BCP PERAWAT GIGI AHLI (BUKTI CATATAN PRIBADI/ HARIAN)

Nama : Suci Rokhani, S.S.T.

NIP : 19610428 198107 2 001
Pangkat/ Gol : Pembina, IVa
Jabatan : Perawat Gigi Ahli Madya
Bulan : Juli 2019
Puskesmas : Mergangsan

TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b

1 01-02-2020 1888 KASIYANTO 65 L L [K06.9/B] Disorder of gingiva [298] Premedikasi 1 1

2 71621 RADEN RARA ZURIDA 48 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

3 1166 YAKIRAH 60 L P [K08.3/B] Retained dental root [566] Pencabutan Dengan Citoject 1 1 1 1

4 77799 SUMARSIH 47 L P [K04.5/L] Chronic apical periodontitis [298] Premedikasi 1 1

4 4 1

5 03-02-2020 88131 RADEN SUTOTO 62 L L [K04.7/K] Periapical abscess [298] Premedikasi 1 1

6 27358 MUJIYEM, NY 46 L P [K02.2/B] Caries of cementum [558] Tumpatan Glass Ionomer 1 1 1

7 8222 VIRA WIJAYA KUSUMA 35 L L [K04.5/L] Chronic apical periodontitis [298] Premedikasi 1 1

8 13831 TRI RAHAYU 54 L P [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

9 2820 FARUQ ABDI 48 L L [K05.2/B] Acute periodontitis [298] Premedikasi 1 1

10 66949 PRIVIA FATNA 36 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

11 9476 PARTIYEM 51 L P [K04.5/K] Chronic apical periodontitis [591] Konsultasi Dokter Gigi 1 1

12 3346 BEBAS TARIGAN BA 78 L L [K05.2/K] Acute periodontitis [298] Premedikasi 1 1

8 8 1
 TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b

13 05-02-2020 77939 DENICIA SIMPONI 3 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

14 70000 RINI EMAWATI 50 L P [K04.7/L] Periapical abscess [298] Premedikasi 1 1

15 77106 HERNANDA EKO SAPUTRA 27 L L [K04.0/B] Pulpitis [554] Tumpatan Sementara 1 1 1

16 64392 ARDIAZ DANENDRA 6 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

17 91236 MAHENDRA REZA FADHILAN 14 B L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1 1

18 14973 SUSILO SAMSUL BAKHRI 78 L L [K06.9/B] Disorder of gingiva [591] Konsultasi Dokter Gigi 1 1
6 6 1 2

19 06-02-2020 25304 RAHAYU MULYONO 64 L L [K04.1/B] Necrosis of pulp [289] Observasi 1 1

20 55061 JASMINE ZALFA 17 L P [K01.1/B] Impacted teeth [289] Observasi 1 1

21 77799 SUMARSIH 47 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

22 1166 YAKIRAH 60 L P [K08.3/B] Retained dental root [566] Pencabutan Dengan Citoject 1 1 1 1

23 53287 DERI YUMAIDA 38 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

24 73741 SAYYIDAH AMINAH RAMALIAH 9 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

25 48538 TAKAMOEMADA KUSANTORO 8 L L [K00.6/B] Disturbances in tooth eruption [289] Observasi 1 1

26 36880 SRI MARDININGSIH 62 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

27 90537 MARY RAMA DONAS.H. 44 L L [K04.1/B] Necrosis of pulp [289] Observasi 1 1

9 9 2 1

28 08-02-2020 22306 LUTFI ADIKUSUMA 40 L L [K04.5/L] Chronic apical periodontitis [298] Premedikasi 1 1

29 56593 FATHIN GHIFFAR 11 L L [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

30 44295 SHERLYN DIVANIA JESE 9 L P [K00.6/B] Disturbances in tooth eruption [289] Observasi 1 1

31 26952 DANANG SUJARWO, DRS 53 L L [K04.5/L] Chronic apical periodontitis [298] Premedikasi 1 1

32 56960 KHAIRUNNISA PUTRI AISAH 7 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

33 38608 EKA SEPTIA RAHMADANI 9 L P [K00.6/B] Disturbances in tooth eruption [289] Observasi 1 1
 TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b

34 62950 OLFAT NIJAR FAJARI 9 L L [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

35 62962 OLFAT NAUFAL NAJIB 9 L L [K02.2/B] Caries of cementum [558] Tumpatan Glass Ionomer 1 1 1

36 91256 DORI WICAKSONO 37 B L [K04.1/B] Necrosis of pulp [568] Trepanasi Gigi Gangren 1 1 1 1

37 37592 SILVIA ANNISA PUTRI ICSANI 9 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1
10 10 1 5 2

38 10-02-2020 8222 VIRA WIJAYA KUSUMA 35 L L [K04.1/B] Necrosis of pulp [289] Observasi 1 1

39 57480 THERESIA LESTARI 57 L P [K08.3/B] Retained dental root [298] Premedikasi 1 1

40 19275 IQBAL KHASAN 14 L L [K02.2/B] Caries of cementum [558] Tumpatan Glass Ionomer 1 1 1

