September

TANGGAL TANGGAL JENIS
NO NO KUNJUNGAN PELAYANAN ENTRI NO KARTU NAMA PESERTA KELAMIN
1 110903010921P000 28-09-2021 28-09-2021 0000079854557 H. SUWARNO L

834 00:00 10:07
2 110903010921P000 28-09-2021 28-09-2021 0000080115658 WARNO L
839 00:00 10:53
110903010921P000 28-09-2021 28-09-2021
3 832 00:00 09:35 0000629699657 KHUSNUL KHOTIMAH P
4 110903010921P000 28-09-2021 28-09-2021 0000630069974 ROANAH P

829 00:00 09:23
110903010921P000 28-09-2021 28-09-2021
5 822 00:00 08:45 0000630588036 KHAMaMI L
6 110903010921P000 28-09-2021 28-09-2021 0000630868689 WASMI P

828 00:00 09:09
7 110903010921P000 28-09-2021 28-09-2021 0000631232471 ELI FITRIAWATI P
827 00:00 09:07
8 110903010921P000 28-09-2021 28-09-2021 0001031611509 KOMARUDIN L
838 00:00 10:48
9 110903010921P000 28-09-2021 28-09-2021 0001084059898 FAKHRIZA NURILMI L
830 00:00 09:29
10 110903010921P000 28-09-2021 28-09-2021 0001324292016 BB HENGKY CHRISTIAN, MTH L
835 00:00 10:10
11 0002316973724 P
110903010921P000 28-09-2021 28-09-2021
NALADHIFA HUMAIRA SYAH
840 00:00 11:59
12 110903010921P000 28-09-2021 28-09-2021 0002429706172 SAINAH P

824 00:00 08:54
13 110903010921P000 28-09-2021 28-09-2021 0002431920093 MANIS P
831 00:00 09:31
14 110903010921P000 28-09-2021 28-09-2021 0002620641328 SUGIYANTO L
825 00:00 08:59
110903010921P000 28-09-2021 28-09-2021
15 821 00:00 08:37 0002620641453 DARINAH P
16 110903010921P000 28-09-2021 28-09-2021 0002853298203 RAISAH P

823 00:00 08:52
17 110903010921P000 28-09-2021 28-09-2021 0002857184864 RAMLI L
837 00:00 10:44
18 110903010921P000 28-09-2021 28-09-2021 0003046676152 SADAN YUDHA FUALAM L
833 00:00 09:42
19 110903010921P000 28-09-2021 28-09-2021 0003092452648 BAYI NYONYA EKA NUR L
836 00:00 10:24 AZIZAH
20 110903010921P000 28-09-2021 28-09-2021 0003095562025 ALMIRA HUSNA SHAHERA P
826 00:00 09:04
21 110903010921P000 27-09-2021 27-09-2021 0000079930146 SAONAH P
802 00:00 08:34
22 110903010921P000 27-09-2021 27-09-2021 0000079930405 RADJIKI L
811 00:00 09:48
23 110903010921P000 27-09-2021 27-09-2021 0000079931496 SIKIN L
810 00:00 09:28
24 110903010921P000 27-09-2021 27-09-2021 0000079931709 SYIFFA P
820 00:00 14:49
25 110903010921P000 27-09-2021 27-09-2021 0000629988748 MUKHIDIN L
805 00:00 08:45
110903010921P000 27-09-2021 27-09-2021
26 806 00:00 08:49 0000630102273 RENSZA ARYA PRADANA L
110903010921P000 27-09-2021 27-09-2021

27 813 00:00 10:30 0000631441956 SITI SALBIYAH P
28 110903010921P000 27-09-2021 27-09-2021 0000632055341 SATORI L

808 00:00 08:57
29 110903010921P000 27-09-2021 27-09-2021 0001031621927 ULFIYATUN NISA P
815 00:00 10:47
110903010921P000 27-09-2021 27-09-2021
30 812 00:00 10:01 0001105343559 ISKA YUNIARTI P
31 110903010921P000 27-09-2021 27-09-2021 0001314558617 DEDE SURYAMAN L

803 00:00 08:40
32 110903010921P000 27-09-2021 27-09-2021 0001389842054 MASDUKI MUFROD L
809 00:00 08:59
110903010921P000 27-09-2021 27-09-2021 ABUBAKAR TEJASUKMANA
33 800 00:00 08:25 0001481289647 L
34 110903010921P000 27-09-2021 27-09-2021 0001614934495 NYANA L

801 00:00 08:31
35 110903010921P000 27-09-2021 27-09-2021 0001850751033 HERU WIDIARMOKO L
817 00:00 10:53
36 110903010921P000 27-09-2021 27-09-2021 0002000971787 MUJILASTRI P
816 00:00 10:51
37 110903010921P000 27-09-2021 27-09-2021 0002128776513 TUMINI P
807 00:00 08:54
38 110903010921P000 27-09-2021 27-09-2021 0002320365699 DJURIYAH P
804 00:00 08:43
39 110903010921P000 27-09-2021 27-09-2021 0002493766552 TOHAL FAZNI L
798 00:00 07:52
40 110903010921P000 27-09-2021 27-09-2021 0002778425256 NURHAYATI P
799 00:00 08:04
110903010921P000 27-09-2021 27-09-2021 MUHAMMAD AL BARRA
41 818 00:00 11:40 0002885547543 RAHMAN L
110903010921P000 27-09-2021 27-09-2021

42 797 00:00 07:45 0003076542999 ARUMI NASHA RAZETA P
43 110903010921P000 27-09-2021 27-09-2021 0003100108882 BAYI NYONYA DARYATI P

819 00:00 12:51
44 110903010921P000 27-09-2021 27-09-2021 0003100165367 BAYI NYONYA DARYATI L
814 00:00 10:40
45 110903010921P000 25-09-2021 25-09-2021 0000079930271 NONO SUGIONO L
788 00:00 09:27
110903010921P000 25-09-2021 25-09-2021
46 784 00:00 09:12 0000079930539 RODHIYAH P
47 110903010921P000 25-09-2021 25-09-2021 0000080077015 SITI MAEMUNAH P

790 00:00 09:39
48 110903010921P000 25-09-2021 25-09-2021 0000630346127 NANI PARLINA PUSPITASARI P
795 00:00 11:50
49 110903010921P000 25-09-2021 25-09-2021 0000630716433 NURUL AENI SAHARA P
793 00:00 10:18
50 110903010921P000 25-09-2021 25-09-2021 0000630844929 KURYATI P
787 00:00 09:23
51 110903010921P000 25-09-2021 25-09-2021 0000632681526 YOGA AJI KUSUMA L
783 00:00 08:26
52 110903010921P000 25-09-2021 25-09-2021 0001671692859 MUDRIKAH ZAIN P
791 00:00 09:51
53 110903010921P000 25-09-2021 25-09-2021 0002132082549 NOK MUHFIDOH P
794 00:00 10:35
54 110903010921P000 25-09-2021 25-09-2021 0002227802905 KANIA TALITA SATRIA P
796 00:00 11:53
110903010921P000 25-09-2021 25-09-2021
55 789 00:00 09:29 0002474991617 KASEM P
56 110903010921P000 25-09-2021 25-09-2021 0002575210634 MUSLICHA P

