DISLIPIDEMIA 0 1 1 4 6
53 KATARAK CONGENITAL 0 0 1 0 1
54 SUSP KATARAK MATUR OD +OS 0 1 0 1 2
55 HERNIA SEROTALIS 0 0 1 0 1
56 IMPAKSI 2 1 0 0 3
57 G3 P2 AB INCOMPLET 0 0 0 1 1
58 NUMERALIS 0 0 1 0 1
59 CHEST PAIN 0 0 0 1 1
60 TRAUMA KEPALA 0 0 1 0 1
61 CARDIOMEGALI 0 0 1 0 1
62 ASAM URAT 1 1 0 0 2
63 PSIKOSA AKUT 0 0 1 0 1
64 EKSEMA 0 1 0 0 1
65 GP 36 1 0 0 0 1
66 MYOPHIA 0 1 0 0 1
67 MYALGIA 0 1 1 0 2
68 GASTROENTERITIS 0 0 0 1 1
69 HORDEOLUM INTERNA 1 0 0 0 1
70 DERMATITIS ALERGI 0 2 0 0 2
71 CONGENITAL HAND I UNITED DIGIL 0 0 0 1 1
72 TRANSIENCE ISCEMIC ATTACK 0 0 1 1 2
73 SUSP TUMOR MAMAE SINISTRA 0 0 0 1 1
74 SUSP LIPOMA 1 0 0 0 1
75 CAD 0 0 0 1 1
76 SUSP HAEMOROID 0 1 1 0 2
77 SUSP ANGINA PECTORIS 1 0 0 0 1
78 DEPREPSI 1 0 0 0 1
79 SUSP ABSES 1 0 0 0 1
80 POST OP LIPOMA 0 0 0 1 1
81 BATUK + G1 P1 A1 0 1 0 0 1
82 OBSTIVASI + ASHMA 1 0 0 0 1
83 SUGESTIF MYOMA UTERI 0 0 0 1 1
84 G2 P1 A0 40 MG 0 1 0 0 1
85 SUSP OMP 1 0 0 0 1
86 HT + ASHD 0 0 1 0 1
87 SUSP PRESENSIAL TUMOR 0 0 0 1 1
88 SUSP DBD 0 0 0 1 1
89 ANXIETAS 0 0 1 2 3
90 POSP OF ENPLAQUE MENINGIUMA 0 0 0 1 1
91 EPILEPSI 0 0 2 4 6
92 KATARAK MATUR 1 0 0 0 1
93 SUSP TUMOR 0 0 0 1 1
94 POS SC 0 0 0 2 2
95 CHD 0 0 1 0 1
96 KONTROL TUMOR PARU SINISTRA 0 0 1 0 1
97 BPH 1 0 0 0 1
98 GASTRITIS + DIABTES MELITUS 0 0 0 1 1
99 TINITUS TELINGA KANAN 0 0 1 0 1
100 SUSP ANEMIA + MELENA 0 0 1 1 2
101 IMPAKSI 88 0 1 0 0 1
102 G8 P7 A0 LETAK SUNGSANG 0 0 0 1 1
103 DEPRESI 0 0 0 1 1
104 HIPERTIROID 0 2 0 4 6
105 G1 PO AO 3 MG SUSP PRE EKLAMSI BERAT 0 0 0 1 1
106 SPACE OCCUPYNG LESSION 0 0 1 0 1
107 G2 P1 AO GRAV 31 MG DENGAN HIPERTENSI 0 0 0 1 1
108 SUGERT MYOMA UTERI 0 0 0 1 1
109 G2 P1 AO SUSP SEROTIN 0 0 0 1 1
110 KISTA OVARIUM 0 1 0 3 4
111 SUSP SINUSITIS 0 0 0 1 1
112 KATARAK 0 1 1 3 5
113 EFUSI FLEURA 0 0 1 0 1
114 ASHD DCT + TB PARU 0 0 1 0 1
115 LIMPADENOPATI 0 1 0 1 2
116 BATUK LAMA KONTROL 0 0 1 0 1
117 PULPITIS 47 1 0 0 0 1
118 SUSP TB ( BTA NEGATIP) 0 0 1 0 1
119 BRONCHITIS 0 0 3 0 3
120 ABORTUS IMINEN 0 0 0 1 1
121 SUSP VERIKOKEL 1 0 0 0 1
122 PTERIGIUM 0 1 0 1 2
PERIODONTITIS APIKALIS CKAUSA GANGREN
PULPA 46
123 0 0 0 1 1
124 TUMOR PARU 0 0 1 0 1
125 SUSP FEBRIS TYPOID 2 1 1 0 4
126 KONTROL CLAVUS 0 0 1 1 2
127 GLAUKOMA 0 0 0 1 1
128 CONGESTIVE RENAL FAILURE 0 0 0 1 1
129 DELATED CARDIOMIOPATI 0 1 0 0 1
130 EPILEPSI 0 0 0 1 1
131 CA NASOFARING 0 0 1 0 1
132 KONTROL PS A1 PARUS PRENDUST DCFC 0 0 0 1 1
133 KONTROL ASHD 0 0 1 1 2
134 DISLOKASI TMJ 0 0 1 0 1
135 GOUT 0 0 1 0 1
136 ANEMIA 0 0 1 0 1
137 OBS FEBRIS 0 0 0 1 1
138 POST OP KATARAK 0 0 0 3 3
139 PUPITIS 38 (IMPAKSI) 0 0 0 1 1
140 KONTROL ASHMA 0 0 1 2 3
141 ASHD 0 0 2 3 5
142 PALPITASI CURDIS TB 0 0 1 0 1
143 KONTROL MYALGIA 0 0 1 0 1
144 KONTROL SPACE OCCUPYNG LESSION 0 0 1 0 1
145 STROKE 0 0 2 0 2
146 KONTROL GLAUKOMA 0 0 1 1 2
147 SUSP DISLOKASI PERGELANGAN TANGAN 0 1 1 1 3
148 KONTROL POST CRANIOTOMI 0 0 1 0 1
149 CA CERVIK 0 0 0 4 4
150 STRUMA 0 0 0 3 3
151 OSTEOPOROSIS 0 0 1 1 2
JUMLAH 30 32 87 134 283

