LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT

PUSKESMAS CIMALAKA
BULAN JANUARI TAHUN 2015

BARU LAMA
NO DIAGNOSA ICD X
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 Ab Iminens 1
2 ASHD 1
3 Batuk 1 Minggu APS 1
4 Benjolan di Bibir Bawah Kanan 1
5 Cardiomyopati DC 1
6 Cellulitis 1
7 CKD 1
8 Dermatitis E14 1
9 Diabetes Mellitus 1 3 6
10 Dillated cardiomyopati 1
11 Dm Uncontrolled + Abces Telapak Kaki Kiri 1
12 Epilepsi G40 1
13 Etopi directrory 1
14 FAM 1
G1 P0 A0 Gravida 39 Minggu dengan KPD Sisa Cairan
15 Hijau 1
16 G2 P1 A0 Gravida 33 minggu + riwayat Mioma + Kista 1
17 G2 P1 A0 Gravida 39 Minggu dengan Lintang 1
18 G2p1A0 34 Minggu sering Berdebar 1
19 G3P2A0 Gravida 41-42 Minggu dengan serotinus 1
20 Gangguan Refraksi Anomali 1
21 Ganti Kaca Mata 1 1
22 General Cek Up 1
23 GIG HP 17 45 1
24 Gigi belakang kanan berlubang Pulpitis 1
25 Gmkb dan periodontitis lunak 1
26 HCD Pneumoni Torax 1
27 Hipertensi I10 1 2
28 Hipertiroid 1
29 Katarak 2
30 Katarak Senile 1
31 Keloid 1
32 Kontrol Aritma 1
33 Kontrol ASHD 1 2
34 Kontrol Batuk 1
35 Kontrol Brocho Pneumonia 1
36 Kontrol Ca Nasofaring 1
37 Kontrol Ca Sub Mandibula 1
38 Kontrol CAD 1 1
39 Kontrol CKD 1
40 Kontrol Decom Cordis 1
41 Kontrol Dermatitis 1
42 Kontrol Diare 1
43 Kontrol Dyspepsia 1 1
44 kontrol Epilepsi 1
45 Kontrol ESRD 5
46 Kontrol Gout Typhuse 1
47 Kontrol Hipertensi 1
48 Kontrol IVB 1
49 Kontrol Katarak 1
50 Kontrol Keloid 1
51 kontrol LBP + Hipertensi 1
52 Kontrol Mioma Uteri 1
53 Kontrol Neprolithiasis Multipel 1
54 Kontrol Neuromyalgia 1
55 Kontrol OMP 1
56 Kontrol Parkinson 1
57 Kontrol Post Dirawat Inap 1
58 Kontrol Post op Katarak 1
59 Kontrol Post Op Mioma Uteri 1
60 Kontrol Post SC 2
61 Kontrol Post Stroke 3

62 Kontrol Presbiop 1
63 Kontrol Prostat 1
64 Kontrol Refraksi Anomali 1
65 Kontrol SLE 1
66 Kontrol Spira Bifida 1
67 Kontrol Stroke 1
68 Kontrol Stroke Infark 1
69 Kontrol Struma 1
70 Kontrol Susp Mioma Uteri +Post kuret 1
71 Kontrol Susp Pterigium 1
72 Kontrol tiroid 1 1
73 Kontrol Tonsiloktomi 1
74 Kontrol Tumor Jaringan Lunak 1
75 Myalgia M791 1
76 Neuromyalgia 1
77 Obs Febris + Anoreksia 1
78 Obs Febris + Dyspepsia +Psikosomatik 1
79 Obs Febris Tipoid 1
80 Of RL (+) 1
81 Oma 1
82 P. eksisi Luas 1
83 P4 CG GP G 1
84 PEB 1
85 Pengobatan OAT Kategori ( Selama 6 Bulan) 1
86 Periodentitis Etcausa Gangren Pulpa 13 1
87 Periodonititis akut gigi untuk riwayat SLE 1
 88 Periodontitis Etcausa Gangren Radis 38 1
89 Periodontitis Etcausa Gangren Radis 5 1
90 Periodontitis Etcausa Gangrn Pulpa 45 Susp Gangren Rad 1
91 Plexopathy Bronchialis Sinistra 1
92 Pneumoni kiri + Broncho Pneumoni Kanan 1
93 Pneumonia Kiri + Brocho Pneumonia 1
94 Post KLL 1
95 Post OF Pemasangan Permanent Fase Markes 1
96 Post Of Plantos Pedis 1
97 Post op Tumor 1
98 Post Operasi Katarak 1
99 Post Stroke 1
100 Presbiop 1 1
101 Refraksi Anomali 1
102 Serotin + Riwayat Meningitis 1
103 Stroke 1
104 Susp Bartholiatid 1
105 Susp Bell Palcy 1
106 Susp Bronchitis 1
107 Susp Chepalgia 2 2
108 Susp Clavus 1
109 Susp Corpus Alineum 2
110 Susp DBD 1 2
111 Susp DBD RL (+) 1 1
112 Susp Decompensasi Cordis 1
113 Susp Defresi 2 1
114 Susp dermatitis kontak allergica 1
115 Susp Dispepsia + Anoreksia 1
116 Susp Dyspepsia 1
117 Susp Febris 1
118 Susp Gangguan Refraksi Anomali 3 2
119 Susp Gastritis K29 1
120 Susp Gout M10 1
121 Susp GR 16 1
122 Susp Heary Telinga Kanan + Omp 1
123 Susp Hipertensi + Chest Pain + Psikosomatik 1
124 Susp Katarak 2 1
125 Susp Katarak Imatur 2 4 1 1
126 Susp Kista di gigi 57 1
127 Susp Konjungtivitis 1 1
128 Susp LBP 1 1
129 Susp Lesis Hearing 1
130 Susp Lipoma Multiple 1
131 Susp Menomethorarge 1
132 Susp Mioma Uteri 1
133 Susp Neprolithiasis 1
134 Susp Osteo Artritis 1 1 3
135 Susp PPOK + Anoreksia 1
136 Susp Prostat Hiperplasia 1
137 Susp Refraksi Anomali 1 1
138 Susp Rematoid Athritis 1 1
139 Susp Serumen + Dermatitis 1
140 Susp Serumen Dalam Telinga Kanan Kiri 1
141 Susp Struma 1
142 Susp TB 1
143 Susp TIA 1
144 Susp Tinea Capitis 1
145 Susp Tinitus 1
146 Susp Tinitus + Serumen Telinga Kiri 1
147 Susp Tonsilitis 1 1
148 Susp Trauma Kepala 1 1
149 Susp Tu jar lunak bahu kanan 1
150 Susp Tu Jaringan Lunak Dahi 1
151 Susp Tu jaringan lunak di dagu 1
152 Susp Tu Jaringan Lunak Labium Mayor 1
153 Susp Tumor Jaringan Lunak Dagu 1
154 Susp Tumor Jaringan Lunak di Gluteus Kaki Kiri 1
155 Susp Tumor Jaringan Lunak Tungkai Bawah 1
156 Susp Veruca di Dahi 1
157 Suspe Hipertensi 1
158 Suspec Kelainan Kongenital Pedis 1
159 Suspec Tinitus 1
160 tertusuk Duri 1
161 Trigeminal Neuralgia 1
162 Tumor Jaringan Lunak di Dahi 1
163 Ulkus pada tibia dexa 1
164 Union Fraktur Left Tibia 1
22 37 66 97

Mengetahui, Sumedang, 4 Pebruari 2015

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Supriyanto, SKM Ena Marlena Sanusi

NIP. 1966044 198803 1 009
Jumlah
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1

1
1
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1
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5
1
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1
1
1
1
1
1
1
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3

1
1
1
1
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1
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1
2
1
1
1
1
1
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222

2015
poran

Sanusi
 LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN PEBRUARI TAHUN 2015
BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 38 posisi miring 0 0 1 0 1
2 Abses 0 0 0 1 1
3 Abses Etcausa Gangren pulpa 0 0 0 1 1
4 Abses etcausa gangren pulpa 46 0 0 1 0 1
5 Abses etcausa gangren radis 38 0 0 0 1 1
6 Anemia Aplastik 0 0 1 0 1
7 Artropati - polineurofati-multiple tropi 0 0 0 1 1
8 ASHD 0 0 1 2 3
9 Aterm ilenns tipe I 0 0 1 0 1
10 Benjolan di dahi 0 0 1 0 1
11 BPH 0 0 1 0 1
12 BPH, Hipertensi Stadium 2 0 0 1 0 1
13 Bronchilitis 0 0 1 0 1
14 Cerumen 0 0 0 1 1
15 Chest Pain 0 0 0 1 1
16 CKD 0 0 0 1 1
17 Clavus 0 0 0 1 1
18 Collic Abdimen dengan solid masa a/r hepar
suspec ca 0 0 1 0 1
19 Combustio 0 0 1 0 1
20 Combustio 0 0 1 0 1
21 Corpal ar kornea 0 0 1 0 1
22 Decomp Cordis 0 0 2 0 2
23 Depresi 0 0 1 0 1
24 Dermatitis 0 1 0 1 2
25 Diabetes melitus 0 0 1 2 3
26 Diabetes melitus + hipertensi 0 0 0 1 1
27 Diabetes mellitus 0 0 0 1 1
28 Dislipidemia 0 0 1 0 1
29 edentolous 0 0 0 1 1
30 Eksmasi multiple 0 0 1 0 1
31 Epilpesi 0 0 0 1 1
32 ESRD 0 0 0 1 1
33 Fam 0 0 0 1 1
34 G2 P1 A0 gravida 21 minggu , Tfu tidak teraba
0 0 0 1 1

35 G2 P1 A0 gravida 35 minggu dengan myoma

uteri 0 0 0 1 1
36 G2 P1 A0 Gravida 37 minggu riwayata sc 0 0 0 1 1
37 G3 P2 A0 Gravida 40-41 minggu 0 0 0 1 1
38 G3 p2 A0 Gravida aterm Kpd 0 0 0 1 1
39 G3 PA A0 Gravida 32 minggu dengan hipertensi
kronis 0 0 0 1 1
40 Gangguan Refraksi Anomali 0 0 1 1 2
41 Gastritis kronis 0 0 1 0 1
42 Gout Artritis 0 0 0 1 1
43 GTSL RB papis 0 0 0 1 1
44 Gynecongestic Bil 0 0 1 0 1
45 Haemoroid 0 0 0 1 1
46 Hernia Inguinalis Lateralis 0 0 0 1 1
47 Hernia Scrotalis 0 0 1 0 1
48 Hipermiopia 0 0 0 1 1
49 Hipertiroid 0 0 0 3 3
50 Hipospadia 0 0 1 0 1
51 HNP 0 0 0 1 1
52 kaki terasa pegal 0 0 1 0 1
53 katarak imatur ods 0 0 0 1 1
54 Keloid multiple 0 0 0 1 1
55 Kemasukan katembad 0 0 0 1 1
56 Konjungtivitis + scar kornea dextra 0 0 0 1 1
57 kontrol ASHD 0 0 1 0 1
58 Kontrol Dyspepsia 0 0 0 2 2
59 Kontrol epilepsi +cp 0 0 0 1 1
60 Kontrol GEA 0 0 0 1 1
61 Kontrol Hepatitis 1 0 0 0 1
62 Kontrol pneumotorax, bronchitis, ckd 0 0 1 0 1
63 kontrol post rawat 0 0 1 0 1
64 kontrol post rawat Inap 0 0 1 0 1
65 Kontrol post stroke 0 0 4 0 4
66 KSI 0 0 0 1 1
67 LBP 0 0 1 3 4
68 Limpadenopati Colli 0 0 1 0 1
69 Lipoma 0 0 0 1 1
70 Luka disudut bibir sebelah kanan vulnus
Seratum di sudut bibir sebelah kanan 0 0 1 0 1
71 Myalgia 1 0 2 2 5
72 Myioma 0 0 0 1 1
73 Myoma uteri 0 0 0 1 1
74 Myopia 0 0 1 2 3
75 Neuromyalgia 0 0 1 3 4
76 NHML 0 0 1 0 1
77 Oa Genue bil 0 0 1 0 1
78 OE 0 0 0 1 1
79 Of ec Suspec darah tipoid 0 0 1 0 1
80 Oma 0 0 1 0 1
81 OMSK 0 0 0 1 1
82 Pendarahan SMBA 0 0 1 0 1
83 Periodontitis etcausa gangren pulpa 12 0 0 0 1 1
84
Periodontitis Etcausa Gangren pulpa 37,38 0 0 1 0 1
85 Periodontitis Etcausa Gangren pulpa 38 0 0 0 1 1
86 Periodontitis etcausa gangren pulpa 7 0 0 0 1 1
87 Periodontitis Etcausa gangren radis 38 0 0 0 1 1
88 Periodontitis Etcausa Gangren radis 48 0 0 1 0 1
89 Periodontitis kronis 0 0 1 0 1
90 poli artritis 0 0 0 1 1
91 polip Nasi 0 0 1 0 1
92 post biopsi eksterpasi 0 0 0 1 1
93 post ekstansi 26 0 0 1 1 2
94 Post op colostomy 0 0 1 0 1
95 Post op katarak 0 0 1 0 1
96 Post op tumor mamae 0 0 0 1 1
97 Post partum I minggu dengan anemia 0 0 0 1 1
98 Post Sc 0 0 0 2 2
99 Post Stroke 0 0 1 0 1
100 Pulpitis 0 0 0 1 1
101 Pulpitis 48 0 0 1 0 1
102
Recorren + Hernia 0 0 1 0 1
103 Refraksi Anomali 0 0 1 1 2

