LAPORAN RUJUKAN PASIEN

NAMA PUSKESMAS : UPT PUSKESMAS CISOMPET

BULAN : JANUARI
TAHUN : 2022
UNIT : RAWAT JALAN

JENIS KELAMIN JENIS RUJUKAN

NO TGL NAMA PASIEN UMUR ALAMAT DIAGNOSA TUJUAN KET
L P UMUM BPJS SIJERUK JAMPERSAL UMUM
Conjunctival degenerations and
1 1/2/2022 RISTA MEIDA √ 26 SUKAMUKTI RS GUNTUR √
deposits (H11.1)
2 1/3/2022 GALIH JANUAR WIGANDRA √ 1 SUKANAGARA Other anaemias (D64) RSUD PMPK √

Disease of stomach and

3 1/3/2022 AI NURAISAH √ 15 DEPOK RSUD PMPK √
duodenum, unspecified (K31.9)

Stroke, not specified as

4 1/3/2022 ATANG KUSNAWAN √ 52 DEPOK RS NURHAYATI √
haemorrhage or infarction (I64)

Observation for suspected

5 1/3/2022 EMEN √ 68 CISOMPET RSUD PMPK √
tuberculosis (Z03.0)
Essential (primary) hypertension
6 1/3/2022 TITIN SATIAH √ 59 CISOMPET RSUD PMPK √
(I10)
Other and unspecified cirrhosis
7 1/3/2022 WAHYU √ 50 JATISARI RSUD PMPK √
of liver (K74.6)
8 1/3/2022 IDAS √ 54 JATISARI Female genital prolapse (N81) RSUD PMPK √
9 1/3/2022 SAROH √ 37 CISOMPET Prolonged pregnancy (O48) RSUD PMPK √

10 1/3/2022 MISKIAH √ 51 SUKAMUKTI Abdominal and pelvic pain (R10) RSUD PMPK √

11 1/3/2022 YAYAH √ 51 JATISARI Ganglion (M67.4) RSUD PMPK √

12 1/3/2022 OO √ 65 CISOMPET Congestive heart failure (I50.0) RSUD PMPK √

13 1/3/2022 ADANG √ 58 NEGLASARI Fracture of coccyx (S32.2) RSUD PMPK √

Surgical follow-up care,
14 1/3/2022 APIP JAENUDIN √ 43 NEGLASARI RSUD PMPK √
unspecified (Z48.9)

Neurofibromatosis
(nonmalignant) (Q85.0),
15 1/4/2022 HENDI √ 43 CISOMPET RSUD PMPK √
Essential (primary) hypertension
(I10)
16 1/4/2022 SUMARNI √ 38 MARGAMULYA Low back pain (M54.5) RS NURHAYATI √
Spontaneous abortion,
17 1/4/2022 RENI SUSANAWATI √ 39 NEGLASARI incomplete, without RSUD PMPK √
complication (O03.4)
 Angina pectoris, unspecified
18 1/4/2022 UMINAH √ 45 NEGLASARI RSUD PMPK √
(I20.9)
Unspecified diabetes mellitus
19 1/4/2022 AI IRMA YULIANTI √ 26 SINDANGSARI RSUD PMPK √
(E14)
Observation for suspected
20 1/5/2022 MARIA ULFA √ 23 SUKAMUKTI BKPM GARUT √
tuberculosis (Z03.0)
Pre-eclampsia, unspecified
21 1/5/2022 DETI SUDIANTI √ 41 SUKANAGARA RSUD PMPK √
(O14.9)
Supervision of normal pregnancy
22 1/5/2022 RILA ANAS TANISA √ 20 CIHAURKUNING RSUD PMPK √
(Z34)
23 1/6/2022 dayuni √ 69 CIAHURKUNING Cataract, unspecified (H26.9) RSUD GARUT √
24 1/6/2022 LENI TRIANI √ 15 SUKAMUKTI Thalassaemia (D56) RSUD PMPK √
Non-insulin-dependent diabetes
25 1/6/2022 E ROMLAH √ 65 CIAHURKUNING RSUD PMPK √
mellitus (E11)

