LAPORAN KUNJUNGAN PASIEN RAWAT INAP

PELAYANAN KESEHATAN GRATIS

KABUPATEN : PANGANDARAN
KECAMATAN : SIDAMULIH
PUSKESMAS : CIKEMBULAN
BULAN / TAHUN : NOVEMBER

NO NAMA PASIEN UMUR NO KTP/KK ALAMAT TGL MASUK TGL KELUAR DIAGNOSA PENGOBATAN

1 2 3 4 5 6 7 8 9
1 RUNASIH 59 320723510860001 PASIRKORED 3/17 11/13/2019 11/18/2019 VERTIGO RL,DHIPEN,CAPTROPIL
2 JUWI 55 3207235209640001 CIBODAS 7/4 11/13/2019 11/16/2019 GEA RL,ZINK,ORALIT

3 MAMAN 62 3207230895700001 CIPARI 6/2 11/14/2019 11/22/2019 PPOK RL,SALBU,AMINOP

4 HENDIKA 7 32072318021200002 CIBODAS 4/3 11/14/2019 11/18/2019 BRONCHITIS AKUT RL,CEFTRI,ONDAN

5 DEWI 13 32042855100600016 SUKAJADI 2/1 11/14/2019 11/16/2019 ISPA RL,SALBU,DEXSTRAL

HT RL,AMLO
6 YUNASIH 41 3207234509780001 CIBODAS 3/3 11/15/2019 11/17/2019
NEBU
7 NAZRIEL 3 3279012606170001 KARANGSARI 6/3 11/15/2019 11/18/2019 TF RL,PCT,CEFTRI
8 SUGIMI 52 3215245506870008 DESA 1/2 11/16/2019 11/18/2019 ISPA RL,AMBROXSOL
9 KAMISIH 64 3207235201550001 CIBEUREUM 3/9 11/16/2019 11/19/2019 HT RL,AMLO,ONDAN
10 KAMEK 80 3207230501390001 KARANGHONJE 5/6 11/16/2019 11/18/2019 DISPEPSIA RL,ONDAN ,ANTASID
11 AINA 1 3218106112180001 SUKAJADI 4/1 11/17/2019 11/20/2019 FEBRIS RL,PCT,CEFTRI
12 MELA 17 3207234808020001 CIKALONG 1/2 11/17/2019 11/19/2019 TF RL,CEFTRI,ONDAN
13 HIKMAH 20 3207235107990001 SUKADANA 22/9 11/17/2019 11/21/2019 DISPEPSIA RL,ONDANOMZ
14 KELVIN 1 3218090301018001 CIKULU 2/3 11/17/2017 11/18/2019 OF RL,PCT,CEFTRI
15 TISAH 55 3207246906640001 CIMNGGU 3/10 11/18/2019 11/19/2019 DM RL,GLIBEN
16 RENA 19 3207235705000001 CILEMPUNG 2/5 11/18/2019 11/20/2019 G1POA0 dg AB IMINENT RL,AS TRNAEX,ONDAN
17 SETIASIH 6 3207234209130001 DESA 3/8 11/18/2019 11/19/2019 TF RL,PCT,ONDAN
18 JUNDI 7 3207232203120001 CIKANGKUNG 2/7 11/18/2019 11/19/2019 TF RL,PCT,ONDAN
19 AHRI 52 3207231403570001 CIKALONG 1/2 11/18/2019 11/21/2019 VOMITUS RL,ONDAN

20 SALSHA 26BLN 3218016609170001 BUDIASIH 2/19 11/18/2019 11/20/2019 BRONCHITIS AKUT RL,SOLAFLUS CEFTRI

21 IPIN 35 3207231003840001 SUKADANA 21/9 11/19/2019 11/20/2019 INTOKSIKASI MAKANAN RL,ONDAN

22 I SURYATI 26 3207326506830001 DESA 1/2 11/19/2019 11/20/2019 DF RL,ONDAN,PCT
23 RASID RESIDA 44 3207232605750001 TARIKOLOT 3/4 11/19/2019 11/20/2019 ANGINA PECTORIS RL,NEROBION
24 TINI 35 3207016807840003 PANGANDARAN BARAT 11/19/2019 11/20/2019 TF RL,ONDAN,PCT
25 YAYAN 38 3207221608810002 PARAPAT 4/7 11/19/2019 11/21/2019 SUSP TF RL,PCT
26 ATQIA 4 3218091161115001 KARANGSARI 6/3 11/19/2019 11/21/2019 ISPA RL,SOLAPLUS
27 ETI 39 3207224602800001 BULAKLAUT 4/6 11/19/2019 11/21/2019 HT RL,AMLO
28 SADIMAN 35 3207232712840003 CIKALONG 2/1 11/19/2019 11/21/2019 ISPA RL,DEXTRAL,PCT