786 00:00 09:16
110903010921P000 25-09-2021 25-09-2021
57 785 00:00 09:15 0003095193925 masruri L
110903010921P000 25-09-2021 25-09-2021

58 792 00:00 10:00 0003095562025 ALMIRA HUSNA SHAHERA P
59 110903010921P000 24-09-2021 24-09-2021 0000629030709 ENDANG SUCIATI P

782 00:00 10:09
110903010921P000 24-09-2021 24-09-2021
60 778 00:00 09:11 0000630447118 BARIYAH P
61 110903010921P000 24-09-2021 24-09-2021 0001031621411 JURI L

774 00:00 08:49
62 110903010921P000 24-09-2021 24-09-2021 0001097350525 LIDYA YOHANA P
781 00:00 10:04
63 110903010921P000 24-09-2021 24-09-2021 0001319111728 INNA ULFATUL KHASANAH P
780 00:00 09:30
64 110903010921P000 24-09-2021 24-09-2021 0001389749117 YAHYA S L
775 00:00 08:51
65 110903010921P000 24-09-2021 24-09-2021 0001475395468 LITA AVIYANTI P
776 00:00 08:53
66 110903010921P000 24-09-2021 24-09-2021 0001864785418 Anissah Oktalina PutrI P
779 00:00 09:14
67 110903010921P000 24-09-2021 24-09-2021 0002703819835 NADA AZIZAH P
777 00:00 09:08
68 110903010921P000 23-09-2021 23-09-2021 0000079822258 HERU SANTOSO L
766 00:00 11:09
69 110903010921P000 23-09-2021 23-09-2021 0000079929843 H. MUHAMMAD ZARUKI L
755 00:00 10:49
70 110903010921P000 23-09-2021 23-09-2021 0000079933454 SURIPAH P
768 00:00 11:11
71 110903010921P000 23-09-2021 23-09-2021 0000629695462 WASMINAH P
765 00:00 11:08
110903010921P000 23-09-2021 23-09-2021
72 772 00:00 11:27 0000629722192 SURATNO L
73 110903010921P000 23-09-2021 23-09-2021 0000630094138 SRI MARTININGSIH P

762 00:00 11:03
74 110903010921P000 23-09-2021 23-09-2021 0000630318791 SUHANA L
764 00:00 11:07
75 110903010921P000 23-09-2021 23-09-2021 0000630430402 NAWEN P
760 00:00 11:00
76 110903010921P000 23-09-2021 23-09-2021 0000630661239 TUMINAH P
759 00:00 10:58
77 0000631166073 DAINYAH P
110903010921P000 23-09-2021 23-09-2021
763 00:00 11:05
110903010921P000 23-09-2021 23-09-2021

78 754 00:00 10:47 0001308975963 SRI PURBOWATI P
79 110903010921P000 23-09-2021 23-09-2021 0001317950684 SA'ADIYAH P
767 00:00 11:10
80 110903010921P000 23-09-2021 23-09-2021 0001816531593 NOFI ANDRI FIRMAWAN L
771 00:00 11:18
81 110903010921P000 23-09-2021 23-09-2021 0001822417931 SIGIT WAHYUDIONO L
757 00:00 10:53
82 110903010921P000 23-09-2021 23-09-2021 0001825611928 INDAH SEPTIANINGRUM P
761 00:00 11:01
83 110903010921P000 23-09-2021 23-09-2021 0001859788293 NASRI P
758 00:00 10:55
84 110903010921P000 23-09-2021 23-09-2021 0002000974511 SA ADAH P
773 00:00 11:49
85 110903010921P000 23-09-2021 23-09-2021 0002054607592 ABDUL BASIR L
753 00:00 09:31
86 110903010921P000 23-09-2021 23-09-2021 0002212800254 RICHANAH P
769 00:00 11:12
87 110903010921P000 23-09-2021 23-09-2021 0002212800952 UMI MARYAM P
770 00:00 11:13
110903010921P000 23-09-2021 23-09-2021
88 750 00:00 09:07 0002427927682 GIBRAN RAMADHANI L
89 110903010921P000 23-09-2021 23-09-2021 0002607052746 ABDUL ROCHIM L

752 00:00 09:25
90 110903010921P000 23-09-2021 23-09-2021 0002860425909 ALFI NUR HIDAYAH P
756 00:00 10:50
110903010921P000 23-09-2021 23-09-2021
91 751 00:00 09:16 0002924374588 AKIRA AISHWA NURIN P
92 110903010921P000 22-09-2021 22-09-2021 0000079690634 SLAMET RIJADI L

745 00:00 10:36
93 110903010921P000 22-09-2021 22-09-2021 0000079742766 SUGIARTI P
735 00:00 09:48
94 110903010921P000 22-09-2021 22-09-2021 0000079930192 NIKDIN RAHMAN L
733 00:00 09:27
95 110903010921P000 22-09-2021 22-09-2021 0000079931992 SOEHARDJO L
737 00:00 09:55
96 110903010921P000 22-09-2021 22-09-2021 0000629129711 M. CHOZIN L
732 00:00 09:25
110903010921P000 22-09-2021 22-09-2021
97 741 00:00 10:07 0000629836817 KARIPAH P
110903010921P000 22-09-2021 22-09-2021

98 742 00:00 10:10 0000629942477 DEWI SOLIKHA P
99 110903010921P000 22-09-2021 22-09-2021 0000630044864 JUNIAH P

729 00:00 08:53
100 110903010921P000 22-09-2021 22-09-2021 0000630176139 MUCHIT L
727 00:00 08:47
101 110903010921P000 22-09-2021 22-09-2021 0000630200878 DERAH P
736 00:00 09:53
102 110903010921P000 22-09-2021 22-09-2021 0000630580623 RODIAH P
743 00:00 10:20
103 110903010921P000 22-09-2021 22-09-2021 0000630720347 MILATUL AENI P
744 00:00 10:30
104 110903010921P000 22-09-2021 22-09-2021 0000630919629 KUNPRIYATI P
739 00:00 09:59
105 110903010921P000 22-09-2021 22-09-2021 0001083806188 AGUS BUDIONO L
740 00:00 10:03
106 110903010921P000 22-09-2021 22-09-2021 0002000964813 M AKMAL FUAD L
730 00:00 08:57
107 0002000975038 SITI ANISAH P
110903010921P000 22-09-2021 22-09-2021
738 00:00 09:58
108 110903010921P000 22-09-2021 22-09-2021 0002000993523 TOYIB L