Radiculopathy (M54.1),
26 1/7/2022 ADE HAERUDIN √ 59 CISOMPET RS NURHAYATI √
Spondylosis, unspecified (M47.9)

27 1/7/2022 OHIM √ 57 MARGAMULYA Inguinal hernia (K40) RSUD PMPK √

28 1/7/2022 NENI IRIANI √ 40 NEGLASARI Cholelithiasis (K80) RS ANISA QUEN √
Adhesive capsulitis of shoulder
29 1/8/2022 ENI SUMARNI √ 39 DEPOK RSUD PMPK √
(M75.0
30 1/8/2022 RIKA MARSELA √ 9 CISOMPET Nephrotic syndrome (N04) RSUD PMPK √

31 1/8/2022 IHAH SOLIHAH √ 59 CISOMPET Congestive heart failure (I50.0) RSUD PMPK √

32 1/8/2022 INKA KRISTI √ 22 JATISARI Prolonged pregnancy (O48) RSUD PMPK √

Prolonged second stage (of
33 1/9/2022 ROSTIKA √ 41 SUKANAGARA RSUD GARUT √
labour) (O63.1)
Essential (primary) hypertension
34 1/10/2022 AMINAH √ 38 CISOMPET RSUD PMPK √
(I10)
35 1/10/2022 ECEP √ 51 CISOMPET Sialoadenitis (K11.2) RSUD PMPK √

36 1/10/2022 JULI √ 76 CISOMPET Congestive heart failure (I50.0) RSUD PMPK √

Non-insulin-dependent diabetes
37 1/10/2022 KARMINI √ 69 SINDANGSARI RSUD PMPK √
mellitus (E11)

38 1/10/2022 UTEP LUKMAN HAKIM √ 34 NEGLASARI Congestive heart failure (I50.0) RSUD PMPK √

39 1/10/2022 ISNA NURUL NURANI √ 21 NEGLASARI Fibroadenosis of breast (N60.2) RSUD PMPK √

Other surgical follow-up care

40 1/10/2022 WILA WILASTRI √ 28 CISOMPET RSUD PMPK √
(Z48)

Chronic ischaemic heart disease

41 1/10/2022 enung rukhyati √ 64 SUKANAGARA RSUD PMPK √
(I25), Dyspepsia (K30)
42 1/11/2022 IIN √ 63 CISOMPET Inguinal hernia (K40) RSUD PMPK √
Calculus of lower urinary tract,
43 1/11/2022 NARSIAH √ 63 CISOMPET RSUD PMPK √
unspecified (N21.9)

44 1/11/2022 IMAS TASRIPAH √ 57 SUKAMUKTI Congestive heart failure (I50.0) RS NURHAYATI √

Necrosis of pulp (K04.1),

45 1/12/2022 APAN AS'ARI √ 40 SUKANAGARA Cellulitis and abscess of mouth RSUD PMPK √
(K12.2)

46 1/12/2022 HAYATI √ 55 NEGLASARI Congestive heart failure (I50.0) RSUD PMPK √

Other and unspecified

47 1/12/2022 ANIENDIA M P √ 7 NEGLASARI RSUD PMPK √
convulsions (R56.8)
48 1/12/2022 ADE HODIJAH √ 58 SINDANGSARI Glaucoma (H40) RS GUNTUR √

Arthrosis, unspecified (M19.9),

49 1/12/2022 TIEN KARTINI √ 67 SUKAMUKTI Other chronic suppurative otitis RSUD PMPK √
media (H66.3)

Chronic ischaemic heart disease

50 1/12/2022 A.D HIDAYAT √ 73 SUKAMUKTI RSUD PMPK √
(I25)
51 1/12/2022 ULFA NURAHMAN √ 24 Oligohydramnios (O41.0) RSUD PMPK √