29 SAPJA 66 3207230102630002 CITEMBONG 4/2 11/20/2019 11/21/2019 BRONCHITIS AKUT RL,CEFAD,PCT

30 WILDA 8 3218094602110002 PADASUKA 3/19 11/20/2019 11/24/2019 ISPA RL,AMBROXOL

RL,PCT,ANTASID
31 NURAISAH 42 3207252097700002 PARAPAT 4/9 11/20/2019 11/21/2019 CHEST PAINT
NEBU
32 DEFA 2 32180107121600001 CIBENDA 1/14 11/21/2019 11/23/2019 TF RL,PCT,ONDAN
33 CICIH 52 32072431267000002 BOJONG 2/8 11/21/2019 11/23/2019 ABD PAIN RL,KETO,ONDAN
34 SARIMAN 54 32072233046500003 WONOHARJO 2/13 11/21/2019 11/23/2019 HIPOTENSI RL,IKANEURON
35 ASEP 40 32072309117900001 CIHERAS 2/1 11/21/2019 11/23/2019 PROOLNG FEAVER RL,PCT,ONDAN
36 KARTI 71 3207246707480001 CIPARI 3/1 11/21/2019 11/23/2019 GEA RL,ZINK,ORALIT
37 GINAR 13 3207230210060001 CIPARI 3/2 11/21/2019 11/22/2019 ISPA RL,HERBAKOF
38 WANTI 36 3207234410830001 TARIKOLOT 6/2 11/21/2019 11/22/2019 GERD RL,ZINK,ORALIT
39 TARSIH 29 3207236609900001 BELENGBENG 1/8 11/21/2019 11/22/2019 DISPEPSIA RL,ONDAN
40 VHAREL 2 3218011108170002 CIBENDA 3/17 11/21/2019 11/22/2019 VOMITUS RL,ONDAN
41 ADE 53 3207233008760001 CIUPARI 6/2 11/21/2019 11/22/2019 VERTIGO RL,RECODRYL
42 REYHAN 6 32180111101300002 CIBENDA 2/14 11/22/2019 11/23/2019 DF RL,PCT
43 NABIHA 2 32181003051700002 CIKANGKUNG 1/4 11/22/2019 11/23/2019 KDS RL,PCT
44 VERREL 5 3207221905140001 WONOHARJO 3/2 11/22/2019 11/24/2019 KDS RL,PCT
45 WILDAN 2 3218090105180002 WONOHARJO 2/10 11/22/2019 11/24/2019 KDK RL,PCT
46 HAYKAL PUTRA 6 3218102609130001 DESA 4/2 11/23/2019 11/25/2019 OF RL,PCR CEFTRI
47 PIDI 77 3207230107420008 KRSARI 2/2 11/24/2019 11/25/2019 VERTIGO R;L,DHIPEN,
48 ILHAM 18 3207221704110002 WONOHARJO 3/19 11/24/2019 11/28/2019 TF RL,ONDAN,PCT
49 NAUFAL 4 3218011609150001 BUDIASIH 2/18 11/24/2019 11/27/2019 OF RL,PCT
50 SUHERMAN 45 3207231604740002 KRHONJE 5/6 11/24/2019 11/26/2019 TF RL,PCT,ONDAN
51 FARHAN 11 3207243030800001 SUCEN 2/23 11/25/2019 11/26/2019 DF RL,PCT,DEXA
52 FATMA 3 3218104611150001 CIKANGKUNG 1/4 11/25/2019 11/26/2019 VOMITUS RL,ONDAN
53 SUHENDAR 47 3207230503720002 CIHERAS 2/1 11/25/2019 11/26/2019 VERTIGO RL,DHIPEN

