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PUSKESMAS LEWA
.............................................................................................
Kode Desa Kode Dusun/Nomer Indeks Status Keluarga
Identitas PS : Identitas PS :
Nama : Nama :
Alamat : Alamat :
No. RM : No. RM :
Tanggal Lahir : Tanggal Lahir :
Berat Badan : Berat Badan :
Nama Dokter : Nama Dokter :
Identitas PS : Identitas PS :
Nama : Nama :
Alamat : Alamat :
No. RM : No. RM :
Tanggal Lahir : Tanggal Lahir :
Berat Badan : Berat Badan :
Nama Dokter : Nama Dokter :
PUSKESMAS LEWA PUSKESMAS LEWA
Jln. Pakauning -Tanggamadita Jln. Pakauning -Tanggamadita
LEWA - SUMBA TIMUR LEWA - SUMBA TIMUR
Dokter : dr Marselyn M.L Lado,S.Ked : dr Marselyn M.L Lado,S.Ked
SIPD :72/SIPD/DPMPTSP-ST/XI/2023 SIPD :72/SIPD/DPMPTSP-ST/XI/2023
Alamat : Puskesmas Lewa Alamat : Puskesmas Lewa
Identitas PS : Identitas PS :
Nama : Nama :
Alamat : Alamat :
No. RM : No. RM :
Tanggal Lahir : Tanggal Lahir :
Berat Badan : Berat Badan :
Nama Dokter : Nama Dokter :
Identitas PS : Identitas PS :
Nama : Nama :
Alamat : Alamat :
No. RM : No. RM :
Tanggal Lahir : Tanggal Lahir :
Berat Badan : Berat Badan :
Nama Dokter : Nama Dokter :
PUSKESMAS LEWA PUSKESMAS LEWA
Jln. Pakauning -Tanggamadita Jln. Pakauning -Tanggamadita
LEWA - SUMBA TIMUR LEWA - SUMBA TIMUR
Dokter : dr Nelson Awang Dokter : dr Nelson Awang
SIPD : DPMPTSP/27/SIPD/IV/2023 SIPD : DPMPTSP/27/SIPD/IV/2023
Alamat : Puskesmas Lewa Alamat : Puskesmas Lewa
Identitas PS Identitas PS
Nama : Nama :
Alamat : Alamat :
No. RM : No. RM :
Tanggal Lahir : Tanggal Lahir :
Berat Badan : Berat Badan :
Nama Dokter : Nama Dokter :
Identitas PS Identitas PS
Nama : Nama :
Alamat : Alamat :
No. RM : No. RM :
Tanggal Lahir : Tanggal Lahir :
Berat Badan : Berat Badan :
Nama Dokter : Nama Dokter :
Bayar jkn gratis sks t0tal petugas pendaftar
1 Januari
2
3
4 4 15 0 19 19 leni
5 2 11 13 13 leni
6 5 12 17 17 hen
7 4 8 12 12 feris = hen
8 2 8 3 13 10 feris denis
9 2 8 10 10 feris
10 0 0
11 2 15 2 19 17 yesi
12 5 9 14 14 yesi
13 1 7 8 8 yesi
14 6 10 16 16 yesi
15 4 14 18 18 yesi
16 2 12 14 14 feris
17 0 0
18 6 14 20 20 mila
19 7 11 18 18 yesi mila
20 3 23 26 26 yesi
21 3 16 19 19 mila
22 6 12 18 18 mila
23 3 10 13 13 mila
24 0 0
25 7 13 20 20 mila
26 7 11 18 18 mila yesi
27 0 14 14 14 yesi mila
28 6 8 14 14 mila
29 4 25 29 29 denis
30 4 14 18 18 denis
31 0 0
0 0
0 0
1 Pebr 6 11 17 17 mila
2 7 14 21 21 mila
3 8 11 2 21 19 mila
4 2 8 10 10 yesi
5 8 17 1 26 25 mila
6 4 20 24 24 yesi
7 0 0
8 5 29 34 34 yesi
9 3 22 1 26 25 yesi
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
0 0
0 0
1 Maret 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 April 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Mey 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
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10 0 0
11 0 0
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20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
1 Juni 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
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18 0 0
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20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Juli 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Agust 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
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20 0 0
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22 0 0
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25 0 0
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27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Sept 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
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15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
0 0
1 Okt 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Nov 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
0 0
1 Des 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
Bayar jkn gratis sks t0tal petugas pendaftar
1 Januari
2
3
4 0 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
1 Pebr 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
0 0
0 0
1 Maret 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 April 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Mey 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
1 Juni 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Juli 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Agust 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
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20 0 0
21 0 0
22 0 0
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24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Sept 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
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13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
0 0
1 Okt 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Nov 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
0 0
1 Des 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
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17 0 0
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20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
Jumlah hari Rawat
Bayar jkn gratis sks t0tal petugas pendaftar
1 Januari
2
3
4 0 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
1 Pebr 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
15 0 0
16 0 0
17 0 0
18 0 0
19 0 0
20 0 0
21 0 0
22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
0 0
0 0
1 Maret 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
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25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 April 0 0
2 0 0
3 0 0
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5 0 0
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29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Mey 0 0
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24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
1 Juni 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
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22 0 0
23 0 0
24 0 0
25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Juli 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
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25 0 0
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27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Agust 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
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29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Sept 0 0
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4 0 0
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25 0 0
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27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
0 0
1 Okt 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
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27 0 0
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29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
1 Nov 0 0
2 0 0
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4 0 0
5 0 0
6 0 0
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9 0 0
10 0 0
11 0 0
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20 0 0
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25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0
0 0
0 0
0 0
0 0
1 Des 0 0
2 0 0
3 0 0
4 0 0
5 0 0
6 0 0
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8 0 0
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10 0 0
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17 0 0
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20 0 0
21 0 0
22 0 0
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25 0 0
26 0 0
27 0 0
28 0 0
29 0 0
30 0 0
31 0 0