Laporan Eling PKM Pandean Juni 2022-Feb 2023

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<big><big>
LAPORAN UNIVERSAL POLI GIGI 
BULAN 01-07-2022 - 28-02-2023 </big></big>
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<table align='center'>
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<td>Total</td>
<td>:</td>
<td>608</td>
</tr>
</table>
<table align="center" width="98%" border="1">
<tr class="row1">
<td width='3%'>No</td>
<td width='6%'>Tanggal</td>
<td width='6%'>PKM</td>
<td width='6%'>No RM</td>
<td width='10%'>Nama</td>
<td width='10%'>NIK</td>
<td width='10%'>Alamat</td>
<td width='6%'>Desa</td>
<td width='5%'>Kecamatan</td>
<td width='5%'>Kabupaten</td>
<td width='6%'>Tgl Lahir</td>
<td width='6%'>Umur Th</td>
<td width='2%'>L/P</td>
<td width='7%'>Pekerjaan</td>
<td width='7%'>Ruangan</td>
<td width='7%'>Petugas</td>
<td width='4%'>Status</td>
<td>Kasus</td>
<td>Cara Bayar</td>
<td>Jenis BPJS</td>
<td>No BPJS</td>
<td>Kode Bridging</td>
<td>ICD-10</td>
<td>Diagnosa</td>
</tr>
<tr align="left" valign="top">

<td>1</td>
<td>01-07-2022</td>
<td>PUSKESMAS PANDEAN</td>
<td>011812</td>
<td>NASHA ABDILA AMALISA</td>
<td>'3503045401160001</td>
<td>DUSUN KRAJAN RT/15 RW/03</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-01-2016</td>
<td>7</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg. Ayu Puspito Ningrum</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802742064</td>
<td>131512020722Y000001</td>
<td align='center'>
K04.1 </td>
<td align='center'>
Necrosis of pulp </td>
</tr>

<td>2</td>
<td>01-07-2022</td>
<td>011233</td>
<td>SITI NUR IMROATUL KASANAH</td>
<td>'3503045306040002</td>
<td>DUSUN TALUN, RT : 055,RW :020 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-06-2004</td>
<td>18</td>
<td>P</td>
<td>MENGURUS RUMAH TANGGA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0000663535394</td>
<td>131512020722Y000002</td>
<td align='center'>
K02.1 </td>
<td align='center'>
Caries of dentine </td>
</tr>

<td>3</td>
<td>02-07-2022</td>
<td>001802</td>
<td>HAFIZ RISKI SAPUTRA</td>
<td>'3503041909160001</td>
<td>1/4 KRAJAN</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002086051059</td>
<td>131512020722Y000003</td>
<td align='center'>
K00.6 </td>
<td align='center'>
Disturbances in tooth eruption </td>
</tr>

<td>4</td>
<td>02-07-2022</td>
<td>012222</td>
<td>MUHAMMAD ALHAFIDHUSSOLIH</td>
<td>'3503043004160002</td>
<td>DSN JURON, RT : 037,RW :019 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-04-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>5</td>
<td>04-07-2022</td>
<td>012860</td>
<td>AYNUL HANAFI</td>
<td>'3503042109160001</td>
<td>DUSUN NGLARAN, RT : 025,RW :013 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0003142878851</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>6</td>
<td>04-07-2022</td>
<td>012864</td>
<td>AHMAD FADHIL AZHAR</td>
<td>'3503040111140002</td>
<td>DUSUN TALUN 48/18</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-11-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002627919325</td>
<td>131512020722Y000007</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>7</td>
<td>04-07-2022</td>
<td>012861</td>
<td>MUHAMMAD SIROJUL FATAN AZNA</td>
<td>'</td>
<td>42/16</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>8</td>
<td>04-07-2022</td>
<td>003385</td>
<td>MUHAMMAD ALFIN ARDIAN</td>
<td>'</td>
<td>PANDEAN DONGKO</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-11-2018</td>
<td>4</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002613438628</td>
<td>131512020722Y000005</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>9</td>
<td>04-07-2022</td>
<td>009389</td>
<td>AVIKA AULIA RAHMAN</td>
<td>'3503046903130002</td>
<td>RT 21/08</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-03-2013</td>
<td>9</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>10</td>
<td>04-07-2022</td>
<td>008000</td>
<td>TSANIA TUHFATUS SALMA</td>
<td>'3503046305130001</td>
<td>RT 11/04</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-05-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>11</td>
<td>04-07-2022</td>
<td>009898</td>
<td>NOVIAN BAYU ALFATAN</td>
<td>'</td>
<td>RT 22/08</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-05-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>12</td>
<td>05-07-2022</td>
<td>012902</td>
<td>YOGA FEBRIAN</td>
<td>'3503040702150001</td>
<td>DUSUN SAMBI, RT : 034,RW :013 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-02-2015</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0002603883082</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>13</td>
<td>05-07-2022</td>
<td>012905</td>
<td>AVIKAYOGI HARATAMI</td>
<td>'3503046507130001</td>
<td>DUSUN KRAJAN 08/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-07-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>KEPALA DESA DAN PERANGKAT DESA</td>
<td>'0002776494453</td>
<td>131512020722Y000059</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>14</td>
<td>06-07-2022</td>
<td>012912</td>
<td>JAYUS </td>
<td>'3503040707720001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-07-1972</td>
<td>50</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665058543</td>
<td>131512020722Y000060</td>
<td align='center'>
S02.5 </td>
<td align='center'>
Fracture of tooth </td>
</tr>

<td>15</td>
<td>07-07-2022</td>
<td>004008</td>
<td>WIWIK</td>
<td>'</td>
<td>PANDEAN 45/17</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-03-2015</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>16</td>
<td>07-07-2022</td>
<td>002388</td>
<td>SULASTRI</td>
<td>'3503044805850002</td>
<td>DSN KLANDRI, RT : 039,RW :020 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-05-1985</td>
<td>37</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001975823482</td>
<td>131512020722Y000381</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
General medical examination </td>
</tr>

<td>17</td>
<td>07-07-2022</td>
<td>012965</td>
<td>RONEM</td>
<td>'3503045304630001</td>
<td>KRAJAN, RT : 008,RW :002 </td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-04-1963</td>
<td>59</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.4 </td>
<td align='center'>
Acute apical periodontitis of pulpal origin
</td>
</tr>

<td>18</td>
<td>08-07-2022</td>
<td>012983</td>
<td>SAHRINI YUNITA</td>
<td>'</td>
<td>34/10</td>
<td>SIKI</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-06-2010</td>
<td>12</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02 </td>
<td align='center'>
Dental caries </td>
</tr>

<td>19</td>
<td>11-07-2022</td>
<td>004103</td>
<td>UMI KALIFAH</td>
<td>'</td>
<td>RT 19 RW 04</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-09-1977</td>
<td>45</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664651293</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
Pulpitis </td>
</tr>

<td>20</td>
<td>11-07-2022</td>
<td>012989</td>
<td>MUHAMMAD FAHRI DAFFA PRATAMA</td>
<td>'3503040801130001</td>
<td>DUSUN PLAPAR, RT : 012,RW :006 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-01-2013</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>21</td>
<td>11-07-2022</td>
<td>008348</td>
<td>MAMIK FITRIANI</td>
<td>'3503116501990002</td>
<td>RT 25/05</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-01-1999</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665339747</td>
<td>131512020722Y000130</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>22</td>
<td>11-07-2022</td>
<td>002567</td>
<td>AGUS RIYONO</td>
<td>'3503041308800004</td>
<td>DESA DONGKO, RT : 40,RW :9 </td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-08-1980</td>
<td>42</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106523201</td>
<td>131512020722Y000561</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>23</td>
<td>11-07-2022</td>
<td>002567</td>
<td>AGUS RIYONO</td>
<td>'3503041308800004</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-08-1980</td>
<td>42</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106523201</td>
<td>131512020722Y000561</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>24</td>
<td>12-07-2022</td>
<td>012860</td>
<td>AYNUL HANAFI</td>
<td>'3503042109160001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003142878851</td>
<td>131512020722Y000138</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>25</td>
<td>12-07-2022</td>
<td>002078</td>
<td>RIFALDI ALDRIANSYAH</td>
<td>'3503041203160002</td>
<td>RT 19 RW 10 DESA CAKUL</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-03-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002131740268</td>
<td>131512020722Y000139</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>26</td>
<td>12-07-2022</td>
<td>013014</td>
<td>SUSIANA MAYASARI</td>
<td>'</td>
<td>43/09</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-12-2004</td>
<td>18</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
S02.5 </td>
<td align='center'>
</tr>

<td>27</td>
<td>13-07-2022</td>
<td>013020</td>
<td>YELSE ARDILA PUTRI</td>
<td>'</td>
<td>35/18</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-06-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>28</td>
<td>13-07-2022</td>
<td>002078</td>
<td>RIFALDI ALDRIANSYAH</td>
<td>'3503041203160002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-03-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002131740268</td>
<td>131512020722Y000147</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>29</td>
<td>13-07-2022</td>
<td>011395</td>
<td>IMAM SAFAÀT</td>
<td>'3503042106710001</td>
<td>DUSUN JOGADI, RT : 013,RW :005 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-06-1971</td>
<td>51</td>
<td>L</td>
<td>PETANI/PEKEBUN</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663536889</td>
<td>131512020722Y000146</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>30</td>
<td>14-07-2022</td>
<td>000345</td>
<td>LINA SAPITRI</td>
<td>'3503046303990001</td>
<td>SALAMWATES 11/04</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-03-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665469854</td>
<td>131512020722Y000153</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>31</td>
<td>14-07-2022</td>
<td>007132</td>
<td>FATHONAH</td>
<td>'</td>
<td>RT 2 RW 1</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-11-1992</td>
<td>30</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663167439</td>
<td>131512020722Y000185</td>
<td align='center'>
K03.6 </td>
<td align='center'>
Deposits [accretions] on teeth </td>
</tr>

<td>32</td>
<td>14-07-2022</td>
<td>012195</td>
<td>SUKANTI RAHMASARI</td>
<td>'3503044410000004</td>
<td>DUSUN NGLANGON RT 20 RW 10</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-10-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003267298001</td>
<td>131512020722Y000186</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>33</td>
<td>14-07-2022</td>
<td>011475</td>
<td>SOLIKAH</td>
<td>'3503046102920005</td>
<td>RT 37/19</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-02-1992</td>
<td>31</td>
<td>P</td>
<td>WIRASWASTA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002014012337</td>
<td>131512020722Y000187</td>
<td align='center'>
K02 </td>
<td align='center'>
</tr>

<td>34</td>
<td>14-07-2022</td>
<td>009868</td>
<td>SULIS SETYOWATI</td>
<td>'3503044703920002</td>
<td>DUSUN KRAJAN, RT : 011,RW :003 </td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-03-1992</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003071755034</td>
<td>131512020722Y000189</td>
<td align='center'>
K03.5 </td>
<td align='center'>
Ankylosis of teeth </td>
</tr>

<td>35</td>
<td>14-07-2022</td>
<td>012564</td>
<td>SULISTIANA</td>
<td>'3503046405950002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-05-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665087411</td>
<td>131512020722Y000191</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>36</td>
<td>14-07-2022</td>
<td>005758</td>
<td>SEPTI YULIANA</td>
<td>'3503045709000005</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-09-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001036891157</td>
<td>131512020722Y000192</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>37</td>
<td>15-07-2022</td>
<td>013055</td>
<td>NENDRA DESTAMA</td>
<td>'3503041612120001</td>
<td>DUSUN BANAR 17/04</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-12-2012</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003262586861</td>
<td>131512020722Y000198</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>38</td>
<td>15-07-2022</td>
<td>000291</td>
<td>BINTI MUSAROPAH</td>
<td>'</td>
<td>CAKUL 03/02</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-07-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664977497</td>
<td>131512020722Y000199</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>39</td>
<td>15-07-2022</td>
<td>010422</td>
<td>DARRELL ARKA DINATA</td>
<td>'3503040702160004</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-02-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002897089648</td>
<td>131512020722Y000197</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>40</td>
<td>16-07-2022</td>
<td>013058</td>
<td>YATINI</td>
<td>'3503046202620001</td>
<td>RT 07/04</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-02-1962</td>
<td>61</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td>'0002748855069</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>41</td>
<td>18-07-2022</td>
<td>013065</td>
<td>SUNIA MAYA SABITA</td>
<td>'</td>
<td>52/19</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-10-2003</td>
<td>19</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
S02.5 </td>
<td align='center'>
</tr>

<td>42</td>
<td>18-07-2022</td>
<td>006133</td>
<td>JUZA SYIFA SALSABILA</td>
<td>'3503045001160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-01-2016</td>
<td>7</td>
<td>P</td>
<td>BELUM/TIDAK BEKERJA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>43</td>
<td>18-07-2022</td>
<td>002326</td>
<td>MARMIATI</td>
<td>'3503045201850002</td>
<td>RT 10/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-01-1985</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664754264</td>
<td>131512020722Y000221</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>44</td>
<td>18-07-2022</td>
<td>013068</td>
<td>DIANA RIRIN FARIASIH</td>
<td>'3506084609900002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-09-1990</td>
<td>32</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>45</td>
<td>18-07-2022</td>
<td>010973</td>
<td>LILIS LISTIANA DEWI</td>
<td>'3503044606950004</td>
<td>RT 23/08</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-06-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664257418</td>
<td>131512020722Y000223</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>46</td>
<td>19-07-2022</td>
<td>000569</td>
<td>MUJIARTO</td>
<td>'3503042912820001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-12-1982</td>
<td>40</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002435118344</td>
<td>131512020722Y000236</td>
<td align='center'>
K02.0 </td>
<td align='center'>
Caries limited to enamel </td>
</tr>

<td>47</td>
<td>20-07-2022</td>
<td>001031</td>
<td>NUR SHOLIKAH</td>
<td>'</td>
<td>RT 17 RW 8 CAKUL</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-07-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665472249</td>
<td>131512020722Y000277</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>48</td>
<td>22-07-2022</td>
<td>001448</td>
<td>MINI ANJARWATI</td>
<td>'3503047112960002</td>
<td>RT 26 RW 8 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-12-1996</td>
<td>26</td>
<td>P</td>
<td>Pembantu Rumah Tangga</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002159508058</td>
<td>131512020722Y000278</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>49</td>
<td>23-07-2022</td>
<td>013159</td>
<td>FADIEL ALFARIZA</td>
<td>'</td>
<td>07/03</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-10-2012</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002600085712</td>
<td>131512020722Y000289</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>50</td>
<td>23-07-2022</td>
<td>005781</td>
<td>EVELIEN LAILATUL PUTRI</td>
<td>'3503046106160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-06-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002681674997</td>
<td>131512020722Y000291</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>51</td>
<td>25-07-2022</td>
<td>010763</td>
<td>DEWI KUSUMA WARDANI</td>
<td>'3503044705000001</td>
<td>DSN NGASINAN, RT : 034,RW :017 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-05-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664746658</td>
<td>131512020722Y000287</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>52</td>
<td>25-07-2022</td>
<td>013178</td>
<td>HOLY CHARITY </td>
<td>'</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-09-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
S02.50 </td>
<td align='center'>
Fracture of tooth, closed </td>
</tr>

<td>53</td>
<td>25-07-2022</td>
<td>013179</td>
<td>QORIATUL MAWLA SALSABILA </td>
<td>'</td>
<td>26/13</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-06-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>54</td>
<td>25-07-2022</td>
<td>013174</td>
<td>NURJANAH</td>
<td>'</td>
<td>DUSUN KORI 38/11</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-02-1992</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02 </td>
<td align='center'>
</tr>

<td>55</td>
<td>25-07-2022</td>
<td>011111</td>
<td>SUSILOWATI</td>
<td>' </td>
<td>DUSUN NGLANGON, RT : 019,RW :010 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-10-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664559684</td>
<td>131512020722Y000317</td>
<td align='center'>
K02 </td>
<td align='center'>
</tr>

<td>56</td>
<td>26-07-2022</td>
<td>011966</td>
<td>NURUL</td>
<td>'3503045101800005</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-01-1979</td>
<td>44</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664335909</td>
<td>131512020722Y000318</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>57</td>
<td>27-07-2022</td>
<td>004610</td>
<td>PARTI</td>
<td>'</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-09-1983</td>
<td>39</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665261695</td>
<td>131512020722Y000468</td>
<td align='center'>
K02 </td>
<td align='center'>
</tr>

<td>58</td>
<td>27-07-2022</td>
<td>013066</td>
<td>WINARTI</td>
<td>'</td>
<td>RT44 RW 22</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-08-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664471269</td>
<td>131512020722Y000429</td>
<td align='center'>
K02 </td>
<td align='center'>
</tr>

<td>59</td>
<td>28-07-2022</td>
<td>003593</td>
<td>MUKTI ANI RAHAYU</td>
<td>'3503055205790002</td>
<td>RT 05/01</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-05-1979</td>
<td>43</td>
<td>P</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106630918</td>
<td>131512020722Y000436</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>60</td>
<td>28-07-2022</td>
<td>013221</td>
<td>LULUK NGAINUN MAKNUN</td>
<td>'3503046911930005</td>
<td>KRAJAN 09/02</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-11-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001978358613</td>
<td>131512020722Y000580</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>61</td>
<td>29-07-2022</td>
<td>013250</td>
<td>ALIFA SARIROTUL FALAH</td>
<td>'3503046502150001</td>
<td>NGLEBAN 15/03</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-02-2015</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802742918</td>
<td>131512020722Y000449</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>62</td>
<td>29-07-2022</td>
<td>013249</td>
<td>SUPANI</td>
<td>'3503040405670004</td>
<td>DUSUN BONSARI, RT : 024,RW :009 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-03-1967</td>
<td>56</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
Chronic periodontitis </td>
</tr>

