Register Ugd 2023

JENIS KASUS STATUS PELAYANAN PEMAKAIAN
ALAT IGD
CATETER
INFUS SET CAIRAN INFLO CHECK LIST KELENGKAPAN DRM UGD
JAM KODE TERAPI INFORMED TRIASE IC UMUM IC KEDOK IC PENOLK M. ASTHSI IC RUJUK RJK RS RISK DWSA RISK PDRTI HASIL LAB PULG PAKSA
NO NO. RM TANGGAL KUNJUNGAN DINAS NON DINAS NAMA PASIEN JK USIA ALAMAT B L UMUM BPJS NIK NO. BPJS RJ RI RJK DIAGNOSA DX TINDAKAN TARIF MA MI RL NS KN D5 D10 ASERING 20 22 24 26 16 18 CONSENT ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK
1 01-008128 01-01-2023 00.15 WAWAN L 38 SIDODADI 2/1 1 1 3505161703850001 1 VULNUS APP IN FACE T14 RAWAT LUKA 50000 1 1
2 07-007581 05.30 LESMINI P 58 SUMBERARUM 2/1 1 1 3505204511640001 0002678316647 1 ASMA + HT J45, I10 NEBULIZER BPJS 1 1
3 01-005069 17.00 FITRI YUSTIANINGSIH P 23 RINGINANYAR 3/2 1 1 3505205812000001 0003177176859 1 G2P0AB1 UK 41 MMG 080.0 PASANG INFUS BPJS 1 1 1 1 1 1
4 06-007680 19.30 MULUD L 60 SUMBERURIP 2/2 1 1 3505201005630001 0002519776912 1 GASTRITIS K29 PASANG INF, INJ BPJS 1 1 1 1 1
5 06-005342 1/2/2023 09.00 SULIS P 55 SUMBERDADI 3/1 1 1 3505204901670001 0002615977653 1 DIABETIC FOOT E11.6 RAWAT LUKA, GENTA SALP BPJS 1 1
6 06-008111 10.00 DIAH LESTARI P 33 SUMBEREJO 1/2 1 1 3505205204880001 1 HIV B20 OBH SY, B6
7 02-006347 02-01-2023 21.30 ILHAM HANUNG SASI KIRONO L 2 SUKOREJO 5/2 1 1 3505200511200001 0003011824945 1 GE, ISPA A09, J06 OMEDOM, PAMOL, KAOLIN PECTINBPJS
8 05-004018 03-01-2023 10.00 NITA WULAN AYU PUSPITA P 36 TULUNGREJO 2/2 1 1 3505205008860003 0000208176311 1 CORPUS ALINEUM T16 PENGAMBILAN BENDA ASING BPJS 1 1
9 10-000041 10.30 MULADI L 86 SUMBEROTO 4/2 1 1 3507011208360001 0000676964788 1 BPH N40 PASANG DC, AMOX, PAMOL, KALK,BPJS 1 1 1 1
10 01-004775 11.45 JUMIYEM P 58 RINGINREJO 2/1 1 1 3505206112660001 0000669710507 1 VULNUS LASERATUM T14 RAWAT LUKA BPJS 1 1
11 05-008128 04-01-2023 08.15 WAWAN L 37 SIDODADI 2/1 TULUNGREJO 1 1 3505161703850001 1 VULNUS ABRATIO T14 RAWAT LUKA, CEFADROXIL, ASME 50000 1 1
12 01-003626 09.00 TUMINI P 54 RINGINSARI 2/3 1 1 3505205807680004 0000669722905 1 CVA I63 KIE RUJUK 1
13 10-000041 10.30 MULADI L 86 SUMBEROTO 4/2 1 1 3507011208360001 0000676964788 1 BPH N40 PASANG DC, AMOX, PAMOL, KALK,BPJS 1 1
14 05-002521 1/6/2023 10.30 SUJIONO L 44 TULUNGREJO 2/1 1 1 3505201203790001 0001037371825 1 SUPERFICIAL INJURY OFS00.9 RAWAT LUKA 1 1 1
15 05-008197 00.45 SUWARNO L 69 TULUNGREJO 3/1 1 1 3505201507540001 1 GASTRITIS K29.7 PASANG INFUS,INJ 1 1 1
16 04-007320 18.30 SUWARTI L 63 SIDOMULYO 5/1 1 1 3505204107600065 0002445805271 1 BRONCHOPNEUMONIA J18.0 RAWAT JALAN 1
17 01-004391 1/7/2023 07.00 MELINA WAHYU SONATA P 21 RINGINANOM 2/2 1 1 3505206910010001 0000669642096 1 TYPHOID FEVER A09 PASANG INF, INJ 1 1 1 1 1 1
18 08-007610 13.30 DINDA RAHMA WATI P 16 MOJOREJO 23/5 1 1 3505204603070002 0002970555794 1 GASTRITIS K29.7 RAWAT JALAN BPJS 1
19 08-008178 17.15 SUNYOTO L 78 BANYUURIP 6/2 1 1 3505200107450132 0000670254974 1 ASHMA BRONCHIALE J45 BPJS 1 1
20 08-007610 00.30 DINDA RAHMA WATI P 16 MOJOREJO 23/5 1 1 3505204603070002 0002970555794 1 GASTRITIS K29.7 PASANG INF, INJ 1 1 1 1 1 1
21 10-008177 12/8/2023 08.00 ABIDAH ROSYIDATUN NISA P 5 PANGGUNGREJO 3/4 1 1 3505134919180001 1 OF+ ISPA R50.9+J06.9 1
22 04-000074 1/9/2023 07.30 VENIA NUR AINI P 17 WATES 4/4 1 1 3505206102060001 0003132868329 1 OPEN WOUND OF UNSPE
T14 RAWAT LUKA BPJS 1 1 1
23 01-005888 13.00 NILUH NOVA P 21 RINGINSARI 3/4 1 1 7201097105020002 0001566830024 1 PARTUS 080.0 BPJS 1 1 1
24 07-007621 08.50 TUNI WIDIANTI P 44 SUMBERARUM 1/1 1 1 3509044503790002 0002857466441 1 UROLITIASIS N20
25 01-004819 14.00 SULADI L 76 RINGINREJO 3/1 1 1 3505202011570001 0000669592012 1 INTOKSIKASI DRUG T60 INJEKSI 1 1 1
26 05-008205 11-01-2023 15.00 MUHAMAD DENI YUSTIANTORO L 14 TULUNGREJO 4/1 1 1 1 CKR S00.9 RAWAT JALAN 1
27 04-008159 12-01-2023 11.00 TUKIMIN L 67 SIDOMULYO 2/1 1 1 3505200107550021 0001917546311 1 OMSK A98 RAWAT JALAN 1
28 05-006266 14.15 INDARI P 29 TULUNGREJO 2/2 1 1 3507296507930001 0003177176578 1 VOMITING R11 PASANG INF,INJ 1 1 1 1 1 1
29 01-008245 19.00 RADIVA VERVE WALOYO P 18 RINGINSARI 1/4 1 1 3505204804040001 0002140225413 1 GASTRITIS K29 PASANG INF, INJ 1 1 1 1 1 1
30 03-005165 13-01-2021 10.00 SULIKAN P 57 TUGUREJO 9/2 1 1 3505204903670002 0000107715396 1 V.ABRATIO T14 RAWAT LUKA 1 1 1
31 10-007831 11.00 SHEREN SHELINGSYA P 10 NGRENDENG 12/2 1 1 1 V.ABRATIO T14 RAWAT LUKA 1 1 1
32 03-005123 31-1-2023 05,00 ARINDA FIDELA ANGELIKA P 20 TUGUREJO 06/02,TUGUREJO WATE 1 1 3505204208030001 0003288285775 1 G1P0AB0 UK 37 MMG DG080.0 1 1 1
33 05-008225 12.00 MARMI P 57 TULUNGREJO 4/2 1 1 1 HT I10 1
34 07-000179 14-01-2023 07.00 PONIYEM P 58 SUMBERARUM 5/1 1 1 3505204201650001 1 OBS VOMITING R11 PASANG INF, INJ BPJS 1 1 1 1 1 1
35 09-008279 19.00 HENI TRI WAHYUNI P 22 BALEREJO II 3/3, PANGGUNGREJO 1 1 350513511010001 1 GEA K29.7 PASANG INF, INJ 1 1 1
36 09-008243 15-01-2023 10.00 INAYATUL LATIFAH NUR SETYA P 10 SIDOMULYO 1/2 1 1 1 V.APP T14,3 RAWAT LUKA 25000 1 1
37 06-008242 14.00 MARVEL UCEL DEVINE L 13 SUMBERASRI 1/1, PURWOREJO 1 1 35052010040900020001991811341 1 V.APP T14 HECTING, RAWAT LUKA 1 1 1 1
38 01-001512 16-01-2023 16.30 NUR SYA'ADZA L 42 RINGINANOM 3/2 1 1 3505201609720001 0001882753244 1 GASTRITIS K29 RAWAT JALAN 1
39 06-008085 17.30 KATIMUN L 60 PURWOREJO 2/2 1 1 3505200603630001 0000670258372 1 VERTIGO H81.4 PASANG INF, INJ 1 1 1 1 1 1
40 01-000709 19.30 SRI HANDAYANI P 23 RINGINREJO 2/1 1 1 3505206411000001 0000669712206 1 GE A09 PASANG INF, INJ 1 1 1 1 1 1
41 04-000073 18-01-2023 09.30 ARMIATI P 48 WATES 4/4 1 1 3505205203740001 1 PARANOKIA L20 EKSTRAKSI KUKU 1 1 1 1
42 04-002674 13.30 DYAH ARGO PALUPI P 18 WATES 2/3 1 1 3505205610090001 0002753248015 1 OF R50 AMOX, PAMOL, ANTASID, DOMP BPJS 1
43 05-001090 04,30 RETNO SETYANINGSIH DIASTARI P 31 SIDODADI 1/2 1 1 35010206601920003 0003244553278 1 PARTUS 080.0 BPJS 1 1 1
44 08-008269 21.46 MARJOKO L 37 MOJOREJO 23/5 1 1 3522061204860001 0002726505731 1 OF R50 PAMOL, ANT, DOMP BPJS 1
45 03-008287 1/19/2023 13.30 PARNU P 65 BEJIREJO 16/4 1 1 3505201110580003 0000669270273 1 VULNU PUNCTUM T14 INJ ATS BPJS 1
46 06-008242 09.30 MARVEL UCEL DEVINE L 13 SUMBERASRI 1/1, PURWOREJO 1 1 35052010040900020001991811341 1 VULNUS APP T14 50000 1
47 08-008281 1/20/2023 10.00 MARIA MELISA DWI ARDIKA P 23 BANYUURIP 10/2 MOJOREJO 1 1 350520450600001 000297054279 1 DHF A90 PASANG INF, INJEKSI BPJS 1 1 1 1
48 08-004784 21.30 SIDIK PURNOMO L 56 BANYUURIP 9/2 1 1 3505200911670001 0002970546039 1 BPH N40.1 PASANG DC BPJS 1 1 1 1
49 06-004580 7.3 NINIK SUWANTI P 57 SUMBERURIP 4/1, PURWOREJO 1 1 3505204108660001 0002681020798 1 VERTIGO H81 PASANG INFUS RL BPJJS
50 10-008288 1/21/2023 08.00 WIJIATI P 36 KARANGREJO 24/14 1 1 3507014601860004 0002486466663 1 GE A09 ATTAPUGIT, ZINK, ASMEF BPJS