746 00:00 10:37
109 110903010921P000 22-09-2021 22-09-2021 0002303901639 SUMARYO L
748 00:00 10:46
110 110903010921P000 22-09-2021 22-09-2021 0002303902113 LAFI KHUSRINI P
749 00:00 10:50
111 110903010921P000 22-09-2021 22-09-2021 0002436585175 IMAM WILDAN MUTTAQIN L
747 00:00 10:40
112 110903010921P000 22-09-2021 22-09-2021 0002597281277 SITI CHOLIPAH P
728 00:00 08:50
110903010921P000 22-09-2021 22-09-2021 MUHAMMAD JURED SUGAWA
113 731 00:00 09:23 0002801704779 L
110903010921P000 22-09-2021 22-09-2021 BAYI NYONYA NADA FAZIA

114 734 00:00 09:34 0003054508356 ROSALBA P
110903010921P000 21-09-2021 21-09-2021

115 724 00:00 11:19 0000080020844 NINIK MURNIATI P
116 110903010921P000 21-09-2021 21-09-2021 0000080203318 MUCHLASOH MURNINGRUM P

718 00:00 10:41
110903010921P000 21-09-2021 21-09-2021
117 726 00:00 11:22 0000629914983 PARSIDI L
118 110903010921P000 21-09-2021 21-09-2021 0000630048712 YUSA B HASIM L

720 00:00 10:49
110903010921P000 21-09-2021 21-09-2021
119 721 00:00 10:50 0000631429378 KOMALASARI P
110903010921P000 21-09-2021 21-09-2021

120 725 00:00 11:20 0000631482221 HELMI RISKI L
121 110903010921P000 21-09-2021 21-09-2021 0001465074347 SUHARTI P

716 00:00 09:21
122 110903010921P000 21-09-2021 21-09-2021 0001474342402 DESI PUTRIYANI P
717 00:00 09:26
123 110903010921P000 21-09-2021 21-09-2021 0002000974509 TEFURI L
719 00:00 10:47
110903010921P000 21-09-2021 21-09-2021
124 715 00:00 09:19 0002020864015 ROMLAH P
125 0002239198536 MUDOFAR L

110903010921P000 21-09-2021 21-09-2021
712 00:00 07:57
126 110903010921P000 21-09-2021 21-09-2021 0002266710456 KHUROTUL AEN P

723 00:00 10:55
127 110903010921P000 21-09-2021 21-09-2021 0002311558233 SITI RODIYAH P
714 00:00 08:59
128 110903010921P000 21-09-2021 21-09-2021 0002349279909 ALFI ANADI PRATAMA L
722 00:00 10:51
129 110903010921P000 21-09-2021 21-09-2021 0002759388772 RANIA THALITA P
713 00:00 08:33
130 110903010921P000 20-09-2021 20-09-2021 0000079675727 SITI ROHANA P
704 00:00 09:45
110903010921P000 20-09-2021 20-09-2021
131 702 00:00 09:35 0000080021248 UMAR YAKUB L
132 110903010921P000 20-09-2021 20-09-2021 0000629619208 WATIAH P

688 00:00 08:56
110903010921P000 20-09-2021 20-09-2021
133 708 00:00 10:24 0000629941072 MUNADI L
134 110903010921P000 20-09-2021 20-09-2021 0000630101619 REZA RESTUMINTARO L

703 00:00 09:42
135 110903010921P000 20-09-2021 20-09-2021 0000630121004 DEVI TRI FEBRIANI P
705 00:00 09:46
136 110903010921P000 20-09-2021 20-09-2021 0000630123232 DENA ROFIANA P
709 00:00 10:41
137 110903010921P000 20-09-2021 20-09-2021 0000630129622 BOWO SUPARNO L
697 00:00 09:16
138 110903010921P000 20-09-2021 20-09-2021 0000630168142 ARIS IRMANTO L
686 00:00 08:44
110903010921P000 20-09-2021 20-09-2021 DWI HAEFA KHOERUNNISA
139 694 00:00 09:10 0000630294074 P
140 110903010921P000 20-09-2021 20-09-2021 0000630301566 DARWATI P

685 00:00 08:30
141 110903010921P000 20-09-2021 20-09-2021 0000630417137 IDA ROYANI P
710 00:00 13:05
142 110903010921P000 20-09-2021 20-09-2021 0000630491038 MUCHRONI L
701 00:00 09:31
143 110903010921P000 20-09-2021 20-09-2021 0000630608927 MASRIYAH P
687 00:00 08:52
144 110903010921P000 20-09-2021 20-09-2021 0000630670151 GANDA FELANI L
699 00:00 09:21
145 110903010921P000 20-09-2021 20-09-2021 0000630840418 KHAERUDIN L
707 00:00 10:17
146 110903010921P000 20-09-2021 20-09-2021 0000631569723 BADRI L
693 00:00 09:08
147 110903010921P000 20-09-2021 20-09-2021 0001031611746 SUYOTO L
691 00:00 09:01
148 110903010921P000 20-09-2021 20-09-2021 0001083986201 KHUSNATUL ASMANAH P
695 00:00 09:12
110903010921P000 20-09-2021 20-09-2021 IKRIMA PUTRI IRIANTI BONAY
149 700 00:00 09:25 0001320523569 P
150 110903010921P000 20-09-2021 20-09-2021 0001435819836 ANI RAHAYU P

706 00:00 10:10
151 110903010921P000 20-09-2021 20-09-2021 0001814374113 SITI AZIZAH P
711 00:00 14:48
152 110903010921P000 20-09-2021 20-09-2021 0002320365317 M TOPIK L
690 00:00 09:00
153 110903010921P000 20-09-2021 20-09-2021 0002616293147 SARIPAH P
692 00:00 09:03
154 110903010921P000 20-09-2021 20-09-2021 0002643852565 SITI JOLEKHA P
689 00:00 08:58
155 110903010921P000 20-09-2021 20-09-2021 0002741067887 M. VAREN KASHEINDRIA L
698 00:00 09:19
110903010921P000 20-09-2021 20-09-2021 FARDHAN KENZIE HAMDANI
156 696 00:00 09:14 0002897925669 L
110903010921P000 18-09-2021 18-09-2021

157 684 00:00 11:43 0000079822776 HANIEF ILMA MAHARDIKA L
158 110903010921P000 18-09-2021 18-09-2021 0000079931002 CHURIYAH P
669 00:00 09:34
159 110903010921P000 18-09-2021 18-09-2021 0000629951861 MELIJULIANA SARI P
644 00:00 08:38
160 110903010921P000 18-09-2021 18-09-2021 0000630006399 NAILAENI P
678 00:00 10:35
161 110903010921P000 18-09-2021 18-09-2021 0000630618243 MUHAMAD SOIM L
683 00:00 11:11
110903010921P000 18-09-2021 18-09-2021
162 675 00:00 10:32 0000630666819 NUR LAELA AGUSTIN P
163 110903010921P000 18-09-2021 18-09-2021 0000631003432 KAMINI P

