PUSKESMAS : TALIWANG

UNIT PELAYANAN : LABORATORIUM

JENIS PELAYANAN : BPJS
BULAN : JANUARI
TAHUN : 2023

Jenis Kunjungan
UMUR No.ID/ NIK / DL HB
TGL NAMA
(THN) BPJS/ KIS
L P L P L P
B L B L B L B L B L B
2 DEVI 21 1 1
ELY 56 1 1
FADLAH 53 1 1
SINTA 19 1 1
HADENAH 63 1 1
RUSTINI 44 1 1
JIHAN MEGA 30 1 1
WETRIYESI 16 1 1
IBRAHIM YUSUF 64 1 1
ARINI 30 1 1
ARIF 30 1 1
DEDI 21 1
RINA 29 1 1
FAHIRA 7 1 1
HADNAN 45 1
DESTI 15 1 1
MANDIARA 39 1
MISNI 33 1
RUSARINISAH 32 1 1
MASJIDAH 57 1
MA'NAH 42 1
FAJAR 19 1
ENDANG 19 1
WAID 17 1
KURNIA 16 1
LINDAWATI 40 1 1
M. HAFIZ 2 1
AYU LESTARI 31 1
APRI 19 1
TAUFIIK 18 1
FAIZAL 18 1
SUPRATAMA 19 1
 DINDA 14 1
AGHA 12 1
AUFI 18 1
LAHAP 58 1 1
3 DARMIATI 51 1 1
HAMIDAH 65 1
SUMIATI 47 1 1
AYU LESTARI 29 1 1
FATMAWATI 31 1
SITI AISAH 61 1
DESTI 15 1 1
YULIANTI 39 1
ANNISA 39 1
A. FAUZI 53 1 1
NURAINI 35 1 1
FIFIN 26 1 1
DARMIATI 51 1 1
SAMIYA 76 1 1
LALU FEBRIAN 30 1
NURYANI 44 1 1
DARMIATI 51 1 1
ADZKIA 10 1
NURHAYATI 45 1
HADIANI 37 1
FARIDA 25 1 1
SUSANYTI 22 1 1
DELI ALANSAH 24 1 1
TRI INDRA 22 1
BQ VINA 24 1 1
SANTI 27 1 1
4 SUSANTI 23 1 1
DARMIATI 51 1 1
AMNAH 42 1
DESI NATALIA 29 1 1
SAHRUL 24 1
RINAWATI 60 1
DESTI 15 1 1
ROHADI 35 1 1
DEFITASARI 30 1 1
ABDUL WAHID 40 1
NAJWA 9 1 1
NILAWAN 49 1
IFA FATHIA 46 1
RISNA S 25 1 1
WANDA S 19 1 1
IRMANSYAH 39 1
MARTHA A 35 1
MARIA TRIANINGSIH 26 1 1
 MU'MINATULLAH 48 1 1
SRI UMI LESTARI 45 1
NOVITA DEWI 32 1 1
BAMBANG IRAWAN 33 1 1
ARDIANSYAH 1 1
SITI NAJMA 56 1 1
5 NURDIN 61 1 1
BAMBANG IRAWAN 52 1
ZAHRAN 7 1 1
DESTI 15 1 1
NURLAILA 43 1 1
HERDIANA 40 1
SOBA 26 1 1
ROSDIANA 35 1 1
SAPTANINGSIH 51 1
ZAKIA 13 1 1
SURYATI 39 1 1
YULIANTI 21 1 1
SUHARLI 53 1 1
DAENG SINARA 63 1
M. RAYYAN 9 1 1
PUTRI WAYA 38 1 1
WAFA 1.3 1 1
EKA SUSILAWATI 55 1
KIKI KURNIAWAN 10 1 1
6 HAFSAH 62 1
ADI RUSLAN 42 1
DESTI ANGGRAINI 15 1 1
KARINA 23 1
AEMA PUTRI 26 1
SYAMSUDDIN 60 1 1
ZANARIAH 52 1 1
YESSI SUSANTI 22 1
M. NURDIN 23 1
RINAWATI 20 1 1
ROSIDAH 44 1
ROHANA 50 1
FITRI 13 1 1
8 CICI 20 1 1
DIANA 46 1 1
9 HERDIANTO 46 1
NURDIN 61 1
TRIYAH 45 1
M. ARFARIZAL 5.2 1 1
RAMLAH 66 1
HUSNUL FAIZA 23 1 1
SRI KUSMIYATI 36 1 1
SRI WAHYUNI 24 1 1
 H. M. SALEH 70 1
FATIMAH 46 1 1
INUL 30 1 1
SITI HAJAR 28 1 1
AYU 22 1 1
SAID B 67 1
FIDA ADLI 12 1 1
RAUDA 43 1 1
FITRI 13 1
SUMIATI 25 1 1
SUKINI 46 1
JIANTI 27 1 1
NADLI 52 1
YULIAN SWASTI 47 1
NURAINI 38 1 1
RUSMINI 41 1 1
MUCHSEN 32 1
NURIYAH 59 1
BQ. MIRANTI 33 1 1
NOVI DWI Y 28 1 1
OLIVIA 17 1 1
MARYAM 69 1
GAMAR AHMAD 59 1
ZAINAB 58 1
DIANA N 33 1 1
DEDI Z 16 1 1
NURAINI 52 1
WIWI 40 1 1
ARY W 28 1 1
INTAN 25 1 1
KAMARIAH 51 1
RINI KUSTIA 22 1 1
ENDANG K 59 1
SENIWATI 25 1 1
JAYA KUSUMA 26 1
10 RANI 18 1 1
RANI 18 1 1
JIBRAN K 10 1 1
LAURA YUNI 14 1 1
YUDI R 15 1
SARNI 23 1
M.O ROMANSYAH 65 1
WIDYA S 25 1 1
JASWAH 44 1
SELVY ANGRAYANI 27 1 1
KUSNADI 35 1
SYFA M. 7 1 1
SYAIFUL 57 1 1
 EGA VANIA 14 1 1
MASITA 77 1
SITI WULANDARI 33 1 1
DIAH 36 1 1
YULIANI 25 1
WIDYA APRILIA 16 1
ELYAH 58 1
MUNIRA 34 1 1
AGUS 32 1
NURAINI 45 1 1
ELLY EKAWATI 28 1 1
DEWI K 31 1 1
UJANG 30 1 1
ABDULLAH 33 1
M. SALEH 49 1
INTAN 23 1 1
11 A. MAJID 72 1 1
M. SALEH IDRIS 67 1 1
SIDIK 58 1
YUNI EKAWATI 40 1
ARINI 49 1 1
ZERRA ANINDITA 26 1 1
MUNANDAR 37 1 1
RAIHANUN 19 1 1
SITI KHADIJA 70 1
NILA K 40 1 1
AHMAD JAYADI 31 1 1
AWAN 64 1
SABARIAH 50 1
ZAMALUDDIN 57 1
MASDIANA 45 1 1
SURIYANTI 25 1
HAMDANI 39 1 1
FAHRIA 34 1 1
SRI MASTUR 23 1
MADIN 40 1 1
SAEPOL 30 1 1
MIFTA KOMALASARI 21 1
HUSNUL 51 1
SYAFIRA N 5 1 1
MISROZAH 55 1
12 LINDAWATI 57 1
SUHAINI 1 1
RANI SUSANTI 42 1 1
HIMAM PRASTANTO 54 1
IKAM HIDAYAT 19 1 1
ARINI 11 1 1
MARATUSOQIR 15 1 1
 WALID HABIB 10 1 1
M. JUNA 9 1 1
AISHA AZAHRA 3.8 1 1
SUMIATI 72 1
SAILAN 60 1
HADIATULLAH 38 1
MAEMUNA 78 1
MARDIANA 29 1
SUPRI HARTINI 32 1 1
HAMIDAH 32 1 1 1
ELVANO 2.8 1 1
NI NENGAH ANGELIAN 17 1 1
SRI WAHYUNI 24 1
FADIAH 53 1 1
BURHANUDDIN 42 1 1
13 WILDA K 32 1 1
LAVINA AZ ZAHRA 9 1 1
GUSTAMIN 39 1 1
TARA 11 1 1
INDRA 44 1
SULHAINI 38 1 1
MARYATUN 40 1 1
ARINY 11 1 1
AHMAD 72 1 1
ASSYIFA 8 1 1
IDA JUMIARTI 34 1 1
KADEK VINAYA 1.3 1 1
SAPRUDIN 47 1 1
SOPIANI 30 1 1 1
ROSDIANA 45 1
RAJEMA 56 1
MARLIANA 53 1 1
CANDRA DEWI 43 1 1
HABIBAH 41 1
ROSIDA 38 1 1
MULIANA 23 1 1
GUSTAMIN 39 1
YALMA 10 BLN 1 1
FEBRI 15 1 1
HIKMAH 32 1 1
ALADANSYAH 16 1 1
INTAN 21 1 1
15 HADIJAH 28 1 1
ABBAS 80 1 1
SUSANTO 93 1
HADENAH 56 1
16 MASTAWAN 59 1 1
ISMIHARIANI 52 1 1
 PUTRI A 21 1 1
ROHIMATUN 46 1
EMILIAH 52 1
HASTUTI 33 1
RISNAWATI 26 1 1
STEFANI 2.3 1 1
SYAMSUDDIN 41 1 1
NURMAH 77 1
ENI NURAINI 23 1 1
ISNI JISNI 7 1 1
GES MANSYUR 46 1
ASMIN 50 1 1
RUKAEDAH 59 1
NURAINI 51 1 1
ARSHAKA 1.9 1 1
RAHMAWATI 60 1
