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No Reg. No BPJS/NIK Nama Dokter Alamat JK Diagnosis Terapi & Tindakan Pekerjaan KIE Riwayat Riwayat Riwayat
s
ur
Riwayat PTM Riwayat Penyakit Riwayat
u
Um
at
Umum BPJS SKTM D P TB BB TD T HR LP Lab Penyakit Perdaraha Pemeriksaan
St
( ≥ 15 th ) Sebelumnya Alergi
Keluarga n IVA/Sadanis
furosemid, amlodipin,
5. 6189 0002520856506 Ny. Intang 57 th dr. Rahma Jalan anang kacil P L ✓ HT Urgency + insomnia ibuprofen, omeprazole, 09.00 09.10 IRT ✓ 147 53 210/117 37 68
alprazolam
Ibuprofen, omeprazole,
6 28.152 0001789410892 Tn. Ruspandi 59 th dr. Rahma Jalan Perum JB L L ✓ Frozen Shoulder eprison 09.10 09.15 WSWASTA ✓ 173 62 144/101 37,1 95
7 22332 0000756592356 An. M. Yusuf 13 th dr. Ferisa Jalan Borneo L L ✓ Post Heacting Dressing 09.00 09.05 Pelajar ✓ 158 45 36,9
8 27.242 6310096903050005 asrianti sari fortuna 17 dr. ferisa jalan perjuangan P L ✓ Dispepsia syndrom lansoprazole, antasida 09.06 09.11 IRT ✓ 147 39 110/94 37 83
Metformin, gliben,
amlodipin, captopril,
9 18.651 0001922783207 Ny. Rusma 50 th dr. Rahma Jalan Rahayu P P ✓ DM type II + HT cetirizine, MP, 09.15 09.30 IRT ✓ 154 50 164/105 36.9 90
Bretametason
domperidone, omeprazole,
13 22.814 0001672699432 Tn. Idul Fitri 38 th dr. Rahma Jalan Pasar ampera L L ✓ obs vomit+ispa pct, cotrimoxazole, 09.41 09.48 SWASTA ✓ 163 87 124/85 36.7 84
guafenesin, zink
Glibenclamid, metformin,
14 2.252 0002720672166 Ny. Linda wati 52 th dr. Ferisa jalan sepakat P L ✓ DM type II natrium diclofenac, vit b12 09.28 09.35 IRT ✓ 175 89 128/84 37 89
amlodipin, natrium
HT Terkontrol, LBP Post
16 3593 0002767542445 Tn. Basuni 63 th dr. Ferisa Jalan raya sungai kecil L L ✓ diclofenac, 09.40 09.50 sWASTA ✓ 156 53 143/76 37.4 103
KLL
methylprednisolon, vit b12
17 28.153 0002376400476 Ny. Nurul Hidayah 50 th dr. Rahma jalan batu benawa P L ✓ Skoliosis + HT rujuk Sp. S, Amlodipin. 10.00 10.08 IRT ✓ 154 78 157/94 36.9 99
18 27.716 0002722825247 Tn. Rizki novdiandi 30 th dr. Ferisa Jalan nusa indah L B ✓ HT amlodipin, captopril 09.55 10.05 Wswasta ✓ 173 72 171/102 37,1 100
19 22.043 0002496357314 An. Aura Nabila 9 th dr. Rahma Jlan kupang P L ✓ Otitis eksterna ibuprofen, chlorampenicol, 10.10 10.18 IRT ✓ 129 18 36.8
Amlodiipin, cetirizine,
20 27.168 umum Tn. Yohanes 59 th dr. Rahma jalan raya serongga L L ✓ HT grade II + ISPA amoxilin, pehavral 10.05 10.12 PNS ✓ 158 74 161/93 37 79
24 3213 0001548138857 Ny. Misawati 42 th dr. Rahma jln swarga P L ✓ Otitis eksterna chlorampenicol, pct, MP 10.30 10.40 IRT ✓ 168 50 92/74 37 82
26 7426 umum Ny. Saleha 61 th dr. Ferisa jalan borneo P L ✓ HT urgency Amlodipin, furosemid 10.15 10.25 IRT ✓ 149 50 208/124 36,8 92
Ambroxol, flutrop,
28 27317 0003066231802 Tn. Ridwan 22 th dr. Ferisa jalan batu benawa L L ✓ ISPA 10.25 10.33 WSWASTA ✓ 162 53 118/90 37,4 98
amoxilin, pct, pehavral
asam mefenamat,
29 7684 0002722626707 Ny. Syamsiah 30 th dr. Ferisa tungkaran pangeran P L ✓ Konjunctivitas 10.35 10.40 IRT ✓ 153 71 123/84 36,4 82
gentamicin,
31 27.356 0002720812105 Ny. Sumiati 23 th dr. Ferisa Tungkaran pangeran P L ✓ F.06.8 Rujuk poli jiwa 10.40 10.50 IRT ✓ 146 52 100/80 36,7 77
34 17.856 0002722637913 Ny. Saderiyah 46 th dr. Rahma JALAN RAHAYU P L ✓ cholelitiasis +HT Rujuk poli penyakit dalam 11.10 11.18 IRT ✓ 159 78 191/107 36,9 78
POLI UMUM
Hari/ Tanggal : Selasa, 3 Januari 2023
Petugas : Imelda,chaterina,jumariah
Pembiayaan
Status
Status
ir
ah
No Register No BPJS NIK No Telpon Nama Dokter Alamat JK Penya Diagnosis Terapi & Tindakan
ur
Kunjungan
lL
Um
Umum BPJS SKTM
kit
Tg
post op fraktur digit III-IV
1 27.292 0002777404331 3305181211680003 0853.8945.3840 Tn.Usman 53 th 12-11-1968 dr.ferisa Jl.Kemakmuran RT.09 , KB L B L ✓ KIE
manus (S)
4 28.160 tdk ada 3526105506820005 0852.4550.0728 Ny.Zehriyah 41 th 15-06-1982 dr.ferisa Jl.Aluh kacil RT.09 / TP P B B ✓ myalgia nadic, vit.b12
5 22.802 0001049520734 6573030909450004 tdk ada Tn.Soebandi 77 th 09-09-1945 dr.Rahma Jl.swarga RT.02 / TP L B B ✓ katarak _
6 133 0002745638572 6310061012730003 0823.5096.7386 Tn. Ahmad Effendi 49 th 10-12-1973 dr.ferisa Jl.kodeco Km.2,6 Rt.6 / GA L B B ✓ PPOK Rujuk. Poli paru RSMP
7 22.950 0001548134572 6310095912800002 0852.8071.4399 Ny. Ida wirda 42th 19-12-1980 dr. ferisa JL. perum JB / GA P B B ✓ HT gr.II +CC furocemite, amlodipin, PCT, flutrop,amroxol
0001869537148
8 22.951 6310065509140002 0852.8071.4400 An. Miftahul jannah 8 th 15-09-2014 dr.rahma JL. perum JB / GA L B B ✓ CC Pct, amox, amroxol, CTM, Vit.C
( PKM S4)
9 28.165 tdk ada 3506094405770003 0821.5175.8992 Ny.wiwiwk indriani 45th 04-05-1977 dr.rahma Jl.perum JB /GA P B B ✓ atraisia nadic, antasida, vit BC
10 10.893 0002720671558 6310060508200001 0821.5853.4189 An. Azka faizan 5th.5 bln 05-08-2020 dr.ferisa Jl.Malewa RT.03 / GA L B B ✓ Diare akut tampa dehidrasi dompridone, kotri, zinc, oralit
11 28.163 0002722609102 6310094810080001 0853.4807.3538 An. Yuvita 15 th 08-10-2007 dr.rahma Jl.mawar RT.04 /TP P B B ✓ OMA ibuprofen, amox, dexa, vit.c
13 24.794 0002722605535 6310090501590002 0821.5464.9991 Tn tafsir 63th 05-01-1959 dr.rahma Jl.Lap.5 okt /DB L B L ✓ HT gr.I amlodipin, nadic, vit.BC
14 28.164 0002849413342 6310094506630009 tdk ada Ny. Hartasiah 59th 05-06-1963 dr. rahma Jl.kodeco RT.01 / GA P B B ✓ HT + hiperurecemia amlodipin, alluprinol, ibuprofen, vit.BC, dexa
15 10.851 tdk ada 6310092012610001 0812.9583.6107 Tn.nurdin 62th 20-12-1961 dr.ferisa Jl.Hidayah RT.07 L B L ✓ HT + vertigo amlodipin, betahistin, antasida, vit BC
16 727 0002471389784 6310066002170001 0815.1746.5481 Ny. Siti khadijah 6th 20-09-2017 dr.rahma Jl.rahayu RT.06 P B B ✓ talasemia+ asma bronchial salbutamol, amroxol, dexa, pct
17 28.162 0002972790336 6302011212730001 0853.2235.5555 Tn.zainudin 49th 12-12-1973 dr.rahma Jl.Borneo RT.13 /Sejatera L B B ✓ Faringitis pct, dexa,amroxol,vit.c
18 15.203 0001922785536 6310091407930010 0823.5000.9343 Tn. Faizal 29th 14-07-1993 dr.ferisa Jl.lap.5 okt /DB L B B ✓ ispa, dispepsia syndrome amroxol, flutup, pct, amox, dexa vit. B