51 06-007737 09.00 TEGUH KURNIANTO L 58 SUMBERDADI 1/2 PURWOREJO 1 1 3505200806640001 0001105151398 1 DIABETC FOOT E11.6 RL, CEFADROXIL, GLIBEN, ASMEF BPJS
52 06-008242 09.30 MARVEL UCEL DEVINE L 13 SUMBERASRI 1/1, PURWOREJO 1 1 35052010040900020001991811341 1 VULNUS APP T14 BPJS 1 1
53 05-008292 10.30 IMAM JUMANTO L 61 TULUNGREJO 3/1 1 1 35052019126200010000107977375 1 SERUMEN H61 PENGAMBILAN SERUMEN, GLISERBPJS 1
54 02-006801 11.30 MUHAMMAD AZKA BAYU SAPUTRA L 6 SIDOREJO 3/1 1 1 3505201209170001 0002285507924 1 TF A01.0 PASANG INFUS, INJ BPJS 1 1 1 1 1 1
55 05-003565 14.00 DJUMANI L 60 TULUNGREJO 3/1 1 1 3505200107630011 0002740781079 1 SNAKE BITE T63.0 PAMOL, PRED BPJS 1
56 02-007318 20.00 SAMINI P 63 MIRIGEDE 3/1 1 1 3505204802600001 0000669193086 1 ASHMA J45 NEBULAZIER BPJS 1 1 1
57 10-008277 20.25 RUSEMI P 74 SUMBEROTO 2/1 1 1 3507014102490002 '0000677052044 1 VERTIGO H81 PASANG INFUS, INJ BPJS 1 1 1 1
58 06-006454 13.30 HANA RUTININGSIH P 52 SUMBERURIP 4/1, PURWOREJO 1 1 3505205710700001 000284189882 1 GEA A09 PASANG INFUS, INJ BPJS 1 1 1 1
59 02-000426 1/22/2023 06.45 IMAM SUHARI L 47 SUKOREJO 4/2 1 1 3505200107760034 0000669193086 1 ASHMA J45 NEBULAZIER BPJS 1 1 1
60 05-000214 09.15 MAGHFIROH LUHUR RUMANTRI P 30 TULUNGREJO 1/3 1 3505206003930002 0002282444291 1 GE A09 PAMOL, ANT, BC BPJS 1
61 05-000480 09.15 WIDAMAR SATRIA NINGRAT L 15 TULUNGREJO 1/3 1 3505202310080001 0002159897624 1 GE A09 PAMOL, ANT, BC, LOPERAMID BPJS 1
62 10-008288 00.45 WIJIATI P 36 KARANGREJO 24/14 1 1 3507014601860004 0002486466663 1 GE A09 PASANG INFUS, INJ BPJS 1 1 1 1
63 02-000231 1/23/2023 06.15 LUCKY ASTIANA P 26 MOJOREJO 15/3 1 1 3505205912960001 0001701893823 1 OF R50 BIONICOM ZINL, PAMOL, DOMP BPJS 1
64 03-008425 07.30 MESIDI L 68 TUGUREJO 13/3 1 1 '0002678312338 1 COLIC ABDOMEN R10 BIONICOM ZINL, PAMOL, BPJS 1
65 03-002051 09.00 BONARI L 53 TUGUREJO 2/1 1 1 '0000669611812 1 PNEUMONIA J18 NEBUL, SALBU, PRED, PAMOL, A BPJS 1
66 08-008281 09.10 MARIA MELISA DWI ARDIKA P 23 BANYUURIP 10/2 1 35052045060000010002970549279 1 POST MRS DF Z09.8 + A09 PAMOL, BIONICOM ZINK, CETIRIZINBPJS 1
67 05-006661 1/24/2023 08.00 IRMA ROBITOTA SALAMA P 25 TULUNGREJO 03/02,TULUNGREJO 1 3505206807880002 0002600986307 1 ISPA J06.9
68 06-008242 09.30 MARVEL UCEL DEVINE L 13 SUMBERASRI 1/1, PURWOREJO 1 1 35052010040900020001991811341 1 VULNUS APP T14 BPJS 1
69 07-008314 1/25/2023 01.19 SIHMIATI P 52 SUMBERARUM 3/1 1 1 3505204807710001 0002970544612 1 LBP M54.4 BPJS 1
70 03-008078 1/27/2023 10.00 SANTOSO L 28 BEJIREJO 16/4 1 1 3505202311950002 0000669272545 1 OF R50.9 BPJS 1
71 10-000524 01.30 GLADIS P 5 SUMBEROTO 5/2 1 1 1 ISPA RJ06.9 1
72 04-008336 20.15 RAHMAT JUNIAWAN L 17 SIDOMULYO 1/3 1 1 VAPP T14 RAWAT LUKA 50000 1 1 1
73 04-000758 11,30 ERNAWATI P 44 WATES 3/2 1 1 3505205010790004 0002323869759 1 VOMITING R11 BPJS 1 1
74 10-008324 04.00 MAHFUDZ L 47 GEMPOL 2/4, PASARUAN 1 1 3516050108760001 0001540698737 1 ISPA J06.9 BPJS 1 1
75 06-008242 1/28/2023 08.54 MARVEL UCEL DEVINE L 18 SUMBERASRI 1/1, PURWOREJO 1 1 35052010040900020001991811341 1 KONTROL RAWAT LUKA Z09.8 BPJS 1 1
76 01-008334 10.30 HARDJO GIMAN L 72 RINGINREJO 2/2 1 1 35052001014000040000099595552 1 BPH N40 PASANG KATETER BPJS 1 1 1
77 03-004262 11.00 SUWITO L 76 TUGUREJO 9/2 1 1 3505200105460001 0000669230649 1 CVA I63 PASANG INF, INJ BPJS 1 1 1 1 1 1 1 1
78 02-008407 1/29/2023 08.30 LILIS P 46 SUKOREJO 5/2 1 1 3505204106760001 1 COLIC ABD R11 PASANG INF, INJ 1 1 1 1 1 1
79 08-007610 23.00 DINDA RAHMA WATI P 15 MOJOREJO 23/5 1 1 35052046030700020002970555794 1 GASTRITIS K29 PASANG INF, INJ 1 1 1 1 1 1
80 04-008379 07.00 MUHAMMAD TSAQIB AL HUDA L 5 SIDOMULYO 4/1 1 1 3505202405180002 0002461491382 1 OF R50.9 BPJS 1
81 01-008428 23.30 GADING L 12 RINGINSARI 2/3 1 1 1 INSECT BITE T63 INJEKSI 25000 1 1 1
82 08-008338 30/1/2023 09.05 MONIKA NOVITA P 16 DSN BANYUURIP 11/3 1 1 35052045050600010000668513283 1 VERTIGO H81 PASANG INF, INJ 1 1 1 1 1 1
83 04-001781 10.00 MARSUSENO L 52 SIDOMULYO 2/1 1 1 3505200501710001 0000669897786 1 PARANOKIA L03 EKSTRAKSI 1 1 1 1
84 03-003480 09.00 ERIK HADI YANTO L 14 TUGUREJO 23/5 1 1 3505202902080001 1 GEA A09 PASANG INF, INJ 1 1 1 1 1 1
85 06-008085 10.30 KATIMUN L 53 SUMBERJO 2/2, PURWOREJO 1 1 3505200603630001 0000670258372 1 VERTIGO H81.4 PASANG INF, INJ 1 1 1 1 1 1
86 08-000802 15.00 GIYAR L 75 MOJOREJO 23/5 1 1 3505200208480001 0000670483629 1 ASHMA J45 NEBULIZER 1 1
87 09-008351 9.4 KATIMAN L 54 BALEREJO II 2/2 1 1 350513011690002 1 HT I10 INJEKSI 1 1 1
88 01-002540 15.00 ARINAWATI P 44 DS. RINGINREJO 4/1 1 1 3505205007790002 1 V. PUNCTUM T14.6 INJEKSI 235000 1 1 1
89 03-005123 31-1-2023 10.49 ARINDA FIDELA ANGELIKA P 20 TUGUREJO 06/02,TUGUREJO WATE 1 1 3505204208030001 0003288285775 1 V.LASERATUM T14 RAWAT LUKA 1 1 1
90 01-007979 12.00 SHAKILA ACELIN AGUSTIN P 5 RINGINSARI 2/3 1 1 3505204908700001 0002803212808 1 OF R50.9 RAWAT JALAN 1
91 02-008429 14.42 EDI L 35 DS.SIDOREJO 4/2 1 1 35052005087700020003244553054 1 V. PUNCTUM T14.6 RAWAT LUKA 1 1 1
92 02-005635 10.00 KURNIA YOGA MAULANA L 22 SUKOREJO 05/01 1 1 1 HERPES B00 ACYCLOFIR. CETIRIZIN. SALP ACYCLOFIR
JAM
NON
NO NO. RM TANGGAL KUNJUNGANDINAS DINAS NAMA PASIEN
1 05-001871 2/1/2023 19.00 MARIYAM
2 02-008415 00.30 S.AINUN NAFISAH
3 01-008480 01,00 SUPRIHATIN SUSANTI
4 10-000041 10.30 MULADI
5 03-008418 2/2/2023 15.00 SRIATIN
6 10-008409 YATINEM
7 04-005787 ZAHRA MEI RANADANI
8 06-006838 02.00 IMELDA RVA NOVIANA
9 02-006047 2/2/2023 09.50 AHMAD AZZAM HARDYANTO
10 08-006375 2/3/2023 05.30 SOINI
11 10-008422 14.00 SHADEN GIBRAN MORENO
12 06-007630 19,30 MULUD
13 10-008421 12.40 TUGIMIN
14 04-001781 4/2/2022 09.00 MARSUSENO
15 04-008430 10.00 FADLI MUHAMMAD Z
16 08-007056 12.30 SITI NURHIDAYA
17 09-008446 12.25 ARITAMA
18 01-005660 14.00 MISTIN SRI
19 10-008436 14.40 SUNARDI
20 01-006630 15.10 SUMITI
21 02-006181 2/5/2023 09.00 BRIAN YAHYA HARDYANTO
22 05-000480 12.00 WIDAMAR SATRIA NINGRAT
23 06-008479 2/6/2023 05.30 ANANG SUKANDHI
24 01-002231 15,00 PUJI LESTARI
25 01-003323 2/7/2023 02.30 RINTAN NUR KHOLIFAH
26 04-007502 17.00 FIFI FEBIANI
27 05-006887 03.30 WARNI
28 02-000528 2/7/2023 06.00 WULAN SURYANTI
29 05-000215 06.45 SALMA JUWITA
30 10-008436 11.30 SUNARDI
31 05-000460 16,00 YAYUK WIGATI
32 02-008472 08/02/2023 11.30 SUNARMI
33 01-008551 13.00 MUHAMMAD RIFKI FADHILAH
34 04-008489 8.3 FAIZ YUDHA PRATAMA
35 02-008472 11.30 SUNARMI
36 02-001685 17.30 HANIF ULFA RIF'AH
37 04-008490 9/2/2023 12.30 SUBARI
38 06-008488 21.45 SUMARTO
39 08-008482 10/2/2023 08.25 SLAMET
40 05-008484 09.45 SUBOWO
41 10-008491 11.00 WAGIYANTO
42 07-008494 20,00 SUWARDI
43 03-000635 18.00 TRI UTAMI
44 02-008533 11/2/2023 01.30 MESINI
45 04-008147 11.30 SRINGATI
46 01-004151 10.00 DESSY PERMADHY
47 01-008334 11.45 HARDJO GIMAN
48 04-008490 11.45 SUBARI
49 08-006516 12/2/2023 13.00 GINO
50 09-008520 14.00 M.ZAKKIYUL
51 10-008548 16.15 ANIS SUCI NUR WIDYAWATI
52 09-008519 14.15 NARASYA JOVAN