ADHAMUDIN 40 1
FARSIH 67 1 1
PUTRI 38 1 1
HALIMAH 60 1
SEPTI 23 1 1
SUHRIANA 57 1 1
ROSLINDAWATI 37 1 1
NURIYAH 72 1
ASMAWATI 33 1 1
ROHANI 52 1
SUSANTI 23 1 1
RABAIYAH 58 1 1
HARTATI 48 1 1
17 YULIANA 30 1 1
DINARYATI 46 1
H. A. AHMAD 77 1
ABDUL KADIR 56 1
SANIA 63 1 1
SYAMSUDDIN 65 1
A. MUIS 49 1 1
MARJUANA 34 1 1
RAFIAH ABDUYLLAH 67 1
NURSIAH 44 1
ERNIDA 46 1
PUTRI AMADI 17 1
ASMAWATI 36 1 1
ANWAR IBRAHIM 42 1 1
MARDIANA 44 1
ENDANG S 39 1
AULIA FARHANA 19 1 1
DINI Y 34 1 1
ANDINI 20 1 1
 INUL DARATISTA 29 1 1
18 REHANUN 19 1 1
HADIATULLAH 43 1 1
REHANUN 19 1 1
RUMININGSIH 35 1
FATONAH 63 1
HALQI 1 1 1
FATMAH 55 1
HASANUDDIN 41 1
ANDRI 29 1 1
HAYATI 23 1 1
SYAFRUDDIN 64 1 1
FITRIA 43 1
MUH BASRI 20 1
SUMARNI 40 1
FADIAH 40 1
NIATUN K 21 1 1
AMINAH 46 1
SRI ADE 30 1
SAKINA 54 1
SAHNAH 56 1 1
MUSLIM 49 1
RAMLAH 68 1 1
ROSMAYANTI 24 1 1
IBRAHIM 77 1 1
19 REHANUN 19 1 1
MARZUANI 47 1
DIAN FIRDAUS 30 1 1
IQBAL TRI 5 1 1
MULYANA 50 1 1
TEDI RAMDANI 27 1 1
FIFI NURAINI 36 1 1
RANA 22 1
SITI AISYAH 51 1
HAIRUDDIN 42 1
WASIDI 66 1
AMIRUDDIN 46 1
JAMINAH 42 1 1
SRIATI 49 1
RAHMAWATI 50 1
WULANDARI 19 1
IDA AYU 19 1
JOHARIAH 38 1 1
MASTIA 23 1
20 MAHREP 63 1
SUKIATUN 32 1 1
RUSLAN 49 1
 HJ. FATIMAH 72 1
FARIDA 31 1 1
JOHARIAH 38 1 1
SAEHUN 51 1 1
OKTALINA 29 1 1
RENI 28 1 1
BY. JOHARIAH 1 HR 1
NURLAILA 30 1 1
MUH. EFENDI 34 1
SHARA ARTIKA 27 1 1
JIHAN 24 1
PUTRI ALIFAH 13 1 1
SAHIDIN DAUN 45 1 1
MISBAH 27 1
SANIYA 54 1 1
HARDONI 28 1 1
ZAKIA 13 1 1
NI NYOMAN 36 1
KHALISA 13 1 1
M. SALEH 28 1
NURUL ILMI 24 1 1
ANRIANTI 29 1 1
SITI ROISAH 42 1
21 HAFSAH 25 1 1
JENNARIA 4 1 1
ZULFAKAR 52 1 1
22 MITA F 29 1 1
ROZIKI 27 1 1
RAODA 1 1
23 NANDI USMA 53 1 1
WETRUYESI 16 1 1
JUMIATI 35 1 1
AFZAL 2.3 1 1
TAZAH 18 1 1
24 RITA 46 1
AMIRA 12 1 1
AN. M. TAROJI 8 1 1
FATMAWATI 47 1 1
MURNIATI 55 1
AISYAH KADIR 57 1
MAEMUNAH 65 1
NADILA A 6 1 1
HJ. MAM NUR AISYAH 58 1
SAHRA 57 1
ARMIRANU 70 1
RAJEMAH 56 1
 MUHAMMAD ILYAS 39 1 1
TSABILA SHABINA 36 1 1
DINA DITA N 19 1 1
FERA FAZIRA 20 1 1
AZMI R 1.1 1 1
ABIDIN 58 1
ZAINAL ARIFIN 48 1
INDRI K 43 1
ABIDIN 58 1
SYABILA 16 1
KARIMAH 15 1 1
SUKMAWATI 18 1 1
ZANARIAH 52 1 1
ANDI KUSUMA 38 1
HARDONI 25 1 1
MUHAMMAD RIDO 17 1
ELY AGUSTIN 20 1
HARENA 31 1 1
HARNIDA 40 1 1
MANINGSIH 30 1 1
25 RAMA 10 1 1
PUTRA 11 1 1
SIPAWATI 70 1
MANDARA 64 1
MAHNUN 55 1
AYANI 45 1 1
SAHEMA 55 1
SANTI DWI 22 1 1
RINNY 34 1 1
YUN MASTIAH 68 1
DANRIYAH 51 1
SRI HRTATI 65 1
RAMLAH 40 1
ALIF 7 1 1
SUKIANI 36 1 1
LALU MUKSAN 27 1
NESYA 24 1 1
JIHAN 24 1
AGUS WIDYA 38 1
HARDONI 28 1 1
KARTINI 45 1
NUR AZURA 25 1 1
UJUNG 69 1 1
ZAETON 49 1 1
SUHAINI 52 1
26 SANTY DWI 22 1 1
 MUSLIMIN 35 1
WAHYU S 9 1 1
DEKI PURNAWAN 30 1 1
OKTAVIANSYAH 26 1 1
DEDI HARTONO 25 1 1
SUSANTY 22 1 1
SAHARIAH 61 1
RIZKY W 26 1 1
SITI HAJAR 63 1
NURUL HIDAYAH 43 1
NURHAYATI 35 1 1
SUPRIADI 41 1 1
SYAMSIAH 40 1
FARTIN 26 1 1
KHARIDAH R 12 1 1
DESI KOMALASARI 21 1
MUNUF B. SALEH 52 1 1
JIBRIL F. 4.7 1 1
JULIA P 11 1 1
SANTI DWI 22 1 1
27 WILDATUN UYUN 56 1
UMAR HASAN 60 1
HIDATININGSIH 50 1
MAHSUN 1
ANGGARA 1 1 1
ELINA 34 1 1
MAULANA 8 1 1
KOMALASARI 47 1 1
RISMA 27 1 1
NURUL FITRIA 27 1 1
SISKA APRILIA 9 1 1
NURSIATI 53 1
SUHARNI 36 1 1
AGNAYA DEVI 35 1 1
MURNI JAYA 49 1
ZAHRA 44 1
HERI JAYADI 34 1
MUH. RIDO 17 1 1
ALIATULLAH 41 1 1
ELLY ERNAWATI 19 1
IMAM SOPOAN 18 1 1
ZAHIRA 12 1 1
M. AMIN 43 1 1
ULFA 29 1 1
ZAETON 48 1 1
ETY MUTMAINNAH 34 1
 ANDY ARDIANTO 19 1
ASMAUL HUSNA 36 1 1
H. DAYAT 68 1 1
29 DIANA 23 1 1
RIDWAN 48 1 1
H. FATAWA 67 1 1
30 NURMIYATI 61 1 1
GUSTIN 39 1 1
ELY NOPIANTI 37 1
ADETRIA 18 1
HJ. HALIMAH 54 1
ASIAH 52 1
DJAFFAR SM 41 1
M. ZIAN 2.1 1 1
WAGIRAN 51 1
IDRUS 42 1
FAIZ RIZKIAH 13 1 1
ASMAUL HUSNA 36 1 1
ALIYAH 67 1
HJ. SOLEHA 62 1 1
SUPRIADI 37 1
SUDIRMAN 44 1
TAZ'AH 18 1 1
KAIDAH 75 1 1
SANTI 41 1 1
AGIAN 18 1 1
ERNA YULIANTI 39 1 1
DESI RATNASARI 29 1 1
OPAN SUSANTO 24 1
RITA A 34 1
HERMAWATI 28 1 1
ARIFUDDIN 49 1 1
RASYA AZKA 8 1 1
SELSY MARSELA 22 1
HUSNUL HOTIMAH 24 1 1
ANI WIJAYANTI 36 1 1
SAGITA 26 1
FITRIANI 21 1
FILANIRISKA 19 1
ZULHAYATI 21 1
ANA TRI 30 1
SUDIRMAN 40 1
TRI APRIANI 37 1
RUHYANTI 32 1 1
NURISAH 43 1
WAWAN 21 1
 LILA F 19 1
YULIA S 36 1
MUH FAHAD 22 1
RIZAL S 19 1
31 SIRHAN 9 1 1
ZAMALUDDIN 63 1
FITRIA 63 1
ZAINUDDIN 46 1 1
DEMMA BALI 57 1
MARLINA 40 1
AHMAD 51 1
HALIDI 63 1
ONY SATRIA 30 1 1
NURTINI 34 1 1
AMRULLAH 44 1
SUPRIADI 41 1 1
ROHANA 32 1 1
AGUS WIDYA 38 1
RATNAWATI 26 1 1
DEWI SANDI 32 1
HASNAINI 51 1
RAUDATUL 33 1
MARYAM SAID 61 1 1
DEDI IRMA 34 1 1
EKA SUPIANA 34 1
ALIATULLAH 41 1 1
TENI ASTUTI 23 1 1
ALDI J 23 1
MARDIAH 50 1 1
IHDAL 26 1
YUSUF USMAN 52 1 1
AN. YUDI ARDIANSYAH 13 1 1

