DINAS KESEHATAN KABUPATEN BANDUNG

PUSKESMAS CIPARAY DTP

JL. RAYA LASWI NO.819 DS.MANGGUNGHARJA KEC.CIPARAY

REGISTER TRACKING DIAGNOSA (E11.9)

Periode Laporan: Februari 2023

Kelurahan/Desa : semua
Kecamatan : CIPARAY

UMUR VITAL SIGN

NO. TGL. NIK NO.BPJS NO.INDEX NAMA PASIEN TGL.LAHIR ALAMAT KUNJ JAMINAN LAYANAN ANAMNESA DIAGNOSA KASUS
L P TD BB/TB SUHU HR/RR

PROLANIS DM01 HT02 ;

1 01-02-2023 3204294303660001 0002524880891 2016/09770 NANI SURYANI 1966-03-03 - 56Th PARIGI RT. 2 RW. 7, KEL.CIPARAY LAMA BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 BARU
0002524880891 ; 128 /73 ; GDP 148

PROLANIS DM02 HT02 ;

2 01-02-2023 3204335707620001 0002524595668 2016/02808 AYI HAPIDOH 1962-07-17 - 60Th CIDAWOLONG RT. 02 RW. 14, KEL.BIRU BARU BPJS PBI POLI LANSIA 0002524595668 ; 121/77 ; GDP 92 120/80 / 36 80/20 E11.9 LAMA
KOL 113
PROLANIS DM02 HT00 ;
3 01-02-2023 3204320409640001 0002903080421 2019/21014 HENI MAESAROH 1964-09-04 - 52Th ANDIR RT. 3 RW. 7, KEL.PAKUTANDANG BARU BPJS NON PBI POLI LANSIA 146/86 / 36 80/20 E11.9 LAMA
0002903080421 ; 146/86 ; GDP 98
PROLANIS DM02 HT02 ;
4 01-02-2023 3204291007400003 0000053380877 2017/04902 ADUN SUHENDI 1940-07-10 82Th - GUNUNGLEUTIK RT. 3 RW. 3, KEL.GUNUNGLEUTIK BARU BPJS NON PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
0000053380877 ; 146/82 ; GDP 76
PROLANIS DM02 HT02 ;
NENENG
5 01-02-2023 3204291310490001 0001337283718 2019/15251 2048-10-13 - 65Th KPLELES RT. 2 RW. 13, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA 0001337283718 ; 151/61 ; GDP 88 151/61 / 36 80/20 E11.9 LAMA
JULAEHA
CHOL 191

PROLANIS DM02 HT02 ;

DEDAH
6 01-02-2023 3204291006520001 0002458169943 2019/15521 1952-06-10 - 64Th JL TOHA RAMDAN RT. 2 RW. 5, KEL.CIPARAY BARU BPJS PBI POLI LANSIA 0002458169943 ; 127/91 ; GDP 93 120/80 / 36 80/20 E11.9 LAMA
JUBAEDAH
KOL 266

PROLANIS DM02 HT02 ;

KARANGANYAR RT. 02 RW. 03, KEL.MANGGUNG
7 01-02-2023 3204295203550006 0001882292826 2016/06532 ROMLAH 1955-03-12 - 67Th BARU BPJS NON PBI POLI LANSIA 0001882292826 ; 143/97 ; GDP 111 130/70 / 36 80/20 E11.9 LAMA
HARJA
KOL 194

PROLANIS DM02 HT02 ;

8 01-02-2023 3204296907650001 0002593657912 2021/31396 HABIBAH IBAH 1965-07-29 - 57Th CIHEULANG AL-FALIHIN RT. 1 RW. 9, KEL.CIHEULANG BARU BPJS PBI POLI LANSIA 130/80 / 36 80/20 E11.9 LAMA
0002593657912 ; 146/96 ; GDP 126

AYI HENDRIK PROLANIS DM02 HT02 ;

9 01-02-2023 3204293009620001 0000415187919 2019/22827 1962-09-30 60Th - RANCA HEULANG RT. 2 RW. 15, KEL.MEKARLAKSANA BARU BPJS PBI POLI LANSIA 120/60 / 36 80/20 E11.9 LAMA
SUPRIATNA 0000415187919 ; 133/79 ; GDP 135

PROLANIS DM02 HT02 ;

10 01-02-2023 3204296311670003 0000976700957 2016/01286 IIS RIZA ORIZA 1967-11-23 - 55Th GANG BUDI DARMA RT. 01 RW. 06, KEL.SARIMAHI BARU BPJS NON PBI POLI LANSIA 0000976700957 ; 144/80 ; GDP 113 120/80 / 36 80/20 E11.9 LAMA
KOL 184
PROLANIS DM01 HT02 ;
ARINI ISMIYATI
11 01-02-2023 3204293107940007 0000053078038 2016/04892 1994-07-31 - 57Th LELES RT. 02 RW. 11, KEL.MEKARSARI BARU BPJS NON PBI POLI LANSIA 0000053078038 ; TD 144/87 ; GDP 144/87 / 36 80/20 E11.9 LAMA
DRA
165