53 08-008547 23.00 ALI SODIKIN
54 04-008608 2/13/2023 14.45 ARIS
55 03-007126 19.45 IIS ERNASARI
56 02-008517 2/15/2023 08.30 WAETON
57 01-004257 17.15 SILISTIYANINGSIH
58 01-008544 2/16/2023 07,30 HARJO GIMAN
59 03-008543 11.30 YANIS SUTIANI
60 04-000621 14.00 SURAJI
62 04-007274 20.30 SUTAMI
63 02-008517 2/17/2023 10.02 WAETON
64 04-007034 09.15 ADI SUWIKNYO
65 04-008552 10.00 LADYS SANDRESA DRES ARTAWINATA
66 06-008420 16.00 KARDI
67 04-000758 17.00 ERNAWATI
68 10-008566 18.30 SLAVINA
69 06-008607 2/17/2023 19.30 WIWIK YUNIARTI
70 04-008567 18-2-2023 08.15 ELISA WIRDANA TUROFIAH
71 04-008565 19-2-2023 18.00 SIGIT WAHYUDI
72 10-000041 20/2/2022 11.00 MULADI
73 04-008580 21/2/2023 12.00 LAYEM
74 04-001820 11.30 SUPARMI
75 09-008605 2/22/2023 15.00 SYAHDANA ADNAN PRIANGGONO
76 08-001530 20.30 KRISTINA SUSANTI
77 03-008604 2/23/2023 11.00 EKO PURWANTO
78 04-000091 2/24/2023 09.44 SAERI
79 02-008612 18.00 MUHAMMAD THOYIB
80 04-000091 2/25/2023 08.55 SAERI
81 01-008611 9.30 DENNIS PUTRA RAMADHAN
82 01-008466 26/2/2023 13.45 WIJIATI
83 01-007411 14.20 SUWENDAH
84 01-007599 17.30 DANI AFANDI
85 04-000091 2/28/2023 09.44 SAERI
86 08-002803 10.00 JAMTO
87 10-000510 14.15 KATINEM
JENIS KASUS STATUS
JK USIA ALAMAT B L UMUM BPJS NIK

P 38 TULUNGREJO 1/1 1 1 3505205310850001
L 42 SUKOREJO 2/3 1 1 3505205108810001
P 62 RINGINANOM 4/2 1 1 3505205011610001
L 86 SUMBEROTO 4/2 1 1 3507011208360001
P 44 TUGUREJO 3/1 1 1 3523154808790001
P 45 SUMBEROTO 1/1 1
P 2 WATES 3/3 1 1
P 25 SUMBERJO 1/2 1 1 3505204108980002
L 1 SIDOREJO 4/2 1 1 3505201810210001
P 49 MOJOREJO 23/5 1 1 3505204107740029
L 19 LOWOKWARU 7/4, MAL 1 1 3573052611040004
L 60 SUMBERURIP 2/2 1 1 3505201005630001
L 53 SUMBEROTO 5/2 1 1
L 56 WATES 2/1 1 1 3505200501710001
L 16 WATES 4/4 1 1
P 30 MOJOREJO 23/5 1 1 3505205801930001
L 9 SUMBERKEMBAR 2/1 1 1
P 53 RINGINANOM 3/2 1 1 3505205403690001
L 62 NGRENDENG 15/4 1 1
P 52 RINGINANOM 3/2 1 1 3505204109700002
L 10 SUKOREJO 4/2 1 1 3505202712130001
L 15 TULUNGREJO 1/3 1 1 3505202310080001
L 45 SUMBEDADI 1/3 PURW 1 1 3505202210780001
P 11 RINGINANYAR 1/2 1 1 3505206107120002
P 12 RINGINSARI 2/1 1 1 3505204101120002
P 28 SIDOMULYO 4/2 1 1 3505205706040003
L 68 TULUNGREJO 1/2 1 1 3505200308540001
P 27 SIDOREJO 2/2 1 1 3505204106950001
P 5 TULUNGREJO 1/3 1 1 3505204303180001
L 62 NGRENDENG 15/4 1 1
P 51 TULUNGREJO 1/3 1 1 3505205904720002
P 84 SUKOREJO 3/2 1 1 3505204107390069
L 10 RINGINREJO 1/3 1 1 3505202105300001
L 4 SIDOMULYO 1/1 1 1
P 84 SUKOREJO 3/2 1 1 3505204107390069
P 34 SUKOREJO 4/2 1 1 3505202709890001
L 80 SUMBERDADI 1/1 1 1 3505200407330001
L 52 BANYUURIP 6/2 MOJOR 1 1 3505200406710002
L 36 TULUNGREJO 3/2 1 1 3505202604860002
L 34 SUMBEROTO 6/1 1 1
L 66 BULUREJO 2/2 1 1 3505201405570001
P 51 WONOSARI 37/6 1 1
P 77 SUKOREJO 2/2 1 1 3505205808470001
P 64 WATES 2/4 1 1 3505204107580061
L 47 RINGINREJO 1/3 1 1 3573023112760001
L 83 RINGINREJO 2/2 1 1
L 72 MOJOREJO 11/3 1 1 3505200504540002
L 14 NGADRI 1/2 1 1
P 36 SURABAYA 3/11 1 1 3505206807840002
L 13 KESAMBEN 1/1 1 1
L 50 BANYUURIP 9/2 1 1 3505201908730001
L 38 WATES 2/4 1 1 3505202101840001
P 33 TUGUREJO 14/3 1 1 3505205108900001
P 74 SUKOREJO KRAJAN 4/3 1 1 3505204107490076
P 34 RINGINREJO 1/2, RING 1 1 3505205504890001
L 83 RINGINREJO 2/2 1 1 3505200101400004
P 56 TUGUREJO 12/3 1 1 3505204608670001
L 59 WATES 2/4 1 1 3505201507640003
P 35 WATES 5/3 1 1 3505204506880002
P 74 SUKOREJO KRAJAN 4/3 1 3505204107490076
L 56 WATES 1/5 1 1 3505201212570003
P 17 WATES 4/5 1 1
L 89 SUMBERASRI 1/2 1 1 3505200102360001
P 44 WATES 3/2 1 1
P 4 KALISANGKRAH 29/7 1 1
P 43 SUMBERDADI 3/2 1 1 3523104403750001
P 22 SIDOMULYO 2/3 1 3505204208010001
L 18 SIDOMULYO 2/1 1 1 3505202205040001
L 84 SUMBEROTO 2/3 1 1 3507011208360001
P 82 WATES 2/3 1
P 35 WATES 4/1 1 1 3507116903880001
L 15 KESAMBEN 1/4 1 1
P 42 BANYUURIP 12/03 1 1 3505206810810002
L 56 TUGUREJO 1/3 1 1 3505200107690033
L 65 WATES 4/2 1 1 3505200108560001
L 58 SUKOREJO 2/3 1 1 3505200107650123
L 65 WATES 4/2 1 1 3505200108560001
L 8 RINGINREJO 3/3 1 1
P 39 RINGINANYAR 3/3 1 1 3505205512830002
L 47 RINGINREJO 2/1 1 1 3505200603780001
L 13 RINGINANYAR 3/2 1 1 3505200911100001
L 65 WATES 4/2 1 1 3505200108560001
L 60 MOJOREJO 10/2 1 1 3505201703630001
P 74 SUMBEROTO 1/1 1 1 3507014101490016
59 27 26 56
PELAYANAN
KODE TERAPI
NO. BPJS RJ RI RJK DIAGNOSA DX TINDAKAN
0000670413071 1 GASTRITIS K29.7 MENOLAK RANAP
0000669093759 1 CEPALGIA G44
1 S.APENDICTITIS K35.9 INFUS
0000676964788 1 BPH N40 PASANG DC, AMOX, PAMOL
0001449870052 1 GASTRITIS K29.7
1 VULNUS APP T14 INJEKSI TETANUS
1 OF R50 PCT,AMOC,PREDISON
1 PARTUS O80.0 pasang inf
1 OF R50
0002970546974 1 GASTRITIS K29.7 RAWAT JALAN
0001900338377 1 VULNUS UPERTUM T14 RAWAT LUKA
0002519776912 1 DYSPEPSIA K30 INFUS
SNAKE BITE T62 PASANG INF, INJ
0000669897786 1 V.APP T14 RAWAT LUKA
1 ABSES L02 RAWAT LUKA
0000670294416 1 GEA A09 PASANG INF, INJ
1 VULNUS APP T14 HEATING, AMOX, PAMOL
1 GASTRITIS K29 PASANG INF, INJ
1 VULNUS APP T14 HEATING, INJ ATS AMOX,
0000669509572 1 SNAKE BITE T63 PASANG INF, INJ
0001267724362 1 ISPA J06 CTM, PAMOL, AMBROXOL
0002159897624 1 OF R50 CTM, PAMOL, ANT, DOMPE
0002155896786 1 GASTRITIS K29 PASANG INF, INJ
0002414272184 1 ASHMA J45 rawat jalan
1 ASMA J45 PASANG INF, INJEKSI, O2
0000669013378 1 PARTUS O80.0 PASANG INF
0000670302314 1 DM E11 PASANG INF, INJEKSI
1 TF A01 PASANG INFUS, INJEKSI
0002300938648 1 OF R50 PASANG INFUS, INJEKSI
1 VULNUS APP T14 RL, CYPRO, ASMEF
0000670322237 1 VERTIGO H81.4 BETAHISTIN, PAMOL, ANT
1 OBS VOMITING R11 RAWAT JALAN
0002414272386 1 OF R50 PASANG INF, INJ
1 OF R50 RAWAT JALAN
1 OBS VOMITING R11 RAWAT JALAN
0000669861022 1 OBS VOMITING R11 RAWAT JALAN
1 V. ABRATIO T14.7 RAWAT LUKA
0002159892674 1 BPH N40 PASANG KATETER
0000668479667 1 VOMITING R11 PASANG INF, INJ
1 COLIC ABD R10.83 PASANG INF, INJ
1 V. PUNCTUM T14 INJ ATS
0000668638293 1 ISPA J06.9 RAWAT JALAN
1 GASTRITIS R11 RAWAT JALAN
0002771999223 1 OBS VOMITING R11 PASANG INF, INJ
0003011827408 1 V.APP, T14 RAWAT LUKA
0002728196561 1 DOC R41 PASANG INF, INJ
1 BPH N40 BPH
1 V.APP T14 RAWAT LUKA
1 SNAKE BITE T63 PASANG INF, INJ
0002997018123 1 DISPEPSIA K30 PASANG INF, INJ
0001474514875 1 GASTRITIS K29 PASANG INF, INJ
0002757034078 1 OF R50 PASANG INF, INJ
1 GASTRITIS K29 RAWAT JALAN
0002970548392 1 V.APP T14 RAWAT LUKA
0001307787884 1 HEG O21.0 PASANG INF, INJ
0000669662673 1 FRACTURE FINGER S62 RAWAT LUKA
0003502476909 1 ASHMA BRONCHIALEJ45 RAWAT JALAN
0002586318117 1 PARTUS O80.0 PASANG INF
0000669050842 1 V.APP T14 RAWAT LUKA
1 MYALGIA M79 RAWA JALAN
1 OF R50 RAWAT JALAN
0002907481263 1 OF R50 PASANG INF
1 VOMITING R11 RAWAT JALAN
0000669747508 1 V.APP T14 RAWAT LUKA
1 BPH N40 PASANG DC
1 DM E11
0001250832172 1 PARTUS
CF S O80.0 PASANG INF
1 RADIALIS DEXTRA R50 PASANG INF, INJ,
0000670247965 1 VERTIGO H81.4 PASANG INF
0000669608032 1 ASITES R18.8 PASANG INF. INJ