151 17 357 58 76 7 203 34 0 0 17

 DAFTAR TAGIHAN KLAIM LABORATORIUM
PROGRAM PELAYANAN KESEHATAN GRATIS PADA PUSKESMAS DAN JARINGANNYA
DINAS KESEHATAN KABUPATEN SUMBAWA BARAT

JENIS PEMERIKSAAN
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HB GD MAL WIDAL IgG/IgM/NS1
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M
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PUSKESMAS : TALIWANG
UNIT PELAYANAN : LABORATORIUM
JENIS PELAYANAN : BPJS
BULAN : JANUARI
TAHUN : 2023

Jenis Kunjungan
UMUR No.ID/ NIK / DL HB
TGL NAMA
(THN) BPJS/ KIS
L P L P L P
B L B L B L B L B L B
1 SURIADI 42 1 1
BQ. LIA K 39 1 1
JAMILA 52 1
SATRIO OGAMA, AN 14 1 1
HARLENA 40 1 1
AISYAH 57 1
YARTA JAYA 62 1
YUDI A 13 1 1
NAOMI, AN 11 1 1
DIANA 33 1 1
WIDYA SUTIANI 25 1 1
JOHARIAH 38 1 1
AN. REGINA W 15 1 1
RIZKI YUNIAR 33 1 1
FARIDA 60 1 1
HENDRA 27 1 1
YONI CANDRA 36 1
RAHMAWATI 37 1 1
ELOK S 53 1 1
ZUHADIH 35 1 1
AGUSTINI 45 1 1
FARIDA 36 1 1
2 SAIPAH 55 1
SAM SURYA 43 1
MURNIATI 50 1
AN. M. FITRAH A 9 1 1
YUNITA HANDAYANI 22 1 1
NURAINI 35 1 1
ERMIYATI 32 1 1
AN. FAYYAD 13 1 1
ZAWARIA 46 1 1
JUFRIADI 24 1 1
 DAHLIA 29 1 1
RIKA RAHIM 1 1
HERI SAYANDI 39 1
NURMAH 39 1
RENI ANGGRAINI 39 1 1
ERNI TRIASI 43 1 1
RINTAN YULIA 19 1 1
WIWIT RIZKIAH 27 1 1
AMRAN A. GANI 45 1 1
RUSMITASARI 22 1 1
BITA 67 1 1
SANTI 41 1 1
3 DEVA SAOMA 14 1 1
SANTI 41 1 1
DINDA 17 1 1
YUARIYAH 42 1 1
SITI MARSI 57 1 1
NIYA WIDAYANI 41 1 1
ABDUL MAJID 74 1 1
SURIADI MANA 69 1
ZAID UBAIDILLAH 1.4 1 1
HUSNUL FAHRI 35 1 1
UNI DARMA YUNITA 24 1 1
ADELIA 6 1 1
SHARAH ARTIKA 27 1 1
HENDRA 27 1 1
PUTRI MAESARI 30 1 1
MISWAR 26 1 1
ROHON NISYA 27 1 1
SUSTINA 30 1 1
SANTI 41 1 1
GAZIA S 24 1 1
SANTI 41 1 1
JUMIATI 1
4 RUMINSIH 36 1 1
NESFI 21 1 1
RUMINSIH 36 1 1
AISYAH M 12 1 1
DIAN K 36 1 1
5 RUMINSIH 36 1 1
YENI RUSTILA 25 1 1
6 DEWI 40 1
SYAMSUDDIN 70 1
TATA WIDIYANTO 64 1
RUSTANTI 60 1
FIRDA PURNAMASARI 21 1 1
PUTRI 24 1 1
WAWAN A 37 1
 SAIDAHAZALIM 54 1
NAWIRAH 47 1
ROHANA 36 1 1
HAINUL WALID 33 1 1
JAMAL 35 1 1
USTADAH INTAN 22 1 1
SUMIATI 42 1
MUNIRA 34 1 1
ASYHAR PUTRA 7.6 1 1
ADYA 6 1 1
AMMAR 8 1 1
INTAN JULFA 23 1 1
FITRIANI 20 1
HASMIATI 40 1 1
RAY ABBIYU 6 1 1
ASMIATI 42 1 1
HAMIDAH 61 1 1
YENI KURNIA 24 1 1
ANIS AISYAH 22 1 1
YOGI GHAZALI 31 1 1
DESI ASTUTI 28 1 1
ROHANA 1
MIZWAR 26 1
NURMA 51 1 1
TAZAH 19 1 1
7 FAIZAH 40 1 1
ERNAWATI 63 1
AISYAH 62 1
SULAIMAN 61 1
PUTRI 38 1
ATIKA 27 1 1
SYAMSIAH 58 1
RISMAWATI 21 1
MARIATI 63 1
FADILLAH A 29 1 1
NUR HAYANI 40 1
DESI RAMDANI 23 1 1
PADILAN 57 1
SAIRAH 30 1 1
RATNAENI 32 1 1
HARIAH 54 1 1
NURAINI 14 1 1
SRI WAHYUNI 31 1 1
HIRTAP 26 1 1
SNAINI 47 1
JUSMAN 28 1
TITAIC SASHA 16 1 1
KESYA NABILA 4.8 1 1
 HILDA 28 1 1
FARIDAH 74 1 1
FITRI 14 1 1
8 HADENAH 53 1
LINDAYANI 49 1
MASITA 56 1
SARTIKA 32 1 1
SINDARMAWAN 44 1
ADEHA PUTRI A 6 1 1
JUMATRI 52 1 1
MARDALIFA 34 1 1
AN. M. ARKHA M 7.7 1 1
RAHMAWATI 33 1 1
KANTI 43 1 1
INSANI ANSHONI 19 1
BADARIAH 46 1 1
ROHANI 23 1 1
SUMIATUN 48 1
MUH HAFIZH 6.6 1 1
CITRA 45 1
SRI ICAH 58 1 1
KATRINA 39 1 1
RAMDANI 25 1
IMAM 22 1 1
SRI MOLA 52 1
AYRA A 11 1 1
9 LESTARI HANDAYANI 30 1 1
AYRA A 11 1 1
DHEA MARISA 23 1 1
AFRIADIN 30 1 1
NURUL A 25 1 1
SALBIYAH 52 1
YEYEN S 21 1 1
DAFIAN 8 1 1
IRAWANSYAH 45 1 1
SUBAIDAH 45 1
SABITA 36 1 1
APRIADI 10 1 1
LESTARI HANDAYANI 30 1 1
AYRA A 11 1 1
SARTINA WAHYUNI 31 1 1
10 SARTINA WAHYUNI 31 1 1
SARTINA WAHYUNI 31 1 1
SITI HAJAR 28 1 1
M. ALVAREL 16 1 1
A. MALIK 32 1 1
MASARI 72 1
TAUFIQ B 48 1 1
 NORMA 55 1
SRI WENI 60 1
BULKIAH 54 1
AAN YULIANI 33 1 1
ARUMI AZZAHRA 3 1 1
SAPAIYAH 46 1
KASUM 81 1
SUKMA S 25 1 1
ARINI FITRIANI 50 1 1
MARLINA 30 1
ANDIKA 23 1
NILA LASMINI 25 1 1
FITRI W 29 1 1
NURHASANAH 40 1 1
RINI ANGGRAINI 31 1 1
AYU LESTARI 30 1
11 RONI 30 1 1
DIAZ 14 1 1
QOIS 14 1 1
12 IKHSAN 75 1 1
AL HINDUAN 70 1
13 NURAINI 51 1
KHALIFATUL, AN 16 1 1