104 Retensio Urin

0 0 2 0 2
105 Scabies 0 0 1 0 1
106 Serumen 0 0 1 0 1
107 Sinusitis Maksilaris 0 0 0 1 1
108 Skizoprenia 0 0 1 0 1
109 SNNT 0 0 0 1 1
110 Spondilosis 0 0 0 1 1
111 Supec Prolap uteri 0 0 0 1 1
112 Susp ASHD 0 0 1 0 1
113 Susp Crf 0 0 0 1 1
114 Susp Dislokasi 0 0 0 1 1
115 Susp Gout artritis + dislipdemia 0 0 1 0 1
116 Susp inf Dengue 0 0 1 0 1
117 Susp infeksi dengue 0 0 1 0 1
118 Susp Ispa + Diare 0 0 1 0 1
119 Susp pharingitis 0 0 0 1 1
120 Susp Pterigium
0 0 1 0 1
121 Susp Rubela 0 0 0 1 1
122 Suspec HP III 0 0 1 0 1
123 Suspec tinitus + hipertensi 0 0 0 1 1
124 T Corporis et cruris 0 0 0 1 1
125 TFA 0 0 0 1 1
126 Tinitus 0 0 1 0 1
127 Trauma tulang punggung 0 0 1 0 1
128 Tumor colli 0 0 0 1 1
129 Tumor di bokong 0 0 0 1 1
2 1 70 85 158

Mengetahui, Sumedang, 5 Maret 2015

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Supriyanto, SKM Ena Marlena Sanusi

NIP. 1966044 198803 1 009
Sumedang, 4 Pebruari 2015
Pembuat Laporan

Ena Marlena Sanusi

 LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN MARET TAHUN 2015

BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 AKSEPTOR IUD GAGAL 0 0 0 1 1
2 AMENORHE SEKUNDER (MENOPAUSE) 0 0 0 1 1
3 ANXIETAS 0 0 1 0 1
4 ASHD 0 0 0 2 2
5 ASMA BRONCHIALE 0 0 1 0 1
6 BATUK 0 0 1 0 1
7 BELL 'S PALSY 0 0 0 1 1
8 BENJOLAN DI BAWAH LIDAH AR (46, 47) 0 0 0 1 1
BENJOLAN DI BIBIR BAWAH SEBELAH KANAN
9 (SUSPEC CA DI BIBIR) 0 0 1 0 1
10 BRONCHOPNEUMONIA 0 0 2 0 2
11 CAD 0 0 0 1 1
12 CE (S) 0 0 0 1 1
13 CERUMEN PLUG 0 0 1 1 2
14 CHEST PAIN 0 0 0 3 3
15 CHOLELITHIASIS MULTIPLE 0 0 2 1 3
16 CLUSTER HEADACHE 0 0 1 0 1
17 CORPAL AR KORNEA + PTERIGIUM 0 0 1 0 1
18 CRF 0 0 1 0 1
19 CTS + ARTRITIS 0 0 1 0 1
20 DECOMPENSATIO CORDIS 0 0 2 0 2
21 DEPRESI 0 0 0 2 2
22 DERMATITIS KONTAK 0 0 0 2 2
23 DIABETES MELLITUS 0 0 4 5 9
24 DISLEKSIA 0 0 1 0 1
25 DISLIPIDEMIA 0 0 0 1 1
26 OE 0 0 2 0 2
27 DYSPEPSIA 0 0 0 1 1
28 EFUSI PLEURA 0 1 0 1 2
29 EPILEPSI 0 0 1 1 2
30 FARINGITIS 0 0 0 2 2
31 FRAKTUR CLAVICULA 0 0 0 1 1
32 NEUROMYALGIA 0 0 0 1 1
G1 P0 A0 GRAVIDA 37 MINGGU DENGAN
33 EPILEPSI 0 0 0 1 1
34 G1 P0 A0 GRAVIDA 39 MG DENGAN PSA 0 0 0 1 1
35 G1 P0 A0 POST ATERM 0 0 0 1 1
G1 P1 A0 GRAVIDA 29 MINGGU SUSPEC
36 PALSENTA PREVIA 0 0 0 1 1
G2 P0 A0 GRAVIDA 39 MINGGU DENGAN
37 MIOMA UTERI 0 0 0 1 1
 G2 P1 A0 GRAVIDA 41 MINGGU DENGAN
38 MIOMA UTERI 0 0 1 0 1
G2 P1 A0 GRAVIDA 37 MINGGU SUSPEC
39 LETAK SUNGSANG 0 0 0 1 1
G2 P1 A0 HAMIL 27.28 MINGGU DENGAN
40 PREMATUR KONTRAKSI 0 0 1 0 1
41 G2 P1 AO GRAVIDA 32 MINGGU 0 0 0 1 1
42 G2P1 A0 0 0 0 1 1
G3 P2 A0 GRAVIDA 16 MINGGU SUSPEC
43 HIDRAMNION 0 0 0 1 1
44 G3P2A0 GRAVIDA SUSPECT SUNGSANG 0 0 0 1 1
G4 P2 Á GRAVIDA 35-36 MINGGU POST SC 10
45 TAHUN 0 0 0 1 1
G4 P3 A0 GRAVIDA 41 MINGGU SUSP
46 SEROTIN 0 0 0 1 1
47 GANGGUAN MATA 0 0 0 1 1
48 GANGGUAN PERKEMBANGAN 0 0 1 0 1
49 GANGGUAN VISUS 0 0 1 1 2
50 GANTI KACA MATA 0 0 1 2 3
51 GASTRITIS 0 0 1 2 3
52 GERD 1 0 0 0 1
53 ANEMIA 0 0 1 0 1
54 HEMANGIOMA 0 0 1 0 1
55 HEMATEMESIS EC PENDARAHAN SMBA 0 0 1 0 1
56 HIL INKARSERATA 0 0 1 0 1
57 HIL REPONIBEL 0 0 1 0 1
58 HIPERTENSI 0 0 0 1 1
59 HIPOSPADIA 0 0 1 0 1
60 HP 17 + 16 0 0 0 1 1
61 IKTERUS NEONATORUM 0 0 1 0 1
62 KATARAK MATUR 0 0 1 1 2
63 KLASIFIKASI INFLOKASI 0 0 0 1 1
64 ABDOMEN KOLIK 0 0 0 1 1
65 ASHD 0 0 1 0 1
66 CEREBRAL INFARCTION 0 0 0 1 1
67 HIPERTENSI 0 0 0 1 1
68 HIPERTENSI + DIABETES MELLITUS 0 0 0 1 1
69 LBP 0 0 0 1 1

70 POST OP TUMOR DI BELAKANG TELINGA KIRI 0 0 0 1 1

71 POST SC 0 0 0 2 2
72 0
73 PRESBIOPIA 0 1 2 2 5
74 TB + BRONKOPNEUMONIA 0 0 1 0 1
75 KONTROL TRIGEMINAL NEURALGIA 0 0 0 1 1
76 KETUBAN PECAH DINI 0 0 0 1 1
77 KATARAK SENILIS IMATUR 0 0 0 2 2

78 LBP 0 0 0 1 1
 79 LIPOMA 0 0 1 0 1
80 MUCOCELE 0 0 0 2 2
81 MYALGIA 0 0 1 1 2
82 MYOPIA 0 0 1 1 2
83 NEURALGIA 0 0 1 0 1
84 NEUROMYALGIA 0 0 0 2 2
85 OA GENU BILATERAL 0 0 1 1 2
86 OBS FEBRIS 0 0 0 1 1
87 OBS NYERI PERUT BAWAH KIRI 0 0 0 1 1
88 OTITIS EKSTERNA 0 0 1 0 1
89 OTITIS MEDIA PURULENTA 0 0 0 1 1
90 OTITIS MEDIA SUPURATIF KRONIS 0 0 0 1 1
91 PA/EC GANGREN RADIS 25 0 1 0 0 1
92 PENURUNAN PENDENGARAN 0 0 0 1 1
PERIODENTITIS ETCAUSA GANGREN PULPA
93 24 0 0 1 0 1
PERIODENTITIS ETCAUSA GANGREN PULPA
94 38 0 0 0 1 1
PERIODENTITIS ETCAUSA GANGREN PULPA
95 47 0 0 1 0 1

96 PERIODENTITIS ETCAUSA GANGREN RADIS 18 0 0 0 1 1

97 PNA 0 0 0 1 1
98 POST SC 11 HARI 0 0 0 1 1
99 POST STROKE 0 0 0 2 2
100 POST TRAUMA ( VULNUS LASERATUM) 0 0 0 1 1
101 PPOK 0 0 1 0 1
102 PULPITIS 15 0 0 0 1 1
103 PULPITIS 17 0 0 0 1 1
104 RHEMATOID ARTHRITIS 0 0 1 0 1
105 RADIKULOPATI LUMBAL 0 0 0 1 1
106 RECURRENT HIL 0 0 1 0 1
107 RL (+) 0 0 1 0 1
108 SOMNOLEN 0 0 0 1 1
109 SPONDILOSIS CALCANEUS 0 1 0 0 1
110 SUSP HIPERMETROP 0 0 0 1 1

111 PENYAKIT LAINNYA 1 1

112 SUSP MYOPIA 0 0 0 2 2
113 RUBELLA 0 0 0 1 1
114 SEROTIN 0 1 0 0 1
115 STROKE 0 0 0 1 1
116 VERUCA 0 0 0 1 1
117 SUSPECT BRONCHITIS 0 0 1 0 1
118 SUSPECT DBD 1 0 0 0 1
119 SUSPECT DEMAM CHIKUNGUNYA 0 0 0 1 1
120 SUSPECT DEMAM REMATIK AKUT 0 0 0 1 1
121 SUSPEC GOUT ARTRITIS 0 0 1 0 1
122 SUSPEC IUGR 0 1 0 0 1
123 SUSPECT MYOPIA 0 1 0 0 1
124 TINEA CORPORRIS 0 0 1 1 2
TBC PARU DALAM THERAFI + DC+ EFUSI
125 PLEURA 0 0 1 0 1
126 TBC PARU DALAM THERAFI + THALASEMIA 0 0 0 1 1
127 TINITUS 0 0 1 3 4
128 TRAUMA KEPALA 0 0 1 0 1
129 TRAUMA THORAX 0 0 1 0 1
130 TUMOR ABDOMEN 0 0 0 1 1
131 TUMOR MAMAE 0 0 0 2 2
132 URETROLITHIASIS 0 0 0 1 1
133 CANDIDIASIS ORAL + POST TB 0 0 0 1 1
134 VERTIGO 0 0 0 2 2
2 7 60 111 180

Mengetahui, Sumedang, 5 April 2015

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Supriyanto, SKM Ena Marlena Sanusi