1 PPOK J44 NRBULZER
0000668422664 1 BITE SCORPION T65 RAWAT JALAN
1 PPOK J44 NEBULIZER
1 V. ABRATIO T14.7 RAWAT ;LUKA
0003503585619 1 V.APP T14.2 RAWAT LUKA
0002414271971 1 HT I10 RAWAT JALAN
1 ISPA J06 RAWAT JALAN
1 PPOK J44 PASANG INFUS
0000108001034 1 KUTIL D21.4 CROS INSISI
0000676983339 1 GASTRITIS K29 RAWAT JALAN
57 22 5
PEMAKAIAN
ALAT IGD CATETER
INFUS SET CAIRAN INFLO
INFORMED TRIASE IC UMUM
TARIF MA MI RL NS KN D5 D10 ASERING 20 22 24 26 16 18 CONSENT ADA TDK ADA
1 1
1
1 1 1 1 1 1
BPJS 1 1 1
1
BPJS 1 1 1
1
1 1 1 1 1 1
1 1 1
1
1 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1
50000 1
1 1 1 1 1 1
75000 1 1
BPJS 1 1 1 1
305000 1 1
BPJS 1 1 1 1
BPJS
BPJS
BPJS 1 1 1 1
BPJS 1
UMUM 1 1 1
1 1 1 1 1 1
BPJS 1 1 1 1
UMUM 1 1 1 1 1
BPJS 1 1 1 1
50,000 1
BPJS 1
BPJS 1 1 2 1 1 1
1
BPJS
50000 1 1
BPJS 1 1
BPJS 1 1 1 1 1 1
1 1 1 1 1 1
235000 1 1
1
1 1 1 1 1
BPJS 1
BPJS 1 1 1 1 1 1
BPJS 1 1 1
1
1 1 1 1 1
1 1
75000 1 1 1 1 1
1 1
BPJS 1 1 1 1 1 1
BPJS 1 1 1 1
1
BPJS 1 1
BPJS 1 1 1 1 1 1
BPJS 1 1
BPJS 1 1
BPJS 1
BPJS 1 1 1 1 1 1
BPJS 1 1
BPJS 1 1
BPJS 1 1
BPJS 1 1
1 1 1 1 1
25000
1 1
1 1 1
BPJS 1 1 1
1 1 1 1 1 1
1 1 1 1 1
1 1 1 1 1 1
1 1 1 1 1 1
1
1 1 1
1 1
FREE 1
1
25000
1 1 1 1 1 1
1
28 2 19 8 1 0 0 0 13 16 0 2 1 2 64 54 0 27
CHECK LIST KELENGKAPAN DRM UGD
IC UMUM IC KEDOK IC PENOLAKAN M. ASTHSI IC RUJUK RJK RS RISK DWSARISK PDRTI HASIL LAB
TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK
1 1
1
1 1
1 1
1 1
1
1
1
1
1 1 1
1
1
1
1
1
1
1
1
1
1
1 1
0 25 0 0 0 5 0 1 0 1 0 0 0 0 0 1 0
PULG PAKSA
ADA TDK
0 0
TANGGAL JAMNON TANGGAL
NO NO. RM KUNJUNGAN DINAS DINAS NAMA PASIEN JK LAHIR
08-008176 08.10 HAIKAL ARKANA SETIAWAN L 5/19/2022
02-008612 05.30 MUHAMMAD THOYEB L 7/1/1965
1 02-001674 3/1/2023 06.30 MUHAMMAD IRSYADUL IBAD L 29/12/2011
01-008466 3/2/2023 07.00 WIJIATI P 15/12/1984
08-007536 02.00 EVA JUANA P 02/13/1992
08-008643 07.00 SULISTIONO L 06/08/1967
08-002803 3/3/2023 08.25 JAMTO L 17/03/1963
06-006698 09.45 ALVIO TEO SAYANDO L 01/01/2007
02-003403 10.20 MAT HASAN L 01./07/1953
04-008652 10.52 M.SHOLEH MARLAN L 26/04/1955
04-000091 10.00 SAERI L 8/1/1956
02-001479 17.00 ZAENAL AZIZ L 2/20/1969
02-001477 17.00 UMI THOYIBAH P 21/10/1970
01-008466 3/4/2023 08.36 WIJIANTI P 15/12/1984
02-008612 22.50 MUHAMMAD THOYEB L 7/1/1965
02-006666 09.00 GIYANTI P 7/1/1964
04-008681 3/5/2023 14.00 SUWAJI L 7/1/1948
03-008635 11.00 IMAM SAMSUDIN L 3/28/1998
04-007857 02.30 SOIMIN L 1/28/1952
06-008679 22.00 ROFIK P 1/1/2020
04-008762 22.10 BONAJI L 7/1/1954
02-006666 3/6/2023 12.30 GIYANTI P 7/1/1964
06-008683 20.00 SUKIMAN L 1/1/1961
01-008466 08.36 WIJIANTI P 15/12/1984
02-006666 09.00 GIYANTI P 7/1/1964
01-006301 06.30 AYU SULISTIANI P 04/08/2001
08-008677 12.00 SUTAJI L 08/09/1968
06-008683 20.00 SUKIMAN L 01/01/1961
08-003624 3/8/2023 08.00 YULIANA S P 01/07/1963
01-008466 08.36 WIJIANTI P 15/12/1984
04-005442 08.00 JASMADI L 01/07/1930
01-002370 3/9/2023 07.30 SUWITO L 5/18/1965
02-000230 02.00 LILIK KASIANI P 4/3/1977
10-000041 08.23 MULADI L 8/12/1936
01-003322 09.00 SUWITO L
01-008544 11-03-2023 11.30 HARJO GIMAN L
04-000899 19.40 KHOLIKUL FAJAR L
03-003753 10.00 SRI ASTUTIK P
01-001370 11.30 LUKENYO L
08-003322 14-03-2023 10.00 EKO SETIAWAN L
04-000899 11.52 KHOLIKUL FAJAR L
02-006181 12.30 BRIAN YAHYA L
01-005213 13.10 NY. YATIN P
06-008751 15/3/2023 00.30 YONGKI L
01-006112 21.30 CHELSEA NADIA P
03-000828 11.00 KATEMIN L
01-008809 20.40 SUTRIS L
04-000889 3/18/2023 07.25 KHOLIKUL FAJAR L
05-005179 11.30 MUHAMMAD NUR REHANSYAH
L 9/1/2015
09-008351 20.45 KATIMAN L
02-008301 21.00 ARGI L
02-008781 20-3-2023 09.30 TUMINEM P
06-008003 22-03-2023 20.00 SANI L
03-008802 23-03-2023 18.45 SUKIMIN L
02-008843 12.30 YUNI ANA P
09-008819 25/3/2023 22.45 RAFIKA P
04-000409 26/3/2023 00.25 SENAH P
10-008847 09.30 SUKARIYANTO L
10-000041 10.00 MULADI L
04-003286 13.00 INDAH RAHAYU P
03-002936 28-3-2023 02.30 AGUS SETIAWAN L
06-008826 10.00 DIDIK L
07-006113 11.20 SUMADJI L
05-001132 13.00 BOIKEM L
02-008835 29-3-2022 00.35 AGNES ARTIKA P
02-008835 02.00 AGNES ARTIKA P
03-009175 30-3-2023 08.30 MESIJAH P
06-008840 10.00 FITRI P
10-008841 12.30 MOHAMMAD YUSUF ELVAN L
06-008844 31-3-2023 11.30 SUHERMIN P
04-008509 18.30 ARKA L
03-008828 21.00 KATIRAN L
JENIS KASUS STATUS
USIA ALAMAT B L UMUM BPJS NIK

1 BANYUURIP 9/2 1 1 3505201905220003
58 SUKOREJO 2/3 1 1 3505200107650123
12 SUKOREJO 4/2 1 1 3505202912110001
39 RINGINANYAR 3/3 1 1 3505205512830002
31 BANYYURIP 14/3 1 1 3505205302920003
38 BANYUURIP 1/1 1 1 3505204608670001
60 MOJOREJO 10/02 1 1 3505201703630001
16 SUMBERJO 2/1 1 1 3505200101070002
70 SUKOREJO 4/1 1 1 3505200107530083
68 SIDOMULYO 2/2 1 1 3505202604550001
67 SIDOMULYO 4/2 1 1 3505200108560001
54 SUKOREJO 5/1 1 1 3505202002690001
53 SUKOREJO 5/1 1 1 3505206110700001
39 RINGIANYAR 3/3 1 1 3505205512830002
58 SUKOREJO 2/3 1 1 3505200107650123
59 SUKOREJO KRAJAN 4/3 1 1 3505204107640107
75 WATES 4/1 1 1 3505200107480058
25 BEJIREJO 16/4 1 3505200606980003
71 WATES 3/5 1 1 3505202801520001
3 PURWOREJO 1/2 1 1
68 WATES 3/1 1 1 3505200107540123
59 SUKOREJO KRAJAN 4/3 1 1 3505204107640107
62 PURWOREJO 1/2 1 1
39 RINGIANYAR 3/3 1 1 3505205512830002
59 SUKOREJO KRAJAN 4/3 1 1 3505204107640107
22 RINGINSARI 3/1 3505204804010001
55 MOJOREJO 20/4 1 1
62 PURWOREJO 1/2 1 1
60 BANYUURIP 15/3 1 1 3505204107630181
39 RINGIANYAR 3/3 1 1 3505205512830002
93 SIDOMULYO 5/1 1 3505200107300104
58 RINGINANOM 2/1 1 1 3505201805650001
46 SUKOREJO KRAJAN 1/1 1 1 3505204304770001
87 SUMBEROTO 4/4 1 1 3507011208360001
63 RINGINANOM 2/1 1 1
83 RINGINREJO 2/2 1 1
15 SIDOMULYO 2/3 1 1
38 TUGUREJO 9/12 1 1
9 SIDOREJO 4/2 1 1
29 SUMBERJO 3/1 1 1
62 TUGUREJO 2/1 1 1
16 WATES 3/2 1 1
7 TULUNGREJO 2/2 1 1 3505200109150001
69 BALEREJO 2/2 1 1
1 SIDOREJO 2/1 1 1
80 SUKOREJO 3/2 1 1
80 TUGUREJO 11/03 1 1
43 SUKOREJO 4/2 1 1
3 PURWOREJO 1/2 1 1
72 KARANGREJO 23/14 1 1
85 SUMBEROTO 4/4 1 1
27 WONOSARI 29/6 1 1 3505200208960001
62 SUMBERDADI 4/3 1 1
83 SUMBERARUM 1/2 1 1
17 SUKOREJO 5/3 1 1 3505205608060001
17 SUKOREJO 5/3 1 1 3505205608060001
68 WATES 5/4 1 1
35 BANYUURIP 15/3 1 1
3 BABADAN 2/5, SURABAYA 1 1 3578260702200003
1 WATES 1/4 1 1
82 TUGUREJO 6/2 1 1
PELAYANAN
KODE TERAPI
NO. BPJS RJ RI RJK DIAGNOSA DX TINDAKAN
0003177528041 1 OF R50.9 PASANG INF INJ
0000668422664 1 OF R50.9 PASANG INF INJ
0002159896454 1 ISPA J06.9 RAWAT JALAN
0003503585619 1 V.APP+DM E11+T14 RAWAT LUKA
0002970547863 1 G2P1 AB 0 UK 38 - 080.0 RUJUK RS
0000669662673 1 SNAKE BITE T63 PASANG INF INJ
0000108001034 1 V. APP T14 RAWAT JALAN
1 SNAKE BITE T63 RAWAT JALAN
1 MYALGIA M79 RAWAT JALAN
0000669890553 1 PPOK J44 PASANG INF INJ
0000107774583 1 HEADCHE J06.9 RAWAT JALAN
0000107774572 1 MYALGIA M79 RAWAT JALAN
0003503585619 1 DM+V.APP E11+T14 RAWAT LUKA
0000668422664 1 DF A90 PASANG INF INJ
0002939216343 1 DM+V.APP E11+T14 RAWAT LUKA
1 FEBRIS R50.9 PASANG INF INJ
