<table width=1200><tr><th colspan=15>REGISTER PUSKESMAS BANJARDAWA PER TANGGAL 26-

11-2022 </th></tr><tr>
<th>NO</th>
<th>NO RM</th>
<th>NAMA</th>
<th>NAMA KK</th>
<th>TGL LAHIR</th>
<th>JK</th>
<th>ALAMAT</th>
<th>RT</th>
<th>RW</th>
<th>CARA BAYAR</th>
<th>NO JAMINAN</th>
<th>POLI</th>
<th>PELAYANAN</th>
<th>DIAGNOSA</th>
<th>THERAPI</th>
</tr><tr><td valign=top>1</td><td valign=top>127406</td><td
valign=top>SULASTRI</td><td valign=top>kardiyan</td>
<td valign=top>1955-07-01</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>1</td><td valign=top>7</td><td valign=top>Jamkesda</td><td
valign=top>0000009122515</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [E11.9] Non-insulin-dependent diabetes
mellitus without complications</td><td>- METFORMIN TABLET 500 MG 10, 2x1 tablet,
<br>- GLIMEPIRIDE TABLET 4 MG 5, 1x1 tablet, <br>- AMLODIPIN TABLET 10 MG 5, 1x1
tablet, <br></tr><tr><td valign=top>2</td><td valign=top>127407</td><td
valign=top>MUDRIAH</td><td valign=top>SUGENG SUYONO</td>
<td valign=top>1953-12-01</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0001030261994</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [E11.9] Non-insulin-dependent diabetes
mellitus without complications</td><td>- METFORMIN TABLET 500 MG 10, 2x1 tablet,
<br>- GLIMEPIRIDE TABLET 4 MG 5, 1x1 tablet, <br>- AMBROXOL TABLET 30MG 10, 3x1
tablet, <br>- CAVIPLEX TABLET 5, 1x1 tablet, <br></tr><tr><td valign=top>3</td><td
valign=top>127408</td><td valign=top>MUHAMMAD RAFIF HAFIDZUAN</td><td
valign=top>AFIF NURHIDAYAT</td>
<td valign=top>2021-12-04</td><td valign=top>L</td><td valign=top>BANJARAN</td><td
valign=top>4</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003112592231</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMBROXOL TABLET 30MG 2, @ 10, 3x1 bgks, <br>- CHLORFENIRAMINE
MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMOXICILLIN KAPLET 500 MG 2, @
10, 3x1 bgks, <br></tr><tr><td valign=top>4</td><td valign=top>127409</td><td
valign=top>PURWANTI</td><td valign=top>M. ILHAM ZHURI</td>
<td valign=top>1994-10-12</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>4</td><td valign=top>7</td><td valign=top>BPJS PBI</td><td
valign=top>0002801152822</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z35.8] Supervision of other high-risk
pregnancies</td><td>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 15, 2x1 tablet, <br>-
N-ACETYL SISTEIN TABLET/KAPSUL 200 MG 15, 3x1 tablet, <br>- AMOXICILLIN KAPLET 500
MG 15, 3x1 tablet, <br></tr><tr><td valign=top>5</td><td valign=top>127410</td><td
valign=top>AYU SEKAR RINI</td><td valign=top>SUTRISNO</td>
<td valign=top>1996-03-12</td><td valign=top>P</td><td valign=top>JEBED
UTARA</td><td valign=top>3</td><td valign=top>3</td><td valign=top>BPJS
NonPBI</td><td valign=top>0002083906451</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[O14.0] Moderate
pre-eclampsia</td><td></tr><tr><td valign=top>6</td><td valign=top>127411</td><td
valign=top>AHMAD FAUZAN</td><td valign=top>ROSIKIN</td>
<td valign=top>2008-02-25</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>4</td><td valign=top>Umum</td><td
valign=top>0002590440827</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- BROCON TABLET
10, 3x1 tablet, <br></tr><tr><td valign=top>7</td><td valign=top>127412</td><td
valign=top>ALDAFFA NUR HAFIZH</td><td valign=top>SUNARTO</td>
<td valign=top>2015-12-27</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>8</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003281414499</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[B37.0] Candidal stomatitis</td><td>-
AMOXICILLIN KAPLET 500 MG 5, 3x1/2 tablet, <br>- PARACETAMOL TABLET 500 MG 5, 3x1/2
tablet, <br>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 5, 3x1/2 tablet,
<br></tr><tr><td valign=top>8</td><td valign=top>127413</td><td valign=top>DWI
RETNO WISMANINGSIH</td><td valign=top>M ARIF ARIYANTO</td>
<td valign=top>1988-12-20</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>1</td><td valign=top>9</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- CIPROFLOXACIN TABLET 500 MG 6, 2x1 tablet, <br>- BROCON
TABLET 10, 3x1 tablet, <br>- CAVIPLEX TABLET 3, 1x1 tablet, <br></tr><tr><td
valign=top>9</td><td valign=top>127414</td><td valign=top>RUSDI</td><td
valign=top>RUSDI</td>
<td valign=top>1940-10-10</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>3</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002261386618</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[M19.9] Arthrosis,
unspecified</td><td></tr><tr><td valign=top>10</td><td valign=top>127415</td><td
valign=top>EVANO ZAFRAN ALFAREZEL</td><td valign=top>ANGGA</td>
<td valign=top>2022-08-09</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN SYR KERING 125mg 1, @ 10, 3x1 sendok teh, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMBROXOL TABLET
30MG 2, @ 10, 3x1 bgks, <br></tr><tr><td valign=top>11</td><td
valign=top>127416</td><td valign=top>AGUS TAMRIN</td><td valign=top></td>
<td valign=top>2020-03-16</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>5</td><td valign=top>7</td><td valign=top>BPJS PBI</td><td
valign=top>0000621099617</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN SYR KERING 125mg 1, 3x1 sendok teh, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMBROXOL TABLET
30MG 2, @ 10, 3x1 bgks, <br>- PARACETAMOL TABLET 500 MG 2, @ 10, 3x1 bgks,
<br></tr><tr><td valign=top>12</td><td valign=top>127417</td><td valign=top>SITI
MUNASIFAH</td><td valign=top>SAPII</td>
<td valign=top>1996-05-14</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>5</td><td valign=top>3</td><td
valign=top>BPJS PBI</td><td valign=top>0000620520129</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[O14.0] Moderate
pre-eclampsia</td><td></tr><tr><td valign=top>13</td><td valign=top>127419</td><td
valign=top>KARSIDAH</td><td valign=top>DUKATNO</td>
<td valign=top>1962-01-03</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>7</td><td valign=top>7</td><td valign=top>BPJS PBI</td><td
valign=top>0001030277542</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[S05.0] Injury of conjunctiva and corneal
abrasion without mention of foreign body</td><td></tr><tr><td valign=top>14</td><td
valign=top>127420</td><td valign=top>NENI GUNARSIH</td><td valign=top>ABDUL
KODIR</td>
<td valign=top>1969-05-05</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>2</td><td valign=top>6</td><td
valign=top>BPJS NonPBI</td><td valign=top>0000078712222</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[K04.1] Necrosis of
pulp</td><td></tr><tr><td valign=top>15</td><td valign=top>127580</td><td
valign=top>MASRIPAH</td><td valign=top></td>
<td valign=top>1967-09-12</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>10</td><td valign=top>BPJS PBI</td><td
valign=top>0002801165905</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- BROCON TABLET 10, 3x1 tablet, <br>- PREDNISONE TABLET 5 MG 10, 3x1
tablet, <br></tr><tr><td valign=top>16</td><td valign=top>127422</td><td
valign=top>AYU PURWANTI</td><td valign=top>NURUL HUDA</td>
<td valign=top>1994-07-06</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>3</td><td valign=top>16</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002205774832</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K02.0] Caries limited to enamel</td><td>-
ASAM MEFENAMAT KAPLET 500 MG 5, 2x1 tablet, <br></tr><tr><td valign=top>17</td><td
valign=top>127423</td><td valign=top>SANDI RUDIYANTO</td><td valign=top>DARSO</td>
<td valign=top>2006-06-15</td><td valign=top>L</td><td valign=top>BANJARAN</td><td
valign=top>6</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0002801105673</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- MOLEXFLU tab
(PARASETAMOL, PPA, CTM) 10, 3x1 tablet, <br>- N-ACETYL SISTEIN TABLET/KAPSUL 200 MG
10, 3x1 tablet, <br></tr><tr><td valign=top>18</td><td valign=top>127424</td><td
valign=top>SITI SUNDARI</td><td valign=top>DARSO</td>
<td valign=top>1978-08-01</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>6</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0001030259439</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- BROCON TABLET 10,
3x1 tablet, <br>- PREDNISONE TABLET 5 MG 10, 3x1 tablet, <br>- MICONAZOLE CREAM 2 %
1, 3 kali oles, <br></tr><tr><td valign=top>19</td><td valign=top>127425</td><td
valign=top>MUHAMMAD AKTAR ALFARIZI</td><td valign=top>DEDI RUWANTO</td>
<td valign=top>2021-06-13</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>4</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMBROXOL TABLET 30MG 2, @ 10, 3x1 bgks, <br>- AMBROXOL TABLET
30MG 2, @ 10, 3x1 bgks, <br>- AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1 bgks, <br>-
CALCIUM LACTAT TABLET 500 MG (KALK) 2, @ 10, 3x1 bgks, <br></tr><tr><td
valign=top>20</td><td valign=top>127426</td><td valign=top>SITI SAROKAH</td><td
valign=top>SUTARMO</td>
<td valign=top>1975-06-17</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>4</td><td
valign=top>BPJS PBI</td><td valign=top>0001830128499</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td>- AMLODIPIN TABLET 10 MG 5, 1x1 tablet, <br>- PARACETAMOL
TABLET 500 MG 10, 3x1 tablet, <br>- ANTASIDA DOEN TAB 10, 3x1 tablet,
<br></tr><tr><td valign=top>21</td><td valign=top>127427</td><td
valign=top>SUPRIYATIN</td><td valign=top>TANURI</td>
<td valign=top>1963-07-01</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>3</td><td valign=top>7</td><td
valign=top>BPJS PBI</td><td valign=top>0000621129148</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper
respiratory tract, unspecified</td><td>- BROCON TABLET 10, 3x1 tablet, <br>-
AMLODIPIN TABLET 10 MG 10, 1x1 tablet, <br></tr><tr><td valign=top>22</td><td
valign=top>127428</td><td valign=top>AZKA NUR P</td><td valign=top>NUROHMAN</td>
<td valign=top>2013-09-26</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>4</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z48.9] Surgical follow-up care,
unspecified</td><td>- ASAM MEFENAMAT KAPLET 500 MG 6, 3x1/2 tablet, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 6, 3x1/2 tablet, <br></tr><tr><td
valign=top>23</td><td valign=top>127430</td><td valign=top>RENI PUSPITA RATNA
DEWI</td><td valign=top>YUSRO</td>
<td valign=top>1991-10-20</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>BPJS PBI</td><td valign=top>0001030261656</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[J11.0] Influenza with pneumonia,
virus not identified</td><td>- CIPROFLOXACIN TABLET 500 MG 6, 2x1 tablet, <br>-