671 00:00 10:29
164 110903010921P000 18-09-2021 18-09-2021 0000631024053 YETI MEIDA AMALIA P
680 00:00 10:36
165 110903010921P000 18-09-2021 18-09-2021 0000631110936 WASRO L
670 00:00 09:55
110903010921P000 18-09-2021 18-09-2021
166 682 00:00 10:37 0001031626934 RONA YUSTIKA FAJRIAT P
167 110903010921P000 18-09-2021 18-09-2021 0001031628216 NURKHAYATI P

641 00:00 08:32
168 110903010921P000 18-09-2021 18-09-2021 0001032482439 KOMARIYAH P
645 00:00 08:54
169 110903010921P000 18-09-2021 18-09-2021 0002022686728 NABILA AULIA PUTRI P
676 00:00 10:33
170 110903010921P000 18-09-2021 18-09-2021 0002074389096 KHURIYAH P
673 00:00 10:30
171 110903010921P000 18-09-2021 18-09-2021 0002093166628 AGUS L
672 00:00 10:30
172 110903010921P000 18-09-2021 18-09-2021 0002120279951 M. NAUFAL MUSTAFID AHYAN L
674 00:00 10:31
173 110903010921P000 18-09-2021 18-09-2021 0002131800614 DEWI SUSIYATI P
677 00:00 10:34
174 110903010921P000 18-09-2021 18-09-2021 0002314488317 AIYRA PUTRI NADHEERA P
643 00:00 08:35
175 110903010921P000 18-09-2021 18-09-2021 0002476195042 ANI UZRIYATI P
679 00:00 10:35
176 110903010921P000 18-09-2021 18-09-2021 0002478813265 HERI SUNARDI L
681 00:00 10:36
177 110903010921P000 18-09-2021 18-09-2021 0003054817247 BAYI NYONYA SITI AYATI L
642 00:00 08:34 MUFLIKHATUN
178 110903010921P000 17-09-2021 17-09-2021 0000079822405 KIMAH P
640 00:00 10:56
179 110903010921P000 17-09-2021 17-09-2021 0000079929775 BADIAH P
634 00:00 10:20
180 110903010921P000 17-09-2021 17-09-2021 0000080196974 NAILI ZULFA MAFAZAH P
619 00:00 08:31
181 110903010921P000 17-09-2021 17-09-2021 0000629102799 TRI WAHYUNI P
631 00:00 10:09
182 110903010921P000 17-09-2021 17-09-2021 0000629852062 ROHAYA P
629 00:00 10:05
110903010921P000 17-09-2021 17-09-2021
183 621 00:00 09:06 0000630149106 TUSRIYATI P
110903010921P000 17-09-2021 17-09-2021

184 635 00:00 10:28 0000630415236 TOMI APRIYADI L
185 110903010921P000 17-09-2021 17-09-2021 0000630435521 LUSI SOLIWINDARTI PUTRI P

620 00:00 08:49
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769 110903010921P000 09-02-2021 02-09-2021 0002049366521 ARIS SUTIYONO L
032 08:51
770 110903010921P000 09-02-2021 02-09-2021 0002072625254 MUNJIYAH P
040 09:47
771 110903010921P000 09-02-2021 02-09-2021 0002132081829 DEWI ANDRIYANI P
047 11:26
772 110903010921P000 09-02-2021 02-09-2021 0002198092015 FARIDAH P
042 10:15
773 110903010921P000 09-02-2021 02-09-2021 0002234578454 DEDY RAHMAT L
045 10:45
774 110903010921P000 09-02-2021 02-09-2021 0002269348435 SUKIMAH P
049 12:03
775 110903010921P000 09-02-2021 02-09-2021 0002279315957 WASILAH P
088 12:26
776 110903010921P000 09-02-2021 02-09-2021 0002351672122 REDAH P
041 09:49
777 110903010921P000 09-02-2021 02-09-2021 0002444878012 MUAWANAH P
072 12:18
778 110903010921P000 09-02-2021 02-09-2021 0002575222481 WAHYUNINGSIH P
046 11:14
779 110903010921P000 09-02-2021 02-09-2021 0002575233448 KHOTIMAH P
035 09:05
780 110903010921P000 09-02-2021 02-09-2021 0002641539813 SITI MUNIROH P
074 12:19
781 110903010921P000 09-02-2021 02-09-2021 0002711413765 LENI UTAMI P
091 12:28
782 110903010921P000 09-02-2021 02-09-2021 0002801702169 YULI TRIYANI P
070 12:17
034 09:01
784 09-01-2021 0000079706092 FATIAH P
110903010921P000 02-09-2021
087 12:26
785 110903010921P000 09-01-2021 01-09-2021 0000079822146 DARSONO L

023 11:22
786 110903010921P000 09-01-2021 01-09-2021 0000079929292 MARSUS L
014 09:30
787 110903010921P000 09-01-2021 01-09-2021 0000079930405 RADJIKI L
002 08:13
788 110903010921P000 09-01-2021 01-09-2021 0000079931709 SYIFFA P
024 11:39
789 110903010921P000 09-01-2021 01-09-2021 0000079931935 SODIK PRIBADI L
003 08:17
110903010921P000 01-09-2021
790 017 09-01-2021 10:18 0000080087387 MASYKUROH P
791 110903010921P000 09-01-2021 02-09-2021 0000080189897 ROSIDAH P

098 12:33
792 110903010921P000 09-01-2021 02-09-2021 0000373767772 SUSANTI P
053 12:08
793 09-01-2021 0000388545592 NURIYAH P
110903010921P000 01-09-2021
016 10:05
794 110903010921P000 09-01-2021 02-09-2021 0000418793264 SUKARNI P

059 12:11
795 110903010921P000 09-01-2021 02-09-2021 0000629431986 UMAYAH P
103 12:39
796 110903010921P000 09-01-2021 02-09-2021 0000629915185 M.SEPTIAN ANDANI L
079 12:22
797 110903010921P000 09-01-2021 02-09-2021 0000630283869 BAmBANG ARiYANTO L
093 12:29
798 110903010921P000 09-01-2021 02-09-2021 0000630316855 MEI DIANAH P
081 12:23
799 110903010921P000 09-01-2021 02-09-2021 0000630357399 RIFKA DILA SARI P
067 12:16
110903010921P000 01-09-2021
800 006 09-01-2021 09:07 0000630371687 MUDIYATI P
801 110903010921P000 09-01-2021 01-09-2021 0000630434608 DASRIYAH P