PROLANIS DM01 HT01 ;

12 01-02-2023 3204295204640003 0000415210882 2019/15953 ESA NURJANAH 1964-04-12 - 58Th PAMINGGIR RT. 2 RW. 11, KEL.MANGGUNG HARJA BARU BPJS NON PBI POLI LANSIA 156/87 / 36 80/18 E11.9 LAMA
0000415210882 ; 178/87 ; GDP 214

PROLANIS DM02 HT02 ;

13 01-02-2023 3204294508120007 0002591581724 2019/22104 ENUR 2012-08-05 - 38Th PANGUPUKAN RT. 1 RW. 6, KEL.MEKARLAKSANA BARU BPJS PBI POLI LANSIA 148/83 / 36 80/20 E11.9 LAMA
0002591581724 ; 148/83 ; GDP 123

PROLANIS DM02 HT02 ;

14 01-02-2023 3204294502510001 0002759297062 2019/18343 DEWI SURYATI 1951-02-05 - 72Th PARIGI RT. 4 RW. 7, KEL.CIPARAY BARU BPJS NON PBI POLI LANSIA 0002759297062 ; 144/77 ; GDP 136 130/80 / 36 80/20 E11.9 LAMA
KOL 183
PROLANIS DM02 HT02 ;
15 01-02-2023 3204295009660001 0000415196818 2020/24696 ANA TRIANA 1966-09-10 - 56Th LEBAK BIRU RT. 2 RW. 14, KEL.CIHEULANG BARU BPJS PBI POLI LANSIA 0000415196818 ; 126/82 ; GDP 127 127/82 / 36 80/20 E11.9 LAMA
KOL 276

PROLANIS DM02 HT02 ;

16 01-02-2023 3204292104760013 0000039287136 2020/29696 SUMARNA 1976-04-21 46Th - ANDIR RT. 1 RW. 11, KEL.PAKUTANDANG BARU BPJS NON PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
0000039287136 ; 131/75 ; GDP 110

PROLANIS DM02 HT02 ;

17 01-02-2023 0 0002524187169 2022/36184 ACIH 1965-03-06 - 57Th HEGARMANAH RT. 3 RW. 03, KEL.MEKARLAKSANA BARU BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
0002524187169 ; 158/95 ; GDP 97
 UMUR VITAL SIGN
NO. TGL. NIK NO.BPJS NO.INDEX NAMA PASIEN TGL.LAHIR ALAMAT KUNJ JAMINAN LAYANAN ANAMNESA DIAGNOSA KASUS
L P TD BB/TB SUHU HR/RR

PROLANIS DM02 HT02 ;

NENDEN
18 01-02-2023 3204295606650002 0002750914585 2017/06167 1965-06-16 - 57Th CIMARIUK RT. 4 RW. 16, KEL.MANGGUNG HARJA BARU BPJS PBI POLI LANSIA 0002750914585 ; 132/71 ; GDP 98 130/70 / 36 80/20 E11.9 LAMA
WIRATNINGSIH
AU4,0

PROLANIS DM02; 415380363; TD

19 01-02-2023 3204295310740002 0000415380363 2019/19168 NINING CAHYANI 1974-10-13 - 48Th JONGOR RT. 3 RW. 16, KEL.SERANGMEKAR BARU BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
133/73; GDP : 133

PROLANIS DM02 HT02 ;

20 01-02-2023 3204294107670010 0000415383423 2021/35436 ODAH 1967-07-01 - 55Th JATI SARI RT. 2 RW. 15, KEL.SARIMAHI BARU BPJS PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0000415383423 ; 152/68 ; GDP 111

PROLANIS DM02 HT02 ;

CUCU
21 01-02-2023 3204295104600005 0000415568283 2019/22390 1960-04-11 - 62Th PARIGI RT. 3 RW. 7, KEL.CIPARAY BARU BPJS PBI POLI LANSIA 0000415568283 ; 125/77 ; GDP 96 125/77 / 36 80/20 E11.9 LAMA
YULIANINGSIH
CHOL 228
PROLANIS DM02 HT02 ;
22 01-02-2023 3204290107500010 0000415394019 2019/18655 AMINAH 1950-07-01 - 69Th PARIGI RT. 5 RW. 7, KEL.CIPARAY BARU BPJS PBI POLI LANSIA 0000415394019 ; 135/67 ; GDP 122 120/80 / 36 76/20 E11.9 LAMA
KOL 247

PROLANIS DM02 HT02 ;

23 01-02-2023 3204294408600011 0001716695493 2016/01195 ENTIN 1960-01-01 - 63Th SUKADANA RT. 02 RW. 05, KEL.MANGGUNG HARJA BARU BPJS NON PBI POLI LANSIA 0001716695493 ; 129/73 ; GDP 130 129/72 / 36 80/20 E11.9 LAMA
KOL 197
PROLANIS DM01 HT02 ;
24 01-02-2023 3204294107830006 0002793286012 2019/19234 ENUNG FARIDA 1973-07-01 - 39Th CIBOTOR RT. 1 RW. 22, KEL.MANGGUNG HARJA BARU BPJS PBI POLI LANSIA 130/80 / 36 80/20 E11.9 LAMA
0002793286012 ; 156/77 ; GDP 235