BROCON TABLET 10, 3x1 tablet, <br></tr><tr><td valign=top>24</td><td
valign=top>127579</td><td valign=top>AHMAD RAMDAN MARHAMDANI</td><td
valign=top>YUSUF AHMADI</td>
<td valign=top>2017-07-09</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>14</td><td
valign=top>Umum</td><td valign=top>0002270899067</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 5, 3x1/2 tablet, <br>- BROCON
TABLET 5, 3x1/2 tablet, <br></tr><tr><td valign=top>25</td><td
valign=top>127433</td><td valign=top>IJMA KIYAS</td><td valign=top>FAIZIN</td>
<td valign=top>1997-06-14</td><td valign=top>L</td><td valign=top>BEJI</td><td
valign=top>1</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000620931341</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J10.0] Influenza with pneumonia, influenza
virus identified</td><td>- CIPROFLOXACIN TABLET 500 MG 6, 2x1 tablet, <br>- BROCON
TABLET 10, 3x1 tablet, <br></tr><tr><td valign=top>26</td><td
valign=top>127434</td><td valign=top>TURAHENI</td><td valign=top>SUWIGNYO</td>
<td valign=top>1969-03-02</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>5</td><td
valign=top>BPJS NonPBI</td><td valign=top>0000085222337</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[H52.5] Disorders of
accommodation</td><td></tr><tr><td valign=top>27</td><td valign=top>127435</td><td
valign=top>HETTY MONGINSIHI</td><td valign=top>HARI MARDIYANTO</td>
<td valign=top>1965-12-20</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>6</td><td valign=top>5</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078420958</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td>- ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br>-
SIMVASTATIN TABLET 10 MG 6, 2x1 tablet, <br></tr><tr><td valign=top>28</td><td
valign=top>127436</td><td valign=top>SRI KARYATI</td><td valign=top></td>
<td valign=top>1999-10-03</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>15</td><td
valign=top>BPJS PBI</td><td valign=top>0000620447308</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper
respiratory tract, unspecified</td><td>- N-ACETYL SISTEIN TABLET/KAPSUL 200 MG 10,
3x1 tablet, <br>- CETIRIZINE TABLET 10 MG 6, 2x1 tablet, <br>- AMOXICILLIN KAPLET
500 MG 10, 3x1 tablet, <br>- CAVIPLEX TABLET 5, 1x1 tablet, <br></tr><tr><td
valign=top>29</td><td valign=top>127438</td><td valign=top>KUSTIRAH</td><td
valign=top>NUSANTO</td>
<td valign=top>1989-01-08</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>6</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003298573978</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[T16] Foreign body in
ear</td><td></tr><tr><td valign=top>30</td><td valign=top>127439</td><td
valign=top>RIAN DWIANTO</td><td valign=top>NUSANTO</td>
<td valign=top>2021-10-18</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>6</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003298575071</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- PARACETAMOL TABLET 500 MG 2, @ 10, 3x1 bgks, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMOXICILLIN
KAPLET 500 MG 2, @ 10, 3x1 bgks, <br></tr><tr><td valign=top>31</td><td
valign=top>127440</td><td valign=top>SUPINAH</td><td valign=top>SUBANDI</td>
<td valign=top>1960-04-12</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>2</td><td
valign=top>BPJS NonPBI</td><td valign=top>0002256046683</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td></tr><tr><td valign=top>32</td><td valign=top>127442</td><td
valign=top>NAELA NIKMAH</td><td valign=top>ANGGI</td>
<td valign=top>1994-12-11</td><td valign=top>P</td><td
valign=top>KALIGELANG</td><td valign=top>5</td><td valign=top>3</td><td
valign=top>BPJS PBI</td><td valign=top>0000621010214</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- MOLEXFLU tab (PARASETAMOL, PPA, CTM) 10, 3x1 tablet, <br>-
AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- PIRIDOKSIN HCL ( VIT B6 ) TABLET 10
MG 10, 3x1 tablet, <br></tr><tr><td valign=top>33</td><td valign=top>127443</td><td
valign=top>HADI ISMANTO</td><td valign=top>HADI ISMANTO</td>
<td valign=top>1979-10-31</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001429755243</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[E11.8] Non-insulin-dependent diabetes
mellitus with unspecified complications</td><td></tr><tr><td valign=top>34</td><td
valign=top>127444</td><td valign=top>TAYU</td><td valign=top>NADIRUN</td>
<td valign=top>1966-07-01</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>4</td><td valign=top>2</td><td
valign=top>BPJS PBI</td><td valign=top>0000620973281</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td>- AMLODIPIN TABLET 10 MG 5, 1x1 tablet, <br>- PARACETAMOL
TABLET 500 MG 10, 3x1 tablet, <br>- OMEPRAZOLE KAPSUL 20 MG 6, 2x1 tablet,
<br></tr><tr><td valign=top>35</td><td valign=top>127445</td><td
valign=top>MARWAH</td><td valign=top>WAGE</td>
<td valign=top>1961-02-27</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>7</td><td
valign=top>BPJS PBI</td><td valign=top>0001030268316</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[E11.8] Non-insulin-dependent
diabetes mellitus with unspecified complications</td><td></tr><tr><td
valign=top>36</td><td valign=top>127448</td><td valign=top>NOVAL ROHMADHANI
SAPUTRO</td><td valign=top>ROHMAT</td>
<td valign=top>2001-11-18</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>15</td><td
valign=top>BPJS PBI</td><td valign=top>0001030273503</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[L23.9] Allergic contact dermatitis,
unspecified cause</td><td></tr><tr><td valign=top>37</td><td
valign=top>127449</td><td valign=top>PUJIATI</td><td valign=top>ABDUL GANI</td>
<td valign=top>1978-10-19</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>13</td><td
valign=top>BPJS PBI</td><td valign=top>0001030274673</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[F20.9] Schizophrenia,
unspecified</td><td></tr><tr><td valign=top>38</td><td valign=top>127450</td><td
valign=top>SUIYAH</td><td valign=top>SUIYAH</td>
<td valign=top>1947-12-01</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>15</td><td
valign=top>BPJS PBI</td><td valign=top>0000621482534</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[J44.1] Chronic obstructive
pulmonary disease with acute exacerbation, unspecified</td><td></tr><tr><td
valign=top>39</td><td valign=top>127451</td><td valign=top>PUPUT SEPTIANA</td><td
valign=top>MOCHTAR</td>
<td valign=top>1996-09-01</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>1</td><td valign=top>5</td><td valign=top>BPJS PBI</td><td
valign=top>0000621196514</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH
DARAH) 30, 1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 30, 1x1 tablet,
<br></tr><tr><td valign=top>40</td><td valign=top>127452</td><td valign=top>ULFAH
SAFITRI</td><td valign=top>SUKISWO</td>
<td valign=top>1990-06-28</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>4</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0002638405001</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[O14.9] Pre-eclampsia, unspecified</td><td>-
DOPAMET 250 MG 6, 2x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 4, 1x1
tablet, <br></tr><tr><td valign=top>41</td><td valign=top>127453</td><td
valign=top>NELI FADILAH</td><td valign=top>ASROFI</td>
<td valign=top>2003-06-30</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>2</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z48.8] Other specified surgical follow-up
care</td><td>- ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>42</td><td
valign=top>127454</td><td valign=top>FAJRIN PUTRA SATRIA</td><td
valign=top>SAEFUL</td>
<td valign=top>2017-03-25</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>4</td><td valign=top>16</td><td
valign=top>BPJS PBI</td><td valign=top>0002464069768</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[K00.4] Disturbances in tooth
formation</td><td>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 3, 1x1/2 tablet,
<br></tr><tr><td valign=top>43</td><td valign=top>127455</td><td valign=top>IRFAN
HERMAWAN</td><td valign=top></td>
<td valign=top>1984-03-31</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>8</td><td
valign=top>BPJS PBI</td><td valign=top>0000000000000</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[K05.3] Chronic
periodontitis</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- ASAM
MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>44</td><td
valign=top>127456</td><td valign=top>NURUL ANISAH</td><td valign=top>MAKMURI</td>
<td valign=top>2002-11-12</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>4</td><td valign=top>16</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- BROCON TABLET 10, 3x1 tablet, <br>- PREDNISONE TABLET 5 MG
10, 3x1 tablet, <br></tr><tr><td valign=top>45</td><td valign=top>127457</td><td
valign=top>JANATUN</td><td valign=top>SOBIRIN</td>
<td valign=top>1992-08-07</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>9</td><td valign=top>BPJS PBI</td><td
valign=top>0000621338534</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 10, 1x1 tablet,
<br></tr><tr><td valign=top>46</td><td valign=top>127458</td><td valign=top>CHANIA
NOVIANTI</td><td valign=top>RIZAL</td>
<td valign=top>1997-07-08</td><td valign=top>P</td><td
valign=top>KALIGELANG</td><td valign=top>2</td><td valign=top>1</td><td
valign=top>BPJS PBI</td><td valign=top>0002021018409</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal
pregnancy, unspecified</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET
(TABLET TAMBAH DARAH) 10, 1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 10,
1x1 tablet, <br></tr><tr><td valign=top>47</td><td valign=top>127459</td><td
valign=top>KASMALI</td><td valign=top>KASMALI</td>
<td valign=top>1945-02-01</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>4</td><td valign=top>4</td><td
valign=top>BPJS PBI</td><td valign=top>0001030268744</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>, [S90.8] Other superficial
injuries of ankle and foot</td><td>- AMLODIPIN TABLET 10 MG 10, 1x1 tablet , <br>-
ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet , <br>- CHLORAMPHENICOL SALEP KULIT 2%
(BUFACETINE) 1, 3 kali oles tipis, <br></tr><tr><td valign=top>48</td><td
valign=top>127461</td><td valign=top>ZIQRI ABDILLAH</td><td valign=top>NURHADI</td>
<td valign=top>2017-04-18</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>10</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[R50.9] Fever, unspecified</td><td>-