NABILA, AN 17 1 1
JAMAL 35 1
RONY KARMILA 42 1 1
KALSUM 62 1
JANARIAH 63 1 1
HAYATI 72 1
MARYAM 69 1 1
JALALUDDIN 45 1
DIAN KURNIAWATI 36 1 1
NURUL AL HINDUAN 70 1
SUUD 49 1
ENI SUSANTI 37 1 1
YULI FITRIANI 25 1 1
SENDAWAN 43 1 1
SIAM SURYA 43 1
AWALUDDIN 47 1
WULANDARI 27 1 1
16 KUSSAHERI 30 1
DIANA SOPIANI 22 1
SURIANI 32 1 1
ARMAWATI 38 1
JANARIAH 64 1 1
NAINI 32 1 1
TA'ZAH 18 1 1
KHAIRULLAH 22 1 1
 RABAL YUDIN 32 1
ADE PRATAMA 35 1 1
RITA 28 1
SUKMAWATI 18 1 1
17 NURLAILI 30 1 1
NOVITASARI 34 1 1
RISKY 36 1 1
NURHAYTAI 43 1 1
DARMIATUN 53 1 1
SARTINI 43 1 1
WILDA 26 1 1
SARIFA 27 1 1
SHARAH ARTIKA 27 1 1
IDA 42 1 1
DIRA AYU 36 1 1
18 NURANISA 29 1 2
NAINA 32 1 2
SALAMIAH 33 1 1
ELOK S 56 1 1
NURSIA 54 1 1
SRI HARTATI 27 1 1
19 NAINA 32 1 1
ELOK S 55 1 1
20 ELOK S 55 1 1
ANDI 9 1 1
HASAN 58 1 1
RUSMIN 41 1 1
SRI ROHAYU 50 1
MARUNI 57 1
SUSILAWATI 30 1 1
SUMIATI 42 1
HJ. SADARAIAH 69 1
DESI 22 1 1
BURHANUDDIN 47 1 1
MAHRUDDIN 57 1
ANGGUN 27 1 1
SRI HARTATI 39 1
ALARIC 10 1 1
BINTANG 2 1 1
ZAKARIAH 71 1
A.WAHID 46 1 1
DRS. SAIFULLAH 53 1
MA'RIFAT 28 1 1
ADRIASNYAH 22 1 1
INNAYATUN SAKINAH 25 1 1
ARIEF SOFYAN 53 1 1
HAYATI 23 1 1
SOPHIA AINULLAH 10 1 1
 NASRULLAH 37 1
ILMAN 32 1 1
NILZA 32 1
SRI DEVI 16 1 1
NURHAYTAI 45 1 1
SAPOAN 33 1 1
LENI ULANDARI 28 1 1
ELOK S 56 1 1
21 ELOK S 56 1 1
SUSANTI 43 1
SIPAWATI 70 1
AHMAD LI 77 1
A.KADIR 76 1
TANTI 20 1 1
SITI SAPIA 52 1
DESI 23 1 1
IR. ABIDIN 66 1
NOVITASARI 26 1
HANIFA 22 1 1
SUMIATI 39 1 1
TINI 38 1
SAMINDARA 28 1 1
SAKINAH 22 1 1
ZUMATA 52 1 1
FEBRI 34 1 1
ARMAWATI 39 1
EKA 55 1
SHANY 37 1
MARSANDA 18 1 1
JAKFAT 29 1 1
22 LILIKA ROSANDY 35 1 1
HENI HERANI 39 1
PUTRI APRILIANTI 27 1
WARDAH 62 1
RATNAENI 57 1
RIZANA 38 1
TATI HARTATI 52 1
JAMILA 27 1 1
JURAIDA 38 1 1
JINABANG 60 1
ANISA 40 1
WAFA 1.2 1 1
MILAH 49 1
PUTRI 1.8 1 1
WALFA 22 1 1
SALRAM 46 1
FEBI 17 1 1
LESTIA 23 1 1
 HAMZAH 75 1 1
MAHDA 37 1 1
23 FATIMAH 4.2 1 1
ANDI 40 1
RAEHAN 52 1
MUNIRA 34 1 1
HJ. SOPIAH 64 1
SAPOAN 33 1 1
ULFA 2.5 1 1
ERNAWATI 39 1
ISMIATI 52 1
M.TAUFIK 50 1
HARZITO 57 1
RAHMAWATI 31 1 1
HAMDI 38 1
YANTI MUSA 35 1
NORMA 24 1 1
ELOK S 55 1 1
TIKA Y 24 1 1
SAHURI 35 1 1
NOVA 34 1 1`
SYAIFUDDIN 58 1 1
NURMALA 26 1 1
MARIAM 67 1
YUNI W 23 1 1
NANDA SRI 23 1 1
24 MAHDA SEPTI 37 1 1
RIZKIA AMELIA 19 1 1
MURNI AFRIANTI 40 1 1
AHMADB. 49 1
MARJUANI 47 1
SRIANI 37 1 1
SITI AMINAH 37 1 1
ALIN WILDANIA 7.7 1 1
YON MARYONO 49 1
SASMITA UTARI 26 1 1
YULIA ANGGRAENI 24 1 1
LAILA MONIKA 33 1 1
JULIONO 29 1 1
PRAYUDHA AKBAR 4.8 1 1
TIYAZ 11 1 1
SAHURI 35 1 1
ETTY SUSANTI 33 1 1
25 AN. M. RIDWAN 6.8 1 1
AYUNG 26 1 1
AN. AZILA 2.1 1 1
27 HANI PATUL. AN 10 1 1
ILHAMUDDIN 50 1
FITRI ANPRIANI 28 1 1
HENI HARANI 39 1
HJ. HANA 72 1 1
JAYA 39 1 1
H. SULAIMAN 83 1
FITRIATI 43 1 1
FATIYATURRAHMI 48 1
NURHASANAH 45 1
AN.GILANG APRIANSYAH 11 1 1
RUSMAN BAKRI 58 1
YASIN 41 1 1
SRINAWAN 39 1 1
SAPARUDDIN 45 1 1
SADIA 50 1
IDA KURNIATI 34 1
HENDRA 40 1 1
SITI AMINAH 52 1 1
SAIBIAH 58 1
QUEENZY, AN 9 1 1
SUNARTI 38 1 1
RATUATI 65 1
JOFRIADI 33 1 1
TITI 18 1 1
KAMARIAH 32 1 1
SEPTI HARYADI 19 1 1
SARAH 40 1 1
SRI SURYATI 49 1
SUKMA LINDA 30 1 1
SAHARI 29 1 1
SUMIATI 28 1 1
JAMAL 35 1 1
NURUL HIKMAH 36 1 1
SOFYA, AN 1.3 1 1
ZAHIRA ARIFAH 22 1 1
MASNA 26 1 1
APRIAN RENGAWAN 34 1 1
INDAH K 32 1 1
MAKBUL S 38 1
FITRIANI 35 1 1
NENENG S 19 1 1
RETNO 48 1
ERNI K 30 1 1
FITRI 31 1 1
SAADIYAH 33 1 1
UMAR HASAN 61 1 1
 M. YASIN 40 1 1
SEPTY H 19 1 1
HERMAN R 32 1 1
28 HERMAN R 32 1 1
SEPTI HARYADI 19 1 1
M. YASIN 40 1 1
MARDIANA 12 1
SULAIMAN POLAH 69 1
FAIJAH 39 1
HANIPA SABILA 22 1 1
NURHAYATI 44 1
HERIYAH 44 1 1
RIFQY HAFIAN 18 1 1
AGUNG MAULANA 22 1
ASMAUL HUSNA 36 1
ENI NURAINI 23 1 1
ADITYA PRATAMA 18 1
FITRI F 25 1 1
SATTU 70 1 1
ASMAWATI 33 1 1
SUDIRMAN 38 1 1 1
SANNAN 41 1 1
SEPTI HARYADI 19 1 1
YASIN 41 1 1
YUNI SULASTRI 33 1 1