<td>63</td>
<td>29-07-2022</td>
<td>009470</td>
<td>MULIK ABIDAH</td>
<td>'3503046002010002</td>
<td>DSN.BONSARI, RT : 043,RW :016 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-02-2001</td>
<td>22</td>
<td>P</td>
<td>PELAJAR/MAHASISWA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665731293</td>
<td>131512020722Y000450</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>64</td>
<td>29-07-2022</td>
<td>012050</td>
<td>IRVAN PRATAMA</td>
<td>'3503042009160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002086479033</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>65</td>
<td>01-08-2022</td>
<td>013282</td>
<td>ERNI</td>
<td>'3503046307910003</td>
<td>SOBO 20/06</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-07-1991</td>
<td>31</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>'0003269115448</td>
<td>131512020822Y000008</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>66</td>
<td>01-08-2022</td>
<td>013274</td>
<td>ANI WASILLATUL NGARIFAH</td>
<td>'</td>
<td>CAKUL RT 42</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-04-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>67</td>
<td>01-08-2022</td>
<td>013278</td>
<td>ROWIYAH</td>
<td>'3503044112690001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-12-1969</td>
<td>53</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02 </td>
<td align='center'>
</tr>
<td>68</td>
<td>01-08-2022</td>
<td>013280</td>
<td>NIRNA TIARA AZZAHRA</td>
<td>'3503045705150002</td>
<td>33/13</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>69</td>
<td>03-08-2022</td>
<td>013289</td>
<td>AZKA ALWI ASSEGAF</td>
<td>'3503041905170001</td>
<td>16/08</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-05-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012957617</td>
<td>131512020822Y000039</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>70</td>
<td>04-08-2022</td>
<td>013316</td>
<td>KAYLA ZAHRA FATMASARI</td>
<td>'</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-03-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>71</td>
<td>04-08-2022</td>
<td>013320</td>
<td>KATINI</td>
<td>'3503044809560002</td>
<td>23/12</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-03-1969</td>
<td>53</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002598927928</td>
<td>131512020822Y000043</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>72</td>
<td>06-08-2022</td>
<td>013351</td>
<td>FAHMI HAFIZ ABDUL MUNIP</td>
<td>'3503043003160002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-03-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>73</td>
<td>06-08-2022</td>
<td>013349</td>
<td>REVA AMELIA</td>
<td>'</td>
<td>31/16</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-10-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>74</td>
<td>08-08-2022</td>
<td>013360</td>
<td>ICCA OKTAVIANA</td>
<td>'3503044710970001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-10-1997</td>
<td>25</td>
<td>P</td>
<td>Karyawan Swasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0003047441747</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>75</td>
<td>08-08-2022</td>
<td>005791</td>
<td>UMI MASRUROH</td>
<td>'3503044309990001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-09-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000661873149</td>
<td>131512020822Y000081</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>76</td>
<td>08-08-2022</td>
<td>013357</td>
<td>AHMAD ILHAM ALFARIZI </td>
<td>'3503041302160002</td>
<td>54/20</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-02-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002081488228</td>
<td>131512020822Y000261</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>77</td>
<td>08-08-2022</td>
<td>013289</td>
<td>AZKA ALWI ASSEGAF</td>
<td>'3503041905170001</td>
<td>16/08</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-05-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012957617</td>
<td>131512020822Y000077</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>78</td>
<td>09-08-2022</td>
<td>011440</td>
<td>TRI INDAH YANTI</td>
<td>'3503045903010001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-03-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002013990974</td>
<td>131512020822Y000097</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>79</td>
<td>09-08-2022</td>
<td>004866</td>
<td>MUSRINI</td>
<td>'350304 </td>
<td>RT 02/01</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-06-1962</td>
<td>60</td>
<td>P</td>
<td>Pensiunan</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106527554</td>
<td>131512020822Y000098</td>
<td align='center'>
K05.2 </td>
<td align='center'>
Acute periodontitis </td>
</tr>

<td>80</td>
<td>09-08-2022</td>
<td>013455</td>
<td>FAIS NAFILATU RISKY</td>
<td>'</td>
<td>12/06</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-04-2012</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>81</td>
<td>09-08-2022</td>
<td>000116</td>
<td>ANYARIA WULAN</td>
<td>'3503044101810011</td>
<td>PETUNG 02/01</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-01-1981</td>
<td>42</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664725892</td>
<td>131512020822Y000101</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>82</td>
<td>10-08-2022</td>
<td>002872</td>
<td>ERVA DWI PRATAMA</td>
<td>'3503040508130002</td>
<td>DUSUN JURON, RT : 049,RW :025 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-08-2013</td>
<td>9</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002505673271</td>
<td>131512020822Y000148</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>83</td>
<td>11-08-2022</td>
<td>013573</td>
<td>BELVA YEDDA PRATAMA</td>
<td>'3503043107150001</td>
<td>KARANGSUDO 04/02</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-07-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002063929184</td>
<td>131512020822Y000150</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>84</td>
<td>11-08-2022</td>
<td>013575</td>
<td>NAILA AZKIA ULAFIFA</td>
<td>'</td>
<td>16/58</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-08-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>85</td>
<td>13-08-2022</td>
<td>009943</td>
<td>MUHAMMAD SHIDQI SAHILUL KHULUQI</td>
<td>'3503041402140002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-02-2014</td>
<td>9</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002288730071</td>
<td>131512020822Y000157</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>86</td>
<td>15-08-2022</td>
<td>013282</td>
<td>ERNI</td>
<td>'3503046307910003</td>
<td>SOBO 20/06</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-07-1991</td>
<td>31</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0003269115448</td>
<td>131512020822Y000165</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>87</td>
<td>16-08-2022</td>
<td>013687</td>
<td>ANIK SURYANI</td>
<td>'3503045710830003</td>
<td>KRAJAN 10/04</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-10-1983</td>
<td>39</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>88</td>
<td>16-08-2022</td>
<td>013689</td>
<td>LAILATUL FITRIYAH</td>
<td>'3503044107020019</td>
<td>DUSUN SOBO, RT : 018,RW :006 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-07-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002014037335</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>89</td>
<td>16-08-2022</td>
<td>013322</td>
<td>DIANA OKTAVIA</td>
<td>'3520055810970001</td>
<td>RT 41</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-10-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002025662657</td>
<td>131512020822Y000174</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>90</td>
<td>16-08-2022</td>
<td>013680</td>
<td>MAISAROH</td>
<td>'3503044608940001</td>
<td>PLAPAR 13/07</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-08-1994</td>
<td>28</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664990356</td>
<td>131512020822Y000524</td>
<td align='center'>
K01.1 </td>
<td align='center'>
Impacted teeth </td>
</tr>

<td>91</td>
<td>16-08-2022</td>
<td>013706</td>
<td>DEWI ANGGUN LESTARI</td>
<td>'3503044807150001</td>
<td>DUSUN NGLEBAN, RT : 016,RW :003 </td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-07-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>92</td>
<td>18-08-2022</td>
<td>012602</td>
<td>DWI DESI ERNIATIN</td>
<td>'3503045712970004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-12-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664528702</td>
<td>131512020822Y000175</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>93</td>
<td>18-08-2022</td>
<td>013724</td>
<td>WIJI SUNARDIONO</td>
<td>'3503040611480001</td>
<td>RT 15/06</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-11-1948</td>
<td>74</td>
<td>L</td>
<td>Pensiunan</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000106799927</td>
<td>131512020822Y000173</td>
<td align='center'>
K08.3 </td>
<td align='center'>
Retained dental root </td>
</tr>

<td>94</td>
<td>18-08-2022</td>
<td>008743</td>
<td>MIFTAKUL HUDA</td>
<td>'3503042909880002</td>
<td>RT 01/01</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-09-1988</td>
<td>34</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664609307</td>
<td>131512020822Y000176</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>95</td>
<td>19-08-2022</td>
<td>010989</td>
<td>WAJIRAN</td>
<td>'3503043112620002</td>
<td>RT 32/05</td>
<td>BESUKI</td>
<td>MUNJUNGAN</td>
<td>TRENGGALEK</td>
<td>31-12-1962</td>
<td>60</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0002600063831</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>96</td>
<td>19-08-2022</td>
<td>013803</td>
<td>KAIRA AZKIA</td>
<td>'</td>
<td>49/18</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-08-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>97</td>
<td>20-08-2022</td>
<td>013680</td>
<td>MAISAROH</td>
<td>'3503044608940001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-08-1994</td>
<td>28</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664990356</td>
<td>131512020822Y000337</td>
<td align='center'>
K01.1 </td>
<td align='center'>
</tr>

<td>98</td>
<td>20-08-2022</td>
<td>009943</td>
<td>MUHAMMAD SHIDQI SAHILUL KHULUQI</td>
<td>'3503041402140002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-02-2014</td>
<td>9</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002288730071</td>
<td>131512020822Y000334</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>99</td>
<td>22-08-2022</td>
<td>006496</td>
<td>MUHAMAD KABIB</td>
<td>'3503040311880002</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-11-1988</td>
<td>34</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664614832</td>
<td>131512020822Y000342</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>100</td>
<td>23-08-2022</td>
<td>013771</td>
<td>DILA TRIA UTAMI</td>
<td>'3503045212110001</td>
<td>NGLANGON 16/08</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-12-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002462513174</td>
<td>131512020822Y000309</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>101</td>
<td>23-08-2022</td>
<td>012628</td>
<td>MUJIASRI</td>
<td>'3502126702820001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-02-1982</td>
<td>41</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0001265685467</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>102</td>
<td>23-08-2022</td>
<td>013188</td>
<td>MARKAMAH</td>
<td>'3503046703950001</td>
<td>DUSUN SOBO RT 013 RW 005 DESA SALAMWATES, RT : 013,RW :005 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-03-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664206816</td>
<td>131512020822Y000282</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>103</td>
<td>23-08-2022</td>
<td>013778</td>
<td>ZIANA AULIA KADIBA</td>
<td>'</td>
<td>15/03</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-01-2013</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>104</td>
<td>23-08-2022</td>
<td>001982</td>
<td>INEZ CAHYA NINGTYAS</td>
<td>'3503044702150001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-02-2015</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002600117379</td>
<td>131512020822Y000314</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>105</td>
<td>23-08-2022</td>
<td>013783</td>
<td>ALYFA NUR HALIZA</td>
<td>'3503045810140002</td>
<td>SAMBI 37/14</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-10-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002860462203</td>
<td>131512020822Y000313</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>106</td>
<td>23-08-2022</td>
<td>013573</td>
<td>'3503043107150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-07-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002063929184</td>
<td>131512020822Y000311</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>107</td>
<td>24-08-2022</td>
<td>013799</td>
<td>IMAM MUFID</td>
<td>'3503040512770003</td>
<td>DSN NGLANGON, RT : 020,RW :010 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-12-1977</td>
<td>45</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012957606</td>
<td>131512020822Y000299</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>108</td>
<td>24-08-2022</td>
<td>013724</td>
<td>'3503040611480001</td>
<td>RT 15/06</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-11-1948</td>
<td>74</td>
<td>L</td>
<td>Pensiunan</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000106799927</td>
<td>131512020822Y000341</td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>109</td>
<td>24-08-2022</td>
<td>000756</td>
<td>A`LA WAHYU RAMADHAN</td>
<td>'3503040907090002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-05-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002253052888</td>
<td></td>
<td align='center'>
K00 </td>
<td align='center'>
Disorders of tooth development and eruption
</td>
</tr>

<td>110</td>
<td>24-08-2022</td>
<td>013811</td>
<td>HENDRI CANGGIH WICAKSONO</td>
<td>'</td>
<td>08/04</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-04-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>111</td>
<td>27-08-2022</td>
<td>013854</td>
<td>SUYATMI</td>
<td>'3503046704840001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-04-1984</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002746815636</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>112</td>
<td>29-08-2022</td>
<td>013886</td>
<td>FEBRI OKTA </td>
<td>'</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-10-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>113</td>
<td>30-08-2022</td>
<td>010252</td>
<td>ALDEBARAN NABHAN</td>
<td>'3503040907160002</td>
<td>DSN KRAJAN, RT : 002,RW :001 </td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-07-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002681678158</td>
<td>131512020822Y000531</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>114</td>
<td>31-08-2022</td>
<td>013981</td>
<td>AFRIZA AL ZAHRI</td>
<td>'3503043003100016</td>
<td>20/06</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-02-2017</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002228101266</td>
<td>131512020822Y000561</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>115</td>
<td>31-08-2022</td>
<td>013982</td>
<td>SUSANTI</td>
<td>'3503026107040002</td>
<td>RT 35/10</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-07-2004</td>
<td>18</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001707191223</td>
<td>131512020822Y000666</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>116</td>
<td>31-08-2022</td>
<td>013985</td>
<td>WIDI ASTUTIK</td>
<td>'3503045008990001</td>
<td>DUSUN NGLEBAN 24/04</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-08-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001975775321</td>
<td>131512020822Y000669</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>117</td>
<td>31-08-2022</td>
<td>012628</td>
<td>MUJIASRI</td>
<td>'3502126702820001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-02-1982</td>
<td>41</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001265685467</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>118</td>
<td>01-09-2022</td>
<td>008671</td>
<td>YENI FATMAWATI</td>
<td>'3503046404030003</td>
<td>RT 13/07</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-04-2003</td>
<td>19</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664688575</td>
<td>131512020922Y000158</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>119</td>
<td>01-09-2022</td>
<td>014011</td>
<td>ANDRIANA ANJU PUSPITA </td>
<td>'3503044108980003</td>
<td>MLOKO 22/05</td>
<td>SUMBERBENING</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-08-1998</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>120</td>
<td>02-09-2022</td>
<td>008348</td>
<td>MAMIK FITRIANI</td>
<td>'3503116501990002</td>
<td>RT 25/05</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-01-1999</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665339747</td>
<td>131512020922Y000003</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>121</td>
<td>02-09-2022</td>
<td>013854</td>
<td>SUYATMI</td>
<td>'3503046704840001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-04-1984</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0002746815636</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>122</td>
<td>02-09-2022</td>
<td>011233</td>
<td>SITI NUR IMROATUL KASANAH</td>
<td>'3503045306040002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-06-2004</td>
<td>18</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000663535394</td>
<td>131512020922Y000006</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>123</td>
<td>03-09-2022</td>
<td>012183</td>
<td>AHMAT SAEPULLOH</td>
<td>'3503042904020001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-04-2002</td>
<td>20</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664088545</td>
<td>131512020922Y000015</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>124</td>
<td>05-09-2022</td>
<td>014029</td>
<td>SITI KOMSIYAH</td>
<td>'3503046510830002</td>
<td>05/01</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-10-1983</td>
<td>39</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664963885</td>
<td>131512020922Y000208</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>125</td>
<td>05-09-2022</td>
<td>014036</td>
<td>SYIFA AMALYA AZZAHRO</td>
<td>'</td>
<td>RT 15/03</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-06-2008</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664821189</td>
<td>131512020922Y000027</td>
<td align='center'>
K07.3 </td>
<td align='center'>
Anomalies of tooth position </td>
</tr>

<td>126</td>
<td>05-09-2022</td>
<td>013981</td>
<td>AFRIZA AL ZAHRI</td>
<td>'3503043003100016</td>
<td>20/06</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-02-2017</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002228101266</td>
<td>131512020922Y000417</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>127</td>
<td>05-09-2022</td>
<td>014046</td>
<td>QORIATUL MAWLA SALSABILA</td>
<td>'3503046606160001</td>
<td>RT 26/13</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-06-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>128</td>
<td>05-09-2022</td>
<td>014048</td>
<td>MARWIYAH</td>
<td>'</td>
<td>15/06</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-11-1947</td>
<td>75</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>129</td>
<td>06-09-2022</td>
<td>008606</td>
<td>ARSYA HAFIZ AYDIN</td>
<td>'3503040707160003</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-07-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>130</td>
<td>07-09-2022</td>
<td>014063</td>
<td>BUDI</td>
<td>'</td>
<td>RT 08/04</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-05-1992</td>
<td>30</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K01.1 </td>
<td align='center'>
</tr>

<td>131</td>
<td>07-09-2022</td>
<td>003918</td>
<td>DEVI TRIANA</td>
<td>'3503044408980003</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-08-1998</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665484849</td>
<td>131512020922Y000061</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>132</td>
<td>07-09-2022</td>
<td>001250</td>
<td>GALANG ARDHY SUNGKONO</td>
<td>'3503040207140006</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-07-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>133</td>
<td>08-09-2022</td>
<td>007163</td>
<td>VINA ROHMATUL UMAH</td>
<td>'3503046812150001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-12-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>134</td>
<td>09-09-2022</td>
<td>000098</td>
<td>NURUL HIDAYAH</td>
<td>'3503044105930001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-05-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664311892</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>135</td>
<td>10-09-2022</td>
<td>014075</td>
<td>SULIS SETIANINGSIH</td>
<td>'3503045709970001</td>
<td>DUSUN BANAR, RT : 030,RW :006 </td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-09-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664887036</td>
<td>131512020922Y000123</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>136</td>
<td>12-09-2022</td>
<td>014082</td>
<td>MARYATIN</td>
<td>'3503044202920001</td>
<td>RT 50/18</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-01-1992</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665367748</td>
<td>131512020922Y000108</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>137</td>
<td>12-09-2022</td>
<td>009542</td>
<td>DHIKA SEPTA A</td>
<td>'</td>
<td>RT 35/19</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-09-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>138</td>
<td>13-09-2022</td>
<td>014082</td>
<td>MARYATIN</td>
<td>'3503044202920001</td>
<td>RT 50/18</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-01-1992</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665367748</td>
<td>131512020922Y000133</td>
<td align='center'>
K11.5 </td>
<td align='center'>
Sialolithiasis </td>
</tr>