52 1/12/2022 PIAT SUPRIATNA √ 40 DEPOK Chest pain, unspecified (R07.4) RSUD PMPK √

Peptic ulcer, site unspecified

53 1/13/2022 LINA MARLINA √ 38 CISOMPET RSUD PMPK √
(K27)
54 1/13/2022 KRISMAWATI √ 23 CISOMPET Acute lymphadenitis (L04) RSUD PMPK √
55 1/13/2022 KIRMAN YA MALIK √ 24 CISOMPET Inguinal hernia (K40) RSUD PMPK √

56 1/13/2022 EGI PERMANA √ 17 SUKAMUKTI Dental caries, unspecified (K02.9) RSUD PMPK √

Supervision of normal pregnancy

57 1/14/2022 MELINDA √ 33 DEPOK RSUD PMPK √
(Z34)

58 1/14/2022 NENG NURANI √ 30 SUKANAGARA Moderate pre-eclampsia (O14.0) RSUD PMPK √

Maternal care for disproportion,

59 1/14/2022 ERNAWATI √ 28 CISOMPET RSUD PMPK √
unspecified (O33.9)

60 1/15/2022 KOMARA √ 72 JATISARI Congestive heart failure (I50.0) RSUD PMPK √

Ulcerative colitis, unspecified

61 1/15/2022 ENCU √ 67 SINDANGSARI RSUD PMPK √
(K51.9)
MUHAMAD RIDWAN
62 1/17/2022 √ 18 CISOMPET Nephrotic syndrome (N04) RSUD PMPK √
GONZALES
Endometrial glandular
63 1/17/2022 FUJI LESTARI √ 22 NEGLASARI RSUD PMPK √
hyperplasia (N85.0)
 Other chronic suppurative otitis
64 1/17/2022 TIEN KARTINI √ 67 SUKAMUKTI media (H66.3), Unspecified RS NURHAYATI √
diabetes mellitus (E14)

Unspecified diabetes mellitus

65 1/17/2022 eutik juhayati √ 65 CISOMPET RSUD PMPK √
(E14)

Anaemia in chronic diseases

classified elsewhere (D63),
66 1/18/2022 hisyam algifari √ 1 CIAHURKUNING Respiratory tuberculosis, RSUD PMPK √
bacteriologically and
histologically confirmed (A15)

Pneumonia, organism
67 1/18/2022 ATA √ 55 JATISARI RSUD PMPK √
unspecified (J18)
68 1/18/2022 TITAN √ 43 JATISARI Somatization disorder (F45.0) RSUD PMPK √
69 1/18/2022 ENONG MARYATI √ 46 CISOMPET Dental caries (K02) RSUD PMPK √
Peptic ulcer, site unspecified
70 1/18/2022 SOPIAH √ 52 SINDANGSARI RSUD PMPK √
(K27)
Periapical abscess with sinus
71 1/18/2022 NINA MARLINA √ 29 CISOMPET RSUD PMPK √
(K04.6)
72 1/18/2022 MISKIAH √ 51 SUKANAGARA Low back pain (M54.5) RSUD PMPK √
Haemorrhage of anus and
73 1/18/2022 IKIN SODIKIN √ 65 NEGLASARI RS ANISA QUEN √
rectum (K62.5)
Systemic lupus erythematosus
74 1/19/2022 ARIS RIZKI MAULANA √ 10 NEGLASARI RSUD PMPK √
(M32)

75 1/19/2022 ARIP PERMANA √ 19 SUKAMUKTI Dental caries, unspecified (K02.9) RSUD PMPK √

76 1/19/2022 INA √ 31 NEGLASARI Threatened abortion (O20.0) RSUD PMPK √

Supervision of normal pregnancy
77 1/20/2022 ULFA NURAHMAN √ 24 SUKAMUKTI RSUD PMPK √
(Z34)
78 1/21/2022 DIANA R.S pamungkas √ 19 CISOMPET Impacted teeth (K01.1) RSUD PMPK √