19 28.158 0002722701442 6310091803730002 0821.5015.8905 Tn.Endang supratna 57th 18-03-1973 dr.rahma Jl.usaha bersama RT.05 / GB L B B ✓ hypermetropia ruj. Poli mata RS DHAAN
21 17.731 0002722637428 6310091508620003 0821.5900.8890 Tn. C.sondang 60th 15-08-1962 dr.rahma JL.batu benawa RT.09 L B B ✓ CHF + CAD + Abses cruris Ruj.poli bedah RS.DHAAN
22 22.101 0002258233007 6310062305150002 0822.5166.5315 An.arkana 7th 23-05-2015 dr.rahma Jl.transmigrasi Km.03 L B B ✓ obs. Vomit dompridone, pct,kotri,oralit
23 27.040 0002312663141 6310061706690001 0813.4889.9800 Tn. H. Rusliadi 53th 17-06-1969 dr.ferisa TP Rt.04 L B L ✓ HT gr.II + hiperuresemia amlodipin, ibuprofen, alluprinol
25 7295 0002659955938 6310094107510029 tdk ada Ny. Kamsiah 61th 7/1/1961 dr,rahma Jl.pelabuhan speed RT.05 P B B ✓ DM tp.II + OA metformin, amlodipin, ibu, amox, vit.BC
26 ✓
14,561 0002722678042 6310092011860002 0853.9087.3032 An.Nazwa 6th 7/13/2016 dr.rahma Jl.rahayu RT.06 /DB P B B CC amroxol, pct, vit.C , CTM
Wkt Playan ;l Riwayat PTM
✓
11.20 11.25 148 38 37
POLI UMUM
Hari/ Tanggal : Rabu, 04 Januari 2023
Petugas : Imelda putri, melinda,widya,
Pembiayaan
Status
Status
ir
JK kunjunga penyakit
ah
No Register No BPJS NIK No Telpon Nama Dokter Alamat Diagnosis
ur
lL
m
n Umum BPJS SKTM
Tg
1 22.802 0001049520734 6573030909450004 Tidak ada Tn.Soebandi 77 th 9-9-1945 dr.Rahmah Jl.Swarga Rt.20 L B B ✓ Post op katarak
Tn.Andrei
2 28.168 Umum 6471032003760001 082248559600 Enrico,SE 46 th 20-3-1976 dr.Ferisa Perum JBV L B B ✓ HT + ISPA
3 22.861 Internet error 6310092303570001 Tidak ada Ny.Hasnah 65 th 23-1957 dr.Rahmah Pasar ampera RT.4 P B L Internet error HT gr I + Atralgia
5. 20.759 0002737322829 6310094611660001 082255813617 Ny.Fatmah 56 th 6-11-1966 dr.rahmah RT.7 TP P B L ✓ Susp TB + CHF
DM dg insulin + HT
6 4.440 0000894910814 6310094412700005 082252162001 Ny.Arbayah 52 th 1-12-1971 dr.Ferisa Jl.Kenanga RT.6 TP P B L Internet error urgency + Qabses pedis
8 20.322 Internet error/ Umum 6310095108110002 081349432799 An.Ilfa Azkia 11 th 11-8-2011 dr.Rahmah RT.3 Kodeco P B B Internet error Epistaksis
9 25.785 Internet error 6310064804010003 082150482474 Ny.Nor Hasanah 21 th 8-4-2001 Jl.Nusa Indah RT.1 P B B ISPA
dr.Ferisa Internet error
Barokah
10 28.156 Umum 7371030811020005 089523905577 Tn.Incet Taruna 20 th 8-11-2002 dr.Rahmah Jl.Kodeco GA L B B ✓ susp.TB
11 22.344 Internet error 6310065403130002 081251055054 An.Nur Nadilla 6 th 14-3-2016 dr.Rahmah Jl.Insgub RT.11 KB P B B Internet error Susp.Def.Vit D + B
12 27.871 000272263361 6310095006800014 Tidak ada Ny.Normayanti 42 th 10-6-1980 dr.Ferisa RT.6 TP P B B ✓ ISPA
14 28.172 Umum 6310021802990002 081248828183 Tn.M Zainal Fahmi 23 th 18-2-1999 Jl,Perjuangan RT.12 L B B ✓ ISPA
dr.Ferisa TP
Ny.Rabiatul
15 25.695 Umum 6310096906990002 085390621009 Adawiyah 23 th 29-6-1999 dr.Rahmah RT.11 Bersujud P B B ✓ Abses Periauricular
14 12.950 Internet error 6310095008810005 085332059183 Ny.Hasnaba 41 th 10-8-1981 dr.Ferisa RT.1 TP P B B Internet error Scabies
15 28.095 Internet error 6310091609650003 082254618092 Tn.Abu Samah 57 th 16-9-1965 dr.Rahmah RT.8 KB L B B Internet error HT urgency
16 28.095 Internet error 6310092805070005 082254618092 An.M Yusuf 15 th 28-5-2007 dr.Rahmah RT.8 KB L B B Internet error Scabies
17 28.173 Internet error 6310091810000003 081391056922 Tn.M Ridho 22 th 18-10-2000 Jl.Perjuangan RT.15 L B B Internet error ISPA + Sindrom dispepsia
Alfiansyah dr.Ferisa TP
18 28.174 Internet error 6310090102700008 081254415954 Tn.Akhmad Gazali 52 th 1-2-1970 dr.Rahmah RT.14 Bersujud L B B Internet error Lifoma dd nervus
19 27.717 Internet error 63100955047000005 081216674488 Ny.Siti Aisyah 52 th 15-4-1970 dr.Rahmah RT.1 KB P B B Internet error HT gr II + dispepsia
20 19.776 Internet error 6310095702870003 082150479299 Ny.Rasmah 36 th 17-2-1987 dr.Ferisa Jl.Fitrianor P B B Internet error DM dg insulin
21 4.359 Internet error 6310060801160003 082351702290 An.M Rifki 6 th 8-1-2016 Swarga RT.20 TP L B B Internet error Common cold +
dr.Ferisa Susp.Dermatofitosis
19 28.175 Umum 6310091701110005 085654466255 An.Alfianor Fadil 12 th 17-1-2011 dr.Rahmah Rt.2 Sejahtera L B B ✓ Scabies
20 26.682 Internet error 6310093112990003 085337899599 Tn.M Ramadani 23 th 31-12-1999 dr.Ferisa Gg.Nurul Yakin L B B Internet error Common cold
21 23.320 Internet error 6310094910750007 085350450419 Ny.Bariah 48 th 9-10-1975 dr.Rahmah Rt.10 Barokah P B B Internet error HT gr II + Vertigo
22 27.126 0002722703139 6310096107000007 082153543381 Ny.Issabel Tiara 22 th 21-7-2000 dr.Ferisa Rt.5 Bersujud P B B ✓ Cephalgia
Wkt Playan Hasil Pemeriksaan Riwayat PTM
Riwayat
Riwayat
Terapi & Tindakan Pekerjaan KIE Riwayat Riwayat Riwayat Pemeriksa
Penyakit Riwayat
D P TB BB TD T HR LP Lab Penyakit PTM ( merokok Perdaraha an
Keluarga ≥ 15 th ) Sebelumn Alergi
n IVA/Sada
ya
nis
Rujuk poli mata
RSUD DHAAN 08.20 08.30 Wiraswasta ✓ 151 43 147/81 36,1 79 - - - - - - - - -
Amlodipine,
Furosemide, 08.27 08.37 Kary.Swasta ✓ 168 84 179/139 37 93 - - HT HT HT Tidak Tidak ada Tidak ada -
Ambroxol, PCT
Amlodipine,
Furosemide,
Ibuprofen, 08.33 08.40 IRT ✓ 143 46 140/84 36,9 81 - - - - - - - - -
Omeprasole,
Bcomp
Omeprasole, PCT,
Guaefenisin, 08.43 08.50 IRT ✓ 150 40 125/97 37 89 - - - - - - - - -
Bcomp
Rujuk poli
penyakit dalam
RSMP, Dressing,
GDP:3
Amlodipine, 08.40 08.50 IRT ✓ 150 58 208/120 36,9 84 - 00 - - - - - - -
Furosemide,
Asmef,
Metronidasole
Amlodipine, Nadic,
Furosemide, 09.01 09.10 IRT ✓ 146 73 176/116 36,9 92 - - HT HT HT - Tidak ada Tidak ada -
Konsul gigi
PCT, Flutrop,
Amox, Pehavral 09.04 09.10 IRT ✓ 155 47 113/82 37 110 - - - - - - - - -
Cek sputum 08.55 09.05 _ ✓ 165 62 108/75 36,9 88 - - - - Tidak ada - Tidak ada Tidak ada -
PCT, Bcomp 09.07 09.12 Pelajar ✓ 124 26 - 37 - - - - - - - - - -
PCT, Antasida,
Bcomp 09.13 09.20 Pelajar ✓ 164 69 105/79 36,9 79 - - - - - - - - -
PCT< Ambroxol,
Flutrop, Amox,
Domperidone, 09.31 09.40 Wiraswasta ✓ 172 85 125/86 37,6 109 - - HT Asma Asma Ya Tidak ada Tidak ada -
Lansoprasole
Ibuprofen,
Metronidasole, 09.15 09.25 IRT ✓ 156 75 135/109 36,7 116 - - - - - - - - -
Dexa, Antasida
Ambroxol, CTM,