104 11 268 55 65 8 182 36 1 0 16

 DAFTAR TAGIHAN KLAIM LABORATORIUM
PROGRAM PELAYANAN KESEHATAN GRATIS PADA PUSKESMAS DAN JARINGANNYA
DINAS KESEHATAN KABUPATEN SUMBAWA BARAT

JENIS PEMERIKSAAN
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M
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JENIS PEMERIKSAAN

IgG/IgM/NS1 HBsAg ANTI HIV SIPILIS GULA CHOL UA

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 PUSKESMAS : TALIWANG
UNIT PELAYANAN : LABORATORIUM
JENIS PELAYANAN : BPJS
BULAN : MARET
TAHUN : 2023

Jenis Kunjungan
UMUR No.ID/ NIK / DL HB
TGL NAMA
(THN) BPJS/ KIS
L P L P L P
B L B L B L B L B L B
1 HERMAN 32 1 1
SEPTI HARIADI 19 1 2
SUKARDI 47 1 2
SAALLUDDIN 62 1 1
GUNAWAN 58 1 1
FAIQAH 1.3 1 1
SABARIAH 62 1
M.YASIN 40 1 3
FERDY 30 1
NANIK R 44 1
BADULU 72 1 1
ISRO'IYAH 40 1 1
CEMPAU 62 1
RIFQI 18 1 1
AGUS S 17 1 1
RAMLA 37 1 1
HELMIATI 48 1
AN. AQIL 13 1 1
RAFA 13 1 1
WAHYU R 50 1 1
SUGIYARTI 27 1 1
SRI HARTATI 35 1 1
SANAH 31 1
ADSIAH 26 1 1
DARA 30 1 1
DESI ANNISARI 35 1 1
ASEP OMAN 30 1 2
IDA ROYANI 36 1 1
YENI R 33 1 1
SRI MARYANTI 52 1
MUNIF 21 1
NAJAMUDDIN 49 1 1
 HALIMAH 47 1 1
2 SRI HARTATI 27 1 1
BQ.DEASUKARDI 25 1 1
SEPTI HARIADI 19 1 1
BADRUSSLAM 5.2 1 1
RAFA 13 1 1
M.YASIN 40 1 1
ASEP OMAN 35 1 1
HERMAN 32 1 1
RAHMIATUN 54 1
AN. AQIL 51 1 1
SYAHREM 13 1
KAMARIAH 56 1 1
RISKIKAH 20 1
SAMILA 21 1 1
M. SALEH 70 1 1
SYIFA 4.1 1 1
ASMAWATI 37 1 1
IBNU DWI 51 1
SUKARDI 47 1 1
RILA APRILLA 19 1 1
HANISA 54 1 1
RAFIF 4.1 1 1
SUSILAWATI 26 1 1
AYU 17 1 1
ROSMANIA 50 1
AHMAD 44 1
FILANIRISKA 19 1 1
HORNIATI 54 1 1
SEPTI HARIADI 19 1 1
M. YASIN 40 1 1
3 RIZKIANTI 13 1 1
SEPTI HARIADI 19 1 1
RAFA 13 1 1
M. YASIN 40 1 1
NURBANI 47 1
FITRIA DWI 45 1
TIA ELIZA 12 1 1
AKBAR A 22 1 1
DWI S 30 1 1
GAZIA 24 1 1
ANGSA RAGITA 19 1 1
YUNI SARAH 1 1
SUMIATI 39 1 1
SMARNI 40 1 1
ANDIKA 20 1
AQUILLA A 26 1 1
ALFI Y 14 1
 MARJUANI 69 1
NURHAYATI 35 1
6 MARLIANA 38 1
LINDARWATI 57 1
ERNAWATI 38 1
KHAMA M. AN 6 1
ZAHRA 4 1
NURUL WARDANI 44 1
LENI PUJIASTUTI 25 1
NURHAYATI 58 1
TENRI ABENG 49 1
RENI MARDIANI 34 1
YULIA K 47 1
HAFSAH 62 1
SALMAH 37 1
ARMAWATI 39 1
TOMY S 21 1
LAILA BADRUN 21 1
PUTRI 30 1
NURAINI 53 1
WIHARJA 58 1
JULIA PUSPITA 25 1
SANIAH 57 1
ARI KUSNIA 39 1
HEN SASMITA 26 1 1
NISA USWATUN 26 1
7 ROHANI 60 1
AMIRULLAH 33 1 1
SYARAFUDDIN 59 1
ASMAWATI 33 1 1
H. MUSTAMIR 59 1
SANIAH 62 1
RUSDIANA 37 1
ZAKIAH 50 1
MIR'ATUNNISA 30 1
ERMA K 48 1
HANIFA IBRAHIM 44 1 1
RONI S 33 1
BAISA 76 1 1
ANAH HASANAH 57 1
A. RIFAI 47 1
RANI SAFITRI 22 1 1
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BELLA 26 1 1
DESI ANNISARI 29 1 1
HARAMINS 62 1
ROHANI 24 1 1
NURUL INTAN 19 1 1
 SYAFRUDDIN 62 1
SURIANI 32 1 2
SASMA AYU 26 1 1
FIRMAN 36 1
ISMI 28 1 1
HIDAYATULLAH 38 1
ANITA 27 1 1
YUNI KURNIATI 29 1 1
DIAN 23 1 1
SEPTI HARIADI 19 1 1
NURHASIDA 41 1 1
NENGAH EKA 23 1 1
ANDI H 32 1
9 SURIANI 40 1 1
DEWI 54 1
SYAFRUDDIN 24 1 1
UNI DARMA 43 1 1
SURYA 48 1
SUNDARI 55 1
ASIA 52 1
ZAINUDDIN 38 1
NURHAYANI 47 1 1
MUSMULYADI 53 1
WAHDAH 72 1
MASARI 54 1
FAUZI AZIS 59 1
SERIBANONG 47 1
HAIRANI 30 1
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SRI HASTUTI 29 1 1
KHAIRUDDIN 55 1
NONI FITRI ANTI 21 1
HANISAH 24 1
SURIANI 32 1 1
SRI NURNANINGSIH 42 1 1
NURHAYATI 45 1 1
10 FITRIA 49 1
RUSTIATI 60 1
TATA WIDIANTO 64 1
M. PANDIANI 16 1
M. SIDIK 57 1 1
NURJANNAH 22 1 1
MIKAI 1 1
HAVIFAH DWI 9 1 1
ARIF K 37 1
NURUL ARMIAL 30 1 1
EVA K 27 1 1
 SITI RIZKI 23 1 1
SRI MULYATI 38 1 1
ENI NURAINI 21 1 1
REGINA 23 1 1
PARMIDA 28 1 1
DWI AMANDA 18 1
NURAENI 60 1
HANA 18 1
PANDA 31 1 1
ADEKANTARI 30 1 1
WIRA BUDIMAN 40 1 1
MUKHLIS 26 1 1
ALENA 2 1 1
11 NENGAH EKA 23 1 1
NENGAH EKA 23 1 1
SYAMSIAH 50 1 1
FAJRIATUL ASRI 14 1 1
12 NENGAH EKA 1 1
LINA PEBRIANA 32 1 1
NENGAH EKA 23 1 1
NENGAH EKA 23 1 1
13 NENGAH EKA 23 1 1
MURMINAH 60 1
ANDI MENANG 45 1
ZANILA 52 1
ROLIANA 34 1 1
PUTRI MAYA 38 1 1
SUSILAWATI 59 1
MASJAYADI 50 1 1
MUH. ALWI 8 1 1
HJ. HAWIAH 63 1
WAHIDAH 53 1
SYAMSUDIN 47 1 1
RISKA SAFITRI 26 1
NURMI 71 1 1
RISNAWATI 27 1 1
KHALIL R 1.4 1 1
ULY 59 1
INDAH SUSANTI 32 1 1
SAMSIAH 51 1
A. MUIS 54 1
ROSDIANA 65 1
INDANA 24 1 1
DARMIANI 59 1
HADINA 70 1
HADIZAH 62 1
EMISARI 39 1 1
HANIPA SABILA 22 1 1
 NANI 44 1
SUMIATI 36 1 1
SYAMSIAH 49 1
DWI PITRI YANI 24 1 1
ULIH TARI 35 1 1
SUMIATI 36 1 1
ZAKIA 48 1
AHMAD 54 1
NASRULLAH 45 1
YUNI ANITA 45 1
HALIMAH 42 1 1
JASMAWATI 42 1 1
KHAERUL R 24 1
SUMIATI 32 1
DEDI IRWANSYAH 29 1
SINTA MENTARI 30 1 1
SAIDAH 30 1 1
SUMAINI 1 1
14 SUSILAWATI 59 1
NENGAH EKA 23 1 1
SALMA 54 1
JUMAIYAH 57 1
A. LATIEF 68 1
HADNAH 67 1
VISCA DERRA 24 1 1
GUSTINA 34 1 1
DELLA FERI A 24 1 1
MARDIANA 39 1 1
FATIMAH 26 1 1
DAENG BAHO 82 1
SAIDAH 31 1 1
DZAKI ADLAN 8 1 1
FEBRIANZA KUSUMA 15 1 1
SUPIATI 38 1 1