Mengetahui, Sumedang, JULI 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

EDI KARYADI. S.I.P Ena Marlena Sanusi


NIP. 19590918 198604 1 004
3
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN JULI TAHUN 2013
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 MASTISTIS CRONIC 0 0 0 1 1
2 SUSP STROKE 0 0 0 1 1
3 KONTROL POST PARTUM SC + SUSP EPILEPSI 0 0 0 1 1
4 GATAL AREA MULUT POST HERVES 0 1 0 0 1
5 GASTRITIS + HIPERTENSI 0 0 1 0 1
6 SUSP TINITUS 1 0 0 0 1
7 SUSP REFRAKSI ANOMALI 0 1 0 1 2
8 SIROSIS HATI 0 0 0 1 1
9 ISPA 0 0 1 0 1
10 KOLESTEROL 0 0 0 1 1
11 TUMOR PARU SINISTRA 0 0 1 0 1
12 OSTEOPOROSIS 0 0 1 0 1
13 SUSP DBD 0 1 0 0 1
14 KONTROL INSUFFISIENSI VERTEBRA BASILER 0 0 1 0 1
15 SUSP KARTILAGO 1 0 0 0 1
16 SUSP SERUMEN 0 0 0 1 1
17 LBP 0 0 0 1 1
18 TUMOR KOLON 1 0 0 0 1
19 POST TRAUMA KEPALA 0 1 0 0 1
20 FIBROADENOMA MAMMAE 0 1 0 0 1
21 SUSP ANEMIA 1 0 0 0 1
22 TRAUMA HIDUNG 0 1 0 0 1
23 MENOMETRORHAGIA 0 1 0 1 2
24 CEREBRAL PALSY 0 0 1 0 1
25 PSIKOSOMATIC INSOMNIA 0 0 0 1 1
26 POST STROKE 0 0 1 4 5
27 CHD 0 0 1 0 1
28 GENERAL CEK UP 0 1 0 0 1
29 POST CURETAGE DENGAN MOLEHIDATOSA 0 0 0 1 1
30 SNNT 1 0 0 1 2
31 TYROID 0 0 0 1 1
32 SUSP CORVUS ALLENIUM 0 0 0 1 1
33 RETINOBLASTOMA CONTRO POST 0 0 1 0 1
34 POST OF GLUKOMA 0 1 0 0 1
35 SUSP DISLOKASI 0 0 2 0 2
36 ULKUS PEPTIKUM 0 0 1 0 1
37 POST TRAUMA KRL 1 0 0 0 1
38 AB IMINENS 0 0 0 1 1
39 SUSP EFUSI PLEURA 0 0 1 0 1
40 CRF,ASHD 0 0 1 0 1
41 ASHD + DISPEPSI 0 0 1 0 1
42 PTERIGIUM 0 1 0 1 2
43 ASND DC + TB PARU 0 0 1 0 1
44 KISTA OVARIUM 0 0 0 2 2
45 PEB 0 1 0 0 1
46 SKIZOPRENIA 0 1 0 1 2
47 DISPEPSIA 1 0 3 2 6
48 ASHD 0 1 5 4 10
49 STRUMA 0 0 0 2 2
50 SERUMEN DALAM 1 0 0 0 1
51 SUSP DIABET MELITUS + HYPERTIROID 1 0 0 0 1
52 DIABETES MELITUS 0 1 8 30 39
53 ESRD 0 0 2 0 2
54 CA CERVIK 0 0 0 1 1
55 SUSP ACNE 0 1 0 0 1
56 SUSP ULCUS 0 0 1 0 1
57 SUSP PRESBIOPO 0 1 1 0 2
58 SUSP KATARAK 5 2 2 4 13
59 MYOMA 0 0 0 1 1
60 HEPATOMEGALI 0 1 0 0 1
61 CRD 0 0 1 0 1
62 MYALGIA 0 0 1 1 2
63 EVANS SYNDROM 0 0 2 0 2
64 SUSP BRONCHITIS 0 0 0 1 1
65 KONTROL SUSP OMP 0 0 0 1 1
66 ARTHTRITIS 0 0 1 0 1
67 CKD 0 0 1 0 1
68 SUSP LIPOMA 0 1 0 1 2
69 GOUT 0 0 1 1 2
70 HIPERTENSI 0 0 2 3 5
71 GANTI KACA MATA 0 2 4 7 13
72 TB PARU 0 0 2 0 2
73 DECOMP CORDIS 0 0 0 2 2
74 DISLIPIDEMIA 1 0 0 4 5
75 MYOPI 0 0 0 2 2
76 11,21 PULPITIS 12,22 HIPEREMI PULPA 0 1 0 0 1
77 AUTISME 0 0 1 0 1
78 PERIDONTITIS 0 1 0 1 2
79 SUSP TUMOR PALPEBRA ATAS 0 1 1 0 2
80 SUSP TUMOR MAMAE 0 1 0 1 2
81 PERIODONTITIS APIKALIS EC GANGREN PULPA 0 0 0 1 1
82 SEROTINUS 0 1 0 0 1
83 SUSP TYPOID 0 0 0 1 1
84 GASTRITIS 0 0 1 1 2
85 SUSP ANEMI + GOUT 0 1 0 0 1
86 KARDIOMIOPATI DENGAN BENDUNGAN PARU 0 0 1 0 1
87 BRONCHITIS 0 0 0 2 2
88 TRIGEMINAL NEURALGIA 0 0 0 2 2
89 POST OF KISTA 0 0 0 2 2
90 SUSP FIB JARINGAN LUNAK PADA GLUTEUS 0 1 0 0 1
91 KONTROL SUSP BPH 0 0 0 1 1
92 G3 P2 A0 GRAVIDA 40 MG 0 0 0 1 1
93 PERIDONTITIS APIKALIS EC GANGREN PULPA 25 0 1 0 0 1
94 IG PULPITIS 0 1 0 0 1
95 KONTROL ASHMA 0 0 0 1 1
96 SEROTIN 42 MG 0 2 0 0 2
97 KONTROL NS 0 0 0 1 1
98 MYALGIA 0 0 1 0 1
99 OBSTIPASI 0 1 0 0 1
100 ASHD + HIPERTENSI 0 0 1 0 1
101 KONTROL CA NASOPARING STAD IV C 0 0 1 0 1
102 SUSP HORDEOLUM OPTIKUS DEXTRA 0 1 0 0 1
103 NHML RECIDIP KONTROL 0 0 1 0 1
104 CP + EPILEPSI 0 0 0 1 1
105 KONTROL POST KLL 0 0 0 1 1
106 NEONATAL HYPERBILI RUBIN 0 0 0 1 1
107 HIPOGLIKEMI 0 0 1 0 1
108 KONTROL STROKE 0 0 1 1 2
109 TB GAGAL 0 0 1 0 1
110 SUSP LYMPADENOPATI COLLI MULTIPLE 0 1 0 0 1
111 SUSP ADNEXITIS 0 1 0 0 1
112 KONTROL STROKE RINGAN 0 0 0 2 2
113 KONTROL POST OP KATARAK 0 0 2 0 2
114 SUSP MYOPIA 0 0 0 2 2
115 KONTROL SERUMEN TELINGA KANAN 0 0 0 1 1
116 P3 AO POST PARTUM DG SEROTIN 0 0 0 1 1
117 CA NASOPARINX 0 0 1 1 2
118 KONTROL PENDARAHAN SALURAN MAKAN BAGIAN ATAS 0 0 0 1 1
119 SUSP ANEMIA 1 0 0 0 1
120 KONTROL TB 0 0 0 1 1
121 KONTROL TIA 0 0 0 2 2
122 SUSP TUMOR PINGGANG KANAN 1 0 0 0 1
123 TBC 0 1 0 0 1
124 KONTROL ASHD 0 0 0 2 2
125 KONTROL DISLIPIDEMIA 0 0 0 2 2
126 SUSP CORPUS ALIENUM 0 0 1 0 1
127 SUSP MYALGIA 0 1 0 1 2
128 SUSP DECOM CORDIS 0 0 1 0 1
129 CHEPALGIA 0 0 1 0 1
G2 P1 AO 40 - 41 MG DG INPARTU KETUBAN HIJAU
130 DAN JANIN DISTRES 0 0 0 1 1
131 SUSP DERMATITIS KONTROL 0 0 0 1 1
132 EPILEPSI 0 0 1 0 1
133 KONJUNGTIVITIS 0 0 0 2 2
134 POST CRANIOTOMY 0 0 0 1 1
135 NEONATAL HIPERBILIRUBIN 0 1 0 0 1
136 SUSP DM + ULCUS 0 1 0 0 1
137 SUSP PSIKOMA AKUT 1 0 0 0 1
138 KONTROL SELESAI PENGOBATAN TB 0 0 1 0 1
139 SUSP KELOID 0 0 0 1 1
140 G2 P1 AO PP TES POSITIF DENGAN RIWAYAT GO 0 1 0 0 1
141 PULPA POLIP 36 0 0 0 1 1
142 KONTROL TINITUS 0 0 0 1 1
143 SUSP KUSTA 1 0 0 0 1
144 SUSP TUMOR JARINGAN PADA PUNGGUNG 1 0 0 0 1
145 G1 PO AO GRAV 10 MG DENGAN ABORTUS 0 1 0 0 1
146 SUSP CANDIDIASIS 1 0 0 0 1
147 GA P3 40 GRAVIDA 26- 27 MG DG SUSPECT IUFD 0 0 0 1 1
148 MUCUCELE BIBIR BAWAH SEBELAH KIRI 0 1 0 0 1
149 PENDARAHAN SMBA SALURAN MAKAN BAGIAN ATAS 0 0 0 1 1
150 SUSP NEVUS PIGMENTUS PADA DAHI (BERDARAH +) 0 1 0 0 1
151 DM TYPE 2 0 0 0 1 1
152 INTOKSIKASI BATANG POHON 0 0 1 0 1
153 POST OF SSNT 0 0 1 0 1
154 SUSP HEPATITIS 0 0 1 0 1
155 KONTROL FARINGITIS 0 0 1 0 1
156 ODF 0 0 1 0 1
157 EVANS SYNDROM 0 0 1 0 1
158 SUSP CONJUNGTIVITIS GO 0 0 1 0 1
159 SUSP ABSES TANGAN KIRI 1 0 0 0 1
160 KONTROL SUSP MYALGIA 0 0 0 1 1
161 LYMPADENOPATI 0 0 0 1 1
162 MYOPIA 0 0 1 1 2
163 REFRAKSI ANOMALI 2 0 0 0 2
164 HEADACHE HIPERTENSI + OBS SYNCOPE 0 0 0 1 1
165 SUSP FIBROMA ADENOUM MAMAE SINISTRA 0 1 0 0 1
166 KONTROL KISTA COKLAT OVARIUM KIRI 0 0 0 1 1
167 SUSP OTITIS MEDIA TULANG KIRI 0 0 1 0 1
168 KONTROL SPONDILITIS LUMBAL 0 1 0 0 1
169 SUSP OSTEOARTHITIS 0 1 0 0 1
170 POST SC 0 0 0 1 1
171 SUSP ABSES PADA MAMAE SINISTRA 0 0 0 1 1
172 KONTROL EPILEPSI 0 0 0 1 1
173 ISK 0 0 0 1 1
174 POST CURATAGE 0 0 0 1 1
175 SUSP APPENDICITIS ACUTE 0 1 0 0 1
176 KONTROL CP + EPILEPSI 0 0 1 0 1
177 KONTROL HIPER OPTALMUS OS 0 0 0 1 1
178 ENDONTULOUS GIGI 21 1 0 0 0 1
179 ASHD DECOM CORDIS + TB PARU 0 0 1 0 1
180 LEST HEARING 1 0 0 0 1

181 SUSP DYSPEPSI 0 1 0 0 1


PERIODENTITIS APIKALIS EC GANGREN PULPA 37
182 GANGREN RADIKS 38 0 1 0 0 1
JUMLAH 26 51 83 147 307

Mengetahui, Sumedang, 12 Agustus 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