<td>139</td>
<td>13-09-2022</td>
<td>001644</td>
<td>AQILA DIANATUL FAKHIROH</td>
<td>'</td>
<td>07/02</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-04-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802743425</td>
<td>131512020922Y000134</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>140</td>
<td>13-09-2022</td>
<td>004315</td>
<td>WINARTI</td>
<td>'3503044701930001</td>
<td>05/02</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-01-1993</td>
<td>30</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002054539629</td>
<td>131512020922Y000351</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>141</td>
<td>13-09-2022</td>
<td>012905</td>
<td>AVIKAYOGI HARATAMI</td>
<td>'3503046507130001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-07-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002776494453</td>
<td>131512020922Y000157</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>142</td>
<td>16-09-2022</td>
<td>014135</td>
<td>SATI</td>
<td>'3503045312650002</td>
<td>RT 13/03</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-12-1965</td>
<td>57</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001036890652</td>
<td>131512020922Y000350</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>143</td>
<td>17-09-2022</td>
<td>014139</td>
<td>DERIL A</td>
<td>'</td>
<td>RT 54/20</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-06-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>144</td>
<td>17-09-2022</td>
<td>013822</td>
<td>TULASRI</td>
<td>'3503046910820003</td>
<td>TALUN 49/18</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-10-1982</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0001975817272</td>
<td>131512020922Y000348</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>145</td>
<td>20-09-2022</td>
<td>010226</td>
<td>GITA NOVA KALISTA</td>
<td>'3503045411110001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-11-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002126138308</td>
<td>131512020922Y000345</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>
<td>146</td>
<td>20-09-2022</td>
<td>007215</td>
<td>MAZANA KAMILIA LAELA</td>
<td>'3503046601160001</td>
<td>RT 01/01</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-01-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002596087618</td>
<td>131512020922Y000347</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>147</td>
<td>21-09-2022</td>
<td>014203</td>
<td>ZIDHAN ARDIGA PRATAMA</td>
<td>'</td>
<td>54/10</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-11-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>148</td>
<td>23-09-2022</td>
<td>014235</td>
<td>MUHAMMAD RAKA DIKA</td>
<td>'</td>
<td>RT 19/07</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-08-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>149</td>
<td>23-09-2022</td>
<td>009816</td>
<td>ADHARA APRILIA PUTRI</td>
<td>'3503044104140002</td>
<td>DUSUN KLANDRI, RT : 042,RW :022 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-04-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0001917685923</td>
<td>131512020922Y000344</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>150</td>
<td>23-09-2022</td>
<td>010612</td>
<td>GIAN ADITYA ARDHANI</td>
<td>'3503041010150001</td>
<td>04/02</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>151</td>
<td>26-09-2022</td>
<td>014280</td>
<td>AIDA RISKY SAFA ASZAHARA</td>
<td>'</td>
<td>05/01</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-11-2006</td>
<td>16</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664964111</td>
<td>131512020922Y000341</td>
<td align='center'>
S02.5 </td>
<td align='center'>
</tr>

<td>152</td>
<td>26-09-2022</td>
<td>014283</td>
<td>MANO EFENDI</td>
<td>'3503040112090001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-12-2009</td>
<td>13</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002126138207</td>
<td>131512020922Y000447</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>153</td>
<td>26-09-2022</td>
<td>014284</td>
<td>TALITA DWI OKTA</td>
<td>'</td>
<td>RT 31/12</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-10-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>154</td>
<td>26-09-2022</td>
<td>014288</td>
<td>LAILA RAMADHANI</td>
<td>'3503044809100003</td>
<td>RT 44/12</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-09-2010</td>
<td>12</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002604602182</td>
<td>131512020922Y000342</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>155</td>
<td>27-09-2022</td>
<td>014305</td>
<td>ULFATUL QOIRIYAH</td>
<td>'3503044811890003</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-11-1989</td>
<td>33</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002681676101</td>
<td>131512020922Y000364</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>156</td>
<td>27-09-2022</td>
<td>013250</td>
<td>ALIFA SARIROTUL FALAH</td>
<td>'3503046502150001</td>
<td>NGLEBAN 15/03</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-02-2015</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802742918</td>
<td>131512020922Y000361</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>157</td>
<td>27-09-2022</td>
<td>013262</td>
<td>KASIM</td>
<td>'3503041501810006</td>
<td>RT. 12 RW. 04</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-01-1981</td>
<td>42</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002600764042</td>
<td>131512020922Y000362</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>158</td>
<td>27-09-2022</td>
<td>002238</td>
<td>NADHIFA ALMAIRA KINARIAN</td>
<td>'3503046309170001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-09-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002775138366</td>
<td>131512020922Y000357</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>159</td>
<td>27-09-2022</td>
<td>012001</td>
<td>WIDYASMOKO</td>
<td>'3503121704920001</td>
<td>RT 27/14</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-04-1992</td>
<td>30</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002261922006</td>
<td>131512020922Y000358</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>160</td>
<td>28-09-2022</td>
<td>010631</td>
<td>SUYATI</td>
<td>'3503044603980004</td>
<td>RT 25/05</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-03-1998</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664878609</td>
<td>131512020922Y000407</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>161</td>
<td>28-09-2022</td>
<td>012185</td>
<td>AHMAD FADIL</td>
<td>'3503042804150002</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-04-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002159510657</td>
<td>131512020922Y000409</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>162</td>
<td>28-09-2022</td>
<td>012001</td>
<td>WIDYASMOKO</td>
<td>'3503121704920001</td>
<td>RT 27/14</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-04-1992</td>
<td>30</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002261922006</td>
<td>131512020922Y000410</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>163</td>
<td>28-09-2022</td>
<td>014333</td>
<td>'3503041705160002</td>
<td>42/16</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003088524227</td>
<td>131512020922Y000412</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>164</td>
<td>29-09-2022</td>
<td>001488</td>
<td>WAHYU APRILIA PUTRI</td>
<td>'3503045804120002</td>
<td>10/04</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-04-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002600063559</td>
<td>131512020922Y000507</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>165</td>
<td>29-09-2022</td>
<td>000807</td>
<td>FATIMATUZZAHRO</td>
<td>'</td>
<td>WATUAGUNG 01/01</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-05-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>166</td>
<td>29-09-2022</td>
<td>014354</td>
<td>MELUINA ENGELIKA PATRISA</td>
<td>'</td>
<td>RT 10/04</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-09-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>167</td>
<td>30-09-2022</td>
<td>010226</td>
<td>GITA NOVA KALISTA</td>
<td>'3503045411110001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-11-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002126138308</td>
<td>131512020922Y000562</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>168</td>
<td>30-09-2022</td>
<td>013316</td>
<td>KAYLA ZAHRA FATMASARI</td>
<td>'</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-03-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>169</td>
<td>30-09-2022</td>
<td>014386</td>
<td>FAIZAL MUBAROK</td>
<td>'3503041511120002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-11-2012</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>170</td>
<td>30-09-2022</td>
<td>000569</td>
<td>MUJIARTO</td>
<td>'3503042912820001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-12-1982</td>
<td>40</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002435118344</td>
<td>131512020922Y000563</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>171</td>
<td>01-10-2022</td>
<td>004169</td>
<td>HARIYATI</td>
<td>'3503046602880001</td>
<td>RT 7 RW 4</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-02-1988</td>
<td>35</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664182314</td>
<td>131512021022Y000001</td>
<td align='center'>
K04.2 </td>
<td align='center'>
Pulp degeneration </td>
</tr>

<td>172</td>
<td>03-10-2022</td>
<td>014410</td>
<td>NURIL HABIBAH</td>
<td>'3503045310960003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-10-1996</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>173</td>
<td>03-10-2022</td>
<td>014411</td>
<td>ULFATUL ROSIDAH</td>
<td>'3503045207110002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-07-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBD)</td>
<td>'0000664555781</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>174</td>
<td>04-10-2022</td>
<td>014425</td>
<td>IMAM</td>
<td>'</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-12-1995</td>
<td>27</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>175</td>
<td>04-10-2022</td>
<td>014280</td>
<td>'</td>
<td>05/01</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-11-2006</td>
<td>16</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664964111</td>
<td>131512021022Y000122</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>176</td>
<td>04-10-2022</td>
<td>014427</td>
<td>JUMIATIN</td>
<td>'3503045101910001</td>
<td>NGLARAN 25/13</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-01-1991</td>
<td>32</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664393307</td>
<td>131512021022Y000027</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>177</td>
<td>04-10-2022</td>
<td>002824</td>
<td>KARINAH</td>
<td>'</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-04-1945</td>
<td>77</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664861307</td>
<td>131512021022Y000587</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>178</td>
<td>05-10-2022</td>
<td>003710</td>
<td>ELISA NADAKOTUL MUNAWAROH</td>
<td>'3503046006090003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-05-2009</td>
<td>13</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001975795378</td>
<td>131512021022Y000123</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>179</td>
<td>05-10-2022</td>
<td>014439</td>
<td>RISKIANING FEBRIANTI</td>
<td>'</td>
<td>06/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-02-2011</td>
<td>12</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>180</td>
<td>05-10-2022</td>
<td>014440</td>
<td>DINA KHOLISATUN</td>
<td>'</td>
<td>21/11</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-03-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>181</td>
<td>05-10-2022</td>
<td>000569</td>
<td>MUJIARTO</td>
<td>'3503042912820001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-12-1982</td>
<td>40</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002435118344</td>
<td>131512021022Y000124</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>182</td>
<td>05-10-2022</td>
<td>013165</td>
<td>SITI ROMLAH</td>
<td>'3503044112840001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-12-1984</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663601421</td>
<td>131512021022Y000711</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>183</td>
<td>06-10-2022</td>
<td>014447</td>
<td>LUTFI ATUNNA </td>
<td>'6207046803030001</td>
<td>17/09</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-03-2003</td>
<td>19</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>184</td>
<td>07-10-2022</td>
<td>014477</td>
<td>DEWI ALFIATUS ZAHRA</td>
<td>'3503045401160003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-05-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011257348</td>
<td>131512021022Y000049</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>185</td>
<td>07-10-2022</td>
<td>012691</td>
<td>SITI KUFABATUL UMA</td>
<td>'3503044305010003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-05-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>
<td>186</td>
<td>07-10-2022</td>
<td>010597</td>
<td>GITA MAFIA</td>
<td>'3503046309000001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-09-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665052311</td>
<td>131512021022Y000712</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>187</td>
<td>07-10-2022</td>
<td>009470</td>
<td>MULIK ABIDAH</td>
<td>'3503046002010002</td>
<td>DSN.BONSARI, RT : 043,RW :016 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-02-2001</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665731293</td>
<td>131512021022Y000713</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>188</td>
<td>07-10-2022</td>
<td>000715</td>
<td>SITI MAHMUDAH</td>
<td>'3503045701820005</td>
<td>DSN. KARANGSUDO, RT : 045,RW :001 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-01-1982</td>
<td>41</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664440851</td>
<td>131512021022Y000107</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>189</td>
<td>10-10-2022</td>
<td>014489</td>
<td>DAFFA ZAINUL ARIFIN</td>
<td>'3503041207160001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-07-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012955391</td>
<td>131512021022Y000053</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>190</td>
<td>10-10-2022</td>
<td>014500</td>
<td>ASMAUL HANIF ASYURA</td>
<td>'3503040510160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-10-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>191</td>
<td>10-10-2022</td>
<td>000844</td>
<td>DIAN PRATAMA</td>
<td>'3503046907040003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-07-2004</td>
<td>18</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>192</td>
<td>11-10-2022</td>
<td>014280</td>
<td>'</td>
<td>05/01</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-11-2006</td>
<td>16</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664964111</td>
<td>131512021022Y000057</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>193</td>
<td>11-10-2022</td>
<td>012596</td>
<td>ZIDAN ARDIGA PRATAMA</td>
<td>'</td>
<td>54/20</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-11-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>194</td>
<td>11-10-2022</td>
<td>006608</td>
<td>NIILA MANNAT URROHMAH</td>
<td>'3503046803140002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-03-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0002598927614</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>195</td>
<td>12-10-2022</td>
<td>014439</td>
<td>RISKIANING FEBRIANTI</td>
<td>'</td>
<td>06/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-02-2011</td>
<td>12</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>196</td>
<td>12-10-2022</td>
<td>014516</td>
<td>AGVI FANAN RAMADHAN</td>
<td>'3503041105190001</td>
<td>DUSUN JOGADI 08/03</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-05-2019</td>
<td>3</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>197</td>
<td>13-10-2022</td>
<td>003710</td>
<td>ELISA NADAKOTUL MUNAWAROH</td>
<td>'3503046006090003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-05-2009</td>
<td>13</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001975795378</td>
<td>131512021022Y000141</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>198</td>
<td>14-10-2022</td>
<td>012848</td>
<td>BONARI</td>
<td>'3503043010540002</td>
<td>RT 17 RW 9 DESA CAKUL KECAMATAN DONGKO</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-10-1954</td>
<td>68</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663409372</td>
<td>131512021022Y000547</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>199</td>
<td>15-10-2022</td>
<td>000768</td>
<td>RESTI DIKA RAMADHANI</td>
<td>' </td>
<td>DUSUN JOGADI RT 02 RW 01 DES. PANDEAN KEL.PANDEAN KEC.DONGKO
KAB.TRENGGALEK, RT : 002,RW :001 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-09-2007</td>
<td>15</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663728343</td>
<td>131512021022Y000165</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>200</td>
<td>17-10-2022</td>
<td>013795</td>
<td>RAHMA AULIYA</td>
<td>'3503044511080002</td>
<td>RT. 52,RW.19, PANDEAN</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-11-2008</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663726813</td>
<td>131512021022Y000164</td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>201</td>
<td>17-10-2022</td>
<td>014560</td>
<td>ANDIKA</td>
<td>'</td>
<td>RT 09/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-05-2004</td>
<td>18</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.2 </td>
<td align='center'>
Caries of cementum </td>
</tr>

<td>202</td>
<td>17-10-2022</td>
<td>014564</td>
<td>ANANG ZAINUL USMA DANA</td>
<td>'</td>
<td>RT 01/01</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-10-2012</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>203</td>
<td>17-10-2022</td>
<td>014565</td>
<td>NIAM HAFIDZ UBAIDILLAH</td>
<td>'3503040503160002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-03-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>204</td>
<td>18-10-2022</td>
<td>009910</td>
<td>DHEVA ZAHRA R.</td>
<td>'3503045510150001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-10-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>
<td>205</td>
<td>18-10-2022</td>
<td>014560</td>
<td>ANDIKA</td>
<td>'</td>
<td>RT 09/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-05-2004</td>
<td>18</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>206</td>
<td>19-10-2022</td>
<td>013551</td>
<td>SAMINGAN</td>
<td>'3503041006870002</td>
<td>RT 47 RW 24 DUSUN NGASINAN</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-06-1987</td>
<td>35</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002734747007</td>
<td>131512021022Y000203</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>207</td>
<td>19-10-2022</td>
<td>012971</td>
<td>FELIX KURNIANTO</td>
<td>'3503042405060001</td>
<td>DUSUN KRAJAN17, RT : 017,RW :006 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-05-2006</td>
<td>16</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002288719124</td>
<td>131512021022Y000211</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>208</td>
<td>19-10-2022</td>
<td>014579</td>
<td>DAFFA MAHARDIKA PRATAMA</td>
<td>'3503041304150002</td>
<td>DUSUN JURON 35/18</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-04-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002598801827</td>
<td>131512021022Y000207</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>209</td>
<td>19-10-2022</td>
<td>014583</td>
<td>SUMARMIATI</td>
<td>'3503064311690001</td>
<td>SUMBER</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>03-11-1969</td>
<td>53</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106591239</td>
<td>131512021022Y000210</td>
<td align='center'>
K12 </td>
<td align='center'>
Stomatitis and related lesions </td>
</tr>