0000669272646 1 HORDEOLUM H00.1 RAWAT JALAN
0002970549911 1 COLIC ABDOMEN R10.8 PASANG INF INJ
1 FEBRIS R50.9 RAWAT JALAN
0000669819363 1 GEA A09 PASANG INF, INJ
0002939216343 1 DM E11 RAWAT LUKA
1 VERTIGO H81.4 RAWAT JALAN
0003503585619 1 V. LASERATUM T14+E11 RAWAT LUKA
0003220673222 1 PROM O42.0 RUJUK RS
1 SNAKE BITE T63 RAWAT JALAN
1 VERTIGO H81.4 RAWAT JALAN
0002970551428 1 V.APP T14+E11 RAWAT LUKA
0002974791014 1 GASTRITIS K29 PASANG INF INJ
0002908936001 1 V.APP T14 RAWAT LUKA
0002488348552 1 MYALGIA M79 RAWAT JALAN
1 BPH N40 PASANG KATETER
1 V.APP T14
1 V.LASERATUM T14 RAWAT LUKA
1 GASTRITIS K29 PASANG INFUS, INJ
1 SNAKE BITE T63 PASANG INFUS, INJ
1 CVA L63 PASANG INF, OKSIGEN
1 INSECT BITE T64 RAWAT JALAN
1 OBS VOMITU K29 PASANG INF, INJ
1 DISPEPSIA K30 PASANG INF, INJ
1 OF R50 PASANG INF, INJ
0002893699282 1 TYPOID A09 PASANG INFUS, INJ
1 DISPEPSIA K30 PASANG INF, INJ
1 DEHIDRASI BERAT E86 PASANG INF
1 VERTIGO H81 RAJAL
1 ASMA BRONCHIALE J45 NEBULIZER
1 HT I10 RAWAT JALAN
1 PEB PASANG INFUS, INJ
1 FEBRIS R50.9 RAWAR JALAN
1 DOC PASANG INFUS, INJ
1 SUSP PPOK J44 PASANG INF INJ
1 BPH N40 PASANG KATETER
1 OF R50 PASANG INF
1 GEA A09 PASANG INF, INJ
1 GASTRITIS K29 RAWAT JALAN ( APS)
1 GEA A09 PASANG INF, INJ
0002600890064 1 ASMA BRONCHIALE J45 RAWAT JALAN
0002600890064 1 ASMA BRONCHIALE J45
1 VERTIGO H81 PASANG INF, INJ
1 COLIC ABD R10.83 PASANG INF, INJ
0003102276914 1 TYPOID FEVER A01 PASANG INF, INJ
1 PPOK J44.9 PASANG INF, INJ
PEMAKAIAN
ALAT IGD
FOLEY
CATETER
INFORMED
TARIF MA MI RL NS KN D5 D10 ASERING 20 22 24 26 16 18 CONSENT
1 1 1 1
1 1 1 1
1 1 1 1
1
1
1
UMUM 1 1 1 1
1 1 1 1
1
1
1 1 1 1
1
1
50000 1
1
1
1
1 1 1 1
1 1 1 1
1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1
1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
45
TRIASE IC UMUM IC KEDOK IC PENOLAKAN M. ASTHSI IC RUJUK RJK RS RISK DWSA
ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA
1 1
1 1
1
1
1
1
1
1
1 1
1 1
1
1
1 1
1
1
1
1
1
1
1 1
1 1
1
1 1 1 1
1 1
1 1
1 1
1
1 1
1 1
1 1
1
1 1
1 1 1 1 1
1 1
1
1 1
1 1
1 1
1 1
1 1 1
1 1 1
1
1 1
1 1
GD
RISK DWSA RISK PDRTI HASIL LAB PULG PAKSA
TDK ADA TDK ADA TDK ADA TDK
1
JAM
NON
NO NO. RM TANGGAL KUNJUNGAN DINAS DINAS NAMA PASIEN JK
1 1-4-2023 09.30 KHUSNUL KHOTIMA P
2 01-008470 4/1/2023 17,30 SUSI P
3 11.48 M.NUR REHAN L
4 18.00 SUYATI P
5 18.05 HABIBIE ARSYIL L
6 18.05 YUNITA YUSTIANA P
7 23.15 ALFI P
8 2-4-2023 21.00 KATIRAN L
9 4-4-2023 04.10 GINO L
10 09.00 CHINTYA ICA P
06-004574 20.45 ANGGUN TRI WAHYUNI P
11 09.30 FIRDAUS MOLA L
12 04.00 AIZZATUL UMMAMI P
13 08.00 NGATINI P
14 12.00 EMANUELL EANORA P
15 19.30 LUKAS L
16 6-4-2023 09.20 EDI BAMBANG L
17 10.15 FIRDAUS NOVA L
18 8-4-2023 11.00 NUR JANATUL P
19 11.00 FIRDAUS NOVAL L
06-005833 IKA WINARSIH P
20 16.45 TRI UTAMI P
21 17.00 RADIMAN L
22 9-4-2023 04.30 ATHARASKA L
23 05-009010 21.15 SOIDI L
24 02-008930 4/10/2023 06.45 SUNARMI P
25 04-006494 08.30 ATHARRAZKA TISHA GEVARIEL L
26 10.00 KATMINI P
27 11.00 SUYANTO L
28 06-006435 4/10/2023 13.45 SULTAN ABIZAR L
29 04-008914 4/10/2023 20.25 SUTIYAH P
30 02-004059 4/10/2023 12.26 MUJIONO L
31 4/11/2023 08.12 DJEMARI L
32 04-008915 4/11/2023 9.40 TOHA L
33 08-005463 09.40 NANIK SUBIANTI P
34 18.00 EVI ROSITA P
35 10-008919 4/11/2023 19.50 LAURENSIA ADISTI RAHAYU P
36 06-005776 16,00 ALESHA ZAHRA NUR PRAMISWARP
37 10.00 WAGINEM P
38 10.20 KATMINI P
39 11.30 NABILA RAMADHAN P
40 03-008969 12.00 MARINI P
41 21.30 LUCKY ASTIANA P
04-001060 10.00 WULANSARI NOVIANA P
42 4/13/2023 10.45 SRI LESTARI P
43 08-009062 12.00 JUMITO L
44 12.45 DORA RESTU L
45 15.30 TUMIRIN L
46 06-001329 16.00 WIJIONO L
47 06-008963 19.30 LUKATI P
48 4/14/2023 08.00 KATMINI P
49 10.00 MULADI L
50 01-006319 10.30 ZAHIDATUL MA'RIFAH P
51 15.50 SARNI SUWARNO L
52 01-008950 4/15/2023 12.06 RIMAH P
53 10-008965 18.45 SUKATEMAN L
54 07-004196 4/16/2023 02.00 FADIL MAULANA FIKRI L
55 10-008970 19.20 SUNARMI P
56 02-000367 20.10 CHALID AINUR ROFIQ L
57 4/17/2023 07.30 GALIH L
58 01-008950 11.55 RIMAH P
59 04-006557 19.00 M.SUWARMAN L
60 01-009012 19.15 ALNANDO ARVISA YO YOYA L
61 4/18/2023 08.43 BINAH P
62 01-006319 09.30 ZAHIDATUL MARIFAH P
63 01-009013 10.00 FLORENSIA MEIDELIN P
64 4/19/2023 07.30 YULITA KRISTIANI P
65 08.00 SANTI NOVITA SARI P
66 08.30 MUJIASIH P
67 09.00 RUJIANI P
68 09.00 SUYITNO L
69 09.00 RAVARO WAFAA L
70 10.00 PARTI P
71 10.00 FAUZAN L
72 03-009014 12.00 LIYA PERMATASARI P
73 13.00 SITUR HANDOKO L
74 14.00 EMILIANA M P
75 17.00 MARNIK P
76 4/20/2023 09.45 SRINGATUN P
77 01-008950 RIMAH P
78 10.30 SUWARTI P
09-008998 4/21/2023 09.00 ALVINO PUTRA NUR HANAFIL
80 06-000017 10.00 KATENI P
81 10.40 RINI P
82 11.30 LILIK KASIANI P
83 16.00 M. RAFKA SUKRON L
84 08-005918 22.30 ANTONIUS SUGENG WIARDI L
85 4/22/2023 15.00 SUMARDI L
86 18.30 EVI ROSITA P
87 01-008950 23/4/2023 08.45 RIMAH P
88 10-008993 16.32 RAYYAN ARKAN MALIK L
89 10-008994 17.00 KAKA ALVARESI L
90 10-008995 19.00 DANIASIH L
91 20.00 NIKO BIMA AL FAKRI L
92 4/24/2023 06.00 BRIAN BAGUS PAMUNGKAS L
93 06-008997 09.00 M.AFIQ DWI ANDIKA L
94 09.20 DEFANTA AYU L
95 10.35 M.RAFKA L
96 25/4/2023 18.45 SRI WAHYUNI P
97 06-008868 21.30 HARWIN P
98 26/4/2023 19.50 SAMUJI L
99 27/4/2023 11.30 KASTIYAH P
100 07-009007 12.30 SISWANDARI P
101 04-009053 28/4/2023 11.00 MUJIONO L
102 07-009063 21.00 BOINI P
103 04-001926 16.30 AMALIA IVANA P
104 01-008410 4/29/2023 09.00 KATMINI P
105 08-009017 10.00 MESIRAN L
106 12.00 AKMAL NIZAMA P
107 03-009065 12.20 GIBRAND ATMADJA L
108 08-005918 10.00 ANTONIUS SUGENG WARDI L
109 01-001236 SHAFIRA RAHMA WATI P
110 10-009064 12.30 SUYANTO L
111 06-009066 19.20 SUMINAH P
112 08-009020 4/30/2023 08.20 YONO L
113 04-001581 09.00 DWI RAHARJO L
114 01-006244 11.30 NINE LILIN ARINANDA P
115 08-000180 14.45 EKO NURMUHONO L
116 01-003719 00.45 MILA PUTRI P
JENIS KASUS STATUS

26 RINGINANYAR 1/1 1 1 3505165208970001
6 TULUNGREJO 2/2 1 1
59 KARANGREJO UTARA 23/14 1 1
9 SUMBERASRI 1/2 1 1
62 RINGINSARI 4/4 1 1
21 SIDOREJO 4/2 1 1
23 SUMBERJO 3/1 1 3505206508000001
30 TUGUREJO 2/1 1 1
26 SIDOMULYO 2/3 1 1 3507186012970004
48 SIDOREJO 3/1 1 1
9BL SIDOREJO 3/2 1 1
54 WONOSARI 1 1
30 TUGUREJO 2/1 1 1
30 TUGUREJO 2/1 1 1
31 SUMBERURIP 4/1 1 3505206212920002
49 WONOSARI 27/6 1 1
62 WONOREJO 4/2 1 1
3 WATES 3/2 1 1
45 TULUNGREJO 2/1 1 1 3505201209780003
56 SUKOREJO 5/2 1 1 3505204107650064
3 WATES 3/2 1 1 3505202911200001
63 SUKOREJO 4/1 1 1
1 SUMBERDADI 2/3 1 1 350520280320001
40 WATES 1/1 1 1
69 SUKOREJO 5/3 1 1 3505200107540090
50 SIDOMULYO 4/2 1 1 3505200412730001
43 BANYUURIP 15/3 1 1 350205008800001
35 WATES 1 1
8 BALEREJO II 2/1 1 1 3505135008150002
4 SUMBERDADI 2/2 1 1 3505204811190001
68 SUMBERDADI3/3 1 1
65 TUGUREJO 6/2 1 1 3506095507580001
33 SIDMULYO 2/3 1 1 3505206411900001
40 WATES 2/4 1 1
61 MOJOREJO 24/5 1 1 3505201006620002
75 PURWOREJO 3/2 1 1 3505202306610001
20 RINGINANOM 2/1 1 1 3505205504030002
84 SUMBERARUM 4/1 1 1
45 RINGINSARI 2/2 1 1 3505205901780001
