DAFTAR PROLANIS DAN PRB

KLINIK RESTU IBU PEJATEN

SEPTEMBER 2022
TGL &TTD TTD KETERANGAN
NO NAMA PASIEN DIAGNOSA NO BPJS OBAT
PENGAMBILAN PETUGAS (NO HP)
METFORMIN 500MG
1 DWI SUPRIYANTO DM 2 0001739396046 3X1 (90) GLIMEPIRIDE
2MG 1X1 (30)
MINIASPI 80MG 1X1
(30)
TANAPRES 5MG 1X1
(30)
CONCOR 2,5MG 1X1
2 TN. KARNO DS. SH HT 0000043249206 087881594556
(30)
NITROKAF 2,5MG 2X1
(60)
SIMVASTATIN 20MG
(30) 1X1
ADALAT OROS 30MG
1X1 (30)
3 TATI ROHAYATI HT GR 2 0001210532084 CONCOR 5MG 1X1 (30) 081281725656
VASALTRAN 80MG
1X1 (30)
SYMBICORT 160 2X1
4 SITI HODIJAH ASMA 0001228653516 087784492404
(60)
AMLODIPINE 10MG
085887737655
1X1 (30)
5 NY. IRMA SANANTI HT 0001228096168
SIMVASTATIN 10MG
(30)
6 SULARSIH DM 0000037849972 METFORMIN 500MG 081808532402
2X1 (60)
SIMVASTATIN 10MG
1X1 (30)
GLIMEPIRIDE 1MG
 (30) 1X1
AMLODIPIN 10MG 1X1
(30)
ATYPICAL CHEST CONCOR 1,25MG 1X1
7 NY. NURHELINDA 0001457640595 085289485820
PAIN (30)
SIMVASTATIN 20MG
(30)
GLIMEPIRIDE 2MG
1X1 (30)
METFORMIN 500MG
3X1 (90)
AMLODIPIN 5MG 1X1 088291826848
8 ETTY ROHANAH DM HT 0001880200462
(30)
CANDESARTAN 8MG
(30)
SIMASTATIN 20MG
(30)
AMLODIPIN 5MG 1X1
(30)
CAPTOPRIL 12,5MG
9 JAMILAH HT 0001624752786 085880403301
2X1 (60)
SIMVASTATIN 20MG
1X1 (30)
AMLODIPIN 10MG 1X1
NY. SITI (30)
10 HT 0000043249217 087881594556
MAKSUDAH VALSARTAN 80MG
1X1 (30)
081290218636
BISOPROLOL 5MG
11 HJ. SUNARTI HT 0001131226885
1X1 (30)
12 NY. WATIYEM HT 0002035213986 AMLODIPINE 5MG 081295404199
1X1 (30)
LISINOPRIL 10MG 1X1
(30)
CONCOR 2,5MG 1X1
(30)
 VITAMIN B COMPLEX
1X1 (30)
CONCOR 2,5 1X1 (30)
CANDESARTAN 8MG
1X1 (30)
13 HJ. SUPRIYATI APS, HT, OA 0001896846827 SIMVASTATIN 20MG
1X1 (30)
VITAMIN B COMPLEX
1X1 (30)
AMLODIPINE 10MG
1X1 (30)
14 NY. RUMINI HT 0000042226187
SIMVASTATIN 20MG
1X1 (30)

LANTUS 1X20UNIT (2)

NOVORAPID
3X15UNIT (5)
B12 3X1 (90) 087804637322
DM AMLODIPIN 10MG 1X1
15 ONI FATIMAH 0002263039514
(30)
VALSARTAN 80MG
1X1 (30)
SIMVASTATIN 20MG
1X1 (30)
METFORMIN 500MG
1X1 (30)
DILTIAZEM 30MG 1X1
(30)
CONCOR 2,5MG 1X1
(30) 085289438583
16 MASITAH ARBI DM 0002047847321
NITROKAF 2,5MG 2X1
(60)
CLOPIDOGREL 75MG
1X1 (30)
SIMVASTATIN 20MG
1X1 (30)
 METFORMIN 500MG
1X1 (30)
MELOXICAM 15MG
1X1 (10)
CANDESARTAN 16MG
1X1 (30)
V-BLOCK 6,05MG 2X1
(60) 085289793427
17 ZURAIDAH ARBI DM 0000037405271 CLONIDIN 0,15MG 2X1
(60)