79 1/22/2022 IIN √ 63 DEPOK Congestive heart failure (I50.0 RSUD PMPK √

Stroke, not specified as

80 1/24/2022 AAN √ 51 CISOMPET haemorrhage or infarction (I64) RS NURHAYATI √

81 1/24/2022 ASEP √ 56 SINDANGSARI Benign neoplasm of liver (D13.4) RSUD PMPK √

82 1/24/2022 NADIA ALISA AJAHRA √ 2 NEGLASARI Epilepsy (G40) RSUD PMPK √

Cutaneous abscess, furuncle and

83 1/24/2022 ITA PUSPITAWATI √ 37 CISOMPET RSUD PMPK √
carbuncle of buttock (L02.3)
 Status asthmaticus (J46),
84 1/24/2022 JAJANG ABDUL ROHMAN √ 57 PANYINDANGAN RSUD PMPK √
Sequelae of tuberculosis (B90)

Observation for suspected

85 1/24/2022 DEWI SRI WULAN SARI √ 35 SUKAMUKTI RSUD PMPK √
tuberculosis (Z03.0)
Thyrotoxicosis, unspecified
86 1/24/2022 LIPIA AGUSTINA √ 30 CISOMPET RSUD PMPK √
(E05.9
Follow-up examination after
87 1/24/2022 yayah √ 51 CISOMPET RSUD PMPK √
treatment of fracture (Z09.4)

88 1/24/2022 NENAH √ 61 MARGAMULYA Congestive heart failure (I50.0) RSUD PMPK √

Haemorrhage in early pregnancy

89 1/24/2022 INA √ 31 NEGLASARI RSUD PMPK √
(O20)
Chronic ischaemic heart disease
90 1/24/2022 UJANG HADIANA √ 53 JATISARI RSUD PMPK √
(I25)
91 1/24/2022 RATNA WULANSARI √ 27 SINDANGSARI Necrosis of pulp (K04.1) RSUD PMPK √
92 1/24/2022 ENDAH √ 72 CIAHURKUNING Low back pain (M54.5) RSUD PMPK √

93 1/25/2022 DEWI RUSTINI √ 40 DEPOK Benign neoplasm of breast (D24) RSUD PMPK √

Unspecified diabetes mellitus

94 1/25/2022 MALA √ 58 SUKANAGARA RSUD PMPK √
(E14)
Spondylolysis, lumbar region
95 1/25/2022 MISKIAH √ 51 CISOMPET RSUD PMPK √
(M43.06)
Follow-up examination after
96 1/25/2022 JAJANG RUDIAWAN √ 46 CIHAURKUNING other treatment for other BKPM GARUT √
conditions (Z09.8)
BAYI NYONYA SELY PUSPITA
97 1/26/2022 √ 0 CISOMPET Torticollis (M43.6) RSUD PMPK √
SARI
98 1/26/2022 rinrin pebriana √ 23 NEGLASARI Keloid scar (L91.0) RSUD PMPK √
Observation for suspected
99 1/26/2022 SYAMIL FAIQ ALBURHANI √ 0 CISOMPET BKPM GARUT √
tuberculosis (Z03.0)
Benign mammary dysplasia
100 1/26/2022 SELGIS APRIONITA √ 30 CIHAURKUNING RSUD PMPK √
(N60)
Observation for suspected
101 1/26/2022 FAWAZ ZAYN ALBURHANI √ 3 CISOMPET BKPM GARUT √
tuberculosis (Z03.0)

Blighted ovum and

102 1/26/2022 DEDE ROHAYATI √ 27 SUKANAGARA RSUD PMPK √
nonhydatidiform mole (O02.0)

