<table class='tabel' width='90%'>

<tr class="form">
<td align="center" colspan="9">
<big><big><span style="font-weight: bold;">
LAPORAN UNIVERSAL POLI GIGI<br>
BULAN 01-05-2023 - 31-05-2023 </span></big></big>
</td>
</tr>
</table>
<table align='center'>
<tr>
<td>Total</td>
<td>:</td>
<td>212</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<br>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>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>014096</td>
<td>MUHAMMAD ZAFRON</td>
<td>'3503052202160001</td>
<td>RT 004 RW 001</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-02-2016</td>
<td>7</td>
 <td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002058933418</td>
<td>131506010523Y000058</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>2</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026772</td>
<td>KAYATI</td>
<td>'3503055304750001</td>
<td>RT 40 RW 7</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>13-04-1975</td>
<td>48</td>
<td>P</td>
<td>Petani / Pekebun</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>3</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>016912</td>
<td>DILHAM EDO NUGROHO</td>
<td>'3503051306020002</td>
<td>DESA WINONG, RT : 8,RW :3 </td>
<td>WINONG</td>
<td>TUGU</td>
 <td>TRENGGALEK</td>
<td>13-06-2002</td>
<td>20</td>
<td>L</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666014826</td>
<td>131506010523Y000066</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>4</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>013103</td>
<td>MUHAMMAD ARKA SAPUTRA</td>
<td>'3503052509160001</td>
<td>RT 019 RW 008</td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>25-09-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002087563487</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>5</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026792</td>
<td>ASYFINA ZAHRA EL AQEELA</td>
 <td>'</td>
<td>RT 021 RW 004</td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-07-2016</td>
<td>6</td>
<td>P</td>
<td>PELAJAR</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>6</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>016690</td>
<td>YANIS WAHYU RAMADHANI (1)</td>
<td>'3503146601980001</td>
<td>RT 44 RW 09</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-01-1998</td>
<td>25</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>'0003285100146</td>
<td>131506010523Y001693</td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>7</td>
<td>02-05-2023</td>
 <td>PUSKESMAS TUGU</td>
<td>026793</td>
<td>EKA SUSANTIYANI</td>
<td>'3503055810850003</td>
<td>SOOKO, RT : 44,RW :9 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>18-10-1985</td>
<td>37</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0002322049893</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>8</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>023157</td>
<td>DENOK AZKA ZAINA PUTRI</td>
<td>'3503054505170001</td>
<td>RT 03 RW 01</td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-05-2017</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002247655072</td>
<td>131506010523Y000880</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>
<tr align="left" valign="top">
<td>9</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>022783</td>
<td>CAECILIA ASKA FAYOLA</td>
<td>'</td>
<td>RT 01 RW 03</td>
<td>TEMPURAN</td>
<td>SAWOO</td>
<td>PONOROGO</td>
<td>14-10-2014</td>
<td>8</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>10</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026794</td>
<td>ARGIA WICAHYA</td>
<td>'3503050705140001</td>
<td>RT 08 RW 04</td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>07-05-2014</td>
<td>9</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>
</tr>

<tr align="left" valign="top">

<td>11</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>022488</td>
<td>TIARA PUTRI RAMADHANI</td>
<td>'</td>
<td>RT 09 RW 02</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-06-2016</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>12</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004173</td>
<td>MUYANI</td>
<td>'3503062104790002</td>
<td>DESA SUMBER, RT : 2,RW :1 </td>
<td>SUMBER</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>21-04-1979</td>
<td>44</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PEKERJA MANDIRI</td>
<td>'0002500287041</td>
<td></td>
<td align='center'>
K04.4 </td>
 <td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>13</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>017854</td>
<td>FANO FRADANA</td>
<td>'3503052406160002</td>
<td>RT 02 RW 02</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-06-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002069126594</td>
<td>131506010523Y000883</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>14</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>010009</td>
<td>KHARIROTUL MAULAWIYATIL KINDA</td>
<td>'</td>
<td>RT 014 RW 004</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-09-2007</td>
<td>15</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
 <td>'0001079979491</td>
<td>131506010523Y000884</td>
<td align='center'>
K04.1 </td>
<td align='center'>
<font color='black'>Necrosis of pulp</font> </td>

</tr>

<tr align="left" valign="top">

<td>15</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026796</td>
<td>NOVIA CINDY MAHADIRA</td>
<td>'3515114711050002</td>
<td>DUSUN JUMOK, RT : 9,RW :4 </td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>07-11-2005</td>
<td>17</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>General medical examination</font> </td>

</tr>

<tr align="left" valign="top">

<td>16</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>016551</td>
<td>JIHAN MAFTUHAH CHLORE</td>
<td>'3503085612000003</td>
<td>RT 12RW 03</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>16-12-2000</td>
<td>22</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>17</td>
<td>02-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026799</td>
<td>FAIZAL FARIS MUSTOFA</td>
<td>'3503051912150002</td>
<td>DUSUN KEBONSARI, RT : 23,RW :6 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>19-12-2015</td>
<td>7</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003186309137</td>
<td>131506010523Y000061</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>18</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>022117</td>
<td>BAMBANG SETYANTO</td>
<td>'3507183110590001</td>
<td>RT 02 RW 01</td>
<td>BULUAGUNG</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>31-10-1959</td>
<td>63</td>
<td>L</td>
<td>Pensiunan</td>
 <td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000111832435</td>
<td>131506010523Y000165</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>19</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>001061</td>
<td>SITI AMINAH</td>
<td>'</td>
<td>RT 20 RW 05</td>
<td>KARANGSOKO</td>
<td>TRENGGALEK</td>
<td>TRENGGALEK</td>
<td>12-02-1976</td>
<td>47</td>
<td>P</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000149233419</td>
<td>131506010523Y000105</td>
<td align='center'>
K04.1 </td>
<td align='center'>
<font color='black'>Necrosis of pulp</font> </td>

</tr>

<tr align="left" valign="top">

<td>20</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>005896</td>
<td>DENISAFAROS NUR JABBAR</td>
<td>'</td>
<td>RT 20 RW 5</td>
<td>KARANGSOKO</td>
<td>TRENGGALEK</td>
<td>TRENGGALEK</td>
<td>03-06-2008</td>
 <td>15</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000163752052</td>
<td>131506010523Y000166</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>21</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>011308</td>
<td>HANA PRAMUDHA WARDHANI</td>
<td>'3503056309120001</td>
<td>KEBONSARI, RT : 24,RW :5 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>23-09-2012</td>
<td>10</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003064357811</td>
<td>131506010523Y000169</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>22</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>016467</td>
<td>SLAMET SANUSI</td>
<td>'3503050401710001</td>
<td>RT 48</td>
<td>PRAMBON</td>
 <td>TUGU</td>
<td>TRENGGALEK</td>
<td>10-09-1970</td>
<td>52</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666314065</td>
<td>131506010523Y000173</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>23</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026808</td>
<td>FADHLI NAILUL HUDA</td>
<td>'3503051605120003</td>
<td>DESA GONDANG, RT : 25,RW :6 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>16-05-2012</td>
<td>11</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003012958168</td>
<td>131506010523Y000176</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>24</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026269</td>
 <td>ANDIKA DWI SAMSU SAPUTRA</td>
<td>'3503055701030001</td>
<td>DUSUN KRAJAN, RT : 5,RW :1 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>17-01-2003</td>
<td>20</td>
<td>L</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PEKERJA MANDIRI</td>
<td>'0002226051753</td>
<td></td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>25</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>008131</td>
<td>NASIFA MULIA AZ ZAHRA</td>
<td>'3503055401150001</td>
<td>RT 53 RW 11</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>14-01-2015</td>
<td>8</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802763102</td>
<td>131506010523Y000182</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>26</td>
 <td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009599</td>
<td>VEVI KANIA PUTRI RAMADHANI</td>
<td>'3503056407140001</td>
<td>SOOKO, RT : 48,RW :10 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-07-2014</td>
<td>8</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>27</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006031</td>
<td>SUPANGAT </td>
<td>'3503052304620001</td>
<td>RT 04 RW 01</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>23-04-1962</td>
<td>61</td>
<td>L</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106840247</td>
<td>131506010523Y000194</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>
<tr align="left" valign="top">
<td>28</td>
<td>03-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>011575</td>
<td>MUHAMMAD SYAFIQ</td>
<td>'</td>
<td>RT 28 RW 07</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>19-02-2017</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>29</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009454</td>
<td>SUYANTO HENDRIAWAN</td>
<td>'3503051305950001</td>
<td>DUSUN KRAJAN, RT : 5,RW :2 </td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>13-05-1995</td>
<td>28</td>
<td>L</td>
<td>Karyawan Swasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665829639</td>
<td>131506010523Y000255</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>30</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>016722</td>
<td>ERJAWANTO</td>
<td>'3503052412830002</td>
<td>DESA WINONG, RT : 9,RW :3 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-12-1983</td>
<td>39</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001978898668</td>
<td>131506010523Y000262</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>31</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025475</td>
<td>AITUN DEPI NOFITA</td>
<td>'3503056511950002</td>
<td>SOOKO, RT : 45,RW :9 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>25-11-1995</td>
<td>27</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
 <td></td>
<td align='center'>
E11.9 </td>
<td align='center'>
<font color='red'>Non-insulin-dependent diabetes mellitus without
complications</font> </td>