AMLODIPIN 10MG 1X1
(30)
HCT 25MG 1X1/2 (15)
SIMVASTATIN 10MG
1X1 (30)
APTOR 100MG 1X1
(30)
AMLODIPIN 10MG 1X1
(30)
18 TN. TUGIMAN HT 0002066181658
SIMVASTATIN 20MG
1X1 (30)
ADALAT OROS 30MG
NY. RATNI 1X1 (30)
19 HT 0000210068717 08170836071
HERMAN SIMVASTATIN 20MG
(30) 1X1
AMLODIPIN 10MG 1X1
(30)
20 JUMADI DM 0000367157946 0895369846301
METFORMIN 850MG
3X1 (90)
AMLODIPIN 10MG 1X1
(30)
DRS. H. OESMAN VIT B COMPLEX 2X1
21 HT 0000043273811
MAS (30)
SIMVASTATIN 20MG
1x1 (30)
22 DJUNARTI HT 0001212845308 AMLODIPINE 5MG
 1X1 (30)
SIMVASTATIN 20MG
(30) 1X1
METFORMIN 500MG
2X1 (60)
DRS. WANA DJAJA DM 2, SIMVASTATIN 10MG 087882952468
23 0000045874888
K HIPERLIPIDEMIA 1X1 (30)
AMLODIPINE 5MG
(30) 1X1
AMLODIPINE 10MG
1X1 (30)
VALSARTAN 80MG
1X1 (30) 083890702487
24 MERDEKAWATI DM, HT, OA 0000043384509
METFORMIN 500MG
3X1 (90)
SIMVASTATIN 20MG
(30)
AMLODIPINE 5MG
1X1 (30)
25 HASANAH DM 0002196954189
SIMVASTATIN 20MG
1X1 (30)
SYAMSUDIN
26 HHD 0000043309563 KENDARON 1X1 (30) 082116978358
BANTO
AMLODIPINE 5MG
1X1 (30)
GLIMEPIRIDE 3MG
1X1 (30)
METFORMIN 500MG
MARULI DM2, NEUROPATI,
27 0001460519212 3X1 (90) 085289485820
SIHOMBING HT, DISLIPIDEMIA
SIMVASTATIN 10MG
1X1 (30)
VIT B COMPLEX 1X1
(30)
MINIASPI 80 1X80 (30)
28 IR. SUROTO HT 0001228656374 ASPILET 80MG 1X1 08129259621
(30)
 CLONIDINE 0,075 2X1
(60)
AMLODIPINE 5MG
1X1 (30)
CANDESARTAN 8MG
1X1 (30)
METFORMIN 500MG
3X1 (90)
GLIMEPIRID 3MG 1X1
29 TN. SUGIYONO DM 2 0001212197578
(30)
SIMVASTATIN 20MG
1X1 (30)
CANDESARTAN 16MG
1X1 (30)
CONCOR 2,5MG 1X1
30 NY. SITI MARIYAM HHD 0001633618348
(30)
ADALAT OROS 30 1X1
(30)
GLIBENCLAMIDE
5MG 1X1 (30)
METFORMIN 500MG
2X1 (60)
31 BUDIYONO UNSPECIFIED DM 0001733614942
AMLODIPINE 10MG
1X1 (30)
CANDESARTAN 16MG
1X1 (30)
AMLODIPIN 10MG 1X1
(30)
MODESTA BR RAMIPRIL 10MG 1X1
32 HHD 0001630264904 081316888502
SIMAMORA (30)
SIMVASTATIN 20MG
1X1 (30)
33 NY. SUMIHAR HT CAD 0000043005802 AMLODIPIN 10MG 1X1 082164568488
DOLOKSARIBU (30)
MINIASPI 80MG 1X1
(30)
 CANDESARTAN 16
MG 1X1 (30)
NITROKAF 2,5MG 2X1
(60)
ALPRAZOLAM 0,5MG
1X1 (30)
CLONIDIN 0,15MG 2X1
(60)
MICARDIS 40MG (30)
SIMVASTATIN 20MG
(30)
CANDESARTAN 8MG
1X1 (30)
BISOPROLOL 5MG
34 TN. MUHAMAD ALI HHD 0000043265946 1X1 (30) 089654329245
ADALAT OROS 30MG
1X1 (30)
MINIASPI 80MG (30)
RAMIPRIL 10MG 1X1
(30)
AMLODIPIN 10MG 1X1
35 SRI NURYANI HT 0001228663539