NIP. 1966044 198803 1 009
Sumedang, 4 Pebruari 2015
Pembuat Laporan

Ena Marlena Sanusi

 LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN MARET TAHUN 2014
BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 PERIODONTITIS APIKALIS KRONIS 0 0 0 2 2
2 CKD 0 0 2 0 2
3 ESRD 0 0 3 4 7
4 SUSPECT MULTIPLE LIMPOMA 0 0 1 0 1
5 DM 0 0 14 25 39
6 REFRAKSI ANOMALI 0 0 1 1 2
7 KONTROL CAD 0 0 1 1 2
8 ABSES 0 0 0 1 1
9 MUCOCELE 0 0 0 2 2
10 POS OPRASI KATARAK 0 0 1 0 1
11 HIPERTENSI 0 0 5 6 11
12 CA UNDIPFRENTRA CAVUM NASI 0 0 0 1 1
13 SUSP VAMOSIS CELL CARCINOMA 0 0 1 0 1
14 POST BIOPI FAM 0 0 0 1 1
15 SUSP MYALGIA 0 0 1 2 3
16 CRONIC DAILY HEDEASE 0 0 1 0 1
17 SUSP PROSTAT 0 0 1 0 1
18 KATARAK 0 0 2 3 5
19 SUSP MYOPI 0 0 1 3 4
20 CKD 0 0 1 0 1
21 DISPEPSI 0 0 2 2 4
22 DECOM CORDIS 0 0 0 2 2
23 G3 P2 A0 GRAV 10 MGGU DG AB IMINENS 0 1 0 0 1
24 KONTROL TRAUMA TERKENA PLITUR 0 0 0 1 1
25 CHD 0 0 1 1 2
26 SUSP KATARAK IMATUR ODS 0 0 0 1 1
27 CLAVUS PD TELAPAK KAKI KANAN 0 0 0 1 1
28 SUPS PARKINSON 0 0 0 1 1
29 SUSP PRESBIOP 0 0 1 0 1
30 GASTRITIS 0 0 0 2 2
31 TB KAMBUH 2 KALI 0 0 1 0 1
32 ILEUS LOKAL 0 0 0 1 1
33 DIARE + DEHIDRASI 0 0 0 1 1
34 MIGRAIN 0 0 0 1 1
35 POST OP KATARAK 0 0 0 1 1
36 ASHD 0 0 7 4 11
37 EPILEPSI 0 0 0 1 1
38 HIPERHIDROLIS 0 0 0 1 1
39 GANTI KACA MATA 0 0 1 5 6
40 ASMA + GASTRITIS 0 0 0 1 1
41 KONTROL IMUNISASI 0 0 1 0 1
42 HIPERTIROID 0 0 0 1 1
43 POST SC ATAS INDIKASI 0 1 0 0 1
44 REMATOID ARTITIS 0 0 0 1 1
45 KONTROL KATARAK 0 0 0 2 2
46 KONTROL CRF 0 0 0 1 1
47 KONTROL POST TRAUMA 0 0 0 1 1
48 SUSPECT FIBRADINOMA MAMAE 0 0 0 1 1
49 ASMA BRONCHIALE 0 0 1 0 1
50 SUSP HMP 0 0 1 0 1
51 EDEntoloud 45 0 0 0 1 1
52 SUSP DERMATITIS 0 0 1 0 1
53 POS OP HEMICOLECTONY 0 0 0 1 1
54 TFU TIDAK SESUAI UMUR HAMIL 0 0 0 5 5
55 KONTROL TIBIA 0 0 1 0 1
56 POST TAMBALAN 0 0 1 0 1
57 KONTROL PARKINSON 0 0 1 0 1
58 KONTROL GAGAL JANTUNG 0 0 0 1 1
59 CORPUS ALIMUN 0 0 1 0 1
60 SUSP FIBROMA 0 0 1 0 1
61 G1 P0 A0 GRAV 41 MGGU DG SUSP SEROTIN 0 0 0 1 1
62 KINTROL MYALGIA 0 0 3 0 3
63 SUSP LEFT HEARING TELINGA KIRI 0 0 0 1 1
64 KONTROL HEART FAILLURE 0 0 0 1 1
65 KONTROL POST CURETAGE 0 0 0 1 1
66 PULPITIS 21 0 0 0 1 1
67 KONTROL HIPERKEROTASIS DI MULUT + TANGAN 0 0 1 0 1
68 SUSP KATARAK IMATUR ODS 0 1 0 2 3
69 SUSP DERMATITIS KONTAK ALERGICA 0 0 0 1 1
70 TUMOR MAMAE 0 1 0 0 1
71 KONTROL LYMPACOLLI 0 0 1 0 1
72 CONGENITAL DISEASE 0 0 1 0 1
73 AB COMPLETE 0 0 0 1 1
G3 P2 A0 GRAV 32 MGGU (RIWAYAT ANAK KE 1
74 THALASEMIA) 0 0 0 1 1
75 SUSP TB 0 1 0 0 1
76 DISLIPIDEMIA 0 0 0 1 1
77 POST STROKE 0 0 2 2 4
78 GOUT 0 0 1 2 3
79 SUSP HNP 0 0 0 1 1
80 KONTROL COLIK 0 0 0 1 1
81 SUSP FIBRO ADENOMA MAMAE SINISTRA 0 0 0 1 1
82 SUSP HIL DEXTRA 0 0 0 1 1
83 OBS FEBRIS + TYPOID 1 0 0 0 1
84 SUSP DBD 0 0 0 2 2
85 G4 P3 A0 INFARK DG KPD 0 0 0 1 1
86 Rl (+) 0 0 0 1 1
87 OBS FEBRIS 0 0 0 1 1
88 IVB 0 0 1 0 1
89 KONTROL HIPERTIROID 0 0 0 2 2
90 ANXIETAS 0 0 1 0 1
91 NELIKOSIS PULPA GIGI 46 0 0 0 1 1
92 G2 P1 A0 GRAV 38-39 + APB 0 0 0 1 1
93 POST TRAUMA KPD KEPALA 0 0 1 0 1
94 KARIES SEKUNDER 12 0 0 0 1 1
G4 P3 A0 GR 35-36 DG APD + RIWAYAT SC +
95 LETAK SUNSANG 0 0 0 1 1
96 PRESBIOP 0 0 0 1 1
97 KONTROL POST INSERSI 0 0 1 0 1
98 REFRAKSI ANOMALI 0 0 1 0 1
99 THALASEMIA 0 0 1 1 2
100 MAU BUKA IUD (BENANG TIDAK ADA) 0 0 0 1 1
101 ANEMIA APLASTIK 0 0 1 0 1
102 EFUSI PLEURA 0 0 1 0 1
103 G3 P2 18 MGGU DG SUSP APENDIK 0 0 0 1 1
104 G2 P1 A0 DG IUGR 0 1 0 0 1
105 POST CYSTECTOMY 0 0 0 1 1
106 BBP 0 0 1 0 1
107 BATUK SUDAH 2 MINGGU 0 0 1 0 1
108 TINITUS 0 0 1 0 1
109 BPH 0 0 1 1 2
110 KONTROL POST OP KATARAK KONGENITAL 0 0 1 0 1
111 SLE 0 0 0 1 1
112 SUSP LIMPADENOPATI 0 0 1 0 1
113 KONTROL TRIGEMINAL NEURALGIA 0 0 0 1 1
114 EPILEPSI 0 0 0 1 1
115 KONTROL IUD +DYSPEPSI +HT 0 0 1 0 1
116 KONRTOL CA MAMAE 0 0 0 1 1
117 KONTROL POST CURATAGE 0 0 0 1 1
HAMIL 9 BULAN ANAK KE 5 MENGELUH
118 DIBAGIAN BOKONG SAKIT 0 0 0 1 1
119 KONTROL CA PARU 0 0 2 0 2
120 CARIES SEKUNDER 37 0 0 0 1 1
121 SUSP LMPADENOPATI WILL SINISTRA 0 0 0 1 1
122 SUSP HNP 0 0 0 1 1
123 SUSP CHOLELITHIASIS 1 0 0 0 1
124 KONRTOL MATA 0 0 1 0 1
125 KELAINAN KELOID 0 0 0 1 1
126 KONTROL OSTEOPOROSIS 0 0 0 1 1
127 SUSP PTERIGIUM 0 0 0 1 1
128 G2 P1 A0 INPARTU ATERM KALA1 0 0 0 1 1
129 PSEUDOPILIA 0 0 0 1 1
130 ABSES BUCALIS 28 0 0 0 1 1
131 TONSIL 0 0 0 1 1
132 SRTUMA 0 0 0 1 1
133 NEUKOSIS PULPA 25 0 0 0 1 1
134 KONTROL CARDIOMEGALI 0 0 0 1 1
135 SUSP PARANOKEA IBU JARI KAKI KAKAN KIRI 0 0 0 1 1
136 G3 P2 A0 GRAV 42 MGGU DG SUSP SC 0 1 0 0 1
137 PERIODONTITIS APIKALIS KRONIS 0 0 0 1 1
138 NEUROMYALGIA 0 0 0 1 1
139 G2 P1 A0 GRAV 37-38 PLACENTA LETAK RENDAH 0 0 0 1 1
140 SUSP LIPOMA 0 0 0 1 1
141 SERUMEN 0 0 1 0 1
142 G3 P2 A0 GRAVIDA 0 0 0 1 1
143 KONTOL CA CERVIK 0 0 0 1 1
144 PISTULA ANI 0 0 1 0 1
145 CARDIOMEGALI DG BENDUNGAN DINI 1 0 0 1 2
146 CHEPALGIA 0 0 0 1 1
147 HHD 0 0 0 2 2
148 SUSP DHF 0 0 0 0 0
149 SERUMEN DALAM TELINGA 0 0 1 0 1
150 KONTROL CHEST PAIN 0 0 1 0 1
151 KATARAK IMATUR 0 0 0 1 1
152 PA EC GR 15 0 0 0 1 1
153 SUSP DERMATITIS 0 0 0 1 1
154 KONTROL POS OPOSISI 0 0 0 1 1
JUMLAH 3 7 89 164 263

Mengetahui, Sumedang, 10 April 2014

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

EDI KARYADI, S.I.P Ena Marlena Sanusi

NIP. 19590918 198603 1 004
 LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN APRIL TAHUN 2014
BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 KONTROL KATARAK 0 0 1 0 1
2 KONTROL STROKE RINGAN 0 0 1 0 1
3 ESRD 0 0 3 5 8
4 OA 0 0 0 1 1
5 GASTO ENTERITIS ACUTE 0 0 0 1 1
6 DIABETES MELLITUS 0 0 7 22 29

G2 P1 A0 UMUR KEHAMILAN 27 MINGGU

7 DG RIWAYAT JANTUNG BAWAAN 0 0 0 1 1
8 SOFT TISUE SARCOMA 0 0 0 1 1
ABSES VUKALIS ETCAUSA GANGREN RADIS
9 27 0 0 1 0 1
10 IMPAKSI GIGI 28 0 0 0 1 1
11 KONTROL MYALGIA 0 0 0 3 3
12 COLIK ABDOMEN 0 0 1 0 1
13 SUSP VERUCA DIPELIPIS KANAN 0 0 0 1 1
14 CKD 0 0 3 3 6
15 G1 P0 A0 GRAVIDA 23-24 MINGGU 0 0 0 1 1
16 ANEMIA 0 0 1 0 1
17 SUSP DYSPEPSIA 0 0 2 1 3
18 NEUROMYALGIA 0 0 0 2 2
19 KARIES SEKUNDER 46 0 0 1 0 1
POST TAMBALAN SEMENTARA SUSP
20 PULPITIS 36 0 0 1 0 1
21 OMP TELINGA KIRI 0 0 1 0 1
22 SUSP CHEPALGIA 0 0 1 1 2
23 RESTI IUFD 2 X 0 0 0 1 1
24 ERITODERMA 0 0 0 1 1
25 HERNIA 0 0 1 0 1
26 AB COMPLITE 0 0 0 1 1
27 KOLESTEROL 0 0 0 1 1
28 KONTROL HIPERTENSI 0 0 1 4 5
29 MUCOCELE 0 0 1 0 1
30 BPH 0 0 1 0 1
31 STROKE 0 0 0 1 1
32 HIPOKALEMIA 0 0 1 0 1
33 REFRAKSI ANOMALI 0 0 0 2 2
34 KONTROL POST KURETAGE 0 0 0 1 1

35 SUSP HIPERTENSI + PARISE EXTRIMITAS KIRI 0 0 1 0 1

36 IMPAKSI 38 0 0 0 1 1
37 SUSP MYOMA UTERI 0 0 0 1 1
38 CAVUM NASI DEXTRA POSTERM 0 0 0 1 1
G3 P1 A1 GRAVIDA 9- 10 MINGGU DG SUSP
39 BO 0 0 0 1 1
40 OBS FEBRIS TYPOID 0 0 1 0 1
41 KARIES SEKUNDE 16 0 0 0 1 1
42 HEAR FAILURE 0 0 1 0 1
43 HIPERTENSI + EPITAKSIS 0 0 1 0 1
44 SUSP MULTIPLE LIPOMA 0 0 0 1 1
45 SUSP DYSPEPSI 0 1 0 1 2
46 SUSP SINUSITIS 0 1 0 0 1
47 SUSP KATARAK IMATUR 0 2 0 1 3
48 KONTROL EPUSI PLEURA 1 0 0 0 1
49 SUSP DBD 0 0 0 2 2
50 SUSP DISLIPIDEMIA 0 0 2 1 3
51 ENDONTILOUS 36 1 0 0 0 1
52 FISTULA ANI 0 0 1 0 1
KONTROL BENJOLAN DI LEHER SEBELAH
53 KIRI 0 0 0 1 1
54 OBS FEBRIS 1 0 0 0 1
55 G2 P1 A0 38 - 39 MINNGU 0 0 0 1 1
56 SUSP LYMPADENOPATI COLLY 1 0 0 0 1
57 DISERPIDEMIA 0 0 0 2 2
58 IMPAKSI 38 0 0 0 1 1
59 SUSP LIPOMA PADA PANGKAL HIDUNG 0 0 0 1 1
60 SUSP VERUCA DIPELIPIS KANAN 0 0 0 1 1
61 SUSP TINITUS 0 0 0 1 1
62 REFRAKSI ANOMALI 0 0 1 1 2
63 SELULITIS 0 0 1 0 1
64 ASHD 0 0 6 1 7
65 SUSP OMP 0 0 0 1 1
66 SUSP DEPRESI 1 0 0 0 1
67 G1 P0 A0 GRAVIDA ATERM 0 1 0 0 1
68 CHEST PAINT 0 0 0 1 1
69 KONTROL BPH 0 0 1 0 1

70 SUSP GANGLION PERGELANGAN TANGAN 0 0 0 1 1

71 G1 P0 A0 GRAVIDA 31-32 MGG DG APP 0 0 0 1 1
72 KONTROL CHRONIK DAILY HEADACHE 0 0 1 0 1
73 KONTROL POS TRAUMA 0 0 0 1 1

74 G4 P3 A0 GRAVIDA 39 MINGGU 0 0 0 1 1
75 RHEMATOID ARTRITIS 0 0 1 0 1
76 SUSP VERTIGO 0 0 0 1 1
77 NEKROSIS PULPA 36 0 0 0 1 1
78 SKIZOPRENIA 0 1 0 0 1
79 DISLIPIDEMIA 0 0 1 2 3
80 CA MAMAE DEXTRA 0 0 0 1 1
81 SUSP FAM DEXTRA 0 0 0 1 1
82 DISPEPSY 0 0 0 1 1
83 KONTROL SPASME CRONIC CLAVICULA 0 0 0 1 1
84 KONTROL KATARAK MATUR 0 0 1 0 1
85 KONTROL THYPOID 0 0 0 1 1
86 HIPERTIROID 0 0 1 1 2
87 SUSP MYOP 0 0 0 1 1
88 KONTROL OBS KEJANG 0 0 0 0 0
89 KONTROL IMATUR ODS 0 0 0 1 1
90 IMPAKSI 25 0 0 0 1 1
91 UP IUD 0 0 0 1 1
92 SUSP OSTEOPOROSIS 0 1 0 0 1
93 26,47 HP 0 0 0 1 1
94 AB IMINENS 0 0 0 1 1