</tr>

<tr align="left" valign="top">

<td>32</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024063</td>
<td>ISTI ROHMAH</td>
<td>'3503054811700001</td>
<td>DESA WINONG KECAMATAN TUGU, RT : 1,RW :1 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-11-1970</td>
<td>52</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001037007617</td>
<td>131506010523Y000265</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>33</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>023368</td>
<td>NUR MAWADAH</td>
<td>'3503056604940004</td>
<td>RT 04 RW 01</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-04-1994</td>
<td>29</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>34</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>005477</td>
<td>PRINCSA KAULIN NURINDANING LANGIT</td>
<td>'3503054907160002</td>
<td>RT 6</td>
<td>TEGAREN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-07-2016</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0002762188345</td>
<td>131506010523Y000268</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>35</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>010172</td>
<td>PUTRA FAJAR RIADI</td>
<td>'3503062904160002</td>
<td>DUSUN KRAJAN, RT : 7,RW :1 </td>
<td>KERJO</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>29-04-2016</td>
<td>7</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
 <td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>36</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>013426</td>
<td>BUDIANA</td>
<td>'3503051602660004</td>
<td>RT 15 RW 4</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>16-02-1966</td>
<td>57</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802761357</td>
<td>131506010523Y000271</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>37</td>
<td>04-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004319</td>
<td>SITI MUAWANAH</td>
<td>' 3503055907660001</td>
<td>DUSUN KEBONSARI, RT : 31,RW :8 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
 <td>19-07-1966</td>
<td>56</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666205806</td>
<td>131506010523Y000276</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>38</td>
<td>05-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006483</td>
<td>AQILA YURISTA RAHMADHANI</td>
<td>'3503054607150001</td>
<td>DUSUN JUMOK, RT : 9,RW :4 </td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-07-2015</td>
<td>7</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>39</td>
<td>05-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003970</td>
<td>RIZQINA DWI UMAMI</td>
<td>'3503115901940001</td>
<td>RT 44 RW 9</td>
 <td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>19-01-1994</td>
<td>29</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>40</td>
<td>05-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>008361</td>
<td>ESTI RAHAYU</td>
<td>'3503054611830001</td>
<td>TENGGAR, RT : 3,RW :1 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-11-1983</td>
<td>39</td>
<td>P</td>
<td>Karyawan Swasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665995656</td>
<td>131506010523Y000285</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>41</td>
<td>05-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026857</td>
 <td>SAFIRA AULIA AZZAHRA</td>
<td>'3503056609160001</td>
<td>DUSUN BENGGLE, RT : 11,RW :4 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-09-2016</td>
<td>6</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002088141311</td>
<td>131506010523Y000292</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>42</td>
<td>05-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>012030</td>
<td>YOGA PRASETYA</td>
<td>'3503051201070002</td>
<td>TAWANG, RT : 2,RW :1 </td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-01-2007</td>
<td>16</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802767229</td>
<td>131506010523Y000293</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>43</td>
 <td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026867</td>
<td>DADANG TRIHATMOKO (1)</td>
<td>'3503052810890001</td>
<td>RT 026 RW 006</td>
<td>ARSO KOTA</td>
<td>ARSO</td>
<td>KEEROM</td>
<td>28-10-1989</td>
<td>33</td>
<td>L</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS PUSAT</td>
<td>'0001633141686</td>
<td>131506010523Y000325</td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>44</td>
<td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>002746</td>
<td>SUHARTINI</td>
<td>'3503056510690002</td>
<td>RT 5 RW 2</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>25-10-1969</td>
<td>53</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106528869</td>
<td>131506010523Y000330</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>
<tr align="left" valign="top">
<td>45</td>
<td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>014306</td>
<td>NIKITA FITROTUN NUR`AINI</td>
<td>'</td>
<td>RT 007 RW 003</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>20-09-2011</td>
<td>11</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>46</td>
<td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>010571</td>
<td>VERNANDO ULIN NUHA</td>
<td>'3503050804170005</td>
<td>RT 09 RW 02</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-04-2017</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002239834588</td>
<td>131506010523Y000961</td>
<td align='center'>
k04.5 </td>
<td align='center'>
<font color='black'>Chronic apical periodontitis</font> </td>
</tr>

<tr align="left" valign="top">

<td>47</td>
<td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009515</td>
<td>SUNWARI VITA SRIWIRATMI</td>
<td>'3503056301870002</td>
<td>DUSUN GONDANG, RT : 9,RW :2 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>23-01-1987</td>
<td>36</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665416271</td>
<td>131506010523Y000962</td>
<td align='center'>
K04.5 </td>
<td align='center'>
<font color='black'>Chronic apical periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>48</td>
<td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006385</td>
<td>IFFAN ANANDA NIZAM PRASETYA</td>
<td>'3504092208140003</td>
<td>RT 13 RW 03</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-08-2014</td>
<td>8</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>49</td>
<td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>019918</td>
<td>NABILLA HANUN FIDIAWATI</td>
<td>'3503056304160001</td>
<td>DUSUN JUMOK, RT : 6,RW :3 </td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>23-04-2016</td>
<td>7</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002208129399</td>
<td>131506010523Y000331</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>50</td>
<td>06-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>001248</td>
<td>WILDAN AJI PRASETYO</td>
<td>'3503050404150001</td>
<td>DUSUN TENGGAR, RT : 4,RW :1 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>04-04-2015</td>
<td>8</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>51</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>013426</td>
<td>BUDIANA</td>
<td>'3503051602660004</td>
<td>RT 15 RW 4</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>16-02-1966</td>
<td>57</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802761357</td>
<td>131506010523Y000388</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>52</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003356</td>
<td>ISMIATUN</td>
<td>'3503056212730001</td>
<td>DUSUN KRAJAN, RT : 15,RW :4 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-12-1973</td>
<td>49</td>
<td>P</td>
<td>Karyawan Swasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
 <td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802761368</td>
<td>131506010523Y000389</td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>53</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025947</td>
<td>ANTIKA FELICIA PUTRI</td>
<td>'</td>
<td>RT 05 RW 02</td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>31-12-2016</td>
<td>6</td>
<td></td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>54</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009841</td>
<td>SALMA DWI RAHMA</td>
<td>'3503056903150002</td>
<td>DUSUN PAKEL, RT : 27,RW :5 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>29-03-2015</td>
<td>8</td>
<td>P</td>
 <td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011260239</td>
<td>131506010523Y000391</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>55</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>014857</td>
<td>ANGGUN PUTRI UTAMI</td>
<td>'3503056404050001</td>
<td>BEJI, RT : 18,RW :8 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-04-2005</td>
<td>18</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666408036</td>
<td>131506010523Y000393</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>56</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026900</td>
<td>AGUNG WAHYU PRASETYO</td>
<td>'1608030609000002</td>
<td>RT 007 RW 002</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
 <td>TRENGGALEK</td>
<td>06-09-2000</td>
<td>22</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>57</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026904</td>
<td>AFSHA AFIFAH PANGESTI</td>
<td>'3503055811110002</td>
<td>DUSUN KRAJAN, RT : 5,RW :2 </td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>18-11-2011</td>
<td>11</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>'0003509929697</td>
<td>131506010523Y000386</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>58</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025458</td>
<td>AZALEA NAURA SETYA</td>
<td>'3503055811160001</td>
 <td>DUSUN GONDANG KIDUL, RT : 10,RW :2 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>18-11-2016</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>59</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026908</td>
<td>WAHYU HIDAYAT</td>
<td>'8171011909880001</td>
<td>DSN KRAJAN, RT : 004,RW :002 </td>
<td>TEGAREN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>19-09-1988</td>
<td>34</td>
<td>L</td>
<td>WIRASWASTA</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>60</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
 <td>026912</td>
<td>MUHAMMAD AL HAKIIM</td>
<td>'3503113108040003</td>
<td>KRAJAN, RT : 1,RW :1 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>31-08-2004</td>
<td>18</td>
<td>L</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106570135</td>
<td>131506010523Y000694</td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>61</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024156</td>
<td>LEON LANGIT PUTRA</td>
<td>'3503051712160001</td>
<td>JAMBU, RT : 022,RW :008 </td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>17-12-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