(30)
SIMVASTATIN 20MG
1X1 (30)
ASPILET 80MG 1X1
(30)
36 TOMI HERMANTO CHEST PAIN 0001620626692 CONCOR 5MG 1X1 (30) 085880958559
NITROKAF 2X1 (60)
ISDN 5MG 1X1 (30)
CANDERSATAN 8MG
(30) 1X1
NITROKAF 2.5MG (30)
37 ELLINDA OTHMAL HT 0001860654655 081519462380
1X1
SIMVASTATIN 20MG
(30) 1X1
38 EMI NURDYATIN DM HT 0002305346332 METFORMIN 500MG 08161939119
 (90) AMLODIPIN 5MG
(30)
CLOPIDOGREL 75MG
(30) 1X1
AMLODIPIN 5MG (30)
1X1
BISOPROLOL 5MG (30)
39 ISMIYATUN CIHD 0000084517525 081252542421
1X1
DIOVAN 80MG (30)
1X1
SIMVASTATIN 20MG
(30) 1X1
GLIMEPIRIDE 1MG
(30) 1X1 METFORMIN
DM,
40 IR DJUNAIDI 0002072832039 500MG (60) 2X1
DISLIPIDEMIA
SIMVASTATIN 10MG
(30) 1X1
AMLODIPINE 5MG
1X1 (30)
CONCOR 2,5MG 1X1
(30)
41 MARWATIH HT 0002100999418 083878086732
CANDESARTAN 8MG
1X1 (30)
SIMVASTATIN 10MG
1X1 (30)
DIOVAN 80MG 1X1
(30)BISOPROLOL 5MG
42 LENA MARTHA APS HHD 0001316155612 081219197603
1X1 (30)SIMVASTATIN
20MG 1X1 (30)
43 SUDIARTO CAD APS 0001229256538 CONCOR 2,5MG 1X1 081219197603
(30)
DIOVAN 80MG 1X1
(30)
ISDN 5MG (10)K/P
SIMVASTATIN 20MG
1X1 (30)
 SIMARC 2MG 1X1 (30)
AMLODIPIN 10MG (30)
1X1
METFORMIN 500MG
(60) 2X1
44 SUMIHARTO DM TIPE 2, HT 0001374707013
CONCOR 2,5MG (30)
1X1
SIMVASTATIN 10MG
1X1 (30)
AMLODIPIN 5MG 1X1
45 JOKO LUWARSO HT 0001657961831 081314820908
(30)
ADALAT OROS 30MG
1X1 (30)
CANDESARTAN 16MG
46 SALHA HHD 0001212119943 085700010001
1X1 (30)
BISOPROLOL 5MG
1X1 (30)
.CONCOR 2.5MG 1X1
(30)
RAMIPRIL 2.5MG 1X1
(30)
CLOPIDOGREL 75MG
1X1 (30)
CHRONIC
SIMVASTATIN 20MG
ISOHAEMIC
47 M ZUHDI 0001421080119 1X1 (30) 082326892660
HEART DAN
ISDN (PRN) 10
DM + NEUROPATI
ACARBOSE 50MG (90)
3X1
GLICIAZIDE 80MG
(2X1) 60
GABAPENTIN 300MG
(30)
48 MUNAWAROH DM 0001836983788 GLIMEPIRID 3MG 1X1 085770873666
(30)
CANDESARTAN 8MG
1X1 (30)
 SIMASTATIN 20MG
(30)
HCT 25MG 1X1/2 (15)
METFORMIN 500MG
2X1 (60)
METFORMIN 850MG
2X1 (60)
GLIMEPIRID 1MG 1X1
(30)
RAMIPRIL 5MG 1X1
49 PARDJAN DM HT 0001212466419 081381655067
(30)
AMLODIPINE 10MG
1X1 (30)
SIMVASTATIN 20MG
(30)
TANAPRES 5MG 1X1
(30)
ADALAT OROS 30MG
1X1 (30)
51 RUSMIATI HT 0001212119921 08818070020
BISOPROLOL 5MG
1X1 (30)
METFORMIN 500MG
1X1 (30)
METFORMIN 500MG
3X1 (90)
53 NENI SHINTA DEWI UNSPECIFIED DM 0001845605417 GLIMEPIRIDE 2MG
1X1 (30)

AMLODIPIN 10MG 1X1

(30)
TANAPRES 5MG 1X1
55 ARY TRIANA SE HT 0001657961842 082114280506