KARANG ANYAR RT. 02 RW. 02, KEL.MANGGUNG PROLANIS DM01 HT02 ;

25 01-02-2023 3204294107650255 0000415369697 2016/00193 WATI SETIAWATI 1965-07-01 - 57Th BARU BPJS PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
HARJA 0000415369697 ; 138/73 ; GDP 250

KP RANCAHELANG RT. 02 RW. 15, PROLANIS DM01 HT02 ;

26 01-02-2023 3204294107730091 0000415317216 2016/03969 EULIS NURHAYATI 1972-03-15 - 50Th BARU UMUM POLI LANSIA 130/80 / 36 80/20 E11.9 LAMA
KEL.MEKARLAKSANA 0000415317216 ; 145/89 ; GDP 250

PROLANIS DM02 HT02 ;

27 02-02-2023 3204294308640001 0000415825874 2022/35505 ENTIN S 1964-08-03 - 57Th PANGUPUKAN RT. 1 RW. 6, KEL.MEKARLAKSANA BARU BPJS PBI POLI LANSIA 130/80 / 36 80/20 E11.9 LAMA
0000415825874 ; 142/81 ; GDP 71
IMAS KALMAH PROLANIS DM02 HT02 ;
28 02-02-2023 3204345611500002 0000053765559 2019/16225 1950-11-16 - 72Th KOYOD RT. 1 RW. 11, KEL.RANCAKASUMBA LAMA BPJS NON PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
ERMAYA 0000053765559 ; 146/57 ; GDP 127

PROLANIS DM02 HT02 ;

LILIS SITI
29 02-02-2023 3204295706570003 0002295897129 2019/22384 1957-06-17 - 65Th LOA ALUN-ALUN RT. 2 RW. 4, KEL.MEKARSARI BARU BPJS NON PBI POLI LANSIA 0002295897129 ; 164/84 ; GDP 99 140/80 / 36 80/20 E11.9 LAMA
SOLIHAH
AU 7,8

PROLANIS DM02 HT02 ;

LILIS YAYAN
30 02-02-2023 3204306508650001 0000053855662 2019/16810 1961-08-25 - 57Th CIPEUJEUH RT. 1 RW. 8, KEL.CIPEUJEUH BARU BPJS NON PBI POLI LANSIA 0000053855662 ; 149/73 ; GDP 82 120/80 / 36 80/20 E11.9 LAMA
RUHYANI
KOL 152

PROLANIS DM02 HT02 ;

31 02-02-2023 3204291610560004 0002060560855 2019/15586 ENOK ROHAENI 1956-10-16 - 65Th GUNUNGLEUTIK RT. 4 RW. 14, KEL.GUNUNGLEUTIK LAMA BPJS NON PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0002060560855 ; 141/67 ; GDP 96

PROLANIS DM02 HT02 ;

32 02-02-2023 3204094606550001 0000053722833 2018/10858 EUIS ROHAYATI 1955-06-07 - 67Th LELES RT. 3 RW. 12, KEL.MEKARSARI BARU BPJS NON PBI POLI LANSIA 130/80 / 36 80/20 E11.9 LAMA
0000053722833 ; 115/75 ; GDP 117
PROLANIS DM02 HT02 ;
33 02-02-2023 3204295507570002 0002524887382 2021/32854 ENI ROHAENI 1957-07-15 - 65Th KP.STASION RT. 3 RW. 16, KEL.SARIMAHI BARU BPJS PBI POLI LANSIA 0002524887382 ; 150/87 ; GDP 96 130/80 / 36 80/20 E11.9 LAMA
KOL 299

PROLANIS DM02 HT02 ;

34 02-02-2023 3204294101550045 0000415766417 2017/08247 ROKAYAH 1955-01-01 - 68Th JL M RAMDAN RT. 1 RW. 9, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
0000415766417 ; 133/67 ; GDP 92

PROLANIS DM01 HT02 ;

35 02-02-2023 3204296701690002 0000415718087 2016/09182 TITI 1969-01-27 - 54Th LANBAU RT. 3 RW. 8, KEL.CIHEULANG BARU BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
0000415718087 ; 136/70 ; GDP 201

SODIKIN BISRI PROLANIS DM01 HT01 ;

36 02-02-2023 320429070347001 0000054109089 2016/08263 1947-03-07 75Th - JONGOR KULON RT. 2 RW. 11, KEL.SARIMAHI LAMA BPJS NON PBI POLI LANSIA 140/80 / 36 80/20 E11.9 LAMA
[PROLANIS DM02] 0000054109089 ; 179/79 ; GDP 180

PROLANIS DM01 HT02 ;

37 02-02-2023 3273116210590006 0000057488736 2017/00157 DEDEH 1959-10-22 - 63Th HUJUNG RT. 2 RW. 2, KEL.CIPARAY BARU BPJS NON PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0000057488736 ; 143/66 ; GDP 139

