REGISTER RUJUKAN EKSTERNAL B

Tanggal No Tanggal Nama No. RM Tanggal Lahir

12/3/2021 1 12/3/2021 Elly Eliantana
2 JUNI KASIANI
3 LIE POH FENG
4 HERRY TERNOTO
5 NA SAUW TIN 1813/10 3/13/1953
12/7/2021 6 12/7/2021 DEDY KURNIAWAN 4597/15 6/20/1946
7 WISA 5224/15/GP 5/15/1940
8 HUTAMA TJAHJADI 2092/16 5/8/1936
9 WELIANA GUNAWAN 6657/20/GP 9/3/1952
10 SOEJONO 9111/21/GP 4/5/1957
11 LIM BUN HO 7099/15 GP 7/23/1960
12 TJEN ELLEN 7259/14 8/24/1956
12/13/2021 1 12/13/2021 LAI, KURNIAWAN 4497/18/GP 1952-06-18
2 LEGIMIN 3613/15 7/15/1957
3 JANI 3613/15 GP 5/30/1959
4 ASPAN KS 12614/12 12/28/1949
5 BONG A SAN 3008/21/GP 11/21/1951
6 NURHANI BUTAR BURTAR 9806/13/GP 3/24/1940
7 KHO TJIN HOA 12636/19 GP 9/11/1955
8 TAN HELEN 11593/21/GP 7/17/1953
9 FARIDAH 3394/15 7/30/1941
10 TITIEK HARIATI 10824/17 gp 7/12/1951
11 KHAYATUN 2857/18/GP 12/9/1960
12 BUN TJEN KHONG 8918/21/GP 4/20/1961
13 DARMAN 3130/21/gp 3/12/1956
14 IE KIANG HOEI 8994/10 3/23/1952
15 ASNAWATI 10655/13/GP 12/5/1948
16 HENDRO PRANOTO 7810/14 5/1/1946
17 CIN DJUK SAUW 625/15/GP 3/3/1952
18 LIE SE MOY 4696/14/GP 11/20/1948
19 TITIN 4453/18 12/31/1952
20 WISA 5224/15/GP 5/15/1940
21 NGADIMAN 5792/17/GP 6/9/1945
22 TITIK SUHARTI 4017/16/GP 10/12/1957
23 HERMIN _8427/21 10/26/1959
24 I GUSTI AYU KARNINA 2352/11/GP 5/16/1940
25 Suparmi 6100/14/GP 5/14/1952
12/15/2021 1 12/15/2021 UJANG MACHRUDIN 12295/18/GP 6/1/1961
2 WISA 5224/15/GP 5/15/1940
3 HUTAMA TJAHJADI 2092/16 5/8/1936
4 MARTA SADJIMAN 5368/18 5/15/1951
5 NA SAUW TIN 1813/10 GP 3/13/1953
6 DRS MAX MULYADI H 13056/19/GP 9/14/1940
7 MURTINAH 8807/13/GP 5/25/1955
8 HEFNAWATI 5494/14GP 11/1/1957
 9 TISWENING 315/15 GP 9/6/1956
12/16/2021 1 12/16/2021 LINGGAWATI SUSANTO 1340/15/gp 6/21/1956
2 hanny verlina wiryanata 3484/15/GP 3/6/1949
3 SUBAGDJA PANCA 8720/19/GP 11/18/1954
4 KWEE HOEI LAN 11997/18 GP 10/8/1946
12/17/2021 1 12/17/2021 ENDANG KADISIH 3222/8/gp 9/10/1955
2 KUSNADI KURNIAWAN 8172/21/GP 9/19/1959
3 BUDYONO 5030/14/UGD 10/10/1946
4 TAN MUI LANG 8464/17 6/25/1956
5 SULISTIYAWATI 3363/11 GP 2/16/1945
6 NELLY SENEWE 4003/14/GP 4/18/1948
7 JIOE PO AY 1570/16/GP 12/22/1953
8 SUDJONO SIMAN 1616/16 GP 3/3/1949
12/20/2021 1 12/20/2021 Lie Giok Du 3382/16
2 SLAMET BUDIANTO 878/21 1/27/1958
3 HIAP TJAN 807/15 4/1/1944
4 MIE MIE 3753/11 8/1/1952
5 SUYATI 292/17 3/14/1952
6 SITI JUARIAH 11735/21 1/9/1958