(30)
CONCOR 2,5MG 1X1
(30)
57 BURHANUDDIN HHD 0001832532614 AMLODIPIN 10MG (30)
1X1
 MINIASPI 80MG (30)
1X1
CONCOR 2,5MG (15)
1X1/2
ADALAT OROS 30MG
(30) 1X1
RAMIPRIL 10MG (30) 081381002213
59 TRISULA K.W HHD 0001309404486
1X1 087885543355
SIMVASTATIN 20MG
(1X1)
AMLODIPIN 10MG (30)
1X1
BISOPROLOL 5MG (30)
1X1
GLIMEPIRIDE 2MG
60 BUDI HARTINI HT 0000041795087 085697512414
(30) 1X1
ALLOPURINOL 100MG
(30) 1X1
SIMVASTATIN 20MG
(1X1)
DIAMICRON 60MG
(30) 1X1
METFORMIN 500MG
(90) 3X1
ACARBOSE 100MG
62 LALU SANUSI NON-INSULIN DM 0000145345241 081850781695
(90) 3X1
AMLODIPIN 10MG (30)
1X1
SIMVASTATIN 10MG
(30) 1X1
AMLODIPIN 10MG (30)
1X1
63 DRS SUPRIADI HT 0001259736647 081316903646
SIMVASTATIN 20MG
(30)
64 WAWAN SUWANDA CHF 0001285513626 ASPILET 80MG (30) 087786550530
1X1
 SIMVASTATIN 20MG
(30) 1X1
LISINOPRIL 10MG (30)
1X1
CONCOR 2,5MG (30)
1X1
ISDN (PRN) 10
RAMIPRIL 10MG (30)
1X1
AMLODIPIN 10MG (30)
1X1
BISOPROLOL 5MG (30)
1X1
65 SUSI YENI HARI JANTUNG 0001261862436 083877196033
SIMVASTATIN 20MG
(30) 1X1
GLIMEPIRIDE 2MG
(30) 1X1
METFORMIN 500MG
(60) 2X1
AMLODIPIN 5MG (30)
1X1
MINIASPI 80MG (30)
1X1
BISOPROLOL 5MG (30)
66 DAMIRI HHD 0002092552211 1X1
CANDESARTAN 8MG
(30) 1X1
SIMVASTATIN 20MG
(30) 1X1
67 TONY SAPUTRA HT 0002141035481 CANDESARTAN 16MG 081219484552
(30) 1X1
AMLODIPIN 10MG (30)
1X1
ISDN 5MG (90) 3X1
BISOPROLOL 2,5MG
(30) 1X1
 SIMVASTATIN 20MG
(30)
GLIMEPIRIDE 3MG
(60) 2X1
68 MARYATI DM 0000045222985 085780570184
METFORMIN 500
(60) 2X1
ASETOSAL TAB 80MG
(30) 1X1
BISOPROLOL 10MG
(30) 1X1
69 HERMANSYAH CHD 0000038078919 087869717793
RAMIPRIL 5MG (30)
1X1
SIMVASTATIN 10MG
(30) 1X1
AMLODIPIN 5MG (30)
1X1
BISOPROLOL 1,25 (30)
1X1
70 BONG SAK MOY HT 0001795242868
CANDESARTAN 16MG
(30) 1X1
SIMVASTATIN 20MG
(30) 1X1
DILTIAZEM 30MG (60)
2X1
CANDERSATAN 8MG
71 NY ENI SYAMSIAH CHF, SVT 0001210796335 081381755573
(30) 1X1
CONCOR 10MG (30)
1X1
72 TN BUDIONO. SE HT 0002698594604 CLOPIDOGREL 75MG
(30) 1X1
SPIRONOLACTON
25MG (30) 1X1
SIMVASTATIN 20MG
(30) 1X1
RAMIPRIL 5MG (30)
1X1
 BISOPROLOL 2.5MG
(30)
MINIASPI 80MG (30)
1X1
AMLODIPINE 5MG
(30) 1X1
TANAPRES 5MG (30)
NY YETTI 1X1
73 HT 0001458118664 08176963502
WIDIASTUTI BISOPROLOL 5MG (30)
1X1
SIMVASTATIN 20MG
(30) 1X1
AMLODIPIN 10MG
(1X1) 30
74 TN SOEKOYO SH. HT 0000063110452 08176963502
CANDERSATAN 16MG
(1X1) 30