EDI KARYADI. S.I.P Ena Marlena Sanusi


NIP. 19590918 198604 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN AGUSTUS TAHUN 2013
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 DECOM CORDIS 1 1 2 2 6
2 16 ABSES PERIDONTAL 0 1 0 0 1
3 SERUMEN 0 0 0 1 1
4 DM 0 1 15 19 35
5 PTERIGIUM OD 0 3 1 0 4
6 ANXIETAS 0 0 0 1 1
7 RHINITIS ALERGICA 0 1 1 0 2
8 FLOUR ALBUS 0 0 0 1 1
9 SUSP KATARAK IMATUR 0 1 1 0 2
10 ESRD 0 0 6 1 7
11 SUSP BPH 1 0 0 0 1
12 CKD 0 0 1 1 2
13 HIPERTENSI 0 1 3 3 7
14 SUSP VERTIGO 0 0 1 0 1
15 SUSP KISTA 0 0 0 2 2
16 HYPERTIROID 0 0 1 2 3
17 SUSP KARDIOMEGALI 0 0 1 0 1
18 POST OP KATARAK 0 0 1 1 2
19 CORPUS ALINEUM 1 0 0 0 1
20 CEPHALGIA 0 1 0 2 3
21 ASHD 0 0 4 3 7
22 MYALGIA 0 0 2 4 6
G1 PO A1 GRAV 8 MG DG INSPECULO TAMPAK
23 JARINGAN DI MULUT RAHIM 0 0 0 1 1
24 RETINOBLASTOMA 0 0 1 0 1
25 POST OF GLUKOMA 0 0 0 1 1
26 CA NASOPARING 0 0 2 1 3
27 HERNIA INGUINALIS 0 1 0 0 1
28 SUSP TUMOR MAMAE SINISTRA 0 1 0 0 1
29 EPILEPSI 0 0 2 2 4
30 ILLEUS 0 1 0 0 1
31 SUSP ANGINA PECTORIS 0 0 0 1 1
PSMBA + ANEMIA DENGAN DIAGNOSA KISTA
32 OVARIUM MESENTRIS 0 1 0 0 1
33 SUSP HIL DEXTRA 0 1 1 0 2
34 HT + ASHD 0 0 0 0 1 1
35 KONTROL SINUSITIS 0 0 0 2 2
36 G1 PO AO PARTUS ATERM 0 0 0 1 1
37 OSTEO ARTHRITIS 0 0 0 1 1
38 SUSP MYOPIA 0 1 0 1 2
39 SUNGSANG 0 0 0 1 1
40 KONTROL NEURODERMATITIS 0 0 1 0 1
41 KONTROL DYSPEPSIA 1 2 0 4 7
42 STROKE 1 0 2 0 3
43 37 KARIES SEKUNDER (GANGRIEN PULPA) 1 0 0 0 1
44 NS 1 0 0 0 1
45 STROMA 1 0 0 1 2
46 SUSP KATARAK ODS 1 1 1 0 3
47 PULPITIS 46 1 0 0 0 1
48 SUSP FRAKTUR TANGAN KANAN 0 0 1 0 1
49 G1 PO AO GRAV 20 MG DG IUFD 0 1 0 0 1
50 DERMATITIS 0 0 0 1 1
51 CA MAMAE KONTROL 0 0 1 0 1
52 SUSP GOUT 0 1 0 0 1
53 KONTROL PSEUDOFILIA 0 0 0 1 1
54 KONTROL HEMOROID 1 0 0 1 2
55 SUSP DISLIPIDEMIA 0 1 0 1 2
56 BGM 1 0 0 0 1
57 ALOPECIA SUDAH 2 BULAN 0 1 0 0 1
58 GEA 0 1 0 0 1
59 SKIZOPRENIA KRONIK 0 0 1 2 3
60 LYMPADENOPATI COLLI 0 0 0 2 2
61 KONTROL OA GENU 0 0 0 1 1
62 IMPAKSI 38 0 1 0 0 1
63 NS 0 0 1 0 1
64 DISLOKASI TMJ 0 1 0 0 1
65 POSTEKSISI MASSA 0 0 1 0 1
66 SUSP ACNE 0 1 0 0 1
67 HIPEREMYE PULPA 22 0 1 0 0 1
PERIODONTITIS APICALIS ATCAUSA GANGREN
68 RADIS 28 0 1 0 0 1
69 KISTA MATUR 0 0 0 1 1
70 TUMOR PARU 0 0 1 0 1
71 EVANS SYNDROM 0 0 1 0 1
72 SUSP CIROSIS HEPATIS 1 0 0 0 1
73 SUSP GASTRITIS 0 1 0 1 2
74 SUSP BPH 1 0 1 0 2
75 SUSP DBD 1 1 0 0 2
76 CAD OMI FC IV 0 0 0 1 1
77 LBP 0 0 1 1 2
78 EPILEPSI 0 0 0 0 0
79 LIMPADENOPATI COLLY DEXTRA 1 1 0 0 2
80 SUSP CARVAL TA KIRI 1 0 0 0 1
PERIODONTITIS APICALIS ATCAUSA GANGREN
81 RADIS 47 0 0 1 0 1
82 KISTA OVARIUM MESENTRIS 0 0 0 1 1
83 CHRONIC DALLY HEADACHE 0 0 1 0 1
84 STROMA DIFUSI TONSIL 0 0 0 1 1
85 KONTROL OMP 0 0 1 0 1
86 KONTROL STROKE INFARK 0 0 1 0 1
87 SUSP MYOMA UTERI 0 0 0 2 2
88 SUSP CONJUNGTIVITIS 0 1 0 0 1
89 TRAUMA TANGAN TERTUSUK JARUM 0 1 0 0 1
90 PULPITIS 34 PERIODONTITIS 6/67 1 0 0 0 1
91 KOLESTEROL TOTAL, LDL, ASAM URAT 0 1 0 0 1
92 KONTROL DEPRESI 0 0 0 1 1
93 SUSP TB 0 2 0 0 2
94 KONTROL TIA 0 0 1 0 1
G1 P1 AO INPARTU ATERM KALA I FASE LATEN
95 DG KETUBAN HIJAU 0 1 0 0 1
96 KONTROL SUSP TINEA 0 0 0 1 1
97 LYMPADENITIS 0 1 0 0 1
CEDERA KEPALA PD BAGIAN MUKA SEBELAH KIRI
98 DG HECTING 30 JAHITAN 1 0 0 0 1
99 REFRAKSI ANOMALI 0 1 0 0 1
100 POST OF KATARAK 0 0 0 1 1
101 KATARAK MATUR ODS 0 1 1 0 2
102 NHML 0 0 1 0 1
103 SCOLIOSIS 0 0 0 1 1
104 SUSP MYOP ODS 4/6 2 3 0 0 5
105 CONGENITAL HAND I UNITED DIGITI 0 0 2 0 2
106 MENOMETHORERGIA 0 1 0 0 1
107 APS MINTA DI RO 0 1 0 0 1
108 SUSP TRAUMA BENDA TAJAM 0 1 0 0 1
109 SUSP KONTROL VERTIGO 0 0 0 1 1
SUSP GANGLION PERGELANGAN TANGAN
110 KANAN 1 0 0 0 1
111 SUSP PRESBIOP + MYOPIA 0 0 0 1 1
112 SUSP STRUMA 0 1 0 0 1
113 SUSP LOSS HEARING 1 0 1 0 2
114 SUSP SIROSIS HEPATIS 0 0 0 0 0
GI PO AO GRAV 14-15 MG PENDARAHAN AKIBAT
115 JATUH 0 1 0 0 1
116 ASMA + HT 0 0 0 1 1
117 PESERTA KB IUD 21 THN DGN BENANG (-) 0 1 0 0 1
118 CORPUS ALINEUM FARING LARING 1 0 0 0 1
119 KONTROL EFUSI PLEURA 0 0 1 0 1
120 KONTRO TB PARU 0 0 0 1 1
121 SUSP FIBRO ADENOMA MAMAE 0 1 0 0 1
122 KONTROL PALPITIS CORDIS TB 0 0 0 1 1
123 KONTROL THYROID 0 0 0 1 1
124 IKTERUS 0 0 0 1 1
125 KONTROL SUSP CICATRIK OD 0 0 1 0 1
126 KONTROL BRONCHITIS 0 0 0 1 1
127 OBS FEBRIS RL (+) 1 1 0 1 3
128 PSIKOSA ALWI 0 0 1 0 1
129 TUMOR MAMAE 0 1 0 0 1
130 SUSP PROSTAT 0 0 0 1 1
131 GANTI KACA MATA 0 0 0 1 1
132 ABSES PD SIMPISIS PUBIS 0 2 0 0 2
133 SELESAI PENGOBATAN TB BTA NEG (RO+) 0 0 0 1 1
134 CARDIOMYOPATI 0 0 0 1 1
135 KONROL CONJUNGTIVITIS ALLERGICA 0 1 0 0 1

PERIODONTITIS APICALIS ATCAUSA GANGREN


PULPA 36 RIWAYAT HIPERTENSI SUSP BELLS
136 PALSY 0 1 0 0 1
137 SUSP GLUKOMA 0 0 0 1 1
138 PULPITIS REVERSIBLE 1 0 0 0 1
139 GANGREN PULPA 47 1 0 0 0 1
27 57 72 96 252

Mengetahui, Sumedang, September 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN SEPTEMBER TAHUN 2013
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 36 ABSES GUSI MASIH BENGKAK DI TERAPI 0 1 0 0 1


2 KONTROL POST APUTANSI 0 0 1 0 1
3 ESRD 0 0 6 3 9
4 EPILEPSI 0 0 1 3 4
PERIODONTITIS APICALIS ATCAUSA GANGREN
5 RADIS 48 0 1 0 0 1
6 SUSP BARTOLINITIS 1 0 0 0 1
7 SKIZOPRENIA PARANOID 0 0 2 0 2
8 SUSP PROSTAT 0 0 1 0 1
9 CAD 0 0 1 5 6
10 KELAINAN GENETALIA 0 0 1 0 1