ARYA RENATA 12 1
RATNA 50 1
DIANA 46 1
IRDAYANI 32 1 1
SAIDAH 31 1 1
15 ZAFIRA 20 1 1
SAIDAH 30 1 1
DELLA FENI 24 1 1
ROZIATI 45 1
NIMAL 56 1
WILDA 40 1 1
A. KADIR 62 1 1
SAIDA SAID 67 1
SAID B 67 1
 BOY ARNOL 34 1
FATMAWATI 58 1 1
NURHAYATI 58 1
INDRA JAYA K 40 1 1
YANTI P 31 1 1
MILA 18 1 1
DESI PUTRIA 21 1 1
NURUL H 46 1
KHAIRIEL 9 1 1
TOPAN A 27 1 1
WENY S 35 1 1
HASAN TAUHID 57 1
ZAHIRA 20 1 1
WILDA 39 1 1
TOPAN A 27 1
ARIYANTO 38 1 1
KETRIN 26 1 1
WILDA 39 1 1
DELIA 24 1 1
16 KHAIRIEL 9 1 1
TOPAN A 27 1 1
DELIA FENI 24 1 1
A HAFID 49 1
SUJAD MANING 51 1
SYAHTIRAH 1.5 1 1
SAHRUL YADI 40 1 1
NURHASANAH 45 1
SAFIRAH 20 1 1
WILDAH 39 1 1
LUSIA ULFHA 31 1 1
EKA HARDIANA 35 1 1
M. ALFATIH 1.11 1 1
LINDA P 33 1 1
SRI WAHYUNI 29 1 1
KHAIRULLAH 50 1
DESI RATNASARI 25 1 1
RIANTULLAH DAENG 12 1 1
ST. MARIAM 19 1 1
WAFA 16 1 1
SUNIATI 29 1 1
RIFAI PUTRA 17 1 1
DAUD 60 1 1
ARINA RUSFA 32 1 1
DELIA FENI 24 1 1
KHAIRIEL 9 1 1
DELIA FENI 24 1 1
LITA M 20 1 1
17 DELIA FENI 24 1 1
 LITA M 20 1 1
KHAIRIEL 9 1 1
JASWATI 44 1
HENI A 58 1
NURHAYATI 57 1
M. ZULKIFLI 12 1 1
KHAERUL HADI 45 1
SITI AISYAH 44 1 1
IDIN H 51 1
FAHRIA 34 1 1
WAHIDAH 53 1 1
SUMIATI 39 1 1
THIAS ROHANA 14 1 1
MASRIANI 36 1 1
NITA 27 1 1
ENI N 27 1 1
DELIA FENI 24 1 1
18 DELIA FENI 24 1 1
ASMINARTI 42 1 1
MURIAH 38 1 1
SUMIATI 26 1 1
19 ST BUNAYAH 88 1 1
ADLI 31 1 1
ROHANI 50 1 1
MURIAH 36 1 1
20 HERWIN 42 1
M. ZULKIFLI 12 1 1
SAHEMAWATI 30 1 1
HAMZAH HASAN 67 1
RAFIAH ABDILLAH 67 1
BQ. NURHASANAH 34 1
RAHIMA 48 1
INTAN PRATIWI 28 1 1
MULIA 41 1 1
SAHLI 38 1 1
AISYAH 65 1 1
WARDAH 49 1 1
RENI ANGGRAINI 20 1 1
HASMA 35 1 1
HESI J 28 1 1
SUAD SALIM 63 1 1
AMINAH 60 1
NURHIDAYATI 36 1 1
MELY G 37 1 1
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NURTINI 34 1 1
DESIANA 36 1
RESI Y 23 1 1
 DWI NOVA 33 1 1
HIKMA NURAINI 33 1 1
MAWADDAH 16 1 1
DENDA A 29 1 1
ZUNAIDI SAHRUN 53 1 1
21 ASMAWATI 32 1 2
AISYAH 58 1
JUMATA 52 1 2
SRI WAHYUNI 23 1 1
FITRIATULLAYLI 24 1 1
ERMA 54 1
ADITYA 38 1
ASMIRANA 79 1
A. LATIEF 66 1 1
SOFIAH 56 1
ROSDIANA 33 1 1
YUYUN 30 1
ROHIANA 33 1 1
WAWAN 56 1 1
ASMAWATI 33 1 1
CLARA HARFIY 30 1 1
ELLA SAPIRA 22 1 1
22 ZULFAKAR 52 1 1
H. RAHMAWATI 67 1 1
SEPTI HARIADI 19 1 1
23 HJ. RAHMAWATI 67 1 1
24 HARRY YUSUF 7 1 1
IDA JUMIANTI 34 1 1
PUTRI 27 1 1
ZULFAKAR 52 1 1
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FILIYANTI 31 1 1
FATMAWATI 22 1 1
MULIANI 35 1
HERNIWATI 39 1 1
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SALSABILAH 6 1
NILA 26 1 1
25 GUSNIA N 24 1 1
SARIPUDDIN 57 1 1
ANDREY 7 1 1
ALWI 30 1 1
SAKIA 66 1 1
EDI ARJUTA 18 1 1
26 YUSFA DELIFA 26 1 1
SARIPUDDIN 57 1 1
ALWI BAHARUN 30 1 1
NOVRELIA 37 1 1
MISNA 42 1 1
SYARIPUDDIN 57 1 1
27 ELOK SARIFAH 56 1 1
DWINTA R 24 1 1
NURHIDAYATI 39 1 1
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PALANTE 62 1 1
AUFAR K 27 1
LISA SUCI 27 1 1
ARSYA ANDI R 2.1 1 1
ANA MARIANA 33 1 1
RENI A 39 1 1
ADSIAH 31 1 1
AMIRULLAH 33 1 1
NURAINUN 26 1 1
ZULFIKRI 23 1 1
NIA M 45 1
NILA LASMINI 25 1
DARMAWATI 40 1
YAYAT S 9 1 1
SAKARIA 81 1 1
HERNA 35 1 1
KARTINI 44 1 1
ABDULLAH 84 1
HELMI 56 1
FATHATUN 33 1 1
HAIKAL H 14 1 1
ZAINAL 48 1
NASRUDDIN 47 1
ASMASURI 43 1 1
BUNIAMIN 74 1
HADIJAH 64 1
NUNUNG YUHAINI 29 1 1
HUSAIN 36 1 1
ANDI R 48 1
SURYATI 26 1
SUCI ANTARI 26 1 1
DINA R 25 1 1
ROKAYAZEN 1.5 1 1
28 AISYAH 57 1
SEMBA GUSAL 17 1
 AHMAD YANI 54 1 1
HUSEIN 40 1 1
MUNISAH 61 1 1
BUNGA DAENG 62 1
RINA 29 1
NURMALA 1
SUMIARTI 39 1 1
FATHIATUN 33 1
SUSI ERNAWATI 33 1 1
NURAINI 36 1 1
ENI NURAINI 23 1 1
ERNAWATI 31 1 1
VIVI 26 1 1
JUMIATI 38 1 1
SANUSI 65 1 1
YULIATI 35 1 1
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YULIATI 34 1 1
MULLIANU 24 1 1
29 ELOK SARIFAH 56 1 1
TOPAN 27 1 1
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SITI MARYAM 46 1
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ARINI 50 1 1
CITRA YUN M 45 1
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MUR 34 1 1
NORMA 55 1
MULIANA 24 1 1
ABDUL MANAF 59 1 1
MUHAMMAD 53 1 1
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MUSLIM 65 1
NURTINI 34 1 1
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ELOK SARIFAH 56 1 1
ILHAM M 57 1 1
AN. AHMAD HASBI M 5.3 1 1
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 TITI IRYANTI 33 1 1
ZAKIAH 50 1
SRIANI 50 1
DINA DITA 20 1 1
SEPTI H 18 1
ELIZA A 37 1 1
HARIANINGGSIH 37 1 1
ANTI TOLA 35 1 1
HIDAYATI 48 1
MANINGSIH 31 1 1
MANINGSIH 31 1
M. NEHI 1.1 1 1
31 MANINGSIH 31 1 1
MIRNAWATI 47 1
DEVI NOVIANTI 34 1 1
IDRUS SALANI 27 1 1
MANDARA 64 1
SITI DAHADA 52 1
SAKIAH LARASATI 23 1 1
TRI ANGGITA 24 1 1
MUNIRA 35 1 1
KANAYA NURUL 14 1 1
IIS SULASTRI 28 1 1
WINDI ANISA 17 1 1
LEMA PURNAWATI 39 1 1
EDI KUSWOYO 32 1 1
SAHMIN NUR 51 1
YULIANTI 39 1
H. M.TAHIR 60 1
DIANA J 22 1