7 LILYANAH ADHI 11751/21/ 1/9/1958
8 TJOE YAN MOY 11754/21 12/27/1944
9 AMATUL HAFIZ SIDIQAH L. 12507/12/ 7/8/1955
10 SULAEMAN HERMAN 3731/11 4/28/1944
11 BUDI SANTOSO 8829/21 2/10/1947
12 TITIK SUHARTI 4017/16 10/12/1957
13 hanny verlina wiryanata 3484/15 3/6/1949
14 ARTINI 8325/17 27/12/197
15 JOSEPH HUTABARAT 11776/21 3/2/1960
16 JACUB AGUN TJIOMAS 8326/21 2/20/1961
12/21/2021 1 12/21/2021 linda aluwi 5707/18 1/30/1945
2 gouw soi weng 1044/15 4/29/1954
3 lim chai seng 10/29/1948
4 rika aryani 2489/18 12/19/1960
12/22/2021 1 12/22/2021 DENY HARTONO 40/21/TDU 10/20/1960
2 HAMBALI 5985/18/GP 2/16/1937
3 LITA KURNIAWAN 1602/15 GP 12/22/2021
4 MAIDE MANALU 2900/5/GP 5/10/1957
5 UDIN SYAFRUDIN 11769/19 GP 10/10/1957
6 HIOE MIE SIU 8168/16/GP 11/20/1955
7 MIAN TONDANG 5779/14/GP 2/20/1955
8 SURYANI 9237/19 GP 11/10/1947
9 HONG SIOE BIE 8952/14/GP 3/13/1954
10 SARWO EDDY WIDJAJA 3022/18/GP 10/2/1947
11 THE EDDY ISKANDAR 6004/14 7/15/1946
12 ZUHRIANAH 2156/2020 8/24/1952
13 CHO SUI TJU 3022/18/GP 3/23/1959
14 HADI PRATIKNO 9406/18 GP 11/11/1956
15 SUKAMTO 11841/21/GP 1/15/1959
 16 TJHAI KHI FAT 10763/17 5/21/1951
17 DARMO KATIMIN 4597/13/GP 9/16/1952
12/23/2021 1 12/23/2021 TJHIN PIANG NAM ALS BUDIANTO 5373/19/GP 9/3/1961
2 SUMIJATI 5614/16/GP 3/1/1956
3 RINA SENTOSA 8671/17/GP 3/11/1954
4 BEJO HARJONO 10598/18 GP 7/5/1956
5 TJEN HIAN HOA 5734/14 9/1/1953
6 SUGIONO 1330/18 6/30/1958
7 SITI AISYAH 11875/21/gp 12/20/1957
8 ALOYSIUS WURYATNO 8300/18 GP 5/27/1940
9 SARWO EDDY WIDJAJA 3022/18/GP 10/2/1947
10 NANDY ISKANDAR 9257/21/GP 4/1/1954
11 radjali josef 5376/14 1/20/1943
12/24/2021 1 12/24/2021 FRISNA BURHAN 4279/17/GP 2/21/1954
2 ATJANG 9932/18 GP 7/10/1954
3 LIE KIOEN LIN 5671/21/GP 12/24/1952
4 SUGIYO 9361/21/gp 5/17/1956
5 SARIYATI 4800/16 GP 7/27/1959
6 LOEI HENDRY 11906/21/gp 11/27/1958
7 TAN CHRISTINY 5888/18/GP 11/24/1956
8 LAUW MUI GUEK 6162/16 5/16/1959
9 TJOE DJOEN TJIN 8509/16/gp 6/5/1950
10 ARWI 6368/7/GP 4/13/1955
11 OEY WAN NIO 11911/21/GP 8/25/1956
12 INDRAWATI KUSUMA WARDANI 1837/17/GP 2/5/1946
13 HERLINA SUTARDJA 3095/16 GP 5/8/1953
14 BING SELAMAT 5669/18/GP 7/14/1957
15 INGE 7447/14/GP 7/23/1953
16 LIE SE MOY 4696/14/GP 11/20/1948
17 EDY YANTO TJHIN 1063/18/GP 2/12/1957
12/27/2021 1 12/27/2021 DARSANTO PRAJOGO 6264/21/GP 5/1/1943
2 VIRGINIA WIDJAJA 6263/21/GP 10/27/1945
3 HUSNIAH 2542/13 3/19/1957