 <td>62</td>
<td>08-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>013924</td>
<td>MARCELIA ANGELICA</td>
<td>'</td>
<td>RT 20 RW 07</td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>29-11-2015</td>
<td>7</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>63</td>
<td>09-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026948</td>
<td>PUTRI AYUDISA PARMADITA</td>
<td>'3503055210190001</td>
<td>RT 13 RW 04</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-10-2019</td>
<td>3</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>ANGGOTA POLRI</td>
<td>'0003062487519</td>
<td>131506010523Y000644</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>
</tr>

<tr align="left" valign="top">

<td>64</td>
<td>09-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026952</td>
<td>ADIVA AFSHEN MYESHA</td>
<td>'</td>
<td>RT 026 RW 011</td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>31-05-2015</td>
<td>8</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
Z00.0 </td>
<td align='center'>
<font color='black'>General medical examination</font> </td>

</tr>

<tr align="left" valign="top">

<td>65</td>
<td>09-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>000511</td>
<td>LAURA ANASTASYA NAUFA BELLA</td>
<td>'3503054909140001</td>
<td>DUSUN KALIPINGGIR, RT : 18,RW :5 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-09-2014</td>
<td>8</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0001865446784</td>
<td>131506010523Y000650</td>
<td align='center'>
K00.6 </td>
<td align='center'>
 <font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>66</td>
<td>09-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>011820</td>
<td>REGA FEBRI VALENTINO</td>
<td>'3503051102160001</td>
<td>DUSUN MLOKO, RT : 52,RW :11 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-02-2016</td>
<td>7</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002681899648</td>
<td>131506010523Y000651</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>67</td>
<td>09-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>021873</td>
<td>SUPARTI</td>
<td>'3172064604700007</td>
<td>RT 11 RW 03</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-04-1970</td>
<td>53</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001327438012</td>
<td>131506010523Y000653</td>
 <td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>68</td>
<td>09-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026576</td>
<td>AINAYYA ALVI FIKRIA RABBANI (2)</td>
<td>'</td>
<td>DUKUH SEMANDING 1/2 TEMPURAN, SAWOO</td>
<td>SAWOO</td>
<td>SAWOO</td>
<td>PONOROGO</td>
<td>10-04-2017</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>KEPALA DESA DAN PERANGKAT DESA</td>
<td>'0002625889702</td>
<td>131506010523Y000658</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
<font color='black'>General medical examination</font> </td>

</tr>

<tr align="left" valign="top">

<td>69</td>
<td>09-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>014306</td>
<td>NIKITA FITROTUN NUR`AINI</td>
<td>'</td>
<td>RT 007 RW 003</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>20-09-2011</td>
<td>11</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>70</td>
<td>10-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009515</td>
<td>SUNWARI VITA SRIWIRATMI</td>
<td>'3503056301870002</td>
<td>DUSUN GONDANG, RT : 9,RW :2 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>23-01-1987</td>
<td>36</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665416271</td>
<td>131506010523Y000761</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>71</td>
<td>10-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>014857</td>
<td>ANGGUN PUTRI UTAMI</td>
<td>'3503056404050001</td>
<td>BEJI, RT : 18,RW :8 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-04-2005</td>
<td>18</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
 <td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666408036</td>
<td>131506010523Y000762</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>72</td>
<td>10-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027060</td>
<td>ERLYTA ARSYFA SALSABILA</td>
<td>'</td>
<td>RT 016 RW 006</td>
<td>DERMOSARI</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>15-01-2017</td>
<td>6</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>73</td>
<td>10-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>021789</td>
<td>ASKA SAFIYA</td>
<td>'</td>
<td>RT 014 RW 004</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-11-2015</td>
 <td>7</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>74</td>
<td>11-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>002322</td>
<td>MAHARDIKA ZAIN PRAKOSA</td>
<td>'3503061112140001</td>
<td>RT 09 RW 03</td>
<td>SALAMREJO</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>11-12-2014</td>
<td>8</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0001966585926</td>
<td>131506010523Y000751</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>75</td>
<td>11-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024063</td>
<td>ISTI ROHMAH</td>
<td>'3503054811700001</td>
<td>DESA WINONG KECAMATAN TUGU, RT : 1,RW :1 </td>
<td>WINONG</td>
 <td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-11-1970</td>
<td>52</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001037007617</td>
<td>131506010523Y000754</td>
<td align='center'>
K00.4 </td>
<td align='center'>
<font color='black'>Disturbances in tooth formation</font> </td>

</tr>

<tr align="left" valign="top">

<td>76</td>
<td>11-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003970</td>
<td>RIZQINA DWI UMAMI</td>
<td>'3503115901940001</td>
<td>RT 44 RW 9</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>19-01-1994</td>
<td>29</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>77</td>
<td>11-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027085</td>
<td>SUKARTONO</td>
 <td>'3503051108650004</td>
<td>MLOKO, RT : 59,RW :12 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-08-1965</td>
<td>57</td>
<td>L</td>
<td>Petani/Pekebun</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666941534</td>
<td>131506010523Y000755</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>78</td>
<td>11-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026900</td>
<td>AGUNG WAHYU PRASETYO</td>
<td>'1608030609000002</td>
<td>RT 007 RW 002</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-09-2000</td>
<td>22</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>79</td>
<td>11-05-2023</td>
 <td>PUSKESMAS TUGU</td>
<td>017674</td>
<td>ADILA NISA AZZAHRA</td>
<td>'3503054110150001</td>
<td>DUSUN KRAJAN II, RT : 28,RW :7 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>01-10-2015</td>
<td>7</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>80</td>
<td>12-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027122</td>
<td>RISA AYU AGUSTIN</td>
<td>'3503055409000001</td>
<td>DUSUN BEJI, RT : 17,RW :7 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>14-09-2000</td>
<td>22</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666148667</td>
<td>131506010523Y000728</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>
<tr align="left" valign="top">
<td>81</td>
<td>12-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>010469</td>
<td>WIRYAMANTA HAMZAH</td>
<td>'3503050306150001</td>
<td>RT 04 RW 02</td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>03-06-2015</td>
<td>8</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0001850207242</td>
<td>131506010523Y000746</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>82</td>
<td>12-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027129</td>
<td>IMAM MALIK</td>
<td>'3503051512760004</td>
<td>RT 07 RW 03</td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>15-12-1973</td>
<td>49</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Deposits [accretions] on teeth</font> </td>
</tr>