PROLANIS DM01 HT02 ;

38 02-02-2023 3204295011520005 0001341194073 2016/04604 E ROHIMAH 1952-11-10 - 70Th LELES RT. 4 RW. 12, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
0001341194073 ; 159/68 ; GDP 165

PROLANIS DM02 HT02 ;

39 02-02-2023 3204294204450004 0000415669015 2019/23807 CICIH 1945-04-02 - 77Th SUKAGALIH RT. 6 RW. 6, KEL.CIKONENG BARU BPJS PBI POLI LANSIA 0000415669015 ; 152/76 ; GDP 106 130/70 / 36 80/20 E11.9 LAMA
KOL 163
 UMUR VITAL SIGN
NO. TGL. NIK NO.BPJS NO.INDEX NAMA PASIEN TGL.LAHIR ALAMAT KUNJ JAMINAN LAYANAN ANAMNESA DIAGNOSA KASUS
L P TD BB/TB SUHU HR/RR

PROLANIS DM02 HT02 ;

40 02-02-2023 3204294404640004 0002519737031 2016/03151 LILIS SETIAWATI 1964-04-04 - 58Th LEUWIJAMBU RT. 06 RW. 13, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA 0002519737031 ; 148/92 ; GDP 166 130/80 / 36 80/20 E11.9 LAMA
AU 7.3

PROLANIS DM02 HT02 ;

41 02-02-2023 3204292710610002 0000054097299 2016/02958 AGUS SUBAGJA 1961-10-27 61Th - CIPARAY INDAH RT. 02 RW. 11, KEL.SARIMAHI BARU BPJS NON PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0000054097299 ; 123/71 ; GDP 117

PROLANIS DM02 HT02 ;

42 02-02-2023 3204290104960004 0001003406073 2019/22400 NENENG 1972-12-11 - 50Th PANGUPUKAN RT. 2 RW. 6, KEL.MEKARLAKSANA BARU BPJS PBI POLI LANSIA 0001003406073 ; 156/80 ; GDP 115 140/70 / 36 80/20 E11.9 LAMA
KOL 127

PROLANIS DM02 HT02 ;

43 02-02-2023 3273174101660004 0000415866183 2016/00314 IDAYPARIDA 1969-08-01 - 53Th LANDBAU RT. 03 RW. 08, KEL.BUMIWANGI BARU BPJS PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0000415866183 ; 155/87 ; GDP 91

EUIS PROLANIS DM02 HT01 ;

44 02-02-2023 3204295010540003 0002617870498 2019/17356 1954-10-10 - 68Th CIMARIUK RT. 2 RW. 19, KEL.MANGGUNG HARJA BARU BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
HENDRAWATI 0002617870498 ; 166/77 ; GDP 150

PROLANIS DM02 HT02 ;

45 02-02-2023 3204291010700010 0000416228995 2019/17608 KOMALASARI 1970-10-10 - 50Th LELES RT. 3 RW. 13, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0000416228995 ; 146/80 ; GDP 155

PROLANIS DM02 HT02 ;

46 02-02-2023 3204294401570001 0001341021497 2019/16384 LILIS SURYANI 1957-01-04 - 66Th LELES RT. 3 RW. 12, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA 130/80 / 36 80/20 E11.9 LAMA
0001341021497 ; 138/76 ; GDP 107

PROLANIS DM02 ; 0002793302447 ;

47 02-02-2023 3204291906020002 0002793302447 2016/01117 IMAS WIDIYA 2002-06-19 - 43Th HEGARMANAH RT. 02 RW. 03, KEL.MEKARLAKSANA BARU BPJS PBI POLI LANSIA 130/70 / 36 80/20 E11.9 LAMA
131/70 ; GDP 90
PROLANIS DM02 HT02 ;
48 02-02-2023 3204295210650004 0002524870293 2020/26388 ETI ROHAETI 1965-10-12 - 57Th ANDIR RT. 1 RW. 10, KEL.PAKUTANDANG BARU BPJS PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0002524870293 ; 130/81 ; GDP 113

PROLANIS DM02 HT02 ;

49 02-02-2023 3204094606550001 0000053722822 2018/10858 HARUN 1955-06-07 72Th - LELES RT. 3 RW. 12, KEL.MEKARSARI BARU BPJS NON PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
0000053722822 ; 157/87 ; GDP 127

PROLANIS DM02 HT02 ;

50 02-02-2023 3204295004790004 0001340627995 2019/18752 YAYAN HUSNI 1979-04-10 53Th - RANCA HEULANG RT. 1 RW. 9, KEL.MEKARLAKSANA BARU BPJS PBI POLI INFEKSIUS 120/80 / 36 80/20 E11.9 BARU
0000053722822 ; 157/87 ; GDP 127

KONTROL POST RAWAT DARI RS

51 03-02-2023 3204291404490002 0000415677385 2019/15888 EDY MULYADI 1949-04-14 73Th - HUJUNG RT. 3 RW. 1, KEL.CIPARAY BARU BPJS PBI POLI LANSIA MAJALAYA, GATAL KAKI, PUSING 120/80 / 36 80/20 E11.9 LAMA
KEPALA

