NO NAMA No Peserta Alamat No.

Telp Diagnosa Tgl test Berikutnya Obat yg diminum

1 Juwariyah 0000.100.527.985 Bratang 085649658565 HT -

2 Sulastri 0000.102.442.026 Keputih tegal Timur 7/36 Sby 5968061 / 085749194595 HT -

3 Djani Sudarmaji 0000.102.442.037 Keputih tegal Timur 7/36 Sby 5968061 / 085749194595 HT -

4 H syahidi 0001.789.412.556 Asem Payung 5991082 HT 1/1/2017

5 Judaningsih 0000.092.880.729 Perumdos ITS B-6 081331643293 HT 7/4/2018

6 M Wahono 0000.092.880.731 Perumdos ITS B-6 081331643293 HT 7/4/2018

7 Tiarsipeni S 0000.092.894.139 ITS F - 7 031-5946276 HT 19/4/2018

8 Aisyah 0000.092.873.507 ITS R 6 sby 031-5931080 HT 25/4/2018

9 Ahmad Mauludiyanto 0000.100.496.046 Perumdos ITS U-8 081332881367 HT -

10 Siti Zahrok 0000.100.516.364 Perumdos ITS M-3 081232652704 HT 23/4/2018

11 Lilik Sukartini 0000.100.527.041 ITS B 11 sby 5947908 / 08121628346 HT -

12 Mardianah 0000.100.516.072 Perumdos U 189 sby 082131984144 HT PRB

13 Retno Tri Hartati 0000.100.523.463 Perumdos U 138 sby 081332701104 HT 9/4/2018

14 Nurhastuty Siswandari 0000.977.391.404 Sukolilo Park Regency N-8 081357221558 HT bkn prolanis

15 M Soegeng L A 0001.857.894.557 Darmawangsa Barat 51 082231363047 HT 9/4/2018

16 Lindu Sunarko 0000.100.514.981 Perumdos ITS H-14 Sby 5931065 / 082139070100 HT 12/4/2018 HT(1/2/2018)DM

17 Lukitaningsih 0000.092.882.226 Perumdos ITS T-2 5932237 / 080649432084 HT -

18 Achmad Baktir 0000.037.468.181 Perumdos ITS N-3 08179328577/0816507850 HT 23/4/2018

19 Mariyati JD 0000.092.882.834 Perum ITS T 3 sby 085325771187 HT 24/4/2018

20 Siti Aminah 0001.461.136.623 Perumdos ITS U 100 sby 085755224472 HT bkn prolanis

21 Sadino 0000.100.524.543 Perum ITS D 6 sby 081226482194 HT 12/4/2018

22 Pudjiastuti 0000.099.904.421 Perum ITS D 6 sby 081226482194 HT 12/4/2018

23 Ratna Komariyah 0000.101.620.146 Taman Sutorejo Timur 58 sby 08123530578 HT bkn prolanis

24 Madramis 0000.101.620.135 Taman Sutorejo Timur 58 sby 08123530578 HT bkn prolanis

25 Moerdijanto 0000.100.519.571 Perum ITS I 2 sby 08123246942 HT 11/4/2018

26 Endang Kasiati 0000.100.506.699 Perum ITS E 4 sby 08123524906 HT 16/4/2018

27 Endang Subetsi 0000.100.502.065 Perum ITS N 19 sby 085100609229 HT -

28 Mawarti S 0000.169.987.454 Perum ITS D 2 sby 081357582201 HT 25/4/2018

29 Sisnalin 0000.092.886.849 Perum ITS D 3 sby 08165407207 HT 16/4/2018

30 Sri Suharsih 0000.100.527.693 Perum ITS T 60 sby 0883184608 HT bkn prolanis

31 Achmadah 0001.857.894.423 Darmawangsa Barat 51 085732889594 HT bkn prolanis

32 Sekartedjo 0000.100.525.342 Perum ITS D 15 sby 5931143 HT bkn prolanis

33 Djoko Santoso 0000.092.878.571 Perum ITS A 14 sby 5947569 HT 30/4/2018

34 Endah Yuswarini 0000.100.506.644 Perumdos ITS I-14 Sby 08123568919 HT 2/4/2018

35 Kurdian Suprapto 0000.100.514.441 Perumdos ITS D-10 Sby 08123251022 HT -

36 Ni Made Utami 0000.100.510.503 Perumdos ITS N-17 081338536262 HT -

37 Rahmawati Nugroho 0001.460.752.863 Kertjaya Indah Timur 19/12 087782678787 HT -

38 Ida Novianty 0001.456.114.509 Graha Santosa Timur ID 083831100611 HT PRB

39 Muning Muraeni 0000.166.815.415 KRI D Rani ID 085746482477 HT -

40 Diana Rosita 0001.437.633.371 Semalang Indah III/16 Sby HT bkn prolanis

41 Rinun Sriniati 0000.100.523.621 Perumdos ITS T-53 08123252055/5931293 HT -

42 R. Soewardojo 0000,100,522,888 Perum ITS A 2 sby 031-5946812 HT -

TTD
NO NAMA No Peserta Alamat No. Telp Diagnosa Tgl Test Berikutnya Obat yg diminum