106 28 245 62 75 17 171 33 0 0 2

 DAFTAR TAGIHAN KLAIM LABORATORIUM
PROGRAM PELAYANAN KESEHATAN GRATIS PADA PUSKESMAS DAN JARINGANN
DINAS KESEHATAN KABUPATEN SUMBAWA BARAT

JENIS PEM
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HB GD MAL WIDAL IgG/IgM/NS1
PROT UL PPT
P L P L P P L P L P L P L
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TORIUM
SKESMAS DAN JARINGANNYA
BAWA BARAT

JENIS PEMERIKSAAN

IgG/IgM/NS1 HBsAg ANTI HIV SIPILIS GULA CHOL UA

P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B

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PUSKESMAS : TALIWANG
UNIT PELAYANAN : LABORATORIUM
JENIS PELAYANAN : BPJS
BULAN :APRIL
TAHUN : 2023

Jenis Kunjungan
UMUR No.ID/ NIK / DL HB
TGL NAMA
(THN) BPJS/ KIS
L P L P L P
B L B L B L B L B L B
1 HIDAYATULLAH 38 1
LENI SURYANI 24 1 1
NILA 25 1 1
2 AHMAD HASBI 5 1
NILA LASMINI 25 1 1
LILIS KARLINA 31 1 1
3 AYU FEBRIANTI 30 1 1
BELLA ENN 24 1 1
ENDANG SULASTRI 39 1
SALEH SALM 65 1
SITI ASIAH 91 1 1
BILQIS R 9 1 1
SAHORA 1
SRI K 36 1 1
MUHARDIN 55 1
YAN ARIANI 36 1 1
JESI HARDIANSYAH 20 1 1
RIRA ARISTA 22 1 1
NURAINI 24 1 1
RIRHO 30 1 1
NURLAILA 58 1
MASNAWATI 35 1
USMAN 69 1
FADIAH B 45 1 1
IDA ZUBAEDAH 51 1
DIANA J 23 1 1
REZA F 23 1 1
RENU SAFITRI 25 1 1
RENI ANGGRAINI 39 1 1
ELOK 56 1 1
NAZRATUL 19 1
SALSABILA 18 1
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FILANIRISKA 19 1 1
HAMIDA 32 1
LISNAWATI 33 1 1
RITA 35 1 1
AWALUDDIN 68 1
YUNITA 19 1 1
HENI ASTUTI 39 1 1
YULIANA O 19 1 1
RISTAUNI M 33 1 1
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NENI A 25 1 1
MIALA 28 1 1
MARYAM 47 1 1
SUMIATI 24 1 1
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FITRI DINANTI 17 1 1
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SRI MARDIATI 33 1
KAMARIAH 48 1
ROHANI 57 1
SYAMSIAH 52 1
SUPIATI 20 1 1
MASTIA 41 1 1
SAMSUL HIDAYAT 34 1 1
MAULANA ZAKIB 24 1
ABDUL AZIS 66 1 1
CHAIRIL F 2 1 1
SAKIAH 60 1
MASITA 67 1
ZULHIJAH 24 1 1
YULIANI 21 1 1
ABDUL RAHIM 42 1
MUHDAR MUHTAR 52 1
SAKIAH 37 1 1
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5 TITIN YASTUTI 1
ANIK WIJAYANTI] 36 1 1
ST AISYAH 48 1
HAJAR 53 1
ULYA S 30 1
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BURHANUDDIN 27 1 1
SUSTINA 30 1 1
ROHANI 23 1 1
SADAM HUSEIN 27 1
 MUHAMMAD 70 1
NURHASANAH 19 1 1
RIZKA SAFITRI 26 1 1
SUSANTY 23 1 1
KHOTIMATUS 45 1
TONO YUSUF 30 1 1
HUSNI 31 1
HASNAWATI 32 1 1
HASYIM 23 1 1
VISCA 24 1 1
WAHIDA 23 1 1
M. YUSUF 62 1 1
KRISTINA 39 1 1
NISFI 21 1 1
NOVIRIANTI 22 1
RAJAMING 57 1 1
VRISCA LIA M 33 1 1
MARLIANA 38 1
6 NASRUDDIN 48 1 1
MAWARIA 34 1 1
NUR SRI BATIN 23 1 1
NIKMAH 56 1 1
HASBULLAH 44 1
SITI HAWA 68 1
TRI KURNIAWAN 19 1
NAHRUL HAYATI 31 1
SILVI SAHARA 27 1 1
YUNI SARTIKA 19 1 1
WAHDIANA 18 1
NURHASANAH 55 1 1
YEYEN 26 1 1
ANANG MARUF 43 1 1
ULFAH 35 1 1
JULIANTY S 8 1 1
SRI ROHANA 37 1 1
JIHAN ZAHRA 18 1
NURHASANAH 55 1
YULIATI 39 1 1
SRI GUSNAWATI 30 1
HUSNAWATI 45 1
SITI HAWA 63 1
NAFALINA 24 1 1
SRI ASTUTI 29 1 1
SUHARTY 39 1
N. ALFIAN S 20 1
7 MARLINA 47 1 1
SUGENG 44 1 1
SALWA ABUBAKAR H 61 1 1
8 SYAIFUDDIN 29 1 1
ADAM IRDA 6 1 1
NURAINI 54 1 1
MUSTAKIM 50 1 1
AMIRUDDIN 34 1 1
9 SILVIA GUSTINA 21 1 1
M. TAYUB 72 1 1
SILVIA A 21 1
NURAINI 26 1 1
HERNA 35 1 1
SILVIA 21 1 1
10 HADIJA 69 1 1
A. GANI 73 1 1
AGUS SALIM 49 1
AHMAD MANATI 60 1
SOPYAN AHMAD 67 1 1
HILDA 29 1 1
RESTU YULIANDARI 21 1 1
ANITA 39 1 1
ERNA APRIANI 35 1 1
WARDAH 30 1
IQBAL ALBY 18 1 1
ILHAM MAHYUDIN 37 1
FATMAWATI 44 1
RUSTA DWI 18 1
SITI ASIAH 38 1
11 ARIANI 34 1 1
RATNA 25 1 1
ASEP DARKUTNI 47 1 1
NALEM 4 1 1
MUSAABIHAN 58 1
ENDANG 32 1 1
NASRUDDIN 48 1
DARMANSYAH 53 1 1
M. AMIN 71 1
AYUTIRA 22 1 1
FATIMATUS SURYANI 48 1
DENDA ANGGRAINI 28 1 1
DR. DEVI 29 1 1
ISMI T 28 1 1
SUHADI 18 1 1
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ROGEIYAH 55 1
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FARHAN RAIHAN 4.5 1
M.IKSAN 39 1 1
SARIANTI 28 1 1
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89 48 172 155 43 27 133 87 0 0
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NURUL HIDAYAH 40 1
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FAIZ RAMADAN 7 1 1