52 03-02-2023 3204294107580176 0003172166199 2021/32895 ENANG 1955-08-20 - 67Th BBKN CARINGIN RT. 5 RW. 5, KEL.CIPARAY BARU BPJS PBI POLI LANSIA NYERI KAKI, KESEMUTAN, 120/80 / 36 80/20 E11.9 LAMA

PROLANIS DM02 HT02 ;

53 03-02-2023 3204291401700003 0000167254367 2017/03947 ELIS SULIYANAH 1970-01-14 - 52Th CIPAKU RT. 1 RW. 18, KEL.PAKUTANDANG BARU BPJS NON PBI POLI LANSIA 0000167254367 ; 124/77 ; GDP 113 130/80 / 36 80/20 E11.9 LAMA
AU 5,7

PROLANIS DM02 ; 0002251893093 ;

54 03-02-2023 3211085012840013 0002251893093 2016/09565 AYI SETIADI 1984-12-10 39Th - BBKN TAROGONG RT. 2 RW. 6, KEL.CIPARAY LAMA BPJS PBI POLI LANSIA 120/80 / 36 80/20 E11.9 LAMA
105/57 ; GDP 111

55 03-02-2023 320429521270007 0002963448134 2019/17752 DEDE AISYAH 1970-12-12 - 52Th CITAMIANG RT. 2 RW. 22, KEL.MEKARLAKSANA BARU BPJS PBI POLI UMUM KONTROL HT DM 155/85 47/150 36 80/20 E11.9 LAMA

PROLANIS DM01 ; 0001328868887 ;

56 03-02-2023 3204294208800011 0001328868887 2019/19230 SITI KHODIZAH 1980-08-02 - 42Th CIBOTOR RT. 2 RW. 22, KEL.MANGGUNG HARJA BARU BPJS PBI POLI LANSIA 130/80 47/150 36 80/20 E11.9 LAMA
136/86 ; GDP 346

PROLANIS DM01 HT02 ;

57 03-02-2023 3204296407680003 0000415962808 2018/11096 IKI RUKMINI 1968-07-24 - 54Th KARASAK RT. 3 RW. 7, KEL.CIHEULANG BARU BPJS PBI POLI LANSIA 120/80 47/150 36 80/20 E11.9 LAMA
0001453988676 ; 121/67 ; GDP 149

PROLANIS DM01 HT01 ;

58 03-02-2023 3204296409150003 0003113646309 2018/13561 ROSMALA DEWI 2015-09-24 - 42Th BOJONGNANGKA RT. 3 RW. 9, KEL.MEKARLAKSANA BARU BPJS PBI POLI UMUM 0003113646309 ; 171/110 ; GDP 160/80 55/155 36 80/20 E11.9 LAMA
227 KOL 278

PROLANIS DM02 ; 0001341209384 ;

59 03-02-2023 3204290803530003 0001341209384 2019/17008 DIDI 1953-03-08 69Th - KARANG ANYAR RT. 1 RW. 1, KEL.MANGGUNG HARJA LAMA BPJS PBI POLI LANSIA 120/80 55/155 36 80/20 E11.9 LAMA
130/78 ; GDP 118 KOL 152

PROLANIS DM01 HT02 ;

60 03-02-2023 320429811720002 0000414919293 2019/20473 ROHAYATI 1972-11-08 - 50Th LELES RT. 5 RW. 12, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA 120/80 55/155 36 80/20 E11.9 LAMA
0000414919293 ; 126/75 ; GDP 166

PROLANIS DM01 HT02 ;

61 03-02-2023 3204304102550021 0 2023/41510 NYAI RUHAMAH 1967-02-01 - 56Th JALAN CAGAK RT. 2 RW. 9, KEL.MARUYUNG BARU UMUM POLI INFEKSIUS 120/80 55/155 36 80/20 E11.9 BARU
0000414919293 ; 126/75 ; GDP 166

PROLANIS DM02 ; 0002837270215 ;

62 03-02-2023 3204294508760010 0002837270215 2017/02653 YULIA 1976-08-05 - 46Th SUKADANA RT. 2 RW. 5, KEL.MANGGUNG HARJA BARU BPJS PBI POLI LANSIA 120/80 55/155 36 80/20 E11.9 LAMA
100/65 ; GDP 134 KOL 154

PROLANIS DM02 HT01 ;

63 03-02-2023 3204295109680001 0002739590267 2017/05055 NURJANAH 1968-09-11 - 54Th LELES RT. 4 RW. 12, KEL.MEKARSARI BARU BPJS NON PBI POLI LANSIA 120/80 55/155 36 80/20 E11.9 LAMA
0002739590267 ; 161/75 ; GDS 260
 UMUR VITAL SIGN
NO. TGL. NIK NO.BPJS NO.INDEX NAMA PASIEN TGL.LAHIR ALAMAT KUNJ JAMINAN LAYANAN ANAMNESA DIAGNOSA KASUS
L P TD BB/TB SUHU HR/RR