1 Moekijasi 0000.092.884.511 Perumdos ITS A-18 Sby 5946468 DM 25/4/18 25/1/18

2 Ismail Bin Bustan 0000.101.070.933 Mulyosari Timur 72 5934986/087853996776 DM 10/4/18 10/1/18

3 Damisatun 0000.169.989.592 Perumdos ITS U-13 Sby 081330646217 DM 21/4/18 21/1/18

4 Ken Wilujeng 0000.102.336.952 Perumdos ITS E-7 5951806 / 0811377796 DM 3/4/18 3/1/18

5 Chanifah 0000.092.894.231 Perumdos ITS G-2 Sby 5931168 / 081331668374 DM PRB

6 Soeweify 0000.100.527.039 Perumdos ITS B-11 Sby 5947908/08121628346 DM PRB

7 Lidwina Herijati 0000.100.862.651 Mulyosari Tengah IX/60 081380854587 DM 5/4/18 5/1/18

8 Toeti Soewantiyah 0000.101.799.123 Kali Kepiting 33 sby 3893232 / 0818392909 DM 4/4/18 4/1/18

9 Maryati 0000.100.516.465 Perumdos ITS U-87 081703287841 DM 16/4/18 16/1/18

10 Dulladji 0000.099.014.602 ARH 8 sby 08155296242 DM npp 1/2/18

11 Akhmad Nijaib 0000.099.917.921 Keputih 3c/61 sby 081330398810 DM npp 1/2/18

12 Soemartojo 0000.100.526.804 Perum ITS D 1 sby 0816504755 DM 2/4/18 2/1/18

13 Wiwiek Tri Hariyanti 0000.092.880.077 Perum ITS F 12 sby 08155006746 DM 7/4/18 7/1/18

14 Ismojowati 0000,092,887,042 Perum ITS P 4 sby 08123572607 DM 10/4/18 10/1/18

15 Nani Wardhani 0000,100,517,398 Perum ITS I 7 sby 5931043 DM 7/4/18 7/1/18

16 Darmiatun 0000.100.503.314 ITS U 109 sby 087853390530 DM npp 1/2/18

17 M Toha 0000.100.517.444 Perum ITS T-37 sby 5993261/082301268422 DM PRB

18 Masrullita 0000,003,865,599 Keputih 1 D / 14 sby DM PRB

19 Susilowati Santoso 0001.429.015.061 Semolowaru Tengah 9/42 0315944816 DM npp 1/3/18

20 Winarto 000.1471.499.177 Marina Emas Timur V/25 0816505078 DM npp 1/3/18

21 Nur Suroiya 0000.100.496.035 Perumdos ITS U-159 082244022549 DM 11/2/16 11/11/15

22 Ahmad Maksum 0000.100.496.024 Perumdos ITS U-159 082244022549 DM 27/8/14 27/4/14

23 Sutarni 0001.804.415.319 Medokan Semampir 87 DM npp 1/3/2018

24 Sumeh 0001.273.516.604 Kejawan Putih Tambak II/41 08998677927 DM PRB

25 Khalimatus S 0000.100.519.582 Perumdos ITS I-2 0315931086 DM PRB

26 Marta Sindrawati 0001.259.041.015 Manyar Kertoadi 8/215 085106919595 DM npp 1/3/18

27 Sutarmi 0001.448.448.131 Deles 4/10A DM 4/4/18 4/1/18

28 Sri Adji 0000.037.473.761 Tegal Mulyorejo Baru 50 th DM PRB

29 Waludjo pudjiono 0001.454.700.969 Klampis Semolo Tengah 4/11 DM PRB

TTD
NO NAMA No Peserta Diagnosa Alamat

1 Juwariyah 0000.100.527.985 HT Bratang

2 Sulastri 0000.102.442.026 HT Keputih tegal Timur 7/36 Sby

3 Djani Sudarmaji 0000.102.442.037 HT Keputih tegal Timur 7/36 Sby

4 H syahidi 0001.789.412.556 HT Asem Payung

5 Judaningsih 0000.092.880.729 HT Perumdos ITS B-6

6 M Wahono 0000.092.880.731 HT Perumdos ITS B-6

7 Tiarsipeni S 0000.092.894.139 HT ITS F - 7

8 Aisyah 0000.092.873.507 HT ITS R 6 sby

9 Ahmad Mauludiyanto 0000.100.496.046 HT Perumdos ITS U-8

10 Siti Zahrok 0000.100.516.364 HT Perumdos ITS M-3

11 Lilik Sukartini 0000.100.527.041 HT ITS B 11 sby

12 Mardianah 0000.100.516.072 HT Perumdos U 189 sby

13 Retno Tri Hartati 0000.100.523.463 HT Perumdos U 138 sby

14 Nurhastuty Siswandari 0000.977.391.404 HT Sukolilo Park Regency N-8

15 M Soegeng L A 0001.857.894.557 HT Darmawangsa Barat 51