09.43 09.50 Pelajar ✓ 108 15 - 36,7 - - - - - - - - - -
Scabimed salf
Furosemide,
Amlodipine, PCT, 09.30 09.40 Wiraswasta ✓ - 69 182/108 36,8 79 - - - HT - - Tidak ada Tidak ada -
Bcomp
Scabimet,
Cetrizine, PCT, 09.21 09.30 Pelajar ✓ 168 73 127/88 36 82 - - - - - - - - -
Amox
PCT, Ambroxol,
Amox, Antasida, 10.03 10.10 Wiraswasta ✓ 169 69 140/100 36,9 122 - - HT - Tidak ada - Tidak ada Tidak ada -
Domperidone
Captopril,
Amlodipine,
Ibuprofen, 09.50 09.57 IRT ✓ 146 47 170/103 37 80 - - - - - - - - -
Omeprasole,
Alprazolam
Rujuk poli
penyakit dalam 09.57 10.05 IRT ✓ 154 51 124/84 36,7 91 - - - - - - - - -
RSUD DHAAN
Captopril,
Amlodipine,
Simvastatin, PCT, 10.49 10.59 IRT ✓ 141 38 161/89 36,9 - - - - - - - - - -
Betahistine,
Allopurinol
Pembiayaan
ir
ah
us
No Register No BPJS NIK No Telpon Nama Dokter Alamat JK
ur
lL
at
m
Umum BPJS
St
U
Tg
1 27288 tdk ada 6308050809850002 082155059444 Tn.Hendar 37 th 08-081983 dr Rahmah jl kodeco pal 1 GA L L ✓
2 22332 tdk ada 6314220910090001 082132301854 An.M.yusuf 13 th 09-10-2009 dr.Ferisa jl.borneo rt 14 sejahtera L L ✓ ✓
Ny.nanik
4 26041 0002722844711 63502147112730001 081259590869 47 th 31-12-1973 dr Ferisa Jl komp.emil rt 8 TP L L ✓
setyowati
5 20239 0002897407225 6310090703500003 tdk ada Tn sarjono 72 th 7-03-1950 dr Rahmah jl anda ujung rt 9 DB L L ✓
6 26792 non aktif 6310090901590002 tdk ada Tn.Syamsudin 64 th 9-01-1959 dr Ferisa Jl.bb Rt 9 gg.blibis DB L L ✓
7 24797 0002586807775 6310064408160001 tdk ada Ny.Elfina nuri yani 52 th 4-8-2016 dr.Ferisa jl BB rt 8 DB P L ✓
9 1458 0002754280708 6310094908000009 082154008033 Nn.Sinta rahim 22 th 9-08-2000 dr ferisa Jl pasar sabtu rt 1 TP P L ✓
13 573 0002743775458 6310095007700013 tdk ada Ny.khoyul 52 th 10-07-1970 dr Rahmah Jll.BB rt 09/provinsi DB P L ✓
Tn.Andi Abdul
14 11.492 0001103693782 6310095906990006 081251940221 Haris 63 th 19-09-1967 dr ferisa jl transmigrasi rt 9 DB L L ✓
Nn.Nisa Azzahrah
22 24.165 0001564541245 7371072412030005 - Aziz 17 th 11-06-2004 dr ferisa Jl.perum jb rt 5 GA P L ✓
23 27923 000192799126 tdk ada 085159867655 Ny.Nor Aidah 65 tn 10-5-1961 dr.ferisa Ll.5 okt rt 4 DB P B ✓
embiayaan Wkt Playan ;l Riwayat PTM
Post cerebral Rujuk poli syaraf rsmp irt ✓ 151 50 215/121 37 tdk ada HT
infection (169.30) 08.18 08.23
Ambroxol,pct,dexa,vit.,surat wiraswas
cc 08.25 929 ✓ 157 50 158/80 36,9 HT
sakit 2 hari ta
Ambroxol,flutup,salbutamol,amo karyawa blm
Ispa 08.28 08.33 ✓ 155 53 118/78 blm scrining
xillin n sawsta 36.8 scrining
kol:256
hipercholestrolemia na.dik,dexa,simvastatin,vit.bcom 08.21 08.25 irt ✓ 154 55 120/87 36,9 tdk ada tdk ada
mg/dl
pct,ambroxol,atd,vit bcom,surat wiraswas
Obs febris sakit 2 hari 09.00 09.05 ta ✓ 170 77 162/105 36,7 tdk ada tdk ada
tdk
SLE (M32.9) Rujuk poli p.dalam rsmp 09.10 09.15 ✓ 153 52 109/86 36,9 tdk ada tdk ada
bekerja
tdk
169.3 rujuk poli saraf rsmp 09.03 09.08 ✓ 152 60 110/77 36,8 tdk ada tdk ada
bekerja
pct,ambroxol,flutrop,cefadroxil,p tdk
Ispa ehavral 09.24 09.29 bekerja ✓ 166 56 128/83 37
wiraswas
Angina pectoris Rujuk sp.pD rsmp 09.26 09.31 ta ✓ 173 87 130/88 36,8 tdk ada tdk ada
GDP:
HT+DM tipe II + amplodipin,glibenklamid,metfor 172,kol:1
09.06 09.12 swasta ✓ 164 53 148/79 37 DM HT,DM tdk ada
Abses pedis sinistra min,gentamicin zalf 49,Au:5,
1
Post oma cloramphenicol tts 10.11 10.16 tdk ada ✓ 153 36
Amplodipin,furosemid,na.dik,gen
HT+Atralgia+piodera 09.51 09.56 IRT ✓ 155 71 177/101 36,7 tdk ada DM tdk ada
tamin zalf
GDS:
HT+GERD Amplodipin, 09.59 10.06 irt ✓ 142 52 157/94 36,8 95,AU: tdk ada
4,2 tdak ada
Amplodipin,Captropil 12,5
HT gr II 10.06 10.12 irt ✓ 163 80 150/106 36,
mg,vit.bcomp
Obs.hemoptoe+sind. wiradsw
Ambroxol,pct,atd,vit.comp 08.10 08.15 ✓ 62 128/95 36,9
dispepsia asta
Ambroxol,cetirizine,pct,amoxilin, tdk
ispa vit.c 10.18 10.23 bekerja ✓ 146 41 108/85 37
pct,ambroxol,cefadroxuil,vit.cbc
isp+LBP 10.24 10.30 irt ✓ 30 122/99 36,9
omp,rujuk poli syaraf rsmp
tdk ada tdk ada
Riwayat
Riwayat Pemeriksa
Perdaraha an
n IVA/Sada
nis
tdk ada
tdk ada
tdk ada
POLI
Hari/ Tanggal : Jumat, 06 Januari 2023
Petugas : Imelda Putri, Jumariah, etty, Isti, Chatrine
i r
ah
No Register No BPJS NIK No Telpon Nama Alamat JK
Tg r
u
lL
Um
Desa Kapung Baru
1 12700 000197494669 6310095510650007 081348407237 Ny. Maimunah 55 th 15-10-1965 P
Rt.13
8 25973 0002722705885 6310066203140002 081251940513 an. Annisa F 8 th 22-03-2014 Jl. PT SBT Rt.08 P
9 25973 0002722705852 6310096505760002 081251940513 Ny. Marlina 46 th 25-05-1976 Jl. PT SBT Rt.08 P
11 28180 Tidak ada 6308105311700001 088804530897 Ny. Syamsiah 53 th 13-11-1970 Gg. Mawar TP Rt.05 P
12 18791 0002720689323 6310096103640003 081348191967 Ny. Siti Jamilah 58 th 21-03-1964 Jl. Kedondong Rt.7 P
13 28183 0003100260306 6306024102000001 083111641797 Ny. Lasmia Rafiah 22 th 01-02-2000 Batu Benawa RT.09 P
14 24023 0000889553542 6302065004650010 082271644774 Ny. Kartini 57 th 10-04-1965 Jl. Wonorejo RT.11 GA P
15 10138 000177279587 6310093105950003 08215700303 Tn. Rusli Hadri 27 th 31-05-1995 Jl. Batu Benawa Rt.09 L
18 17266 0000894880528 tidak ada 081254217474 Ny. Mariani 57 th 01-05-1965 Jl. Banyuwangi Rt.14 P
20 13636 0001554372551 6310097004850008 081250021781 Ny. Dahliana 33 th 30-04-1985 Jl. Trans RT.13 P
24 6851 0002659958212 6310064509160002 085389253456 an. Nabila Zaskia Putri 6 th 05-09-2016 Jl. Perjuangan RT.17 P
Status
Pendididk
Pekerjaan Dokter kunjunga Status Diagnosis Terapi & Tindakan KIE
an penyakit Umum BPJS SKTM D P
n
IRT dr. Ferisa B B ✓ CAD + GERD Rujuk poli penyakit dalam 08.05 08.10 ✓
SMP IRT dr. Rahmah B B ✓ Commond Cold amlodipin, GG, cetirizine, pct 08.30 08.40 ✓
amlodipin, ibuprofen,
IRT dr. Ferisa B B ✓ HT gr I + GERD ✓
lansoprazol, antasida, vit B 12 08.35 08.45
metformin, glibenclamide,
furosemide, amlodipin,
MI IRT dr. Rahmah B B ✓ DM Tipe II + HT ✓
ibuprofen, omeprazole, vit B 08.50 09.00
com
SMA Tidak ada dr. Ferisa B B ✓ Ispa Surat Sakit, Obat masih ada 09.05 09.15 ✓
Belum sek Tidak ada dr. Ferisa B B ✓ Scabies CTM, Scabimite 09.35 09.45 ✓
Belum
sekolah Tidak ada dr. Rahmah B B ✓ Commond Cold pct, ambroxol, ctm, vit C 09.45 09.55 ✓