019 10:52
802 110903010921P000 09-01-2021 01-09-2021 0000630497136 SITI ZAFIYAH P
021 11:14
803 110903010921P000 09-01-2021 02-09-2021 0000630559686 SAROFAH P
100 12:35
804 110903010921P000 09-01-2021 02-09-2021 0000630623338 MUHAMAD KHALIMI L
056 12:10
805 110903010921P000 09-01-2021 02-09-2021 0000630645625 YULIS KARUNIAWATI P
064 12:15
806 110903010921P000 09-01-2021 02-09-2021 0000630738617 RINI PUSPITA SARI P
075 12:20
807 110903010921P000 09-01-2021 02-09-2021 0000630895307 EDY HARYANTO L
104 12:40
110903010921P000 02-09-2021
808 055 09-01-2021 12:09 0000630970435 LINDA AGUSTINA P
110903010921P000 02-09-2021
809 083 09-01-2021 12:24 0000631200306 MUADAH P
810 110903010921P000 09-01-2021 01-09-2021 0000631556526 WIYAN EFENDI L

020 11:01
811 110903010921P000 09-01-2021 01-09-2021 0001030765307 NURHAYATI P
009 09:13
812 110903010921P000 09-01-2021 02-09-2021 0001031625099 SUPARMO L
102 12:38
813 110903010921P000 09-01-2021 01-09-2021 0001031627351 MIFTAHUDIN L
015 09:59
814 110903010921P000 09-01-2021 01-09-2021 0001481289647 ABUBAKAR TEJASUKMANA L
004 09:01
815 110903010921P000 09-01-2021 02-09-2021 0001649335285 ELY FUHAEROH P
090 12:27
816 110903010921P000 09-01-2021 02-09-2021 0002019477429 ANNAIHA AMARA B L P
077 12:21
817 110903010921P000 09-01-2021 01-09-2021 0002042983675 NUR HIDAYATI P
008 09:11
818 110903010921P000 09-01-2021 01-09-2021 0002078573962 MUSHONEF L
022 11:20
819 110903010921P000 09-01-2021 02-09-2021 0002098150784 ARI ASNANIAH P
052 12:07
110903010921P000 01-09-2021
820 005 09-01-2021 09:05 0002142635692 TOATI P
821 110903010921P000 09-01-2021 02-09-2021 0002232684966 LAELY PUSPITA SARI P

050 12:05
110903010921P000 02-09-2021
822 097 09-01-2021 12:32 0002265315039 SRI NUR MARPUAH P
823 110903010921P000 09-01-2021 01-09-2021 0002270089405 KHOSYI' AH P

007 09:09
824 110903010921P000 09-01-2021 02-09-2021 0002303901639 SUMARYO L
085 12:25
825 110903010921P000 09-01-2021 02-09-2021 0002309444188 IKLIMA MAULINA P
095 12:30
826 110903010921P000 09-01-2021 02-09-2021 0002465118167 DESTI KURNIASARI P
105 12:41
827 110903010921P000 09-01-2021 02-09-2021 0002497389873 PUTRI AYU WULANDARI P
101 12:37
828 09-01-2021 0002501100494 salsabilla rahwa dina P
110903010921P000 01-09-2021
012 09:20
110903010921P000 01-09-2021
829 018 09-01-2021 10:26 0002501209765 SYARLA LAYKA MAFAZAA P
830 09-01-2021 0002579566847 ST JOLEKHA P

110903010921P000 01-09-2021
001 07:49
110903010921P000 01-09-2021
831 010 09-01-2021 09:14 0002742616732 SAFIRA LAELYANA PUTRI P
832 110903010921P000 09-01-2021 01-09-2021 0002760928615 ASA KHOERUNISA P

013 09:28
833 110903010921P000 09-01-2021 02-09-2021 0002770320655 ARI YULIANA DEWI P
069 12:17
834 110903010921P000 09-01-2021 02-09-2021 0002778439228 NAJMA PUTRI ADIBA P
099 12:34
835 110903010921P000 09-01-2021 01-09-2021 0002864985142 SUJIRAH P
011 09:18
836 110903010921P000 09-01-2021 02-09-2021 0002909327837 UMI HANNI P
071 12:18
837 110903010921P000 09-01-2021 02-09-2021 0003003904113 AFRIKA KURNIASIH P
073 12:19
838 09-01-2021 0003004328057 LISMAWATI P
110903010921P000 02-09-2021
051 12:06

092 12:28
840 110903010921P000 09-01-2021 02-09-2021 0003066754263 RAFAN DAFFA MUMTAAZ L
062 12:13
STATUS
JENIS PESERTA DIAGNOSA PULANG PRB PROLANIS
- Nephrotic syndrome, Rujuk Vertikal

unspecified
- Rheumatoid arthritis, Rujuk Vertikal
unspecified
Follow-up examination after
- other treatment for other Rujuk Vertikal
conditions
- Disorders of trigeminal nerve Rujuk Vertikal

conditions
- Congestive heart failure Rujuk Vertikal
- Irregular menstruation, Rujuk Vertikal

unspecified
- Secondary hypertension, Rujuk Vertikal
unspecified
- Fracture of upper end of ulna Rujuk Vertikal
- Congestive heart failure Rujuk Vertikal Diabetes Mellitus Diabetes Mellitus
- Bronchitis and pneumonitis due Rujuk Vertikal

to chemicals, gases, fumes and
vapours
- Dyspnoea Rujuk Vertikal

unspecified
Unspecified diabetes mellitus
- with unspecified complications Rujuk Vertikal
- Other disorders of middle ear Rujuk Vertikal

and mastoid
- Other disorders of ear, not Rujuk Vertikal
elsewhere classified
- Noninfective neonatal diarrhoea Rujuk Vertikal
- Dyspnoea Rujuk Vertikal
- Fracture of neck of femur, Rujuk Vertikal

closed
- Stroke, not specified as Rujuk Vertikal
haemorrhage or infarction
- Other arthritis Rujuk Vertikal
- Benign neoplasm of prostate Rujuk Vertikal

Other retinal disorders in
- diseases classified elsewhere Rujuk Vertikal
Tuberculosis of lung,
- bacteriologically and Rujuk Vertikal
histologically negative
- Inguinal hernia Rujuk Vertikal
- Pulpitis Rujuk Vertikal
Hyperemesis gravidarum with

- metabolic disturbance Rujuk Vertikal
- Surgical follow-up care, Rujuk Vertikal

unspecified
- Benign neoplasm of prostate Rujuk Vertikal

- Gastric ulcer Rujuk Vertikal
- Arthritis, unspecified Rujuk Vertikal
- Nasal polyp, unspecified Rujuk Vertikal

unspecified
- Chronic kidney disease Rujuk Vertikal
- Neonatal jaundice, unspecified Rujuk Vertikal
- Neonatal jaundice, unspecified Rujuk Vertikal
- Glaucoma Rujuk Vertikal

- Low vision, both eyes Rujuk Vertikal

- Infective dermatitis Rujuk Vertikal
- Inflammation of eyelid, Rujuk Vertikal

unspecified
- Prolonged pregnancy Rujuk Vertikal
- Pulp degeneration Rujuk Vertikal
Unspecified diabetes mellitus Diabetes Mellitus Diabetes Mellitus