16 Lindu Sunarko 0000.100.514.981 HT Perumdos ITS H-14 Sby

17 Lukitaningsih 0000.092.882.226 HT Perumdos ITS T-2

18 Achmad Baktir 0000.037.468.181 HT Perumdos ITS N-3

19 Mariyati JD 0000.092.882.834 HT Perum ITS T 3 sby

20 Siti Aminah 0001.461.136.623 HT Perumdos ITS U 100 sby

21 Sadino 0000.100.524.543 HT Perum ITS D 6 sby

22 Pudjiastuti 0000.099.904.421 HT Perum ITS D 6 sby

23 Ratna Komariyah 0000.101.620.146 HT Taman Sutorejo Timur 58 sby

24 Madramis 0000.101.620.135 HT Taman Sutorejo Timur 58 sby

25 Moerdijanto 0000.100.519.571 HT Perum ITS I 2 sby

26 Endang Kasiati 0000.100.506.699 %syahidi Perum ITS E 4 sby

27 Endang Subetsi 0000.100.502.065 HT Perum ITS N 19 sby

28 Mawarti S 0000.169.987.454 HT Perum ITS D 2 sby

29 Sisnalin 0000.092.886.849 HT Perum ITS D 3 sby

30 Sri Suharsih 0000.100.527.693 HT Perum ITS T 60 sby

31 Achmadah 0001.857.894.423 HT Darmawangsa Barat 51

32 Sekartedjo 0000.100.525.342 HT Perum ITS D 15 sby

33 Djoko Santoso 0000.092.878.571 HT Perum ITS A 14 sby

34 Endah Yuswarini 0000.100.506.644 HT Perumdos ITS I-14 Sby

35 Kurdian Suprapto 0000.100.514.441 HT Perumdos ITS D-10 Sby

36 Ni Made Utami 0000.100.510.503 HT Perumdos ITS N-17

37 Rahmawati Nugroho 0001.460.752.863 HT Kertjaya Indah Timur 19/12

38 Ida Novianty 0001.456.114.509 HT Graha Santosa Timur ID

39 Muning Muraeni 0000.166.815.415 HT KRI D Rani ID

40 Diana Rosita 0001.437.633.371 HT Semalang Indah III/16 Sby

41 Rinun Sriniati 0000.100.523.621 HT Perumdos ITS T-53

42 R. Soewardojo 0000,100,522,888 HT Perum ITS A 2 sby

 No. Telp minimal tgl periksa

085649658565 bisa dilayani

5968061 / 085749194595 bisa dilayani

5968061 / 085749194595 bisa dilayani

5991082 1 januari 2017

081331643293 7 april 2018

081331643293 7 april 2018

031-5946276 19 april 2018

031-5931080 25 april 2018

081332881367 bisa dilayani

081232652704 23 april 2018

5947908 / 08121628346 bisa dilayani

082131984144 tidak bisa dilayani

081332701104 9 april 2018

081357221558 tidak bisa dilayani

082231363047 9 april 2018

5931065 / 082139070100 12 april 2018

5932237 / 080649432084 bisa dilayani

08179328577/0816507850 23 april 2018

085325771187 24 april 2018

085755224472 tidak bisa dilayani

081226482194 12 april 2018

081226482194 12 april 2018

08123530578 tidak bisa dilayani

08123530578 tidak bisa dilayani

08123246942 11 april 2018

08123524906 16 april 2018

085100609229 bisa dilayani

081357582201 24 april 2018

08165407207 16 april 2018

0883184608 tidak bisa dilayani

085732889594 tidak bisa dilayani

5931143 tidak bisa dilayani

5947569 30 april 2018

08123568919 2 april 2018

08123251022 bisa dilayani

081338536262 bisa dilayani

087782678787 bisa dilayani

083831100611 tidak bisa dilayani

085746482477 bisa dilayani

tidak bisa dilayani

08123252055/5931293 bisa dilayani

031-5946812 bisa dilayani

 Keterangan

sdh dtg tgl 11 mei 2018

sdh dtg tgl 11 mei 2018

sdh dtg tgl 16 april 2018

sdh dtg tgl 19 april 2018

sdh dtg tgl 25 april 2018

sdh dtg tgl 11 mei 2018

sdh dtg tgl 09 mei 2018

PRB

sdh dtg 30 mei 2018

bkn prolanis

sdh dtg tgl 11 mei 2018