<tr align="left" valign="top">

<td>83</td>
<td>12-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027131</td>
<td>ELANG DUTRA RAHARJO</td>
<td>'</td>
<td>RT 011 RW 003</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>30-04-2016</td>
<td>7</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>84</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>010996</td>
<td>SITI JUARIYAH</td>
<td>'3503056202800002</td>
<td>TENGGAR, RT : 2,RW :1 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-02-1980</td>
<td>43</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003064259812</td>
<td>131506010523Y000847</td>
<td align='center'>
 K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>85</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>018802</td>
<td>HILMAN DZANNADHOR</td>
<td>'3503050504170001</td>
<td>TENGGAR, RT : 2,RW :1 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-04-2017</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003064259924</td>
<td>131506010523Y000848</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>86</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>018863</td>
<td>NAHDHIYATUR ROSYIIDAH</td>
<td>'3503056112150001</td>
<td>TENGGAR, RT : 2,RW :1 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>21-12-2015</td>
<td>7</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
 <td>'0003064259957</td>
<td>131506010523Y000849</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>87</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027138</td>
<td>MESINEM</td>
<td>'3503057112520013</td>
<td>DUSUN TENGGAR, RT : 5,RW :1 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>31-12-1952</td>
<td>70</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PRAJURIT AL</td>
<td>'0002056104797</td>
<td>131506010523Y000850</td>
<td align='center'>
K06.2 </td>
<td align='center'>
<font color='black'>Gingival and edentulous alveolar ridge lesions
associated with trauma</font> </td>

</tr>

<tr align="left" valign="top">

<td>88</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027139</td>
<td>SRI UTAMI</td>
<td>'3503055107720005</td>
<td>DUSUN KRAJAN, RT : 003,RW :001 </td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-07-1972</td>
<td>50</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
 <td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K07.4 </td>
<td align='center'>
<font color='black'>Malocclusion, unspecified</font> </td>

</tr>

<tr align="left" valign="top">

<td>89</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>020481</td>
<td>AZRINA KOTRUNADA </td>
<td>'</td>
<td>RT 21 RW 04</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>19-08-2016</td>
<td>6</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>90</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>011132</td>
<td>RIFQI HANIF WICAKSONO</td>
<td>'3503052808140003</td>
<td>RT 15 RW 04</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>28-08-2014</td>
<td>8</td>
<td>L</td>
 <td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001978457027</td>
<td>131506010523Y000851</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
<font color='black'>General medical examination</font> </td>

</tr>

<tr align="left" valign="top">

<td>91</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>011133</td>
<td>RIFAI HANIF SETIAJI</td>
<td>'3503052808140002</td>
<td>RT 15 RW 04</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>28-08-2014</td>
<td>8</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001978457016</td>
<td>131506010523Y000852</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>92</td>
<td>13-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027146</td>
<td>ASHILLA ANINDYA NAURA SAKILA</td>
<td>'</td>
<td>RT 12 RW 03</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
 <td>31-08-2015</td>
<td>7</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>93</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027163</td>
<td>MUHAMMAD AZHAR ALIF ALGHOZALI</td>
<td>'</td>
<td>RT 006 RW </td>
<td>KOTA BANGUN III</td>
<td>KOTA BANGUN</td>
<td>KUTAI KARTANEGARA</td>
<td>22-04-2007</td>
<td>16</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Necrosis of pulp</font> </td>

</tr>

<tr align="left" valign="top">

<td>94</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027165</td>
<td>LILIS SOFAQOHIRIYAH (1)</td>
<td>'3503056705920002</td>
<td>DUSUN SANGGRAHAN, RT : 6,RW :2 </td>
 <td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>27-05-1992</td>
<td>31</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS PUSAT</td>
<td>'0000665947179</td>
<td>131506010523Y001269</td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>95</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026786</td>
<td>MIFTAHUL ULUM AZHARI</td>
<td>'3503050907990002</td>
<td>DUSUN KALIPINGGIR, RT : 19,RW :5 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-07-1999</td>
<td>23</td>
<td>L</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802765003</td>
<td>131506010523Y001270</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>96</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>023185</td>
 <td>ARJUNA ARYA SATYA</td>
<td>'</td>
<td>RT 21 RW 08</td>
<td>DERMOSARI</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>07-11-2019</td>
<td>3</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>97</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027175</td>
<td>SITI KOMARIYAH</td>
<td>'3503054711990001</td>
<td>RT 57 RW 12</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>07-11-1999</td>
<td>23</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

 <td>98</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027173</td>
<td>INTAN JULIA BRILIANTI</td>
<td>'3503054307040003</td>
<td>RT 003 RW 002</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>03-07-2004</td>
<td>18</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665758607</td>
<td>131506010523Y001271</td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>99</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027177</td>
<td>ALFIAN NURDIANSYAH</td>
<td>'3503051309060001</td>
<td>DESA WINONG, RT : 1,RW :1 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>13-09-2006</td>
<td>16</td>
<td>L</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001978896936</td>
<td>131506010523Y001272</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>
</tr>

<tr align="left" valign="top">

<td>100</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>022255</td>
<td>MUHAMMAD SAKA ARDANI</td>
<td>'</td>
<td>RT 09 RW 03</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>15-09-2015</td>
<td>7</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>101</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004740</td>
<td>LESTARI</td>
<td>'6472035702900003</td>
<td>DUSUN CORAH MULYO, RT : 1,RW :1 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>17-02-1990</td>
<td>33</td>
<td>P</td>
<td>Karyawan Swasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666102789</td>
<td>131506010523Y001273</td>
<td align='center'>
K01.1 </td>
<td align='center'>
 <font color='black'>Impacted teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>102</td>
<td>15-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027181</td>
<td>WINARTI</td>
<td>'3503055203770002</td>
<td>RT 004 RW 001</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-03-1977</td>
<td>46</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>103</td>
<td>16-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026792</td>
<td>ASYFINA ZAHRA EL AQEELA</td>
<td>'</td>
<td>RT 021 RW 004</td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-07-2016</td>
<td>6</td>
<td>P</td>
<td>PELAJAR</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>104</td>
<td>16-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>022117</td>
<td>BAMBANG SETYANTO</td>
<td>'3507183110590001</td>
<td>RT 02 RW 01</td>
<td>BULUAGUNG</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>31-10-1959</td>
<td>63</td>
<td>L</td>
<td>Pensiunan</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000111832435</td>
<td>131506010523Y001276</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>105</td>
<td>16-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025734</td>
<td>SALMA KIRANA AYU PRAMESTI</td>
<td>'3503055206140001</td>
<td>DUSUN GONDANG KIDUL, RT : 10,RW :2 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-06-2014</td>
<td>8</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>106</td>
<td>16-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>005501</td>
<td>NUR AHMAD FUADI</td>
<td>'3503051412050003</td>
<td>DUSUN KRAJAN, RT : 9,RW :3 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>14-12-2005</td>
<td>17</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666383286</td>
<td>131506010523Y001277</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>107</td>
<td>16-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>020487</td>
<td>CALISTA VANIA ALZAIRAH</td>
<td>'3503054512160001</td>
<td>DUSUN KRAJAN, RT : 21,RW :4 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-12-2016</td>
<td>6</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
 <td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>108</td>
<td>16-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>021996</td>
<td>ANANG DWI CAHYO</td>
<td>'3503052912150001</td>
<td>DESA WINONG, RT : 7,RW :3 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>29-12-2015</td>
<td>7</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003186309508</td>
<td>131506010523Y001278</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>109</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027215</td>
<td>ADZKIA BILQIS RAHAYUNINGTYAS</td>
<td>'3503056102190001</td>
<td>RT 15 RW 06</td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>21-02-2019</td>
<td>4</td>
 <td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0003067612828</td>
<td>131506010523Y001288</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>110</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006930</td>
<td>HOLIDAH</td>
<td>'3526164107900564</td>
<td>KEBONSARI, RT : 21,RW :5 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>01-07-1990</td>
<td>32</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>'0001959685569</td>
<td>131506010523Y001689</td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>111</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009841</td>
<td>SALMA DWI RAHMA</td>
<td>'3503056903150002</td>
<td>DUSUN PAKEL, RT : 27,RW :5 </td>
<td>PRAMBON</td>
<td>TUGU</td>
 <td>TRENGGALEK</td>
<td>29-03-2015</td>
<td>8</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003011260239</td>
<td>131506010523Y001291</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>112</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027222</td>
<td>NURUL HIDAYAH</td>
<td>'9106125509730001</td>
<td>RT 18 RW 05</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>15-09-1973</td>
<td>49</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PRAJURIT AD</td>
<td>'0001390413273</td>
<td>131506010523Y001292</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>113</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006166</td>
<td>LUTFIYATUL MUKAROMAH</td>
<td>'3503054409120001</td>
 <td>DUSUN PAKEL, RT : 35,RW :6 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>04-09-2012</td>
<td>10</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>114</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>021953</td>
<td>YUMNA AQRA NABIHA</td>
<td>'3503076902160001</td>
<td>PRAMBON, RT : 29,RW :5 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>29-02-2016</td>
<td>7</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>115</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
 <td>012937</td>
<td>EARLYTA MYESHA APRILIANI</td>
<td>'3503056504130001</td>
<td>DUSUN JUMOK, RT : 9,RW :4 </td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>25-04-2013</td>
<td>10</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003067885653</td>
<td>131506010523Y001293</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>116</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>013103</td>
<td>MUHAMMAD ARKA SAPUTRA</td>
<td>'3503052509160001</td>
<td>RT 019 RW 008</td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>25-09-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0002087563487</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