95 ASHD + HYPERTENSI 0 0 1 0 1
96 SUSP HEPATITIS 0 0 0 1 1
97 DECOMP CORDIS 0 0 0 1 1
98 STROKE 0 0 0 1 1
99 GOUT 0 0 0 1 1
100 SUSP MYOMA UTERI 0 0 0 1 1
101 CARIES SEKUNDER 0 0 0 1 1
102 SUSP HIL SINISTRA 0 0 1 0 1
103 MYALGIA 0 0 0 1 1
104 EPILEPSI 0 0 1 0 1
105 ERITODERMA 0 0 0 1 1
106 THALASEMIA 0 0 0 1 1
107 NEKROSIS PULPA 26 0 0 0 1 1
108 KONTROL TIA 0 0 0 1 1
109 EVANS SYNDROM 0 0 1 0 1
110 SUSP OMP TELINGA KANAN 0 0 0 1 1
111 GASTRITIS 0 0 0 1 1
112 SUSP MYOPI 0 0 0 1 1
113 GANTI KACA MATA 0 0 0 2 2
114 G3 P2 A0 GRAVIDA 40-41 MINGGU 0 0 1 0 1
115 TUMOR PARU KIRI 0 0 1 0 1
116 DISPEPSY 0 0 0 1 1
117 PARKOINSON 0 0 0 1 1

118 67 HP 19 1 0 0 0 1
119 SUSP PRESBIOP 0 0 0 1 1
120 KONTROL ERITODERMA 0 0 0 1 1
121 KONTROL DERMATITIS ALLERGICA 0 0 1 0 1
122 SUSP MYOPI 0 0 0 1 1
123 KONTROL TUMOR PARU KIRI 1 0 0 0 1
124 KATARAK IMATUR 0 0 0 1 1
125 KONTROL STRUMA 0 0 0 1 1
126 LYMPADENOPATI 0 0 1 0 1
127 PTERIGIUM 0 0 1 1 2
128 MIGRAIN 0 0 0 1 1
129 KONTROL HIPERTENSI + DYSPEPSI 0 0 1 0 1
130 SUSP KATARAK IMATUR OD 0 0 0 2 2

G1 PO AO HPHT 28-1-2014 TFU BELUM

131 TERABA 0 0 0 1 1
132 CRF 0 0 1 0 1
133 KONTROL DERMATITIS 0 1 0 0 1
134 IMPAKSI 0 0 0 1 1
135 TB + PNEUMOTORAX POST RAWAT RS PD 0 0 1 0 1
136 KONTROL BRONCHITIS 0 0 1 0 1
137 MYOMA 0 0 0 1 1
138 POST CYSTECTOMY 0 0 1 0 1

139 KONTROL POST KURETAGE 0 0 0 1 1

140 KONTROL IVB 0 0 0 1 1
141 G1 PO AO GRAVIDA 21-22 MGGU 0 0 0 1 1
142 KONTROL G2P1 AO 0 0 0 1 1
URETERO PYECOCACIECTASIS +
143 VESICDITHIASIS + HIPERTROPI PROSTAT 0 0 0 1 1
144 KONTROL APENDIK 0 0 1 0 1
145 KONTROL HNP 0 0 0 1 1
146 PA EC GP 46 DG POLIP 0 0 1 0 1
147 SUSP VERUCA 0 0 0 1 1
148 KONTROL IBP 1 0 0 0 1
149 KARIES SEKUNDER 16 0 0 0 1 1
150 CEK HD PNC 1 0 0 0 1
151 KONTROL SUSP CERUMEN 1 0 0 0 1
152 KONTROL PSEUDOPILIA 0 1 0 0 1
153 SUSP CHEST PAIN 0 0 0 1 1
154 KONTROL GLAUKOMA 0 0 0 1 1
155 PA EC GP 47 0 0 0 1 1
156 KONTROL CHEPALGIA 0 0 1 1 2
157 SUSP PTERIGIUM 0 0 0 1 1
158 POST STROKE 0 0 1 0 1
159 KISTA DERMOID 0 0 0 1 1
160 MENORANGE 0 0 0 1 1
161 KONTROL FARINGITIS RIWAYAT DM 0 0 0 1 1
162 SUSP TUMOR JARINGAN LUNAK 0 0 1 0 1
163 SUSP ISK 1 0 0 0 1
G3 P2 AO, GRAVIDA 23 MINGGU DG SUSP
164 IUFD 0 0 0 1 1

G1 PO AO GRAVIDA 38 MINNGU JANIN

165 HIDUP TUNGGAL 0 0 1 0 1
166 KONTROL KELOID 0 0 1 0 1
167 SUSP HEPACTOMA 0 0 0 1 1
168 KONTROL ANEMIA 0 0 1 0 1
169 SUSP LBP 0 0 1 0 1
170 KONTROL CELLULITIS 0 0 0 1 1
171 SUSP PRESBIOP + TINITUS 0 0 1 0 1
172 KONTROL TINEA 0 0 0 1 1
173 SUSP TINEA CORPORIS 0 0 0 1 1
174 LBP 0 0 0 1 1
175 CORPUS ALINEUM 0 0 0 1 1
176 SSUP AB IMINEN 0 0 0 1 1
JUMLAH 11 9 74 153 247

Mengetahui, Sumedang, 6 Mei 2014

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Supriyanto, SKM Ena Marlena Sanusi

NIP. 1966044 198803 1 009
 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 JUNI TAHUN 2014
BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 ESRD 0 0 0 2 2 4
2 KONTROL OA 0 0 0 1 1
3 KONTROL DIABETES MELLITUS 1 0 13 26 40
4 IMPAKSI 0 0 0 1 1
5 KONTROL HIPERTENSI 0 1 3 1 5
6 SUSP KATARAK 0 1 4 2 7
7 KONTROL POST STROKE 0 0 10 1 11
8 CKD 0 0 2 2 4
9 KONTROL NUEROMYALGIA 0 1 0 2 3
10 HIPERTENSI + GASTRITIS 0 0 1 0 1
11 DISPEPSI + GOUT 0 0 1 0 1
12 TYPOID 0 1 0 0 1
13 SUSP LPD G1 P0 A0 GRAVIDA 30 MG 0 1 0 0 1
14 KONTROL SKIZOPRENIA 1 0 0 0 1
15 EROSI PORTIO 0 1 0 0 1
16 SUSP SEURUMEN 0 1 0 1 2
17 SUSP MYALGIA 0 1 0 1 2
18 CHF 0 0 1 0 1
19 DISLOKASI 1 0 0 0 1
20 PUP SMEAR 0 1 0 0 1
21 SUSP TUMOR DORSUM PEDIS DEXTRA 0 0 0 1 1
22 KONTROL KATARAK IMATUR 0 1 3 3 7
23 KONTROL EVANS SYDROM 0 0 1 0 1
24 KONTROL KELOID 0 0 2 0 2
25 REFRAKSI ANOMALI 0 0 1 2 3
26 SUSP NEPROTIK SYNDROM 1 0 0 0 1
27 KONTROL ASHD 0 0 2 0 2
28 KONTROL DISLIPIDEMIA 0 1 0 3 4
29 SUSP CLAVUS 0 0 1 0 1
30 LBBB COMPLIT ISKEMIK 1 0 1 0 2
31 SUSP LBP 2 1 0 2 5
32 SUSP BPH 3 0 1 0 4
33 KONTROL THALASEMI 0 0 1 2 3
34 EPILEPSI 0 0 2 0 2
35 SUSP DISLIPEDEMIA 0 3 0 2 5
36 PA EC GP 26 0 0 0 1 1
37 G2 P1 A0 DENGAN SEROTIN 0 1 0 0 1
38 KISTA OVARIUM 0 1 0 0 1
39 OSTEOPOROSIS 0 0 2 1 3
40 OBS FEBRIS 4 1 0 0 5
41 EPILEPSI + CP 0 0 1 0 1
42 KONTROL SKABIES 1 0 0 0 1
G2 P1 A0 GRAV 16 MINGGU DENGAN
43 MOLAHIDATILUSA 0 1 0 0 1
 BATUK PILEK RIWAYAT KEJANG DENGAN
44 KELUHAB RIWAYAT TB 0 1 0 0 1
45 SUSP ISPA 1 0 0 0 1
SUSP TUMOR JARINGAN LUNAK PANGGUL
46 KANAN 0 1 0 0 1
G2 P1 A0 GRAVIDA 41- 42 MINGGU
47 DENGAN SEROTIN 0 1 0 0 1
48 CORPUS ALINEUM 1 0 0 0 1
49 KEJANG+ EPILEPSI 1 0 1 0 2
50 MIOMA UTERI 0 1 0 0 1
51 SUSP DBD rl + 0 4 0 0 4
52 SUP OMP 1 0 0 0 1
53 SUSP SKIZOPREN 0 0 1 0 1
54 GASTRITIS 0 0 0 2 2
KONTROL SUSP TUMOR DORSUM PEDIS
55 DEXTRA 0 0 0 1 1
56 SUSP PTERIGIUM 0 1 0 0 1
57 SUSP OMP 1 1 1 0 3
58 SUSP DECOM PERDIS 1 0 0 0 1
59 KONTROL ASMA 0 0 1 0 1
60 SUSP IKTERUS + NAPAS CEPAT 0 1 0 0 1
61 REMATOID ATRITIS 0 1 0 0 1
62 ASMA BRONCHIALE 0 1 0 0 1
63 KONTROL TIPOID + DB 0 0 0 1 1
64 KONTROL ATRITIS 0 0 0 1 1
65 SUSP IKTERUS 1 0 0 0 1
66 KONTROL MIGRAIN 0 0 0 1 1
67 ABSES DIGIGIT 1 0 0 0 1
68 KONTROL OMI INF + BRONHITIS KRONIS 0 0 0 1 1
69 SUSP TUMOR CAVUMNASI 0 1 0 0 1
70 KONTROL EPILEPSI 0 0 1 2 3
SUSP GANGLION PADA PERGELANGAN
71 TUNGKAI KIRI 0 1 0 0 1
72 EDONTULOUI 1 0 0 0 1
73 SUSP TINITUS 0 4 1 0 5
74 ABSES DI PANTAT 0 0 0 1 1
75 ASHD + EFUSI PLEURA 0 0 1 0 1
76 TIA + HT 0 0 0 1 1
77 KONTROL PC WSD 0 0 1 0 1
78 OBS FEBRIS + EPITAKSIS rl (-) 0 0 1 0 1
79 SUSP BRONCHITIS KRONIS LAB BTA (-) 0 1 0 0 1
80 G1 P0A0 4 MINGGU SIGURTHARIA 0 1 0 0 1
81 KONTROL CEPHALGIA 0 0 0 2 2
SPINA BITIDA + OLD UNREDUCED HIP
82 DISLOKASI 0 1 0 0 1
83 SUSP KONJUNGTIVITIS ALERGI 0 1 0 0 1
84 ENDOTINITUS 0 0 1 0 1
85 OBS KEJANG 1 0 1 0 2
 G1 P0 A0 GRAVIDA 32 MINGGU DENGAN
86 KPD 0 1 0 0 1
87 KONTROL POST OP TRAUMA VAGINA 0 0 0 1 1
88 CAD 0 0 1 0 1
89 MIOPIA 0 1 2 2 5
90 SUSP PRESBIOP 1 0 3 1 5
91 DMC + CKD 0 0 0 2 2
92 CHES PAIN 0 1 3 1 5
93 G1 P0 A0 41 MINGGU DENGAN EPILEPSI 0 1 0 0 1
94 SUSP VERTIGO + DYSPEPSI 0 1 0 0 1

95 KONTROL POST OP KATARAK KONGENITAL 0 0 1 0 1

96 KONTROL SUSP DYSPEPSI 0 0 0 1 1
97 SUSP KATARAK IMATUR 1 0 1 0 2
98 DACC GR 0 1 0 0 1
99 SUSP DERMATITIS KONTAK ALERGI 2 0 0 1 3
100 SUSP PTERIGIUM OD 1 0 0 0 1
101 SEROTIN 0 1 0 0 1
102 IVB 0 0 1 0 1
103 MIALGIA + HT 0 0 0 1 1
104 PRO / RONTGEN PERIAPIKAL FOTO GIGI 2 1 0 0 0 1
105 KONTROL PARKINSON 0 1 2 0 3
106 KONTROL GOUT 0 0 0 1 1
107 BENJOLAN DIATAS SYMPISIS 0 1 0 0 1
108 SUSP TONSILITIS 1 0 0 0 1
109 KONTROL OMA 1 0 0 0 1
110 SUSP STRUMA 0 2 0 0 2
111 PSUDOPILIA 0 0 0 2 2
112 KONTROL PTERIGIUM 0 0 0 1 1
113 SUSP SINUSITIS 1 0 0 0 1
114 BAYI SUSAH MENELAN 0 1 0 0 1
SAKIT PADA LEHER ADA BENJOLAN DI
115 LEHER KANAN 0 0 0 1 1
116 KONTROL HNF 1 0 1 1 3
117 KONTROL CRF 0 0 1 0 1
118 RIWAYAT EPILEPSI 0 1 0 0 1
119 PSIKOSA AKUT 1 0 0 0 1
120 GASTRITIS HEMORAGIK 0 0 0 1 1
121 TIA + HT + DISPEPSI 0 0 0 1 1
122 SUSP NEPOTILIASIS 1 0 0 0 1
123 SUSP NEUROSIS 0 0 2 0 2
124 KONTROL HAEMAPTOE 1 0 1 0 2
125 KONTROL SUSP NEUROMYALGIA TB GR 1 0 0 1 0 1
PERIODONTITIS APICALIS ETCAUSA
126 GANGREN RADIS 15 0 0 1 0 1
127 KONTROL CHD 0 0 0 2 2
128 OBS FEBRIS 0 1 0 0 1
129 KONTROL GASTRITIS 0 0 0 1 1
130 KONTROL DISPEPSI 0 0 1 1 2
131 G2 P1 A0 GRABIDA 0 1 0 0 1
132 KONTROL HT + GOUT 0 0 0 1 1
133 ANEMIA APLASTIK 0 0 1 0 1