Supervision of normal pregnancy

103 1/26/2022 YANI √ 21 CISOMPET RSUD PMPK √
(Z34)
Benign neoplasm of bronchus
104 1/27/2022 ahim burhanudin √ 49 DEPOK RSUD GARUT √
and lung (D14.3)
105 1/27/2022 ANGELINA PUTRI √ SUKAMUKTI Epilepsy (G40) RSUD PMPK √
106 1/27/2022 ENDANG KARTIWA √ 65 CIKONDANG Cholelithiasis (K80) RSUD PMPK √
107 1/27/2022 NIDA PAUZIAH MARTIKA √ 18 SINDANGSARI Anal polyp (K62.0 RSUD PMPK √
108 1/28/2022 ADI CAHYADI √ 35 DEPOK Myopia (H52.1) RS GUNTUR √
Other benign neoplasms of
109 1/28/2022 HERMIN SUSILAWATI √ 48 NEGLASARI connective and other soft tissue RSUD PMPK √
(D21)
Insulin-dependent diabetes
110 1/28/2022 TRIANI HOPIPAH √ 25 NEGLASARI RSUD PMPK √
mellitus (E10
Unspecified diabetes mellitus
111 1/29/2022 NIK MAWATI √ 38 SUKAMUKTI RSUD PMPK √
(E14)
Unspecified nonorganic
112 1/31/2022 ADE ISAM √ 24 CISOMPET RS GUNTUR √
psychosis (F29)
Malignant neoplasm of
113 1/31/2022 AGUS SUHERMAN √ 51 SINDANGSARI nasopharynx, unspecified RS NURHAYATI √
(C11.9)
114 1/31/2022 ENDAH √ 72 PANYINDANGAN Low back pain (M54.5) RSUD PMPK √
JUMLAH : 114
Pelaksana Rujukan Cisompet, 31 Januari 2022
Kepala UPT Puskesmas Cisompet

Ricky Wahyudi, S.KM dr. Titi Sari, M.Kes

NIP. 19760110 201412 2 001
 LAPORAN RUJUKAN PASIEN
NAMA PUSKESMAS : UPT PUSKESMAS CISOMPET
BULAN : FEBRUARI
TAHUN : 2022
UNIT : RAWAT JALAN

JENIS KELAMIN JENIS RUJUKAN

NO TGL NAMA PASIEN UMUR ALAMAT DIAGNOSA TUJUAN KET
L P UMUM BPJS SIJERUK JAMPERSAL UMUM
Abnormal uterine and vaginal
1 2/1/2022 MELSYA DWI LESTARI √ 26 CISOMPET RSUD PMPK √
bleeding, unspecified (N93.9)
2 2/2/2022 SHABIR AHMAD SADIQ √ 1 CISOMPET Granuloma annulare (L92.0) RSUD PMPK √
3 2/2/2022 E RUHIAT √ 62 SUKAMUKTI Low back pain (M54.5) RSUD PMPK √
Tuberculosis of other organs
4 2/2/2022 merlina cahaya putri √ 14 CIHAURKUNING RSUD PMPK √
(A18)

5 2/2/2022 NURUL PADILAH √ 13 CISOMPET Leukaemia, unspecified (C95.9) RSUD PMPK √

6 2/2/2022 ALDI MAULANA √ 21 JATISARI Inguinal hernia (K40) RSUD PMPK √

Maternal care for breech
7 2/2/2022 TITA ENDANG PERMATA √ 28 SUKANAGARA RSUD PMPK √
presentation (O32.1)
Observation for suspected
8 2/2/2022 NANI √ 60 NEGLASARI RSUD PMPK √
tuberculosis (Z03.0)
9 2/2/2022 SELI NURHAMIDAH √ 22 SINDANGSARI Hydatidiform mole (O01) RSUD PMPK √
Multiple dislocations of fingers
10 2/2/2022 RIANDA SAHRIL ROMADON √ 19 SUKAMUKTI RSUD PMPK √
(S63.2)

Blighted ovum and

11 2/3/2022 GITA AYUMIATI √ 28 JATISARI RSUD PMPK √
nonhydatidiform mole (O02.0)

Traumatic amputation of lower

limb, level unspecified (T13.6),
12 2/3/2022 OTIH √ 53 SINDANGSARI RSUD PMPK √
Non-insulin-dependent diabetes
mellitus (E11)