4 TJHIE KHIUK LIAN 11924/21/gp 12/1/1953
5 GORETINA CANDRAWAN_ 11926/21/GP 9/12/1959
6 FAHRUDDIN 8938/21/GP 5/7/1944
7 SOEMIRAH,LIE 7670/13/GP 1/17/1957
8 LIANBRIL RUSLI 11778/21/gp 4/18/1954
9 BUNARTO 6593/18/GP 8/27/1950
10 CHAIRUL MALIUS 9962/20/GP 8/16/1961
11 FATIMAH 3376/13/GP 3/6/1960
12 TJENG KHIEUN JIN 4136/15/GP 3/18/1960
13 SUKARJI 12013/21/GP 3/1/1959
14 ROSMANI 375/18/GP 8/16/1938
15 hardijanto widjaja 2331/21/GP 5/15/1945
16 KURNIADI HIMAWAN 3655/21/GP 8/5/1943
17 SUKARJI 12013/21/GP 3/1/1959
12/28/2021 1 12/28/2021 CLEARESTA T TJIO FOEILAN 2336/16 5/18/1960
 2 HARTONO GUNAWAN 5029/17/GP 1/10/1964
3 SUGIANTO 889/20 jb 6/15/1960
4 JENIWATININGSIH 6475/16 GP 9/22/1959
5 LAY JIN HIE 6475/16_gp 11/22/1948
6 ARMILA 2331/15 GP 5/16/1957
7 TJHIN TJUN LIN 12046/21/gp 4/15/1947
8 LAIJ KHIM NIE 3529/8/GP 1/29/1950
9 DARMO KATIMIN 4597/13/GP 9/16/1952
10 SETIAWAN TIRTOWALUYO 6541/14/GP 7/23/1947
11 HERMAN SOESENO 6235/18/gp 2/23/1941
12 LILY YULIANTY SOESENO 6512/18/GP 4/15/1946
13 WATI MUKSIN 1451/16 7/24/1957
14 NYI ASWINAH 4060/12/GP 4/15/1961
12/29/2021 1 12/29/2021 TJIONG MAN HWA 4274/16 10/11/1952
2 HENG GEK KIM 2418/21/GP 4/4/1955
3 MARKUS 315/16/GP 11/11/1945
4 TJEN HIAN HOA 5734/14 9/1/1953
5 WOEN JAM SON 5734/14/GP 8/10/1959
6 THJIN KOEI FA 7788/14 5/20/1948
7 SUBAGDJA PANCA 8720/19/GP 11/18/1954
8 THE EDDY ISKANDAR 6004/14 7/15/1946
9 MUDJIYANTI 12007/13 12/15/1966
10 MARIMIN 12007/13/GP 4/30/1957
11 ANTON SEWONO WONG 12072/21/GP 12/20/1954
12 SYAMSUNAR_ 4813/14/GP 2/21/1951
13 HANDOYO KURNIAWAN 9730/12/GP 3/25/1948
14 TJENG KHIEUN JIN 4136/15/GP 3/18/1960
15 HELEN AFFANDIE 9197/20 4/1/1957
12/30/2021 1 12/30/2021 SENI WATI CHANDRA 2355/02/GP 1/7/1951
TAUFIK SYAIFULLAH 7408/14/GP 4/3/1959
BUDI IMAN RUSTANDI 1285/19/GP 5/21/1942
NURLIMAH 7809/15/GP 7/16/1957
LAI, KURNIAWAN 4497/18/GP 6/18/1952
DENY HARTONO 566/2021/gp 10/20/1960
ANNA LUSIWATI KARTIKA 7342/18/GP 6/25/1959
HENDRY TAN 12110/21/GP 11/28/1954
LINA 12110/21/GP 1/21/1948
NINIE 11921/21/GP 9/22/1949
NYI ASWINAH 4060/12/GP 4/15/1961
12/31/2021 1 12/31/2021 KOMSIAH 8119/15/gp 1/8/1962
LIM HOCK LAI/PEITHER S ./7767/21GP 1/8/1954
ARMILA 2331/15 GP 5/16/1957
SAHRONI 2458/16/GP 12/20/1957
FAM LAN SHONG 878/21 9/12/1957
JACUB AGUN TJIOMAS 8326/21 2/20/1961
REDJO B WONGSOKARMO 4017/16
R RUJUKAN EKSTERNAL BPJS DAN NON BPJS LANSIA