5 SUMBERARUM 2/1 1 1 3505202510170001
60 KALISANGKRAH 28/6 1 1
32 SUKOREJO 3/2 1 1 3505201201910003
17 SUMBEROTO 2/1 1
45 RINGINSARI 2/2 1
68 WATES 2/3 1 1 3505200107550125
3 RINGINREJO 2/1 1 1 3505201401200003
20 RINGINANYAR 1/1 1 1 3505205504030002
2 RINGINSARI 3/3 1 1 3505205705210001
59 MERDEKA 1/1 1 1
61 SUMBERURIP 4/1 1 1
17 SUKOREJO 4/2 1
59 SUMBERJO 3/1 1 1
4 TUGUREJO 6/2 1
28 WONOSARI 27/6 1 1 3505206501950001
53 WONOREJO2/3 1 1
67 PALDOYONG, SAMBIGEDE 1 1
68 WONOSARI 29/6 1
45 RINGINSARI 2/2 1 1 3505200107550125
63 WATES 5/1 1
1 BALEREJO II 4/1 1 1 3505130208220002
63 SUMBERDADI 4/1 1 1 3505204107610092
65 RINGINREJO 4/1 1
45 SUKOREJO 1/1 1
12 WATES 1/5 1 1
65 WATES 3/4 1 1
35 WATES 1/1 1 1
45 RINGINSARI 2/2 1 3505200107550125
1 WARU SIDOARJO 1 1
12 JL PISANG CANDI 3/4 MALANG 1 1
53 JL SALAK 3/7 SEMARANG 1 1 3313114505120004
4 SUMBERJO 2/2 1 1 3505200708180001
12 WATES 1/5 1 1
31 SUMBERURIP 1/2 1 1 3505204908780003
25 SUMBERURIP 3/2 1 1 3505165612950001
70 WATES 3/2 1 1 3505201106520001
58 SUMBERARUM 3/2 3505164107650008
19 WATES 2/3 1 1 3505205610030002
78 RINGINREJO 2/2 1 1 3505204101430002
60 BANYUURIP 15/2 1 1 3505200312630001
2 TUGUREJO 1/2 1 1 3505201104210001
58 BANYUURIP 10/2 1 1 3505201505650001
RINGINANYAR 1/1 3505204405130002
66 GEDANGAN 20/3 3505160409570003
59 PURWOREJO 4/2 1 1 3505204702640002
85 MOJOREJO 16/4 1 1 3505200107420010
35 SIDOREJO 4/2 WATES 1 1 3505201910870001
19 RINGINANYAR 1/1 1 1 3505206206040001
40 BANYUURIP 1/1 1 1 3505200902830002
22 RINGINSARI 4/4 1 1 3505206302010001
PELAYANAN
NO. BPJS RJ RI RJK DIAGNOSA

1 HT GR II
38 -39 MMG DGN
0003301935592 1 PROM +PE
1 COLIC ABD
1 ISPA
1 ISPA
1 ISPA
1 FEBRIS
1 VERTIGO
1 COLIC ABD
1 ABSES
0000669782158 1 G1P0AB 0 UK 37 - 38 MMG, PROM
1 ABSES
0000683517868 1 PARTUS
1 ASMA
1 OF
1 OF
1 V.APP
1 ABSES
1 COLIC ABD
1 ABSES
0002598767289 1 G3P1 AB 0 UK 31- 32 MMG, S.IUFD
1 ISPA
1 SNAKE BITE
1 GEA
1 COLIC ABD
1 GEA
1 OF GEA
1 V.APP
1 V.APP
0003262683058 1 BURN INVOLVING 10-19% OF BODY SURFACE
1 ISPA
0001037366818 1 HT
1 V.APP
1 VULNUS APERTUM
0000668941468 1 DIARE AKUT
1 VERTIGO
1 ISPA
1 FEBRIS
1 CARCINOMA
1 V.APP
1 COLIC ABD
0001702687083 1 HIPOGLIKEMIA
1 GASTRITIS
0003177527962 1 G4P3AB 1 UK 40 +INPARTU KALA 1 FASE MEMANJANG
1 V.APP
1 SNAKE BITE
1 ISPA
1 HT
0002678315444 1 KOLELITIASIS
1 VERTIGO
1 V.APP
1 BPH
0002929119794 1 HIPEREMESIS
1 COVID 19
0000669913942 FRUNKEL
1 COVID 19
0002419184687 1 ASMA
1 ASMA
0002625068687 1 COVID 19
1 V.ABRATIO
1 ABSES
0002089771751 1 COLIC ABD
1 VOMITING
1 XEROSIS
0002929119794 1 HIPEREMESIS
1 KEJANG
1 HT
1 ABSES
1 ISPA
1 GASTRITIS
1 HT
1 SCABIES
1 HT
1 ISPA
1 COLIC ABD
1 HEMATOMA
1 GASTRITIS
1 GASTRITIS
1 DEMAM
0002089771751 1 ABSES
1 MYALGIA
1 ISPA
0000670513689 1 DM
1 HT
1 PRURITUS
1 V.APP
1 V.APP
1 COLIC ABD
1 V. ABRATIO
0002089771751 1 ABSES
0003132679615 1 ISPA
0001534800598 1 DEMAM
0000077390548 1 MYALGIA
1 OF
1 VOMITING
0002480980061 1 SERUMEN
1 OF
1 V.APP
1 POST PARTUM
0003136515906 1 ASMA
1 OBS VOMITING
1 OF
1 ABSES
0000669773777 1 COMBUSTIO
0000671109489
0002198671468 1 TYPOID
0000071942499 1 V.APP
0000670479153 1 COVID 19
1 PNEMONIA
1 OF
0002970549257 1 VAPP
0002159895982
SNAKE BITE
0002867903291 1 OF
0000670180667 1 ISK
0002678311686 1 V.APP
1 GEA
0002970547828 1 COVID 19
0000669587229 1 G1POABO UK 37 MMG+KPD
PEMAKAIAN
ALAT IGD
KODE TERAPI
DX TINDAKAN TARIF MA MI RL NS KN D5 D10 ASERING 20 22 24
I10 PASANG INF, INJ UMUM 1 1 1
o80 PASANG INF BPJS
A10 PASANG INF, INJ BPJS 1 1 1
J06
J06
J06
R50 PASANG INF, INJ BPJS 1 1 1
H81.4 PASANG INF, INJ BPJS 1 1 1
A10 BPJS
L80 RAWAT LUKA BPJS
O42 RUJUK RS BPJS
L80 RAWAT LUKA BPJS
080.0 PERSALINAN
J45 NEBUL
R50 RAWAT JALAN
R50 RAWAT JALAN
T14 RAWAT LUKA
L80 RAWAT LUKA
A09 PASANG INF INJ 1 1 1
L80 RAWAT LUKA
O36.4 RUJUK RS
J06 RAWAT JALAN
T63 PASANG INF INJ 1 1 1
T14 RAWAT LUKA
T14 RAWAT LUKA
T31.1 RAWAT LUKA
J06.9
I10
T14 RAWAT LUKA
T14
A09 PASANG INFUS INJ
H81 RAWAT JALAN
J06 RAWT JALAN
R50.9 PASANG INFUS INJ
C50 RAWAT LUKA
T14 RAWAT LUKA
A10 RAWAT JALAN
E08 PASANG INF INJ 1 1 1
K29 RAWAT JALAN
RUJUK RS
T14 RAWAT LUKA
T63 PASANG INF INJ 1 1 1
J06 RAWAT JALAN
I10 RAWAT JALAN
H80 PASANG INF INJ 1 1 1
H81.4 PASANG INF INJ 1 1 1
T14 RAWAT LUKA
N40 PASANG KATETER
O21 PASANG INF INJ 1 1 1
B34.2 RAWAT JALAN
L02.2 RAWAT LUKA
B34.2 RAWAT JALAN
J45 PASANG INF INJ 1 1 1
J45 NEBUL
B34.2 RAWAT JALAN
T14 RAWAT JALAN
L02.2 RAWA LUKA
R10 PASANG INF INJ 1 1 1
K29 PASANG INF INJ 1 1
L82 RAWAT LUKA
O21 RAWAT JALAN
R50 PASANG INF INJ 1 1
I10 RAWAT JALAN
L02.2 RAWAT JALAN
J06 RAWAT JALAN
K29 RAWAT JALAN
I10 RAWAT JALAN
B86 RAWAT JALAN
I10 RAWAT JALAN
J06 RAWAT JALAN
M79 RAWAT LUKA
K29 RAWAT JALAN
K29 RAWAT JALAN
R50 RAWAT JALAN
L02.2 RAWAT LUKA
M79 RAWAT JALAN
J06 PASANG INF INJ 1 1
E11 RAWAT JALAN
I10 RAWAT JALAN
L29.9 RAWAT JALAN
T14 RAWAT LUKA
T14 RAWAT LUKA
T14.6 RAWAT JALAN
L02.2 RAWAT JALAN
J06 RAWAT JALAN
R50 RAWAT JALAN
M79 RAWAT JALAN
R50 PASANG INF INJ 1 1
K29 RAWAT JALAN
H81 RAWAT JALAN
R50 RAWAT JALAN
T14 RAWAT LUKA 50000
O80 PASANG INF INJ 1 1 1
J45 PASANG INF INJ 1 1 1
K29 RAWAT JALAN
R50 PASANG INF, INJ 1 1 1
L02.2 RAWAT LUKA
T30 RAWAT LUKA
A01 PASANG INF, INJ 1 1 1

T14 RAWAT LUKA
B34.4 RAWAT JALAN
j18.9 PASANG INF, INJ 1 1
R50 PASANG INF, INJ 1 1
T14 RAWAT LUKA
R50 PASANG INF, INJ 1 1 1

A54 RAWAT JALAN
T14 RAWAT JALAN
A09 PASANG INF, INJ 1 1 1
B34.2 RAWAT JALAN
O42.9 RUJUK RS
CATETER
INFLO CHECK LIST KELENGKAPAN DRM UGD
INFORMED TRIASE IC UMUM IC KEDOK IC PENOLK M. ASTHSI IC RUJUK RJK RS
26 16 18 CONSENT ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA
1 1 1
1 1 1
1 1 1
1 1 1
1
1
1 1 1
1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1
1
1
1
1 1 1
1
1 1 1 1
1 1 1 1
1 1 1 1
1
1 1 1
1 1 1
1 1
1 1
1 1 1
1
1 1
1 1 1
1 1 1 1 1
1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1
1 1
1 1 1
1 1 1
1 1
1 1
1 1 1
1 1
1 1 1 1 1 1
1
1 1 1
1 1 1
1
56
NGKAPAN DRM UGD
RJK RS RISK DWSA RISK PDRTI HASIL LAB PULG PAKSA
TDK ADA TDK ADA TDK ADA TDK ADA TDK
1
1
JAM
NON
NO NO. RM TANGGAL KUNJUNGA DINAS DINAS NAMA PASIEN JK
1 05-007342 1-5-2023 07.30 ZAEEM GHIFARI ALFARASYA L
2 08-008757 2-5-2023 09.35 VERONIKA SRI W P
3 06-009022 09.00 WAGINEM P
4 10-000041 09.00 MULADI L
5 04-009042 10.00 PUJI RAHAYU P
6 02-001481 10.45 FADILA AZIZ PUSTAKA N P
7 01-009048 14.30 IRA LESTARI P
8 05-002925 21.50 MUHAMMAD FAHMI SHIDIQ L
9 01-006353 3/5/2023 12.11 MUDJITO L
10 10-008175 5/4/2023 06.30 DAMIANUS REGIO MARIA CYL
11 04-004538 15.45 BONIYEM P
12 06-001449 13.40 SUWITO L
13 04-009168 17.20 SUTADI HARIANTO L
14 04-009079 18.00 RYAN AGUSTIN P
15 04-002770 19.00 SARIYATI P
03-000634 12.00 LUKAS MULYONO L
16 04-002780 19.00 SUHERMAN L
17 05-002839 5/5/2023 10.10 ZAINUR ROZIQIN L

18 08-009083 11.45 SITI SILVIANA P
19 08-009041 18.00 CHRISNA FERNANDO L
20 04-002780 19.00 SUHERMAN L
21 04-002770 19.00 SARIYATI P
22 05-002903 20.00 NOVIA ROMADHONI P