SD Wiraswasta dr. Ferisa B B ✓ Post SNH Rujuk Poli Saraf RSMPH 09.30 09.40 ✓
Belum
Tidak ada dr. Ferisa B B ✓ GEA pct, kotrimoxazole, zinc, oralit 09.40 09.50 ✓
sekolah
SMP IRT dr. Rahmah B B ✓ LBP + OA Genue Rujuk Poli saraf RSMP 09.25 09.35 ✓
SD Tidak ada dr. Rahmah B B ✓ LBP + OA Genue Rujuk poli saraf RSMP 09.25 09.35 ✓
Belum
sekolah Tidak ada dr. Ferisa B B ✓ Epilepsy Rujuk poli anak RSMP 10.00 10.10 ✓
165 60 124/76 37 78
Sea food +
157 65 141/99 36,4 96 HT HT
ayam ras
135 25 36,8
GDS : 357,
58 162/92 36,8 Chol : 215,
AU : ^,8
79 203/110 37 79
118 16 37
102 17 36,9
150 57 150/92 37 93
122/84 37 73
147 56 128/79 37 78
119 20 37
101 14 37
149 36 36,7
ir
ah
No Register No BPJS NIK No Telpon Nama Alamat JK
Tg r
u
lL
m
U
Jl. Padaidi Rt.9
1 14,785 tidak ada 6310064205160004 085387660689 An. Maria 6 th 12/05/2016 P
Sejahtera
10 13,974 0002484308485 6310090305690005 085347062501 Tn. Satimin 60 th 31/03/1963 Jl. Banyuwangi Rt.14 TP L
12 5,192 0000895205799 tidak ada di status 085349541936 Ny. Khairunnisa 63 th 14/06/1959 Jl. Kenanga Rt.6 TP P
Jl. Banyuwangi/Senada
16 17,587 0001429904158 6310097112580007 081348647943 Ny. Srikonah 64 th 31/12/1958 Rt.7 GA P
0001098738617 Jl. Perum Bumi
17 28,193 (Faskes S4) 6310094401040 08198403073 Nn. Tia Nur Safitri 18 th 04/01/2004 Bersujud Baroqah P
0003089815525
Jl. Batu Benawa
18 28,194 (faskes PKM 63210267001170001 082254220049 An. Rehana Samrotul F 6 th 30/01/2017 P
Maulasam) Bersujud
19 25,784 0002722700496 6310095612010006 087806967919 Ny. Siti Aisyah 21 th 16/12/2001 Jl. Mega Indah rt.6 GB P
20
21
22
23
24
25
26
27
POLI UMUM
Status
Pendididk
Pekerjaan Dokter kunjunga Status Diagnosis Terapi & Tindakan KIE
an penyakit Umum BPJS SKTM D P
n
Ambroxol, Cetirizine,
SMK IRT dr. Ferisa B B ✓ ISPA Amoxilin, Vit.C 08.25 08.35 ✓
Masih
Pelajar dr. Rahmah B B ✓ Commond Cold PCT, Ambroxol, CTM 08.25 08.35 ✓
Sekolah
Amlodipin, Metformin,
DM tp.II + HT +
SD IRT dr. Rahmah B B ✓ Simvastatin, Rujuk Poli Mata 08.20 08.30 ✓
Susp. Miopi RSUD DHAAN
Metronidazole, Ibuprofen,
SMK Wiraswasta dr. Rahmah B B ✓ Abses Mandibulla 08.20 08.25 ✓
Dexamethasone, Antasida
Cetirizine, Scabimid,
SD Wiraswasta dr. Ferisa B B ✓ Scabies + HT 09.00 09.10 ✓
Amlodipin
Masih
Pelajar dr. Ferisa B B ✓ Tonsilitis PCT, Amoxilin, Vit.Bcomp 10.35 10.45 ✓
Sekolah
SMK IRT dr. Ferisa B B ✓ Faringitis + Anemia PCT, Amoxilin, Vit.C, Hemafort 10.30 10.40 ✓
✓ 09.40 09.50 ✓
✓ 09.40 09.50 ✓
✓ 09.25 09.35 ✓
✓ 09.25 09.35 ✓
✓ 10.00 10.10 ✓
✓ 09.40 09.50 ✓
✓ 09.40 09.50 ✓
✓ 09.21 09.31 ✓
;l Riwayat PTM
Riwayat
Riwayat Riwayat
Riwayat Riwayat Pemeriksa
PTM Penyakit
TB BB TD T HR LP Lab Penyakit merokok Riwayat Alergi Perdaraha an
( ≥ 15 Sebelumn
Keluarga th ) n IVA/Sada
ya
nis
114 19 38,4
145,
5 55 120/95 37 94
120 20
165 53 147/96 37 72 HT
HT, HT,
166 77 169/113 36,9 86 Stroke Stroke
155 72 190/118 36 72
157 72 197/107 37 60 HT HT
126/75 36,8
GDS:152
150 65 154/87 36,7 71 AU:7,9 HT
160 50 128/82 36,9 88
122 20 37,4
r
i
ah
No Register No BPJS NIK No Telpon Nama Alamat
Tg r
u
lL
m
U
00027228 63100670 An. Azzahra 30/05/20 Jl. Raya TP
1 26,663 03118 05140003 081253908430 Arinata 8 Th 14 RT.07 / TP
Jl. Lapangan
00022836 63100911 Tn. 11/04/19
2 28,195 43427 04730005 081280045476 Budiyardi 48 Th 73 5 Oktober
RT.05/ DB
Jl.
Pelabuhan
4 7,295 00026599 63100941 Tidak Ada Ny. Kamsiah 61 Th 01/07/19 Speed
55938 07510029 61
RT.05 (Desa
Sejahtera)
Jl.
00019227 63100957 Ny. Devi Ika 17/11/19 Sampurna /
5 26,566 085346045626 28 Th
36442 11930002 Noviana 93 Desa
Barokah
Jl. Borneo
00007565 63242209 An. M. 09/10/20
11 22,332 082132301854 13 Th RT.14 / Ds.
92356 10090001 Yusuf 09
Sejahtera
Jl. Lapangan
00008959 63100912 01/12/19
12 15,252
07720005 Tidak Ada
Tn. Asruni 51 Th 71 5 Oktober
84209
RT.06/ DB
Jl.
63060413 Tn. Ahmad 13/05/19
13 27,950 - 081253484784 24 Th Mulawarma
05980001 Baihaqi 98
n RT.15 /TP
Jl. Raya
14 27,717 - 63100955 081216174488 Ny. Siti 52 Th 15/04/19 Batulicin
04700005 Aisyah 70
RT.01 /KB
Jl. Pel.
63100989 Tn. M. 09/06/19 Speed
15 7,885 tidak ada 085390828406 45 Th
06740006 Taher 74 RT.05 / Ds.
Sejahtera
Jl. Pelita
00001224 63020645 Ny. Noer 05/01/19 Permai
16 23,566 80357 01750004 085251454388 Hasanah 44 Th 75 Insgub , Ds.
KB
Jl. Mangga
00030719 63100965 25/11/19
17 15,893 081349602988 Ny. Irliani 51 Th II RT.14 /
21275 11710003 71
DB
An. Alzena
00018946 63100657 17/06/20 Jl.
18 24,185 10204
05130001 082150766667
Ayesha 7 Th 13 Mulawarma
Hawari n RT.16 /TP
Jl. Raya
19 20,546 00027227 63100952 082158924552 Ny. Puji 48 Th 12/10/19 SERONGGA
23536 10740006 Tuaningsih 74 KM.05
RT.04/ GB
Jl. Raya
00027227 63100621 An. Septian 21/09/20 SERONGGA
20 20,546 082158924552 6 Th
23569 09160001 Risky 16 KM.05
RT.04/ GB
Jl. Raya
00027227 63100958 Ny. 18/04/19 Serongga
21 26,314 085332060895 67 Th
23931 04550002 Wartinah 55 KM.07
RT.05/ GB
Jl. Lapangan
25 18,063 00026564 63100644 082256068312 An. Sa'adah 8 Th 04/05/20 5 Oktober
06878 05150004 Rahmawati 15
RT.05 / DB
Gg. Bunga
63100905 An. M. 05/10/20 RT.07 /
28 28,202 - 18030007 089689119689 Firmansyah 19 Th 03 Kupang
Berkah
Jl. Raya
Ny. Mariya Transmigras
63100947 07/05/19
29 28,204 - 089560605956 Mukti 25 Th i Dusun II
05980004 Hasma 98 RT.12 /
Mantewe
Jl. Perum
00016726 63021906 06/11/19
30 15,346 081251255727 Tn. Suyanto 27 Th PT. SMART/
99307 11950001 95
TP
Jl. Pasar
00027226 63100910 10-05-
31 25,731 085348860943 Tn. Cangga 74 Th Ampera
38655 05580005 1958
RT.18
00033059 63020611 Tn. M. 11/09/20 Jl. Kodeco
32 4,302 45968 09030001 082256034518 Alfian 19 Th 03 RT.04 /GA
Pembiayaan
Status
Pendidik Status
JK Pekerjaan Dokter kunjun Diagnosis
an penyakit Umum BPJS SKTM
gan
DIII
DM Type II dg
P Kebidan Bidan dr. Ferisa B L ✓
Insulin, LBP
an
ISPA +
p SD Pelajar dr. Ferisa B B ✓ Dispepsia
Syndrom
Wiraswas
L TK dr. Ferisa B L ✓ Enduftalmitis
ta
Wiraswas
L SMP dr. Ferisa B L ✓ HT GR II
ta
Post Hecting ec
L SD Pelajar dr. Ferisa L L ✓
VL a/r Manus
Wiraswas HT Gr. I
L SD dr. Ferisa B L ✓
ta Terkontrol
Wiraswas
L SMP dr. Ferisa B B ✓ ISPA
ta
HT, Dispepsia
P SMA IRT dr. Ferisa L L ✓ Syndrome,
Faringitis
HT Gr. II +
P - Guru dr. Ferisa B B ✓ Insomnia
Tonsilitis + Obs.