AMOXICILLIN SYR KERING 125mg 1, 3 x 1 sendok makan, <br>- PARACETAMOL TABLET 500
MG 4, @ 10, 3 x 1 bungkus, <br>- AMBROXOL TABLET 30MG 4, @ 10, 3 x 1 bungkus,
<br>- CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 4, @ 10, 3 x 1 bungkus, <br>-
PIRIDOKSIN HCL ( VIT B6 ) TABLET 10 MG 4, @ 10, 3 x 1 bungkus, <br></tr><tr><td
valign=top>49</td><td valign=top>127463</td><td valign=top>DWI MEI JAYANTI</td><td
valign=top>KASMURI</td>
<td valign=top>1987-05-18</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>3</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0001716674859</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[L08.9] Local infection of skin and
subcutaneous tissue, unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1
tablet, <br>- ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br>- HIDROKORTISON KRIM
2.5 % 1, 3 kali oles, <br></tr><tr><td valign=top>50</td><td
valign=top>127464</td><td valign=top>BINTANG ASHILLA PERTAMA</td><td valign=top>IKA
INDRA SANJAYA</td>
<td valign=top>2015-01-02</td><td valign=top>P</td><td valign=top>SEWAKA</td><td
valign=top>4</td><td valign=top>8</td><td valign=top>Umum</td><td
valign=top>0002311886597</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K00.6] Disturbances in tooth
eruption</td><td>- AMOXICILLIN KAPLET 500 MG 5, 3x1/2 tablet, <br>- PARACETAMOL
TABLET 500 MG 5, 3x1/2 tablet, <br></tr><tr><td valign=top>51</td><td
valign=top>127465</td><td valign=top>SULASTRI</td><td valign=top>WARJITO</td>
<td valign=top>1976-11-01</td><td valign=top>P</td><td valign=top>JEBED
UTARA</td><td valign=top>3</td><td valign=top>9</td><td valign=top>Umum</td><td
valign=top>0000620416809</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[L23.9] Allergic contact dermatitis,
unspecified cause</td><td>- HIDROKORTISON KRIM 2.5 % 1, 3 kali oles, <br>- DEXTAF
TABLET 10, 3x1 tablet, <br>- PARACETAMOL TABLET 500 MG 10, 3x1 tablet,
<br></tr><tr><td valign=top>52</td><td valign=top>127466</td><td
valign=top>KASMIRAH</td><td valign=top>AMBARI</td>
<td valign=top>1965-09-01</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>6</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000620032869</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[L23.9] Allergic contact dermatitis,
unspecified cause</td><td>- FUCILEX (NATRIUM FUSIDAT) CR 1, 3 kali oles, <br>-
CETIRIZINE TABLET 10 MG 6, 2x1 tablet, <br>- AMOXICILLIN KAPLET 500 MG 10, 3x1
tablet, <br>- PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br></tr><tr><td
valign=top>53</td><td valign=top>127467</td><td valign=top>PUJIONO</td><td
valign=top></td>
<td valign=top>1979-05-29</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>3</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002135109699</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- CIPROFLOXACIN TABLET 500 MG 6, 2x1 tablet, <br>- MOLEXFLU tab
(PARASETAMOL, PPA, CTM) 10, 3x1 tablet, <br>- N-ACETYL SISTEIN TABLET/KAPSUL 200 MG
10, 3x1 tablet, <br></tr><tr><td valign=top>54</td><td valign=top>127468</td><td
valign=top>SUNDARI</td><td valign=top>JUMADI</td>
<td valign=top>1967-07-01</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>3</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0000620461506</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td>- ANTASIDA DOEN TAB 10, 3x1 tablet, <br>- PARACETAMOL TABLET
500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>55</td><td
valign=top>127469</td><td valign=top>USIYATI</td><td valign=top>NUROHIM</td>
<td valign=top>1980-11-22</td><td valign=top>P</td><td
valign=top>KALIGELANG</td><td valign=top>5</td><td valign=top>3</td><td
valign=top>BPJS PBI</td><td valign=top>0002596837735</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td>- AMLODIPIN TABLET 10 MG 10, 1x1 tablet, <br>- OMEPRAZOLE
KAPSUL 20 MG 6, 2x1 tablet, <br>- PARACETAMOL TABLET 500 MG 10, 3x1 tablet,
<br></tr><tr><td valign=top>56</td><td valign=top>127471</td><td valign=top>TIAS
EKO CAHYANTI</td><td valign=top>APRILIANTO</td>
<td valign=top>1997-05-17</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000621501939</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[M79.1] Myalgia</td><td>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br>- PREDNISONE TABLET 5 MG 10, 3x1 tablet, <br>-
TIAMINE HCL (VITB1) TABLET 50MG 10, 3x1 tablet, <br></tr><tr><td
valign=top>57</td><td valign=top>127473</td><td valign=top>SUWARDI</td><td
valign=top>SUWARDI</td>
<td valign=top>1966-06-01</td><td valign=top>L</td><td
valign=top>BANJARDAWA</td><td valign=top>3</td><td valign=top>1</td><td
valign=top>BPJS PBI</td><td valign=top>0000621212872</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>, [J00] Acute nasopharyngitis
[common cold]</td><td>- METFORMIN TABLET 500 MG 20, 2x1 tablet, <br>- MOLEXFLU tab
(PARASETAMOL, PPA, CTM) 10, 3x1 tablet, <br></tr><tr><td valign=top>58</td><td
valign=top>127628</td><td valign=top>AZFAR RABBANI</td><td valign=top></td>
<td valign=top>2019-12-11</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003102988825</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[H60.9] Otitis externa,
unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 3, @ 10, 3x1 bgks, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 3, @ 10, 3x1 bgks, <br></tr><tr><td
valign=top>59</td><td valign=top>127479</td><td valign=top>WAHIDIN</td><td
valign=top>WAHIDIN</td>
<td valign=top>1968-01-01</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>9</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001888763152</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- SALBUTAMOL TABLET 2 MG 10, 3x1 tablet, <br>- BROCON TABLET 10, 3x1
tablet, <br>- CAVIPLEX TABLET 5, 1x1 tablet, <br></tr><tr><td valign=top>60</td><td
valign=top>127480</td><td valign=top>NUR ROMADHON</td><td valign=top>NUR
ROMADHON</td>
<td valign=top>1986-06-06</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>5</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0000621327069</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[K04.5] Chronic apical
periodontitis</td><td></tr><tr><td valign=top>61</td><td valign=top>127481</td><td
valign=top>SITI ARIYAH</td><td valign=top>KAYEM</td>
<td valign=top>1961-01-18</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>13</td><td
valign=top>BPJS PBI</td><td valign=top>0000619997411</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>, [L23.9] Allergic contact
dermatitis, unspecified cause</td><td>- AMLODIPIN TABLET 10 MG 5, 1x1 tablet, <br>-
CETIRIZINE TABLET 10 MG 5, 1x1 tablet, <br></tr><tr><td valign=top>62</td><td
valign=top>127484</td><td valign=top>SURYATI</td><td valign=top>WEDHO
SUHARJOYO</td>
<td valign=top>2000-04-06</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>9</td><td
valign=top>Umum</td><td valign=top>0002922235075</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>63</td><td valign=top>127485</td><td
valign=top>KHAIRUN NISA</td><td valign=top>AGUS SALIM</td>
<td valign=top>1999-03-15</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0001873256185</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>64</td><td valign=top>127486</td><td
valign=top>ISMI NUR BAETI</td><td valign=top>NASORI</td>
<td valign=top>2000-03-10</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>9</td><td valign=top>BPJS PBI</td><td
valign=top>0000620300529</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.0] Supervision of normal first
pregnancy</td><td>- PIRIDOKSIN HCL ( VIT B6 ) TABLET 10 MG 10, 1x1 tablet, <br>-
CALCIUM LACTAT TABLET 500 MG (KALK) 30, 1x1 tablet, <br>- BESI FUMARAT 60 MG ASAM
FOLAT 0,4 MG TABLET (TABLET TAMBAH DARAH) 30, 1x1 tablet, <br></tr><tr><td
valign=top>65</td><td valign=top>127487</td><td valign=top>HANDIKA RAMADHAN</td><td
valign=top>ROHMAT</td>
<td valign=top>2001-11-22</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0001406109587</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>66</td><td valign=top>127488</td><td
valign=top>SRI KUNAENI</td><td valign=top>SRI KUNAENI</td>
<td valign=top>1963-05-02</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>4</td><td valign=top>7</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078628691</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[I11.0] Hypertensive heart disease with
(congestive) heart failure</td><td></tr><tr><td valign=top>67</td><td
valign=top>127489</td><td valign=top>SANTIKA PUTRI</td><td valign=top>SORIKHI</td>
<td valign=top>1999-11-07</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>10</td><td valign=top>Umum</td><td
valign=top>0001836131657</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.0] Supervision of normal first
pregnancy</td><td></tr><tr><td valign=top>68</td><td valign=top>127490</td><td
valign=top>EKA RATNA ASIH</td><td valign=top></td>
<td valign=top>1990-06-01</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>BPJS PBI</td><td valign=top>0000000000000</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[K04.1] Necrosis of
pulp</td><td></tr><tr><td valign=top>69</td><td valign=top>127491</td><td
valign=top>LAILY MAGFIROTU SIYAM</td><td valign=top>SITI ROLIYAH</td>
<td valign=top>2006-11-01</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>8</td><td valign=top>Umum</td><td
valign=top>0000619906623</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K29.7] Gastritis, unspecified</td><td>-
PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br>- VASTRAL (NEUROTROPIC) KAPLET 5, 1x1
tablet, <br></tr><tr><td valign=top>70</td><td valign=top>127492</td><td
valign=top>SITI ROLIYAH</td><td valign=top>SITI ROLIYAH</td>
<td valign=top>1967-06-19</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>8</td><td valign=top>BPJS PBI</td><td
valign=top>0000619904788</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [K29.7] Gastritis, unspecified</td><td>-
AMLODIPIN TABLET 10 MG 5, 1x1 tablet, <br>- OMEPRAZOLE KAPSUL 20 MG 6, 2x1 tablet,
<br>- PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br></tr><tr><td
valign=top>71</td><td valign=top>127494</td><td valign=top>SRIYATI</td><td
valign=top>M NURT GHOZALI</td>
<td valign=top>1987-07-21</td><td valign=top>P</td><td valign=top>WANAREJAN
SELATAN</td><td valign=top>3</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000619792852</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>, [K29.7] Gastritis, unspecified</td><td></tr><tr><td
valign=top>72</td><td valign=top>127495</td><td valign=top>AKBAR ARYA
SAPUTRA</td><td valign=top>DAMURI</td>