134 G2 P1 A0 GRAVIDA 36 MINGGU RIWAYAT SC 0 1 0 0 1

135 SERUMEN KERAS 1 0 0 0 1
136 TB 1 0 0 0 1
137 ASHD DC + TB PARU 0 0 1 0 1
138 SUSP LIPOMA PADA ALIS 0 0 0 1 1
139 TRIGEMINAL NERALGIA 0 0 0 1 1
140 PSA 0 0 0 1 1
141 SUSP PSIKOSA AKUT 0 0 0 1 1
SUSP LYMPADENOPATI MANDIBULA
142 DEXTRA 0 0 1 0 1
143 SUSP FIBRO ADENOMA MAMAE KIRI 0 1 0 0 1
144 SUSP HORDEOLUM 0 1 0 0 1
SUSP G3 P2 A0 GRAVIDA 9-10 MG
145 AKSEPTOR KB IUD 0 1 0 0 1
146 LMPADENOPATI COLY 0 0 1 0 1
147 IKTERUS + CANDIDIASIS 1 0 0 0 1
METASTASE MALIGNAN MELANOMA
148 INGUINAL DEXTRA 1 0 0 1
149 LYMPA COLLY 0 1 0 0 1
JUMLAH 42 62 92 97 293

Mengetahui, Sumedang, 5 JULI 2014

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Supriyanto, SKM Ena Marlena Sanusi

NIP. 1966044 198803 1 009
 LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN JULI TAHUN 2014
BARU LAMA
NO DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN
1 KONTROL STROKE 0 0 0 1 1
2 SUSP OSTEOPOROSIS 0 1 0 0 1
3 SUSP THT 0 0 1 0 1
4 KONTROL MYALGIA 0 0 1 0 1
5 SUSP MIOPI 1 0 0 1 2
6 EPILEPSI 0 0 2 3 5
7 KONTROL CKD 0 0 1 3 4
8 SUSP PRESBIOP 1 1 1 0 3
9 OBS. FBERIS TYPOID 0 1 0 0 1
10 THALASEMIA 0 1 0 2 3
11 DIABETES MELLITUS 0 0 11 21 32
12 KONTROL ESRD 0 0 2 5 7
13 KONTROL POST STROKE 0 0 1 2 3
14 NEKROSIS PULPA 37 PULPITIS 3 P 1 0 0 0 1
15 POST SC 0 1 0 0 1
16 KONTROL DISLIPIDEMIA 0 0 0 1 1
17 BPH 0 0 1 0 1
18 SUSP ANEMIA 1 0 0 0 1
19 PSIKOSA 0 0 0 1 1
20 SUSP DISLOKASI LUTUT 1 0 0 0 1
21 ASHD 0 0 1 5 6
22 SKIZOPREN 0 1 2 0 3
23 PERIDONTITIS AKUT GIGI 46 0 1 0 0 1
24 KONTROL PARKINSON 0 0 0 1 1
25 GANGREN PULPA 0 0 0 1 1
26 HIPERTENSI 0 0 1 4 5
27 AUTISME 0 0 1 0 1
28 KONTROL CA MAMAE 0 0 0 1 1
29 SUSP OMA TELINGA KIRI 0 1 0 1 2
30 SUSP KATARAK IMATUR 0 0 0 1 1
31 DYPEPSI 0 0 1 1 2
32 SUSP BELLS PALSY + HIPERTENSI 0 1 0 0 1
33 SUSP DISLIPIDEMIA 0 1 0 0 1
34 SUSP AB INCOMPLET 0 1 0 0 1
35 KONTROL CA CERVIK 0 0 0 1 1
36 KONTROL CHEPALGIA 0 0 0 1 1
37 KONTROL ABLASIO RETINA 0 1 0 0 1
38 SUSP ABORTUS 0 1 1 0 2
39 KONTROL PNA 0 0 0 0 0
40 STROKE INFARK 0 0 0 1 1
41 SUSP NEFROTIS SINISTRA 0 1 0 0 1
42 HYPERTIROID 0 0 1 0 1
43 OA 0 0 1 0 1
44 OBS. BANGKITAN 0 0 1 0 1
45 POST CYSTECTOMY EX RUPTURE URETRA 0 0 1 0 1

46 CHF 0 0 1 0 1
47 GANTI KACA MATA 0 0 0 1 1
48 G1 P0A0 PATURIEN DENGAN KPD 0 0 0 1 1
49 YELONEFNITIS AKUT SINISTRA 0 0 0 1 1
50 SUSP TBC GAGAL 0 0 1 0 1
51 ANEMI APLASTIK 0 0 1 0 1
52 NEPROLITHIASIS KANAN 0 0 0 1 1
53 CHEPALGIA 0 0 0 1 1
54 DISLIPIDEMIA 0 1 2 4 7
55 ARTHEROSKLEROSIS 0 0 1 0 1
56 SUSP VERTIGO 0 0 0 1 1
57 POST OF KATARAK 0 0 0 2 2
58 SUSP GANGLION PERGELANGAN 0 0 0 1 1
59 SUSP DYSPEPSIA 0 0 0 1 1
60 OMP 0 0 1 0 1
61 PARKINSON 0 0 0 1 1
62 CELLULITIS 0 0 0 1 1
63 STRAUMA 0 0 0 1 1
64 KPD 0 0 0 1 1
65 CROWDING ARTERIOR 0 0 0 1 1
66 SUSP CHEST PAIN 1 0 0 0 1
67 CA CERVIX 0 0 0 1 1
68 G1P0A0 GRAVIDA 4 MINGGU 0 1 0 0 1
69 SINUSITIS 0 0 0 1 1
70 KONTROL TBC TULANG 0 0 0 1 1
71 TUMOR RECTORYMOID 0 0 1 0 1
72 APPENDIK 0 1 0 0 1
73 SUSP PLEGTIMAN 0 0 1 0 1
74 KONTROL OSTEO ARTHRITIS 0 0 0 1 1

75 G1P0A0 GRAVIDA 33-34 MINGGU GEMELI + PEB 0 1 0 0 1

G2P1A0 GRAVIDA 32 MINGGU DENGAN
76 PREMATUR KORTALI 0 0 0 1 1
77 SUSP ARTIOSIS HEPATIS 0 0 0 1 1
78 KLIN RENCANA OP APPENDIK 0 0 0 1 1
79 SUSP KONJUNGTIVITIS 0 1 0 0 1
80 SUSP TUMOR RECTOSYMOID 0 0 1 0 1
81 KONTROL KATARAK IMATUR 0 0 0 1 1
82 SUSP MYALGIA 1 1 0 0 2
83 NEUROMYALGIA 0 0 0 1 1
84 KONTROL KELAINAN CONGENITAL 0 0 0 1 1
85 RA 0 0 1 1 2
86 CONJUNGTIVITIS ALERGI 0 0 1 0 1
87 SUSP NEUROSIS 0 0 0 1 1
88 MIGREIN 0 0 0 1 1
89 EVANS SYNDROME 0 0 1 0 1
90 BA 0 0 0 1 1
 91 HIPERTIROID 0 0 0 1 1
92 CHES PAIN 0 0 0 1 1
93 NEVUS PIGMENTASI 0 0 0 1 1
94 LIMPADENITIS 0 0 0 1 1
95 MENOMETORAGIS 0 0 0 1 1
96 MENORHOE 3 BULAN 0 0 0 1 1
97 SUSP MASTITIS 0 0 1 0 1
98 PERIKSA PTC 0 0 1 0 1
99 CAD 0 0 1 0 1
100 SUSP STRUMA 0 0 1 0 1
101 SUSP DYSPEPSIA + PSIKOSOMATIK 0 0 1 0 1
102 11 HP 0 0 0 1 1
103 GEA + DIABETES MELLITUS 0 0 0 1 1
104 AB INCOMPLIT 0 0 0 1 1
105 SUSP RHEMATOID ARTRITIS 0 0 1 0 1
106 KONTROL DC 0 0 0 1 1
107 KONTROL KATARAK CONGENITAL 0 0 1 0 1
108 KARIES SEKUNDER AC 0 0 0 1 1
109 SUSP DISLOKASI 0 1 0 0 1
110 KONTROL POST OPTHOPUS 0 0 0 1 1
111 SUSP MELENA 0 0 0 1 1
112 ASMA 0 0 0 1 1
113 KONTROL THALASEMIA 0 0 1 0 1

114 G1P0A0 GRAVIDA 38039 MINGGU DENGAN PSA 0 1 0 0 1

115 MYOPIA 0 0 1 2 3
116 KONTROL HHD DC 0 0 0 1 1
117 SUSP GO 0 1 0 0 1
118 KONTROL STROKE INFARK 0 0 0 1 1
119 OBS FEBRSI 0 1 0 0 1
120 KELOID 0 0 0 1 1
121 DECOM 0 0 0 1 1
122 LBBB COMPLETE ISKEMIK 0 0 1 0 1
123 OA GENU 0 0 0 1 1
124 SUSP HEMIFUNSE EXSLEKIN 0 0 0 1 1

125 KONTROL TIA + HIPERTENSI 0 0 0 1 1

G2P1A0 GRAVIDA 37-38 MINGGU JANIN
TUNGGAL DENGAN KPD
126 0 0 0 1 1
127 KONTROL VERTIGO 0 0 0 1 1
128 KONTROL POST HECTING GOUT 0 0 0 1 1
129 KEHAMILAN DENGAN MYOMA 0 0 0 1 1
G2 P1 A0 GRAVIDA 10-11 MINGGU + SUSP
130 HERVES OPTHALMICUS 0 0 0 1 1
131 KONTROL GOUT 0 0 1 0 1
132 SUSP CICATRIK DS 0 0 0 1 1
133 SUSP PRESBIKUSIS 0 0 1 0 0 1
134 KONTROL KATARAK MATUR ODS 0 0 0 1 1
135 OA 0 0 0 1 1
136 SUSP DERMATITIS ALLERGIC 1 0 0 0 1
137 KONTROL KATARAK + PTERIGIUM 0 0 0 1 1
138 POST STROKE 1 0 0 0 1
139 SUSP LBP 0 1 0 0 1
140 OMA 0 1 0 0 1
141 SUSP ISPA 0 0 1 0 1
142 SUSP TUMOR JARINGAN LUNAK PADA DAGU 0 1 0 0 1
143 KONTROL HAEMOPTOU 0 0 1 0 1
144 HAMIL 8 BULAN G2P1A0 DG RIWAYAT SC 0 1 0 0 1
JUMLAH 9 29 58 123 219

Mengetahui, Sumedang, 7 AGUSTUS 2014

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Supriyanto, SKM Ena Marlena Sanusi