P SD Pelajar dr. Ferisa B B ✓ Vomitus +
Susp. GEA
P SMK IRT dr. Ferisa B B ✓ Athralgia
Syndrome
L SD Pelajar dr. Ferisa B B ✓ Dispepsia +
Miliaria
HT terkontrol +
P SD IRT dr. Ferisa B L ✓ Obs
AbdominalPain
Susp. Ulkus
Wiraswas
L SD dr. Ferisa B B ✓ Peptik + Susp.
ta
BPH + HT
DM dengan
Terapi Insulin +
P SD IRT dr. Ferisa B B ✓
HT +
Haemorroid
ISPA + Suspek
P SD Pelajar dr. Ferisa B B ✓ Demam
Typhoid
DM Type II ON
P SMP IRT dr. Ferisa B L ✓
Insulin
Belum Hidradenitis
L SMA Bekerja dr. Ferisa B B ✓ Supurativa
P S1 Guru dr. Ferisa B B ✓ Susp. ISK
Konjungtivitis
L SMK Swasta dr. Ferisa B B ✓
OD
Wiraswas
L SMU dr. Ferisa B B ✓ Vertigo
ta
PCT,
Typhoid
Domperidone, 08.23 08.28 ✓ 120 26 - 37,1 88 Tongue (+)
Kotri, Zinc
GDS: 151
HIV: NR
OAT Kat I (1x3 TCM: High
Tab) Pagi 08.25 08.35 ✓ 165 47 112/95 36,8 106 Detected
(27/12/202
2)
Nadic,
Dexamethasone,
✓ 155 73 133/85 36,9 78
Omeprazole, Vit 08.35 08.40
Bcomplek
Methformin,
Amlodipin, Nadic,
Omeprazole, 08.40 08.45 ✓ 163 57 153/99 36,8 75 Asma
Simvastatin, Vit
BC
Rujuk Poli
penyakit Dalam 08.30 08.35 ✓ 151 78 120/84 36,8 89
RSMP
PCT, Ambroxol,
CTM, Amoxilin, 08.43 08.48 ✓ 123 20 - 36,9 88
Antasida
Rujuk Poli Mata
09.05 09.10 ✓ 167 71 154/96 36,9 57
RSUD DHAAN
Ibuprofen,
09.20 09.25 ✓ 152 49 129/97 37 116
Antasida, Vit B1
Amlodipin,
Furosemid, 09.15 09.20 ✓ 162 72 160/96 37 77
Ibuprofen
Dressing,
08.50 08.57 ✓ 158 44 - 37 92
Gentamicin Zalf
Ambroxol, CTM,
PCT, Amoxilin, 09.40 09.45 ✓ 165 50 134/83 36,9 64
Vit.C
Captropil,
Faring
Ibuprofen, ✓ 146 48 137/88 37 76 Hiperemesi
Amoxilin, Lanso, 09.45 09.50
s
Antacid, VitBC
Visus: (-)
Surat Keterangan 200 BW:( -)
Sehat, Tidak BW, 09.55 10.00 ✓ 154 77 128/87 37 88
Golongan
Sehat
Darah : O
Amlodipin,
Furosemid, Lanso,
Antasida, 10.06 10.11 ✓ 148 56 162/119 37 96
Ibuprofen,
Alprazolam
Amlodipin,
GDS: 131
Furosemid, 09.45 09.50 ✓ 152 48 183/104 37 116
AU: 4,4
Ibuprofen, VitBC
PCT, Domperidon,
Amoxilin, Antasid, 10.05 10.10 ✓ 126 23 37,4 88
Zinc
Nadic, Vit B1 ✓ 153 70 154/99 36,9 75 GDP: 97
10.15 10.20 AU: 4,1
Antasida, PCT,
CTM, 10.25 10.30 ✓ 111 18 37 92
Hidrocortison
Amlodipin, CTM,
Hyoscine,
10.10 10.15 ✓ 144 51 115/72 36,8 109
Antasida,
Scabimite, PCT
Rujuk Poli
penyakit Dalam 09.45 09.50 ✓ 165 73 152/85 36,9 66
RSMP
Rujuk Poli
Penyakit Dalam
RSMP, Amlodipin, 09.30 09.35 ✓ 150 69 155/82 36,9 79
Furosemid,
Antihaemorroid
Asam
Mefenamat,
10.30 10.35 ✓ 150 64 145/111 37,2 115
Cefadroxil,
Chloramphenicol
PCT, Ambroxol,
CTM, ✓ 135 17 37,4 92
Domperidon, 10.35 09.50
Kotrimoxazol
Rujuk Sp. PD
10.30 10.35 ✓ 162 65 138/88 36,9 102
RSMP
Asam
Mefenamat,
Cefadroxil, 10.40 10.45 ✓ 169 124 162/133 36,7 127
Gentamicin Zalf
Asam
Mefenamat, 11.00 11.06 ✓ 154 45 95/66 37 86
Ciprofloxacin
Chloramfenicol
11.07 11.12 ✓ 166 71 145/98 37 92
Eye Drop
Betahistin,
10.55 11.00 ✓ 157 58 110/71 36,9 75
Antasida, Vit B1
Dressing, Up.
Hecting 11.55 12.00 ✓ 168 55 147/76 36,9 83
Betahistin, PCT.
Omeprazole, 11.50 11.55 ✓ 67 122/78 36,6 76
Pehavral
Riwayat PTM
Riwayat
Riwayat Riwayat
Riwayat Pemeriksa
PTM Penyakit Riwayat
merokok Perdaraha an
( ≥ 15 Sebelumn Alergi
th ) n IVA/Sada
ya
nis
HT, HT,
Stroke Stroke
HT HT
HT
Hari/ Tanggal : Selasa, 10 Januari 2023
Petugas : Sumarning, Bertha,Caterina
ir
ah
No Register No BPJS NIK No Telpon Nama
ur
lL
m
U
Tg
631009420271
1 18,651 0001922783207 08521634125 Ny.Rusmah 50 th 2-2-1971
0001
631009020358 02-03-
2 2,602 0001548130375 0002 081258412512 Tn.Samson 60 th 1958
630206640462 24-04-
5 27,843 0001929135014 08225013626 NY.Rarbayah 60 th
0001 1962
00019222277788 631009120368
6 25,117 6 085362932378 Tn.Jainadi 51 th 12-3-1968
0006
110213260205
7 12,776 0000214014767 082153040620 An.Alfred 17 th 26-2-2005
00003
631009110473 11/04/19
14 28,195 0002283643427 081280045476 Tn. Budiyardi 48 Th
0005 73
631009040281 04-02-
16 23,873 0000124102776 085350475000 Tn. Triyono 41 Th
0003 1981
01-12-
17 10,489 0000894710981 - - Ny. Makiyah 40 Th 1973
631009521284 12-12-
22 26,820 0002722843967 082153238871 Ny. Suarni 38 Th
0010 1984
POLI UMUM
Pembiayaan
Status Status
Pendidi
r
hi
La
kan
m
l
Tg
DM tipe
Jl rahayu rt 7
P SD irt dr.Ferisa B L ✓ II,HT,Derma
DB
titis
Jl.transmigrasi
DM tipe
rt 11 L SD swasta dr rahmah B L ✓ II+dispepsia
sarigadung
Lap.5 okt.rt 5b
SLTA wiraswast dr DM tipe II dg
L B B ✓
DB a Rahmah insulin +CKD
Jl.mutiara
P SD irt dr rahmah B B ✓ OA genu
indah rt 2 Gb
Gg sejahtrera rt
L SMA wirswasta dr rahmah B B ✓ cc
13 sejahtera
Jlmmawar rt 8 I20
P SLTA irt dr rahmah B B ✓
GA skizofrenia
Jl.batu benawa L SLTP wiraswast dr B B ✓ CHF
rt 9 Bersujud a Rahmah ec.CAD+HT
Jl gunung dispepsia
L D3 tdk ada dr rahmah B B ✓
antasari rt 2 GA sind.
Jl. Banyuwangi
P SMK IRT dr rahmah B L ✓ Susp. ISK
RT.01 /GA
Jl. Lapangan 5
Wiraswas
Oktober L S1 dr rahmah L L ✓ Konsultasi
RT.05 / DB ta
Gg.
Wira
Hidayatullah L D3 dr rahmah L L ✓ Pterigium
RT.10 / DB swata
Terapi &
KIE
Tindakan D P TB BB TD T HR LP Lab
metfotmin,glib
enklamid,ampl
✓ 154 52 143/87 36,9 80
odipin,cetirizin, 09.15 09.20
betametazonen
metformin,glib
enklamid,pct,o
meprazole,vit.b 09.16 09.20 ✓ 167 70 134/83 36,8 73
com
Rujuk poli
penyakit dalam 09.21 09.25 ✓ 165 67 157/85 37,2 85
rsmp
tdk di
Na.dik,omepraz
ukur px
ole,amplodipin, 09.30 09.35 ✓ 48 150/102 36,9 100
sakit
kalk
lutut
pct,amoxillin,a
mbroxol,ctm,vi 09.45 09.50 ✓ 164 54 151/94 36,9 67
t.c
pct,amoxilil,gg,
09.00 09.04 ✓ 168 62 127/92 36,9 90
flutrop,vit.c
pct,omeprazole
,vit.bcom,surat 08.40 08.45 ✓ 166 82 136/82 36,9 69
sakit
Ciprofloxacin,
Asam
10.20 10.25 ✓ 158 44 - 37 92
Mefenamat,
Antasida
PCT,
Dexametason,
Vit.C,
Omeprazole, 09.45 09.50 ✓ 149 80 112/96 36,8 97
Surat Sakit 1
Hari
Methformin,
Furosemid,
Amlodipin, 11.20 11.25 ✓ 165 90 166/99 37 89
Aspilet, PCT,
Omeprazole
Nadic, MPH,
11.05 11.10 ✓ - 48 121/89 37,1 92
Vit. BC
Ibuprofen,
Omeprazole, 09.40 09.45 ✓ 146 69 114/80 36,8 80
Vit.BC
Rujuk Poli
Penyakit Dalam 10.05 10.10 ✓ 165 101 163/120 36,5 87
RSMP
Rujuk Poli Mata
11.45 11.50 ✓ 153 51 135/71 36,9 79
RS DHAAN
PCT,
Omeprazole, 11.55 12.00 ✓ 145 62 116/82 36,7 77
Pehavral
Riwayat PTM
Riwayat
Riwayat Riwayat
Riwayat Riwayat Pemeriksa
PTM Penyakit Riwayat
Penyakit merokok Perdaraha an
( ≥ 15 Sebelumn Alergi
Keluarga th ) n IVA/Sada
ya
nis
stroke HT,DM
DM(adek) DM
HT HT
tdk ada DM
blm
blm scrining
scrining
HT
Hari/ Tanggal : Rabu, 11 Januari 2023
Petugas : Sumarning, Bertha,Caterina
No
ir
ah
No Register No BPJS NIK Nama Alamat JK
ur
Telpon
lL
m
U
Tg
Jl. Simpang
00027226 63100945 05-06-
1 16,790 - Ny. Yatmi 58 Th Sari RT.02 / P
22973 06650005 1965
TP
Jl.