Congenital malformation of
- cardiac septum, unspecified Rujuk Vertikal
- Intervertebral disc disorder, Rujuk Vertikal

unspecified
Unspecified diabetes mellitus Diabetes Mellitus
- without complications Rujuk Vertikal

unspecified
unspecified
- Status asthmaticus Rujuk Vertikal

unspecified
- Retained dental root Rujuk Vertikal
- Other chronic suppurative otitis Rujuk Vertikal

media
- Other bacterial intestinal Rujuk Vertikal
infections
PNS DAERAH Cataract, unspecified Rujuk Vertikal
- Congestive heart failure Rujuk Vertikal Hipertensi Hipertensi
- Cervical root disorders, not Rujuk Vertikal

elsewhere classified
Unspecified haemorrhoids with
- other complications Rujuk Vertikal
- Chronic mucoid otitis media Rujuk Vertikal
PBI (APBN) Stroke, not specified as Rujuk Vertikal

PBI (APBN) Gastric ulcer Rujuk Vertikal
- Fracture of lower leg, including Rujuk Vertikal

ankle
- Other benign neoplasm of Rujuk Vertikal
connective and other soft tissue
of head, face and neck
PEKERJA MANDIRI Diabetes Mellitus

Gastric ulcer Rujuk Vertikal Hipertensi Hipertensi
unspecified
- Schizophrenia, unspecified Rujuk Vertikal
- Enteroviral vesicular pharyngitis Rujuk Vertikal
- Atrophy of thyroid (acquired) Rujuk Vertikal

unspecified
- Unspecified diabetes mellitus Rujuk Vertikal
PEKERJA MANDIRI Congestive heart failure Rujuk Vertikal
PEKERJA MANDIRI Rheumatoid arthritis, Rujuk Vertikal

unspecified
PEKERJA MANDIRI Intervertebral disc disorder, Rujuk Vertikal
unspecified
Other benign neoplasms of
- connective and other soft tissue Rujuk Vertikal
PBI (APBN) Hyperplasia of prostate Rujuk Vertikal
PBI (APBN) Malignant neoplasm of breast Rujuk Vertikal
- Hyperplasia of prostate Rujuk Vertikal
PENERIMA PENSIUN Necrosis of pulp Rujuk Vertikal

PNS

PBI (APBN) other treatment for other Rujuk Vertikal
conditions
PBI (APBN) bacteriologically and Rujuk Vertikal

unspecified
unspecified
- Benign neoplasm of breast Rujuk Vertikal

- Other specified erythematous Rujuk Vertikal
conditions
- Fractures of other parts of femur Rujuk Vertikal
- Supervision of pregnancy with Rujuk Vertikal
other poor reproductive or
obstetric history
- Retention of urine Rujuk Vertikal
PEKERJA MANDIRI Renovascular hypertension Rujuk Vertikal
PBI (APBD) Low vision, both eyes Rujuk Vertikal
Chronic obstructive pulmonary

- disease, unspecified Rujuk Vertikal
- Rheumatoid arthritis, Rujuk Vertikal

unspecified
conditions

conditions
PEKERJA MANDIRI Thyrotoxicosis, unspecified Rujuk Vertikal

unspecified
- Idiopathic peripheral autonomic Rujuk Vertikal
neuropathy
conditions
vapours
PBI (APBN) Congestive heart failure Rujuk Vertikal
- Renovascular hypertension Rujuk Vertikal
- Other orthopaedic follow-up Rujuk Vertikal

care
- Fever of other and unknown Rujuk Vertikal
origin
- Other specified disorders of Rujuk Vertikal
bone, other site
PENERIMA PENSIUN Unspecified diabetes mellitus
PNS with unspecified complications Rujuk Vertikal
- Thyroiditis, unspecified Rujuk Vertikal

PBI (APBN) disease, unspecified Rujuk Vertikal
- Malignant neoplasm of breast Rujuk Vertikal
- Thyroiditis, unspecified Rujuk Vertikal

unspecified
PBI (APBN) Status asthmaticus Rujuk Vertikal
- Haemorrhage in early Rujuk Vertikal

pregnancy
- Periodontosis Rujuk Vertikal
PBI (APBN) Pterygium Rujuk Vertikal
PBI (APBN) Epilepsy Rujuk Vertikal
- Urethral stricture, unspecified Rujuk Vertikal
PBI (APBN) Chronic kidney disease Rujuk Vertikal

- Thyrotoxicosis, unspecified Rujuk Vertikal

PBI (APBN) Gastric ulcer Rujuk Vertikal
- Epilepsy, unspecified Rujuk Vertikal
- Necrosis of pulp Rujuk Vertikal
- Other dermatitis Berobat Jalan
PBI (APBN) Chronic kidney disease Rujuk Vertikal
Other disorders of gingiva and

- edentulous alveolar ridge Berobat Jalan
- Myalgia Berobat Jalan

- Dyspepsia Berobat Jalan
- Benign neoplasm of breast Rujuk Vertikal
- Fever of other and unknown Berobat Jalan

origin
- Acute nasopharyngitis [common Berobat Jalan

cold]

origin
- Low vision, one eye Rujuk Vertikal
PENERIMA PENSIUN Uterovaginal prolapse, Rujuk Vertikal

PNS unspecified
- Rheumatoid arthritis, Rujuk Vertikal Hipertensi

unspecified
- Unspecified diabetes mellitus Rujuk Vertikal
with coma
PBI (APBN) with unspecified complications Rujuk Vertikal
Other benign neoplasm of

- connective and other soft tissue, Rujuk Vertikal
unspecified
- Maternal care for disproportion, Rujuk Vertikal
unspecified
unspecified
unspecified
PBI (APBN) Low back pain Rujuk Vertikal
PBI (APBN) bacteriologically and Rujuk Vertikal
PBI (APBN) Infective dermatitis Rujuk Vertikal
- Myositis ossificans traumatica Rujuk Vertikal
- Endometriosis, unspecified Rujuk Vertikal


- Parkinson's disease Rujuk Vertikal

PBI (APBN) Congestive heart failure Rujuk Vertikal Hipertensi Hipertensi



conditions



unspecified
- Other disorders of middle ear Rujuk Vertikal
and mastoid

cold]
origin
origin
- Calculus of kidney and ureter Rujuk Vertikal

- Prurigo nodularis Rujuk Vertikal
- Gangrene, not elsewhere Rujuk Vertikal

classified

obstetric history

vapours
cold]
cold]
PENERIMA PENSIUN Stroke, not specified as Rujuk Vertikal

PNS haemorrhage or infarction
PENERIMA PENSIUN Renovascular hypertension Rujuk Vertikal Hipertensi
PNS
PENERIMA PENSIUN Intervertebral disc disorder, Rujuk Vertikal
TNI unspecified
PNS unspecified
PENERIMA PENSIUN Low vision, both eyes Rujuk Vertikal