<td>210</td>
<td>20-10-2022</td>
<td>014489</td>
<td>DAFFA ZAINUL ARIFIN</td>
<td>'3503041207160001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-07-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012955391</td>
<td>131512021022Y000227</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>211</td>
<td>20-10-2022</td>
<td>002693</td>
<td>SUNNI LATIFATUL AZIZAH</td>
<td>'3503046308930001</td>
<td>RT 12 RW 04 DESA GAYAM KEC PANGGUL KAB TRENGGALEK, RT : 12,RW :4
</td>
<td>GAYAM</td>
<td>PANGGUL</td>
<td>TRENGGALEK</td>
<td>23-08-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002250640743</td>
<td>131512021022Y000579</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>212</td>
<td>20-10-2022</td>
<td>013317</td>
<td>SITI MUALIPAH</td>
<td>'3503046104910004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-04-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665237935</td>
<td>131512021022Y000578</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>213</td>
<td>20-10-2022</td>
<td>014592</td>
<td>INTAN DEWI R</td>
<td>'</td>
<td>20/10</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-05-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>214</td>
<td>20-10-2022</td>
<td>014593</td>
<td>ELVA MEFIANA</td>
<td>'3503045112000001</td>
<td>DUSUN NGLARAN 12/23</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-12-2000</td>
<td>22</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664675953</td>
<td>131512021022Y000231</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>215</td>
<td>20-10-2022</td>
<td>014594</td>
<td>AHMAD SAHRI</td>
<td>'</td>
<td>19/10</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-01-1998</td>
<td>25</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>216</td>
<td>20-10-2022</td>
<td>013280</td>
<td>'3503045705150002</td>
<td>33/13</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>217</td>
<td>20-10-2022</td>
<td>012050</td>
<td>'3503042009160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002086479033</td>
<td>131512021022Y000236</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>218</td>
<td>21-10-2022</td>
<td>014622</td>
<td>M.IKMAL ZAMZAMI</td>
<td>'3503040209150001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-09-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002440357446</td>
<td>131512021022Y000260</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>219</td>
<td>21-10-2022</td>
<td>002672</td>
<td>DWI SUDARWININGSIH</td>
<td>'3503115306850001</td>
<td>DUSUN KRAJAN RT05 RW02 REJOWINANGUN, RT : 5,RW :2 </td>
<td>REJOWINANGUN</td>
<td>TRENGGALEK</td>
<td>TRENGGALEK</td>
<td>13-06-1985</td>
<td>37</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI PEMERINTAH DENGAN PERJANJIAN KERJA</td>
<td>'0001307386866</td>
<td>131512021022Y000261</td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>220</td>
<td>21-10-2022</td>
<td>014625</td>
<td>AQILA FELICYA PUTRI</td>
<td>'3503045704160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-04-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>221</td>
<td>21-10-2022</td>
<td>012534</td>
<td>MUALIMAH</td>
<td>'3506235208830004</td>
<td>DUSUN JAJAR 22/07</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-08-1983</td>
<td>39</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>222</td>
<td>21-10-2022</td>
<td>012754</td>
<td>AL AZAM</td>
<td>'</td>
<td>RT 12 RW 4</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-06-2019</td>
<td>3</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>223</td>
<td>22-10-2022</td>
<td>012222</td>
<td>MUHAMMAD ALHAFIDHUSSOLIH</td>
<td>'3503043004160002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-04-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>
<td>224</td>
<td>24-10-2022</td>
<td>012082</td>
<td>DEVI ASTARI</td>
<td>'3503044208020001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-08-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>225</td>
<td>24-10-2022</td>
<td>003140</td>
<td>RENI SRI ASTUTI</td>
<td>'3503044703910004</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-03-1991</td>
<td>32</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011255379</td>
<td>131512021022Y000702</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>226</td>
<td>24-10-2022</td>
<td>014655</td>
<td>AINUN FAUZIAH</td>
<td>'3503041210010002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-10-2001</td>
<td>21</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0000664566423</td>
<td></td>
<td align='center'>
K04.5 </td>
<td align='center'>
Chronic apical periodontitis </td>
</tr>

<td>227</td>
<td>24-10-2022</td>
<td>012359</td>
<td>KOIRIYAH</td>
<td>'3503045706880004</td>
<td>DUSUN KRAJAN RT 09 RW 03</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-06-1988</td>
<td>34</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002842485243</td>
<td>131512021022Y000703</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>228</td>
<td>24-10-2022</td>
<td>009875</td>
<td>HAMIM NURAZIZAH</td>
<td>'3503045109010002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-09-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001975730477</td>
<td>131512021022Y000704</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>229</td>
<td>24-10-2022</td>
<td>003465</td>
<td>YUNI RAHMAWATI</td>
<td>'</td>
<td>RT 13/03</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-06-1981</td>
<td>41</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106632832</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>230</td>
<td>24-10-2022</td>
<td>012361</td>
<td>ROHMAN</td>
<td>'3503041206670001</td>
<td>DUSUN KORI, RT : 041,RW :012 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-06-1967</td>
<td>55</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663734687</td>
<td>131512021022Y000294</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>231</td>
<td>24-10-2022</td>
<td>014670</td>
<td>RAYA PUTRI ANJANI</td>
<td>'</td>
<td>RT 08/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-07-2018</td>
<td>4</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>232</td>
<td>24-10-2022</td>
<td>014673</td>
<td>NIZAM NAUFAL RAFASSYA</td>
<td>'</td>
<td>RT 14/07</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>233</td>
<td>25-10-2022</td>
<td>008077</td>
<td>AINUN NAZAROH</td>
<td>'3503047012010002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-12-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665031396</td>
<td>131512021022Y000705</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>234</td>
<td>25-10-2022</td>
<td>008428</td>
<td>OZHIL APRILLIO CAHYO</td>
<td>'3503041904140001</td>
<td>RT 54/20</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-04-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002137628665</td>
<td>131512021022Y000322</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>235</td>
<td>25-10-2022</td>
<td>013100</td>
<td>WARSIH</td>
<td>'3504014304840004</td>
<td>38/15</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-04-1984</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002014019368</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>236</td>
<td>26-10-2022</td>
<td>013771</td>
<td>DILA TRIA UTAMI</td>
<td>'3503045212110001</td>
<td>NGLANGON 16/08</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-12-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002462513174</td>
<td>131512021022Y000334</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>237</td>
<td>26-10-2022</td>
<td>010763</td>
<td>DEWI KUSUMA WARDANI</td>
<td>'3503044705000001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-05-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664746658</td>
<td>131512021022Y000575</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>238</td>
<td>26-10-2022</td>
<td>009899</td>
<td>SITI SAROPAH</td>
<td>'3503046210000001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-10-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802742683</td>
<td>131512021022Y000576</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>239</td>
<td>26-10-2022</td>
<td>013724</td>
<td>'3503040611480001</td>
<td>RT 15/06</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-11-1948</td>
<td>74</td>
<td>L</td>
<td>Pensiunan</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000106799927</td>
<td>131512021022Y000348</td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>240</td>
<td>27-10-2022</td>
<td>011916</td>
<td>ALFIATUS </td>
<td>'</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-04-1996</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664844027</td>
<td>131512021022Y000706</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>241</td>
<td>27-10-2022</td>
<td>008530</td>
<td>EVA SEPTIANA</td>
<td>'3503044609960003</td>
<td>RT 06/02</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-09-1996</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665021889</td>
<td>131512021022Y000707</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>242</td>
<td>27-10-2022</td>
<td>014734</td>
<td>NANDA FITRIANI</td>
<td>'3503015612010001</td>
<td>DUSUN PLAPAR 09/05</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-12-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663480639</td>
<td>131512021022Y000708</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>
<td>243</td>
<td>27-10-2022</td>
<td>000756</td>
<td>A`LA WAHYU RAMADHAN</td>
<td>'3503040907090002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-05-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0002253052888</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>244</td>
<td>27-10-2022</td>
<td>014738</td>
<td>RIBUT ANGGRIAWAN</td>
<td>'3503040406970001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-04-1997</td>
<td>25</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665015398</td>
<td>131512021022Y000692</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>245</td>
<td>27-10-2022</td>
<td>008300</td>
<td>SAFIRA AULIA PUTRI</td>
<td>'3503046106170001</td>
<td>RT08RW02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-06-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002734748842</td>
<td>131512021022Y000431</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>246</td>
<td>28-10-2022</td>
<td>003676</td>
<td>UMI ZAHROÌN</td>
<td>'3503044211000004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-11-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664740011</td>
<td>131512021022Y000474</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>247</td>
<td>29-10-2022</td>
<td>014075</td>
<td>SULIS SETIANINGSIH</td>
<td>'3503045709970001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-09-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664887036</td>
<td>131512021022Y000599</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>248</td>
<td>29-10-2022</td>
<td>014790</td>
<td>SUMARNI</td>
<td>'3503043112720030</td>
<td>DUSUN NGULUH, RT : 40,RW :9 </td>
<td>SIKI</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-12-1972</td>
<td>50</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664280278</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>249</td>
<td>31-10-2022</td>
<td>014840</td>
<td>MUHAMMAD FIKRI AL FARISI</td>
<td>'3503041505160001</td>
<td>RT 31/12</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-05-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012950351</td>
<td>131512021022Y000543</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>250</td>
<td>31-10-2022</td>
<td>014839</td>
<td>NUR ROHMI</td>
<td>'3503046706930002</td>
<td>RT 14/05</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-06-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002014035704</td>
<td>131512021022Y000833</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>251</td>
<td>31-10-2022</td>
<td>009393</td>
<td>SUWATI</td>
<td>'3503046802000003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-02-2000</td>
<td>23</td>
<td>P</td>
<td>WIRASWASTA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>252</td>
<td>31-10-2022</td>
<td>014850</td>
<td>KEVIN ERLANGGA</td>
<td>'3503042002130002</td>
<td>RT 42/21</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-02-2013</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002729550958</td>
<td>131512021022Y000544</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>253</td>
<td>31-10-2022</td>
<td>004583</td>
<td>ARIK SAFITRI</td>
<td>'3503044406900003-180298</td>
<td>DSN.KRAJAN, RT : 016,RW :006 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-06-1990</td>
<td>32</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002734748267</td>
<td>131512021022Y000834</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>254</td>
<td>01-11-2022</td>
<td>013053</td>
<td>RAFA DANU ADITYA</td>
<td>'</td>
<td>44/22 CAKUL DONGKO</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-05-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002041737287</td>
<td>131512021122Y000001</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>255</td>
<td>01-11-2022</td>
<td>001066</td>
<td>LILIK INDARYATI</td>
<td>'3503044204940001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-04-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000664717184</td>
<td>131512021122Y000071</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>256</td>
<td>01-11-2022</td>
<td>008300</td>
<td>SAFIRA AULIA PUTRI</td>
<td>'3503046106170001</td>
<td>RT08RW02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-06-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002734748842</td>
<td>131512021122Y000008</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>257</td>
<td>02-11-2022</td>
<td>014902</td>
<td>HASBINA RAHMA FERDIA</td>
<td>'3503045602160001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-02-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003056721603</td>
<td>131512021122Y000010</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>258</td>
<td>02-11-2022</td>
<td>014903</td>
<td>AQILA SETEFANI</td>
<td>'</td>
<td>06/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-01-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>259</td>
<td>02-11-2022</td>
<td>001123</td>
<td>ELIZA FANIA DEA ANANDA</td>
<td>'3503044205140001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-05-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>260</td>
<td>03-11-2022</td>
<td>014917</td>
<td>LIONEL CLIFOD MAULANA</td>
<td>'3503041703180003</td>
<td>RT 08/03</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-03-2018</td>
<td>4</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002440571231</td>
<td>131512021122Y000012</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>261</td>
<td>03-11-2022</td>
<td>000269</td>
<td>WINARSIH</td>
<td>'3522275309890001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-09-1989</td>
<td>33</td>
<td>P</td>
<td>BURUH HARIAN LEPAS</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000745841788</td>
<td>131512021122Y000013</td>
<td align='center'>
K01.1 </td>
<td align='center'>
</tr>
<td>262</td>
<td>03-11-2022</td>
<td>014920</td>
<td>MUHAMMAD AZIDAN NAUFAL RAMADANI</td>
<td>'</td>
<td>RT 24/04</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-06-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>263</td>
<td>03-11-2022</td>
<td>003038</td>
<td>FAHRINA</td>
<td>'3503044709820001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-09-1982</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001294524325</td>
<td>131512021122Y000049</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>264</td>
<td>03-11-2022</td>
<td>005116</td>
<td>RINA</td>
<td>'3503046207020001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-07-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664546904</td>
<td>131512021122Y000072</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>265</td>
<td>03-11-2022</td>
<td>014922</td>
<td>MUHAMMAD RAFAEL ARIFIN</td>
<td>'</td>
<td>RT 27/09</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-08-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>266</td>
<td>03-11-2022</td>
<td>012050</td>
<td>'3503042009160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002086479033</td>
<td>131512021122Y000052</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>267</td>
<td>03-11-2022</td>
<td>006608</td>
<td>NIILA MANNAT URROHMAH</td>
<td>'3503046803140002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-03-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002598927614</td>
<td>131512021122Y000051</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>268</td>
<td>03-11-2022</td>
<td>000360</td>
<td>ALBY LUTHFY FACHRY</td>
<td>'3503042702150001</td>
<td>DSN.KRAJAN, RT : 020,RW :008 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-05-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002860461213</td>
<td>131512021122Y000050</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>269</td>
<td>04-11-2022</td>
<td>014930</td>
<td>JUMINI</td>
<td>' </td>
<td>DUSUN MBELANG RT 031 RW 010 DESA SALAMWATES, RT : 031,RW :010 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-01-1975</td>
<td>48</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663859888</td>
<td>131512021122Y000053</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>270</td>
<td>04-11-2022</td>
<td>005973</td>
<td>SAMINI</td>
<td>'3503045107010004</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-07-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663663328</td>
<td>131512021122Y000075</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>271</td>
<td>04-11-2022</td>
<td>014353</td>
<td>'3503044709000001</td>
<td>20/06</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-09-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000666114963</td>
<td>131512021122Y000074</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>272</td>
<td>04-11-2022</td>
<td>012050</td>
<td>'3503042009160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002086479033</td>
<td>131512021122Y000060</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>273</td>
<td>04-11-2022</td>
<td>002824</td>
<td>KARINAH</td>
<td>'</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-04-1945</td>
<td>77</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664861307</td>
<td>131512021122Y000073</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>274</td>
<td>05-11-2022</td>
<td>001003</td>
<td>KOMSIYAH</td>
<td>'3503045001890002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-11-1989</td>
<td>33</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664958891</td>
<td>131512021122Y000077</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>275</td>
<td>05-11-2022</td>
<td>002672</td>
<td>DWI SUDARWININGSIH</td>
<td>'3503115306850001</td>
<td>DUSUN KRAJAN RT05 RW02 REJOWINANGUN, RT : 5,RW :2 </td>
<td>REJOWINANGUN</td>
<td>TRENGGALEK</td>
<td>TRENGGALEK</td>
<td>13-06-1985</td>
<td>37</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001307386866</td>
<td>131512021122Y000076</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>276</td>
<td>05-11-2022</td>
<td>014945</td>
<td>WIWIN SRI ASTUTI</td>
<td>'3503044205990001</td>
<td>RT 27/06</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-05-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>277</td>
<td>07-11-2022</td>
<td>014840</td>
<td>MUHAMMAD FIKRI AL FARISI</td>
<td>'3503041505160001</td>
<td>RT 31/12</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-05-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012950351</td>
<td>131512021122Y000095</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>278</td>
<td>07-11-2022</td>
<td>014955</td>
<td>LU`LUUL JANNAH</td>
<td>'3503046408970002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-08-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664645083</td>
<td>131512021122Y000096</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>279</td>
<td>07-11-2022</td>
<td>014957</td>
<td>FAJRIN UMAYATUL</td>
<td>'3503044612990003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-02-1999</td>
<td>24</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>280</td>
<td>07-11-2022</td>
<td>014958</td>
<td>TOIDJEM</td>
<td>'</td>
<td>NGRENCAK</td>
<td>NGRENCAK</td>
<td>PANGGUL</td>
<td>TRENGGALEK</td>
<td>07-11-1942</td>
<td>80</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>281</td>
<td>07-11-2022</td>
<td>014960</td>
<td>SITI AMINAH</td>
<td>'3503044910940004</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-10-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665194454</td>
<td>131512021122Y000094</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>282</td>
<td>07-11-2022</td>
<td>014965</td>
<td>RAZIQ HANAN</td>
<td>'</td>
<td>RT 41/21</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-10-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>283</td>
<td>08-11-2022</td>
<td>014967</td>
<td>SUNARMI</td>
<td>'3503046008930004</td>
<td>RT 25/05</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-02-1993</td>
<td>30</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664733619</td>
<td>131512021122Y000098</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>284</td>
<td>08-11-2022</td>
<td>003038</td>
<td>FAHRINA</td>
<td>'3503044709820001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-09-1982</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001294524325</td>
<td>131512021122Y000097</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>285</td>
<td>08-11-2022</td>
<td>010469</td>
<td>ANIS FITRIANI</td>
<td>'3503044701000001</td>
<td>BANAR, RT : 026,RW :006 </td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-01-2000</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0003075973536</td>
<td>131512021122Y000100</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>286</td>
<td>08-11-2022</td>
<td>014969</td>
<td>ANDIK ANTONI</td>
<td>'3503040910870001</td>
<td>RT 37/19</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-10-1987</td>
<td>35</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>287</td>
<td>08-11-2022</td>
<td>014085</td>
<td>LASMINI</td>
<td>'3503044207800001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-07-1980</td>
<td>42</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665375038</td>
<td>131512021122Y000101</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>288</td>
<td>09-11-2022</td>
<td>000157</td>
<td>DAFFA NUHA RAMADHAN</td>
<td>'</td>
<td>CAKUL11/06</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-06-2018</td>
<td>4</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>289</td>
<td>09-11-2022</td>
<td>001936</td>
<td>LUKI MARLANDO</td>
<td>'3503040101170001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-01-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002212835321</td>
<td>131512021122Y000103</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>290</td>
<td>09-11-2022</td>
<td>014979</td>
<td>AHMAD FAUZI</td>
<td>'</td>
<td>RT 21/11</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>291</td>
<td>11-11-2022</td>
<td>003238</td>
<td>MICHEL CANTIKA PUTRI</td>
<td>'3503045001130001</td>
<td>RT 06/02</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-01-2013</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002433923796</td>
<td>131512021122Y000160</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>292</td>
<td>11-11-2022</td>
<td>011812</td>
<td>'3503045401160001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-01-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802742064</td>
<td>131512021122Y000161</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>293</td>
<td>11-11-2022</td>
<td>007001</td>
<td>ALVARO ANDRES MORATA</td>
<td>'3503041108160001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-08-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>294</td>
<td>11-11-2022</td>
<td>001271</td>
<td>JEMIRIN</td>
<td>'3503041205710001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-05-1971</td>
<td>51</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664781444</td>
<td>131512021122Y000169</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>295</td>
<td>12-11-2022</td>
<td>009134</td>
<td>DIYEM</td>
<td>'3503044405590001</td>
<td>DUSUN KRAJAN RT 011 RW 004 DESA SALAMWATES, RT : 011,RW :004 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-05-1959</td>
<td>63</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665179132</td>
<td>131512021122Y000157</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>296</td>
<td>12-11-2022</td>
<td>014999</td>
<td>FHAREL YOGI PRATAMA</td>
<td>'3503043011150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-11-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003142878737</td>
<td>131512021122Y000158</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>297</td>
<td>14-11-2022</td>
<td>003038</td>
<td>FAHRINA</td>
<td>'3503044709820001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-09-1982</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001294524325</td>
<td>131512021122Y000164</td>
<td align='center'>
K02 </td>
<td align='center'>
</tr>