11 SUSP HORDEOLUM INTERNA PALPEBRA ATAS OD 0 1 0 0 1


12 ASHD 0 1 9 2 12
13 KONTROL STROKE 0 0 5 3 8
14 KONTROL IVB 0 0 1 0 1
15 SUSP PRESBIOP 0 0 0 1 1
16 SUSP LIPOMA 0 0 1 0 1
17 SUSP TRAUMA GLUTEUS KIRI 1 0 0 0 1
18 KONTROL SUSP MYALGIA 1 1 0 4 6
19 KONTROL CHEPALGIA 0 0 2 2 4
20 CKD 0 0 1 0 1
21 GEA 0 0 2 0 2
22 DM 1 2 8 20 31
23 SUSP MYOPI 0 1 0 1 2
24 SUSP KATARAK 1 3 2 1 7
25 KONTROL PPOK 1 1 0 0 2
26 SUSP DISLIPIDEMIA 0 1 0 3 4
27 PULPITIS 0 1 0 0 1
28 CHEST PAIN 0 1 0 0 1
29 ABSES PARU KIRI TU PARU KIRI 0 0 0 1 1
30 SUSP ISK + DISPEPSIA 1 0 0 0 1
31 KONTROL DYSPEPSIA 1 0 1 0 2
32 KARIES SEKUNDER 21 0 1 0 0 1
33 KONTROL SPONDILITIS 0 0 0 1 1
34 SUSP TB LAB BTA 0 1 0 0 0 1
PERIODONTITIS APICALIS ATCAUSA GANGREN
35 RADIS 26 0 0 0 1 1
36 KONTROL PRO USG 0 0 1 0 1
37 ANXIETAS 0 0 0 1 1
38 GANTI KACA MATA 1 0 0 1 2
39 KONTROL CRF 0 0 0 1 1
40 KONTROL VERTIGO 0 0 0 1 1
41 SUSP PTERIGIUM 0 0 0 1 1
42 SUSP CORFUS ALINEUM OS 0 0 1 0 1
43 SUSP TRAUMA KEPALA 0 1 0 0 1
44 PENDARAHAN UTERUS ABNORMAL 0 1 0 0 1
45 KONTROL CHD 0 0 1 0 1
46 HIPERTENSI 0 0 6 6 12
47 SUSP HIL DEXTRA 1 0 0 0 1
48 KONTROL CA CERVIK STAD III 0 0 0 1 1
49 POST EXTERPANCI ATSINDIKASI KISTA 0 0 0 1 1
50 AB INKOMPLIT 0 1 0 0 1
51 APPENDICTIS AKUT 1 0 0 1 2
52 SUSP SINUSITIS 0 0 1 0 1
53 SUSP HEPATITIS 1 0 0 0 1
54 SUSP GANGLION 0 1 0 0 1
55 SPONDILOSIS CERVICALIS 0 0 1 0 1
56 KONTROL SNNT 0 0 0 1 1
57 SUSP GASTRITIS 1 0 0 0 1
58 BO BLATED OVUM 0 1 0 0 1
59 MENOMETORHAGIA 0 1 0 0 1
60 KONTROL OBS FEBRIS 0 0 0 1 1
61 KONTROL UNTUK GANTI BOLA MATA PALSU 0 0 0 1 1
62 KONTROL ASMA 0 0 1 0 1
SUSP CARDIOMEGALI DG ANCAMAN BENDUNGAN
63 PARU 1 0 0 0 1
64 EPILEPSI 0 0 1 2 3
65 POST MOLAHIDATIDOSA 0 0 0 1 1
66 KONTROL DERMATITIS 0 0 0 3 3
67 HEG 0 1 0 0 1
68 ADA BENJOLAN DI SUDUT MATA KIRI 0 1 0 0 1
69 OSTEOPOROSIS 0 0 1 0 1
70 SUSP TIC PALPEBRA ATAS OS 1 0 0 0 1
71 KONGENITAL DISORDER OF UROGENITALIA 0 0 1 0 1
72 G1 PO AO PANGGUL SEMPIT 0 1 0 0 1
73 KONTROL CA NASOPARING 0 0 0 2 2
74 SUSP HAEMOROID 0 1 0 0 1
75 GASTRITIS KRONIS 0 0 1 0 1
76 POST TERTUSUK PAKU ± 1 MG 0 1 0 0 1
77 SUSP DISLOKASI POST JATUH 0 1 0 0 1
78 KONTROL SELESAI PENGOBATAN TB 0 0 0 1 1
79 POST TRAUMA BENDA TUMPUL 0 0 1 0 1
80 KONTROL GLUKOMA 0 0 0 1 1
81 SUSP URTICARIA 1 0 0 0 1
82 KONTROL PRESBIOPI 0 1 0 1 2
83 KONTROL DECOM CORDIS 0 0 1 1 2
84 KONTROL RIWAYAT TB 0 0 1 0 1
85 SUSP ECZEMA KERING DI KEDUA KAKI 1 0 0 0 1
86 SUSP DERMATITIS 1 0 0 0 1
BBL 6 HARI SUSP NEONATAL HIPERBILIRUBINT
87 SEPSIS 1 0 0 0 1
88 POST SC 0 0 0 1 1
89 EFUSI PLEURA 0 0 0 1 1
90 BAK ADA DARAH RIWAYAT NS 0 1 0 0 1
91 TUMOR PARU SINISTRA 0 0 1 0 1
92 SUSP CRF 0 1 0 0 1
93 KONTROL STRUMA 0 0 1 1 2
94 FEBRIS 0 1 1 0 2
95 KONTROL PALPITASI CORDIS 0 0 0 1 1
96 NEUROMYALGIA 0 0 0 1 1
97 SUSP KELENJAR BARTHOLIN 0 1 0 0 1
98 POST KLL ± 2 MG YANG LALU 0 0 0 1 1
99 KONTROL CA CERVIK STAD III B 0 0 0 1 1
100 SKIZOPRENIA 1 0 0 1 2
101 SUSP PAROKIA 1 0 1 0 2
102 COLIK ABDOMENT 0 3 0 1 4
103 SAKIT KAKI/ TELAPAK KAKI ±3 BULAN YANG LALU 0 0 0 1 1
104 KONTROL EVANS SYNDROM 0 0 1 0 1
105 KATARAK OD 0 0 1 0 1
106 VULNUS LASERATUM DI KAKI SEBELAH KANAN 0 1 0 0 1
107 IUFD 0 1 0 0 1
108 G1 PO AO GRAV 39 MG DG RIW HEPATITIS B 0 1 0 0 1
109 TIA 0 0 1 0 1
110 SUSP PULPITIS 23 POSISI MIRING 0 1 0 0 1
111 KONTROL HIPERTIROID 0 0 0 1 1
PERIODONTITIS APICALIS ATCAUSA GANGREN
112 RADIS 45 46 0 1 0 0 1
113 SUSP AB IMINEN 0 1 0 0 1
114 SUSP ANEMIA 0 1 0 0 1
115 TFA 0 1 0 0 1
116 G2 P1 AO GRAV 16-12 MG DG IUFD 0 0 0 1 1
117 SINUSITIS 0 0 0 2 2
118 SUSP ACNE 0 1 0 0 1
119 PRESBIOP 0 0 0 1 1
120 TRIGEMINAL NEURALGIA 0 0 0 1 1
121 ASHMA BRONHIAL 0 0 1 1 2
122 CORPUS ALINEM TELINGA KANAN 0 0 0 1 1
123 III PULPITIS 0 1 0 0 1
124 OBS VOMITUS 0 1 0 0 1
125 TB PARU 0 1 0 1 2
126 KONTROL LBP 0 0 0 1 1
PERIODONTITIS APICALIS ATCAUSA GANGREN
127 PULPA 16 1 0 0 0 1
128 CA COLON POST RESEKSI 0 0 1 0 1
129 OBS KEJANG 0 0 1 0 1
130 SUSP PENYAKIT YANG DISEBABKAN OLEH VIRUS 1 0 0 0 1
131 KONTROL KOLESTEROL 0 0 1 0 1
132 ANEMIA 0 0 1 0 1
133 TERTUSUK DURI IKAN 0 1 0 0 1
134 SUSP VESIKOLITIASIS 1 1 0 0 2
135 IDCM DEXTRA POST MASEKTOMI 1 0 0 0 1
136 SUSP TUMOR CAVUM NASAL 0 1 0 0 1
137 SUSP KELENJAR BARTHOLINI 0 0 0 1 1
138 CONFUKSI PRAKTUR VERTEBRA 0 0 0 1 1
139 SUSP MYALGIA 0 1 0 0 1
140 SUSP AUTISME 1 0 0 0 1
141 CA MAMAE 0 1 0 0 1
142 CA NASOPARING 0 0 1 0 1
JUMLAH 27 53 77 102 259

Mengetahui, Sumedang, OKTOBER 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