sdh dtg tgl 11 mei 2018

sdh dtg tgl 09 mei 2018

sdh dtg tgl 16 mei 2018

bkn prolanis

sdh dtg tgl 11 mei 2018

bkn prolanis

bkn prolanis

Sdh dtg tgl 16 april 2018

sdh dtg tgl 3 mei 2018

sdh dtg tgl 3 mei 2018

bkn prolanis

bkn prolanis

bkn prolanis

sdh dtg tgl 09 mei 2018

sdh dtg 21 april 2018

PRB

bkn prolanis

sdh dtg tgl 20 april 2018

NO NAMA No Peserta Alamat

1 Moekijasi 0000.092.884.511 Perumdos ITS A-18 Sby

2 Ismail Bin Bustan 0000.101.070.933 Mulyosari Timur 72

3 Damisatun 0000.169.989.592 Perumdos ITS U-13 Sby

4 Ken Wilujeng 0000.102.336.952 Perumdos ITS E-7

5 Chanifah 0000.092.894.231 Perumdos ITS G-2 Sby

6 Soeweify 0000.100.527.039 Perumdos ITS B-11 Sby

7 Lidwina Herijati 0000.100.862.651 Mulyosari Tengah IX/60

8 Toeti Soewantiyah 0000.101.799.123 Kali Kepiting 33 sby

9 Maryati 0000.100.516.465 Perumdos ITS U-87

10 Dulladji 0000.099.014.602 ARH 8 sby

11 Akhmad Nijaib 0000.099.917.921 Keputih 3c/61 sby

12 Soemartojo 0000.100.526.804 Perum ITS D 1 sby

13 Wiwiek Tri Hariyanti 0000.092.880.077 Perum ITS F 12 sby

14 Ismojowati 0000,092,887,042 Perum ITS P 4 sby

15 Nani Wardhani 0000,100,517,398 Perum ITS I 7 sby

16 Darmiatun 0000.100.503.314 ITS U 109 sby
17 M Toha 0000.100.517.444 Perum ITS T-37 sby
18 Masrullita 0000,003,865,599 Keputih 1 D / 14 sby

19 Susilowati Santoso 0001.429.015.061 Semolowaru Tengah 9/42

20 Winarto 000.1471.499.177 Marina Emas Timur V/25

21 Nur Suroiya 0000.100.496.035 Perumdos ITS U-159

22 Ahmad Maksum 0000.100.496.024 Perumdos ITS U-159

23 Sutarni 0001.804.415.319 Medokan Semampir 87

24 Sumeh 0001.273.516.604 Kejawan Putih Tambak II/41

25 Khalimatus S 0000.100.519.582 Perumdos ITS I-2

26 Marta Sindrawati 0001.259.041.015 Manyar Kertoadi 8/215

27 Sutarmi 0001.448.448.131 Deles 4/10A

28 Sri Adji 0000.037.473.761 Tegal Mulyorejo Baru

29 Waludjo pudjiono 0001.454.700.969 Klampis Semolo Tengah 4/11

 No. Telp Diagnosa minimal tgl periksa

5946468 DM 25 april 2018

5934986/087853996776 DM 10 april 2018

081330646217 DM 21 april 2018

5951806 / 0811377796 DM 03 april 2018

5931168 / 081331668374 DM tidak bisa dilayani PRB

5947908/08121628346 DM tidak bisa dilayani PRB

081380854587 DM 5 april 2018

3893232 / 0818392909 DM 4 april 2018

081703287841 DM 16 april 2018

08155296242 DM bisa dilayani

081330398810 DM bisa dilayani

0816504755 DM 2 april 2018

08155006746 DM 7 april 2018

08123572607 DM 10 april 2018

5931043 DM 7 april 2018

087853390530 DM bisa dilayani

5993261/082301268422 DM tidak bisa dilayani PRB

DM tidak bisa dilayani PRB

0315944816 DM bisa dilayani

0816505078 DM bisa dilayani

082244022549 DM bisa dilayani

082244022549 DM bisa dilayani

DM bisa dilayani

08998677927 DM tidak bisa dilayani PRB

0315931086 DM tidak bisa dilayani PRB

085106919595 DM bisa dilayani

DM 4 april 2018
50 th DM tidak bisa dilayani PRB

DM tidak bisa dilayani PRB

 Keterangan

sdh dtg tgl 11 april 2018

sdh dtg tgl 23 april 2018

sdh dtg tgl 03 april 2018

sdh dtg tgl 09 mei 2018

sdh dtg tgl 8 mei 2018

sdh dtg tgl 10 april 2018

sdh dtg tgl 11 mei 2018

sdh dtg tgl 11 mei 2018