Diagnosis Kode ICD 10 Poli Tujuan Rumah Sakit

Myastenia Gravis Saraf RS Patria IKKT
DM
Disorder Accomodation H52.5 Mata RS Duta Indah
Spondilolithesi M43 Ortopedi RS Atma Jaya
GERD K29.7 Penyakit Dalam RS SW
CAD I25.9 Jantung RS Pelni
DM E11.6 PD RSSW
CRF N18.9 PD RSSW
AF I25 Jantung RSSW
Deviasi Septum Nasi J34 THT RS Bhakti Mulia
CAD I25.9 Jantung RS Pelni
CAD I25.9 Jantung RS Pelni
Neuroapti M79.1 Saraf RS Patria IKKT
Neopalsma buli Uro RSSW
STROKE I64.9 Saraf RSSW
OA genu M25.5 OT RSSW
Distonia G24.9 Distonia RSSW
STROKE I69 Saraf Patria
Katarak H25.5 Mata Patria
Gonarhrosis M25.5 Ortopedi BM
cts G56 Ortopedi BM
Trauma orbita S05 Mata DI
lbp m50 OT H DM
hemoroid k62 bedah di
stroke saraf di
CAD JP0 Pelni
dm, cad PD RSSW
cad JP0 rs pelni
CAD jp rssw
DM PD RSUD C
CAD jp pelni
Osteomyelitis femur ot rssw
HHD JP Pelni
Tumor pituitari saraf pelni
Degenerasi Makula Mata di
DM PD Pelni
CAD JP RSSW
CAD JP Pelni
neuritis saraf rssw
ppok paru rssw
CA Vulva sarana kemoterapi rs kanker dharmis
tb paru rssw
DKA kulit rssw
LBP Saraf pelni
LBP Saraf pelni
oesophagitis SPPD rssw
OA genu OT RSSW
LSK KK RSSW
Parkinson saraf Patria
Tirotoksikosis PD RSSW
Katarak Mata RSDI
Hernia bedah Hermina Daan mogot
Efusi pleura paru rssw
FAM Bedah RSDI
Bronkitis Paru Pelni
Mysathenia Gravis Saraf RSSW
Hearing loss THT Pelni
Post op katarak Mata Pelni
HHD Jantung Pelni
Senile Catarct Mata RSDI
Epilepsi post stroke Saraf RSSW
PPOK Paru RSSW
HT, CAD, Disaritmia Jantung RSSW
Katarak Mata RSDI
KATARAK Mata RSDI
Neoplasma breast Bedah RS Bakti mulia
Chronic Ischemic Heart disease Jantung Pelni
BPH Urologi RSSW
Malignant neoplasma liver IPD RS Atna
DM tipe 2, insulin IPD Pelni
DM tipe 2 IPD RSSW
CAD Jantung Pelni
Massa coli bedah RSDI
Hydrocephalus Bedah Saraf Pelni
Low Vision Both Eyes Mata RS Patria IKKT
Cataract, unspecified Mata RS Patria IKKT
Low Vision Both Eyes Mata RSDI
Tremor Saraf RS Patria IKKT
vertigo saraf rssw
tumor buli uro rsbm
ischialgia saraf pelni
hipertiroid pd pelni
Epilepsi saraf patria
Ca mamae b onk rssw
HHD JP RSSW
HHD JP RSDD C
Katarak Mata Patria
HEARING LOSS THT RS BM
HHD Jantung Hermina Daan mogot
kolelitiasis sppd rssw
Katarak mata RS duta Indah