NIP. 1966044 198803 1 009
 LAPORAN KASUS PENYAKIT YANG DIRUJUK KE RUMAH SAKIT
PUSKESMAS CIMALAKA
BULAN AGUSTUS 2014
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 CKD 0 0 4 1 5
2 DISLIPIDEMIA 0 0 0 3 3
3 STROKE INFARK 0 0 1 1 2
4 DIABETES MELLITUS 0 0 9 18 27
5 CHF 0 0 2 0 2
6 SUSP OMA TELINGA KIRI 0 0 0 1 1
7 KATARAK IMATUR 0 0 0 2 2
8 NHML 0 0 1 0 1
9 KONTROL CRF 0 0 0 2 2
10 HIPERTENSI 0 0 5 5 10
11 ESRD 0 0 0 1 1
12 SUSP CORPUS ALINEUM 0 0 1 2 3
13 SUSP PRESBIOP 1 1 3 2 7
14 SUSP RA 0 0 0 1 1
15 KONTROL SLE 0 0 0 1 1
16 SUSP CHEPALGIA 0 0 0 1 1
17 PTERIGUM 0 0 0 1 1
18 BPH 0 0 1 0 1
19 KELOID 0 0 1 0 1
20 TB 0 0 1 0 1
21 LIMPADENITIS 0 0 0 1 1
22 BND 0 0 1 0 1
23 SUSP OMP 1 0 0 0 1
24 SUSP DISLOKASI PINGGUL KANAN 0 0 0 1 1
25 KONTROL GINJAL KIRI 0 0 0 1 1
26 DISPEPSI 0 0 3 1 4
27 CARSINOMA MAMAE 0 0 0 1 1
28 POST NEPTOMI SINISTRA HIDROPREFTOSIS 0 0 0 1 1
29 MYOMA UTERI 0 0 0 1 1
30 PERIODENTITIS GANGREN RADIS 8 0 0 1 0 1
31 SUSP CHEST PAIN 0 0 0 1 1
32 ASHD 0 0 3 2 5
33 GASTRITIS 0 0 0 1 1
34 COLIC ABDOMEN 0 0 0 1 1
35 DECOM CORDIS 0 0 0 3 3
36 PSEUDOPILIA 0 0 0 1 1
37 RHEMATOID ARTRITIS 0 0 0 1 1
38 ABLATINO RETINA 0 1 0 0 1
39 INVASIF CA MAMAE DEXTRA 0 1 0 0 1
40 CA CERVIK 0 0 0 1 1
41 KONTROL POST HECTING 0 0 1 0 1
42 HIPERTENSI + ASMA 0 0 0 1 1
43 GASTRITIS HAEMMRORAGIC 0 1 0 0 1
44 SUSP SINDROMA NEFROTIK 0 0 1 0 1
45 SUSP KATARAK MATUR OS 0 0 1 0 1
46 TINITUS 0 0 0 1 1
47 ABSES PERIODENTAL 0 0 0 1 1
48 ZANDOPTALAMUS CHOSE 0 1 0 0 1
49 KONTROL POST CYSTECTOMY 0 0 1 0 1
50 REFRAKSI ANOMALI 0 0 0 1 1
51 SELESAI PENGOBATAN TB FASE INTENSIF OEDEMA KEDUA KAKI 0 1 0 0 1
52 SUSP NEUROSE 0 0 1 0 1
53 SUSP KATARAK IMATUR 0 0 1 1 2
54 KONTROL LBP 0 0 0 2 2
55 SUSP APPENDISITIS 0 0 0 1 1
56 SERUMEN 0 0 0 1 1
57 KONTROL NS 0 0 1 0 1
58 KONTROL CHEPALGIA 0 0 0 1 1
59 KONTROL SPASME CLAVULASMA 0 0 0 1 1
60 KONTROL CA MAMAE DEXTRA 0 0 0 1 1
61 KONTROL POST STROKE 0 0 3 1 4
62 CURETAGE 0 1 0 0 1
63 KONTROL EPILEPSI 0 0 1 0 1
64 SUSP MYOMA UTERI 0 1 0 0 1
65 KONTROL POST STROKE 0 0 1 0 1
66 KONTROL MATUR OD 0 0 1 0 1
67 G1 P0 A0 GRVAVIDA 39 MINGGU DAN JANIN DENGAN PEB 0 1 0 0 1
68 SERUMEN 0 0 1 0 1
69 HP GP 0 0 1 0 1
70 EPILEPSI 0 0 0 1 1
71 DYSPEPSI + SUSP MELENA 0 0 1 0 1
72 SUSP GLUKOMA 0 0 0 1 1
73 SUSP FAM 0 0 0 1 1
74 SUSP TINITUS 0 0 1 0 1
75 SUSP GANGLION 0 0 0 1 1
76 SUSP PIGMENTASI DAUN TELINGA 0 1 0 0 1
77 SUSP LYMPADENOPATI 0 1 0 0 1
78 KONTROL DECOMP 0 0 0 1 1
79 POST AMPUTASI DIGITI 0 0 0 1 1
80 SUSP RADIKULOPATI 0 0 0 1 1
81 G1 P0 A0 GRAVIDA 20 MINGGU 0 0 0 1 1
82 KONTROL PRESBIOP 0 0 0 2 2
83 SUPS SCABIES 0 0 0 1 1
84 POST OP APPENDISITIS 0 0 0 1 1
85 KISTA OVARIUM 0 0 0 1 1
86 POST OP KATARAK 0 0 0 1 1
87 SUSP BRONCHITIS 0 0 1 0 1
88 ANEMIA 0 0 1 0 1
89 G2 P1 A0 GRAVIDA 36-37 MINGGU 0 0 0 1 1
90 KONTROL OMP 0 0 1 0 1
91 KONTROL HNP 0 0 0 1 1
92 PULPITIS 0 0 0 1 1
93 SUSP SINDROME NEFROTIS 0 0 0 1 1
94 KONTROL ASMA 0 0 1 0 1
95 NEUROTIS 0 0 1 0 1
96 TONSILITIS 0 0 1 0 1
 97 EPILEPSI 0 0 1 0 1
98 DEFREPSI 0 0 1 0 1
99 SUSP MYALGIA 0 0 0 2 2
100 HORDEOLUM 0 0 0 1 1
101 KONTROL SPIM GIPIA 0 0 0 1 1
102 GANTI KACA MATA 0 0 0 4 4
103 KONTROL NS 0 0 1 0 1
104 KONTROL PARKINSON 0 0 0 1 1
105 KONTROL SUSP NEVUS PIGMENTASI DAUN TELINGA 0 0 0 1 1
106 MASA INTRA ABDOMEN 0 0 0 1 1
107 KONTROL PSIKOSA AKUT 0 0 1 0 1
108 SUSP RADIKULOPATI LUMBAL 0 0 0 1 1
109 SUSP RA 0 0 0 1 1
110 SUSP KATARAK IMATUR ODS + PTERIGIUM 0 0 0 1 1
111 SUSP TB 0 0 0 1 1
112 TIA+ HT+ DISPEPSI 0 0 0 1 1
113 PULPITIS 0 0 0 1 1
114 PRESBIOP 0 0 0 1 1
115 SUSP SKABIES 0 0 0 1 1
116 ASMA 0 0 0 1 1
117 LIMPADENOPATI 0 0 1 2 3
118 G1P0 A0 GRAVIDA 26-27 DENGAN ASMA 0 0 0 1 1
119 SUSP PRESBIKUSIS 0 0 0 1 1
120 BO 0 0 0 2 2
121 SUSP TUMOR JARINGAN LUNAK LENGAN KIRI ATAS 1 0 0 0 1
122 HAEMOROID 0 0 1 0 1
123 CHEPALGIA 0 0 0 2 2
124 PROSTAT HIPERPLAMI 0 0 1 0 1
125 SUSP STRUMA 0 0 0 2 2
126 SUSP DENGAN REFRAKSI ANOMALI 0 2 0 1 3
127 OMP INF+ BRONCHITIS 0 0 0 1 1
128 KONTROL POST RAWAT INAP 0 0 0 1 1
129 SROKE 0 0 0 1 1
130 TINITUS 0 0 1 0 1
131 NEUROMYALGIA 0 0 0 1 1
132 KONTROL POS DRIP DIGITI 0 0 1 0 1
133 KONTROL LYMPADENITIS 0 0 1 0 1
134 SUSP DYSPEPSI 0 0 0 1 1
135 CELULITIS 0 0 0 1 1
136 CHEPALGIA 0 0 0 1 1
137 SUSP COLLIC 0 0 0 1 1
138 ASMA BRONHIAL 0 0 1 1 2
139 SUSP TYPPOID 0 0 1 0 1
140 PERIODENTITIS ATCAUSA GANGREN RADIS 16 0 0 0 1 1
141 THALASEMIA 0 0 0 1 1
142 G1 P0 A0 GRAVIDA 40-41 MINGGU 0 0 0 1 1
143 POST STROKE 0 0 1 0 1
144 STROKE 0 0 0 1 1
145 MYALGIA 0 0 1 0 1
146 TRAUMA BENDA ASING MATA KANAN 0 1 0 0 1
147 ABSES 0 0 1 0 1
148 KATARAK 0 0 0 1 1
149 SAB 0 0 0 1 1
150 SUSP TINITUS 1 0 0 0 1
151 NEUROMYALGIA 0 0 0 1 1
152 PSIKOSA AKUT 0 1 0 0 1
153 KONTROL ARTRITIS 0 1 0 1 2
154 ASMA 0 1 0 0 1
155 SUSP BO 0 0 0 1 1
156 STEMI ANTERIOR LUAR 0 0 0 1 1
157 SINDROME OBSERVASI + DISPEPSI 1 0 0 0 1
158 CA PARU 0 0 1 0 1
159 SKIZOPRENIA 0 0 0 1 1
160 SUSP NEUROTIK 0 0 1 0 1
161 G1P0 A0 KEP 0 1 0 0 1
162 HERPES 0 0 0 1 1
163 SUSP KISTA OVARIUM 0 1 0 0 1
164 KONTROL HABIS OBAT 0 0 1 0 1
165 SUSP HAEMOROID 0 0 1 0 1
166 KONTROL BPH 0 0 1 0 1
167 CARDIOMYOPATI 0 0 0 1 1
168 PALPITAI KORDIS 0 0 0 1 1
169 SUSP SKABIES 1 0 0 0 1
170 SUSP RA 0 0 0 2 2
171 SUSP MYOMA 0 0 0 1 1
JUMLAH 6 19 80 148 253

Mengetahui, Sumedang, 8 September 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 SEPTEMBER 2014
BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 KONTROL DIABETES MELLITUS 1 0 10 20 31

2 ASHD 0 0 4 2 6
3 SKIZOPRENIA 0 0 1 0 1
4 STROKE 0 0 1 0 1
5 CKD 0 0 3 3 6
6 CRF 0 0 0 2 2
7 ESRD 0 0 2 2 4
8 SUSP FIBRA DENOMA MAMAE 0 0 0 1 1
9 ABLASIA RETINA 0 0 0 1 1
0 0 1 0 1
10 KONTROL HECTING KORNEA + GLUKOMA SEKUNDER
11 SUSP PARKINSON 0 0 1 0 1
12 KONTROL SUSP BPH 0 0 1 0 1
13 SERUMEN 0 0 1 1 2
14 SUSP DECOMP CORDIS + OEDEMA 1 0 0 0 1
15 KONTROL ILLEUS 0 0 1 0 1
16 SERUMEN PADAT 1 0 0 1 2
17 ISPA 0 0 1 0 1
18 KONTROL NS 0 0 1 0 1
19 SUSP CONJUNGTIVITIS 0 0 0 1 1
20 KONTROL COLESTEROL 0 0 0 1 1
21 KONTROL DISPEPSI 0 0 1 2 3
22 KONTROL EVANS SYNDROME 0 0 1 0 1
23 POST HECTING SUSP GOUT THOPUS 0 0 0 1 1
24 SUSP GRONCHEPALI 0 0 0 1 1
25 susp tinitus 1 0 0 1 2
26 SUSP STRUMA 0 0 0 1 1
27 EPILEPSI 0 0 0 1 1
28 OBS FEBRIS 0 0 0 1 1
29 SUSP NEURAMYALGIA 1 1 1 0 3
30 NEFROLITHIASIS 0 0 0 1 1
31 SUSP DISLIPIDEMIA 0 2 0 1 3
32 IMPAKSI 48 0 0 0 1 1
33 KONTROL GASTRITIS 0 0 0 1 1
34 REFRAKSI ANOMALI 0 0 1 0 1
35 NS 0 0 1 0 1
36 ULKUS PEPTIKUM 0 0 0 2 2
37 SUSP PTERIGIUM 0 0 0 1 1
38 SERUMEN 0 0 1 0 1
39 LYMPADENOPATI 0 0 0 1 1
40 INTOKSINASI 0 0 0 1 1
41 SUSP DERMATITIS 1 1 1 0 3
 42 KONTROL BPH 0 0 1 0 1
43 KONTROL POST STROKE 0 1 0 0 1
44 SUSP ABSES 31,32 0 1 0 0 1
45 SUSP RA 0 1 0 0 1
46 SUSP KELOID 0 1 0 0 1
47 KONTROL STROKE 0 0 0 1 1
48 CALXYL + TS 0 0 1 0 1
49 KOLESTEROL 0 0 0 1 1

50 48 PERIODENTITIS ETCAUSA GANGREN RADIS 0 0 0 1 1

51 KONTROL PRESBIOP 0 0 0 1 1
52 KONTROL MYOPIA 0 0 0 1 1
53 KONTROL DISLIPIDEMIA 0 0 0 2 2
54 ASMA BRONCHIALE 0 0 0 1 1
55 SUSP PTERIGIUM 0 0 0 1 1
56 EPILEPSI 0 0 0 1 1
57 SUSP GANGGUAN REFRAKSI ANOMALI 0 1 0 0 1
58 CHF 0 0 0 1 1
59 PTERIGIUM 0 0 0 1 1
60 SUSP CLAVUS KAKI KIRI 1 0 0 0 1
61 PERIODENTITIS ETCAUSA GANGREN PULPA 7 0 0 0 1 1
62 HIPERTENSI 0 0 1 1 2
63 SUSP KATARAK MATUR 0 2 0 0 2
64 SUSP KATARAK 0 0 1 0 1
65 PROSTAT 0 0 1 0 1
66 KONTROL MATTUITIS 0 0 1 0 1
67 SUSP TIA 0 0 1 0 1
68 11, 12,21 HP 0 0 0 1 1
69 SUSP THYPOID 1 1 0 0 2
70 POST STROKE 0 0 0 2 2
71 PARKINSON 0 0 0 1 1
72 KONTROL HAMIL 0 0 0 1 1
73 SUSP REFRAKSI ANOMALI 1 5 0 3 9
74 GLUKOMA 0 0 0 1 1
75 SUSP OMP 0 0 1 0 1
76 HIPERTENSI + OA GENUS 0 0 0 1 1
77 PULPITIS 36 0 0 0 1 1
78 GASTRITIS +VES 0 0 0 1 1
79 G1 P0 A0 GRAVIDA 32 MINGGU JANIN HIDUP
INTRAVTERINE DENGAN KURANG SESUAINYA USIA
KEHAMILAN DENGAN TFU 0 0 0 1 1