SAKIT BADAN, RIWAYAT AMPUTASI,

64 03-02-2023 0 0 2017/07897 IIS YUHAETI 2017-02-03 - 61Th CIDAWOLONG RT. 3 RW. 19, KEL.BIRU LAMA UMUM POLI LANSIA 140/80 55/155 36 80/20 E11.9 LAMA
GATAL
PROLANIS DM02 HT02 ;
EUIS TATI
65 03-02-2023 3273074511570002 0001265138908 2019/14725 1957-11-05 - 65Th PERMATA REGENCY RT. 4 RW. 18, KEL.BUMIWANGI BARU BPJS NON PBI POLI LANSIA 0001265138908 ; 144/52 ; GDP 92 130/70 55/155 36 80/20 E11.9 LAMA
HARYATI
KOL 124

PROLANIS DM02 HT02 ;

66 03-02-2023 3204295605720004 0003094798329 2017/03472 IDAH ROSIDAH 1972-05-16 - 50Th BOJONGKALONG RT. 5 RW. 2, KEL.SUMBERSARI BARU BPJS NON PBI POLI LANSIA 0003094798329 ; 160/80 ; GDP 84 140/70 55/155 36 80/20 E11.9 LAMA
KOL 139

67 03-02-2023 3204290105640004 0000414934266 2017/03569 ATE SAMSUDIN 1964-05-01 58Th - KP. CALENGKA RT. 1 RW. 1, KEL.BUMIWANGI LAMA BPJS PBI POLI UMUM KONTROL DM HT 117/74 65/160 36 80/20 E11.9 LAMA

BATUK BERDAHAK PILEK 1

68 06-02-2023 3204294701560005 0002011602813 2019/19236 TITI SUMIATI 1956-01-07 - 57Th CIBOTOR RT. 48 RW. 19, KEL.MANGGUNG HARJA BARU BPJS PBI POLI LANSIA 170/100 65/160 36 80/18 E11.9 BARU
MINGGU. GDP 92

NYERI TELAPAK KAKI. GDP 325

69 06-02-2023 3204294407540004 0003208493924 2023/41536 YANI HANDAYANI 1954-07-04 - 68Th KP JONGOR RT. 1 RW. 02, KEL.SARIMAHI BARU BPJS PBI POLI LANSIA 110/70 65/160 36 80/18 E11.9 BARU
CHOL TOTAL 243

70 07-02-2023 3204295505780018 0 2021/34258 BETI NOERBAETI 1978-05-15 - 44Th BBK CARINGIN RT. 3 RW. 5, KEL.CIPARAY LAMA UMUM POLI UMUM KONTROL DM 140/80 80/156 36 80/20 E11.9 LAMA

71 08-02-2023 3204294707560002 0002063466178 2016/09171 YAYAH ROKAYAH 1956-07-07 - 66Th CIMARIUK RT. 3 RW. 17, KEL.MANGGUNG HARJA BARU BPJS NON PBI POLI LANSIA Kontrol DM GDP 190 140/70 80/156 36 80/20 E11.9 LAMA

72 08-02-2023 3204294811740002 0000415252001 2018/11301 IHAT SOLIHAT 1974-11-01 - 48Th CIMARIUK RT. 5 RW. 19, KEL.MANGGUNG HARJA LAMA BPJS PBI POLI UMUM NYERI KEPALA 142/79 50/150 36 86/18 E11.9 LAMA

PROLANIS; GDP 506; CHOL 344; TD

73 08-02-2023 3204295308520001 0000053726815 2019/23307 TUTI SUHATI 1952-08-13 - 70Th JL LASWI RT. 4 RW. 2, KEL.MANGGUNG HARJA BARU BPJS NON PBI POLI LANSIA 140/70 50/150 36 80/18 E11.9 BARU
140/71

74 08-02-2023 3273122909100001 0001297998731 2016/04775 AGUS ISMAIL 2010-09-29 56Th - LEUWIJAMBU RT. 06 RW. 13, KEL.MEKARSARI BARU BPJS NON PBI POLI UMUM LUKA DI KAKI 128/76 60/160 36 88/18 E11.9 BARU

PROLANIS ; 0002524894356; TD
75 09-02-2023 3204296005480002 0002524894356 2020/25392 RATIAH 1948-05-20 - 74Th CIPONGPORANG RT. 2 RW. 19, KEL.SERANGMEKAR LAMA BPJS PBI POLI LANSIA 145/70; GDP . BATUK KERING > 1 145/70 60/160 36 80/18 E11.9 BARU
BULAN
76 09-02-2023 3204291107690006 0000415769319 2019/15723 AHMAD SOPIAN 1969-07-11 53Th - KARASAK RT. 3 RW. 7, KEL.CIHEULANG BARU BPJS PBI POLI UMUM KAKI KESEMUTAN (+) 157/100 60/160 36,5 82/20 E11.9 BARU