63100924 08539079 Tn. Deny 24-01- Mulawarm
2 25,592 - 01990003 1180 Cahyono 23 Th 1999 an RT.16/ L
TP
Tn.
3 28,211 00018346 63100903 08134541 Muhammad 29 Th 03-03- Jl. BB L
41786 03930008 4243 Agus 1993 rt.09 /DB
Jl. Poros
63100944 08539383 Lapangan 5
4 10,947 - Ny. Faridah 35 Th - P
02870006 5433 Oktober
RT.05 /DB
Jl. Perum
00019227 63100927 08538874 Nn. Nur Fitri 27-12- Plajau
5 27,548 20 Th P
82217 12010004 2060 Natalia Sidik 2001 Indah RT.07
/DB
Jl.
Lapangan 5
00012408 63100945 08213592 05-06-
7 7,124 Ny. Saniati 70 Th 1952 Oktober P
4912 06520002 9361
Gg.
Delima / DB
An. Mozes Jl. Serongga
00027512 63020624 08238953 24-01- Komlek
8 24,899 Vallentino 12 Th L
96354 01080002 00.. 2008 Griya Raya
Putra
Permai/ GB
Jl.
00012454 31009680 08134973 28-08-
11 3,363 Ny. Nurhayati 60 Th 1962 Kedondong P
02745 8620001 9089
RT.07/ TP
Jl. Pasar
00028869 63100968 08534853 28-12-
12 6,307 Ny. Mariani 55 Th 1977 Ampera P
91841 12770003 2371
RT.04/ TP
Jl. Raya
63100610 08386272 Tn. Wahyuni 10-09-
13 26,960 - 09850004 6923 Abidin 36 Th 1985 Serongga L
RT. 02/ GB
Jl.
00016772 63010714 08225170 Ny. Hasma
14 26,658 34 Th 14-11- Banyuwang P
78788 11880002 0705 1988
i RT.14 / GA
Jl. Raya
00029111 63100601 08575400 01-05- Serongga
18 28,065 An. M. Rizky 7 Th L
73524 05160005 5634 2016 KM.3,5
RT.01 / GB
Jl. Mangga
00030719 63100965 08134960 26-11-
19 15,893 Ny. Irliani 51 Th II RT.14 / P
21275 11710003 2988 1971 DB
Jl. Pasar
00028967 63100909 08215311 09-03-
20 20,392 Tn. Mahmud 60 Th Ampera L
75482 03820003 5069 1962
RT.02 / TP
Tn.
00022209 63100925 08135144 25-05- Jl. Swarga I
21 18,001 Muhammad 49 Th L
822468 05730007 1644 1973 RT.01/ TP
Toyib
Jl.
00027225 63100657 08539283 An. Aisyaa 17-07-
23 11,614 6748 07150002 2525 Salsabila T 7 Th 2015 Perjuangan P
RT.14/TP
Jl.
08520000 Ny. Hadiana 07-03- Sempurna /
25 28,027 - - 23 Th P
0131 Aulia 1999 Ds.
Sejahtera
Jl.
Transmigra
00019227 63100909 08235250 Tn. M. Hasbi 09-12-
27 28,212 46 Th si RT.02 / L
62823 12760001 1094 Hairullah 1976
Desa
Barokah
Jl. Nusa
00019227 63100950 08524848 Nt. Siti 10-02- indah
28 6,365 50 Th RT.01/ P
48254 02720008 5095 Fatimah 1972
Desa
Barokah
Jl.
00010657 63101029 08782770 29-09- Transmigra
29 28,213 Tn. M. Lestari 21 Th L
61043 09010002 2548 2001 si RT.11 /
Dukuh Rejo
Jl. Pasar
Minggu
00022281 16-03-
30 13,537 - - Ny. Sanainah 57 Th RT.02/ P
18041 1965 Desa
Sejahtera
Jl.
00027228 63100959 08134946 Ny. Muna 19-03- Hidayatulla
32 26,206 49 Th 1973 P
44531 03730001 0455 Wati Murni h RT.10 /
DB
POLI UMUM
Pembiayaan
Status Status
Pendidika Pekerjaa Terapi &
Dokter kunjunga penyak Diagnosis
n n n it Umum BPJS SKTM Tindakan
Methformin,
DM Type II + Amlodipin, PCT,
SD IRT dr rahmah B B ✓ HT +
Vit B, Gentamicin
Konjungtivitis
Eye Drop
Ibuprofen,
Amoxilin,
S1 Karyawa B B ✓ Tonsilitis Akut Dexamethasone,
n Swasta dr rahmah Antasida, Surat
Sakit 1 Hr
PCT, Hyoscine,
dr Kolic
- IRT B B ✓ Omeprazole,
Rahmah Abdomen VitBC
OAT TB Fase
Tidak TB Paru + Lanjutan 1 x 3
SMA dr. B L ✓ Tab. Masker TB,
Ada Ferisha Insomnia
Vit BC,
Alprazolam
Amlodipin,
dr. Sindrom
D2 IRT B B ✓ Ranitidin,
Ferisha Dispepsia
Antacida, VITBC
PCT, Ambroxol,
dr. ISPA + Flutrop, Amoxilin,
SD Pelajar B B ✓
Ferisha Konjungtivitis Gentamicin Eye
Drop
PCT, Ambroxol,
SD Pelajar dr. B B ✓ ISPA + Scabies Flutrop, Amoxilin,
Ferisha Scabimed
Amlodipin,
Wira dr. HT + DM Type Methformin,
- B L ✓
Swasta Ferisha II + ISPA Ambroxol,
Flutrop, Cetirizine
DM Type II
denganInsulin Rujuk Poli
Aliah IRT dr. B L ✓ + Neuropaty Penyakit Dalam
Ferisha DM + HT On RSMP
Treatment
Rujuk POLI
DM Type II Penyakit Dalam
SD IRT dr. B L ✓ dengan
Ferisha RSMP, Amlodipin
Insulin
1 x 10mg
Amlodipin,
HT Gr. II + Ambroxol,
SD IRT dr. B L ✓ ISPA + Flutrop, PCT,
Ferisha Dispepsia Amoxilin,
Ranitidin
dr. Serumen
S1 IRT B B ✓ Phenol Glyserol
Ferisha Prop AD
Wira dr. Pterigium Rujuk Poli Mata
SD B L ✓
swata Ferisha Post OP RS DHAAN
HT Amlodipin,
Perangk dr. +Dermatofito Captropil, CTM,
SMA B B ✓
at Desa Ferisha sis + Ketocomazole,
Dispepsia Ranitidine
Infus RL 1 Kolf,
Sindrom Inj. Esomeprazole
dr. Dispepsia + 1 Vial. Inj.
SMP Swasta B B ✓
Ferisha TB On Metoclopramid.
TREATMENT Obat Oral : PCT,
Ranitidin, Antasid
PCT,
SD Pelajar dr. B B ✓ Diare Akut Kotrimoxazole,
Ferisha Zinc, Oralit
Asam
Tidak dr. Mefenamat,
SMK B B ✓ Kalazion
Bekerja Ferisha Gentamicin Zalf
Mata
PCT. Ambroxol,
Karyawa dr.