13 2/3/2022 AMELIA FASKA √ 29 SINDANGSARI Polyp of vagina (N84.2) RSUD PMPK √

Congestive heart failure (I50.0),
14 2/3/2022 TITA PUSPITA √ 67 SUKAMUKTI Polyneuropathy, unspecified RSUD PMPK √
(G62.9)

15 2/3/2022 DIAN NURYANI √ 18 SINDANGSARI Supervision of normal pregnancy RSUD PMPK √

(Z34)
16 2/3/2022 RIANDA SAHRIL ROMADON √ 19 CISOMPET Multiple dislocations of fingers RSUD PMPK √
(S63.2)
17 2/3/2022 SELI NURHAMIDAH √ 22 SUKANAGARA Hydatidiform mole (O01) RSUD PMPK √

18 2/3/2022 NANI √ 60 CISOMPET Observation for suspected RSUD PMPK √

tuberculosis (Z03.0)
19 2/4/2022 FARIDA GUSTINAWATI √ 44 NEGLASARI Diabetic retinopathy (H36.0) RS GUNTUR √

20 2/4/2022 ENTIN √ 65 NEGLASARI Fracture of lateral malleolus RSUD PMPK √

(S82.6)
21 2/6/2022 LASTRI √ 29 DEPOK Haemorrhage in early pregnancy RSUD PMPK √
(O20)
22 2/7/2022 DAROJAH √ 63 CIHAURKUNING Other benign neoplasms of RSUD PMPK √
uterus (D26)
23 2/7/2022 NURUL AWANAH √ 30 CIAHURKUNING Dental caries, unspecified RSUD PMPK √
(K02.9)

24 2/7/2022 SELI APUPIANTI √ 29 SUKAMUKTI Placenta praevia specified as RSUD PMPK √

without haemorrhage (O44.0)
25 2/7/2022 SURYATI √ 63 CIAHURKUNING RSUD PMPK √
Other disorders of thyroid (E07)
26 2/8/2022 LILIS KURAESIN √ 42 CISOMPET Other benign neoplasm of other RSUD PMPK √
parts of uterus (D26.7)
27 2/8/2022 adila izzatun nisa √ 0 CISOMPET Twin, born in hospital (Z38.3) RSUD PMPK √

28 2/8/2022 SUKIDAH √ 67 NEGLASARI Malignant neoplasm of breast RSUD PMPK √

(C50)
29 2/8/2022 DEWI PURNAMA SARI √ 42 DEPOK Supervision of normal pregnancy RSUD PMPK √
(Z34)
30 2/8/2022 NAYLA SUSANTO √ 1 CISOMPET Extremely low birth weight RSUD PMPK √
(P07.0)
31 2/8/2022 ATIN √ 61 CISOMPET Spondylosis (M47) RSUD PMPK √
32 2/8/2022 KOSIDIN √ 62 NEGLASARI Angina pectoris (I20) RSUD PMPK √

Unspecified abortion,
33 2/8/2022 LASTRI √ 29 SUKANAGARA incomplete, without RSUD PMPK √
complication (O06.4)
34 2/8/2022 IKE NURHAYATI √ 22 SUKAMUKTI Supervision of normal pregnancy RSUD PMPK √
(Z34)
35 2/8/2022 TIA √ 25 CISOMPET B20 RSUD PMPK √

36 2/9/2022 TATI √ 45 CISOMPET Peptic ulcer, site unspecified RSUD PMPK √

(K27)