 <td>117</td>
<td>17-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>002104</td>
<td>MUSLIMAH</td>
<td>'3503056005720002</td>
<td>KARANGPLOSO, RT : 012,RW :004 </td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>20-05-1972</td>
<td>51</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106539344</td>
<td>131506010523Y001294</td>
<td align='center'>
Z00.1 </td>
<td align='center'>
<font color='black'>Routine child health examination</font> </td>

</tr>

<tr align="left" valign="top">

<td>118</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026808</td>
<td>FADHLI NAILUL HUDA</td>
<td>'3503051605120003</td>
<td>DESA GONDANG, RT : 25,RW :6 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>16-05-2012</td>
<td>11</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003012958168</td>
<td>131506010523Y001301</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>
</tr>

<tr align="left" valign="top">

<td>119</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027245</td>
<td>TUTIK ALAWIYAH</td>
<td>'3503055206780001</td>
<td>DESA GONDANG, RT : 25,RW :6 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-06-1978</td>
<td>44</td>
<td>P</td>
<td>Petani/Pekebun</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665851994</td>
<td>131506010523Y001302</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>120</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>019204</td>
<td>FATIMAH</td>
<td>'3503135103790001</td>
<td>RT 02 RW 02</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-03-1979</td>
<td>44</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665927458</td>
<td>131506010523Y001303</td>
<td align='center'>
K05.3 </td>
 <td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>121</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027246</td>
<td>AVRILYA WULANDARY</td>
<td>'</td>
<td>RT 029 RW RW 015</td>
<td>PULE</td>
<td>PULE</td>
<td>TRENGGALEK</td>
<td>05-04-2010</td>
<td>13</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>122</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>002160</td>
<td>ARIL DWI SAPUTRA</td>
<td>'3503052705160001</td>
<td>KRAJAN, RT : 7,RW :2 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>27-05-2015</td>
<td>8</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002212048383</td>
 <td>131506010523Y001307</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>123</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>005233</td>
<td>ANGGER AMUKTI WICAKSONO</td>
<td>'3503052401150002</td>
<td>DESA WINONG, RT : 2,RW :1 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-01-2015</td>
<td>8</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003067626846</td>
<td>131506010523Y001308</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>124</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027255</td>
<td>CLEMIRA SOFIA (2)</td>
<td>'3503054509180001</td>
<td>RT 05 RW 02</td>
<td>DERMOSARI</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-09-2018</td>
<td>4</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
 <td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0002492477785</td>
<td>131506010523Y001311</td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>125</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>020083</td>
<td>NAURA NAHDA RAFANDA</td>
<td>'3503056603160002</td>
<td>PRAMBON RT 6/1</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-03-2016</td>
<td>7</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0003011605727</td>
<td>131506010523Y001313</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>126</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006868</td>
<td>DWINARTI</td>
<td>'3503056204800003</td>
<td>SOOKO, RT : 44,RW :9 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-04-1980</td>
<td>43</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
 <td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>127</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027260</td>
<td>NILA NUR EKA SETYARINI</td>
<td>'3503056608000001</td>
<td>DSN KRAJAN, RT : 3,RW :1 </td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-08-2000</td>
<td>22</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
<td>'0001978452224</td>
<td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>128</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004030</td>
<td>ABBAS SANDY PANGESTU</td>
<td>'3503051505150005</td>
<td>RT 22 RW 6</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>15-05-2015</td>
<td>8</td>
 <td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>KEPALA DESA DAN PERANGKAT DESA</td>
<td>'0002420472881</td>
<td>131506010523Y001315</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>129</td>
<td>19-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027263</td>
<td>LUTFIANA FARIDA</td>
<td>'</td>
<td>RT 01 RW 01</td>
<td>WONOREJO</td>
<td>SUMBERGEMPOL</td>
<td>TULUNGAGUNG</td>
<td>06-07-2000</td>
<td>22</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>130</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004740</td>
<td>LESTARI</td>
<td>'6472035702900003</td>
<td>DUSUN CORAH MULYO, RT : 1,RW :1 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
 <td>TRENGGALEK</td>
<td>17-02-1990</td>
<td>33</td>
<td>P</td>
<td>Karyawan Swasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666102789</td>
<td>131506010523Y001279</td>
<td align='center'>
K01.1 </td>
<td align='center'>
<font color='black'>Impacted teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>131</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>014806</td>
<td>ASHIF IBNU HARIANTO</td>
<td>'3503050411160001</td>
<td>DUSUN CORAH MULYO, RT : 22 RW :06</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>04-11-2016</td>
<td>6</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>132</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>018008</td>
<td>AKBARI WIJAYA KUSUMAH</td>
<td>'3578031811910001</td>
 <td>RT 02 RW 01</td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>18-11-1991</td>
<td>31</td>
<td>L</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0001838871685</td>
<td>131506010523Y001540</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>133</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027271</td>
<td>RAKHMAT DONI (1)</td>
<td>'3503061511080002</td>
<td>DUSUN TALUN, RT : 5,RW :2 </td>
<td>BULUAGUNG</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>15-11-2008</td>
<td>14</td>
<td>L</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000664580215</td>
<td>131506010523Y001541</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>134</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
 <td>012048</td>
<td>ALIFIA MUFIDA SAFIRA</td>
<td>'</td>
<td>RT 08 RW 03</td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-11-2014</td>
<td>8</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>135</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024775</td>
<td>RAFICA DEWI WULANDARI</td>
<td>'3503056907970002</td>
<td>RT 012 RW 006</td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>29-07-1997</td>
<td>25</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665442909</td>
<td>131506010523Y001543</td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>
<tr align="left" valign="top">
<td>136</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>002702</td>
<td>VIVIA VALENTINA A</td>
<td>'353055212120001</td>
<td>RT 59 RW 12</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-12-2012</td>
<td>10</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002583397236</td>
<td>131506010523Y001545</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>137</td>
<td>20-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006042</td>
<td>ARJUNA ARKHAN AYA BEATRICE</td>
<td>'3503053008160002</td>
<td>SOOKO, RT : 42,RW :9 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>30-08-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>General medical examination</font> </td>
</tr>