CAD JP RSSW
Lipoma bedah rs di
Katarak Mata rs di
BPH Uro RSUD C
Ca paru paru rs kanker dharmais
Gg refraksi Mata rs duta indah
Tirotoksikosis PD RSSW
HHD JP RSSW
HHD JP RSSW
Frozen shoulder ot rssw
Gg akomodasi Mata rsdi
DM PD RS Patria IKKT
Katarak Mata Rs di
HHD Jantung RSSW
SYNCOPE Collapse PD Duta Indah
OA genu ot rssw
Ca paru paru rssw
Faringitis kronis THT Pelni
Post op katarak mata Patria
katarak Mata Patria
Ca paru paru dharmais
Post op katarak Mata Patria
Ca cervix B- onk dharmais
katarak mata Duta Indah
glaukoma Mata Duta Indah
Kardiomegali Jantung Patria
DM PD Patria
Katarak Mata Duta Indah
DM PD RSSW
hnp lumbak saraf Patria
dm pd RSUD C
DM PD Duta Indah
CAD Jantung pelni
CAD Jantung pelni
KATARAK Mata Duta Indah
mata Mata Duta Indah
Stroke saraf pelni
glaukoma Mata RSUD C
OA genu ot RS Bhakti Mulia
Melena pd Duta Indah
Post stroke saraf rssw
katarak Mata Duta Indah
crf pd Duta Indah
hipertiroid pf rssw
Lipoma bedah patra
cad jantung rssw
Stroke saraf Duta Indah
CRF PD Patria
Lipoma bedah patria
AF Jantung rssw
Katarak Mata Patria
CAD Jantung RSUD Cengkareng
HHD Jantung pelni
tbc paru pelni
CRF HD Pelni
Katarak Mata Duta Indah
CAD Jantung pelni
stroke saraf RSUD Cengkareng
neuropati saraf rssw
katarak Mata patria
katarak Mata patria
CRF PD RSSW
CAD Jantung RSUD C
Ca mamae bedah Duta Indah
Gg akomodasi mata Duta Indah
CAD Jantung Hermina Daan mogot
Post op katarak Mata Duta Indah
Gg akomodasi Mata Duta Indah
Gg akomodasi Mata Duta Indah
Post op katarak Mata Duta Indah
Gg akomodasi Mata patria
DM PD RSUD Cengkareng
HHD Jantung RSUD Cengkareng
CAD Jantung RSUD Cengkareng
Kalazion Mata Duta Indah
HHD Jantung RSSW
HHD Jantung RSSW
Gg akomodasi Mata patria
Post herpetic neuralgia Saraf Hermina Daan mogot
katarak mata patria
Parkinson saraf rssw
DM PD RSSW
Katarak Mata patria
PPOK Paru RSSW
HHD Jantung RSSW
Gg akomodasi Mata Duta Indah
Gg akomodasi Mata Duta Indah
Tirotoksikosis PD Duta Indah
Oesophagitis PD RSUD Cengkareng
abulia mata Duta Indah
Post op katarak Mata Duta Indah
CRF BTKV Pelni
Gg akomodasi Mata Duta Indah
Ca tiroid Bedah Onkologi Hermina Daan mogot
post vp shunt hydrocephalus Jantung RS Pelni
Dokter Perujuk