37 2/9/2022 HOJAR √ 45 SINDANGSARI Community Acquired Pneumonia RSUD PMPK √

(J18.90), Essential (primary)
hypertension (I10)
38 2/9/2022 IKIN SODIKIN √ 65 NEGLASARI Malignant neoplasm of rectum RS ANISA QUEN √
(C20)
39 2/9/2022 ROSTIKA √ 57 NEGLASARI Dental caries, unspecified RSUD PMPK √
(K02.9)
40 2/10/2022 BAYI NYONYA POPI MARINA √ 0 CISOMPET Neonatal jaundice, unspecified RSUD PMPK √
(P59.9)
 Chronic ischaemic heart disease
41 2/10/2022 LOMRAH √ 55 SUKANAGARA (I25), Unspecified diabetes RSUD PMPK √
mellitus (E14)
42 2/10/2022 MELY MELANDANI √ 38 CISOMPET Hypokalaemia (E87.6) RSUD PMPK √

43 2/11/2022 weni √ 41 CISOMPET Unspecified diabetes mellitus RSUD PMPK √

(E14)
44 2/12/2022 MARYAMAH √ 57 SUKAMUKTI Sequelae of tuberculosis (B90) BKPM GARUT √

45 2/12/2022 DJUARIAH √ 75 SUKANAGARA Chronic ischaemic heart disease, RS NURHAYATI √

unspecified (I25.9)
46 2/14/2022 SEPTIYANA √ 2 CISOMPET Epilepsy (G40) RSUD PMPK √

47 2/14/2022 EMPAT √ 73 SINDANGSARI Osteoporosis, unspecified RSUD PMPK √

(M81.9)
48 2/14/2022 HENI YERHANI √ 37 CISOMPET Dental caries, unspecified RSUD PMPK √
(K02.9)
49 2/14/2022 CUCU √ 61 SUKAMUKTI Low back pain (M54.5) RSUD PMPK √
50 2/15/2022 RIZQI PUTRA NURSALIM √ 1 SUKAMUKTI Acute tonsillitis (J03) RSUD PMPK √

51 2/15/2022 IRSYAN NAUFA ARRAYAN √ 12 CISOMPET Observation for suspected RSUD PMPK √
tuberculosis (Z03.0)

Other benign neoplasms of

52 2/15/2022 ADE SURYATI √ 66 SINDANGSARI connective and other soft tissue RSUD PMPK √
(D21)

53 2/15/2022 merlina cahaya putri √ 14 CISOMPET Cutaneous abscess, furuncle and RSUD PMPK √
carbuncle, unspecified (L02.9)
54 2/15/2022 WIWIN SUMINAR √ 62 CISOMPET Unspecified diabetes mellitus RSUD PMPK √
(E14)

Other benign neoplasms of

55 2/15/2022 HERMIN SUSILAWATI √ 48 NEGLASARI connective and other soft tissue RSUD PMPK √
(D21)
56 2/15/2022 SOPADIANA √ 33 SUKAMUKTI RSUD PMPK √
Orchitis and epididymitis (N45)
57 2/15/2022 FAIZ PURNAMA MAULUD √ 21 DEPOK Abscess of anal and rectal RSUD PMPK √
regions (K61)
58 2/15/2022 AJAT SUDRAJAT √ 69 CIHAURKUNING Observation for suspected BKPM GARUT √
tuberculosis (Z03.0)
59 2/15/2022 SUNDINI √ 17 NEGLASARI RSUD PMPK √
Benign neoplasm of breast (D24)

60 2/16/2022 PANJI ADI WIJAYA √ 1 JATISARI Respiratory tuberculosis, BKPM GARUT √

bacteriologically and
histologically confirmed (A15)
61 2/16/2022 YAKUB SUPRIATNA √ 50 SUKANAGARA Chronic intestinal amoebiasis RSUD PMPK √
(A06.1)
62 2/16/2022 RIANA √ 21 CISOMPET Dental caries (K02) RSUD PMPK √
63 2/16/2022 SUTISNA √ 68 SUKAMUKTI RSUD PMPK √
Congestive heart failure (I50.0)
BAYI NYONYA SINTIa
64 2/17/2022 √ 0 NEGLASARI RSUD PMPK √
IRMAWATI Birth asphyxia (P21)
65 2/17/2022 LASTRI HANA FAUZIAH √ 23 DEPOK Other single delivery by RSUD PMPK √
caesarean section (O82.8)
66 2/17/2022 NENG FITRI HANDYANI √ 21 CIAHURKUNING Astigmatism (H52.2) RS GUNTUR √
67 2/18/2022 KODIR √ 59 JATISARI Inguinal hernia (K40) RSUD PMPK √
68 2/18/2022 ACENG DEDEN MUCHTAR √ 38 JATISARI B20 RSUD PMPK √