EDI KARYADI. S.I.P Ena Marlena Sanusi


NIP. 19590918 198604 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN OKTOBER TAHUN 2013
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 KONTROL ESRD 0 0 3 3 6
2 EPILEPSI 0 0 2 3 5
3 REFRAKSI ANOMALI 0 2 1 1 4
4 DCFC 0 0 0 1 1
5 KONTROL MYALGIA 1 3 5 11 20
6 HIPERTENSI 0 0 5 6 11
7 GANTI KACA MATA 0 0 2 1 3
8 11,21 POS EXO DI RSU 0 0 0 1 1
9 RHEUMATOID ARTHRITIS 0 0 0 1 1
10 DERMATITIS 1 0 4 2 7
11 DIABETES MELLITUS 0 0 16 23 39
12 CEPHALGIA 0 0 2 6 8
13 SUSP DECOM CORDIS 0 1 1 0 2
14 EMPYEMA PARU DEXTRA TB +BRONCHOCIETAS 0 0 1 0 1
15 SUSP ASHD 0 0 6 1 7
16 CA PARU 0 0 1 0 1
17 KISTA OVARIUM 0 0 1 3 4
18 CKD 0 0 1 0 1
19 DISLIPIDEMIA 0 0 1 4 5
20 SUSP VERUCA 0 1 1 0 2
21 CA NOSAFARING 0 0 2 0 2
22 PARKINSON 0 0 0 1 1
23 NHL RELAP 0 0 1 0 1
24 SELULITIS 0 0 0 1 1
25 STROK 0 0 4 2 6
26 11,21 HIPERAMAE PULPA 0 1 0 0 1
27 SUSP PTERIGIUM 0 0 0 1 1
28 OBS BANGKITAN 1 0 0 0 1
29 ILEUS OBSTRUKSI 1 0 0 0 1
30 KONTROL RETINOBLASTOMA 0 0 1 0 1
31 KONTROL SUSP PRESBIOP 0 0 2 0 2
PERIODONTITIS APICALIS ATCAUSA GANGREN PULPA
32 46 1 0 0 0 1
33 SUSP ASHMA BRONCHIAL 1 0 0 0 1
34 POST AMPUTANSI 0 0 1 0 1
TERLIHAT BENJOLAN DIBIWIR BAWAH KANAN ± 1
35 TAHUN 0 1 0 0 1
36 KONTROL STRUMA 0 0 0 1 1
37 NEUROMYALGIA 0 0 0 1 1
38 KONTROL TIROID 0 0 0 1 1
39 SUSP KATARAK OD 0 0 2 2 4
40 SUSP DYSPEPSIA 1 2 4 1 8
41 SUSPEK HIL POST KLL 0 1 1 0 2
PERIODONTITIS APICALIS ATCAUSA GANGREN PULPA
42 35 0 0 0 1 1
43 SPONDILITIS TB 0 0 0 1 1
44 CHD 0 0 2 0 2
45 G4 P3 AO GRAV 12 MG DG BO 0 1 0 0 1
46 SUSP FARINGITIS 0 1 0 0 1
47 CA CERVIK + ANEMIA + DEHIDRASI UNBALANCE INTAKE 0 1 0 0 1
48 AUTISME 0 0 1 0 1
49 KONTROL LBP 0 0 0 1 1
50 KISTA OVARIUM 0 0 0 1 1
51 SUSP DISENTRI 0 0 1 0 1
52 SCHIZOPREN 0 0 1 0 1
53 DNA 0 0 1 0 1
54 TONSILITIS 0 0 0 1 1
55 POST STROKE 0 0 0 1 1
56 OEDEMA PD TANGAN (JARI &KAKI) 0 0 0 1 1
PERIODONTITIS APICALIS ATCAUSA GANGREN PULPA
57 47 0 0 0 1 1
58 GE 1 0 0 0 1
59 KONTROL RA 0 0 0 1 1
60 VARISES 0 0 0 1 1
61 POS KANETRASI 0 0 0 1 1
62 SINUSITIS 0 0 0 1 1
PERIODONTITIS APICALIS ATCAUSA GANGREN RADIS
63 38 0 0 0 1 1
64 SUSP TONSILITIS 0 1 0 0 1
65 SUSP GASTRITIS 0 0 1 1 2
66 OSTEOPOROSIS 0 0 0 1 1
67 SUSP ISK 0 0 0 1 1
68 NEPHROLIHIASIS 0 1 0 0 1
69 TYROID 0 0 1 0 1
70 DCFC 0 0 0 1 1
71 SUSP POLIP 0 1 0 0 1
72 KOTROL IVB 0 0 1 0 1
73 GIGI BAWAH KANAN BERLUBANG INGIN DI CABUT 1 0 0 0 1
74 SUSP BPH 0 0 1 0 1
75 KOTROL POST RAWAT 0 0 1 0 1
76 KONTROL ABIS OBAT PUT 0 0 0 1 1
77 G1 PO AO GRAV 17 MG TPU TIDAK SESUAI BJA 0 1 0 0 1
78 HP 21 0 0 0 1 1
79 26 PULPA POLIP 0 0 0 1 1
80 KONTROL KONGENITAL HAND I UNITED DIGITI 0 0 1 0 1
81 KONTROL POST OP PASANG PEN 0 0 0 1 1
82 KONTROL ANXIETAS 0 0 1 0 1
83 KELUHAN LUTUT KANAN TERASA LINU DAN NYERI 0 1 0 0 1
84 PA EC GP 48 0 0 1 0 1
85 SUSP POLIP DEXTRA 0 0 1 0 1
86 KONTROL GASTRITIS KRONIS 0 0 1 1 2

87 LYPOMA KAKI KIRI 0 0 0 1 1


88 EVANS SYNDROM 0 0 1 0 1
89 PPOK 0 0 1 0 1
90 TUMOR CAVUM NASAL 0 0 0 1 1
91 SUPS RINITIS 0 0 0 1 1
92 KONTROL GLUKOMA 0 0 0 2 2
93 G1 P3 AO GRAV 11-12 TFU TIDAK SESUAI DEGAN VK 0 1 0 0 1
94 KONTROL TONSILITIS 0 0 0 1 1
95 KONTROL DA 0 0 0 1 1
96 KONTROL POS OPHERNIA 0 0 1 0 1
97 SUSP IKTERIK 0 0 1 0 1
98 11,21 HP 0 0 1 0 1
99 SUSP KONJUNGTIVITIS 0 0 1 0 1
100 38 IMPAKSI SEBAGIAN 1 0 0 0 1
101 KONTROL HI + SUSP DSYPEPSIA 0 0 0 1 1
102 KONTROL BPH 0 0 1 0 1
103 KPNTROL HYPERTIROID 0 0 1 1 2
104 KONTROL PALPITASI KORDIS 0 0 0 1 1
105 KONTROL SYNCOPE 1 0 0 0 1
106 ASHMA 0 0 0 1 1

KELUHAN TELINGA KANAN HAMPIR TIDAK BISA


107 MENDENGAR , KELUHAN TELINGA KIRI BERGEMURUH 1 0 0 0 1
108 SUSP KLAVUS 0 1 0 0 1
109 SUSP MIOPI 0 0 1 0 1
110 POST STROKE 0 0 1 1 2
111 KONTROL TB PARU 0 0 0 1 1
112 SUSP ABSES 0 0 1 0 1
113 SUSP SERUMEN TELINGA KIRI 1 0 0 0 1
114 SUSP OMP 0 1 0 0 1
115 47,48 POS EXO DI RSU 0 1 0 0 1
116 SUSP HEPATITIS 0 0 0 1 1
117 IMPAKSI 0 0 0 1 1
118 PA EC GP 48 0 0 1 0 1
KELUHAN BATUK + 2 BULAN YANG LALU DEMAM + 3
119 MG BADAN PANAS 1 0 0 0 1
120 SUPS NS 1 0 0 0 1
121 SUSP EROSI POS TIO 0 0 0 1 1
122 ASHD 0 0 0 1 1
123 BRONCHIALIS 0 0 1 0 1
124 POST OF KATARAK 0 0 1 0 1
1 MG SAKIT + BENGKAK PADA DALAM TELINGA PUS (+)
125 DARAH (-) 1 0 0 0 1
126 SEROTIN 0 0 0 1 1
127 CRONIC DAILY HEADACHE 0 0 1 0 1
128 G1 PO AO GRAV 23 DG SUSP GENELI 0 0 0 1 1
129 17 0 0 0 1 1
130 ULIKUS PEPTIKUM 0 0 0 1 1
131 SUSP PAM 0 0 0 1 1
132 KONTROL POST TE 0 0 0 1 1
133 SUSP PNEUMONIA 1 0 0 0 1
134 TRIGEMIAL NEURALGIA 0 0 0 1 1
135 KONTROL PARKINSON 0 0 1 0 1
136 KONTROL DCFC 0 0 0 1 1
137 SERUMEN 0 0 0 1 1
138 HIPERLIPIDEMIA 0 0 0 1 1
139 SUSP HORDEOLUM INTERNA PALPARIS 1 0 0 0 1
140 KPD 0 1 0 0 1
141 NYERI TELINGA SEBELAH KANAN 0 0 0 1 1
142 PROLAPSOS UTERI 0 0 0 1 1
143 FLOUR ALBUS 1 0 0 0 1
144 MYOPI 0 0 1 0 1
145 TONSLITIS 0 0 1 0 1
146 SUSP LYMPOMA 0 0 0 1 1
147 TU JARINGAN LUNAK FEMUR PROXIMAL 0 0 0 1 1
148 CORPUS ALINEUM OD 0 0 0 1 1
149 OBS FEBRIS 1 1 0 0 2
150 SUSP PAROCHIA 1 0 0 0 1
151 PA EC GP 46 0 0 0 1 1
152 CKD 0 0 1 0 1
153 SUSP STRUMA 0 0 0 1 1
154 HDR 0 0 0 1 1
155 CA MAMAE DEX 0 0 0 1 1
JUMLAH 21 26 106 136 289