<td>298</td>
<td>14-11-2022</td>
<td>015018</td>
<td>JUMILAH</td>
<td>'350304510890001</td>
<td>37/11</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-06-1989</td>
<td>33</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001706980869</td>
<td>131512021122Y000165</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>299</td>
<td>14-11-2022</td>
<td>015024</td>
<td>HEMI ALFAIZ ASYRAF</td>
<td>'</td>
<td>48/18</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-11-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>300</td>
<td>14-11-2022</td>
<td>004143</td>
<td>NURHAYATI</td>
<td>'3503046003890007</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-03-1989</td>
<td>33</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664517092</td>
<td>131512021122Y000255</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>301</td>
<td>14-11-2022</td>
<td>008000</td>
<td>TSANIA TUHFATUS SALMA</td>
<td>'3503046305130001</td>
<td>RT 11/04</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-05-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>
<td>302</td>
<td>14-11-2022</td>
<td>015030</td>
<td>SAMINGUN</td>
<td>'3503041004700001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-04-1970</td>
<td>52</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000665194015</td>
<td></td>
<td align='center'>
S02.5 </td>
<td align='center'>
</tr>

<td>303</td>
<td>14-11-2022</td>
<td>015029</td>
<td>SITI NURKALIMAH</td>
<td>'3503134606850003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-06-1985</td>
<td>37</td>
<td>P</td>
<td>Buruh Harian Lepas</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0003173745655</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>304</td>
<td>15-11-2022</td>
<td>003234</td>
<td>REHAN RAHMA S</td>
<td>'</td>
<td>RT 34/10</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-07-2013</td>
<td>9</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>305</td>
<td>15-11-2022</td>
<td>004169</td>
<td>HARIYATI</td>
<td>'3503046602880001</td>
<td>RT 7 RW 4</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-02-1988</td>
<td>35</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664182314</td>
<td>131512021122Y000200</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>306</td>
<td>15-11-2022</td>
<td>005264</td>
<td>OSKAR DISTI PUTRA</td>
<td>'3503110303890003</td>
<td>RT 01/04</td>
<td>GENTONG</td>
<td>PARON</td>
<td>NGAWI</td>
<td>03-03-1989</td>
<td>34</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002036983882</td>
<td>131512021122Y000201</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>307</td>
<td>15-11-2022</td>
<td>008499</td>
<td>EKY MULYANTI</td>
<td>'3503044105990002</td>
<td>DUSUN NGASINAN, RT : 030,RW :015 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-05-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0000665082281</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>308</td>
<td>15-11-2022</td>
<td>015040</td>
<td>TOIJEM</td>
<td>'3503017112470004</td>
<td>RT 22/09</td>
<td>NGRENCAK</td>
<td>PANGGUL</td>
<td>TRENGGALEK</td>
<td>31-12-1947</td>
<td>75</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002642796731</td>
<td>131512021122Y000612</td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>309</td>
<td>16-11-2022</td>
<td>014839</td>
<td>NUR ROHMI</td>
<td>'3503046706930002</td>
<td>RT 14/05</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-06-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002014035704</td>
<td>131512021122Y000599</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>310</td>
<td>16-11-2022</td>
<td>010250</td>
<td>VIYA CANTIKA PUTRI</td>
<td>'3503044308030001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-08-2003</td>
<td>19</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664914104</td>
<td>131512021122Y000600</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>311</td>
<td>16-11-2022</td>
<td>015061</td>
<td>NASRUL WAFA</td>
<td>'3503042504110005</td>
<td>RT 36/14</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-04-2011</td>
<td>11</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012953771</td>
<td>131512021122Y000203</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>312</td>
<td>16-11-2022</td>
<td>015065</td>
<td>NIZAM RAVA</td>
<td>'</td>
<td>RT 23/12</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>313</td>
<td>18-11-2022</td>
<td>015084</td>
<td>UMASIYAH</td>
<td>'3503046001830006</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-01-1983</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664406346</td>
<td>131512021122Y000598</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>314</td>
<td>21-11-2022</td>
<td>012430</td>
<td>LAILATUL ROHMAH</td>
<td>'3503045505990001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-05-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002014120563</td>
<td>131512021122Y000378</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>315</td>
<td>21-11-2022</td>
<td>012532</td>
<td>MIFTAKHUL KHOIRIYAH</td>
<td>'3503044210910002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-10-1991</td>
<td>31</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>316</td>
<td>21-11-2022</td>
<td>003038</td>
<td>FAHRINA</td>
<td>'3503044709820001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-09-1982</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001294524325</td>
<td>131512021122Y000261</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>317</td>
<td>21-11-2022</td>
<td>014159</td>
<td>MUJIATIN</td>
<td>'3503045203880002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-03-1988</td>
<td>34</td>
<td>P</td>
<td>LAINNYA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664177948</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>318</td>
<td>21-11-2022</td>
<td>012779</td>
<td>NUR ASIYAH</td>
<td>'3503044809910005</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-09-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003142877736</td>
<td>131512021122Y000380</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>319</td>
<td>21-11-2022</td>
<td>015134</td>
<td>FIKI MESI EVAWATI</td>
<td>'3503046608000002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-08-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664506731</td>
<td>131512021122Y000379</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>320</td>
<td>21-11-2022</td>
<td>009992</td>
<td>YENI SUSANTI</td>
<td>'3503045609870004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-09-1987</td>
<td>35</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0003137383708</td>
<td>131512021122Y000381</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>
<td>321</td>
<td>21-11-2022</td>
<td>001982</td>
<td>INEZ CAHYA NINGTYAS</td>
<td>'3503044702150001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-02-2015</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002600117379</td>
<td>131512021122Y000258</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>322</td>
<td>21-11-2022</td>
<td>000901</td>
<td>M ARKHANA ABDELLA MIRZA</td>
<td>'</td>
<td>DESA WATUAGUNG</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002087571622</td>
<td>131512021122Y000259</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>323</td>
<td>21-11-2022</td>
<td>015030</td>
<td>SAMINGUN</td>
<td>'3503041004700001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-04-1970</td>
<td>52</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000665194015</td>
<td></td>
<td align='center'>
S02.5 </td>
<td align='center'>
</tr>

<td>324</td>
<td>21-11-2022</td>
<td>012201</td>
<td>FADLI SHOLIKHIN</td>
<td>'3503042202170002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-02-2017</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002227219672</td>
<td>131512021122Y000260</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>325</td>
<td>22-11-2022</td>
<td>015155</td>
<td>TUTIK ANDAYANI</td>
<td>'6473014805830005</td>
<td>JL. JEND. SUDIRMAN 16/00</td>
<td>KARANG BALIK</td>
<td>TARAKAN BARAT</td>
<td>KOTA TARAKAN</td>
<td>08-05-1983</td>
<td>39</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0001388132234</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>326</td>
<td>22-11-2022</td>
<td>013680</td>
<td>MAISAROH</td>
<td>'3503044608940001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-08-1994</td>
<td>28</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664990356</td>
<td>131512021122Y000596</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>327</td>
<td>22-11-2022</td>
<td>004169</td>
<td>HARIYATI</td>
<td>'3503046602880001</td>
<td>RT 7 RW 4</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-02-1988</td>
<td>35</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664182314</td>
<td>131512021122Y000597</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>328</td>
<td>23-11-2022</td>
<td>015170</td>
<td>ERIK EFENDI</td>
<td>'3503040408970001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-08-1997</td>
<td>25</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664580406</td>
<td>131512021122Y000330</td>
<td align='center'>
C08.0 </td>
<td align='center'>
Malignant neoplasm of submandibular gland
</td>
</tr>

<td>329</td>
<td>23-11-2022</td>
<td>012453</td>
<td>ANGGA HAYUWANSYAH</td>
<td>'3503040612140001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-12-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002505674733</td>
<td>131512021122Y000595</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>330</td>
<td>24-11-2022</td>
<td>015179</td>
<td>MUHAMMAD HARUN AR-RASYID</td>
<td>'350304081260002</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-12-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002520043356</td>
<td>131512021122Y000329</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>331</td>
<td>24-11-2022</td>
<td>015185</td>
<td>SOIKEM</td>
<td>'</td>
<td>RT 41/21</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-12-1953</td>
<td>69</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011604197</td>
<td>131512021122Y000332</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>332</td>
<td>24-11-2022</td>
<td>015202</td>
<td>RUSTINI</td>
<td>'3503044605620004</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-05-1962</td>
<td>60</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>333</td>
<td>25-11-2022</td>
<td>015204</td>
<td>AINI</td>
<td>'3503044712840003</td>
<td>15/03</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-12-1984</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0001975791183</td>
<td>131512021122Y000916</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>334</td>
<td>25-11-2022</td>
<td>015207</td>
<td>ABDUL AZIZ RAMDANI</td>
<td>'</td>
<td>15/03</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-06-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012954366</td>
<td>131512021122Y000377</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>335</td>
<td>28-11-2022</td>
<td>001271</td>
<td>JEMIRIN</td>
<td>'3503041205710001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-05-1971</td>
<td>51</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664781444</td>
<td>131512021122Y000593</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>336</td>
<td>28-11-2022</td>
<td>013680</td>
<td>MAISAROH</td>
<td>'3503044608940001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-08-1994</td>
<td>28</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664990356</td>
<td>131512021122Y000592</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>337</td>
<td>28-11-2022</td>
<td>015250</td>
<td>BAMBANG JOKO SUSILO</td>
<td>'3503042205010001</td>
<td>DUSUN SOBO 05/15</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-05-2001</td>
<td>21</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665091246</td>
<td>131512021122Y000594</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>338</td>
<td>29-11-2022</td>
<td>003038</td>
<td>FAHRINA</td>
<td>'3503044709820001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-09-1982</td>
<td>40</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001294524325</td>
<td>131512021122Y000591</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>339</td>
<td>29-11-2022</td>
<td>015260</td>
<td>SUMIARSIH</td>
<td>'3503047012930005</td>
<td>RT 02/02</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-12-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>
<td>340</td>
<td>29-11-2022</td>
<td>014969</td>
<td>ANDIK ANTONI</td>
<td>'3503040910870001</td>
<td>RT 37/19</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-10-1987</td>
<td>35</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>341</td>
<td>30-11-2022</td>
<td>014902</td>
<td>HASBINA RAHMA FERDIA</td>
<td>'3503045602160001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-02-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003056721603</td>
<td>131512021122Y000711</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>342</td>
<td>01-12-2022</td>
<td>015325</td>
<td>USWATUN HASANAH</td>
<td>'3503045105890004</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-05-1989</td>
<td>33</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664406144</td>
<td>131512021222Y000242</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>343</td>
<td>01-12-2022</td>
<td>015330</td>
<td>AMBRUN</td>
<td>'3503043112610028</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-12-1961</td>
<td>61</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002598927759</td>
<td>131512021222Y000115</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>344</td>
<td>01-12-2022</td>
<td>015337</td>
<td>MUHMMAD BURHAN MUZAMMIL</td>
<td>'3503041908170002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-08-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>345</td>
<td>02-12-2022</td>
<td>001568</td>
<td>SRI MURTINI</td>
<td>'3503044804900003</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-04-1990</td>
<td>32</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002600764075</td>
<td>131512021222Y000245</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>346</td>
<td>02-12-2022</td>
<td>001219</td>
<td>MURSILAH</td>
<td>'3503044201770001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-01-1977</td>
<td>46</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664544136</td>
<td>131512021222Y000113</td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>347</td>
<td>02-12-2022</td>
<td>015340</td>
<td>BIMA DWI CAHYONO</td>
<td>'3503041908920002</td>
<td>RT 07/02</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-08-1992</td>
<td>30</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>348</td>
<td>02-12-2022</td>
<td>015341</td>
<td>HENI NOVITA</td>
<td>'1807094809780003</td>
<td>RT 22/05</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-09-1978</td>
<td>44</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0003303228802</td>
<td>131512021222Y000243</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>349</td>
<td>02-12-2022</td>
<td>002446</td>
<td>NUR SHOLIKAH</td>
<td>'3503047003980002</td>
<td>NGLEBAN, RT : 021,RW :004 </td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-03-1998</td>
<td>24</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0000665153684</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>350</td>
<td>02-12-2022</td>
<td>000646</td>
<td>RUKOYAH</td>
<td>'3503045006950003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-06-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663207985</td>
<td>131512021222Y000244</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>351</td>
<td>02-12-2022</td>
<td>013291</td>
<td>NURBADRIYAH</td>
<td>'3503037103990001</td>
<td>RT. 036, RW. 015, DESA SIDOMULYO, KECAMATAN PULE, KABUPATEN
TRENGGALEK, RT : 36,RW :15 </td>
<td>SIDOMULYO</td>
<td>PULE</td>
<td>TRENGGALEK</td>
<td>31-03-1999</td>
<td>23</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664760125</td>
<td>131512021222Y000246</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>352</td>
<td>02-12-2022</td>
<td>001193</td>
<td>SITI MARYAM</td>
<td>'3503044306930001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-06-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000664701254</td>
<td>131512021222Y000114</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>353</td>
<td>03-12-2022</td>
<td>001802</td>
<td>HAFIZ RISKI SAPUTRA</td>
<td>'3503041909160001</td>
<td>1/4 KRAJAN</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002086051059</td>
<td>131512021222Y000111</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>354</td>
<td>03-12-2022</td>
<td>015250</td>
<td>BAMBANG JOKO SUSILO</td>
<td>'3503042205010001</td>
<td>DUSUN SOBO 05/15</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-05-2001</td>
<td>21</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665091246</td>
<td>131512021222Y000112</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>355</td>
<td>05-12-2022</td>
<td>015369</td>
<td>RAVA AZKA PRATAMA</td>
<td>'</td>
<td>RT 11/06</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-08-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>356</td>
<td>06-12-2022</td>
<td>015382</td>
<td>QUEENZHA BENING IRTUHAYU</td>
<td>'</td>
<td>28/09</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-04-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>357</td>
<td>07-12-2022</td>
<td>007364</td>
<td>AZKHA DUANTITO YOGANTARA</td>
<td>'3503040906150001</td>
<td>RT 08/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-06-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002867870889</td>
<td>131512021222Y000034</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>358</td>
<td>07-12-2022</td>
<td>014087</td>
<td>INDRA MUBAROKATUS SAFITRI</td>
<td>'3503047112000005</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-12-2000</td>
<td>22</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>
<td>359</td>
<td>07-12-2022</td>
<td>003909</td>
<td>WARTINI</td>
<td>'3503045307870005</td>
<td>RT 22</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-07-1987</td>
<td>35</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665490587</td>
<td>131512021222Y000410</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>360</td>
<td>07-12-2022</td>
<td>015282</td>
<td>PARTINI</td>
<td>'3503044409910004</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-09-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>361</td>
<td>07-12-2022</td>
<td>010794</td>
<td>UMI INAYAH</td>
<td>'3503044410890002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-10-1989</td>
<td>33</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002867869642</td>
<td>131512021222Y000409</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>362</td>
<td>08-12-2022</td>
<td>010337</td>
<td>MASHEL NAURA SHAFANA</td>
<td>'6171047103160001</td>
<td>RT 04/37</td>
<td>SIANTAN HILIR</td>
<td>PONTIANAK UTARA</td>
<td>KOTA PONTIANAK</td>
<td>31-03-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002940045276</td>
<td>131512021222Y000036</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>363</td>
<td>08-12-2022</td>
<td>015395</td>
<td>AFIFAH KIRANA NUR FADILAH</td>
<td>'</td>
<td>29/09</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-11-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>364</td>
<td>08-12-2022</td>
<td>014957</td>
<td>FAJRIN UMAYATUL</td>
<td>'3503044612990003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-02-1999</td>
<td>24</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>365</td>
<td>08-12-2022</td>
<td>009368</td>
<td>ENI NOFITA SARI</td>
<td>'3503044804010003</td>
<td>RT 43/16</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-04-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664159149</td>
<td>131512021222Y000730</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>366</td>
<td>08-12-2022</td>
<td>012981</td>
<td>SRI SUMARMI</td>
<td>'3503044207840005</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-07-1984</td>
<td>38</td>
<td>P</td>
<td>WIRASWASTA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>367</td>
<td>08-12-2022</td>
<td>013996</td>
<td>YULIANA</td>
<td>'3503044505930005</td>
<td>KLANDRI 42/21</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-05-1993</td>
<td>29</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>368</td>
<td>08-12-2022</td>
<td>015398</td>
<td>ICA NATASYA PUTRI</td>
<td>'3503045509160003</td>
<td>DUSUN NGLANGON 16/08</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-09-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012957268</td>
<td>131512021222Y000107</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>369</td>
<td>08-12-2022</td>
<td>013360</td>
<td>ICCA OKTAVIANA</td>
<td>'3503044710970001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-10-1997</td>
<td>25</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0003047441747</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>370</td>
<td>10-12-2022</td>
<td>015414</td>
<td>IRA FATIMATUS ZAHRO`</td>
<td>'3503046412140001</td>
<td>DUSUN NGASINAN 34/17</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-12-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002867869247</td>
<td>131512021222Y000095</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>371</td>
<td>10-12-2022</td>
<td>015416</td>
<td>KAVI IRWAN B</td>
<td>'</td>
<td>11/03</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-03-2017</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>372</td>
<td>10-12-2022</td>
<td>015419</td>
<td>SUWARJI</td>
<td>'3503041603850002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-03-1985</td>
<td>37</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664473341</td>
<td>131512021222Y000109</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>373</td>
<td>10-12-2022</td>
<td>015421</td>
<td>MUHAMMAD FARIZ ALFATH</td>
<td>'</td>
<td>52/03</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-06-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>374</td>
<td>12-12-2022</td>
<td>012869</td>
<td>MANGI</td>
<td>'3503044404830008</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-04-1983</td>
<td>39</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003282185608</td>
<td>131512021222Y000594</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>375</td>
<td>12-12-2022</td>
<td>014041</td>
<td>NURUL HIDAYAH</td>
<td>'3503046301030003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-01-2003</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665191743</td>
<td>131512021222Y000596</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>376</td>
<td>12-12-2022</td>
<td>015258</td>
<td>DIAN ANGGARITA</td>
<td>'3503045007950002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-07-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664954042</td>
<td>131512021222Y000595</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>377</td>
<td>12-12-2022</td>
<td>000855</td>
<td>ENI LESTARI</td>
<td>'3503046212890004</td>
<td>PETUNG 19/04</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-12-1989</td>
<td>33</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665248454</td>
<td>131512021222Y000597</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>378</td>
<td>12-12-2022</td>
<td>007215</td>
<td>MAZANA KAMILIA LAELA</td>
<td>'3503046601160001</td>
<td>RT 01/01</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-01-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002596087618</td>
<td>131512021222Y000110</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>379</td>
<td>12-12-2022</td>
<td>015435</td>
<td>FATMA DIAN PRATIWI</td>
<td>'3503045405020001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-05-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0000665832611</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>380</td>
<td>12-12-2022</td>
<td>001021</td>
<td>ERNI SETYA DEWI</td>
<td>'3503044409830004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-09-1983</td>
<td>39</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0001324205763</td>
<td>131512021222Y000133</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>381</td>
<td>12-12-2022</td>
<td>015436</td>
<td>LINDA RISTIANA</td>
<td>'</td>
<td>06/03</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-07-1998</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>382</td>
<td>13-12-2022</td>
<td>002359</td>
<td>SITI AISAH</td>
<td>'3503044111990001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-11-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002842485131</td>
<td>131512021222Y000589</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>383</td>
<td>13-12-2022</td>
<td>002376</td>
<td>JUMANI</td>
<td>'</td>
<td>RT06RW 02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-08-1963</td>
<td>59</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664824126</td>
<td>131512021222Y000137</td>
<td align='center'>
K05.5 </td>
<td align='center'>
Other periodontal diseases </td>
</tr>