69 2/18/2022 M BILLKY FAREZA GUSTIANA √ 13 CISOMPET Essential (primary) hypertension RSUD PMPK √
(I10)
70 2/18/2022 m. taqy riyadhulfalhan al- √ 3 CISOMPET RSUD PMPK √
faqih Hydrocephalus (G91)
71 2/18/2022 BINTANG AHMAD TAOPIK √ 10 JATISARI Periapical abscess without sinus RSUD PMPK √
(K04.7)
72 2/18/2022 NONONG √ 57 SUKAMUKTI Unspecified diabetes mellitus RSUD PMPK √
(E14)
73 2/18/2022 TATI √ 61 NEGLASARI Anaemia, unspecified (D64.9) RSUD PMPK √
74 2/19/2022 carissa alnaira putri √ 3 CISOMPET Ileus, unspecified (K56.7) RSUD PMPK √

75 2/19/2022 A SUMARNI √ 60 CISOMPET RS NURHAYATI √

Congestive heart failure (I50.0)
76 2/19/2022 UCUM √ 54 PANYINDANGAN Hypermetropia (H52.0) RS GUNTUR √

77 2/21/2022 RIZQIA RAHMANIA PUTRI √ 0 SUKAMUKTI RSUD PMPK √

Pneumonia, unspecified (J18.9)
78 2/21/2022 MANSUR √ 60 JATISARI RSUD PMPK √
Acute myocardial infarction (I21)
79 2/21/2022 WASIDIN √ 71 SUKANAGARA Low back pain (M54.5) RSUD PMPK √

80 2/21/2022 LEMAN SULAEMAN √ 62 MARGAMULYA Fracture of lumbar spine and RSUD PMPK √
pelvis (S32)
81 2/21/2022 TATI √ 45 CISOMPET Anal polyp (K62.0) RSUD PMPK √

82 2/21/2022 BUDI HERLIMANSYAH √ 47 NEGLASARI Peptic ulcer, site unspecified RSUD PMPK √
(K27)

83 2/22/2022 ARVA NUR MAULANA √ 10 CISOMPET Examination and observation for RSUD PMPK √
unspecified reason (Z04.9)
84 2/22/2022 SIDIK √ 64 SUKAMUKTI Other intervertebral disc RSUD PMPK √
disorders (M51)

85 2/22/2022 SURYATI √ 52 CIKONDANG Examination and observation for BKPM GARUT √

other specified reasons (Z04.8)

Follow-up examination after

86 2/23/2022 KINANTI TRI ANDINI √ 5 JATISARI surgery for other conditions RSUD PMPK √
(Z09.0)
87 2/23/2022 M ALTHAF ALGHIFARI √ 1 CISOMPET Pneumonia, organism RSUD PMPK √
unspecified (J18)
88 2/23/2022 M. ALWI MAULANA √ 10 DEPOK Nephrotic syndrome (N04) RSUD PMPK √

Spontaenous abortion,
89 2/23/2022 SRI AMELIA DEWI √ 29 SUKANAGARA incomplete, with other and RSUD PMPK √
unspecified complications
(O03.3)

NABIL RABBANI ALFARIZI Examination and observation for

90 2/26/2022 √ 2 SUKAMUKTI RSUD PMPK √
WAHAB unspecified reason (Z04.9)

JUMLAH : 90

Cisompet, 28 Februari 2022 Pelaksana Rujukan

Kepala UPT Puskesmas Cisompet

dr. Titi Sari, M.Kes Ricky Wahyudi, S.KM

NIP. 19760110 201412 2 001