23 02-001481 6/5/2023 08.00 FADILA AZIZ PUSTAKA N P
24 04-002512 09.00 AHMAD YANI L
25 09-009223 7/5/2023 16.45 KUMIANTO L
26 07-009091 5/8/2023 08.45 ALMEERA TSANISHA AZZAHRA P
27 10-009094 9.20 ANITA ERWIN P
28 05-009224 14.00 YATI P
29 06-009182 16.00 YANI L
30 02-001675 18.00 MUHAMMAD KHOIRUL IBAD L
31 05-007696 9/5/2023 15.00 SAIRIN L
32 10-000126 17.00 RRAFANDRA AQLA MULYONO L
33 10-009124 17.00 SULIANI P
34 03-009125 18.30 SUKIRAN L
35 02-008759 5/10/2023 09.00 UMIATI P
36 08-009123 10.00 DENNY PURNALA L
37 01-009143 5/11/2023 07.30 WIJI P
38 09-009151 10.00 FLORENTINA NADIVA JULIANP
39 01-005130 19.00 SUSIATI P
40 03-006999 10.45 YUANITA M P
41 05-000086 13.00 FARHAN L
42 03-009146 01.30 GIBRAN ADZRIEL ALFAREZI L
43 04-006993 23.30 TARMI P
44 04-006993 5/12/2023 10.00 TARMI P
45 10-003800 IIN DWININGSIH P
46 01-002206 06.45 YANIK TRI WAHYUNI P
47 05-000589 10.30 AHMAD AFANDI L
48 09-000988 12.20 CHELSEA VANESSA P
49 02-007561 13.30 TUMIRAN L
50 06-009166 5/13/2023 08.30 REYNA YUHENDRIKA P
51 01-009163 9.00 SASHECIA QUEENSHA SAQUEENAP
52 04-004196 16.43 FADIL MAULANA VIKRI L
53 01-006570 04.00 FEBRIANTI AYU PERDANA P
54 10-009174 02.00 SUGITO L
55 04-005225 13.00 RESTU DWI JAYANTI P
56 04-007066 5/14/2023 8.30 DIENA HABBIN AMIEQ P
57 01-004782 12.00 JESIKA MEIRITA P
58 02-007425 08.00 SRI WULANDARI P
59 06-009220 14.30 HARYONO L
60 01-009201 5/15/2023 13.00 MUSADI L
61 05-007841 14.00 KATIMAN L
62 02-007346 5/16/2023 13.00 SURIP L
63 01-009107 17.15 SUROSO L
64 02-007246 5/17/2023 13.15 KATENI L
65 01-009216 19.00 SUMINI P
66 05-007841 22.00 KATIMAN L
67 05-009212 5/18/2023 20.00 DJEMADI L
68 01-004249 10.15 TATIK INDRAWATI P
69 10-000041 5/19/2023 10.00 MULADI L
70 02-009229 10.55 GIYANTI P
71 01-009262 5/20/2023 21.30 SUGANTI P
72 03-009214 22.00 KARMUN L
73 05-000215 5/21/2023 12.00 SALMA JUWITA P
74 08-003916 16.00 DEFANTA BAYU RAMADHANA L
75 05-007841 5/22/2023 09.27 KATIMAN L
76 10-009275 20.35 RETI ARDIANTI P
77 05-008479 12.30 ANANG SUBANDHI L
78 09-009276 14.00 JAMARDIN L
79 03-001639 5/23/2023 14.00 BOINI P
80 04-005234 12.30 SUMIRAH P
81 01-000206 5/24/2023 07.48 SUKADI L
82 04-001679 08.52 VINSENSIUS EDY SUGIANTO L
83 08-007682 16.00 LULIS IRAWATI P
84 01-001236 5/25/2023 13.30 SHAFIRA RAHMA WATI P
85 01-009277 18.00 KARDI L
86 06-007948 26/05/2023 15.00 SARMAN HERI FIRDAUS L
87 01-000499 27-05-2023 13.30 SITIN P
88 02-009274 13.35 EKA BAGUS SETIANTO L
89 04-001611 16.30 MUHAMMAD ROSID L
90 10-009124 28-05-2023 23.45 SULIANI P
91 01-009285 29-05-2023 10.45 AYU OCVITASARI PUTRI P
92 03-006554 17.30 ILYAS ARYA MUHARRAM L
93 01-007584 08.00 EKA AGUSTINA P
94 10-001370 03.40 LUKENYO L
95 01-009292 30-05-2023 09.55 RITA AMANDA P
96 03-009305 5/31/2023 16.28 SULASTRI P
97 10-009306 5/31/2023 17.17 YOHANES KARNAWAN L
JENIS KASUS STATUS

1 TULUNGREJO 1/1 1 1 3505201904220001
58 MOJOREJO 14/3 1 1 3505206504650001
66 SUMBERJO 2/2 1 3505204704560001
85 SUMBEROTO 4/4 1 3507011208360001
37 WATES 3/4 1 3505205605860003
26 SUKOREJO 5/1 1 1 3505205309970001
35 RINGINSARI 3/4 1 1 6401095005710003
16 TULUNGREJO 3/2 1 1 3505200102070003
62 RINGINANOM 3/2 1 1 3505200709590002
1 SURABAYA 3/4 1 3578100311220007
70 WATES 1/1 1 1 3505204107530113
57 SUMBERURIP 1/2 1 3505200303660001
61 WATES 5/4 1 1 3505201705620002
28 WATES 4/2 1 1
53 SIDOMULYO 15/4 1 1 3505205504700001
54 WONOSARI 27/6 1 1 3505202508690003
55 SIDOMULYO 2/1 1 1 3505200605680004
25 TULUNGREJO 4/1 1 1 3505201009970001

20 BANYUURIP 3/1 1
30 MOJOREJO 14/3 1 1 3505201103930001
53 SIDOMULYO 2/1 1 1 3505205504700001
20 SIDODADI 5/1 1 1 3505204611030001

25 SUKOREJO 5/1 1 1 3505205309970001
16 KRAJAN 15/4 1 1
56 BALEREJO 2/1 1 1 3505130704670002
1 SUMBERARUM 6/1 1 1 3505203102220001
51 SUMBEROTO 5/2 1 3507014412720002
55 SIDODADI 5/1 1 1 3505204301680001
83 SUMBERDADI 4/3 1 1 3505200309510001
6 SUKOREJO 4/2 1 1 3505200112170001
60 TULUNGREJO 3/3 1 1 3505200107630040
9 SUMBEROTO 6/1 1 1 3507011012140002
42 SUMBEROTO 6/1 1 1 3507016003810001
58 SUKOREJO 5/3 1 3505204909650001
28 MOJOREJO 14/3 1 1 3505201806940005
55 RINGINANYAR 1/3 1 350520112680005
3 BALEREJO 2/1 1 1 3505124207200001
72 RINGINANYAR 1/2 1 1 3505204112510004
39 TUGUREJO 2/1 1 3505204106840002
8 SIDODADI 1/2 1 1 3505200410150002
3 BEJIREJO 25/5 1 1
67 WATES 4/4 1 1 3505204711560001
67 WATES 4/4 1 1 3505204711560001
34 SUMBEROTO 9/2 1 1 3507015601890001
27 RINGINANOM 3/2 1 1 3505207010940001
16 TULUNGREJO 4/2 1 1 3505203006070001
3 BIROWO 3/3 1 1 3505164304200001
53 SUKOREJO 3/3 1 1 3505200206720001
12 SUMBERASRI 2/3 1 1 3505206909110001
2 RINGINREJO 2/3 1 1 3505205303210001
6 SUMBERARUM 2/1 1 1 3505202510170001
21 SUKOREJO 4/1 1 1 3505204802020001
63 NGRENDENG 14/3 1 1 3507012512600002
26 BANYUURIP 2/1 1 3572026910970001
19 SIDOMULYO 4/1 1 3505206609040001
23 RINGINREJO 3/1 1 1 3505205405000001
23 SUKOREJO 5/2 1 1 3505167007000002
61 SUMBERDADI 2/1 1 1 3505203006620001
83 RINGINANOM 2/2 1 1 3505202001400001
61 SIDODADI 2/1 1 1 3505200202620004
63 SUKOREJO 4/2 1 1 3505205309600001
69 RINGINSARI 2/1 1 1 3505202709270001
74 RINGINREJO 2/1 1 1 3505201301490001
61 SIDODADI 2/1 1 1 3505200202620004
84 TULUNGREJO 1/2 1 1 3505201505390001
38 RINGINREJO 2/1 1 1 3505205107850002
85 SUMBEROTO 4/4 1 1 3507011208360001
59 SUKOREJO 4/3 1
68 RINGINANYAR 1/3 1 1 3505204704550001
5 TULUNGREJO 1/3 1 1 3505204303180001
28 MOJOREJO 10/2 1 1 3505200302950001
61 SIDODADI 2/1 1 1 3505200202620004
27 KALISANGRAH 30/7 1 3507014301960006
45 SUMBERDADI 2/1 1 1 3505202210780001
50 BIROWO 3/3 1 1 3505162505730002
55 TUGUREJO 2/1 1 1 3505204107680126
52 WATES 4/2, 1 1 3505204107710084
62 RINGINANOM 3/2 1 1 3505200401610003
41 SIDOMULYO 1/2 1 1 3505201110820002
34 MOJOREJO 3/1 1 1 3505185409890001
10 RINGINANYAR 1/1 1 1
22 RINGINSARI 3/3 1 1 3505200703680002
56 SUMBERJO 3/1 1 1 3505200111590001
65 RINGINANOM 3/1 1 1 3505204806570002
1 SUKOREJO 3/4 1 1
10 WATES 4/1 1 1 3505202708120001
42 SUMBEROTO 6/1 1 1 3507016003810001
20 RINGINANOM 1 1
4 WATES 11/3 1 1 3505200710170001
32 RINGINSARI 3/2 3504084108910001
72 RINGINANOM 3/2 1 1 3505201801510001
RINGINSARI 1/1 1 1 3505205206050002
60 TUGUREJO 14/3 1 3505205811630001
45 SUMBEROTO 3/1 1 3507012606780002
PELAYANAN
KODE
NO. BPJS RJ RI RJK DIAGNOSA DX
1 ISPA J06.9
0002317531476 1 OF R50.9
1 VOMITING R11
0000676964788 1 BPH N40
VOMITING R11
1 ABSES NAIL L03
0003099468251 1 APP PERFORASI K35.2
1 GEA A01
1 V.APP T14
OF H 2 R50.9
1 TINEA CRUCIS
1 MYALGIA M79.1
0002426879621 1 CHF I50.9
1 DIARE
1 HT I10
0001842856806 1 OF R50.9
0002242585661 1 DIARE
1 CROSS INSISI
0002970549167 1 TINEA CRUCIS
0002317531825 1 OF R50
1 DIARE A09
0002242583482 1 HT I10
1 GEA A09
1 ABSES NAIL L03
1 V.APP T14
0000668739723 1 DECOMP L50.9
0003256346935 1 TYPOID FEVER A01.0
1 Acquired stenosis of external ear canal H61.3
1 VOMITING K29
0002159895374 1 VOMITING K29
0002316249077 1 ISPA J06.9
0002155803941 1 GEA A01.0
0003336239474 1 ISPA J0.6.9