<td valign=top>2008-01-15</td><td valign=top>L</td><td valign=top>BANJARAN</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K56.2] Volvulus</td><td>- AMOXICILLIN
KAPLET 500 MG 5, 3x1/2 tablet, <br>- ASAM MEFENAMAT KAPLET 500 MG 5, 3x1/2 tablet,
<br>- CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 10, 3x1 tablet, <br></tr><tr><td
valign=top>73</td><td valign=top>127496</td><td valign=top>ALDA SEPTIANAH</td><td
valign=top>KURSIN</td>
<td valign=top>2001-09-07</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>4</td><td valign=top>15</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- MOLEXFLU tab (PARASETAMOL, PPA, CTM) 10, 3x1 tablet,
<br></tr><tr><td valign=top>74</td><td valign=top>127497</td><td
valign=top>UMROH</td><td valign=top>ABDUL BASOR</td>
<td valign=top>1969-05-13</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>BPJS PBI</td><td valign=top>0000620826838</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[R51] Headache</td><td>- OMEPRAZOLE
KAPSUL 20 MG 6, 2x1 tablet, <br>- PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br>-
CAVIPLEX TABLET 3, 1x1 tablet, <br></tr><tr><td valign=top>75</td><td
valign=top>127498</td><td valign=top>RADJA ARTADI</td><td valign=top>SUTADI</td>
<td valign=top>2013-05-20</td><td valign=top>L</td><td valign=top>BEJI</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[L23.9] Allergic contact dermatitis,
unspecified cause</td><td>- HIDROKORTISON KRIM 2.5 % 1, 3 kali oles, <br>-
AMOXICILLIN KAPLET 500 MG 6, 3x1/2 tablet, <br>- ASAM MEFENAMAT KAPLET 500 MG 6,
3x1/2 tablet, <br></tr><tr><td valign=top>76</td><td valign=top>127499</td><td
valign=top>TJIPTADI PUTRA</td><td valign=top>SUTADI</td>
<td valign=top>2006-11-20</td><td valign=top>L</td><td valign=top>BEJI</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[B02.9] Zoster without
complication</td><td>- PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br>-
DEXAMETHASONE TABLET 0,5 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>77</td><td
valign=top>127501</td><td valign=top>ABDUL AZIZ</td><td valign=top>ABDUL AZIZ</td>
<td valign=top>1988-08-21</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>78</td><td valign=top>127502</td><td
valign=top>AMANAH</td><td valign=top>TAHYONO</td>
<td valign=top>1998-02-15</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>3</td><td valign=top>13</td><td valign=top>BPJS PBI</td><td
valign=top>0000620862276</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [Z23.5] Need for immunization against
tetanus alone</td><td>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 10, 1x1 tablet,
<br></tr><tr><td valign=top>79</td><td valign=top>127504</td><td valign=top>KAILA
OCTAVIANI</td><td valign=top>DENI SETIAWAN</td>
<td valign=top>2017-10-05</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>5</td><td valign=top>5</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMBROXOL TABLET 30MG 3, @ 10, 3x1 bgks, <br>- CHLORFENIRAMINE
MALEAT ( CTM ) TABLET 4 MG 3, @ 10, 3x1 bgks, <br>- AMOXICILLIN KAPLET 500 MG 3, @
10, 3x1 bgks, <br></tr><tr><td valign=top>80</td><td valign=top>127505</td><td
valign=top>LUSIANA DWI LESTARI</td><td valign=top>KHAERUDIN</td>
<td valign=top>1996-04-08</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>10</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[N61] Inflammatory disorders of
breast</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>81</td><td
valign=top>127506</td><td valign=top>HERY OKTAFIANTO</td><td valign=top>HERY
OKTAFIANTO</td>
<td valign=top>1979-10-02</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002284668922</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[H60.9] Otitis externa,
unspecified</td><td>- CIPROFLOXACIN TABLET 500 MG 6, 2x1 tablet, <br>- ASAM
MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br>- DEXTAF TABLET 10, 3x1 tablet,
<br></tr><tr><td valign=top>82</td><td valign=top>127507</td><td valign=top>SITI
KOMARIYAH</td><td valign=top>PURWANTO</td>
<td valign=top>1993-10-21</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0002127901847</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td></tr><tr><td valign=top>83</td><td valign=top>127597</td><td
valign=top>RAZELIN ZAKEISHA</td><td valign=top>RAHMAT ZAKARIA</td>
<td valign=top>2022-10-26</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z41.3] Ear piercing</td><td></tr><tr><td
valign=top>84</td><td valign=top>127596</td><td valign=top>VIVIN EMIS
SAPUTRI</td><td valign=top>CONDRO WIBOWO</td>
<td valign=top>1993-05-11</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002323783899</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br>- DEXAMETHASONE
TABLET 0,5 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>85</td><td
valign=top>127511</td><td valign=top>ENDI KURNIAWAN</td><td
valign=top>SOFIYANTO</td>
<td valign=top>2005-03-10</td><td valign=top>L</td><td valign=top>BEJI</td><td
valign=top>2</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0000620935468</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td></tr><tr><td valign=top>86</td><td valign=top>127512</td><td
valign=top>TITIN HESTI NINGSIH</td><td valign=top> CITRA MULYA</td>
<td valign=top>1996-11-14</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>2</td><td
valign=top>BPJS PBI</td><td valign=top>0002123970456</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[Z34.8] Supervision of other normal
pregnancy</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH
DARAH) 30, 1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 30, 1x1 tablet,
<br></tr><tr><td valign=top>87</td><td valign=top>127513</td><td valign=top>BIMA
ABIANSYAH</td><td valign=top>DUL PAING</td>
<td valign=top>2013-11-01</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0001915633091</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- CETIRIZINE TABLET 10 MG 4, 2x1/2 tablet, <br>- N-ACETYL
SISTEIN TABLET/KAPSUL 200 MG 4, 2x1/2 tablet, <br>- AMOXICILLIN KAPLET 500 MG 5,
3x1/2 tablet, <br></tr><tr><td valign=top>88</td><td valign=top>127514</td><td
valign=top>MURIP LATIPAH</td><td valign=top>RACHMAT</td>
<td valign=top>1987-04-14</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0002601270663</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[L23.9] Allergic contact dermatitis,
unspecified cause</td><td>- MICONAZOLE CREAM 2 % 1, 3x1 oles, <br>- KETOCONAZOL
TABLET 200 MG 6, 2x1 tablet, <br>- CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 10,
3x1 tablet, <br></tr><tr><td valign=top>89</td><td valign=top>127516</td><td
valign=top>ADZRIEL RAFIF ALFARIZQI</td><td valign=top>HERI IRAWAN</td>
<td valign=top>2020-09-09</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>5</td><td valign=top>BPJS PBI</td><td
valign=top>0003063889912</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN SYR KERING 125mg 1, 3x1 sendok makan, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1bgks, <br>- CALCIUM LACTAT
TABLET 500 MG (KALK) 2, @ 10, 3x1bgks, <br>- AMBROXOL TABLET 30MG 2, @ 10, 3x1bgks,
<br>- PARACETAMOL TABLET 500 MG 2, @ 10, 3x1bgks, <br></tr><tr><td
valign=top>90</td><td valign=top>127517</td><td valign=top>RIZKI ARDIANSYAH
PRATAMA</td><td valign=top>HERI IRAWAN</td>
<td valign=top>2013-05-13</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>5</td><td valign=top>BPJS PBI</td><td
valign=top>0002631791799</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN KAPLET 500 MG 5, 3x1/2 tablet, <br>- PARACETAMOL TABLET
500 MG 5, 3x1/2 tablet, <br>- AMBROXOL TABLET 30MG 5, 3x1/2 tablet,
<br></tr><tr><td valign=top>91</td><td valign=top>127518</td><td valign=top>ITA
AMIATI</td><td valign=top>SAHURI</td>
<td valign=top>1988-03-02</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>13</td><td
valign=top>BPJS PBI</td><td valign=top>0000621324999</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[O14.9] Pre-eclampsia,
unspecified</td><td></tr><tr><td valign=top>92</td><td valign=top>127520</td><td
valign=top>SULASMI</td><td valign=top>ROHMAT</td>
<td valign=top>1988-04-12</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000621113635</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- CALCIUM LACTAT TABLET 500 MG (KALK) 20, 1x1 tablet, <br>-
BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH DARAH) 10, 1x1 tablet,
<br>- TIAMINE HCL (VITB1) TABLET 50MG 10, 1x1 tablet, <br></tr><tr><td
valign=top>93</td><td valign=top>127521</td><td valign=top>IMAM SUASA SURYO
ANGGORO</td><td valign=top>TARMO</td>
<td valign=top>1993-05-17</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>8</td><td valign=top>BPJS PBI</td><td
valign=top>0000620475682</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td></tr><tr><td valign=top>94</td><td valign=top>127523</td><td
valign=top>NOVA AYU TRISNAWATI</td><td valign=top>KUSNENDI</td>
<td valign=top>1996-11-15</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>6</td><td valign=top>7</td><td valign=top>BPJS PBI</td><td
valign=top>0000620811369</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH
DARAH) 30, 1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 30, 1x1 tablet,
<br>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- PARACETAMOL TABLET 500 MG 10,
3x1 tablet, <br></tr><tr><td valign=top>95</td><td valign=top>127524</td><td
valign=top>DEFFITA LISDA SAR</td><td valign=top></td>
<td valign=top>1989-07-21</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>96</td><td valign=top>127525</td><td
valign=top>AFIT AFRIZAL</td><td valign=top>SUYATNO</td>
<td valign=top>1996-04-16</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>3</td><td
valign=top>Umum</td><td valign=top>0001738631349</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>97</td><td valign=top>127526</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2001-12-04</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>98</td><td valign=top>127528</td><td
valign=top>KARDONO</td><td valign=top></td>
<td valign=top>1982-08-26</td><td valign=top>L</td><td
valign=top>MULYOHARJO</td><td valign=top>2</td><td valign=top>24</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[S02.5] Fracture of tooth</td><td>-
PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>99</td><td
valign=top>127529</td><td valign=top>WIKUNTO</td><td valign=top>SAGRIB</td>
<td valign=top>1973-01-13</td><td valign=top>L</td><td valign=top>KABUNAN</td><td
valign=top>2</td><td valign=top>4</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001527763656</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[N18.9] Chronic renal failure,