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MASTIKA 65 1 1
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YULIANTI 24 1 1
LARA IRAWATI 32 1 1
MASAYRNG 55 1
NURSAFITRI 28 1 1
22 A. MALIK NURDIN 58 1 1
NENENG 52 1 1
SRI HASTUTI 29 1 1
SYAFRUDDIN 31 1 1
ENY HANDAYANI 36 1 1
SUGIANTO 65 1
ELLEND PUTRI 24 1 1
RISKA ALFIANA 32 1 1
YUNI WULANDARI 23 1 1
SUMIATI 34 1
 SUHAYNI 21 1 1
NURNANINGSIH 52 1
ROHYATUN 31 1
M YASIN 60 1 1
HJ. ASIAH 73 1
FATIMAH 70 1
NURLELA 46 1 1
HENDRI K 48 1 1
TIARA RADILA 12 1 1
S. FATIH 5 1 1
23 H. AHMAD LI 78 1
MASITA 44 1 1
HALIMAH 51 1
ASIAH 52 1
HJ. ZUBAIDAH 71 1 1
MARUNI 57 1
NURANI 46 1 1
SUMIATI 37 1 1
HADNA 58 1 1
NURMAWATI 44 1 1
ZAHRA 58 1 1
SYAMSIAH 41 1 1
RENSIANA 41 1
BUNGARIA 53 1
RAHMAWATI 45 1
MISNAH 48 1
LILI TARI 36 1 1
RAMINAWATI 30 1 1
ABYAN S 1.1 1 1
NAFISAH 25 1
ROHAYU 26 1 1
ABDUL 51 1
ADIET 21 1
24 BQ MARWIYAH 32 1
IMANUDDIN 27 1
DAYANG NUR. AN 4.7 1
MANCA 72 1
SAHODA 66 1
MELLY V 28 1
FITRATIN NUR 37 1
ALAMIN 21 1
HANIFAH I 45 1
AHMAD B 59 1
ZULKIFLI M 13 1
INDER JAYADI 56 1
FERDIANSYAH. AN 13 1
SUPIANI 55 1
MASDELI KARTIKA 21 1
 ANDRIANTO 26 1
MAEMUNA 41 1
NINDI 25 1
SADARIAH 39 1
25 AZIZAH 60 1
AZKIA 12 1
ANDI SOFA 35 1
ZAKIAH 51 1
SIRAJUDDIN 60 1
SALSABILA 7.1 1
SAHARIA 69 1
SUCI 28 1
MADHANI 45 1
NURYANI 40 1
NINDI 23 1
LALMA M. 7 1
ANDRE A 20 1
SRI SAMSIDARIA 37 1
NURAINI 47 1
HASANUDDIN 68 1
DIAN SUCI 20 1
26 CANTI 26 1
CANDRA 58 1
28 NADIM 14 1
RAFLI 17 1
GIAWAN 68 1
SIRAJUDDIN 61 1
SITI AISYAH 35 1
SUPAAT 49 1
MASNIWATI 47 1
SRI MARTINA 27 1
HERMIATI 56 1
FAIZ HIDAYAT 4.5 1
SAIPAH 55 1
HASNAWATI 36 1
H. ABIDIN 73 1
NADEEVA. AN 9 BLN 1
ENDANG SULASTRI 39 1
RAHMAWATI 59 1
NURHAYATI 58 1
YUSUF ZAINUDDIN. TN 31 1
SYARAFUDDIN 48 1
SRINAWAN 40 1
ROHMI LATIFA 23 1
DEDY ISKANDAR 49 1
FITRIAH 37 1
RINA MARLINA 31 1
AYU SAPIRA 23 1
 CICI DEVITA S 25 1
EKA 29 1
YENI AFRIANTI 38 1
SARAH SORAYA 34 1
SRINAWAN 40 1
ADE KAYANTI 18 1
MUSLIMIN 35 1
FITRA 26 1
CICI DEVITA S 25 1
29 CICI DEVITA S 25 1
SRINAWAN 40 1
WENY 35 1
SYARIFAH 55 1
WAHYU 27 1
M. AFIFUDDIN 11 1
FILANIRISKA 19 1
ERMA WATI 31 1
ZAHRAH 40 1
FATMAWATI 58 1
AINUL YAQIN 28 1
AMINAH 46 1
MISNAWATI 33 1
HERLINAWATI 38 1
LINDA KUSUMAWATI 29 1
SULTHANA 11 1
SUMIATI 48 1
30 AISYAH 56 1
SITI AISYAH 64 1
ZIVAN K 20 1
MUCHSIN 47 1
ISNATUL HASANAH 31 1
FIRDAWATI 41 1
ZAHRATUL HANNA 20 1
HENDRI K 48 1 1
FITRI MUTMAINNA 27 1
FITRIANI 27 1
HERTI RAHAYU 35 1
RIFQI BAFADIAL 24 1
RANI APRIANSANI 37 1
IMELDA APRIANA 24 1
NADA ULANDARI 20 1
31 ANGELIKA 13 1
NINDI 22 1
SAPAIYA 52 1
MAHRUM 59 1
NURUL AINI 28 1
RITA FEBRIANTI 29 1
NASRUDDIN 26 1
SAGITA 27 1
AMANDA 29 1
NURWAHIDA 47 1
ANDI WAWAN S 20 1
NUNUNG 30 1
NURAINI 15 1

127 40 234 166 54 19 134 70 1 0

 DAFTAR TAGIHAN KLAIM LABORATORIUM
PROGRAM PELAYANAN KESEHATAN GRATIS PADA PUSKESMAS DAN JARIN
DINAS KESEHATAN KABUPATEN SUMBAWA BARAT

JENIS PE
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HB GD MAL WIDAL IgG/IgM/NS1
PROT UL PPT
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23 15 1 0 46 31 23 6 43 22 44 8 19 0 40 12 28 6 56 13 0 1 2 0 25
RATORIUM
USKESMAS DAN JARINGANNYA
MBAWA BARAT

JENIS PEMERIKSAAN

IgG/IgM/NS1 HBsAg ANTI HIV SIPILIS GULA CHOL

L P L P L P L P L P L P
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PUSKESMAS : TALIWANG
UNIT PELAYANAN : LABORATORIUM
JENIS PELAYANAN : BPJS
BULAN :SEPTEMBER
TAHUN : 2023

Jenis Kunjungan
UMUR No.ID/ NIK / DL HB
TGL NAMA (THN) BPJS/ KIS
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FATMAWATI 38 1
NOVITASARI 26 1
TITIN KURNIATI 24
BUNGARIA 53
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MUHAINI 58 1
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20 6 54 37 0 0 0 0 3
 DAFTAR TAGIHAN KLAIM LABORATORIUM
PROGRAM PELAYANAN KESEHATAN GRATIS PADA PUSKESMAS DAN JAR
DINAS KESEHATAN KABUPATEN SUMBAWA BARAT

JENI
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HB GD MAL WIDAL
PROT UL PPT
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BORATORIUM
A PUSKESMAS DAN JARINGANNYA
SUMBAWA BARAT

JENIS PEMERIKSAAN

IgG/IgM/NS1 HBsAg ANTI HIV SIPILIS GULA CHOL

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