Mengetahui, Sumedang, OKTOBER 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan
EDI KARYADI. S.I.P Ena Marlena Sanusi
NIP. 19590918 198604 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN NOPEMBER TAHUN 2013
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 ESRD 0 0 2 2 4
2 CKD 0 0 2 0 2
3 IVB 0 0 2 0 2
4 GASTRITIS 0 0 1 1 2
5 EPILEPSI 0 0 2 5 7
6 POST OP APP 0 0 0 1 1
7 POST KLL 0 1 0 0 1
8 SUSP MYALGIA 0 0 5 4 9
9 ASHD 0 0 3 6 9
10 SUSP DISPEPSI 1 0 8 2 11
11 SUSP PTERIGIUM 1 1 0 0 2
12 SUSP FAM 0 0 1 1 2
13 TRAUMA POST JATUH PADA TANGAN KANAN 0 0 0 1 1
14 KONTROL MYOPIA 0 0 0 1 1
15 DIABETES MELLITUS 1 0 9 32 42
16 SUSP HYPERTIROID 0 0 0 1 1
17 KONTROL NEURALGIA 0 0 0 1 1
18 SUSP REFRAKSI ANOMALI 0 0 2 0 2
19 CHEPALGIA 0 0 1 2 3
20 CONGENITAL HAND I UNITED DIGITI 0 0 1 0 1
21 SUSP HORDEOLUM 0 1 0 1 2
22 SSNT 0 0 0 1 1
23 G1 PO AO INPARTU KALA 1 DG SUNSANG 0 1 0 0 1
24 SUSP TINITUS 1 1 0 0 2
25 POST STROKE 0 0 1 2 3
26 HIPERTENSI 0 1 1 4 6
27 SEROTIN G3 P2 AO 41, 42 MG 0 0 0 1 1
28 EFUSI PLEURA 0 0 0 1 1
29 DYSLIPEDEMIA 0 0 2 2 4
30 SUSP BPH 1 0 1 0 2
31 MYOMA UTERI 0 1 0 0 1
32 ISPA 1 0 0 0 1
33 PSEDOPILIA 0 0 0 1 1
34 G1 PO AO KALA I FASE LATEN 0 1 0 0 1
35 LYPOMA 1 0 0 0 1
36 CORPUS ALINEUM 0 1 0 1 2
37 OSTEOPOROSIS 0 0 1 0 1
38 KONTROL POST OP KATARAK 0 0 2 1 3
39 OBS SYNCOPE 0 0 1 0 1
40 DCFC 0 0 1 0 1
G1 PO AO GRAV 28 MG K/U IBU BAIK JANIN SUSP IUFD
41 BJA - 0 0 0 1 1
G1 PI AO GRAVIDA 40 MG JANIN TUNGGAL HIDUP DG
42 SUSP SEROTIN 0 0 0 1 1
43 KONTROL PSIKOSA AKUT 0 0 0 1 1
44 SUSP CA TUMOR 1 0 0 0 1
45 KATARAK IMATUR 0 0 2 0 2
46 CERUMEN 0 0 1 0 1
47 ASTHMA BRONHIALE 0 0 1 1 2
48 PULPITIS 34 0 0 1 0 1
49 POST TRAUMA OD 0 0 0 1 1
50 SUSP OMA 0 0 1 0 1
51 TUMOR OVARIUM 0 1 0 0 1
52 IDCM DEXTRA POST MASTEKTOMI 0 0 0 1 1
53 HIPOSPADIA 1 0 0 0 1
54 POST EXO D RS 0 1 0 0 1
55 UP IUD SEBAGIAN MASIH TERTINGGAL 0 1 0 0 1
56 SKIZOPRENIA KRONIK 0 0 2 0 2
57 PARKINSON 0 0 0 1 1
58 LBP 0 0 0 2 2
59 KONTROL SMBA 0 0 0 1 1
60 SUSP KISTA OVARIUM 0 0 0 2 2
61 SUPS LIPOMA 0 0 1 0 1
62 HYPERLIPIDEMIA 0 0 1 0 1
63 DERMATITIS PADA KEPALA 0 0 1 0 1
64 ANEMIA 0 0 0 1 1
65 KATARAK 0 0 0 1 1
66 EVANS SYNDROME 0 0 1 0 1
67 SUSP TBC PARU DUPLEX AKTIF 1 0 0 0 1
68 KONTROL SUSP ISK 0 1 0 0 1
69 SUSP HERNIA INGUINALIS SINISTRA 0 0 0 1 1
21 PERIODONTITIS APICALIS ETCAUSA GANGREN
70 PULPA 0 0 0 1 1
71 43 MALOKLUSI 0 1 0 0 1
72 BAB KEHITAMAN 1 0 0 0 1
73 OBS FEBRIS 0 0 1 2 3
74 BELLS PALSY 0 0 0 1 1
75 TU HIDRASTIUM 0 0 1 0 1
76 GANTI KACA MATA 1 0 0 1 2
77 GEMELI 0 1 0 0 1
78 KONTROL RIWAYAT PROSTAT 0 0 1 0 1
79 CA CERVIX 0 0 0 1 1
80 VERUKA 0 0 0 1 1
81 CARDYOMYOPATI 0 0 0 1 1
82 CIKATRIK OD 0 0 0 1 1
83 G5 P4 AO 0 0 0 1 1
84 HIPERTIROID 0 0 0 1 1
85 OMA 0 0 1 0 1

86 POST KLL TRUMA KEPALA 0 0 0 1 1


87 SUSP DEPRESI 0 0 0 1 1
88 MYOPIA 0 0 1 0 1
89 PRAKTUR MAHKOTA 11.21 0 0 1 0 1
90 SUSP PRESBIOP 0 1 0 1 2
91 SUSP KATARAK 0 2 0 1 3
92 SUSP SERUMEN 1 1 0 0 2
93 SUSP STRUMA 0 0 0 1 1
94 HEPATOMEGALI 0 0 0 1 1
95 SUSP NS 0 0 0 1 1
96 THALASEMIA 0 0 1 0 1
PERIODONTITIS APICALIS ATCAUSA GANGREN PULPA
97 16 0 0 0 1 1
98 DISLIPIDEMIA 0 0 0 1 1
99 DILATED CARDIOMYOPATI 0 0 1 1 2
100 CYANOSIS 0 0 0 1 1
101 KATARAK MATUR ODS 0 0 0 1 1
102 TB PARU 0 0 0 1 1
103 MYOMA UTERI 0 0 0 1 1
104 KONTROL STRUMA 0 0 0 1 1
105 DCFC 0 0 0 1 1
106 BRONCHITIS 0 0 0 1 1
107 POST OP KATARAK 0 0 3 1 4
108 SUSP GANGLION 0 0 1 0 1
109 TINITUS 0 0 1 1 2
110 STROKE 0 0 1 2 3
111 G4 P3 AO GRAVIDA DG SUSP AB IMINENS 0 1 0 0 1
112 NEUROSIS 0 0 0 1 1
113 REFRAKSI ANOMALI 1 0 0 0 1
114 HIPERTIROID 0 0 1 0 1
115 SUSP ANEMIA 0 0 0 1 1
116 SUSP RHINITIS ALERGICA 0 0 1 0 1
117 CAD 0 0 1 1 2
118 GANGREN PULPA 737 0 0 0 1 1
119 17 POST TUMPATAN ANGLE (+) 0 1 0 0 1

120 KONTROL SUSP PENYAKIT YANG DIAKIBATKAN VIRUS 1 0 0 0 1


121 KONTROL RA 0 0 0 1 1
122 BPH 0 0 0 1 1
123 PERIODENTITIS 0 0 1 0 1
124 SUSP PARESE PIPI KIRI 0 0 0 1 1
PERIODONTITIS APICALIS ATCAUSA GANGREN RADIS
125 33 0 0 0 1 1
126 G3 P2 AO GRAV 37-38 MG DG VARISES VAGINA 0 1 0 0 1
127 SPONDILOSIS LAMSUL 0 0 0 1 1
128 G1 PO AO GRAVIDA 16 MG TFU TIDAK TERABA 0 0 0 1 1
129 BENJOLAN PADA LEHER 0 1 0 0 1
130 BELLS PALSY 0 0 0 1 1
131 SUSP BO 0 0 1 0 1
132 KONTROL ABIS OBAT 0 0 1 0 1
133 CA MAMAE 0 0 0 1 1
134 ANEMIA/KISTA 0 0 0 1 1
135 KONTROL DECOMP 0 0 0 1 1
136 SPASME OTOT SPONDIOLISIS 0 0 0 1 1
137 KARIES 0 1 0 0 1
138 KONTROL NEPROLITHIASIS 0 0 0 1 1
139 PRESBIOP 1 0 0 0 1
140 SUSP LYPOMA 0 0 0 1 1
141 POST TERJATUIH TERKENA BATU 0 1 0 0 1
142 TRIGEMINAL NEURALGIA 0 0 0 1 1
143 PREMATUR 0 1 0 0 1
JUMLAH 16 26 81 140 263