<tr align="left" valign="top">

<td>138</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>019204</td>
<td>FATIMAH</td>
<td>'3503135103790001</td>
<td>RT 02 RW 02</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-03-1979</td>
<td>44</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665927458</td>
<td>131506010523Y001443</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>139</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>001496</td>
<td>SRI UTAMI</td>
<td>'</td>
<td>RT 14 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>03-04-1969</td>
<td>54</td>
<td>P</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106534912</td>
<td>131506010523Y001556</td>
<td align='center'>
K02.1 </td>
 <td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>140</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027299</td>
<td>ADITYA RIFQI PRATAMA</td>
<td>'</td>
<td>RT 027 RW 003</td>
<td>GAMPING</td>
<td>SURUH</td>
<td>TRENGGALEK</td>
<td>27-07-2016</td>
<td>6</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>141</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027303</td>
<td>KHOIRUL FAHRUL NUR AULIA</td>
<td>'3503051202960002</td>
<td>RT 13 RW 03</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-02-1996</td>
<td>27</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002159512571</td>
 <td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>142</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026085</td>
<td>REVANIA SHAKILA ATTABINA</td>
<td>'3503055404170001</td>
<td>DESA GONDANG, RT : 8,RW :2 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>14-04-2017</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>143</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006906</td>
<td>SITI JUARIYAH</td>
<td>'3502056611810004</td>
<td>RT 002 RW 001</td>
<td>TEMPURAN</td>
<td>SAWOO</td>
<td>PONOROGO</td>
<td>26-11-1981</td>
<td>41</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
 <td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000660566215</td>
<td>131506010523Y001558</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>144</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027305</td>
<td>MESIYAH</td>
<td>'3510054407540004</td>
<td>RT 06 RW 01</td>
<td>WRINGINPUTIH</td>
<td>MUNCAR</td>
<td>BANYUWANGI</td>
<td>04-07-1954</td>
<td>68</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>'0003340101723</td>
<td>131506010523Y001560</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>145</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025408</td>
<td>GALEN REIGA WIJAYA</td>
<td>'3503052401160001</td>
<td>DUSUN KRAJAN, RT : 8,RW :3 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-01-2016</td>
<td>7</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
 <td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>ANGGOTA POLRI</td>
<td>'0002047632625</td>
<td>131506010523Y001561</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>146</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027307</td>
<td>SUKATMI</td>
<td>'3502054506950002</td>
<td>RT 02 RW 05</td>
<td>TEMPURAN</td>
<td>SAWOO</td>
<td>PONOROGO</td>
<td>05-06-1995</td>
<td>27</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>147</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>001240</td>
<td>EVI NOVITASARI</td>
<td>'3503076611950001</td>
<td>DUSUN KRAJAN, RT : 3,RW :1 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-11-1995</td>
<td>27</td>
 <td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI PEMERINTAH DENGAN PERJANJIAN KERJA</td>
<td>'0001036871133</td>
<td>131506010523Y001565</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>148</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027313</td>
<td>DHELA NUR AZHILA RAMADHANI</td>
<td>'3503054807150003</td>
<td>RT 09 RW 04</td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-07-2015</td>
<td>7</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>149</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003336</td>
<td>ACHMAD SYAIFUDIN</td>
<td>'35020514079460002</td>
<td>RT 1 RW 3</td>
<td>TEMPURAN</td>
<td>SAWOO</td>
 <td>PONOROGO</td>
<td>14-07-1994</td>
<td>28</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000661458251</td>
<td>131506010523Y001569</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>150</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>018802</td>
<td>HILMAN DZANNADHOR</td>
<td>'3503050504170001</td>
<td>TENGGAR, RT : 2,RW :1 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-04-2017</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003064259924</td>
<td>131506010523Y001571</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>151</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>022083</td>
<td>ILONA NIRMALA AMALYA S</td>
<td>'</td>
 <td>RT 03 RW 01</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>29-11-2016</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>152</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009702</td>
<td>RAISA AZZAHRA SHOHIBUS SYAFA`AH</td>
<td>'3503057008160002</td>
<td>RT 01 RW 01</td>
<td>TUMPUK</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>30-08-2016</td>
<td>6</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>153</td>
<td>22-05-2023</td>
<td>PUSKESMAS TUGU</td>
 <td>027321</td>
<td>MARSCHEL RADITYA PUTRA</td>
<td>'3503050403150001</td>
<td>RT 03 RW 01</td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>04-03-2015</td>
<td>8</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001978467309</td>
<td>131506010523Y001572</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>154</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027326</td>
<td>NAURA QARIRAH QURATU`AIN</td>
<td>'3503055712140001</td>
<td>RT 009 RW 005</td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>17-12-2014</td>
<td>8</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEKERJA MANDIRI</td>
<td>'0003300490348</td>
<td>131506010523Y001579</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

 <td>155</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>012645</td>
<td>AHMAT FAIRUZ RISQI GUSYA</td>
<td>'3503051408130001</td>
<td>DUSUN SALAM, RT : 60,RW :12 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>19-08-2013</td>
<td>9</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002596615492</td>
<td>131506010523Y001580</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>156</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025534</td>
<td>AYUNDA ARDILA </td>
<td>'3503095909150001</td>
<td>DUSUN PULE, RT : 024,RW :008 </td>
<td>SUMURUP</td>
<td>BENDUNGAN</td>
<td>TRENGGALEK</td>
<td>19-09-2015</td>
<td>7</td>
<td>P</td>
<td>BELUM/TIDAK BEKERJA</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>
</tr>

<tr align="left" valign="top">

<td>157</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025889</td>
<td>IMAM ROHIB</td>
<td>'3503050904880002</td>
<td>DESA GONDANG, RT : 25,RW :6 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-04-1988</td>
<td>35</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001037002634</td>
<td>131506010523Y001588</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>158</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027334</td>
<td>SUMARTIN</td>
<td>'3503055507550001</td>
<td>DUSUN GONDANG, RT : 9,RW :2 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>15-07-1955</td>
<td>67</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
 <font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>159</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024775</td>
<td>RAFICA DEWI WULANDARI</td>
<td>'3503056907970002</td>
<td>RT 012 RW 006</td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>29-07-1997</td>
<td>25</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665442909</td>
<td>131506010523Y001591</td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>160</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027342</td>
<td>ABDUL MALIK</td>
<td>'3503051606860001</td>
<td>RT 014 RW 006</td>
<td>DUREN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>16-06-1986</td>
<td>36</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0001155835912</td>
<td></td>
 <td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>161</td>
<td>23-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027344</td>
<td>THARIQ ANWAR KARIM</td>
<td>'</td>
<td>RT 007 RW 002</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>25-11-2015</td>
<td>7</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>162</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025892</td>
<td>AFIV FIRMANSYAH</td>
<td>'3503050803160001</td>
<td>DUSUN KRAJAN, RT : 24,RW :4 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-03-2016</td>
<td>7</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
 <td>PBI (APBN)</td>
<td>'0002582380157</td>
<td>131506010523Y001652</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>163</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>001061</td>
<td>SITI AMINAH</td>
<td>'</td>
<td>RT 20 RW 05</td>
<td>KARANGSOKO</td>
<td>TRENGGALEK</td>
<td>TRENGGALEK</td>
<td>12-02-1976</td>
<td>47</td>
<td>P</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000149233419</td>
<td>131506010523Y001653</td>
<td align='center'>
Z00.0 </td>
<td align='center'>
<font color='black'>General medical examination</font> </td>