<td>384</td>
<td>13-12-2022</td>
<td>014287</td>
<td>LUTFI ATUNNA N</td>
<td>'</td>
<td>RT 6 RW 2</td>
<td>SIKI</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-09-2003</td>
<td>19</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>385</td>
<td>13-12-2022</td>
<td>011284</td>
<td>OKANA WULAN AFILIA</td>
<td>'3503044704950007</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-04-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>386</td>
<td>13-12-2022</td>
<td>015440</td>
<td>ROHMATIN</td>
<td>'3503044304930002</td>
<td>DUSUN BONSARI 30/12</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-04-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002638453601</td>
<td>131512021222Y000590</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>387</td>
<td>13-12-2022</td>
<td>012564</td>
<td>SULISTIANA</td>
<td>'3503046405950002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-05-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665087411</td>
<td>131512021222Y000591</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>388</td>
<td>13-12-2022</td>
<td>008039</td>
<td>MARDIYAH</td>
<td>'3503046511840004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-11-1984</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664533505</td>
<td>131512021222Y000592</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>389</td>
<td>13-12-2022</td>
<td>013008</td>
<td>RUSTIANA</td>
<td>'3503044402920001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-05-1992</td>
<td>30</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBD)</td>
<td>'0000664950519</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>390</td>
<td>13-12-2022</td>
<td>009259</td>
<td>ANIS PUJI LESTARI</td>
<td>'3503025411950002</td>
<td>RT 19/03</td>
<td>NGULUNGWETAN</td>
<td>MUNJUNGAN</td>
<td>TRENGGALEK</td>
<td>14-11-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664373531</td>
<td>131512021222Y000593</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>391</td>
<td>13-12-2022</td>
<td>003775</td>
<td>SIWI PALUPI</td>
<td>'</td>
<td>RT 08/02</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-05-1971</td>
<td>51</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106528015</td>
<td>131512021222Y000142</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>392</td>
<td>13-12-2022</td>
<td>003548</td>
<td>SUSIANA</td>
<td>'3503046104930002</td>
<td>RT 09/02</td>
<td>SIKI</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-04-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002328572575</td>
<td>131512021222Y000143</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>393</td>
<td>14-12-2022</td>
<td>014411</td>
<td>'3503045207110002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-07-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000664555781</td>
<td>131512021222Y000156</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>394</td>
<td>14-12-2022</td>
<td>015455</td>
<td>IRSYADA ALVIANO ROYANUL T.</td>
<td>'3503041409120002</td>
<td>DUSUN BELANG, RT : 027,RW :009 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-09-2012</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>395</td>
<td>15-12-2022</td>
<td>015465</td>
<td>RANDIA SYIFA </td>
<td>'</td>
<td>RT 16/08</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-04-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>396</td>
<td>16-12-2022</td>
<td>007906</td>
<td>MAMIK DWI ASTUTI</td>
<td>'3503046204850005</td>
<td>RT 03/01</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-04-1985</td>
<td>37</td>
<td>P</td>
<td>Perawat</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0000106699836</td>
<td>131512021222Y000240</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>397</td>
<td>16-12-2022</td>
<td>015479</td>
<td>KAILA ALMIRA MARIZA</td>
<td>'3503044910150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-10-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003088534713</td>
<td>131512021222Y000192</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>398</td>
<td>16-12-2022</td>
<td>007084</td>
<td>NARTONI IFANSAH</td>
<td>'</td>
<td>RT 24 RW 4</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-01-1980</td>
<td>43</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664322872</td>
<td></td>
<td align='center'>
K05.5 </td>
<td align='center'>
</tr>
<td>399</td>
<td>16-12-2022</td>
<td>009259</td>
<td>ANIS PUJI LESTARI</td>
<td>'3503025411950002</td>
<td>RT 19/03</td>
<td>NGULUNGWETAN</td>
<td>MUNJUNGAN</td>
<td>TRENGGALEK</td>
<td>14-11-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664373531</td>
<td>131512021222Y000241</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>400</td>
<td>16-12-2022</td>
<td>015482</td>
<td>TRI KASANI</td>
<td>'</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-07-1989</td>
<td>33</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664989129</td>
<td>131512021222Y000193</td>
<td align='center'>
K05.5 </td>
<td align='center'>
</tr>

<td>401</td>
<td>17-12-2022</td>
<td>015491</td>
<td>ADHIRA AFRILIA PUTRI</td>
<td>'3503044104140001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-04-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0001917685912</td>
<td>131512021222Y000202</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>402</td>
<td>17-12-2022</td>
<td>015493</td>
<td>AFARA MISELA AGUSTIN</td>
<td>'</td>
<td>RT 34/10</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-06-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>403</td>
<td>17-12-2022</td>
<td>014625</td>
<td>AQILA FELICYA PUTRI</td>
<td>'3503045704160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-04-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>404</td>
<td>17-12-2022</td>
<td>015498</td>
<td>IMELDA SYAFITRI</td>
<td>'3529114907160002</td>
<td>RT 06/03</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-07-2016</td>
<td>6</td>
<td>P</td>
<td>pelajar</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>405</td>
<td>17-12-2022</td>
<td>015499</td>
<td>MUHAMMAD FARID ALFATIH</td>
<td>'</td>
<td>RT 52/03</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-06-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>406</td>
<td>19-12-2022</td>
<td>013090</td>
<td>AYU LESTARI</td>
<td>'3503044802960002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-02-1996</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000665372474</td>
<td>131512021222Y000414</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>407</td>
<td>19-12-2022</td>
<td>014790</td>
<td>SUMARNI</td>
<td>'3503043112720030</td>
<td>SIKI</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-12-1972</td>
<td>50</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664280278</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>408</td>
<td>19-12-2022</td>
<td>010973</td>
<td>LILIS LISTIANA DEWI</td>
<td>'3503044606950004</td>
<td>RT 23/08</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-06-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664257418</td>
<td>131512021222Y000411</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>409</td>
<td>19-12-2022</td>
<td>005389</td>
<td>ARI SAVITA DEVI</td>
<td>'3503114701970001</td>
<td>DSN.SUKOBANTENG RT 15/ RW 03 DESA KARANGSOKO,TRENGGALEK., RT :
015,RW :003 </td>
<td>KARANGSOKO</td>
<td>TRENGGALEK</td>
<td>TRENGGALEK</td>
<td>07-01-1997</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665692863</td>
<td>131512021222Y000412</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>410</td>
<td>19-12-2022</td>
<td>014505</td>
<td>SULIYAH</td>
<td>'3503046306910003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-06-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002434597492</td>
<td>131512021222Y000413</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>411</td>
<td>19-12-2022</td>
<td>011812</td>
<td>'3503045401160001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-01-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802742064</td>
<td>131512021222Y000208</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>412</td>
<td>19-12-2022</td>
<td>015516</td>
<td>AFIFA AILANI AZKA</td>
<td>'3503045409150001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-09-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003088495495</td>
<td>131512021222Y000209</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>413</td>
<td>20-12-2022</td>
<td>012779</td>
<td>NUR ASIYAH</td>
<td>'3503044809910005</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-09-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003142877736</td>
<td>131512021222Y000415</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>414</td>
<td>20-12-2022</td>
<td>012948</td>
<td>PARTINI</td>
<td>'3503044607880006</td>
<td>DUSUN NGLEBAN RT 13 RW 3</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-07-1988</td>
<td>34</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000661841188</td>
<td>131512021222Y000416</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>415</td>
<td>20-12-2022</td>
<td>014568</td>
<td>NIKMAH HIDAYATI</td>
<td>'3503044906920001</td>
<td>RT 20/06</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-05-1992</td>
<td>30</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>416</td>
<td>20-12-2022</td>
<td>014353</td>
<td>'3503044709000001</td>
<td>20/06</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-09-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000666114963</td>
<td>131512021222Y000417</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>417</td>
<td>20-12-2022</td>
<td>015398</td>
<td>ICA NATASYA PUTRI</td>
<td>'3503045509160003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-09-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012957268</td>
<td>131512021222Y000418</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>
<td>418</td>
<td>20-12-2022</td>
<td>010479</td>
<td>ADITYA RIFQI HAMIZAN</td>
<td>'</td>
<td>RT 11/01</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>419</td>
<td>21-12-2022</td>
<td>007364</td>
<td>AZKHA DUANTITO YOGANTARA</td>
<td>'3503040906150001</td>
<td>RT 08/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-06-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002867870889</td>
<td>131512021222Y000606</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>420</td>
<td>21-12-2022</td>
<td>015557</td>
<td>MARYANA MUÀZAROH</td>
<td>'3503044611020001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-11-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664319777</td>
<td>131512021222Y000266</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>421</td>
<td>21-12-2022</td>
<td>010252</td>
<td>ALDEBARAN NABHAN</td>
<td>'3503040907160002</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-07-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002681678158</td>
<td>131512021222Y000263</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>422</td>
<td>21-12-2022</td>
<td>001193</td>
<td>'3503044306930001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-06-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000664701254</td>
<td>131512021222Y000275</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>423</td>
<td>22-12-2022</td>
<td>015582</td>
<td>JIAN IKA OKTAVIA</td>
<td>'3503044310120001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-10-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001916538175</td>
<td>131512021222Y000327</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>424</td>
<td>22-12-2022</td>
<td>012564</td>
<td>SULISTIANA</td>
<td>'3503046405950002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-05-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665087411</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>425</td>
<td>22-12-2022</td>
<td>004070</td>
<td>MUZAYANAH</td>
<td>'</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-05-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664986227</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>426</td>
<td>22-12-2022</td>
<td>012415</td>
<td>VILIANA YULIANI</td>
<td>'3503045307020001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-07-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002159509623</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>427</td>
<td>22-12-2022</td>
<td>009548</td>
<td>NAFA KHANZA AZIZAH</td>
<td>'3503044104130002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-04-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002066786998</td>
<td>131512021222Y000331</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>428</td>
<td>22-12-2022</td>
<td>015583</td>
<td>ALI MUSTOFA</td>
<td>'3503040409870003</td>
<td>11/06</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-09-1987</td>
<td>35</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0000665455781</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>429</td>
<td>22-12-2022</td>
<td>013732</td>
<td>RAFA AZKHA PRATAMA</td>
<td>'3503041808160002</td>
<td>DUSUN PLAPAR RT 11 RW 06 DESA CAKUL KECAMATAN DONGKO</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-08-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>430</td>
<td>22-12-2022</td>
<td>002494</td>
<td>MARTYEM</td>
<td>'350304405730004</td>
<td>RT 30/09</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-05-1973</td>
<td>49</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664148529</td>
<td>131512021222Y000332</td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>431</td>
<td>24-12-2022</td>
<td>015391</td>
<td>MUTOHAROH</td>
<td>'3518015104830001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-04-1983</td>
<td>39</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000732325476</td>
<td>131512021222Y000394</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>432</td>
<td>26-12-2022</td>
<td>008972</td>
<td>ROFIK DIANATUL JANAH</td>
<td>'3503045408000001</td>
<td>RT 08/02</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-08-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002734752655</td>
<td>131512021222Y000831</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>433</td>
<td>26-12-2022</td>
<td>015617</td>
<td>DIRGA CAHYA PRADANA</td>
<td>'3503041105150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-05-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0002598927726</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>434</td>
<td>26-12-2022</td>
<td>015618</td>
<td>RISTI SILVIA RAMADHANI</td>
<td>'3503044708120001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-08-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003011254997</td>
<td>131512021222Y000419</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>435</td>
<td>26-12-2022</td>
<td>005116</td>
<td>RINA</td>
<td>'3503046207020001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-07-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664546904</td>
<td>131512021222Y000832</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>436</td>
<td>26-12-2022</td>
<td>008947</td>
<td>ALFI CAHYANI</td>
<td>'3503045705010001</td>
<td>RT 40/15</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-05-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664153929</td>
<td>131512021222Y000421</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>
<td>437</td>
<td>27-12-2022</td>
<td>008077</td>
<td>AINUN NAZAROH</td>
<td>'3503047012010002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-12-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665031396</td>
<td>131512021222Y000431</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>438</td>
<td>27-12-2022</td>
<td>015646</td>
<td>JAMIRAH</td>
<td>'3503045711930001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-11-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664312735</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>439</td>
<td>27-12-2022</td>
<td>015649</td>
<td>EKA NOVIANA</td>
<td>'3503044611100001</td>
<td>DUSUN KORI 39/11</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-11-2010</td>
<td>12</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002601356253</td>
<td>131512021222Y000434</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>440</td>
<td>27-12-2022</td>
<td>014721</td>
<td>ANIS SURURIN</td>
<td>'3503045201940002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-01-1994</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002729551871</td>
<td>131512021222Y000432</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>441</td>
<td>27-12-2022</td>
<td>012205</td>
<td>NURUL HIDAYATI</td>
<td>'350725568930006</td>
<td>DUSUN TALUN RT 47 RW 17</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-08-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002857438394</td>
<td>131512021222Y000433</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>442</td>
<td>27-12-2022</td>
<td>013579</td>
<td>ENDANG YULIANTI</td>
<td>'3503044503870002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-03-1987</td>
<td>36</td>
<td>P</td>
<td>WIRASWASTA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>443</td>
<td>27-12-2022</td>
<td>015662</td>
<td>ANNAA HAFIDHOH</td>
<td>'3503045604110002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-04-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>444</td>
<td>27-12-2022</td>
<td>015663</td>
<td>AFIS AKILA</td>
<td>'</td>
<td>41/16</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-08-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>445</td>
<td>27-12-2022</td>
<td>015666</td>
<td>SITI SAROPAH</td>
<td>'3503046812960001</td>
<td>DUSUN SAMBI 39/15</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-12-1996</td>
<td>26</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665023353</td>
<td>131512021222Y000435</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>446</td>
<td>27-12-2022</td>
<td>015667</td>
<td>KASIATI</td>
<td>'3503042607940001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-07-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665023239</td>
<td>131512021222Y000436</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>447</td>
<td>28-12-2022</td>
<td>015682</td>
<td>SUWARNI</td>
<td>' </td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-04-1952</td>
<td>70</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664417765</td>
<td>131512021222Y000437</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>448</td>
<td>28-12-2022</td>
<td>009389</td>
<td>'3503046903130002</td>
<td>RT 21/08</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-03-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>449</td>
<td>28-12-2022</td>
<td>009956</td>
<td>ALFIA ANITA FINITASARI</td>
<td>'</td>
<td>39/20</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-02-2016</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>450</td>
<td>28-12-2022</td>
<td>000805</td>
<td>SITI NGAISAH</td>
<td>'3503046607740001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-06-1974</td>
<td>48</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665293274</td>
<td>131512021222Y000456</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>451</td>
<td>29-12-2022</td>
<td>014790</td>
<td>SUMARNI</td>
<td>'3503043112720030</td>
<td>SIKI</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-12-1972</td>
<td>50</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664280278</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>452</td>
<td>30-12-2022</td>
<td>015727</td>
<td>SITI NURHIDAYAH</td>
<td>'3503044801030001</td>
<td>DUSUN KARANGSUDO 45/01</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-01-2003</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664604572</td>
<td>131512021222Y000531</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>453</td>
<td>30-12-2022</td>
<td>015730</td>
<td>DEWI YULIANA</td>
<td>'3503046710090001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-03-2009</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664066809</td>
<td>131512021222Y000532</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>454</td>
<td>31-12-2022</td>
<td>015733</td>
<td>JOKO SUNYONO</td>
<td>'3503041610850004</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-10-1985</td>
<td>37</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>455</td>
<td>31-12-2022</td>
<td>005086</td>
<td>AZAHRA JUANA PUTRI</td>
<td>'3503046404150002</td>
<td>RT 06/02</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-04-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002860461641</td>
<td>131512021222Y000540</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>456</td>
<td>31-12-2022</td>
<td>015738</td>
<td>RAKA BINTANG </td>
<td>'</td>
<td>29/15</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-04-2005</td>
<td>17</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>457</td>
<td>31-12-2022</td>
<td>015730</td>
<td>DEWI YULIANA</td>
<td>'3503046710090001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-03-2009</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664066809</td>
<td></td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>458</td>
<td>31-12-2022</td>
<td>015740</td>
<td>SASMITO TIRTA WIDODO</td>
<td>'</td>
<td>10/04</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-06-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>459</td>
<td>31-12-2022</td>
<td>014887</td>
<td>GANDI RAHMADHANI</td>
<td>'3503040911060001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-11-2006</td>
<td>16</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002014094992</td>
<td>131512021222Y000549</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
</tr>