TNI
- Gastro-oesophageal reflux Berobat Jalan
disease

of abdomen
- Orthopaedic follow-up care, Rujuk Vertikal

unspecified


cold]
- Epilepsy Rujuk Vertikal
- Acute upper respiratory Berobat Jalan Diabetes Mellitus Diabetes Mellitus

infection, unspecified
PEGAWAI SWASTA Congestive heart failure Rujuk Vertikal Hipertensi
- Intervertebral disc disorder, Rujuk Vertikal Diabetes Mellitus Diabetes Mellitus

unspecified

origin
- Orthopaedic follow-up care, Rujuk Vertikal

unspecified
- Acute upper respiratory Berobat Jalan
- Fracture at wrist and hand level Rujuk Vertikal

origin
PBI (APBN) Congenital malformation of Rujuk Vertikal

heart, unspecified
PEKERJA MANDIRI Dyspepsia Berobat Jalan

origin
- Hydrocephalus Rujuk Vertikal

origin

cold]

- other treatment for other Berobat Jalan
conditions
cold]
- Acute nasopharyngitis [common Berobat Jalan Diabetes Mellitus Diabetes Mellitus
cold]
- Other specified pleural Rujuk Vertikal
conditions
cold]
cold]
- Headache Berobat Jalan

conditions
cold]
cold]
- Fracture of vault of skull Rujuk Vertikal


cold]

- Low back pain Rujuk Vertikal

cold]
cold]
cold]
- Essential (primary) hypertension Berobat Jalan

cold]
- Arthritis, unspecified Berobat Jalan

cold]
unspecified
cold]
origin
cold]
- Unspecified injury of ankle and Rujuk Vertikal

foot
TNI unspecified
Other specified intervertebral
- disc displacement Rujuk Vertikal

unspecified
Other specified chronic
- obstructive pulmonary disease Berobat Jalan
- Cataract, unspecified Rujuk Vertikal
- Shoulder lesions Rujuk Vertikal

cold]
- Dyspepsia Berobat Jalan Hipertensi

cold]
- Supervision of normal Berobat Jalan
pregnancy
- Malignant neoplasm of skin, Rujuk Vertikal

unspecified
conditions
- Pulpitis Berobat Jalan

unspecified

cold]
pregnancy
- Acute nasopharyngitis [common Berobat Jalan Hipertensi
cold]
- Status asthmaticus Berobat Jalan

cold]
cold]
unspecified
- Surgical follow-up care, Rujuk Vertikal
unspecified
- Thyrotoxicosis, unspecified Rujuk Vertikal Hipertensi Hipertensi

obstetric history
- Malignant neoplasm of colon, Rujuk Vertikal

unspecified
PBI (APBN) Abdominal and pelvic pain Rujuk Vertikal
Unspecified haemorrhoids with

- other complications Rujuk Vertikal

cold]
PENERIMA PENSIUN
SWASTA Congestive heart failure Rujuk Vertikal

cold]
cold]
- Disorder of globe, unspecified Rujuk Vertikal Hipertensi

- Adhesive capsulitis of shoulder Rujuk Vertikal

origin
cold]
pregnancy
- Disorders of trigeminal nerve Rujuk Vertikal

cold]
pregnancy

cold]
cold]
cold]
conditions
- Fever, unspecified Berobat Jalan
- Hypospadias, unspecified Rujuk Vertikal

pregnancy
- Respiratory disorder, Rujuk Vertikal
unspecified
- Arthrosis, unspecified Rujuk Vertikal

unspecified
- Inguinal hernia Rujuk Vertikal
- Disease of digestive system, Rujuk Vertikal

unspecified
unspecified

origin
Other symptoms and signs

- concerning food and fluid intake Rujuk Vertikal
- Cough Berobat Jalan
- Senile cataract Rujuk Vertikal

cold]
cold]
unspecified


cold]

cold]
- Low back pain, site unspecified Rujuk Vertikal
- Infective dermatitis Berobat Jalan
Other specified intervertebral

- disc displacement Rujuk Vertikal
- bacteriologically and Berobat Jalan

conditions

cold]
- Other arthritis Berobat Jalan
- Myalgia Berobat Jalan Hipertensi
- Twin pregnancy Rujuk Vertikal
PBI (APBN) Acute nasopharyngitis [common Berobat Jalan

cold]
PEKERJA MANDIRI Hypertensive heart disease Rujuk Vertikal

- disease, unspecified Berobat Jalan

cold]
PEGAWAI SWASTA Stroke, not specified as Rujuk Vertikal

Disorders of conjunctiva in
- diseases classified elsewhere Rujuk Vertikal
Unspecified diabetes mellitus Diabetes Mellitus Diabetes Mellitus


cold]
PBI (APBN) Malignant neoplasm of breast Rujuk Vertikal

conditions
- Myalgia Berobat Jalan Hipertensi Hipertensi

cold]
cold]

Disorder of gingiva and
- edentulous alveolar ridge, Rujuk Vertikal
unspecified
- Acute sinusitis, unspecified Rujuk Vertikal

cold]
unspecified
- Other cataract Rujuk Vertikal

unspecified
conditions
cold]
- Fever of other and unknown Rujuk Vertikal
origin
- Traumatic amputation of part of Rujuk Vertikal

head
PENERIMA PENSIUN Unspecified diabetes mellitus
PNS with unspecified complications Rujuk Vertikal
PENERIMA PENSIUN Low vision, both eyes Rujuk Vertikal

PNS
PNS DAERAH Secondary hypertension, Rujuk Vertikal
unspecified
- Glaucoma, unspecified Rujuk Vertikal
PENERIMA PENSIUN Chronic obstructive pulmonary

PNS disease, unspecified Rujuk Vertikal

cold]
PBI (APBN) Acute nasopharyngitis [common Berobat Jalan
cold]
- Fracture of femur Rujuk Vertikal

pregnancy

pregnancy
PBI (APBN) Renovascular hypertension Rujuk Vertikal Hipertensi Hipertensi

pregnancy
cold]
- Pre-eclampsia, unspecified Rujuk Vertikal
Systemic lupus erythematosus,

- unspecified Rujuk Vertikal
Other acute upper respiratory

- infections of multiple sites Berobat Jalan

unspecified
pregnancy
conditions
cold]
unspecified

pregnancy
PEGAWAI SWASTA Fever of other and unknown Rujuk Vertikal
origin
PEKERJA MANDIRI Chronic obstructive pulmonary

disease, unspecified Rujuk Vertikal
- Follow-up examination after Rujuk Vertikal

unspecified treatment for other
conditions
cold]
cold]
- Arthritis, unspecified Berobat Jalan Diabetes Mellitus Diabetes Mellitus
- Heart failure Rujuk Vertikal