unspecified</td><td></tr><tr><td valign=top>100</td><td valign=top>127530</td><td
valign=top>ANWARTONO</td><td valign=top></td>
<td valign=top>1970-08-21</td><td valign=top>L</td><td
valign=top>BOJONGBATA</td><td valign=top>2</td><td valign=top>8</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[S67.0] Crushing injury of thumb and other
finger(s)</td><td>- CIPROFLOXACIN TABLET 500 MG 6, 2x1 tablet, <br>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>101</td><td
valign=top>127531</td><td valign=top>MAYA HARTATI</td><td valign=top>amin</td>
<td valign=top>1999-06-30</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000620440233</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td></tr><tr><td valign=top>102</td><td valign=top>127532</td><td
valign=top>KHOIRIYATUN NAILLA</td><td valign=top>RIYANTO</td>
<td valign=top>2002-08-20</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>1</td><td valign=top>9</td><td valign=top>BPJS PBI</td><td
valign=top>0000620961219</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[H00.0] Hordeolum and other deep
inflammation of eyelid</td><td>- CHLORAMPHENICOL SALEP MATA 1% 1, 3 kali oles,
<br>- ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br>- DEXTAF TABLET 10, 3x1
tablet, <br></tr><tr><td valign=top>103</td><td valign=top>127533</td><td
valign=top>WAHYUDI</td><td valign=top>WAHYUDI</td>
<td valign=top>1965-12-01</td><td valign=top>L</td><td valign=top>BANJARAN</td><td
valign=top>1</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000621208607</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- COTRIMOXAZOLE TABLET KOMB 480 MG 12, 2x2 tablet, <br>-
MOLEXFLU tab (PARASETAMOL, PPA, CTM) 10, 3x1 tablet, <br>- N-ACETYL SISTEIN
TABLET/KAPSUL 200 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>104</td><td
valign=top>127536</td><td valign=top>DWI MENTARI YULIANTI</td><td valign=top>AGUS
SUDARTO</td>
<td valign=top>1999-07-10</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000621502446</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH
DARAH) 30, 1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 30, 1x1 tablet,
<br></tr><tr><td valign=top>105</td><td valign=top>127537</td><td
valign=top>NUFAISYAH AL HURAH LISETIANTO</td><td valign=top>GILANG</td>
<td valign=top>2021-10-18</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>4</td><td valign=top>16</td><td
valign=top>BPJS PBI</td><td valign=top>0003112457591</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper
respiratory tract, unspecified</td><td>- PARACETAMOL SYRUP 120 MG/5 ML 1, 3x1
sendok teh, <br>- AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1bgks, <br>- CHLORFENIRAMINE
MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1bgks, <br>- AMBROXOL TABLET 30MG 2, @ 10,
3x1bgks, <br></tr><tr><td valign=top>106</td><td valign=top>127538</td><td
valign=top>ARYANI CAHAYA ABADI</td><td valign=top>IRNOMO</td>
<td valign=top>2009-12-29</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000619874324</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td></tr><tr><td valign=top>107</td><td valign=top>127539</td><td
valign=top>DEWI RAKHMATIKA</td><td valign=top>JUMADI</td>
<td valign=top>1999-09-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>11</td><td
valign=top>BPJS NonPBI</td><td valign=top>0000620204422</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[R51] Headache</td><td>-
PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br>- VASTRAL (NEUROTROPIC) KAPLET 5, 1x1
tablet, <br>- PIRIDOKSIN HCL ( VIT B6 ) TABLET 10 MG 10, 3x1 tablet,
<br></tr><tr><td valign=top>108</td><td valign=top>127540</td><td valign=top>AQSA
RAMADHANI RIFQI ZAHID</td><td valign=top>ACHSIN</td>
<td valign=top>2015-08-20</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>1</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN KAPLET 500 MG 6, 3x1/2 tablet, <br>- PARACETAMOL TABLET
500 MG 6, 3x1/2 tablet, <br>- AMBROXOL TABLET 30MG 6, 3x1/2 tablet,
<br></tr><tr><td valign=top>109</td><td valign=top>127541</td><td
valign=top>SOLATI</td><td valign=top>CASMUDI</td>
<td valign=top>1981-04-10</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>13</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003110362863</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[I11.0] Hypertensive heart disease with
(congestive) heart failure</td><td></tr><tr><td valign=top>110</td><td
valign=top>127542</td><td valign=top>SUBEKTI NURIAN</td><td valign=top></td>
<td valign=top>2007-05-24</td><td valign=top>L</td><td valign=top>GONDANG</td><td
valign=top>13</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003110363357</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[T78.4] Allergy, unspecified</td><td>-
MOLEXFLU tab (PARASETAMOL, PPA, CTM) 10, 3x1 tablet, <br>- PREDNISONE TABLET 5 MG
10, 3x1 tablet, <br></tr><tr><td valign=top>111</td><td valign=top>127544</td><td
valign=top>SRIBOW CEMPAKA WUNGU</td><td valign=top>HENDRA BUDIANTO</td>
<td valign=top>1997-10-16</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0001722096999</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- N-ACETYL
SISTEIN TABLET/KAPSUL 200 MG 10, 3x1 tablet, <br>- ASCORBIC ACID ( VIT C ) TABLET
50 MG 15, 2x1 tablet, <br></tr><tr><td valign=top>112</td><td
valign=top>127549</td><td valign=top>QHAIRA KEI ASHANA</td><td valign=top>DENY
S</td>
<td valign=top>2019-03-16</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>5</td><td valign=top>5</td><td
valign=top>BPJS NonPBI</td><td valign=top>0002926328218</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper
respiratory tract, unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1
bgks, <br>- CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>-
AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1 bgks, <br></tr><tr><td
valign=top>113</td><td valign=top>127547</td><td valign=top>FAIZ MUHAMMAD
SHAKI</td><td valign=top>JUMARI</td>
<td valign=top>2022-02-12</td><td valign=top>L</td><td valign=top>PENER</td><td
valign=top>4</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003254998577</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1 bgks, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMBROXOL TABLET
30MG 2, @ 10, 3x1 bgks, <br>- PARACETAMOL SYRUP 120 MG/5 ML 1, 3x1 sendok teh,
<br></tr><tr><td valign=top>114</td><td valign=top>127548</td><td
valign=top>RAWIN</td><td valign=top>SAHURI</td>
<td valign=top>1993-04-01</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>16</td><td
valign=top>BPJS PBI</td><td valign=top>0000620513886</td><td valign=top>POLI
</td><td valign=top>Dirujuk</td><td valign=top>[F20.9] Schizophrenia,
unspecified</td><td></tr><tr><td valign=top>115</td><td valign=top>127550</td><td
valign=top>WENIANTI</td><td valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>1975-08-20</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[A16.0] Tuberculosis of lung,
bacteriologically and histologically negative</td><td></tr><tr><td
valign=top>116</td><td valign=top>127551</td><td valign=top>UNTUNG
SABARYANTO</td><td valign=top>UNTUNG SABARYANTO</td>
<td valign=top>1964-11-10</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>4</td><td valign=top>6</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078858516</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>117</td><td valign=top>127552</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2001-08-02</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>118</td><td valign=top>127555</td><td
valign=top>EL SAFA PUTRI DESYON</td><td valign=top>KUSWAHYONO</td>
<td valign=top>2022-03-18</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1 bgks, <br>- CHLORFENIRAMINE
MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMBROXOL TABLET 30MG 2, @ 10,
3x1 bgks, <br>- PARACETAMOL SYRUP 120 MG/5 ML 1, 3x1sendok teh, <br></tr><tr><td
valign=top>119</td><td valign=top>127553</td><td valign=top>TURJINAH</td><td
valign=top>WARYO</td>
<td valign=top>1955-12-22</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>3</td><td valign=top>5</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078892637</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- ANTASIDA DOEN TAB 10, 3x1 tablet, <br>- BROCON TABLET 10, 3x1
tablet, <br>- CIPROFLOXACIN TABLET 500 MG 6, 2x1 tablet, <br>- CAVIPLEX TABLET 4,
1x1 tablet, <br></tr><tr><td valign=top>120</td><td valign=top>127632</td><td
valign=top>RARAS AMIATI</td><td valign=top>KARIMO</td>
<td valign=top>1990-01-15</td><td valign=top>P</td><td valign=top>PENGGARIT</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002610565896</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[O80.0] Spontaneous vertex
delivery</td><td></tr><tr><td valign=top>121</td><td valign=top>127556</td><td
valign=top>AIDHA SYIFA ROSYADA</td><td valign=top>ACHSIN</td>
<td valign=top>2022-05-16</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>1</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[B30.9] Viral conjunctivitis,
unspecified</td><td>- CHLORAMPHENICOL SALEP MATA 1% 1, 3x1 oles, <br></tr><tr><td
valign=top>122</td><td valign=top>127557</td><td valign=top>CEMPLON</td><td
valign=top>MUSTAM</td>
<td valign=top>1973-12-31</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Umum</td><td
valign=top>0000620293465</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td>- AMLODIPIN TABLET 10 MG 10, 1x1 tablet, <br>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br>- CAVIPLEX TABLET 3, 1x1 tablet, <br></tr><tr><td
valign=top>123</td><td valign=top>127558</td><td valign=top>SYAFIRA ANGGRIANI
SAFITRI</td><td valign=top>AINUR ROFIKI</td>
<td valign=top>2019-05-30</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>4</td><td valign=top>4</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K02.1] Caries of dentine</td><td>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMOXICILLIN
KAPLET 500 MG 2, @ 10, 3x1 bgks, <br>- PARACETAMOL TABLET 500 MG 2, @ 10, 3x1 bgks,
<br></tr><tr><td valign=top>124</td><td valign=top>127559</td><td valign=top>TITIK
FINDIARTI</td><td valign=top></td>
<td valign=top>1997-12-04</td><td valign=top>P</td><td valign=top>WANAREJAN
UTARA</td><td valign=top>1</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- ANTASIDA DOEN TAB 10, 3x1 tablet, <br>- CALCIUM LACTAT TABLET
500 MG (KALK) 20, 1x1 tablet, <br></tr><tr><td valign=top>125</td><td
valign=top>127560</td><td valign=top>PURWANTI</td><td valign=top>PURWANTI</td>