80 SUSP PARONICHIA 0 0 0 1 1
81 PAPSMEAR 0 0 1 0 1
82 MIOMA UTERI 0 0 0 1 1
83 SUSP HNP 0 1 0 0 1
84 HABIS OBAT TB 0 0 0 1 1
85 PENDARAHAN SUB HYALOID 0 0 0 1 1
86 ANXIETAS 0 0 1 0 1
87 DEFRESI 1 0 0 0 1
88 SUSP NEUROTIK 0 0 1 0 1
89 KONTROL GOUT 0 0 0 1 1
90 KONTROL RR 0 0 0 1 1
91 SERUMEN 0 0 2 0 2
92 KONTROL POST RAWAT INAP FEBRIS 0 0 1 0 1
93 PERIODENTITIS ETCAUSA GANGREN PULPA 18 0 0 1 0 1
94 HIPERTENSI + POST STROKE 0 0 0 1 1
95 SUSP DEPRESI 0 1 1 1 3
96 CP + EPILEPSI 0 0 1 0 1
97 KONTROL OSTEO ARTRITIS 0 0 0 1 1
98 RIWAYAT EPILEPSI 0 0 0 1 1
99 HIPERTIROID 0 0 0 1 1
100 LUKA PADA BIBIR BAWAH RIWAYAT PARKINSON 0 1 0 0 1
101 SUSP PTERIGIUM 0 1 0 0 1
102 KONTROL POST SC 0 0 0 0 0
103 G1 P1 A0 GRAVIDA 24 MINGGU JANIN TUNGGAL 0 0 0 1 1
104 KONTROL ONIF DIGIT DISTAT 0 0 1 0 1
105 SUSP HIPERTIROID + HIPERTENSI 0 0 0 1 1
106 KONTROL LYMPADENOPATI 0 0 0 1 1
107 SUSP ANEMIA 0 0 0 1 1
108 KONTROL SUSP DERMATITS ALLERGIC 0 0 1 0 1
109 SUSP NEVUS PIGMENTOSUS 0 0 1 0 1
110 KONTROL POST RAWAT INAP 0 0 0 1 1
111 SUSP ABSES 41, 42 0 0 0 1 1
112 KONTROL KELOID 0 0 0 1 1
113 SUSP LYMPADENOPATI 0 0 1 0 1
114 CHEST PAIN 0 0 0 1 1
115 SUSP DIARE MUNTAH 0 0 0 1 1
116 KONTROL ANEMI APLASTIC 0 0 1 0 1
117 SUSP T3-T2 KRONIS 0 1 0 0 1
118 SUSP EPITAKSIS 0 0 0 1 1
119 SUSP NEUROMYALAGIA 0 1 0 0 1
120 KATARAK 0 0 1 1 2
121 SPASME CLANCULA SINISTRA 0 0 0 1 1
122 ERITOMA 1 0 0 0 1
123 SUSP ADNEXITAS 0 0 0 1 1
124 POST OP FAM SINISTRA 0 0 0 1 1
125 POST SC 0 0 0 1 1
126 GASTRITIS HAEMOROGIC 0 0 0 1 1
127 GANTI KACA MATA 0 0 1 1 2
128 SUSP TINEA 0 0 1 0 1
129 EPILEPSI 0 0 1 0 1
130 NEUROMYALGIA 0 0 1 1 2

131 POST KLL TRAUMA KEPALA KELUAR DARAH DARI 0 1 0 0 1

TELINGA KANAN
132 KONTROL NS 0 0 1 0 1
133 SERUMEN KERAS, TELINGA KIRI KANAN 0 0 1 0 1
134 OBS BANGKITAN 0 0 1 0 1
135 CA COLON POST RESEKSI 0 0 1 0 1
136 SUSP KATARAK 0 0 1 0 1
137 IUD 0 0 0 1 1
138 PERIODENTITIS ETCAUSA GANGREN RADIS 26 0 0 1 0 1
139 SERUMEN PADAT KANAN KIRI 0 0 1 0 1
140 ULKUS PEPTIKUM 0 0 0 1 1
141 KONTROL TIA 0 0 0 1 1
142 PERIODENTITIS ETCAUSA GANGREN 7 0 0 0 1 1
143 KONTROL VERTIGO 0 0 0 1 1
144 KONTROL GOUT 0 0 0 1 1
145 BILA PLATUS KELUAR FECES 0 0 1 0 1
146 TRAUMA TELINGA KANAN 0 0 0 1 1
147 SERUMEN 0 0 0 1 1
148 GYNECO MASTOID 0 0 1 0 1
149 DCFC 0 0 1 0 1
150 KONTROL MATA 0 0 1 0 1
151 DECOM CORDIS 0 0 0 1 1
152 SUSP LMYPADENOPATI COLI DEXTRA 1 0 0 0 1
153 KONTROL KATARAK 0 0 0 1 1
154 KONTROL HABIS OBAT DEPRESI 0 0 1 0 1
155 SUSP KATARAK IMATUR ODS 1 0 0 0 1
156 SUSP IKTERUS 1 0 0 0 1
157 RADIKULOPATI 0 0 0 1 1
158 SUSP FRAKTUR LENGAN BAWAH KIRI ( POST KLL) 1 0 0 0 1
159 KONTROL DISLIPIDEMIA 0 0 0 1 1
160 SUSP MIOMI UTERI 1 0 0 0 1
161 SUSP CONJUNGTIVITIS ALLERGI 0 1 0 0 1
162 HIPERTENSI + CHEST PAIN 0 0 0 1 1
163 SUSP TINEA CAPITIS 0 1 0 0 1
164 SUSP CICATRIC OS VISUM 1 0 0 0 1
165 G2P1 A0 GRAVIDA 41/42 MINGGU 0 0 0 1 1
166 SERUMEN PADA TELINGA KIRI 0 1 0 0 1
167 SUSP BELL PALSY 1 0 0 0 1
168 HIPERTENSI 0 1 0 0 1
169 KONTROL HABIS OBAT 0 0 1 0 1
170 SISTITIS 0 0 0 1 1
171 KONTROL TB PARU 0 0 0 1 1
172 KONTROL SUSP TUMOR CAVUM 0 1 0 0 1
173 HIPERTENSI + GASTRITIS 0 0 1 0 1
174 KATARAK + PTERIGIUM 0 0 0 1 1
175 TUMOR JARINGAN LUNAK FEMUR SINISTRA 0 0 0 1 1
176 SUSP FAM 0 0 0 1 1
177 KONTROL DILATIO KARDIOMEGALI 0 0 0 1 1
178 SUSP CA LYMPHADENOPATI 0 1 0 0 1
179 KONTROL OA GENUS 0 0 0 1 1
180 SUSP TUMOR VACUM NASI 0 0 0 1 1
 0 1 0 0 1
181 PERIODONTITIS ATCAUSA GANGAREN RADIS 48
182 TUMOR MAMAE SINISTRA 0 0 0 1 1
183 SUSP DERMATITIS ALERGI 0 0 0 1 1
184 SUSP GANGLION 0 0 0 1 1
185 LBP + POST TETANUS 0 0 1 0 1
186 SUSP CA 0 0 1 0 1
187 KONTROL POST CA CERVIK 0 0 0 1 1
188 KONTROL HNP 0 0 0 1 1
189 KONTROL CHEPALGIA 0 0 0 1 1
190 KONTROL POST RAWAT 0 0 2 0 2
191 SUSP SINUSITIS 0 0 1 0 1
192 KONTROL PARKINSON 0 0 1 0 1
193 SUSP DERMATITIS ALLERGIC 0 0 0 0 0
194 GIGI PALING BELAKANG BEREVUSI 0 1 0 0 1
195 SUSP GLINEKOMASTOID 0 0 1 0 1
196 NEPROLITHIASIS 0 0 1 0 1
197 KONTROL SUSP KATARAK 0 0 0 1 1

198 PERIODENTITIS ETCAUSA GANGREN PULPA 2 0 0 0 1 1

199 KONTROL POST OP SYMASTOID 0 0 1 0 1
200 SUSP KELOID PADA PINGGANG KIRI 0 0 0 1 1
201 EPILEPSI 0 0 1 0 1
202 KONTROL MYALGIA 0 1 0 0 1
203 CEPHALGIA 0 0 1 0 1
204 PULPITIS 0 0 0 1 1
205 MYOPI 0 0 1 0 1
206 CERUMENT 0 0 1 0 1
207 SUSP HERNIA 1 0 0 0 1
19 33 89 140 281

Mengetahui, Sumedang, Oktober 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 2014

BARU LAMA
No DIAGNOSA ICD X JUMLAH
LAKI-LAKI PEREMPUAN LAKI-LAKI PEREMPUAN

1 SUSP HERNIA 1 0 0 0 1
2 KONTROL HIPERTENSI 1 0 1 1 3
3 REFRAKSI ANOMALI 1 0 3 6 10
4 DISLIPIDEMIA 0 0 0 2 2
5 G4P2A1 DENGAN HIPERTENSI DALAM KEHAMILAN 0 0 0 1 1
6 DIABETES MELLITUS 0 0 5 9 14
7 KONTROL CKD 0 0 2 3 5
8 SUSP VERUKA DIPIPI KIRI 0 1 0 0 1
9 KONTROL PENDARAHAN SMBA 0 0 1 0 1
10 SUSP PTERIGIUM 1 1 0 2 4
11 EVANS SYNDROME 0 0 1 0 1
12 RADIKULOPATI LUMBAL 0 0 0 1 1