PROLANIS ; 0000415677723 ;
77 09-02-2023 3204294101520058 0000053721944 2016/03977 ERAT 1952-01-01 - 71Th SUKADANA RT. 01 RW. 05, KEL.MANGGUNG HARJA BARU BPJS NON PBI POLI LANSIA 120/70 ; GDP 160 CHOL 321. KAKI 120/70 60/160 36 80/18 E11.9 BARU
SERING KESEMUTAN, MATA BERAIR

TELAPAK KAKI KESEMUTAN (+),

78 09-02-2023 320429570567004 0000415275388 2017/07889 ELIH 1967-05-17 - 55Th RANCA HEULANG RT. 1 RW. 9, KEL.MEKARLAKSANA BARU BPJS PBI POLI UMUM 152/73 55/155 36 91/20 E11.9 LAMA
BATUK (+) KERING

CIPONGPORANG INDAH RT. 4 RW. 08,

79 10-02-2023 3273246110610001 0 2022/38013 SITI SUMIYATI 1961-10-21 - 61Th LAMA UMUM POLI LANSIA KONTROL HT 120/70 55/155 36 80/20 E11.9 LAMA
KEL.SERANGMEKAR

JARI TANGAN KESEMUTAN, KEBAS,

80 11-02-2023 320325650986004 0001906709589 2019/21682 ARIFIN 1968-09-25 43Th - KP GEULIS RT. 1 RW. 13, KEL.MANGGUNG HARJA BARU BPJS NON PBI POLI UMUM 120/80 56/156 36 80/20 E11.9 BARU
RIWAYAT DM

81 13-02-2023 3204290106680001 0001521741431 2017/02845 TUMIRAN 1968-05-01 54Th - KARANG ANYAR RT. 1 RW. 1, KEL.MANGGUNG HARJA BARU BPJS NON PBI POLI UMUM KONTROL DM. GDP 196 120/80 55/155 36 88/18 E11.9 BARU

82 13-02-2023 3204294311140006 0 2021/34379 BONG KUAN HOI 2014-11-03 - 48Th KP. JONGOR KALER RT. 2 RW. 2, KEL.SARIMAHI BARU UMUM POLI UMUM NYERI KEDUA BAHU. RIW DM 110/70 55/155 36 88/16 E11.9 BARU

83 14-02-2023 3204292102590002 0001003390413 2022/40552 DAHLAN 1959-02-21 64Th - PALAWIJA RT. 1 RW. 10, KEL.MEKARSARI LAMA BPJS PBI POLI LANSIA RIWAYAT PENYAKIT GULA 150/70 55/155 36 80/20 E11.9 LAMA

84 14-02-2023 3204292807580001 0000053950228 2020/25353 YUYUN YUHAETI 1958-07-28 - 59Th KBSI BLOK A NO 3 RT. 1 RW. 08, KEL.GUNUNGLEUTIK BARU BPJS NON PBI POLI UMUM BATUK PILEK. RIW DM. GDP 398 120/70 55/155 36 80/18 E11.9 BARU

85 15-02-2023 3204295807600003 0001003373392 2020/29645 RALEM 1960-07-18 - 62Th LELES RT. 3 RW. 11, KEL.MEKARSARI LAMA UMUM POLI LANSIA PEGAL-PEGAL, BATUK 120/80 55/155 36 80/20 E11.9 LAMA

86 15-02-2023 3204294608560003 0000415555648 2016/04296 DIMAH 1956-08-06 - 66Th LELES RT. 05 RW. 12, KEL.MEKARSARI BARU BPJS PBI POLI LANSIA GATAL, 120/70 55/155 36 80/20 E11.9 BARU

KELUHAN LEMAS, SERING HAUS

87 15-02-2023 3204294605120004 0001003367417 2018/12749 PIPIT NURHAYATI 2012-05-06 - 42Th CIMARIUK RT. 2 RW. 18, KEL.MANGGUNG HARJA BARU BPJS PBI POLI UMUM DAN BANYAK KENCING. GDS 408 100/80 55/155 36 88/20 E11.9 BARU
GDP 269

88 16-02-2023 3204324107590166 0 2022/40875 ECI 1959-07-01 - 63Th LAMPINGHAUR RT. 1 RW. 16, KEL.MEKARLAKSANA LAMA UMUM POLI LANSIA NYERI PERUT KIRI 160/70 55/155 36 80/20 E11.9 LAMA
Y. BENNY
89 16-02-2023 3204292404530002 0000053386097 2016/09830 1952-04-24 69Th - KP.BANDIR RT. 01 RW. 03, KEL.MANGGUNGHARJA BARU BPJS NON PBI POLI LANSIA KESEMUTAN 130/60 55/155 36 80/20 E11.9 LAMA
SUBAGIO

90 16-02-2023 3204294504650006 0002837234878 2021/33857 FATIMAH 1965-04-05 - 57Th KP RANCAHELANG RT. 1 RW. 9, KEL.MEKARLAKSANA BARU BPJS PBI POLI UMUM KONTROL DM. GDP 157 160/70 55/155 36 80/18 E11.9 BARU