<td valign=top>1959-09-09</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>5</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0000619885056</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[M79.1] Myalgia</td><td>- NATRIUM DIKLOFENAK
TABLET 25 MG 10, 2x1 tablet, <br>- VASTRAL (NEUROTROPIC) KAPLET 4, 1x1 tablet,
<br></tr><tr><td valign=top>126</td><td valign=top>127561</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>1946-04-12</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [L08.9] Local infection of skin and
subcutaneous tissue, unspecified</td><td>- AMLODIPIN TABLET 10 MG 5, 1x1 tablet,
<br>- ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br>- EKSTRAK PLACENTA NEOMYCIN
JELLY (NEOCENTA JEL) 1, 3 kali oles tipis, <br></tr><tr><td valign=top>127</td><td
valign=top>127562</td><td valign=top>EKA RATNA ASIH</td><td valign=top></td>
<td valign=top>2021-11-14</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[L08.8] Other specified local infections of
skin and subcutaneous tissue</td><td>- CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG
2, @ 10, 3x1 bgks, <br>- AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1 bgks, <br>- CALCIUM
LACTAT TABLET 500 MG (KALK) 2, @ 10, 3x1 bgks, <br></tr><tr><td
valign=top>128</td><td valign=top>127564</td><td valign=top>SUMIYATI</td><td
valign=top>TEPUR RIYADI</td>
<td valign=top>1983-09-15</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000619888645</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[L08.8] Other specified local infections of skin and
subcutaneous tissue</td><td>- KETOCONAZOL TABLET 200 MG 15, 1x1 tablet, <br>-
CETIRIZINE TABLET 10 MG 5, 1x1 tablet, <br>- MICONAZOLE CREAM 2 % 1, 3xoles,
<br></tr><tr><td valign=top>129</td><td valign=top>127565</td><td valign=top>ANGGUN
WACHYUNINGSIH</td><td valign=top>TOHARI</td>
<td valign=top>1996-06-01</td><td valign=top>P</td><td
valign=top>KALIGELANG</td><td valign=top>1</td><td valign=top>5</td><td
valign=top>BPJS PBI</td><td valign=top>0000620735815</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal
pregnancy, unspecified</td><td>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 15, 2x1
tablet, <br>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH DARAH) 10,
1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 10, 1x1 tablet,
<br></tr><tr><td valign=top>130</td><td valign=top>127566</td><td valign=top>ULIN
NAFIS</td><td valign=top>AHMAD THOIF</td>
<td valign=top>2003-08-12</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>5</td><td
valign=top>BPJS PBI</td><td valign=top>0000620907693</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[K04.0] Pulpitis</td><td>- ASAM
MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>131</td><td
valign=top>127568</td><td valign=top>SULIS TIATUN</td><td valign=top>AGUS</td>
<td valign=top>1974-11-01</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>3</td><td valign=top>13</td><td valign=top>BPJS PBI</td><td
valign=top>0000621775361</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K08.3] Retained dental root</td><td>-
AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- PARACETAMOL TABLET 500 MG 10, 3x1
tablet, <br></tr><tr><td valign=top>132</td><td valign=top>127570</td><td
valign=top>AHMAD BAIHAQI</td><td valign=top>AGUS TEGUH</td>
<td valign=top>2014-03-09</td><td valign=top>L</td><td
valign=top>MULYOHARJO</td><td valign=top>4</td><td valign=top>11</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN KAPLET 500 MG 6, 3x1/2 tablet, <br>- PARACETAMOL TABLET
500 MG 6, 3x1/2 tablet, <br>- AMBROXOL TABLET 30MG 6, 3x1/2 tablet,
<br></tr><tr><td valign=top>133</td><td valign=top>127571</td><td valign=top>ALGY
LUTFI FAHRI</td><td valign=top>SUNARI</td>
<td valign=top>2016-09-25</td><td valign=top>L</td><td valign=top>PENGGARIT</td><td
valign=top>4</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K00.6] Disturbances in tooth
eruption</td><td>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 3, 1x1 tablet, <br>-
PARACETAMOL TABLET 500 MG 5, 3x1/2 tablet, <br></tr><tr><td valign=top>134</td><td
valign=top>127572</td><td valign=top>MUTMAINAH</td><td valign=top>ENTONG</td>
<td valign=top>1978-12-22</td><td valign=top>P</td><td valign=top>PENGGARIT</td><td
valign=top>5</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K02.1] Caries of
dentine</td><td></tr><tr><td valign=top>135</td><td valign=top>127621</td><td
valign=top>FATNURYANTI</td><td valign=top>EKO WIDIANURI</td>
<td valign=top>1984-06-07</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>BPJS PBI</td><td
valign=top>0000620011337</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH
DARAH) 15, 2x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 10, 1x1 tablet,
<br></tr><tr><td valign=top>136</td><td valign=top>127574</td><td
valign=top>SUPARLAN</td><td valign=top>MARJA UTAMA</td>
<td valign=top>1962-09-01</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>6</td><td valign=top>7</td><td valign=top>Gratis</td><td
valign=top>0000078859124</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td></tr><tr><td valign=top>137</td><td valign=top>127575</td><td
valign=top>MASRIAH</td><td valign=top>KK</td>
<td valign=top>1950-05-04</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0002801097066</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J45.9] Asthma, unspecified</td><td>-
SALBUTAMOL TABLET 2 MG 10, 2x1 tablet, <br>- VASTRAL (NEUROTROPIC) KAPLET 10, 2x1
tablet, <br></tr><tr><td valign=top>138</td><td valign=top>127576</td><td
valign=top>KUSMIATI</td><td valign=top>AGUS MUIN</td>
<td valign=top>1987-04-01</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>4</td><td valign=top>16</td><td
valign=top>BPJS PBI</td><td valign=top>0003156066808</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[Z12.4] Special screening
examination for neoplasm of cervix</td><td></tr><tr><td valign=top>139</td><td
valign=top>127577</td><td valign=top>SUKARJO</td><td valign=top>TARJUKI</td>
<td valign=top>1987-02-27</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>BPJS NonPBI</td><td valign=top>0000000000000</td><td valign=top>POLI
</td><td valign=top>Belum Dilayani</td><td valign=top>[Z12.4] Special screening
examination for neoplasm of cervix</td><td></tr><tr><td valign=top>140</td><td
valign=top>127578</td><td valign=top>ANDRI AVIANTI DWI WAHYUNINGRUM</td><td
valign=top>KASTARI</td>
<td valign=top>1968-05-10</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0002521137993</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z12.4] Special screening examination for neoplasm of
cervix</td><td></tr><tr><td valign=top>141</td><td valign=top>127581</td><td
valign=top>KIKI MULIANA</td><td valign=top>TARDJO</td>
<td valign=top>1988-09-18</td><td valign=top>P</td><td valign=top>JEBED
UTARA</td><td valign=top>2</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0000620534338</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z12.4] Special screening examination for neoplasm of
cervix</td><td></tr><tr><td valign=top>142</td><td valign=top>127582</td><td
valign=top>MUHAMMAD RISQIANSYAH</td><td valign=top>WUNTONI</td>
<td valign=top>2022-05-07</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>4</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0003272410091</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN SYR KERING 125mg 1, 3x1 sendok teh, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- PARACETAMOL
TABLET 500 MG 2, @ 10, 3x1 bgks, <br>- AMBROXOL TABLET 30MG 2, @ 10, 3x1 bgks,
<br></tr><tr><td valign=top>143</td><td valign=top>127584</td><td valign=top>HERI
SURYANTO</td><td valign=top>KOMARI</td>
<td valign=top>1997-05-23</td><td valign=top>L</td><td valign=top>BEJI</td><td
valign=top>3</td><td valign=top>15</td><td valign=top>BPJS PBI</td><td
valign=top>0000621040858</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td></tr><tr><td valign=top>144</td><td valign=top>127585</td><td
valign=top>KUMPUL SUTRISNO</td><td valign=top>KUMPUL SUTRISNO</td>
<td valign=top>2022-02-03</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 2, @ 10, 3x1 bgks, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2, @ 10, 3x1 bgks, <br>- AMBROXOL TABLET
30MG 2, @ 10, 3x1 bgks, <br></tr><tr><td valign=top>145</td><td
valign=top>127588</td><td valign=top>WENIANTI</td><td valign=top>AGUS PUTRA
PAMUNGKAS</td>
<td valign=top>1983-11-12</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>146</td><td valign=top>127589</td><td
valign=top>HANUM ISWARI</td><td valign=top></td>
<td valign=top>1948-10-10</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[A16.0] Tuberculosis of lung,
bacteriologically and histologically negative</td><td></tr><tr><td
valign=top>147</td><td valign=top>127590</td><td valign=top>WENIANTI</td><td
valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>1957-12-31</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[A16.0] Tuberculosis of lung,
bacteriologically and histologically negative</td><td></tr><tr><td
valign=top>148</td><td valign=top>127591</td><td valign=top>GUSTI FEBRIANTI
PRADANI</td><td valign=top>S. AGUS SULAIMAN, S.PD.</td>
<td valign=top>1998-02-18</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>6</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z23.5] Need for immunization against
tetanus alone</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET (TABLET TAMBAH
DARAH) 10, 1x1 tablet, <br></tr><tr><td valign=top>149</td><td
valign=top>127592</td><td valign=top>CASRIYAH</td><td valign=top>agus</td>
<td valign=top>1982-03-01</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>6</td><td valign=top>BPJS PBI</td><td
valign=top>0000621711257</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- ASCORBIC ACID ( VIT C ) TABLET 50 MG 10, 1x1 tablet,
<br></tr><tr><td valign=top>150</td><td valign=top>127594</td><td
valign=top>NARSO</td><td valign=top>NARSO</td>
<td valign=top>1954-05-04</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0003002273245</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [E11.8] Non-insulin-dependent diabetes
mellitus with unspecified complications</td><td>- AMLODIPIN TABLET 10 MG 10, 1x1
tablet, <br>- METFORMIN TABLET 500 MG 10, 2x1 tablet, <br>- GLIMEPIRIDE TABLET 4 MG
4, 1x1 tablet, <br>- ALLOPURINOL 100 MG 15, 3x1 tablet, <br></tr><tr><td
valign=top>151</td><td valign=top>127595</td><td valign=top>ARRAFI FARZAN
ATHALLA</td><td valign=top>AGUS SANTOSO</td>
<td valign=top>2022-10-25</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>5</td><td valign=top>BPJS PBI</td><td