SMA B B ✓ ISPA Flutrop, Amoxilin,
n PUPR Ferisha
Vit BC
Glibenclamid,
DM Type II + Methformin,
SD IRT dr. B L ✓ Hiperurisemia Allupurinol,
Ferisha + Dispepsia Ranitidin,
Antasida
SMA - dr. B B ✓ Obs. Febris PCT, Vit BC
Ferisha
Amlodipin,
Lansoprazole,
dr. ISPA + HT + Ibuprofen,
SD IRT B L ✓
Ferisha Vertigo + LBP Betahistin, Kalk,
Vit BC, Ambroxol,
Cetirizine
Rujuk Poli
SD IRT dr. B B ✓ Susp. CHF Penyakit Dalam
Ferisha RSMP
Riwayat
KIE Riwayat
PTM
D P TB BB TD T HR LP Lab Penyakit
( ≥ 15
Keluarga th )
Faring
08.19 08.24 ✓ 164 49 124/88 36,9 64 Hiperemesi
s
Tonsil :
09.21 09.25 ✓ 166 55 157/85 37.1 114 T3/T3
Hiperemis
blm blm
08.35 08.40 ✓ 152 39,7 86/55 37,2 77
scrining scrining
Faring
09.10 09.15 ✓ 149 55 169/105 36,9 122
Hiperemis
10.25
09.05 (up ✓ 162 54 110/70 36,8 69
Infus)
No
ir
ah
No Register No BPJS NIK Nama Alamat JK
ur
Telpon
lL
m
U
Tg
Jl.Padaidi
63100950 08538766 10-11-
1 14,785 Umum 09890003 0689 Ny.Ria Andini 33 th Rt.9 P
1989
Sejahtera
63020203 08592489
2 27,044 Umum 08950002 4534 Tn.Junaedi 27 th 3-8-1995 Lap 5 Okt L
00019288 63100941
6 4,168 Tidak ada Ny.Samsidar 55 th 1-2-1950 Rt.2 TP P
44189 03600001
63100955 RT.9
26 28,225 Umum 09920005 Tdk ada Ny.Ika Novita 30 th 15-9-1992 Sejahtera P
63100929
00019228 08539325 Jl.Karang
27 25,902 07620000 5119 Tn.Sayinudin 60 th 29-7-1962 jawa L
04537
1
30
POLI UMUM
Pembiayaan
Status Status
Pendidika Pekerjaa Terapi &
Dokter kunjunga penyak Diagnosis
n n n it Umum BPJS SKTM Tindakan
Sindrom Lansoprasole,
SMA Satpam dr.Ferisa B B ✓
dispepsia Antasida, PCT
Amlodipin,
Captopril,
HT+DM+Ane Glibenclamide,
SMP IRT dr.Ferisa B B ✓
mia
Metformin,
Heafort, Bcomp
Obs.edema+a
sites, KIE kontrol ke RS,
SMA Wiraswa B B ✓ Susp.ganggua Furosemide,
sta dr.Ferisa n liver, Ambroxol, CTM,
Insomnia, Amox
ISPA
Amlodipine,
SD IRT dr.Ferisa B B ✓ HT gr Nadic, Ranitidine,
Kalk
Nadic,
dr.Rahma HT gr II + OA Amlodipine,
SD IRT B L ✓ Allopurinol,
h Genu
Omeprasole,
Bcomp
HT terkontrol Amlodipine,
Wiraswa dr.Rahma + Ambroxol,
SMA sta B L ✓ Hiperurisemia Allopurinol, PCT,
h
+ ISPA Bcomp
PCT, Dexa,
Ponpes Pelajar dr.Rahma B B ✓ Faringitis Omeprasole,
h Bcomp
Ibuprofen,
Amlodipine,
Bcomp,
dr.Rahma OA Genu + HT
SMP - B B ✓ Simvastatin,
h gr II
Rujuk poli
penyakit dalam
RS Marina
Scabies +
SD Pelajar dr.Rahma B B ✓ infeksi PCT, Cetrizine,
h Amox, Salep 24
sekunder
Rujuk poli
SD IRT dr.Rahma B L ✓ CHF + UAP penyakit dalam
h RS MArina
Ibuprofen,
Wiraswa dr.Rahma Muscle
SMA B L ✓ Antasida, Bcomp,
sta h spasme
Eperison HCl
dr.Rahma PCT, Amox,
SMP - B B ✓ Obs febrsi H4
h Antasida, Bcomp
Amlodipine,
dr.Rahma Common cold Furosemide, PCT,
SD IRT B B ✓
h + HT gr II Guaefenisine,
CTM
Ergofamin
maleat,
SMK IRT dr.Rahma B B ✓ Migrain Ibuprofen,
h Omeprasole,
Bcomp
G3P2A0 Uk
dr.Rahma 26- Acyclovir, PCT,
SMK IRT B B ✓ 27mgg+Varic VitC
h
ella
PCT, Amlodipine,
Wiraswa dr.Rahma Ht gr II +
SD B B ✓ Omeprasole,
sta h Gastritis
Pehavral
Furosemide,
dr.Rahma HT gr II + Amlodipine,
SD IRT B B ✓
h Dislipidemia Simvastatin, PCT,
Bcomp
Ciprofloxacyn,
dr.Rahma Susp.ISK + PCT, Ambroxol,
- IRT B B ✓
h Common cold Omeprasole,
Amlodipine
dr.Rahma ✓
h
Wkt Playan ;l Riwa
Riwayat
KIE Riwayat
PTM
D P TB BB TD T HR LP Lab Penyakit
( ≥ 15
Keluarga th )
Hb:9,9
08.15 08.23 ✓ 152 36 163/98 36,9 117 - - -
GDP:223
GDS:171 ;
08.50 08.56 ✓ 143 45 152/83 36,7 90 - - -
AU:8,6
GDS:200 ;
08.40 08.46 ✓ 166 66 138/81 36,9 109 - AU:8,6 - -
Chol:228 ;
11.04 11.09 ✓ 148 57 167/98 37 86 - GDS:168 ; - -
AU:56
✓ - - - -
Riwayat PTM
Riwayat
Riwayat
Riwayat Pemeriksa
Penyakit Riwayat
merokok Perdaraha an
Sebelumn Alergi
n IVA/Sada
ya
nis
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
Hari/ Tanggal : Jum'at, 13 Januari 2023
Petugas : Caterina, Erni, Widya,Jumariah
No
ir
ah
No Register No BPJS NIK Nama Alamat JK
ur
Telpon
lL
m
U
Tg
Jl. Kodeco
63100944
1 17,033 Umum 12750005 - Ny. Yuliana 48 th 4-12-1975 Km. 2,5 P
RT.11
Jl. Kodeco
63100958 An. Wafa 18-09-
2 17,033 Umum 09090005 - Aisyah 13 th 2009 Km. 2,5 P
RT.11
Jl.
00008895 63929650
6 24,023
04650010 Tidak ada Ny. Kartini
57 th 10-4-1965 Wonorejo P
53542
RT 11
00008952 63100903
7 14,030 66843 03540003 Tidak ada Tn. Bahrudin 65 th 3-3-1954 JL. Antasan L
Jl. Raya
00027227 63100621 08215892 An. Septian
11 20,546 6 th 21-9-2016 Serongga L
23569 09160001 4552 Riski RT 4
Jl.
17 10,145 00022201 63100919 Sudah Tn. Sanib 66 th 19-03- Bhayangkar L
78937 03560002 ada 1956
a RT.10
Jl. Raya
21 27,729 Umum 63100951 08134670 Ny. Masitah 47 th 11-05- Batulicin, L
05750006 0990 1975
RT.03
POLI UMUM
IGD: Suradi, Abdillah
Pembiayaan
Status Status
Pendidika Pekerjaa Terapi &
Dokter kunjunga penyak Diagnosis
n n n it Umum BPJS SKTM Tindakan
PCT, Amox,
dr.Rahma HT gr I, Cetirizine,
S1 IRT B L ✓
h Scabies Amlodipin, Salep
24, Furocemide
Amoxilin,
Cetirizine, PCT,
SD Pelajar dr. Rahma B L ✓ Ectima, CC Guafenesin,
Flutrop
Amoxilin,
Cetirizine,
SMA Wiraswa B L ✓ HT, Susp. Ambroxol, PCT,
sta dr. Rahma Bronkitis Omeprazole,
Amlodipine
Scabies
dengan CTM, Scabimide
SMP Pelajar dr.Ferisa B B ✓
Infeksi Zalf, Gentamicin
Skunder
Amlodipijn,
Metfprmin,
HT gr II, DM
SMA Swasta dr.Rahma B L ✓ Tipe II Glibenclamide,
h PCT, Omeprazole,
Vit BC
Wiraswa Flutrop,
SMA dr. Ferisa B B ✓ CC
sta Ibuprofen, Vit C
HT, Kolik
Amlodipin,
SMP IRT dr. Ferisa B B ✓ Abdomen,
Susp. BSK Hyoscin,Antacida
Obstruksi
Wiraswa Kolik
SMP dr. Ferisa B B ✓ Hyoscin, PCT
sta Abdomen,
Susp. BSK
Amoxilin, Asam
Wiraswa dr.Rahma Hemoroid Gr Tranexamat,
S1 sta B B ✓ II Ibuprofen, Anti
h
Hemoroid
Amlodipin,
dr.Rahma HT gr II, DM Furocemide,
SD IRT B L ✓
h Tipe II Metformin,
Gliben, PCT
Furocemide,
Amlodipine,
dr.Rahma HT Gr II, OA Nadic,
SD IRT B B ✓
h Genu Omeprazole, Vit.