41 50508 AQIVA VANIA PUTRI 8 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

42 1248 SURATNO 51 L L [K05.2/B] Acute periodontitis [298] Premedikasi 1 1

43 78397 AJENG WIDAD TAMIMAH 8 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

44 70840 YUNI DWI ASTUTI 43 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

45 81088 DWI ISTRIYANTI 37 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

8 8 2

46 11-02-2020 59743 EVI PURWANI 44 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

47 89929 TITIK BUDIARTI 30 L P [K08.3/B] Retained dental root [298] Premedikasi 1 1

48 24186 RINDU MARIA ASTUTI 31 L P [K02.2/B] Caries of cementum [552] Perawatan Kaping Pulpa 1 1 1

49 4211 SUPARTINAH 61 L P [K04.7/L] Periapical abscess [298] Premedikasi 1 1

50 57965 OKTAPIA WULANDARI 27 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

51 90305 MAHAJENG INARA JATI 0 L P [Q35/B] Cleft Palate [591] Konsultasi Dokter Gigi 1 1

52 5530 INDAH SEKAR MAYANG SARI 36 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

53 91273 SYAIFUDDIN 47 B L [K05.2/B] Acute periodontitis [298] Premedikasi 1 1 1

8 8 1 1
 TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b

54 12-02-2020 7758 SUYATINI 54 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

55 89825 BIMA PRAKOSO 18 L L [K02.1/B] Caries of dentine [561] Tumpatan Light Cured 1 1 1

56 17713 AJENG AYU ANNABA 22 L P [K08.3/B] Retained dental root [566] Pencabutan Dengan Citoject 1 1 1 1

57 91278 MUHAMMAD HAFIZH 21 B L [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1 1
4 4 1 2 1

58 13-02-2020 90893 ESTER YULIANA 20 L P [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

59 12233 PATMULATSIH YUNIATI 43 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

60 11820 TUKILAH 53 L P [K08.3/B] Retained dental root [298] Premedikasi 1 1

61 49412 RAISYA ATHAYYA ROCHIM 8 L L [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

62 91174 RAHMA REZA AZIZAH 14 L P [K04.1/L] Necrosis of pulp [289] Observasi 1 1

63 90320 SURDIYANTO 36 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

64 9467 SUPRIYANTO 39 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

7 7 1 2

65 14-02-2020 91174 RAHMA REZA AZIZAH 14 L P [K04.1/B] Necrosis of pulp [289] Observasi 1 1

66 91289 EKA RATNA SARI 59 B P [K02.1/B] Caries of dentine [560] Tumpatan Light Cured 1 1 1 1

67 73533 DARYATI 68 L P [K05.2/B] Acute periodontitis [298] Premedikasi 1 1

68 25596 CONDRO PADMONO 42 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

69 16042 AGUS PRIYANTO 41 L L [K05.5/B] Other periodontal diseases [289] Observasi 1 1

5 5 1 1

70 18-02-2020 30306 AMBAR SULISTYANI 51 L P [K02.8/B] Other dental caries [289] Observasi 1 1

71 4211 SUPARTINAH 61 L P [K04.1/B] Necrosis of pulp [298] Premedikasi 1 1

 TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b

72 4524 YOHANES TRIBIYUN 79 L L [K08/B] strai, trauma [298] Premedikasi 1 1

73 57779 DEVA SATYA GARUDA 8 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

74 24186 RINDU MARIA ASTUTI 31 L P [K02.1/B] Caries of dentine [558] Tumpatan Glass Ionomer 1 1 1

75 32404 LESTARI SETYANINGSIH 38 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

76 74373 SITI MUKAROMA AGUSTIN 31 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

77 27257 DIMAS RASYA FAUZAN 10 L L [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

78 3406 SRI MULYANI W., NY 53 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

79 1194 SARWATI ULFAH 61 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

80 75802 MUHAMMAD AL GHAZALI 4 L L [K02.1/B] Caries of dentine [298] Premedikasi 1 1

11 11 3

81 19-02-2020 41575 NADIN ZAHIRA WULANDARI 9 L P [K02.1/B] Caries of dentine [561] Tumpatan Light Cured 1 1 1

82 84351 KOESTANTO 54 L L [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

83 80207 ENDAH 20 L P [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

84 19000 SUMARDAL DIYONO 56 L L [K04.1/L] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1
4 4 2 2

85 20-02-2020 53618 EDELYN DWI CANTIKA 7 L P [K04.1/B] Necrosis of pulp [568] Trepanasi Gigi Gangren 1 1 1

86 83436 TUKINO 56 L L [K04.7/B] Periapical abscess [298] Premedikasi 1 1

87 4438 DRA SUYAMI, M. HUM 55 L P [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

88 444 TRIYASINTA NOOR 18 L P [K00.6/B] Disturbances in tooth eruption [298] Premedikasi 1 1

89 23892 JUWANTI 41 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

90 19054 SURAMI 63 L P [K08/B] strai, trauma [298] Premedikasi 1 1

91 57637 ISTI WURYANI 64 L P [K12/B] Stomatitis [591] Konsultasi Dokter Gigi 1 1

92 91357 MUHAMMAD AHSAN 4 B L [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1 1
 TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b