valign=top>0003304141323</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td></tr><tr><td valign=top>152</td><td valign=top>127598</td><td
valign=top>AZKAYRA NUR MALIKA</td><td valign=top></td>
<td valign=top>2019-02-19</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>3</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K04.0] Pulpitis</td><td></tr><tr><td
valign=top>153</td><td valign=top>127600</td><td valign=top>SAYUDHA
PRASETYA</td><td valign=top>JUMADI</td>
<td valign=top>2017-09-17</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>7</td><td valign=top>1</td><td valign=top>BPJS PBI</td><td
valign=top>0002286788771</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMOXICILLIN KAPLET 500 MG 5, 3x1/2 tablet, <br>- DEXTAF
TABLET 5, 3x1/2 tablet, <br></tr><tr><td valign=top>154</td><td
valign=top>127633</td><td valign=top>ITA AMIATI</td><td valign=top>SAHURI</td>
<td valign=top>1988-03-02</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>13</td><td
valign=top>BPJS PBI</td><td valign=top>0000621324999</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[K04.0] Pulpitis</td><td>-
PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>155</td><td
valign=top>127602</td><td valign=top>ANIESSA NOOR MUTMAINAH</td><td
valign=top>MUHAMMAD ALI</td>
<td valign=top>1997-06-19</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>156</td><td valign=top>127603</td><td
valign=top>AQILLA GALUH MAHARDIKA</td><td valign=top>THOMAS KURNIAWAN</td>
<td valign=top>2003-08-17</td><td valign=top>P</td><td valign=top>JEBED
UTARA</td><td valign=top>3</td><td valign=top>4</td><td valign=top>BPJS
NonPBI</td><td valign=top>0002437106872</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[L23.9] Allergic contact dermatitis,
unspecified cause</td><td>- CETIRIZINE TABLET 10 MG 6, 2x1 tablet, <br></tr><tr><td
valign=top>157</td><td valign=top>127604</td><td valign=top>DEFFITA LISDA
SAR</td><td valign=top></td>
<td valign=top>1984-05-16</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[M79.1] Myalgia</td><td>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br>- PREDNISONE TABLET 5 MG 10, 3x1 tablet, <br>-
TIAMINE HCL (VITB1) TABLET 50MG 10, 3x1 tablet, <br></tr><tr><td
valign=top>158</td><td valign=top>127605</td><td valign=top>HANUM ISWARI</td><td
valign=top></td>
<td valign=top>1968-06-20</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[A16.0] Tuberculosis of lung,
bacteriologically and histologically negative</td><td></tr><tr><td
valign=top>159</td><td valign=top>127606</td><td valign=top>VANIA SEKAR
ATMAJA</td><td valign=top>TARYOSO UNTUNG</td>
<td valign=top>2015-11-29</td><td valign=top>P</td><td valign=top>SOKAWANGI</td><td
valign=top>1</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K00.6] Disturbances in tooth
eruption</td><td>- CALCIUM LACTAT TABLET 500 MG (KALK) 5, 2x1/2 tablet,
<br></tr><tr><td valign=top>160</td><td valign=top>127607</td><td valign=top>ADRIAN
RAKA BUMI</td><td valign=top>LANTIF SRI WIYONO</td>
<td valign=top>2015-04-29</td><td valign=top>L</td><td valign=top>SUNGAPAN</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001965384573</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- DEXTAF TABLET 5, 3x1/2 tablet, <br>- AMOXICILLIN KAPLET 500
MG 5, 3x1/2 tablet, <br></tr><tr><td valign=top>161</td><td
valign=top>127608</td><td valign=top>SRI ASTUTI</td><td valign=top>AGUS
MUJIANTORO</td>
<td valign=top>1978-07-09</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>4</td><td valign=top>2</td><td valign=top>BPJS NonPBI</td><td
valign=top>0002436970498</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [I10] Essential (primary)
hypertension</td><td>- BROCON TABLET 10, 3x1 tablet, <br>- CAVIPLEX TABLET 5, 1x1
tablet, <br></tr><tr><td valign=top>162</td><td valign=top>127609</td><td
valign=top>RAENI</td><td valign=top>DAFRIL</td>
<td valign=top>1967-08-10</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>1</td><td valign=top>8</td><td valign=top>BPJS PBI</td><td
valign=top>0000619664297</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>, [Z99.2] Dependence on renal
dialysis</td><td></tr><tr><td valign=top>163</td><td valign=top>127610</td><td
valign=top>MASRIPAH</td><td valign=top></td>
<td valign=top>2022-10-25</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>10</td><td valign=top>BPJS PBI</td><td
valign=top>0002801165905</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- AMOXICILLIN KAPLET 500 MG 2, @ 12, 3x1 bgks, <br>- CHLORFENIRAMINE
MALEAT ( CTM ) TABLET 4 MG 2, @ 12, 3x1 bgks, <br>- PARACETAMOL TABLET 500 MG 2, @
12, 3x1 bgks, <br></tr><tr><td valign=top>164</td><td valign=top>127611</td><td
valign=top>ARIF AJI PRASETIYO</td><td valign=top>TARYONO</td>
<td valign=top>1976-12-17</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>13</td><td
valign=top>BPJS PBI</td><td valign=top>0000000000000</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[L23.9] Allergic contact
dermatitis, unspecified cause</td><td>- CHLORAMPHENICOL SALEP KULIT 2% (BUFACETINE)
1, 3 kali oles, <br>- AMLODIPIN TABLET 10 MG 5, 1x1 tablet, <br>- BROCON TABLET 10,
3x1 tablet, <br></tr><tr><td valign=top>165</td><td valign=top>127612</td><td
valign=top>YUNITA SULISTIYANI</td><td valign=top>MUSLIM DAHLAN</td>
<td valign=top>2006-12-23</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>11</td><td
valign=top>BPJS PBI</td><td valign=top>0002801140402</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[I84.5] External haemorrhoids
without complication</td><td>- ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet, <br>-
PHYTOMENADIONE ( VIT K1 ) TABLET SALUT GULA 10 MG 10, 3x1 tablet, <br></tr><tr><td
valign=top>166</td><td valign=top>127613</td><td valign=top>AHMAD SOFYAN
NANDI</td><td valign=top></td>
<td valign=top>2019-04-30</td><td valign=top>L</td><td valign=top>WANAMULYA</td><td
valign=top>4</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0001030135476</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- PARACETAMOL SYRUP 120 MG/5 ML 1, 3x1 sendok makan, <br>-
CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 3, @ 10, 3x1 bgks, <br></tr><tr><td
valign=top>167</td><td valign=top>127614</td><td valign=top>TRI AGUSTINI</td><td
valign=top>SUHARSONO</td>
<td valign=top>1967-08-29</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>4</td><td valign=top>14</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001110519628</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[I10] Essential (primary)
hypertension</td><td>- AMLODIPIN TABLET 10 MG 10, 1x1 tablet, <br>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br>- MICONAZOLE CREAM 2 % 1, 3 kali oles,
<br></tr><tr><td valign=top>168</td><td valign=top>127615</td><td
valign=top>SUGIHARTI</td><td valign=top>SAMIUN</td>
<td valign=top>1957-10-17</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078812537</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [I10] Essential (primary)
hypertension</td><td>- AMBROXOL TABLET 30MG 10, 3x1 tablet, <br>- AMLODIPIN TABLET
10 MG 5, 1x1 tablet, <br>- VASTRAL (NEUROTROPIC) KAPLET 5, 1x1 tablet,
<br></tr><tr><td valign=top>169</td><td valign=top>127616</td><td
valign=top>ROHYATI</td><td valign=top>TASIRON</td>
<td valign=top>1986-07-17</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>3</td><td valign=top>4</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K01.1] Impacted teeth</td><td>- AMOXICILLIN
KAPLET 500 MG 10, 3x1 tablet, <br>- ASAM MEFENAMAT KAPLET 500 MG 10, 3x1 tablet,
<br></tr><tr><td valign=top>170</td><td valign=top>127617</td><td valign=top>SAHID
ADNAN</td><td valign=top>CASMAD</td>
<td valign=top>1991-12-05</td><td valign=top>L</td><td valign=top>BEJI</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>Jamkesda</td><td
valign=top>33271013050331</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[F20.9] Schizophrenia,
unspecified</td><td></tr><tr><td valign=top>171</td><td valign=top>127618</td><td
valign=top>HILDA NUR AZIZAH</td><td valign=top>KASIRIN</td>
<td valign=top>1998-02-08</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>1</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000620987949</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal pregnancy,
unspecified</td><td>- CALCIUM LACTAT TABLET 500 MG (KALK) 30, 1x1 tablet,
<br></tr><tr><td valign=top>172</td><td valign=top>127619</td><td
valign=top>YUHROTUN NIZA</td><td valign=top>SIHABUDIN</td>
<td valign=top>2000-05-11</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000620589339</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[R51] Headache</td><td>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br>- TIAMINE HCL (VITB1) TABLET 50MG 10, 3x1 tablet,
<br></tr><tr><td valign=top>173</td><td valign=top>127620</td><td valign=top>KHANZA
ALMAHIRA</td><td valign=top>WIWIT EKO P</td>
<td valign=top>2020-02-28</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>7</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J00] Acute nasopharyngitis [common
cold]</td><td>- PARACETAMOL SYRUP 120 MG/5 ML 1, 3x1 sendok teh, <br>- AMBROXOL
TABLET 30MG 2, @ 10, 3x1 bgks, <br>- CHLORFENIRAMINE MALEAT ( CTM ) TABLET 4 MG 2,
@ 10, 3x1 bgks, <br></tr><tr><td valign=top>174</td><td valign=top>127622</td><td
valign=top>TARIYAH</td><td valign=top>TARIYAH</td>
<td valign=top>1960-03-29</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>4</td><td valign=top>BPJS NonPBI</td><td
valign=top>0000078765726</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[J39.9] Disease of upper respiratory tract,
unspecified</td><td>- AMBROXOL TABLET 30MG 10, 3x1 tablet, <br>- CETIRIZINE TABLET
10 MG 6, 2x1 tablet, <br>- CAVIPLEX TABLET 4, 1x1 tablet, <br></tr><tr><td
valign=top>175</td><td valign=top>127623</td><td valign=top>ERVIYANTI RINI
PUJIATUN</td><td valign=top></td>
<td valign=top>1979-08-16</td><td valign=top>P</td><td valign=top>CIBELOK</td><td
valign=top>6</td><td valign=top>1</td><td valign=top>BPJS NonPBI</td><td
valign=top>0001318437977</td><td valign=top>POLI </td><td
valign=top>Dirujuk</td><td valign=top>[O20.0] Threatened
abortion</td><td></tr><tr><td valign=top>176</td><td valign=top>127624</td><td
valign=top>INDANA ZULFA</td><td valign=top>SUKARDI</td>
<td valign=top>2000-06-29</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>1</td><td valign=top>2</td><td
valign=top>BPJS PBI</td><td valign=top>0000621024028</td><td valign=top>POLI
</td><td valign=top>Dilayani</td><td valign=top>[Z34.9] Supervision of normal
pregnancy, unspecified</td><td>- BESI FUMARAT 60 MG ASAM FOLAT 0,4 MG TABLET