BC, Gentamicin,
zalf
Amlodipin,
SMP Tidak B L ✓ HT Gr II, OA Captopril,
Berkerja dr. Ferisa Genu Natrium, Kalk, Vit
B1
HT
Nadic, Kalk, Vit
SD IRT dr. Ferisa B L ✓ Terkontrol,
Atralgia B1, Amlodipin
Amlodipin,
Hemafort,
SMK IRT dr. Ferisa B L ✓ HT, Anemia Ibuprofen,
Antasida
HT gr II, Furocemide,
SD IRT dr.Rahma B L ✓ Amlodipin, PCT,
Hiperuresemi Omeprazole,
h
a Allopurinol,Vit BC
Guanifensin, PCT,
SMP IRT dr.Rahma B L ✓ CC Omeprazole, Vit
h BC
Wkt Playan ;l Riwa
Riwayat
KIE Riwayat
PTM
D P TB BB TD T HR LP Lab Penyakit
( ≥ 15
Keluarga th )
GDS: 165 ;
08.40 08.46 ✓ 160 69 160/103 36,9 76 - AU : 5,4 - -
GDS : 109 ;
09.46 09.55 ✓ 146 44 151/86 36,8 92 - - -
AU : 6,0
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
HT - - - -
- - - - -
- - - - -
- - - - -
HT,DM - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- HT - - -
- HT - - -
- - - - -
Hari/ Tanggal : Sabtu, 14 Januari 2023
Petugas : Caterina, Erni, Widya
No
ir
ah
No Register No BPJS NIK Nama Alamat JK
ur
Telpon
lL
m
U
Tg
Jl.Suka
63100954 08535030
1 8,006 Umum 02640002 8695 Ny.Haryani 58 th 14-2-1964 Damai RT.7 P
KB
Nn.Noor
63100923 08134992 23-12-
2 5,424 Umum Ramadhan 24 th RT.6 GA P
12980005 1757 1998
Rizkiah
Jl.Pembatu
00027227 63100941 08139393
3 28,234 Ny.Ririn 52 th 1-7-1970 an Atas P
10519 07700203 4272
Rt.5 GB
Jl.Sampurn
00019227 63100912 08524842
7 27,455 69369 05850003 3244 Tn.Mustafa 37 th 12-5-1985 a RT.8 L
Barokah
Jl.Sampurn
00019227 63100959 08524842 Ny.Yani
8 27,455 34 th 19-9-1988 a RT.8 P
69371 09880005 3244
Barokah
00001241 63100910 08135107 Tn.M Wahyu Komp.BHP
9 23,377 54 th 10-7-1968 L
02991 07680011 4333 Yulianto RT.3 GB
Jl.Nusa
63100901 Tn.Husain
13 28,238 Umum 03610005 - 61 th 1-3-1961 Indah RT.1 L
Effendi
Barokah
Samping
17 27,073 00027226 63100965 08524655 Ny.Sabrina 34 th 25-6-1988 SMP P
10182 06880001 6022 Kodeco
Rt.11 TP
An.Balqis Az
00023156 63100643 08133065 5th
18 15,011 Zahra 3-6-2017 Rt.8 TP P
60951 06170001 6028 7bln
Ramadani
00008955 63100926
22 17,261 35842 05990004 Tidak ada Tn.Diddi 22 th 1-5-2000 Rt.7 GA L
Pembiayaan
Status Status
Pendidika Pekerjaa Terapi &
Dokter kunjunga penyak Diagnosis
n n n it Umum BPJS SKTM Tindakan
Captopril,
dr.Rahma Amlodipine, PCT,
SD IRT B L ✓ Ht gr II
h Omeprasole,
Bcomp
Ambroxol, PCT,
SD IRT dr.Rahma B B ✓ Susp.TB VitC, Omeprasole,
h Cek sputum
Metformine,
DM tipe II +
Krisis Glimipiride,
SMP IRT dr.Rahma B L ✓ Ibuprofen,
h hiperglikemia
VitB12,
+ Neuropati Omeprasole
Domperidone,
- Pelajar dr.Rahma B B ✓ Obs.vomit Antasida, PCT,
h Zinc
Post op
Wiraswa dr.Rahma Fraktur Digiti Nadic, VitB12,
SMA B L ✓
sta h III-IV + Antasida
Neuropati
Ibuprofen,
Wiraswa dr.Rahma Dispepsia
SD sta B B ✓ sindrome Omeprasole,
h Bcomp
dr.Rahma Furosemide,
SD IRT B L ✓ HT
h Amlodipine
Sequele of
dr.Rahma Rujuk poli saraf
A.II PNS B B ✓ cerebral
h infarctum RS Marina
Furosemide,
SMA - dr.Rahma B B ✓ HT gr II Amlodipine, PCT,
h Bcomp
Ambroxol,
SMA Guru dr.Rahma B B ✓ Common cold Ibuprofen,
Kontrak h Antasdia, Bcomp
Captopril,
Wiraswa dr.Rahma Amlodipine, PCT,
SMP B B ✓ HT urgency
sta h Omeprasole,
Bcomp
Ibuprofen, Amox,
Ambroxol, KIE ke
- Pelajar dr.Rahma B B ✓ Obs febris H2 IGD jika tidak ada
h
perubahan 2 hari
Ibuprofen, Asam
dr.Rahma Hemoroid gr
- IRT B B ✓ II traneksamat,
h Antihaemoroid
PCT, Omeprasole,
dr.Rahma Dispepsia +
SMA IRT B B ✓ Amlodipine,
h HT
Bcomp
Susp.Typoid Kaolin pectin,
Wiraswa dr.Rahma Omeprasole, PCT,
SMA B B ✓ + GEA tanpa
sta h Kotrimoxasole,
dehidrasi Guaefenisine
PCT, Dexa,
Kary.PU dr.Rahma
SMA L B ✓ Common cold Ambroxol, Vit.C,
PR h Surat ket berobat
PCT, Flutrop,
Kary.sw dr.Rahma
SMA asta B B ✓ Common cold Guafenisin, VitC,
h Surat sakit 1 hari
Frozen
shoulder + Nadic,
SMP IRT dr.Rahma B B ✓ Omeprasole,
h Dispepsia
Bcomp
sindrom
Wkt Playan ;l Riwa
Riwayat
KIE Riwayat
PTM
D P TB BB TD T HR LP Lab Penyakit
( ≥ 15
Keluarga th )
GDS:102 ;
09.19 09.24 ✓ 162 87 169/128 37,1 105 - - -
AU:5,7
GDS:106 ;
09.30 09.35 ✓ 155 58 121/84 36,9 75 - - -
AU:5,7
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
Hari/ Tanggal : Senin, 16 Januari 2023
Petugas : Caterina, Melynda, Widya
No
ir
ah
No Register No BPJS NIK Nama Alamat JK
ur
Telpon
lL
m
U
Tg
Sungai
63100905 08539327
1 24,781 Umum 06650007 2333 Tn.Hairuddin 57 th 5-6-1965 Hanau RT.7 L
GB
Jl.Kemakm
00027774 33051812 08538943 Tn.Usman 12-11-
3 28,235 54 th uran Rt.9 L
04331 11680003 3840 Urs Sagala 1968
KB
Jl.Borneo
63242209 08213230
6 22,332 Umum 10090001 1854 An.M Yusuf 13 th 9-10-2009 RT.14 L
Sejahtera
Pelita
00001224 63020645 08525145 Ny.Noer Permai
10 23,566 47 th 5-1-1975 P
80357 01750004 4388 Hasanah,S.Pd InsGub
Rt.11 KB
Jl.Mutiara
63020664 08225013
15 27,843 Umum Ny.Arbayah 60 th 24-4-1962 Indah Rt.2 P
04620001 6206
GB
00022642 Jl.Singosari
17 19,612 - Tidak ada Ny.Aslamiah 46 th 15-1-1976 P
23249 RT.15 TP
Jl.Borneo
18 1,394 Umum 63021765 08124712 An.Rizki Rini 9 th 25-3-2013 Rt.12 P
03130001 1267 Anjani
Sejahtera
19 27,456 00027225 63100601 08125334 Tn.M Alwi 60 th 1-1-1963 RT.3 GA L
79918 01630003 4155
63021647 08575485
20 28,192 Umum Ny.Rasidah 44 th 7-5-1978 Rt.3 KB P
05780002 8831
63100641
33 15,327 Umum Tidak ada Ny.Arbayah 36 th 1-1-1987 Rt.6 GA P
01870001
Pembiayaan
Status Status
Pendidika Pekerjaa Terapi &
Dokter kunjunga penyak Diagnosis
n n n it Umum BPJS SKTM Tindakan
Ibuprofen, VitB1,
Wiraswa
SMP sta dr.Ferisa B B ✓ Cephalgia Saran cek
kolesterol diluar
Amlodipine,
D2 IRT dr.Ferisa B L ✓ Krisis HT Furosemide,
Nadic, VitB1
Furosemide,
dr.Rahma HT gr II + Amlodipine,
SMP IRT L L ✓
h Insomnia Alprazolam,
VitBcomp
Metformin,
dr.Rahma DM tipe II + Amlodipine, PCT,
- IRT B L ✓
h HT + OA Omeprasole, KIE
kontrol Ke RSMP
HT + Amlodipine,
Hiperurisemia Simvastatin,
- Guru dr.Ferisa B B ✓ + Allopurinol,
Hiperlipidemi Alprazolam,
a + Insomina Josnul poli gigi
Amlodipine,
Wiraswa HT gr II +
SMA dr.Ferisa B B ✓ Captopril,
sta Hiperurisemia
Allopurinol, Nadic
Amlodipine,
Ht gr II + DM Captopril,
SMP - dr.Ferisa B L ✓ tipe II +
Metformin,
Anemia
Hemafort, Bcomp
MNAdic,
dr.Rahma Amlodipine, Kalk,
SD IRT L L ✓ OA Genu + HT
h Alprazolam,
Omeprasole
Furosemide,
Amlodipine, PCT,
dr.Rahma Ht gr II +
SD IRT B B ✓ Omeprasole,
h Common cold
Guaefenisin,
Flutrop
dr.Rahma Captopril,
- IRT B B ✓ HT gr II
h Amlodipine
PCT, Ambroxol,
ISPA +
Tk Pelajar dr.Ferisa B B ✓ VitBcomp, Amox,
Stomatitis
Nystatin drop
Furosemide,
Ht gr II +
Amlodipine, PCT,
SD - dr.Rahma B L ✓ Katarak Omeprasole,
h imatur +
Rujuk poli mata
Suele stroke
RSUD DHAAN
Amlodipine,
Ibuprofen,
OMA std Ciprofloxacin,
SD IRT dr.Ferisa L L ✓ perforasi dd Chloramphenicol
OMSK + HT tetes telinga,
Saran:konsul ke
poli THT
Asmef,
OMA std
SMP IRT dr.Ferisa B B ✓ Ciprofloxacin,
perforasi
Chloramphenicol
Captopril,
dr.Rahma HT gr II + Ibuprofen,
SD IRT B L ✓
h Dispepsia Omeprasole,
VitBcomp
Captopril,
SD IRT dr.Rahma B B ✓ HT urgency Amlodipine,
h VitBcomp
Omeprasole, PCT,
Wiraswa dr.Rahma Dispepsia Domperidone,
SMK B B ✓
sta h sindrom Hyocine, Surat
sakit 1 hari
Ibuprofen,
dr.Rahma Konjungtivitis Gentamicin zalf
SD IRT B B ✓ mata,
h + HT
Amlodipine,
Bcomp
Betahistine,
Dispepsia Lansoprasole,
SD IRT dr.Ferisa B L ✓ Antasida,
sindrom
Domperidoene,
VitBcomp
Amlodipine,
SD IRT dr.Ferisa B B ✓ HT gr II Captopril,
Ibuprofen
Alloputirinol,
Kary.hon dr.Rahma
S1 B B ✓ Common cold Ibuprofen,
orer h Antasida, VitC
Wkt Playan ;l Riwa
Riwayat
KIE Riwayat
PTM
D P TB BB TD T HR LP Lab Penyakit
( ≥ 15
Keluarga th )
Chol:275 ;
09.15 09.20 ✓ 150 55 137/100 37 104 - GDS:120 ; - -
AU:11,5
GDP:99 ;
08.52 08.57 ✓ 166 71 175/112 37 68 - - -
AU:8
Hb:10,1 ;
08.57 09.02 ✓ 162 56 176/93 37 71 - - -
GDS:188
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
HT Tidak ada Tidak ada Tidak ada -
- - - - -
- - - - -
- - - - -
- - - - -