</tr>

<tr align="left" valign="top">

<td>164</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>017231</td>
<td>MUHAMAMMAD GALIH WAHYU NUGROHO</td>
<td>'</td>
<td>RT 31 RW 08</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-12-2015</td>
<td>7</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>165</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027346</td>
<td>NGALIYAH</td>
<td>'3503054503720001</td>
<td>SOOKO, RT : 46,RW :9 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-03-1972</td>
<td>51</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000666245496</td>
<td>131506010523Y001765</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>166</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>000778</td>
<td>SUYATIN</td>
<td>'3503054812690001</td>
<td>DUSUN KRAJAN I, RT : 12,RW :6 </td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-12-1969</td>
<td>53</td>
<td>P</td>
 <td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003068090177</td>
<td>131506010523Y001766</td>
<td align='center'>
K04.5 </td>
<td align='center'>
<font color='black'>Chronic apical periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>167</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>001496</td>
<td>SRI UTAMI</td>
<td>'</td>
<td>RT 14 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>03-04-1969</td>
<td>54</td>
<td>P</td>
<td>Pegawai Negeri Sipil</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106534912</td>
<td>131506010523Y001767</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>168</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>008997</td>
<td>VEFI FEBRIONA SARI</td>
<td>'3503054602040004</td>
<td>DUSUN MLOKO, RT : 58,RW :12 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
 <td>06-02-2004</td>
<td>19</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>KEPALA DESA DAN PERANGKAT DESA</td>
<td>'0002014091414</td>
<td>131506010523Y001768</td>
<td align='center'>
K04.5 </td>
<td align='center'>
<font color='black'>Chronic apical periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>169</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>017733</td>
<td>MUNARTI</td>
<td>'3503054803750005</td>
<td>DUSUN SOKO, RT : 49,RW :10 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>08-03-1975</td>
<td>48</td>
<td>P</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003067661474</td>
<td>131506010523Y001769</td>
<td align='center'>
K04.5 </td>
<td align='center'>
<font color='black'>Chronic apical periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>170</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027356</td>
<td>SUDARTIK</td>
<td>'3503055403780002</td>
<td>DESA WINONG, RT : 9,RW :3 </td>
 <td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>14-03-1978</td>
<td>45</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0000665670767</td>
<td></td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>171</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024439</td>
<td>ANGGI PUTRI APRILLIA DINI</td>
<td>'3503054704040001</td>
<td>KRAJAN, RT : 2,RW :1 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>07-04-2004</td>
<td>19</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106540593</td>
<td>131506010523Y001774</td>
<td align='center'>
K01.1 </td>
<td align='center'>
<font color='black'>Impacted teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>172</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004815</td>
 <td>ZIDNA FAHMA MAZAYYA</td>
<td>'3503055209160001</td>
<td>DUSUN KALIPINGGIR, RT : 18,RW :5 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>12-09-2016</td>
<td>6</td>
<td>P</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0002423115472</td>
<td>131506010523Y001775</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>173</td>
<td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004818</td>
<td>SUKARYATI</td>
<td>'3503055108700003</td>
<td>DUSUN BENGGLE, RT : 12,RW :4 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-08-1970</td>
<td>52</td>
<td>P</td>
<td>Lainnya</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665677405</td>
<td>131506010523Y001777</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>174</td>
 <td>24-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027358</td>
<td>RAHMAT ARILIAN NUGROHO</td>
<td>'3503060203140001</td>
<td>DUSUN BURET, RT : 13,RW :5 </td>
<td>BULUAGUNG</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>02-03-2014</td>
<td>9</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>175</td>
<td>25-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003826</td>
<td>INTI TRI WULIDHA</td>
<td>'3503057012940001</td>
<td>DUSUN KRAJAN, RT : 15,RW :4 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>30-12-1994</td>
<td>28</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665627139</td>
<td>131506010523Y001896</td>
<td align='center'>
K12.0 </td>
<td align='center'>
<font color='red'>Recurrent oral aphthae</font> </td>

</tr>
<tr align="left" valign="top">
<td>176</td>
<td>25-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027382</td>
<td>IDA NURHIDAYAH</td>
<td>'3504184909910002</td>
<td>RT 021 RW 005</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-09-1991</td>
<td>31</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665546995</td>
<td>131506010523Y001813</td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>177</td>
<td>25-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027383</td>
<td>ZIDAN AMAR ZUHRI</td>
<td>'3503052205160001</td>
<td>RT 03 RW 02</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>22-05-2016</td>
<td>7</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002802745124</td>
<td>131506010523Y001816</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>
</tr>

<tr align="left" valign="top">

<td>178</td>
<td>25-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027398</td>
<td>ULVA EMILIA RAHAYU</td>
<td>'3503055006000001</td>
<td>RT 08 RW 02</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>10-06-2000</td>
<td>22</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002012755678</td>
<td>131506010523Y001814</td>
<td align='center'>
K03.6 </td>
<td align='center'>
<font color='black'>Deposits [accretions] on teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>179</td>
<td>26-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024439</td>
<td>ANGGI PUTRI APRILLIA DINI</td>
<td>'3503054704040001</td>
<td>KRAJAN, RT : 2,RW :1 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>07-04-2004</td>
<td>19</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106540593</td>
<td>131506010523Y001903</td>
<td align='center'>
 K01.1 </td>
<td align='center'>
<font color='black'>Impacted teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>180</td>
<td>26-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>000982</td>
<td>ALI MUSTOFA</td>
<td>'3503051711070352</td>
<td>PRAMBON RT24/4</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-09-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002083121763</td>
<td>131506010523Y001910</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>181</td>
<td>26-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>026347</td>
<td>HAFIZA KHAIRA L</td>
<td>'3503055103170001</td>
<td>DUSUN KRAJAN, RT : 002,RW :001 </td>
<td>TEGAREN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-03-2017</td>
<td>6</td>
<td>P</td>
<td>BELUM/TIDAK BEKERJA</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td>PBI (APBN)</td>
 <td>'0002461808362</td>
<td></td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>182</td>
<td>27-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004818</td>
<td>SUKARYATI</td>
<td>'3503055108700003</td>
<td>DUSUN BENGGLE, RT : 12,RW :4 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-08-1970</td>
<td>52</td>
<td>P</td>
<td>Lainnya</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665677405</td>
<td></td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>183</td>
<td>27-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>012773</td>
<td>NIHA FIRDA AANNDA</td>
<td>'3503055111080001</td>
<td>DUSUN KRAJAN, RT : 6,RW :1 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-11-2008</td>
<td>14</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>184</td>
<td>27-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025109</td>
<td>NAYYARA HANUM FITROTUL ASSYIFA</td>
<td>'3503055704170002</td>
<td>DUSUN GONDANG, RT : 16,RW :4 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>17-04-2017</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>185</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>001685</td>
<td>SIH WAHYUDIATI</td>
<td>'3503056803750005</td>
<td>KRAJAN, RT : 003,RW :001 </td>
<td>JAMBU</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>28-03-1975</td>
<td>48</td>
 <td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0000106631605</td>
<td>131506010523Y002006</td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>186</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>004818</td>
<td>SUKARYATI</td>
<td>'3503055108700003</td>
<td>DUSUN BENGGLE, RT : 12,RW :4 </td>
<td>WINONG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-08-1970</td>
<td>52</td>
<td>P</td>
<td>Lainnya</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665677405</td>
<td>131506010523Y002011</td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>187</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024439</td>
<td>ANGGI PUTRI APRILLIA DINI</td>
<td>'3503054704040001</td>
<td>KRAJAN, RT : 2,RW :1 </td>
<td>NGEPEH</td>
 <td>TUGU</td>
<td>TRENGGALEK</td>
<td>07-04-2004</td>
<td>19</td>
<td>P</td>
<td>Pelajar/Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106540593</td>
<td>131506010523Y001987</td>
<td align='center'>
K01.1 </td>
<td align='center'>
<font color='black'>Impacted teeth</font> </td>

</tr>

<tr align="left" valign="top">

<td>188</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>009607</td>
<td>ALFI AULIYA NISAI</td>
<td>'</td>
<td>RT 011 RW 005</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>17-01-2007</td>
<td>16</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0001978439286</td>
<td></td>
<td align='center'>
K02.1 </td>
<td align='center'>
<font color='black'>Caries of dentine</font> </td>

</tr>

<tr align="left" valign="top">

<td>189</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003336</td>
<td>ACHMAD SYAIFUDIN</td>
 <td>'35020514079460002</td>
<td>RT 1 RW 3</td>
<td>TEMPURAN</td>
<td>SAWOO</td>
<td>PONOROGO</td>
<td>14-07-1994</td>
<td>28</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000661458251</td>
<td>131506010523Y002142</td>
<td align='center'>
K04.0 </td>
<td align='center'>
<font color='black'>Pulpitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>190</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>006906</td>
<td>SITI JUARIYAH</td>
<td>'3502056611810004</td>
<td>RT 002 RW 001</td>
<td>TEMPURAN</td>
<td>SAWOO</td>
<td>PONOROGO</td>
<td>26-11-1981</td>
<td>41</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000660566215</td>
<td>131506010523Y002143</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>191</td>
<td>29-05-2023</td>
 <td>PUSKESMAS TUGU</td>
<td>009636</td>
<td>FAUZAN FATAH ALI</td>
<td>'3503050612100001</td>
<td>RT 26 RW 06</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-12-2010</td>
<td>12</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0002920432893</td>
<td>131506010523Y002144</td>
<td align='center'>
K06.2 </td>
<td align='center'>
<font color='black'>Gingival and edentulous alveolar ridge lesions
associated with trauma</font> </td>