(TABLET TAMBAH DARAH) 10, 1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG (KALK) 10,
1x1 tablet, <br></tr><tr><td valign=top>177</td><td valign=top>127625</td><td
valign=top>AHMAD FERY FADLY AL HAKIM</td><td valign=top>WIDARTO</td>
<td valign=top>2005-10-12</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>9</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K04.7] Periapical abscess without
sinus</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- ASAM MEFENAMAT
KAPLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>178</td><td
valign=top>127627</td><td valign=top>SILVIA MUFIDAH</td><td valign=top>FAJAR
SHODIQ</td>
<td valign=top>2001-03-16</td><td valign=top>P</td><td valign=top>JEBED
UTARA</td><td valign=top>1</td><td valign=top>6</td><td valign=top>Umum</td><td
valign=top>0000621318104</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>, [K52.0] Gastroenteritis and colitis due to
radiation</td><td>- AMOXICILLIN KAPLET 500 MG 10, 3x1 tablet, <br>- BROCON TABLET
10, 3x1 tablet, <br>- ATTAPULGIT (NEW ANTIDES) TAB 10, 3x1 tablet, <br></tr><tr><td
valign=top>179</td><td valign=top>127629</td><td valign=top>SITI KOMARIYAH</td><td
valign=top>PURWANTO</td>
<td valign=top>1993-10-21</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>2</td><td valign=top>BPJS PBI</td><td
valign=top>0002127901847</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K04.0] Pulpitis</td><td>- AMOXICILLIN
KAPLET 500 MG 10, 3x1 tablet, <br></tr><tr><td valign=top>180</td><td
valign=top>127630</td><td valign=top>DWI ARIF PRAYOGO</td><td valign=top>AKROM
HASANI</td>
<td valign=top>2001-10-23</td><td valign=top>L</td><td valign=top>BANJARAN</td><td
valign=top>3</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>181</td><td valign=top>127634</td><td
valign=top>SULASMI</td><td valign=top>ROHMAT</td>
<td valign=top>1988-04-12</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>2</td><td valign=top>3</td><td valign=top>BPJS PBI</td><td
valign=top>0000621113635</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K08.3] Retained dental root</td><td>-
PARACETAMOL TABLET 500 MG 10, 3x1 tablet, <br>- BESI FUMARAT 60 MG ASAM FOLAT 0,4
MG TABLET (TABLET TAMBAH DARAH) 10, 1x1 tablet, <br>- CALCIUM LACTAT TABLET 500 MG
(KALK) 10, 1x1 tablet, <br></tr><tr><td valign=top>182</td><td
valign=top>127636</td><td valign=top>DWI MENTARI YULIANTI</td><td valign=top>AGUS
SUDARTO</td>
<td valign=top>1999-07-10</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000621502446</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[K03.6] Deposits [accretions] on
teeth</td><td></tr><tr><td valign=top>183</td><td valign=top>127637</td><td
valign=top>TAUFIK</td><td valign=top>UMAYAH</td>
<td valign=top>1993-02-17</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>2</td><td
valign=top>Umum</td><td valign=top>0000620258297</td><td valign=top>POLI </td><td
valign=top>Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>184</td><td valign=top>127638</td><td
valign=top>IBRAHIM AKSA BASWARA</td><td valign=top>ASKAR SANIF</td>
<td valign=top>2022-02-10</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>185</td><td valign=top>127639</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>186</td><td valign=top>127640</td><td
valign=top>SHANKARA HARUN</td><td valign=top>PRATAMA</td>
<td valign=top>2022-06-03</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>9</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>187</td><td valign=top>127641</td><td
valign=top>EKA RATNA ASIH</td><td valign=top></td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>188</td><td valign=top>127642</td><td
valign=top>ADIFA JENNAIRA P</td><td valign=top>AGUS FARKHAN </td>
<td valign=top>2022-06-01</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>1</td><td valign=top>9</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>189</td><td valign=top>127643</td><td
valign=top>WENIANTI</td><td valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>190</td><td valign=top>127644</td><td
valign=top>EKA RATNA ASIH</td><td valign=top></td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>191</td><td valign=top>127645</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>192</td><td valign=top>127646</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>193</td><td valign=top>127647</td><td
valign=top>EKA RATNA ASIH</td><td valign=top></td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>194</td><td valign=top>127648</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>195</td><td valign=top>127649</td><td
valign=top>EKA RATNA ASIH</td><td valign=top></td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>196</td><td valign=top>127650</td><td
valign=top>DEFFITA LISDA SAR</td><td valign=top></td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>197</td><td valign=top>127651</td><td
valign=top>RAZELIN ZAKEISHA</td><td valign=top>RAHMAT ZAKARIA</td>
<td valign=top>2022-10-26</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>3</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>198</td><td valign=top>127652</td><td
valign=top>ARRAFI FARZAN ATHALLA</td><td valign=top>AGUS SANTOSO</td>
<td valign=top>2022-10-25</td><td valign=top>L</td><td valign=top>CIBELOK</td><td
valign=top>5</td><td valign=top>5</td><td valign=top>Umum</td><td
valign=top>0003304141323</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>199</td><td valign=top>127653</td><td
valign=top>WENIANTI</td><td valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>200</td><td valign=top>127654</td><td
valign=top>WENIANTI</td><td valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>201</td><td valign=top>127655</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>202</td><td valign=top>127656</td><td
valign=top>MUHAMMAD TABA</td><td valign=top>TOAT</td>
<td valign=top>2022-07-14</td><td valign=top>L</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>6</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>203</td><td valign=top>127657</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>204</td><td valign=top>127658</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>205</td><td valign=top>127659</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>206</td><td valign=top>127660</td><td
valign=top>WENIANTI</td><td valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>207</td><td valign=top>127661</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>208</td><td valign=top>127662</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>209</td><td valign=top>127663</td><td
valign=top>WENIANTI</td><td valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>210</td><td valign=top>127664</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>211</td><td valign=top>127665</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>212</td><td valign=top>127666</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>213</td><td valign=top>127667</td><td
valign=top>JENNAIRA HAFSAH PUTRI PRAYITNO</td><td valign=top>RYAN PRAYITNO</td>
<td valign=top>2021-12-24</td><td valign=top>P</td><td valign=top>BEJI</td><td
valign=top>3</td><td valign=top>12</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>214</td><td valign=top>127668</td><td
valign=top>EKA RATNA ASIH</td><td valign=top></td>
<td valign=top>2022-05-19</td><td valign=top>P</td><td
valign=top>BANJARDAWA</td><td valign=top>0</td><td valign=top>0</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>215</td><td valign=top>127669</td><td
valign=top>SYAQILLA AZZAHRA FITRIYANI</td><td valign=top>RIAN ANDRIAWAN</td>
<td valign=top>2021-05-19</td><td valign=top>P</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>216</td><td valign=top>127670</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>217</td><td valign=top>127671</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>218</td><td valign=top>127672</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>219</td><td valign=top>127673</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>220</td><td valign=top>127674</td><td
valign=top>GUSTIN ARDELIA</td><td valign=top></td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>BEJI</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Gratis</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>221</td><td valign=top>127675</td><td
valign=top> AULIA PUSPA ARUM</td><td valign=top></td>
<td valign=top>2022-02-13</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>2</td><td valign=top>14</td><td
valign=top>Umum</td><td valign=top>0003255023158</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>222</td><td valign=top>127676</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>223</td><td valign=top>127677</td><td
valign=top>AKIO MANDANI FATHAAN</td><td valign=top>HENDI PURWANTO</td>
<td valign=top>2022-08-12</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>1</td><td valign=top>7</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>224</td><td valign=top>127678</td><td
valign=top>WENIANTI</td><td valign=top>AGUS PUTRA PAMUNGKAS</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>GONDANG</td><td
valign=top>2</td><td valign=top>1</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>225</td><td valign=top>127679</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>226</td><td valign=top>127680</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-11-26</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>227</td><td valign=top>127681</td><td
valign=top>SUWARDJO</td><td valign=top>SUWARDJO</td>
<td valign=top>2022-10-19</td><td valign=top>L</td><td valign=top>TAMAN</td><td
valign=top>8</td><td valign=top>3</td><td valign=top>Umum</td><td
valign=top>0000078692578</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>228</td><td valign=top>127682</td><td
valign=top>DEFFITA LISDA SAR</td><td valign=top></td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td valign=top>BANJARAN</td><td
valign=top>0</td><td valign=top>0</td><td valign=top>Umum</td><td
valign=top>0000000000000</td><td valign=top>POLI </td><td valign=top>Belum
Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr><tr><td valign=top>229</td><td valign=top>127683</td><td
valign=top>NAZWA</td><td valign=top>TRI BUDIHARTO</td>
<td valign=top>2022-11-26</td><td valign=top>P</td><td
valign=top>PEDURUNGAN</td><td valign=top>3</td><td valign=top>12</td><td
valign=top>Umum</td><td valign=top>0000000000000</td><td valign=top>POLI </td><td
valign=top>Belum Dilayani</td><td valign=top>[Z00.0] General medical
examination</td><td></tr>