1 2 3 4 5

Column1Column15 Column2 Column4 Column42 Column5 Column58

Column59
Column60
Column61
Column62

NO. 0-7 8-28 29-1 1-4 5-6

NO. LOKET NO. REG B/L NAMA
JKM/JKD/AS th hr th th th

1 1079 JAMALUDIN 0 0 0 0 0
2 1160 QUSYAIRI 0 0 0 0 0
3 1083 RIO FERDINAN 0 0 0 0 0
4 1098 MAS CIPLUK 0 0 0 0 0
5 1100 AMSANI 0 0 0 0 0
6 SABIYAH 0 0 0 0 0
7 1123 DIDIK 0 0 0 0 0
8 1121 M.SUPRIADI 0 0 0 0 0
9 1108 MASHURI 0 0 0 0 0
10 1144 MOH RIFAI 0 0 0 0 0
11 1148 NUR HASAN 0 0 0 0 0
12 1153 MAT SAKI 0 0 0 0 0
13 1155 ROFIUDIN 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
TOTAL 0 0 0 0 0
 6 7 8 9 10 11 12 13 14 15 16 17 18
Column63
Column64
Column65
Column66
Column67
Column52
Column53
Column54
Column55
Column552
Column553
Column56
Column57
Column6Column7
Column74
Column72
Column73
Column732

6-9 10- 12- 15- 18- 20- 25- 35- 45- 55- 60- 65- >70 UMUR UMUR L/P JML L JML CARA
th 11 th 14 th 17 th 19 th 24 th 34 th 44 th 54 th 59 th 64 th 69 th th P BAYAR

THN BLN

0 0 0 0 0 1 0 0 0 0 0 0 0 20 L 1 0

0 0 0 0 0 0 1 0 0 0 0 0 0 33 L 1 0

0 0 1 0 0 0 0 0 0 0 0 0 0 14 L 1 0

0 0 0 0 0 0 0 0 0 0 1 0 0 62 P 0 1

0 0 0 0 0 0 0 1 0 0 0 0 0 35 P 0 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 0 1 1 1 0 0 1 0 0 3 2 5
 Col Col
Colu um
Column82
Column822
Column83
Column84
Column842
Column85 umColumn10
Column104
Column105
Column102
Column103 Column12 Column17
mn9 n92 n93

U J BPJS D A G /DW
LW DW LW SP H P R X ALAMAT DIAGNOSA

U 0 0 0 0 0 0 0 0 0 0 0 KKK KLL
U 0 0 0 0 0 0 0 0 0 0 0 KKK KLL
U 0 0 0 0 0 0 0 0 0 0 0 JBC VULL AP
J 0 0 0 0 0 0 0 0 0 0 0 JBS VULLAPP
U 0 0 0 0 0 0 0 0 0 0 0 SIDODADI VUL APP
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Column20

KELENGKAPAN INFORMED
CONSENT

TL
TL
TL
TL
TL
TL
TL
TL
TL
TL
TL
TL
TL