13 SUSP DECOMP CORDIS 1 0 0 0 1

14 LBP 0 0 1 0 1
15 APP NON SPESIFIK 0 0 0 1 1
16 SUSP KATARAK 0 1 0 1 2
G1P0A0 HAMIL 8 BULAN, KELUAR DARAH SEGAR
17 CAIR SATU CO PENUH SEPERTI HAID 0 1 0 0 1
18 SKIZOPRENIA 0 0 1 0 1
19 38 MEOPERSI 0 0 0 1 1
20 EPILEPSI 0 0 1 2 3
21 OBS FEBRIS 0 0 0 2 2
22 OMP 0 0 1 0 1
23 G5P4A0 0 0 0 1 1
24 GANGREN PULPA 37, RIWAYAT DM 0 0 1 0 1
25 SUSP ANXIETAS 1 0 0 0 1
26 HIPERTENSI + DISPEPSI 0 0 1 0 1
27 KONTROL ESRD 0 0 0 1 1
28 POST STROKE 0 0 1 4 5
29 KONTROL KELOID 0 0 2 0 2
30 TONSILITIST OBS FEBRIS 0 1 0 0 1
31 TRIGEMINAL NEURALGIA 0 0 1 0 1
32 KONTROL THYROID 0 0 1 0 1
33 SUSP APP NON SPESIFIK 0 0 0 1 1
34 SUSP REFRAKSI ANOMALI 0 1 0 0 1
35 GIGI BELAKANG BAWAH KIRI BERLUBANG 0 0 0 1 1
36 SUSP LYMPADENOPATI COLLI 0 0 0 1 1
37 KONTROL PASCA OPERASI KATARAK 0 0 1 0 1
38 SUSP KATARAK MATUR ODS 0 1 0 0 1
39 POST PERAWATAN DI RSU (GIGI) 0 0 0 1 1
40 SUSP MASTIDITIS 0 1 0 0 1
41 SUSP KATARAK IMATUR 1 0 0 0 1
42 G4P3A0 GRAVIDA 708 MINGGU DENGAN SUSP BO 0 1 0 0 1
43 SUSP EPITAKSIS ALLERGIAN 1 0 0 0 1
44 SUSP HIPERLACRIMALIS 1 0 0 0 1
45 KONTROL SUSP MYALGIA 0 0 0 1 1
46 SUSP HP 47 0 0 1 0 1
47 GANTI KACA MATA 0 0 1 0 1
48 STROKE INFARK 0 0 1 0 1
49 BENJOLAN 0 0 1 0 1
50 CEK KOLESTEROL ASAM URAT 0 0 0 1 1
51 SUSP MENOMETROLARGIA 0 1 0 0 1
52 PENDARAHAN SMBA 0 0 1 0 1
53 TB PARU 0 0 0 1 1
54 KONTROL SUSP STRUMA 0 0 0 1 1
55 SUSP MYALGIA 0 1 1 2 4
56 KONTROL POST OP TM PALPEBRA OS 0 0 1 0 1
57 POLIP SERVIC 0 0 0 1 1
58 TINEA INGUINITAS 0 0 0 1 1
59 PULPITIS 0 0 1 0 1
60 KATARAK IMATUR 0 0 0 1 1
61 SUSP DISPEPSI 0 0 1 0 1
62 SUSP REMATOID ARTITIS 1 0 0 0 1
63 FIBRO LYPOMA SINISTRA 0 0 0 1 1
64 HAEMOROID 0 0 1 0 1
65 DISPEPSI/GASTRITIS 0 0 0 1 1
66 KISTA BARTOLITIS 0 0 0 1 1
67 SUSP DISPESI +HIPERTENSI 0 1 0 0 1
68 G3P2A0 GRAVIDA 41 MINGGU DENGAN LET 0 0 0 1 1
69 POST PSA (PERAWATAN SALURAN AKAR) 0 0 1 0 1
70 NHML 0 0 1 0 1
71 CHF 0 0 1 0 1
72 KONTROL SUSP REFRAKSI ANOMALI 0 1 0 0 1
73 36 PULPITIS 0 0 1 0 1
74 G1P0A0 INPARTU ATERIM 0 0 0 1 1
75 PENDARAHAN SMBA 0 0 0 1 1
76 SUSP ASMA BRONCHIALE 0 1 0 0 1
77 GANGREN REGION PEDIS KIRI 0 0 0 1 1
78 SERUMEN 0 0 1 0 1
79 LYMPADENOPATI COLLY 0 0 1 0 1
80 IMPLAMASI DI GINJAL 0 0 0 1 1
81 EPITAKSIS +HIPERTENSI 0 0 1 0 1
82 ASHD 0 0 4 0 4
GINGTIVITIS MARGINALIS KRONIS GENERALITA
83 PERIODENTITIS KRONIS 0 0 1 0 1
84 SUSP KATARAK IMATUR 0 0 1 0 1
85 SUSP IKTERUS + GASTRITIS 1 0 0 0 1
 G1P0A0 PARTURIENT ATERM KALA I PASE LATEN
86 DENGAN SUSPEC PSR 0 0 0 1 1
87 KONTROL MASTOIDITIS 0 0 1 0 1
88 SUSP VERUCA 0 0 1 0 1
89 CAD OMI ARTERO CEFMI 0 0 1 0 1
90 KONTROL KATARAK 0 0 0 1 1
91 SUSP HEMAPTOE 0 0 0 1 1
92 KONTROL TB PARU 0 0 0 1 1
93 KONTROL POST STROKE 0 0 0 1 1
G1P0A0 GRAVIDA 38 MINGGU DENGAN SUSP BAYI
94 BESAR 0 0 0 1 1
95 SUSP DISLIPIDEMIA 0 0 0 1 1
96 KONTROL SUSP STRUMA 0 0 0 1 1
97 OBS FEBRIS 0 0 1 0 1
98 SUSP DECOMPENSASI CORDIS 1 0 0 0 1
99 BGM DENGAN BATUK LAMA 0 0 1 0 1
100 OBS FEBRIS RL + 1 0 0 0 1
101 PAPSMEAR 0 0 0 1 1
102 GASTRITIS 0 0 0 1 1
103 KONJUNGTIVITIS 0 0 0 1 1
104 SKIZOPRENIA 0 0 1 0 1
105 SUSP TYPOID 1 0 0 0 1
106 IMS 0 0 0 0 0
107 KEHAMILAN LATEN ITERIN 8 MINGGU DENGAN BO 0 0 0 1 1
108 HNP 0 0 0 1 1
109 HIPERTIROID 0 0 0 1 1
110 TRAUMA KEPALA 0 0 0 1 1
111 KONTROL TIA 0 0 0 1 1
112 KONTROL STROKE 0 0 0 1 1
113 SUSP PTERIGIUM 0 1 0 0 1
114 KONTROL DISLIPIDEMIA + GOUT 0 0 0 1 1
115 GANGLION 0 0 0 1 1
116 DECOM CORDIS 0 0 0 1 1
117 KONTROL DCFC 0 0 0 1 1
118 SUSP HERNIA 0 0 1 0 1
119 AKSEPTRO IUD DENGAN BENANG (-) 0 0 0 1 1
120 G3P2A0 GRAVIDA 42/43 MINGGU DENGAN IUFD 0 0 0 1 1
121 SUSP LIPOMA PADA PANGKAL HIDUNG 1 0 0 0 1
122 NEPROLITIASIS KANAN 0 0 0 1 1
123 KONTROL POST SC 0 0 0 1 1
124 SUSP DERMATITIS 0 0 1 0 1
125 ATRIAL FIBRILASI 0 0 1 0 1
126 PO OP NEPROLITHIASIS 0 0 0 1 1
127 SEROTIN 0 0 0 1 1
128 PULPITIS 47 0 0 0 1 1
129 SUSP SUPERNUMERER REGRO 16,17 0 0 0 1 1
130 SUSP POLIP PORTIO 0 0 0 1 1
131 POST ORIF DIGIT I DISTAL 0 0 1 0 1
132 TRAUMA OD 0 0 1 0 1
133 KONTROL RADIKULOPATI LUMBAL + HNP 0 0 1 0 1

134 SUSP HEMIPARISE 0 0 1 0 1

135 PERIODENTITIS ETCAUSA GANGEN RADIS 28 0 0 1 0 1
136 PERIKSA URIUM,KRETAIN 0 0 1 0 1
137 RUFTUR URETHA 0 0 1 0 1
138 SUSP HILL SINISTRA 0 0 1 0 1
139 SUSP FAM (MAMAE SINISTRA) 0 0 0 1 1
140 CELULITIS 0 0 0 1 1

141 SUSP DYSPEPSIA 0 0 1 0 1

142 SUSP KATARAK + RIWAYAT DM 0 0 0 1 1
143 KONTROL ASHD + TB PARU 0 0 0 1 1
144 ANEMIA EC PENDARAHAN SMBA 0 0 0 1 1
145 KONTROL DYSPEPSIA 0 0 1 0 1
146 CKD + PNC EPITAKSIS 0 0 1 0 1
147 38 PULPITIS 0 0 0 1 1
VULNUS LACERATUR DI MUKOSA BIKAL SEBELAH
148 KANAN ATAS GIGI 83,84 POST TRAUMA I 1 0 0 0 1
149 CAVUM NASI 0 0 0 1 1
150 SUSP MIOMA UTERI + POST CURETAGE 0 0 0 1 1
151 KONTROL GOUT + TOPUS 0 0 0 1 1
152 KONTROL STROKE 0 0 1 0 1
153 SUSP FIBROADENOMA MAMAE DEXTRA 0 0 0 1 1
154 KONTROL IVB 0 0 1 0 1
155 KONTROL CELULITIS 0 0 0 1 1
156 SUSP GANGGUAN REFRAKSI ANOMALI 0 0 0 1 1
157 SUSP ARTIO ARTRITIS 0 0 0 1 1
158 KONTROL BRONCHITIS 0 0 1 0 1
SUSP TUMOR JARINGAN LUNAK KAPALA BAGIAN
159 BELAKANG KIRI 0 0 1 0 1
160 SUSP LYMPADENOPATI COLLI DEXTRA 0 0 1 0 1
161 PERIODENTITIS ETCAUSA GANGREN PULPA 47 0 0 1 0 1
162 KONTROL PAPSMEAR ULANG FA 0 0 0 1 1
163 SUSP DECOMP 0 0 0 1 1
164 KONTROL POST OP KISTA 0 0 0 1 1
165 KONTROL ULANG SUSP KISTA OVARIUM 0 0 0 1 1
166 KONTROL MORBILLI 0 0 0 1 1
167 KONTROL BD+TB+ANEMIA 0 0 1 0 1
168 THYROID 0 0 0 1 1
169 TB PARU 0 0 1 0 1
170 CA PARU 0 0 1 0 1
171 DERMATITIS 0 0 1 0 1
172 LIMPADENITIS EC TBC A/R COLLI DEXTRA 0 0 0 1 1
173 STROKE 0 0 1 0 1
174 OSTEOMA DO/ METASTASIS CA TEMPORAL 0 0 0 1 1
175 OBS FEBRIS 1 0 0 0 1
176 RHEMATOID ARTRITIS 0 0 0 1 1
177 SUSP LYMPADENOPATI 0 0 1 0 1
178 SUSP LBP 0 0 1 0 1
179 SUSP KATARAK IMATUR ODS 0 0 0 1 1
180 CKD EC PNC 0 0 0 1 1
181 STRUMA 0 0 1 1 2
182 SUSP DEMAM REMATIK 0 0 1 0 1
183 SUSP DISLOKASI 1 0 0 0 1

18 15 83 114 230

Mengetahui, Sumedang, Oktober 2014

Kepala UPTD Puskesmas Cimalaka Pembuat Laporan

Supriyanto, SKM Ena Marlena Sanusi

NIP. 1966044 198803 1 009
 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
2 16 ABSES PERIDONTAL
3 SERUMEN
4 DM
5 PTERIGIUM OD
6 ANXIETAS
7 RHINITIS ALERGICA
8 FLOUR ALBUS
9 SUSP KATARAK IMATUR
10 ESRD
11 SUSP BPH
12 CKD
13 HIPERTENSI
14 SUSP VERTIGO
15 SUSP KISTA
16 HYPERTIROID
17 SUSP KARDIOMEGALI
18 POST OP KATARAK
19 CORPUS ALINEUM
20 CEPHALGIA
21 ASHD
22 MYALGIA
G1 PO A1 GRAV 8 MG DG INSPECULO TAMPAK
23 JARINGAN DI MULUT RAHIM
24 RETINOBLASTOMA
25 POST OF GLUKOMA
26 CA NASOPARING
27 HERNIA INGUINALIS
28 SUSP TUMOR MAMAE SINISTRA
29 EPILEPSI
30 ILLEUS
31 SUSP ANGINA PECTORIS
PSMBA + ANEMIA DENGAN DIAGNOSA KISTA
32 OVARIUM MESENTRIS
33 SUSP HIL DEXTRA
34 HT + ASHD 0
35 KONTROL SINUSITIS
36 G1 PO AO PARTUS ATERM
37 OSTEO ARTHRITIS
38 SUSP MYOPIA
39 SUNGSANG
40 KONTROL NEURODERMATITIS
41 KONTROL DYSPEPSIA
42 STROKE
43 37 KARIES SEKUNDER (GANGRIEN PULPA)
44 NS
45 STROMA
46 SUSP KATARAK ODS
47 PULPITIS 46
48 SUSP FRAKTUR TANGAN KANAN
49 G1 PO AO GRAV 20 MG DG IUFD
50 DERMATITIS
51 CA MAMAE KONTROL
52 SUSP GOUT
53 KONTROL PSEUDOFILIA
54 KONTROL HEMOROID
55 SUSP DISLIPIDEMIA
56 BGM
57 ALOPECIA SUDAH 2 BULAN
58 GEA
59 SKIZOPRENIA KRONIK
60 LYMPADENOPATI COLLI
61 KONTROL OA GENU
62 IMPAKSI 38
63 NS
64 DISLOKASI TMJ
65 POSTEKSISI MASSA
66 SUSP ACNE
67 HIPEREMYE PULPA 22
PERIODONTITIS APICALIS ATCAUSA GANGREN
68 RADIS 28
69 KISTA MATUR
70 TUMOR PARU
71 EVANS SYNDROM
72 SUSP CIROSIS HEPATIS
73 SUSP GASTRITIS
74 SUSP BPH
75 SUSP DBD
76 CAD OMI FC IV
77 LBP
78 EPILEPSI
79 LIMPADENOPATI COLLY DEXTRA
80 SUSP CARVAL TA KIRI
 PERIODONTITIS APICALIS ATCAUSA GANGREN
81 RADIS 47
82 KISTA OVARIUM MESENTRIS
83 CHRONIC DALLY HEADACHE
84 STROMA DIFUSI TONSIL
85 KONTROL OMP
86 KONTROL STROKE INFARK
87 SUSP MYOMA UTERI
88 SUSP CONJUNGTIVITIS
89 TRAUMA TANGAN TERTUSUK JARUM
90 PULPITIS 34 PERIODONTITIS 6/67
91 KOLESTEROL TOTAL, LDL, ASAM URAT
92 KONTROL DEPRESI
93 SUSP TB
94 KONTROL TIA
G1 P1 AO INPARTU ATERM KALA I FASE LATEN
95 DG KETUBAN HIJAU
96 KONTROL SUSP TINEA
97 LYMPADENITIS
CEDERA KEPALA PD BAGIAN MUKA SEBELAH KIRI
98 DG HECTING 30 JAHITAN
99 REFRAKSI ANOMALI
100 POST OF KATARAK
101 KATARAK MATUR ODS
102 NHML
103 SCOLIOSIS
104 SUSP MYOP ODS 4/6
105 CONGENITAL HAND I UNITED DIGITI
106 MENOMETHORERGIA
107 APS MINTA DI RO
108 SUSP TRAUMA BENDA TAJAM
109 SUSP KONTROL VERTIGO
SUSP GANGLION PERGELANGAN TANGAN
110 KANAN
111 SUSP PRESBIOP + MYOPIA
112 SUSP STRUMA
113 SUSP LOSS HEARING
114 SUSP SIROSIS HEPATIS
GI PO AO GRAV 14-15 MG PENDARAHAN AKIBAT
115 JATUH
116 ASMA + HT
117 PESERTA KB IUD 21 THN DGN BENANG (-)
118 CORPUS ALINEUM FARING LARING
119 KONTROL EFUSI PLEURA
120 KONTRO TB PARU
121 SUSP FIBRO ADENOMA MAMAE
122 KONTROL PALPITIS CORDIS TB
123 KONTROL THYROID
124 IKTERUS
125 KONTROL SUSP CICATRIK OD
126 KONTROL BRONCHITIS
127 OBS FEBRIS RL (+)
128 PSIKOSA ALWI
129 TUMOR MAMAE
130 SUSP PROSTAT
131 GANTI KACA MATA
132 ABSES PD SIMPISIS PUBIS
133 SELESAI PENGOBATAN TB BTA NEG (RO+)
134 CARDIOMYOPATI
135 KONROL CONJUNGTIVITIS ALLERGICA

PERIODONTITIS APICALIS ATCAUSA GANGREN

PULPA 36 RIWAYAT HIPERTENSI SUSP BELLS
136 PALSY
137 SUSP GLUKOMA
138 PULPITIS REVERSIBLE
139 GANGREN PULPA 47

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