<td>460</td>
<td>02-01-2023</td>
<td>001189</td>
<td>SYAHRUL JANUAR WIDODO</td>
<td>'9203010101080003</td>
<td>WATUAGUNG 02/01</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-06-2011</td>
<td>11</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011255976</td>
<td>131512020123Y000003</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>461</td>
<td>02-01-2023</td>
<td>000367</td>
<td>SUPRAPTO</td>
<td>'</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-04-1968</td>
<td>54</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106529894</td>
<td>131512020123Y000004</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>462</td>
<td>02-01-2023</td>
<td>015754</td>
<td>PONIEM</td>
<td>'3503046903750001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-03-1975</td>
<td>47</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664459582</td>
<td>131512020123Y000006</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>463</td>
<td>02-01-2023</td>
<td>015760</td>
<td>AISYAH AL ARIF</td>
<td>'3503046311180001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-11-2018</td>
<td>4</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>464</td>
<td>04-01-2023</td>
<td>013291</td>
<td>NURBADRIYAH</td>
<td>'3503037103990001</td>
<td>RT. 036, RW. 015, DESA SIDOMULYO, KECAMATAN PULE, KABUPATEN
TRENGGALEK, RT : 36,RW :15 </td>
<td>SIDOMULYO</td>
<td>PULE</td>
<td>TRENGGALEK</td>
<td>31-03-1999</td>
<td>23</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664760125</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>465</td>
<td>04-01-2023</td>
<td>012996</td>
<td>SARMI</td>
<td>'3503044307880002</td>
<td>BANAR 24/05</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-07-1988</td>
<td>34</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664860925</td>
<td>131512020123Y000333</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>466</td>
<td>04-01-2023</td>
<td>015457</td>
<td>DIDIN EKOSTA RINDA</td>
<td>'3504171905890001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-05-1989</td>
<td>33</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665896353</td>
<td>131512020123Y000334</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>467</td>
<td>04-01-2023</td>
<td>014281</td>
<td>TITIS NILA KUSIMAWATI</td>
<td>'3503047009940002</td>
<td>BANAR, RT : 018,RW :004 </td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-09-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664966168</td>
<td>131512020123Y000335</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>468</td>
<td>04-01-2023</td>
<td>015779</td>
<td>DINA CHALISA</td>
<td>'</td>
<td>RT 21/11</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-03-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>469</td>
<td>05-01-2023</td>
<td>015789</td>
<td>THALITA DWI OCTAVIA</td>
<td>'3503046810150001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-10-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>470</td>
<td>05-01-2023</td>
<td>013811</td>
<td>HENDRI CANGGIH WICAKSONO</td>
<td>'</td>
<td>08/04</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-04-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>471</td>
<td>05-01-2023</td>
<td>009741</td>
<td>SRI WINARSIH</td>
<td>'3503044308940001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-08-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664265542</td>
<td>131512020123Y000014</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>472</td>
<td>06-01-2023</td>
<td>015359</td>
<td>YUNI KRISTIANINGSIH</td>
<td>'3503037006010003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-06-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002184260499</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>473</td>
<td>06-01-2023</td>
<td>009741</td>
<td>SRI WINARSIH</td>
<td>'3503044308940001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-08-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664265542</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>474</td>
<td>09-01-2023</td>
<td>013825</td>
<td>MITA SULASTRI</td>
<td>'3504114208880002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-08-1988</td>
<td>34</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBD)</td>
<td>'0000667031984</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>475</td>
<td>09-01-2023</td>
<td>015807</td>
<td>SRI WAHYUNI</td>
<td>'3503044607910003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-07-1991</td>
<td>31</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664455791</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>476</td>
<td>09-01-2023</td>
<td>012981</td>
<td>SRI SUMARMI</td>
<td>'3503044207840005</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-07-1984</td>
<td>38</td>
<td>P</td>
<td>WIRASWASTA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>477</td>
<td>09-01-2023</td>
<td>002236</td>
<td>SULATIN</td>
<td>'3503046107940004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-07-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0002257183192</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>478</td>
<td>09-01-2023</td>
<td>002668</td>
<td>NOVA DWI LAKSANA</td>
<td>'3503042811990001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-11-1999</td>
<td>23</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664650202</td>
<td>131512020123Y000021</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>479</td>
<td>09-01-2023</td>
<td>002668</td>
<td>NOVA DWI LAKSANA</td>
<td>'3503042811990001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-11-1999</td>
<td>23</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664650202</td>
<td>131512020123Y000021</td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>480</td>
<td>09-01-2023</td>
<td>015805</td>
<td>PARMI</td>
<td>'3503045005700002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-05-1970</td>
<td>52</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>481</td>
<td>10-01-2023</td>
<td>015420</td>
<td>SOLIKAH</td>
<td>'3503046001860002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-01-1986</td>
<td>37</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002603696106</td>
<td>131512020123Y000338</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>482</td>
<td>10-01-2023</td>
<td>015440</td>
<td>ROHMATIN</td>
<td>'3503044304930002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-04-1993</td>
<td>29</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002638453601</td>
<td>131512020123Y000339</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>483</td>
<td>10-01-2023</td>
<td>013066</td>
<td>WINARTI</td>
<td>'</td>
<td>RT44 RW 22</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-08-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664471269</td>
<td>131512020123Y000340</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>484</td>
<td>10-01-2023</td>
<td>012600</td>
<td>DEWI NAWANG WULAN</td>
<td>'3503044603030004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-03-2003</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002593970201</td>
<td>131512020123Y000031</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>485</td>
<td>10-01-2023</td>
<td>015617</td>
<td>DIRGA CAHYA PRADANA</td>
<td>'3503041105150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-05-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002598927726</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>486</td>
<td>10-01-2023</td>
<td>014333</td>
<td>'3503041705160002</td>
<td>42/16</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003088524227</td>
<td>131512020123Y000034</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>487</td>
<td>10-01-2023</td>
<td>003465</td>
<td>YUNI RAHMAWATI</td>
<td>'</td>
<td>RT 13/03</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-06-1981</td>
<td>41</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106632832</td>
<td>131512020123Y000033</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>488</td>
<td>11-01-2023</td>
<td>000861</td>
<td>ANIS KARIMMATUN NISAK</td>
<td>'3503045006020001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-06-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002734748662</td>
<td>131512020123Y000341</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>489</td>
<td>11-01-2023</td>
<td>012556</td>
<td>SRI LESTARI</td>
<td>'3503045504940003</td>
<td>DUSUN SOBO RT 020 RW 006 DESA SALAM, RT : 020,RW :006 </td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-04-1994</td>
<td>28</td>
<td>P</td>
<td>Pembantu Rumah Tangga</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>490</td>
<td>11-01-2023</td>
<td>015835</td>
<td>PRAMUDIANTO</td>
<td>'3503042203730001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-03-1973</td>
<td>49</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000663490787</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>491</td>
<td>12-01-2023</td>
<td>010722</td>
<td>UGIK SUPRIANTO</td>
<td>'3503040810870001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-10-1987</td>
<td>35</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664458658</td>
<td>131512020123Y000057</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>492</td>
<td>12-01-2023</td>
<td>010997</td>
<td>ASYIFA DINDA AZ-ZAHRA</td>
<td>'3503044410150001</td>
<td>DUSUN NGASINAN, RT : 047,RW :024 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-10-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>493</td>
<td>12-01-2023</td>
<td>010476</td>
<td>DIKA SEPTA ALDYANSAH</td>
<td>'3503041109150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-09-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>494</td>
<td>12-01-2023</td>
<td>015179</td>
<td>MUHAMMAD HARUN AR-RASYID</td>
<td>'350304081260002</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-12-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002520043356</td>
<td>131512020123Y000061</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>495</td>
<td>12-01-2023</td>
<td>007891</td>
<td>DINA MARITA</td>
<td>'3502016703060002</td>
<td>RT 14 RW 03 </td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-03-2006</td>
<td>16</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000660666429</td>
<td>131512020123Y000062</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>496</td>
<td>14-01-2023</td>
<td>015408</td>
<td>FIFI WIDIANTARI</td>
<td>'3503065211060004</td>
<td>DUSUN KAYEN, RT : 5,RW :2 </td>
<td>KAYEN</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>12-11-2006</td>
<td>16</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663296095</td>
<td>131512020123Y000343</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>497</td>
<td>14-01-2023</td>
<td>015864</td>
<td>ADI SUTIKNO</td>
<td>'3503072405050001</td>
<td>DUSUN BULUROTO 42/10</td>
<td>NGADIMULYO</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>24-05-2005</td>
<td>17</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665254888</td>
<td>131512020123Y000121</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>498</td>
<td>16-01-2023</td>
<td>010722</td>
<td>UGIK SUPRIANTO</td>
<td>'3503040810870001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-10-1987</td>
<td>35</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664458658</td>
<td>131512020123Y000385</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>499</td>
<td>16-01-2023</td>
<td>014961</td>
<td>ALMEER IZHAR MAUZA</td>
<td>'</td>
<td>RT 09/02</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-11-2011</td>
<td>11</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>500</td>
<td>16-01-2023</td>
<td>015871</td>
<td>VINA REVIANA SAPUTRI</td>
<td>'3503044106150002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-06-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012950024</td>
<td>131512020123Y000126</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>501</td>
<td>16-01-2023</td>
<td>015805</td>
<td>PARMI</td>
<td>'3503045005700002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-05-1970</td>
<td>52</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>502</td>
<td>16-01-2023</td>
<td>005923</td>
<td>AULIA NAKESYA</td>
<td>'3503046111050001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-11-2005</td>
<td>17</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664625992</td>
<td>131512020123Y000128</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>503</td>
<td>16-01-2023</td>
<td>015877</td>
<td>AKBAR SANDI PRATAMA</td>
<td>'3503040705150001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-05-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>504</td>
<td>17-01-2023</td>
<td>007891</td>
<td>DINA MARITA</td>
<td>'3502016703060002</td>
<td>RT 14 RW 03 </td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>27-03-2006</td>
<td>16</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000660666429</td>
<td>131512020123Y000134</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>505</td>
<td>17-01-2023</td>
<td>008947</td>
<td>ALFI CAHYANI</td>
<td>'3503045705010001</td>
<td>RT 40/15</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-05-2001</td>
<td>21</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664153929</td>
<td>131512020123Y000136</td>
<td align='center'>
K04.6 </td>
<td align='center'>
Periapical abscess with sinus </td>
</tr>

<td>506</td>
<td>17-01-2023</td>
<td>013280</td>
<td>'3503045705150002</td>
<td>33/13</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>507</td>
<td>17-01-2023</td>
<td>013280</td>
<td>'3503045705150002</td>
<td>33/13</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>508</td>
<td>18-01-2023</td>
<td>015414</td>
<td>IRA FATIMATUS ZAHRO`</td>
<td>'3503046412140001</td>
<td>DUSUN NGASINAN 34/17</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-12-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002867869247</td>
<td>131512020123Y000140</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>509</td>
<td>18-01-2023</td>
<td>002684</td>
<td>JEKI NASUTION</td>
<td>'3503040604960001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-04-1996</td>
<td>26</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>GRATIS</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>510</td>
<td>18-01-2023</td>
<td>015901</td>
<td>DIENA KHOOLISHOH</td>
<td>'3503046103160001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-03-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>511</td>
<td>18-01-2023</td>
<td>011283</td>
<td>NURAINI</td>
<td>'3503044307990003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-07-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665774379</td>
<td>131512020123Y000142</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>512</td>
<td>19-01-2023</td>
<td>009322</td>
<td>VANESYA FITRIA AGESTIN</td>
<td>'3503046908110001</td>
<td>RT 26/13</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-08-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001916540043</td>
<td>131512020123Y000158</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>513</td>
<td>20-01-2023</td>
<td>003040</td>
<td>YANI AL DASARI</td>
<td>'3503044804980003</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-04-1998</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K07.4 </td>
<td align='center'>
Malocclusion, unspecified </td>
</tr>