91 16-02-2023 3204294805530001 0000053652982 2017/05634 ROSMIYATI 1953-01-01 - 70Th BBKN CARINGIN RT. 2 RW. 8, KEL.CIPARAY BARU BPJS NON PBI POLI LANSIA SAKIT BAHU 140/70 55/155 36 80/20 E11.9 LAMA

92 20-02-2023 3204295505700001 0001341070975 2021/35183 TATI 1970-05-15 - 52Th LIO MADUR RT. 1 RW. 12, KEL.MEKARLAKSANA BARU BPJS PBI POLI UMUM KONTROL DM. GDS 341 120/70 55/155 36 80/20 E11.9 LAMA

93 20-02-2023 3205425010750005 0 2021/32503 LILIS LISNAWATI 1975-10-10 - 47Th CIMARIUK RT. 4 RW. 17, KEL.MANGGUNG HARJA LAMA UMUM POLI UMUM KONTROL DM, KONTROL HT 150/110 55/155 36 88/20 E11.9 LAMA
94 21-02-2023 3204295009710004 0002522393199 2022/37225 IIS 1971-09-10 - 51Th JOLOK RT. 1 RW. 8, KEL.MEKARSARI BARU BPJS PBI POLI INFEKSIUS KONTROL DM, KONTROL HT 150/110 55/155 36 88/20 E11.9 LAMA
 UMUR VITAL SIGN
NO. TGL. NIK NO.BPJS NO.INDEX NAMA PASIEN TGL.LAHIR ALAMAT KUNJ JAMINAN LAYANAN ANAMNESA DIAGNOSA KASUS
L P TD BB/TB SUHU HR/RR

95 22-02-2023 3204294811740002 0000415252001 2018/11301 IHAT SOLIHAT 1974-11-01 - 48Th CIMARIUK RT. 5 RW. 19, KEL.MANGGUNG HARJA LAMA BPJS PBI POLI UMUM KONTROL GULA DAN KOLESTEROL 150/90 60/160 36 88/20 E11.9 LAMA

96 22-02-2023 3204292102590002 0001003390413 2022/40552 DAHLAN 1959-02-21 64Th - PALAWIJA RT. 1 RW. 10, KEL.MEKARSARI LAMA BPJS PBI POLI LANSIA KONTROL DM 163/80 60/160 36 80/20 E11.9 LAMA
WAWAN
97 22-02-2023 3204290608670004 0001003410178 2023/41801 1967-08-05 55Th - CALENGKA RT. 2 RW. 1, KEL.BUMIWANGI BARU BPJS PBI POLI UMUM PEGAL-PEGAL BADAN 110/70 60/160 36 88/22 E11.9 BARU
AGUSTIAN

98 23-02-2023 3204290101620084 0 2019/23668 ONIH 1962-01-01 - 61Th BUMIASIH RT. 3 RW. 11, KEL.BUMIWANGI LAMA UMUM POLI UMUM NYERI BADAN 130/70 60/160 36 88/22 E11.9 BARU

99 23-02-2023 3204294208730015 0001003390042 2016/10147 ELIN KARLINA 1973-02-08 - 50Th LIO TANJUNGLAYA RT. 2 RW. 9, KEL.SARIMAHI BARU BPJS PBI POLI UMUM KONTROL DM 120/80 56/155 36 80/20 E11.9 LAMA

100 24-02-2023 3273025810780001 0002087052704 2023/41103 SITI ROHMAH 1978-10-18 - 44Th JL CIDAWOLONG RT. 1 RW. 1, KEL.BIRU LAMA BPJS NON PBI POLI UMUM KONTROL DM 120/80 60/155 36 88/22 E11.9 BARU

DADAN
101 24-02-2023 3204320506740002 0001460760985 2022/40680 1974-06-05 48Th - RANCABOGO RT. 5 RW. 07, KEL.SAGARACIPTA LAMA BPJS NON PBI POLI UMUM KESEMUTAN 3 MINGGU, BAAL 130/90 60/160 36 88/22 E11.9 BARU
MAHMUDIN

NYERI DAN KESEMUTAN PADA

TANGAN DAN KAKI. SERING BAK (+)
102 24-02-2023 3204291203570001 0002961429838 2023/41739 UYUN SUJANA 1957-03-12 66Th - BOJONG KADU RT. 2 RW. 05, KEL.MEKARLAKSANA LAMA BPJS PBI POLI LANSIA PENURUNAN BERAT BADAN (+). 160/90 60/160 36 80/20 E11.9 BARU
RIW JATUH. GDP SEBELUMNYA 147.
GDP 159

NYERI DAN KESEMUTAN PADA

TANGAN DAN KAKI. SERING BAK (+)
103 28-02-2023 3204295104700005 0002603685172 2021/33117 TINI 1970-04-11 - 52Th KOMP.CIPARAY INDAH RT. 1 RW. 10, KEL.SARIMAHI LAMA BPJS PBI POLI TB DOTS PENURUNAN BERAT BADAN (+). 160/90 60/160 36 80/20 E11.9 LAMA
RIW JATUH. GDP SEBELUMNYA 147.
GDP 159