54 KARSAH 68 3207235707510001 CIPARI 4/2 11/25/2019 11/26/2019 BRONCHITIS AKUT RL,GG,CEFAD

55 UKING 67 3207231110420001 SUKAJADI 1/2 11/26/2019 11/27/2019 DISPEPSIA RL,ONDAN

56 DINI 9 3207237105100001 CILEMPUNG 11/25/2019 11/27/2019 HEPATITIS A RL,CEFTRI,ONDAN
57 ROSANAH 42 3207224602720003 KALENBUAYA 3/4 11/25/2019 11/28/2019 BRONCHITIS AKUT RL,PCT,DEXTRAL
58 KEZYA 2 3218095704170002 BOJONGAREN 4/4 11/26/2019 11/27/2019 TF RL,CEFTRI,ONDAN
59 TARKONO 67 3207221504520002 PADASUKA 1/8 11/26/2019 11/27/2019 GEA RL,ONDAN,ZINK
60 ANIS 16 3207260040300001 SAWANGAN 11/27/2019 11/29/2019 SUSP TF RL,PCT
61 SUSMAN 59 3207230608600002 CIMNGGU 3/2 11/27/2019 11/29/2019 HT RL,AMLO
62 AHMAD 21 3207232304980001 NENGKLOK 3/6 11/28/2019 11/29/2019 VERTIGO RL,BETAHISTINE
63 MILA 6 3218105505130001 CIMANGGU 3/2 11/26/2019 11/27/2019 ABSES RL,CEFTRI,ONDAN
64 ZEN FIRDAUS 3 3218102111600002 DESA 3/8 11/26/2019 11/30/2019 TF RL,PCT
65 PAJAR 17 3207284905020002 BANGUNSARI 11/27/2019 3-0/11/19 DISPEPSIA RL,PCT
66 KOMARIAH 65 3207234106580002 KRANGWANGKAL 1/3 11/28/2019 11/30/2019 GEA RL,PCT,ZINK
67 HAURA 4 3218014408150002 SUCEN 1/21 11/28/2019 11/30/2019 ISPA RL,CEFTRI,ONDAN
68 RASKANDAR 64 3207237707550001 CIBEUREUM 3/9 11/29/2019 11/30/2019 TF RL,PCT
JUMLAH

Mengetahui,
Kepala UPTD Puskesmas Cikembulan

TATI HARYATI, AM.Keb

NIP. 19680313 199003 2 007
AT INAP
IS

JASA JUMLAH JASA JML JUMLAH JASA JUMAH VISITE DOKTER JUMLAH
QUANTY PELAYANAN PELAYANAN HARI 1 HARI RAWAT VISITE
TINDAKAN TINDAKAN TINDAKAN TINDAKAN RAWAT 1 HARI/2KALI JASA PELAYANAN
DOKTER
(Rp) (Rp) Rp 24,000 Rp 20,000 (13+15+17)
10 11 12 13 14 15 16 17 18
INFUS 1 Rp 15,000 Rp 15,000 5 Rp 120,000 10 Rp 100,000 Rp 235,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 5 Rp 50,000 Rp 137,000
INFUS 1 Rp 15,000 Rp 15,000 8 Rp 192,000 18 Rp 180,000 Rp 387,000
O2 1 Rp 9,000 Rp 9,000 Rp 9,000
NEBULIZER 1 Rp 15,000 Rp 15,000 Rp 15,000
INFUS 1 Rp 15,000 Rp 15,000 4 Rp 96,000 9 Rp 90,000 Rp 201,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
NEBULIZER 1 Rp 15,000 Rp 15,000 Rp 15,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 2 Rp 20,000 Rp 83,000
NEBULIZER 1 Rp 15,000 Rp 15,000 Rp 15,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 5 Rp 50,000 Rp 137,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 6 Rp 60,000 Rp 147,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 6 Rp 60,000 Rp 123,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 5 Rp 50,000 Rp 137,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 6 Rp 60,000 Rp 123,000
INFUS 1 Rp 15,000 Rp 15,000 4 Rp 96,000 9 Rp 90,000 Rp 201,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 6 Rp 60,000 Rp 123,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 7 Rp 70,000 Rp 157,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
NEBULIZER 1 Rp 15,000 Rp 15,000 Rp 15,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 1 Rp 10,000 Rp 49,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 2 Rp 20,000 Rp 59,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 4 Rp 40,000 Rp 103,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 4 Rp 40,000 Rp 103,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
NEBULIZER 1 Rp 15,000 Rp 15,000 Rp 15,000
INFUS 1 Rp 15,000 Rp 15,000 4 Rp 96,000 9 Rp 90,000 Rp 201,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 2 Rp 20,000 Rp 59,000
NEBULIZER 1 Rp 15,000 Rp 15,000 Rp 15,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 6 Rp 60,000 Rp 123,000
 INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 3 Rp 30,000 Rp 93,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 4 Rp 40,000 Rp 103,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 4 Rp 96,000 9 Rp 90,000 Rp 201,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 6 Rp 60,000 Rp 147,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 4 Rp 40,000 Rp 103,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
NEBULIZER 1 Rp 15,000 Rp 15,000 Rp 15,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 8 Rp 80,000 Rp 167,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 2 Rp 20,000 Rp 59,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 3 Rp 30,000 Rp 69,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 5 Rp 50,000 Rp 137,000
INFUS 1 Rp 15,000 Rp 15,000 3 Rp 72,000 5 Rp 50,000 Rp 137,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 2 Rp 48,000 5 Rp 50,000 Rp 113,000
INFUS 1 Rp 15,000 Rp 15,000 1 Rp 24,000 4 Rp 40,000 Rp 79,000
Rp 1,134,000 133 Rp 3,192,000 324 Rp 3,240,000 Rp 7,566,000

Cikembulan, DESEMBER 2019

Pengelola Pelayanan Kesehatan Gratis
UPTD Puskesmas Cikembulan

Hj. DEWI MEILIA, S.Kep, Ners

NIP. 19770501 200701 2 006