PBI (APBD) with unspecified complications Rujuk Vertikal
- Haemorrhage in early Rujuk Vertikal

pregnancy, unspecified

cold]
- Thyrotoxicosis, unspecified Rujuk Vertikal
- Acute serous otitis media Rujuk Vertikal
- Maternal care for transverse Rujuk Vertikal

and oblique lie
- other treatment for other Rujuk Vertikal Hipertensi
conditions
- Counselling, unspecified Berobat Jalan

unspecified
PBI (APBN) Intervertebral disc disorder, Rujuk Vertikal
unspecified

- Other and unspecified Rujuk Vertikal

hydronephrosis
- Hyperhidrosis Rujuk Vertikal
PEGAWAI SWASTA Gastric ulcer Rujuk Vertikal

obstetric history
- Keloid scar Rujuk Vertikal

unspecified
- Foreign body in ear Rujuk Vertikal

Tuberculosis of lung, Diabetes Mellitus Diabetes Mellitus

- Follow-up care involving Rujuk Vertikal

removal of fracture plate and
other internal fixation device
Maternal care for other

- conditions predominantly Rujuk Vertikal
related to pregnancy
unspecified

PNS unspecified
- Unspecified diabetes mellitus Berobat Jalan
PBI (APBN) Dyspepsia Berobat Jalan

- Unspecified haematuria Rujuk Vertikal

cold]
- Foreign body in cornea Rujuk Vertikal
PBI (APBN) Schizophrenia, unspecified Rujuk Vertikal
- Essential (primary) hypertension Berobat Jalan Hipertensi
- Acute upper respiratory Berobat Jalan Hipertensi Hipertensi


PBI (APBN) Thyrotoxicosis [hyperthyroidism] Rujuk Vertikal

conditions
- Chronic ischaemic heart Rujuk Vertikal

disease, unspecified
- Abdominal and pelvic pain Rujuk Vertikal
PEKERJA MANDIRI Unspecified diabetes mellitus Diabetes Mellitus Diabetes Mellitus

with unspecified complications Rujuk Vertikal

conditions

- Disorder of external ear, Rujuk Vertikal

unspecified
unspecified


origin
- Neonatal jaundice, unspecified Berobat Jalan



- Stroke, not specified as Rujuk Vertikal Hipertensi
- Rheumatic heart disease, Rujuk Vertikal
unspecified
- Arthritis, unspecified Berobat Jalan Hipertensi
- Unspecified injury of ankle and Rujuk Vertikal

foot

unspecified

unspecified
- Infective dermatitis Rujuk Vertikal Hipertensi
PEKERJA MANDIRI Low vision, both eyes Rujuk Vertikal
PEKERJA MANDIRI Unspecified diabetes mellitus Diabetes Mellitus Diabetes Mellitus

with unspecified complications Rujuk Vertikal
Unspecified viral infection Rujuk Vertikal

PEKERJA MANDIRI characterized by skin and
mucous membrane lesions

conditions

Congenital absence, atresia and

- stenosis of anus with fistula Rujuk Vertikal
Hypertensive heart disease

- without (congestive) heart Rujuk Vertikal
failure
- Hemiplegia Rujuk Vertikal
PNS DAERAH Renovascular hypertension Rujuk Vertikal
- Peptic ulcer, site unspecified Rujuk Vertikal
- Peptic ulcer, site unspecified Rujuk Vertikal
- Adhesive capsulitis of shoulder Rujuk Vertikal
- Status asthmaticus Berobat Jalan Hipertensi

PBI (APBN) Low back pain Rujuk Vertikal


cold]
PEKERJA MANDIRI Unspecified abdominal hernia Rujuk Vertikal
PBI (APBN) Gastric ulcer Rujuk Vertikal Hipertensi Hipertensi

cold]
cold]

unspecified
PBI (APBN) Cough Berobat Jalan
Other benign neoplasms of

- Chronic kidney disease Rujuk Vertikal Hipertensi Hipertensi

cold]
unspecified
PBI (APBN) Low vision, both eyes Rujuk Vertikal

PBI (APBN) Surgical follow-up care, Rujuk Vertikal Diabetes Mellitus

unspecified

origin
unspecified

PEKERJA MANDIRI Stroke, not specified as Rujuk Vertikal


origin

cold]

cold]
PENERIMA PENSIUN Acute nasopharyngitis [common Berobat Jalan
TNI cold]
- Acute renal failure, unspecified Rujuk Vertikal
PENERIMA PENSIUN Stroke, not specified as Rujuk Vertikal

PNS haemorrhage or infarction
PNS DAERAH Renovascular hypertension Rujuk Vertikal
- Asthma Berobat Jalan

cold]
cold]
cold]
cold]
cold]

conditions
cold]
- Endometrial glandular Rujuk Vertikal
hyperplasia
Gastro-oesophageal laceration-
- haemorrhage syndrome Rujuk Vertikal
- Fracture of patella Rujuk Vertikal

pregnancy

- without complications Rujuk Vertikal Hipertensi
- Myasthenia gravis and other Rujuk Vertikal

myoneural disorders
- Other specified surgical follow- Rujuk Vertikal
up care
conditions

cold]

- Follicular cyst of ovary Rujuk Vertikal
- Heart failure, unspecified Rujuk Vertikal
- Vitreous syndrome following Rujuk Vertikal

cataract surgery

cold]
pregnancy
- Impacted teeth Rujuk Vertikal
- Diarrhoea and gastroenteritis of Berobat Jalan

presumed infectious origin
PNS DAERAH Chronic ischaemic heart Rujuk Vertikal

disease
- Fracture of lower leg, including Rujuk Vertikal

ankle
- Benign neoplasm of prostate Rujuk Vertikal Hipertensi

PNS DAERAH with unspecified complications Rujuk Vertikal

obstetric history

origin


cold]


cold]
- Congestive heart failure Berobat Jalan
- Other and unspecified cirrhosis Rujuk Vertikal
of liver
- Congestive heart failure Berobat Jalan
- Urethral stricture, unspecified Rujuk Vertikal

cold]
PNS PUSAT Keratitis, unspecified Rujuk Vertikal
PEGAWAI SWASTA Tuberculosis of lung,

bacteriologically and Rujuk Vertikal
PEKERJA MANDIRI Stroke, not specified as Rujuk Vertikal
PEKERJA MANDIRI Congestive heart failure Berobat Jalan
PEKERJA MANDIRI Acute nasopharyngitis [common Berobat Jalan
cold]
cold]
cold]
vapours
Congenital malformation of
- urinary system, unspecified Rujuk Vertikal
- Dislocation, sprain and strain of Rujuk Vertikal

joints and ligaments of shoulder
girdle

conditions
- Acute appendicitis, unspecified Rujuk Vertikal

cold]
- Diarrhoea and gastroenteritis of Berobat Jalan
presumed infectious origin

origin

September

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TANGGAL TANGGAL JENIS

NO NO KUNJUNGAN PELAYANAN ENTRI NO KARTU NAMA PESERTA KELAMIN

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