Mengetahui, Sumedang, DESEMBER 2013


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

EDI KARYADI. S.I.P Ena Marlena Sanusi


NIP. 19590918 198604 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN DESEMBER TAHUN 2013
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 VERTIGO 0 0 0 1 1
2 RHEMATOID ARTHRITIS 0 0 1 0 1
3 ESRD 0 0 4 3 7
4 PULPITIS 48 0 0 0 1 1
5 CHEPALGIA 0 1 0 3 4
6 POST OF TUMOR CAVUM NASAL 0 0 0 1 1
48 PERIODONTITIS APICALIS ATCAUSA GANGREN
7 RADIS 0 0 0 1 1
8 SUSPEC APPENDICITIS KRONIS 0 0 0 1 1
9 SUSP CONJUNGTIVITIS 0 0 1 0 1
10 SUSP TINITUS 1 1 1 0 3
11 KONTROL MYALGIA 0 0 1 0 1
12 SUPS KATARAK MATUR OD 0 0 1 2 3
13 ASHD 1 0 4 5 10
14 PP 28 HARI DG SUSP TUMOR BILI 0 0 1 0 1
15 CKD KRONIS 0 0 1 0 1
16 OBS FEBRIS (+) 1 0 0 0 1
17 SELULITIS 0 0 0 1 1
18 MILD HI 0 0 0 1 1
19 KONTROL CKD 0 0 1 0 1
20 CHRONIC DAILASE 0 0 1 0 1
21 HIL BILATERAL 0 0 1 2 3
22 DIABETES MELITUS 1 0 14 32 47
23 SUSP MYALGIA 0 0 2 3 5
24 ABSES DI ANUS 0 1 0 0 1
25 SUSP BPH 1 0 0 0 1
26 CALCANEUS TPOR 0 1 0 0 1
27 KONTROL STRUMA 0 0 1 0 1
28 SUSP DYSPEPSI 0 1 0 1 2
29 AUTISME 0 0 1 0 1
30 KONTROL MYALGIA 0 0 0 1 1
31 KONTROL STROKE 0 0 0 1 1
32 SUSP BRONCHITIS 1 0 0 0 1
33 SUSP EPILEPSI 0 0 1 0 1
34 VOD 0 0 0 1 1
35 GANTI KACA MATA 0 1 1 1 3
36 SUSP AB IMINEN 0 1 0 0 1
37 POST STEP 0 0 1 0 1
38 SUSP ALLOPERA 0 0 0 1 1
39 KISTA OVARIUM 0 0 1 2 3
40 SUSP PTERIGIUM 0 0 0 1 1
41 PSIKOSA 0 0 0 1 1
PERIODONTITIS APICALIS ATCAUSA GANGREN RADIS
42 48 0 1 0 0 1
43 HIPETRENSI 0 0 2 0 2
44 POS KLL + 1 BULAN YANG LALU LUTUT SAKIT 0 0 2 0 2
45 TIA 0 0 1 0 1
46 38 ABSES 0 0 0 1 1
47 DCFC 0 0 0 2 2
48 SUSP PTERIGIUM 0 0 1 0 1
49 KATARAK MATUR 0 0 0 1 1
50 SUSP VERUCA 0 1 0 0 1
51 PSIKOSA AKUT 0 0 1 0 1
52 PALPITASI WIDN 0 0 0 0 0
PERIODONTITIS APICALIS ETCAUSA GANGREN PULPA
53 47 1 0 0 0 1
54 KONTROL ISK 0 0 1 0 1
55 HNP 0 0 0 1 1
56 SUSP PTERIGIUM ODS 0 0 0 1 1
57 PULPITIS 48 0 0 0 1 1
58 SPONDIOLISIS CERVIKALIS 0 0 1 0 1
59 16 KARIES SEKUNDER 0 1 0 0 1
60 SUSP TU PADA PALPEBRA 1 0 0 0 1
61 SUSP PRESBIOP 0 0 1 0 1
62 SUSP BPH 1 0 0 0 1
63 SUSP NEVUS PIGMMENTUS PADA SKLERA OS 0 1 0 0 1
64 G4 P1 A2 GRAV 37 MG DG POS SC 0 0 0 1 1
65 VERTIGO 0 0 0 1 1
66 KONTROL TB PARU 0 0 0 1 1
67 RHEMATOID ARTHRITIS 0 0 1 0 1
28 PERIODONTITIS APICALIS ETCAUSA GANGREN
68 RADIS 0 0 1 0 1
69 SUSP VERUCA VULGARIS 0 0 0 1 1
70 66 PILPITIS 0 0 0 1 1
71 SKIZOPRENIA 0 0 1 0 1
72 KONTROL POST STROK 0 0 3 1 4
73 STRUMA 0 1 0 2 3
74 BENJOLAN PADA REGIO 38 0 1 0 0 1
75 MILD HI + FRAKTUR MANDIBULA BILATERAL 0 1 0 0 1
76 G1 PO AO POST ATERM DG SUSP CVD 0 1 0 0 1
77 SUSP PTERIGIUM ODS 0 0 1 0 1
78 KONTROL CA PARU 0 0 1 0 1
79 POLINEUROPATI 0 0 0 1 1
80 STROKE RINGAN 0 0 0 1 1
81 CAD 0 0 1 0 1
82 SUSP CLAVUS PEDIS KAKI KANAN 0 0 1 0 1
83 FLOUR ALBUS 0 0 0 1 1
84 RADIKULOPATI 0 0 0 1 1
85 SKIZOPRENIA KRONIC 0 0 1 0 1

86 SUSP GOUT 0 0 1 1 2
87 OMA 0 0 0 1 1
PERIODONTITIS APICALIS ETCAUSA GANGREN PULPA
88 48 0 0 0 1 1
89 SUSP GANTI KACA MATA 0 2 0 0 2
90 POST RAWAT KELUHAN PANAS 1 0 0 0 1
91 SUSP MYOPIA 0 1 0 0 1
92 DISLIPIDEMIA 0 0 0 3 3
93 G1 PO AO GRAV 36-37 MG DG PERPROTEIN POSITIF 2 0 0 0 1 1
94 OBS FEBRIS RL (-) 0 0 0 0 0
95 KONTROL HYS TEROCTOMY 0 0 0 1 1
96 PULPITIS 37 0 0 0 1 1
97 BRONCHITIS 0 0 0 1 1
98 HIPERTIROID 0 0 1 1 2
99 SUSP STROKE BELL PALSY 0 0 1 0 1
100 EVANS SYNDROM 0 0 1 0 1
101 OA GENU 0 0 0 2 2
102 DECOM CORDIS 0 0 1 0 1
103 SUSPEC CICATRIK 0 0 0 1 1
104 KONTROL DCFC 0 0 0 1 1
105 DERMATITIS 0 0 0 1 1
106 TU PADAT OVARIUM 0 1 0 0 1
107 SUSP KELAINAN JANTUNG CONGENITAL 0 1 0 0 1
108 NYERI LUKA BEKAS POS OP 6 TAHUN YANG LALU 0 0 0 1 1
109 THYROID 0 0 0 1 1
110 KPD 0 1 0 0 1
111 GOUT 0 0 0 1 1
112 ANCIETAS 0 0 1 0 1
113 EPILEPSI 0 0 1 1 2
114 KONTROL ASHMA BRNHIAL 0 0 0 1 1
115 SUSP DISLOKASI 0 0 0 1 1
116 CA CERVIK 0 0 1 1 2
117 KONTROL DECOM 0 0 0 1 1
118 GE 0 0 1 0 1
119 PULPITIS 28 0 0 1 0 1
120 SUSP CARDIOMECALI 0 0 0 1 1
Jumlah 10 21 71 111 213

Mengetahui, Sumedang, JANUARI 2014


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

EDI KARYADI. S.I.P Ena Marlena Sanusi


NIP. 19590918 198604 1 004
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN OKTOBER TAHUN 2012

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM 9 9 24 24 66
2 HYPERTENSI 5 5 21 16 47
3 ASHMA 0 0 2 2 4
4 PPOK 0 0 3 0 3
5 ASHD 4 2 10 8 24
6 BRONCHOPNEUMONIAL 0 0 1 0 1
7 CHEST PAIN 0 0 2 1 3
8 DYSPEPSIA 7 7 16 17 47
9 TIROTOKSIN 0 0 0 1 1
10 THALASEMIA 0 0 2 2 4
11 SPASME LUMBAL 1 0 0 0 1
12 SIROSIS HEPATIS 0 0 0 2 2
13 OBS. FEBRIS SUSP DBD 0 2 0 0 2
14 ILLEUS OBSTRUKTIF 0 0 0 1 1
HIL ( Hernia Inguinalis Lateral)
15 1 0 0 0 1
16 ASPHYXIA 0 0 1 0 1
17 NEPROTIK SYNDROME 0 0 4 0 4
18 THALASEMIA 0 0 2 1 3
19 IKTERUS 0 2 0 0 2
20 TUMOR WILLMS 0 0 1 0 1
21 OBS. FEBRIS SUSP.TYPOID 0 1 0 0 1
22 BGM 1 0 0 0 1
23 EPILEPSI 0 0 3 1 4
24 CLAVUS 0 0 0 1 1
FAM SIN ( Fibroadenoma
25 Mamae) 0 0 0 4 4
26 COLOSTAMI 0 0 2 0 2
27 BPH 0 0 0 1 1
28 HAEMOROID 0 0 0 1 1
CKD ( Chronic Kidney Disease)
29 0 0 0 1 1
30 HIDROCOCEL 1 0 0 0 1
31 TUMOR PD KETIAK 1 0 0 0 1
32 AB IMINEN 0 5 0 1 6
33 GRAVIDA DG CHEST PAIN 0 0 0 1 1
34 GRAVIDA DG STRUMA 0 0 0 1 1
GRAVIDA DG AB. INKOMPLIT
35 0 1 0 0 1
36 GRAVIDA DG HT + SU 0 1 0 0 1
37 HISTEREKTOMI 0 0 0 1 1
38 CA CERVIK 0 0 0 1 1
39 METRORANGIA 0 0 0 1 1
40 TINITUS 1 4 1 0 6
TUMOR CAVUMNASI DEXTRA
41 0 1 0 0 1
42 OTHALGIA 0 0 1 0 1
43 EPITAKSIS 0 1 0 0 1
44 FARINGITIS 0 0 1 0 1
45 SERUMEN DALAM 0 0 1 0 1
46 GANTI KACA MATA 0 2 0 0 2
47 GLAUKOMA 0 0 0 2 2
48 KATARAK 1 3 1 3 8
PADA MATA KANAN CICATRIK
49 0 1 0 0 1
50 CORPUS ALINEUM 0 0 2 0 2