dr. Lina

dr. Lina

dr. Lina

dr. Lina
 dr. Lina

dr. Lina

dr.Lina
Daan mogot

dr.Natascha

dr. lina

dr. Lina

Daan mogot
dr. Lina

dr. lina

dr. lina

dr. lina
 dr. lina

Daan mogot

Daan mogot

dr. Lina

dr. Natascha
 REGISTER RUJUKAN EKSTERNAL BPJS DAN NO

Tanggal No Tanggal Nama No. RM Tanggal Lahir

1 12/3/2022 LIM FUI NEN 5605/14 2/10/1960
2 RIENA WIDYASTUTI 3663/21 10/16/1957
3 JO MI LI 154/17 5/4/1957
4 HIAP TJAN 3222/16 4/1/1944
5 REDJO B WONGSOKARMO 4017/16 4/5/1954
6 SUSANTO WIBOWO 2472/21 11/1/1952
7 NGOEI MIE HAN 305/18 1/20/1953
8 AGUSTINI 1464/14 8/1/1959
9 DR. MAX MULYADI 13056/19 9/14/1940
10 ANGELA IRYAWATI LUKMAN 7551/20 11/26/1955
11 LIM BIOE OEY 2271/16 3/4/1961
1 12/4/2022 SAHRONI 2458/16/GP 12/20/1957
2 ROSMANIDAR 7412/7 1/5/1956
3 MINANSI SJUKRI 2845/15 3/24/1954
4 HENDRO PRANOTO 7810/14/GP 5/1/1946
5 SUTINAH 8870/13/GP 12/19/1954
6 GO SOE TJENG 6267/14/GP 1/17/1952
7 MAEMUNAH 11426/13/GP 10/11/1958
8 RUDIYANTO MARGONO 2529/20/GP 7/6/1958
1 1/13/2021 NOMAN ARIEF_4452/14/GP_4740/14UGD () TL: 1960-01-10
2 MARYATI MULYONO_5174/20/GP () TL: 1958-08-11
3 SUAIB BIN TOING-4001/19/gp, 980/15 JB () TL: 1949-11-25
UJUKAN EKSTERNAL BPJS DAN NON BPJS LANSIA

Diagnosis Kode ICD 10 Poli Tujuan Rumah Sakit Dokter Perujuk

HHD I11.0 Jantung RSUD Cengkareng dr. Anggun
NIDDM E11.6 Penyakit Dalam RS SW dr. Anggun
Schizophrenia F20.9 Jiwa RS SW dr. Anggun
CHF I50.0 Jantung RS SW dr. Anggun
BPH N40 Urologi RS PELNI dr. Anggun
CAD I25.9 Jantung RS PELNI dr. Anggun
Low Back Pain M54.57 Orthopedi RS SW dr. Anggun
Lipoma D21.9 Bedah RS Duta Indah dr. Anggun
Benign Neoplasm of Ski D23.9 Bedah RS SW dr. Anggun
Ca Paru C34.9 Paru RS Patria IKKT dr. Anggun
HHD I11.9 Jantung RS Patria IKKT dr. Anggun
katarak mata RS Duta Indah dr. Lina
HHD Jantung RS PELNI
LBP Saraf Duta indah
BPH Urologi RS PELNI
DM Penyakit Dalam RS Duta Indah
katarak mata RS Patria IKKT
OA GENU Orthopedi RSUD Cengkareng
Hepatitis B + ikterik Penyakit Dalam RS Duta Indah
Insulin DM Penyakit Dalam RS Pelni dr.Natascha
Lung cancer Kemoterapi RS Dharmais
DM, HT, Stroke I69,3, E11,6, I1 Saraf RS Duta Indah