93 12838 NOORRISKHAH HIKMA 51 L P [K04.7/B] Periapical abscess without sinus [298] Premedikasi 1 1
9 9 1 1

94 21-02-2020 52915 FITRI ARYANI 36 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

95 57138 AYTHA BRIGGITA 7 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1

96 69840 HELLENA ANGGUN 5 L P [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

97 54839 FEFINKA ERLINA VG 7 L P [K00.6/B] Disturbances in tooth eruption [562] Pencabutan Anestesi Topical 1 1 1
4 4 2

98 22-02-2020 83141 WIDOWATI 18 L P [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

99 24-02-2020 91373 NUR BERLIANA RAHMAT 19 B P [K00/B] Gg pertumbuhan Gigi dan Erupsi [298] Premedikasi 1 1 1

100 30777 I PUTU SUADNYANA, SH 65 L L [K04.1/B] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

101 69029 ASHRIANI NUR HALIMAH 19 L P [K05/B] Penyakit gusi [298] Premedikasi 1 1

102 82066 FORLAN DAIDULLAH 9 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

103 20731 ANING SUSENO 71 L P [K03.6/B] Deposits [accretions] on teeth [595] Pembersihan Karang Gigi 1 1 1 2

104 60209 FRANSISKUS FANO 11 L L [K04.1/B] Necrosis of pulp [568] Trepanasi Gigi Gangren 1 1 1
6 6 1 2 2

105 26-02-2020 78968 SARI DEWI ANGGRAINI 21 L P [K03.6/B] Deposits [595] Pembersihan Karang Gigi 1 1 1 2

106 64920 ALANCA ANTONI PAHSAN 53 L L [K04.5/B] Chronic apical periodontitis [298] Premedikasi 1 1

107 84671 NAREESWARI ADEENA 2 L P [K00/B] Gg pertumbuhan Gigi dan Erupsi [591] Konsultasi Dokter Gigi 1 1

108 22672 LANTANG WIJANARKO 25 L L [K04.1/B] Necrosis of pulp [289] Observasi 1 1

4 4 1 2
 TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b

109 27-02-2020 89719 NUR ANA 21 L P [K04.1/L] Necrosis of pulp [591] Konsultasi Dokter Gigi 1 1

110 73009 MUHAMMAD SODIQ 35 L L [K03.6/B] Deposits [289] Observasi 1 1

111 19563 SARJIYATI 56 L P [K03.6/B] Deposits [289] Observasi 1 1

112 52773 BULAN CAHYA KIRANA 7 L P [K04.5/B] Chronic apical period [298] Premedikasi 1 1
4 4

113 28-02-2020 84400 BARAKALLAH GARUDA YAKSA 2 L L [K05.2/B] Acute periodontitis [591] Konsultasi Dokter Gigi 1 1

114 89929 TITIK BUDIARTI 30 L P [K08.3/B] Retained dental root [566] Pencabutan Dengan Citoject 1 1 1 1

115 91518 RIYANTI 28 L P [K03.6/B] Deposits [591] Konsultasi Dokter Gigi 1 1

116 88358 PUTERI DWI KUSUMA 24 L P [K04.7/B] Periapical abscess [298] Premedikasi 1 1

117 69676 SATRIANA PARMANTYA PETRUS 50 L L [K04.1/B] Necrosis of pulp [289] Observasi 1 1
5 5 1 1

118 29-02-2020 71621 RADEN RARA ZURIDA 48 L P [K02.1/B] Caries of dentine [558] Tumpatan Glass Ionomer 1 1 1

119 9914 TATY HARIYATI HARNOKO 54 L P [K05.6/B] Periodontal disease [298] Premedikasi 1 1

120 78570 HELIN IFFA ASTILA RAHMA 5 L P [K02.2/B] Caries of cementum [298] Premedikasi 1 1

121 91165 ADDIN MAHMUDI 36 L L [K04.1/L] Necrosis of pulp [553] Tumpatan Sementara 1 1 1

122 60209 FRANSISKUS FANO 11 L L [K02.8/L] Other dental caries [591] Konsultasi Dokter Gigi 1 1

123 31703 LASTINAH 46 L P [K02.2/B] Caries of cementum [557] Tumpatan Glass Ionomer 1 1 1

124 91529 KHAIRUNNISA FITRI 15 B P [K04.1/B] Necrosis of pulp [302] Surat Rujukan Dokter 1 1 1

125 91533 MUHAMMAD SIDIQ 48 B L [K02.2/B] Caries of cementum [558] Tumpatan Glass Ionomer 1 1 1 1
8 8 2 4

Yogyakarta, 29Juli 2019

Mengetahui
 TGL
NO RM NAMA USIA B/L L/P DIAGNOSIS TINDAKAN KODE KEGIATAN
PERIKSA
6a 6b 6c 7a1 9a 9c 14b
Kepala Puskesmas Mergangsan Pelaksana

drg. Risa Dhiana Permanasari Suci Rokhani, S.S.T.

NIP. 19740310 200604 2 003 NIP. 19610428 198107 2 001