<td>514</td>
<td>20-01-2023</td>
<td>004163</td>
<td>KHARIROTUL BAZAZIYAH ALWI</td>
<td>'3503044708960004</td>
<td>DUSUN KARANGSUDO, RT : 006,RW :003 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-08-1996</td>
<td>26</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665000335</td>
<td>131512020123Y000160</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>515</td>
<td>21-01-2023</td>
<td>004168</td>
<td>NURUL ALFIAH YUNIATI</td>
<td>'3503045906770003</td>
<td>RT 6 RW 3</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-06-1977</td>
<td>45</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PNS DAERAH</td>
<td>'0001082277843</td>
<td>131512020123Y000161</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>516</td>
<td>21-01-2023</td>
<td>010645</td>
<td>MISLATIN</td>
<td>'3503045101740003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-01-1974</td>
<td>49</td>
<td>P</td>
<td>LAINNYA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664692816</td>
<td>131512020123Y000163</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>517</td>
<td>24-01-2023</td>
<td>010645</td>
<td>MISLATIN</td>
<td>'3503045101740003</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-01-1974</td>
<td>49</td>
<td>P</td>
<td>LAINNYA</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664692816</td>
<td>131512020123Y000187</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>518</td>
<td>24-01-2023</td>
<td>015963</td>
<td>MIFTAQUR RIDWAN</td>
<td>'3503040407960003</td>
<td>RT 11/01</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-07-1996</td>
<td>26</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665067936</td>
<td>131512020123Y000188</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>519</td>
<td>24-01-2023</td>
<td>015965</td>
<td>ALIYA ARIANTI</td>
<td>'3503046012040001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-12-2004</td>
<td>18</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664811425</td>
<td>131512020123Y000717</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>520</td>
<td>24-01-2023</td>
<td>015968</td>
<td>ASYILA HUMAIRA ANDINI</td>
<td>'</td>
<td>RT 16/04</td>
<td>SIKI</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-11-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>521</td>
<td>24-01-2023</td>
<td>015969</td>
<td>LULUK NURFIDAH</td>
<td>'</td>
<td>RT 37/19</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-01-2014</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>522</td>
<td>24-01-2023</td>
<td>015901</td>
<td>'3503046103160001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-03-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>523</td>
<td>24-01-2023</td>
<td>011283</td>
<td>NURAINI</td>
<td>'3503044307990003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-07-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665774379</td>
<td>131512020123Y000720</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>524</td>
<td>24-01-2023</td>
<td>013573</td>
<td>'3503043107150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-07-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002063929184</td>
<td>131512020123Y000721</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>525</td>
<td>24-01-2023</td>
<td>006763</td>
<td>YENINGTYAS</td>
<td>'3503046903920001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-03-1992</td>
<td>30</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664605279</td>
<td>131512020123Y000723</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>526</td>
<td>25-01-2023</td>
<td>010422</td>
<td>DARRELL ARKA DINATA</td>
<td>'3503040702160004</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-02-2016</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>'0002897089648</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>527</td>
<td>25-01-2023</td>
<td>015980</td>
<td>MUTIA</td>
<td>'</td>
<td>RT 14/07</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-06-2012</td>
<td>10</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>528</td>
<td>25-01-2023</td>
<td>016009</td>
<td>RAZELA NURHANA GUMILANG</td>
<td>'3503045711160002</td>
<td>54/12</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-11-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>529</td>
<td>25-01-2023</td>
<td>015986</td>
<td>FAIZ ARDIANSYAH SUCIPTO</td>
<td>'3503041411190001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-11-2019</td>
<td>3</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>530</td>
<td>26-01-2023</td>
<td>004279</td>
<td>SITI MASRIPAH</td>
<td>'3503045103740007</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>11-03-1974</td>
<td>48</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106760283</td>
<td>131512020123Y000209</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>531</td>
<td>27-01-2023</td>
<td>011757</td>
<td>MOHAMAT YASIN</td>
<td>'3503042211970002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-11-1997</td>
<td>25</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664429162</td>
<td>131512020123Y000232</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>532</td>
<td>27-01-2023</td>
<td>004163</td>
<td>KHARIROTUL BAZAZIYAH ALWI</td>
<td>'3503044708960004</td>
<td>DUSUN KARANGSUDO, RT : 006,RW :003 </td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-08-1996</td>
<td>26</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665000335</td>
<td>131512020123Y000248</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>533</td>
<td>28-01-2023</td>
<td>009322</td>
<td>VANESYA FITRIA AGESTIN</td>
<td>'3503046908110001</td>
<td>RT 26/13</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-08-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001916540043</td>
<td>131512020123Y000247</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>534</td>
<td>30-01-2023</td>
<td>011757</td>
<td>'3503042211970002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-11-1997</td>
<td>25</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664429162</td>
<td>131512020123Y000246</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>535</td>
<td>30-01-2023</td>
<td>009389</td>
<td>'3503046903130002</td>
<td>RT 21/08</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-03-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>536</td>
<td>30-01-2023</td>
<td>014920</td>
<td>MUHAMMAD AZIDAN NAUFAL RAMADANI</td>
<td>'</td>
<td>RT 24/04</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-06-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>537</td>
<td>30-01-2023</td>
<td>013280</td>
<td>'3503045705150002</td>
<td>33/13</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-05-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>538</td>
<td>31-01-2023</td>
<td>015508</td>
<td>NAUVAN VAREL</td>
<td>'</td>
<td>29/15</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-04-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002159507946</td>
<td>131512020123Y000274</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>539</td>
<td>31-01-2023</td>
<td>013545</td>
<td>SUPRININGSIH</td>
<td>'3503046409850004</td>
<td>RT 33 RW 17 DUSUN NGASINAN</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-09-1985</td>
<td>37</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011257552</td>
<td>131512020123Y000275</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>540</td>
<td>31-01-2023</td>
<td>015963</td>
<td>MIFTAQUR RIDWAN</td>
<td>'3503040407960003</td>
<td>RT 11/01</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-07-1996</td>
<td>26</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665067936</td>
<td>131512020123Y000276</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>541</td>
<td>01-02-2023</td>
<td>011805</td>
<td>DEA VITALOKA</td>
<td>'</td>
<td>DUSUN TALUN RT/54 RW/02</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-12-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665433472</td>
<td>131512020223Y000803</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>542</td>
<td>01-02-2023</td>
<td>015681</td>
<td>RUKMIYATI</td>
<td>'3523014112940001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-12-1994</td>
<td>28</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000749647899</td>
<td>131512020223Y000800</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>543</td>
<td>01-02-2023</td>
<td>005116</td>
<td>RINA</td>
<td>'3503046207020001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-07-2002</td>
<td>20</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664546904</td>
<td>131512020223Y000802</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>544</td>
<td>01-02-2023</td>
<td>014551</td>
<td>KENZIE HAGAI A.K</td>
<td>'3503041709150002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-09-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002734748739</td>
<td>131512020223Y000804</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>545</td>
<td>01-02-2023</td>
<td>015871</td>
<td>VINA REVIANA SAPUTRI</td>
<td>'3503044106150002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-06-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012950024</td>
<td>131512020223Y000805</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>546</td>
<td>02-02-2023</td>
<td>015358</td>
<td>TAMROATIN</td>
<td>'3503047010830002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-10-1983</td>
<td>39</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002600051534</td>
<td>131512020223Y000013</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>547</td>
<td>02-02-2023</td>
<td>003348</td>
<td>EVELIEN LAILATULL PUTRI</td>
<td>'</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-06-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002681674997</td>
<td>131512020223Y000014</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>548</td>
<td>02-02-2023</td>
<td>009313</td>
<td>AIDATUL FITRIYAH</td>
<td>'3503044801000001</td>
<td>23/12</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-01-2000</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664406201</td>
<td>131512020223Y000016</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>549</td>
<td>02-02-2023</td>
<td>016181</td>
<td>'3503046512990001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-12-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000665433472</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>550</td>
<td>02-02-2023</td>
<td>000119</td>
<td>FEBRY MUSTIKA NINGRUM</td>
<td>'3521025707960002</td>
<td>RT 01/01</td>
<td>DONGKO</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>17-02-1996</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000194083738</td>
<td>131512020223Y000418</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>551</td>
<td>06-02-2023</td>
<td>011757</td>
<td>'3503042211970002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>22-11-1997</td>
<td>25</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664429162</td>
<td>131512020223Y000068</td>
<td align='center'>
K04.6 </td>
<td align='center'>
Periapical abscess with sinus </td>
</tr>

<td>552</td>
<td>06-02-2023</td>
<td>014411</td>
<td>'3503045207110002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-07-2011</td>
<td>11</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0000664555781</td>
<td>131512020223Y000069</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>553</td>
<td>06-02-2023</td>
<td>000830</td>
<td>AZKA AL ZIKRA</td>
<td>'</td>
<td>PETUNG 23</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-04-2020</td>
<td>2</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0003064072454</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>554</td>
<td>06-02-2023</td>
<td>004729</td>
<td>DYAH YUNIARSIH</td>
<td>'3503046306940001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-05-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663050248</td>
<td>131512020223Y000807</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
<td>555</td>
<td>06-02-2023</td>
<td>011805</td>
<td>'</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-12-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665433472</td>
<td>131512020223Y000806</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>556</td>
<td>06-02-2023</td>
<td>013573</td>
<td>'3503043107150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-07-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>'0002063929184</td>
<td>131512020223Y000808</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>557</td>
<td>06-02-2023</td>
<td>016218</td>
<td>SOPIYAH</td>
<td>'3503014205720003-177972</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-05-1972</td>
<td>50</td>
<td>L</td>
<td>WIRASWASTA</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>558</td>
<td>07-02-2023</td>
<td>016226</td>
<td>PUTRI RAHMADHANI</td>
<td>'3503046606150002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-06-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012949899</td>
<td>131512020223Y000127</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>559</td>
<td>07-02-2023</td>
<td>000968</td>
<td>PITA DWI ASTUTIK</td>
<td>'3503046509950001</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-09-1995</td>
<td>27</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664402869</td>
<td>131512020223Y000128</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>560</td>
<td>07-02-2023</td>
<td>016228</td>
<td>MUHAMMAD RAIZA NURZAKI</td>
<td>'3503043004160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-04-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>561</td>
<td>07-02-2023</td>
<td>003348</td>
<td>EVELIEN LAILATULL PUTRI</td>
<td>'</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-06-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002681674997</td>
<td>131512020223Y000148</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>562</td>
<td>08-02-2023</td>
<td>000220</td>
<td>ALISHA AZKAYLA NADHIFA</td>
<td>'3503047112130004</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-12-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802744459</td>
<td>131512020223Y000126</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>563</td>
<td>11-02-2023</td>
<td>004729</td>
<td>'3503046306940001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-05-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663050248</td>
<td>131512020223Y000147</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>564</td>
<td>11-02-2023</td>
<td>016181</td>
<td>'3503046512990001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-12-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000665433472</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>565</td>
<td>13-02-2023</td>
<td>016281</td>
<td>GALIH KURNIAWAN</td>
<td>'3503042009120004</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-09-2012</td>
<td>10</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002158233142</td>
<td>131512020223Y000809</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>566</td>
<td>13-02-2023</td>
<td>016282</td>
<td>'3503045504890001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>15-04-1989</td>
<td>33</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665490295</td>
<td>131512020223Y000810</td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>567</td>
<td>13-02-2023</td>
<td>016283</td>
<td>PATONAH</td>
<td>'3503044407880001</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-07-1988</td>
<td>34</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665405976</td>
<td>131512020223Y000431</td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>568</td>
<td>13-02-2023</td>
<td>016285</td>
<td>KATIMIN</td>
<td>'3503041206550001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>12-06-1955</td>
<td>67</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0002741747229</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
</tr>

<td>569</td>
<td>14-02-2023</td>
<td>015516</td>
<td>AFIFA AILANI AZKA</td>
<td>'3503045409150001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>14-09-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003088495495</td>
<td>131512020223Y000290</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>570</td>
<td>14-02-2023</td>
<td>015065</td>
<td>NIZAM RAVA</td>
<td>'</td>
<td>RT 23/12</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>10-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>571</td>
<td>14-02-2023</td>
<td>007565</td>
<td>MARWIYAH</td>
<td>'3503047012480002</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>30-12-1948</td>
<td>74</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003011257001</td>
<td>131512020223Y000177</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>572</td>
<td>14-02-2023</td>
<td>012050</td>
<td>'3503042009160001</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>20-09-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002086479033</td>
<td>131512020223Y000812</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>573</td>
<td>14-02-2023</td>
<td>003523</td>
<td>SRI WAHYUNI</td>
<td>'3503046404920003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-04-1992</td>
<td>30</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664420634</td>
<td></td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>
<td>574</td>
<td>14-02-2023</td>
<td>015360</td>
<td>SUMINI</td>
<td>'3503044107810056</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-12-1984</td>
<td>38</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002158234086</td>
<td>131512020223Y000811</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>575</td>
<td>14-02-2023</td>
<td>015819</td>
<td>AFINA FAWWA RISKA </td>
<td>'3504094204000003</td>
<td>RT 01/01</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>02-04-2000</td>
<td>22</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>576</td>
<td>15-02-2023</td>
<td>000719</td>
<td>HAMDAN HILMI FREDIKA</td>
<td>'3503041403120002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-08-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002280984221</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>577</td>
<td>15-02-2023</td>
<td>014991</td>
<td>MELFIN</td>
<td>'</td>
<td>RT 07/02</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001975788944</td>
<td>131512020223Y000815</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>578</td>
<td>15-02-2023</td>
<td>014491</td>
<td>SITI MASITOH</td>
<td>'</td>
<td>DUSU KARANGSUDO 07/04</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-03-1987</td>
<td>36</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000664482622</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>579</td>
<td>16-02-2023</td>
<td>014960</td>
<td>SITI AMINAH</td>
<td>'3503044910940004</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-10-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>dr. Oskar Disti Putra</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665194454</td>
<td>131512020223Y000816</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>580</td>
<td>16-02-2023</td>
<td>016311</td>
<td>ROFIK KUNUHA</td>
<td>'3503041902050003</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>19-02-2005</td>
<td>18</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.0 </td>
<td align='center'>
</tr>

<td>581</td>
<td>16-02-2023</td>
<td>011805</td>
<td>'</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>25-12-1999</td>
<td>23</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665433472</td>
<td>131512020223Y000817</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>582</td>
<td>16-02-2023</td>
<td>013862</td>
<td>ROSIIN</td>
<td>'3503014507980003</td>
<td>KERTOSONO 34/10</td>
<td>KERTOSONO</td>
<td>PANGGUL</td>
<td>TRENGGALEK</td>
<td>05-07-1998</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002190220143</td>
<td>131512020223Y000818</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>583</td>
<td>16-02-2023</td>
<td>004729</td>
<td>'3503046306940001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-05-1994</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000663050248</td>
<td>131512020223Y000332</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>584</td>
<td>16-02-2023</td>
<td>016316</td>
<td>MAESWARI MUSTIMANGGALI</td>
<td>'3503044708160002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>07-08-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>585</td>
<td>20-02-2023</td>
<td>014991</td>
<td>MELFIN</td>
<td>'</td>
<td>RT 07/02</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>24-10-2015</td>
<td>7</td>
<td>L</td>
<td>POLI GIGI</td>
<td>dr. OCTIANTO</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001975788944</td>
<td>131512020223Y000819</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>586</td>
<td>20-02-2023</td>
<td>000719</td>
<td>HAMDAN HILMI FREDIKA</td>
<td>'3503041403120002</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>29-08-2017</td>
<td>5</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002280984221</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>587</td>
<td>20-02-2023</td>
<td>004744</td>
<td>NIMAS CHIKA OCTAVIA</td>
<td>'3503044510130001</td>
<td>RT 14/07</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-10-2013</td>
<td>9</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002682088885</td>
<td>131512020223Y000821</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>588</td>
<td>20-02-2023</td>
<td>006565</td>
<td>DEWI RAHAYU</td>
<td>'</td>
<td>KARANGSUDO</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-04-2008</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664693367</td>
<td>131512020223Y000822</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>589</td>
<td>21-02-2023</td>
<td>016381</td>
<td>TYAS NURYANI</td>
<td>'3503046812080001</td>
<td>TALUN, RT : 049,RW :018 </td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>28-12-2008</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0000666042546</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>590</td>
<td>22-02-2023</td>
<td>000358</td>
<td>CITRA EFA HUDAIFAH</td>
<td>'3503047101170001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>31-01-2017</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002221101044</td>
<td>131512020223Y000814</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>591</td>
<td>22-02-2023</td>
<td>016402</td>
<td>TUMINI</td>
<td>'3503046109600001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-09-1960</td>
<td>62</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664468277</td>
<td>131512020223Y000820</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>592</td>
<td>22-02-2023</td>
<td>016403</td>
<td>YUNITA WULANSARI</td>
<td>'3503045306910002</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>13-06-1991</td>
<td>31</td>
<td>P</td>
<td>KARYAWAN SWASTA</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>
<td>593</td>
<td>22-02-2023</td>
<td>002238</td>
<td>NADHIFA ALMAIRA KINARIAN</td>
<td>'3503046309170001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-09-2017</td>
<td>5</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002775138366</td>
<td>131512020223Y000813</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>594</td>
<td>22-02-2023</td>
<td>016406</td>
<td>ENY WATI</td>
<td>'3503046307850006</td>
<td>RT 02/01</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>23-07-1985</td>
<td>37</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.1 </td>
<td align='center'>
</tr>

<td>595</td>
<td>22-02-2023</td>
<td>016411</td>
<td>KURNIA SETYAWAN</td>
<td>'</td>
<td>KAMPAK</td>
<td>NGADIMULYO</td>
<td>KAMPAK</td>
<td>TRENGGALEK</td>
<td>22-05-2018</td>
<td>4</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>596</td>
<td>23-02-2023</td>
<td>014449</td>
<td>JAITUN</td>
<td>'3503044611810005</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>06-11-1981</td>
<td>41</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011256325</td>
<td>131512020223Y000385</td>
<td align='center'>
K05.2 </td>
<td align='center'>
</tr>

<td>597</td>
<td>23-02-2023</td>
<td>016373</td>
<td>JIYAH</td>
<td>'3503045807980002</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-07-1998</td>
<td>24</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002600747763</td>
<td>131512020223Y000384</td>
<td align='center'>
K03.6 </td>
<td align='center'>
</tr>

<td>598</td>
<td>24-02-2023</td>
<td>016423</td>
<td>JUVITA ARMADHANI</td>
<td>'</td>
<td>DUSUN KLANDRI 40/20</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-12-2005</td>
<td>17</td>
<td>P</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>

<td>599</td>
<td>24-02-2023</td>
<td>015479</td>
<td>KAILA ALMIRA MARIZA</td>
<td>'3503044910150001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>09-10-2015</td>
<td>7</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003088534713</td>
<td>131512020223Y000823</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>600</td>
<td>25-02-2023</td>
<td>016440</td>
<td>AZAM PUTRA AL FATIH</td>
<td>'</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>03-11-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002198364063</td>
<td>131512020223Y000799</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>601</td>
<td>25-02-2023</td>
<td>013783</td>
<td>ALYFA NUR HALIZA</td>
<td>'3503045810140002</td>
<td>SAMBI 37/14</td>
<td>PANDEAN</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>18-10-2014</td>
<td>8</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002860462203</td>
<td>131512020223Y000801</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>602</td>
<td>25-02-2023</td>
<td>006565</td>
<td>DEWI RAHAYU</td>
<td>'</td>
<td>KARANGSUDO</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>04-04-2008</td>
<td>14</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664693367</td>
<td>131512020223Y000894</td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>603</td>
<td>25-02-2023</td>
<td>015806</td>
<td>MUSTOFA AJI</td>
<td>'3503041604010003</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>16-04-2001</td>
<td>21</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.1 </td>
<td align='center'>
</tr>

<td>604</td>
<td>28-02-2023</td>
<td>016482</td>
<td>ADIT PUTRA PRATAMA</td>
<td>'3503042804140002</td>
<td>SALAMWATES</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>08-05-2014</td>
<td>8</td>
<td>L</td>
<td>POLI GIGI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003071756182</td>
<td>131512020223Y000798</td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>605</td>
<td>28-02-2023</td>
<td>006587</td>
<td>AHMAD ZAYYIN NAUFAL</td>
<td>'3503042604160001</td>
<td>WATUAGUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>26-04-2016</td>
<td>6</td>
<td>L</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>606</td>
<td>28-02-2023</td>
<td>003298</td>
<td>IDA</td>
<td>'3503044102950002</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>01-02-1995</td>
<td>28</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0000663492892</td>
<td></td>
<td align='center'>
K08.3 </td>
<td align='center'>
</tr>

<td>607</td>
<td>28-02-2023</td>
<td>015901</td>
<td>'3503046103160001</td>
<td>CAKUL</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>21-03-2016</td>
<td>6</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
</tr>

<td>608</td>
<td>28-02-2023</td>
<td>014498</td>
<td>FADYUN IMROATUL MUFIDAH</td>
<td>'3503044505100003</td>
<td>PETUNG</td>
<td>DONGKO</td>
<td>TRENGGALEK</td>
<td>05-05-2010</td>
<td>12</td>
<td>P</td>
<td>POLI GIGI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003267298157</td>
<td>131512020223Y000824</td>
<td align='center'>
K04.0 </td>
<td align='center'>
</tr>
</table>

Laporan Eling PKM Pandean Juni 2022-Feb 2023

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