</tr>

<tr align="left" valign="top">

<td>192</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>020558</td>
<td>MUHAMMAD ASKA YUSUF ARZAKY</td>
<td>'</td>
<td>RT 01 RW 01</td>
<td>NGENTRONG</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>16-09-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>
<tr align="left" valign="top">
<td>193</td>
<td>29-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027478</td>
<td>STEFHANIE SYAUQI THAFANA</td>
<td>'3503054910170001</td>
<td>RT 09 RW 05</td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-10-2017</td>
<td>5</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0003012960137</td>
<td>131506010523Y002145</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>194</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027490</td>
<td>SUMANI</td>
<td>'3503050909700001</td>
<td>DUSUN KRAJAN, RT : 24,RW :4 </td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>09-09-1970</td>
<td>52</td>
<td>L</td>
<td>Petani/Pekebun</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'</td>
<td></td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>
</tr>

<tr align="left" valign="top">

<td>195</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>024783</td>
<td>AISYAH SILMI AFIQA (2)</td>
<td>'3175056606160004</td>
<td>RT 044 RW 009</td>
<td>PRAMBON</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-06-2016</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>196</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027499</td>
<td>HAIFA` NUR RUFAIDA WAHID</td>
<td>'3503054202150001</td>
<td>RT 01 RW 01</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>02-02-2015</td>
<td>8</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0002500900435</td>
<td>131506010523Y002152</td>
<td align='center'>
 K04.1 </td>
<td align='center'>
<font color='black'>Necrosis of pulp</font> </td>

</tr>

<tr align="left" valign="top">

<td>197</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027512</td>
<td>FARIHA PUTRI SALSABILA </td>
<td>'</td>
<td>RT 007 RW 002</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-04-2015</td>
<td>8</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>198</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>019204</td>
<td>FATIMAH</td>
<td>'3503135103790001</td>
<td>RT 02 RW 02</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>11-03-1979</td>
<td>44</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
 <td>'0000665927458</td>
<td>131506010523Y002156</td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>

<tr align="left" valign="top">

<td>199</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>017854</td>
<td>FANO FRADANA</td>
<td>'3503052406160002</td>
<td>RT 02 RW 02</td>
<td>SUKOREJO</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>24-06-2016</td>
<td>6</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0002069126594</td>
<td>131506010523Y002157</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>200</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003826</td>
<td>INTI TRI WULIDHA</td>
<td>'3503057012940001</td>
<td>DUSUN KRAJAN, RT : 15,RW :4 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>30-12-1994</td>
<td>28</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
 <td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665627139</td>
<td></td>
<td align='center'>
K04.4 </td>
<td align='center'>
<font color='black'>Acute apical periodontitis of pulpal origin</font>
</td>

</tr>

<tr align="left" valign="top">

<td>201</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>003827</td>
<td>DZAKY IRHAB ZULFADHLI</td>
<td>'3503052508170001</td>
<td>DUSUN KRAJAN, RT : 15,RW :4 </td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>25-08-2017</td>
<td>5</td>
<td>L</td>
<td>Belum/Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBD)</td>
<td>'0002280170845</td>
<td>131506010523Y002158</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>202</td>
<td>30-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>000190</td>
<td>NYNA MAWARNI</td>
<td>'3503054609140001</td>
<td>RT 5 RW 3</td>
<td>BANARAN</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-09-2014</td>
<td>8</td>
<td>P</td>
 <td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PNS DAERAH</td>
<td>'0002442383291</td>
<td>131506010523Y002159</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>203</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027255</td>
<td>CLEMIRA SOFIA (2)</td>
<td>'3503054509180001</td>
<td>RT 05 RW 02</td>
<td>DERMOSARI</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>05-09-2018</td>
<td>4</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI SWASTA</td>
<td>'0002492477785</td>
<td>131506010523Y002238</td>
<td align='center'>
K04.2 </td>
<td align='center'>
<font color='black'>Pulp degeneration</font> </td>

</tr>

<tr align="left" valign="top">

<td>204</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027527</td>
<td>NAYLA OKTA AYU NINDIA</td>
<td>'</td>
<td>RT 005 RW 002</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
 <td>09-10-2016</td>
<td>6</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>205</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>021670</td>
<td>ARJUNA ALDRICH ALFATIH PRASTIYO </td>
<td>'3503050201160001</td>
<td>RT 11 RW N03</td>
<td>NGLONGSOR</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>02-01-2016</td>
<td>7</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PRAJURIT AD</td>
<td>'0002425708844</td>
<td>131506010523Y002247</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>206</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>008511</td>
<td>SARTINI</td>
<td>'</td>
<td>RT 04 RW 02</td>
 <td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>26-11-1959</td>
<td>63</td>
<td>P</td>
<td>Pensiunan</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PENERIMA PENSIUN PNS</td>
<td>'0000106765435</td>
<td>131506010523Y002252</td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>207</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027532</td>
<td>GISELA AZALIA KIRANA</td>
<td>'</td>
<td>RT 006 RW 002</td>
<td>SUMBER</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>18-10-2012</td>
<td>10</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>208</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025743</td>
 <td>MIALIFI BUDI HARTININGRUM</td>
<td>'3503054610040001</td>
<td>NGLEGOK, RT : 8,RW :3 </td>
<td>NGEPEH</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>06-10-2004</td>
<td>18</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PBI (APBN)</td>
<td>'0000665864537</td>
<td>131506010523Y002253</td>
<td align='center'>
K04.7 </td>
<td align='center'>
<font color='black'>Periapical abscess without sinus</font> </td>

</tr>

<tr align="left" valign="top">

<td>209</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>025109</td>
<td>NAYYARA HANUM FITROTUL ASSYIFA</td>
<td>'3503055704170002</td>
<td>DUSUN GONDANG, RT : 16,RW :4 </td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>17-04-2017</td>
<td>6</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>210</td>
 <td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027538</td>
<td>MUHAMMAD NURINDAFFA ALFATIH</td>
<td>'3503062901140002</td>
<td>DUSUN TAMTU, RT : 21,RW :10 </td>
<td>SUKOWETAN</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>20-01-2014</td>
<td>9</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS</td>
<td>PEGAWAI PEMERINTAH DENGAN PERJANJIAN KERJA</td>
<td>'0003279377957</td>
<td>131506010523Y002258</td>
<td align='center'>
K00.6 </td>
<td align='center'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>

<tr align="left" valign="top">

<td>211</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027539</td>
<td>MEKKY ZAMRI PUTRA WIJAYA</td>
<td>'</td>
<td>RT 001 RW 001</td>
<td>GONDANG</td>
<td>TUGU</td>
<td>TRENGGALEK</td>
<td>27-02-2009</td>
<td>14</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</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'>
<font color='black'>Disturbances in tooth eruption</font> </td>

</tr>
 <tr align="left" valign="top">
<td>212</td>
<td>31-05-2023</td>
<td>PUSKESMAS TUGU</td>
<td>027540</td>
<td>RIBUDIANI</td>
<td>'3503065211720003</td>
<td>DUSUN JAMPI, RT : 3,RW :1 </td>
<td>NGENTRONG</td>
<td>KARANGAN</td>
<td>TRENGGALEK</td>
<td>12-11-1972</td>
<td>50</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI GIGI</td>
<td>drg.ASTINIA WIDYASTUTI</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM</td>
<td></td>
<td>'0003173713773</td>
<td></td>
<td align='center'>
K05.3 </td>
<td align='center'>
<font color='black'>Chronic periodontitis</font> </td>

</tr>
</table>