BENJOLAN PADA KELOPAK


51 MATA (Hordeulum Externa)
0 1 0 0 1
52 DERMATITIS 1 0 4 3 8
53 SELULITIS 0 0 1 1 2
54 GASTRITIS REKUREN 0 0 1 0 1
55 EDONTALOUS 1 0 0 0 1
56 IMFAKSI 1 0 0 0 1
57 POST EKSTRAKSI 0 0 0 1 1
58 GANGREN PULPA 0 0 0 1 1
59 ABSES SUBMANDIBULA 0 0 0 1 1
60 POST STROKE 0 0 1 6 7
61 AUTISME 0 1 0 0 1
62 RA ( Rhematoid Arthritis) 0 2 5 1 8
63 RADIK LUMBAL 0 0 0 1 1
64 CHEPALGIA 0 0 1 1 2
65 DISLIPIDEMIA 0 0 0 2 2
66 VERTIGO 0 0 1 0 1
67 PARKINSON 0 0 1 0 1
68 OSTEO ARTRITIS 1 2 3 7 13
69 NEUROMYYALGIA 0 0 2 0 2
70 GOUT 0 0 2 0 2
71 DEPRESI 0 0 1 1 2
72 ESRD ( End Stoge Renal Disease) 0 0 2 6 8
JUMLAH 36 53 126 127 342

Mengetahui, Sumedang, 8 November 2012


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN NOPEMBER TAHUN 2012

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM 0 1 10 32 43
2 OA 0 1 4 9 14
3 Katarak 1 4 4 2 11
4 CRF 2 1 2 5 10
5 ASHD 0 0 5 5 10
6 Dispepsia 0 2 1 6 9
7 HT 0 0 6 3 9
8 Serumen 1 6 1 0 8
9 Stroke 0 0 3 6 9
10 Epilepsi 0 0 4 2 6
11 Struma 0 1 1 5 7
12 Ganti kaca mata 0 1 3 3 7
13 Kista Ovarium 0 1 0 5 6
14 Dislipidemia 0 0 1 5 6
15 PAM 0 1 0 4 5
16 Radikulopati 2 0 3 1 6
17 Thalasemia 2 0 1 2 5
18 Grav dg Letak Sungsang 0 3 0 2 5
19 Impaksi 1 2 0 2 5
20 Lymp Colli 0 0 2 2 4
21 Dermatitis 0 0 4 0 4
22 Obs Febris Typoid 2 0 1 1 4
23 Ballpalsy 0 0 0 3 3
24 DBD 1 2 0 0 3
25 Cephalgia 0 1 1 1 3
26 Miopia 1 0 1 1 3
27 Chest Pain 1 0 0 2 3
28 Ca Hepar 1 0 0 1 2
29 RA 0 1 0 1 2
30 Trauma Mata 1 1 0 0 2
31 AB Iminens 0 2 0 0 2
32 RHD 1 1 0 0 2
33 TB Paru dg Hemaptou 2 0 0 0 2
34 LBP 0 0 0 2 2
35 Ashma Bronkhial 1 0 1 0 2
36 Fharingitis 1 0 0 1 2
37 Tumor Abdomen 0 0 1 1 2
38 OMP 1 0 1 0 2
39 CMKG 0 0 0 2 2
40 Alopecia 1 0 1 0 2
41 Karies 0 1 0 0 1
42 Pseudopilia 0 0 0 1 1
43 Grav 35 mg prolen +++ 0 0 0 1 1
44 Lympadenopati mandibula 0 0 1 0 1
45 Tinea Capitis 0 0 1 0 1
46 Bronchitis 0 0 1 0 1
47 Curatage 0 1 0 0 1
48 OMA 0 0 1 0 1
49 IVB 0 0 0 1 1
50 Decom 0 0 1 0 1
BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
51 Lipoma 0 0 0 1 1
52 Trauma Kepala 0 0 0 1 1
53 Panggul Sempit Absolut 0 1 0 0 1
54 Neuromialgia 0 0 0 1 1
55 Depresi 0 0 1 0 1
Post partum dg VCE +
56 Retensio Urine 0 1 0 0 1
57 Grav dg Placenta pravia 0 1 0 0 1
58 Tumor Paru 0 0 1 0 1
59 Serotin 0 0 0 1 1
60 Post Extraksi 0 1 0 0 1
61 Pulpitis 0 1 0 0 1
62 Psikosomalia 0 0 0 1 1
63 Spoting 0 1 0 0 1
64 Rhinitis 0 0 0 1 1
65 Hepatomegali 1 0 0 0 1
66 Radikulopati 0 0 0 1 1
67 GE 1 0 0 0 1
68 Appendik akut 0 1 0 0 1
69 Tinitus 0 1 0 0 1
70 Hernia Scrotalis 1 0 0 0 1
71 PPOK 0 0 1 0 1
72 Skizoprenia Kronic 0 0 0 1 1
73 Kardiomyopati 0 1 0 0 1
74 Tonsilitis 0 1 0 0 1
75 Hepatitis 0 0 1 0 1
76 Othalgia 1 0 0 0 1
77 Palip nasal 1 0 0 0 1
78 Obs Febris Susp DBD 1 0 0 0 1
79 Glaukoma 0 0 0 1 1
80 Pterigium 0 0 0 1 1
81 Tonsilitis 0 1 0 0 1
82 Clavus 0 1 0 0 1
Jumlah 29 46 71 130 276

Mengetahui, Sumedang, Desember 2012


Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

dr. Hj.Herni Wiwik H Ena Marlena Sanusi


NIP. 19710301 200212 2 002
LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN DESEMBER TAHUN 2012

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 DM 1 1 16 28 46
2 DISLIPIDEMIA 5 11 2 3 21
3 RA 0 1 7 13 21
4 HT 0 0 7 6 13
5 DYSPEPSIA 2 3 2 5 12
6 ASHD 0 0 4 5 9
7 DERMATITIS 2 1 4 1 8
8 KATARAK 0 0 3 4 7
9 THALASEMIA 0 0 2 4 6

OBS.FEBRIS SUSP.TYPOID
10 4 1 0 1 6
11 EPILEPSI 0 0 3 3 6
12 BPH 1 0 3 1 5
13 PSIKOSA 0 0 2 3 5
14 CRF 1 0 2 1 4
15 MYOPIA 0 2 1 1 4
16 CEPHALGIA 0 1 2 0 3
17 STROKE 0 0 1 2 3
18 GANTI KACA MATA 0 0 0 3 3
19 ASMA 0 0 2 1 3
20 LBP 1 0 2 0 3
21 POST OP CLAVIKULA 1 1 0 1 3
22 POST OP KISTA 0 0 0 2 2
23 LIPOMA 1 1 0 0 2
24 ANEMIA GRAVIS 1 0 0 1 2
25 GRAVIDA DG SEROTIN 0 2 0 0 2
26 MENORHARGIA 0 0 0 2 2
27 GMKG PERIODONTIS 0 0 0 2 2
28 BO 0 2 0 0 2
29 POST SC 0 1 0 1 2
30 AB IMINENS 0 1 0 1 2
31 DYSMENORE 0 0 0 2 2
32 GP 38 1 1 0 0 2
33 PAPS SMEAR 0 0 0 2 2
34 VERUCA 1 1 0 0 2
35 HIL 0 0 2 0 2
36 PTERYGIUM 0 1 0 0 1
37 CHEST PAIN 0 0 1 0 1
38 VARISES 0 0 0 1 1
39 PPOK 0 0 1 0 1
40 NEUROSPIGMENTOSUS 0 0 0 1 1
41 TINEA PD KEPALA 1 0 0 0 1
VOMITUS + DEHIDRASI
42 GRAD II 0 1 0 0 1
43 PRESBIOPIA 0 0 1 0 1
44 STRUMA 0 0 1 0 1
POLIP CAVUM NASI
45 SINISTRA 0 1 0 0 1
46 CARDIOMEGALI 0 0 1 0 1
47 FLOUR ALBUS 0 0 0 1 1
48 GRAVIDA DG HT 0 0 0 1 1
49 ESRD 0 0 0 1 1
50 CA CERVIX 0 0 0 1 1
51 SERUMEN DALAM 1 0 0 0 1
52 IVB 0 0 1 0 1
53 TUMOR CAVUM NASI 0 0 1 0 1
54 KONTROL CURETAGE 0 0 0 1 1
55 HIPERTIROID 0 1 0 0 1
56 PLACENTA PRAVIA 0 0 0 1 1
57 MUCOCOLA LABIA 1 0 0 0 1
58 GP 46 0 1 0 0 1
59 PRESMAKOSIS 0 0 1 0 1
60 SUSP GO 1 0 0 0 1
61 PARKINSON 0 0 1 0 1
62 CA MAMAE 0 0 0 1 1
63 FAM 0 0 0 1 1
64 HIPOSPADIA 0 0 1 0 1
65 ISPA 1 0 0 0 1
66 TINITUS 0 0 1 0 1
67 DBD 0 0 0 1 1
68 AB INCOMPLITE 0 1 0 0 1
69 DUB 0 0 0 1 1
70 OMP 0 0 0 1 1
71 ISK 0 1 0 0 1
72 PSEUDOPILIA 0 1 0 0 1
73 SEROSIS HEPATIS 0 0 0 1 1
Jumlah 27 39 78 113 257
Mengetahui, Sumedang, 9 Januari 2013
A/N Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Edi Karyadi,SIP Ena Marlena Sanusi


NIP.19590918 198603 1 004

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