0003336239507 1 ISPA J06.9
1 ISPA J06.9
0003011825327 1 DM, HT, DYSPEPSIA E11,I10,K30
1 CORPUS MATA T15
HT I10
0003113203241 1 OF R50
0002884773284 1 DYSPEPSIA K30
0001082962473 1 CKD N18.9
0002159896151 1 VOMITING R11
1 VOMITING R11
0000668955969 1 ASHMA J45
0000668955969 1 ASHMA J45
1 OF R50.9
0002731221977 VOMITING R11
1 GASTRITIS K30
1 OF HARI 1 R50
0003011838456 1 DISPEPSIA K30
1 OF R50.9
SERUMEN PROP H61.2
0002419184687 1 ISPA J06.9
0000669522881 1 HAMIL DENGAN ANEMIA O99.0
1 GASTRITIS K30
OF R50.9
POST OP KISTA Z09.8 +L72.0
0003510048598 1 G1P0AB0 UK 35 -36 MMNG+ PPI 060.0
0002970508814 1 G1P0AB0 UK 37 -38 MMG +S CPD O33.9
0002155898035 ISK N39.0
1 PNEUMONIA J18
0000670354863 1 V.APP T14
0000107724802 DYSPEPSIA K30
0003176738381 DYSPEPSIA K30
0000668707964 ASHMA BRONCHIALE J45
1 OF R50.9
0000670354863 1 V.APP T14
0003177177581 ASHMA J45
0003220872906 1 G5P0AB 0 UK 37-38 MMG +PRE EKLAMSI O14.9
0000676964788 1 BPH N40
DM E11
0000668814344 1 S. Ketoasidosis diabetik Z03.8+ E11.10
1 CVA L63.9
0002300938648 1 ISPA J06.9
0001652751279 1 Bitten or stung by nonvenomous insect a W57
0000670354863 1 DM VAPP T14
HEG O21
0002155896786 1 DYSPEPSIA A09
SNAKE BITE T63.0
0001037368811 1 ASHMA BRONCIALE J45.9
0001704995458 1 TYPOID FEVER A01.0
0000670448204 1 VULNUS LACERATUM Z09.8
0002678314206 1 OPEN WOUND OF FOOD S91.3
0002970552982 1 G2P1AB0 UK 39 MMG DGN PROM +S.MAKROSOMO42.0
1 TYHPOID A01
0000669593136 1 HERPES B02
0003174178094 1 V.APP T14
0002155900162 1 DIARE A09
1 ISPA J06
0003274574771 1 ISPA J06
0003336239507 1 ASMA J44
1 VULNUS AP T14
00031119772025 1 NASOFARING AKUT J00
0001037275053 PARTUS NORMAL O80.0
0002300569806 1 GASTRITIS K29
0002680923453 1 ABSES KUKU L02
COR
VULNUS APPERTUM
PEMAKAIAN
ALAT IGD CATETER
TERAPI
TINDAKAN TARIF MA MI RL NS KN D5 D10 ASERING 20 22 24 26 16
RAWAT JALAN
RAWAT JALAN
PASANG INF INJ 1 1 1
PASANG KATETER 1
RAWAT LUKA
PASANG INF, INJ 1 1 1

RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN

RAWAT JALAN
RAWAT LUKA
PASANG INF INJEK 1 1 1
MENOLAK MRS
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
IRIGASI 30000
RAWAT JALAN
RAWAT LUKA
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RUJUK RS 1 1 1
RAWAT JALAN
RAWAT JALAN
RAWAT LUKA
RUJUK RS 1 1 1
RUJUK RS 1 1 1
RUJUK RS 1 1 1
RAWAT LUKA
APS
RAWAT JALAN
RAWAT JALAN
RAWAT LUKA
APS
RUJUK RS 1 1 1
PASANG DC
RAWAT JALAN
RUJUK RS 1 1 1
RAWAT JALAN
RAWAT JALAN
RAWAT JALAN
RAWAT LUKA
RAWAT INAP
RAWAT INAP
RAWAT JALAN
RAWAT LUKA
RAWAT JALAN
RUJUK RS 1 1 1
RAWAT JALAN
RAWAT LUKA
RAWAT JALAN
ALPARA, BC
NEBUL, SALBU, PRED
RAWAT LUKA, AMOX, ASMEF
RAWAT JALAN
PASANG INF INJ
EKSTRAKSI KUKU, AMOX, BPJS
CATETER
INFORMED TRIASE IC UMUM IC KEDOK IC PENOLK M. ASTHSI IC RUJUK RJK RS
18 CONSENT ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK
1 1
1
1
1
1
1 1 1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
44
N DRM UGD
RISK DWSA RISK PDRTI HASIL LAB PULG PAKSA
ADA TDK ADA TDK ADA TDK ADA TDK
PEMAKAIAN
JENIS KASUS STATUS PELAYANAN
ALAT IGD CATETER
INFUS SET CAIRAN INFLO CHECK LIST KELENGKAPAN DRM UGD
TANGGAL JAM
NON KODE TERAPI TRIASE IC UMUM IC KEDOK IC PENOLK M. ASTHSI IC RUJUK RJK RS RISK DWSA RISK PDRTI HASIL LAB PULG PAKSA
NO NO. RM KUNJUNGAN DINAS DINAS NAMA PASIEN JK USIA ALAMAT B L UMUM BPJS NIK NO. BPJS RJ RI RJK DIAGNOSA DX TINDAKAN TARIF MA MI RL NS KN D5 D10 ASERING 20 22 24 26 16 18 ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK
1 10-009275 6/1/2023 14.30 RETI ARDIANTI P 27 KALISANGRAH 30/7 1 1 3507014301960006 1 HEG O21 PASANG INF INJK 1
2 02-007277 16.30 ENI WAHYUNINGSIH P 31 SUKOREJO 5/2 1 1 3505204703920003 0003176767648 1 FEVER R50.9 PASANG INF INJK 1
3 05-005995 09.00 NUNGKI RAHMAWATI P 21 SIDODADI 5/1 1 1 3505206802020001 0003220872862 1 PARTUS 080.0 PASANG INF INJK 1
4 08-003418 6/2/2023 07.00 KURMEN L 84 BANYUURIP 9/2 1 1 3505202205390001 0002525548959 1 CHEPALGIA G44 RAWAT JALAN
5 10-009300 08.00 LASMANU P 66 BULULAWANG 13/4 1 1 3507141411590001 1 HBSAG B19 PASANG INF INJK 1 1 1 1
6 05-006511 08.30 ELVI SRI RAHAYU P 23 SIDODADI 5/2 1 1 350520430400001 0000670275178 1 PARTUS 080.0 PASANG INF INJK 1 1 1 1
7 03-001020 6/3/2023 03.50 SUMIATI P 39 TULUNGREJO 1/2 1 1 3505204207830001 0001037371904 1 HIPERTENSI I10 RAWAT JALAN
8 10-009306 15.00 YOHANES KARNAWAN L 45 SUMBEROTO 3/1 1 1 3507012606780002 1 VULNUS LACERATUM T14 RAWAT LUKA 1
9 10-009314 23.45 ERVI ISPARYATI P JOMBLANG
28 DK.KADIROJO 2/0, BANTUL,DIY1 1 3402155510950001 0000650932525 1 GASTRITIS K.29 RAWAT JALAN BPJS
10 04-006770 6/4/2023 06.00 DANELA RAHELTINA SUSANTI P 23 WATES 1/3 1 1 3505205803000001 0000668996065 1 PARTUS 080.0 PASANG INF INJK 1 1 1 1
11 10-000041 6/5/2023 09.00 MULADI L 85 SUMBEROTO 4/4 1 1 3507011208360001 0000676964788 1 BPH N40 PASANG KATETER 1 1
12 01-009337 14.30 TOHARI L 68 RINGINREJO 1/3 1 1 3505203112550003 1 VULNUS LACERATUM T14 RAWAT LUKA 1
13 06-009416 17.05 ZALFA MAULIDA PUTRI P 4 SUMBERDADI 4/2 1 1 1 THYPOID FEVER A01 PASANG INF, INJ 1
14 01-008466 6/6/2023 12.30 WIJIATI P 39 RINGINANYAR 3/3 1 1 3505205512830002 0003503585619 1 LUKA GANGGREN DM E11 RAWAT LUKA 1
15 10-009275 14.00 RETI ARDIANTI P 27 KALISANGRAH 30/7 1 1 3507014301960006 1 HEG O21 RAWAT INAP 1 1 1 1
16 01-009340 11.00 YATINI P 55 RINGINANYAR 2/1 1 1 000669284289 1 CVA I63.9 PASANG INF, INJ 1 1 1 1
17 02-009384 14.00 SAMUN L 85 SIDOREJO 2/2 1 1 3505200107380067 0000668728598 1 SNAKE BITE T63 PASANG INF, INJEK 1 1 1 1
18 10-000041 18.00 MULADI L 85 SUMBEROTO 4/4 1 1 3507011208360001 0000676964788 1 BPH N40 PASANG KATETER 1 1
19 04-007208 6/7/2023 13.00 AHMAD BASTIAN ALVINO L 12 SIDOMULYO 1/3 1 1 3505200511110002 0003006560248 1 ISPA J06.9 RAWAT JALAN
20 09-001697 14.20 MUHAMMAD ASKA ALI HUZAIN L 7 BALEREJO 3/1 1 1 3505132712160001 0002212455194 1 OF R50.9 RAWAT JALAN
21 07-009369 6/8/2023 09.00 KHOFIFATUL HASANAH P 19 JL. ANGGREK 1/2 SUMBERARUM 1 1 1 FRAKTUR HAND S62 RAWAT LUKA 1
22 01-008466 09.00 WIJIATI P 38 RINGINYAR 03/03 1 1 3505205512830002 0003503585619 ULKUS DIABETIKUM E11 RAWAT LUKA, METRO 1
23 07-009369 11.00 KHOFIFATUL C P 20 JL. ANGGREK 1/2 SUMBERARUM 1 1 1 V.APP T14 RAWAT LUKA 1
24 07-004196 23.30 FADIL MAULANA L 7 SUMBERARUM 1/1 1 1 1 OF R50 PASANG INF INJK 1 1 1 1
25 04-009372 6/9/2023 09.30 MARTINA P 39 WATES 4/3 1 1 1 SERUMEN H61 PENGAMBILAN SERUMEN, GLISERIN 1
26 10-009377 10.30 ADITYA LANANG RAMAD L 11 SUMBEROTO 4/2 1 1 0002501609319 1 V.APP T14 RAWAT LUKA 1
27 05-009410 10.30 SRI UTAMI P 55 TULUNGREJO 1/3 1 1 3505204107670001 1 ABSES L02 RAWAT JALAN
28 01-002418 20.00 SUASTIN P 54 RINIGNREJO 1/3 1 1 3505207011690001 0000670020603 1 GASTRITIS K29.7 RAWAT JALAN
29 10-009275 10.30 RETI ARDIANTI P 27 KALISANGRAH 30/7 1 1 3507014301960006 1 HEG O21 INJEKSI ONDAN 1
30 04-009378 14.45 MUHAJIR L 63 WATES 3/5 1 1 '3505200107600178 0003275543261 1 DYSPEPSIA
HAMIL K30 RAWAT JALAN
31 06-008236 21.00 EVI YUNI FITRIANA P 31 SUMBERURIP 1/1 1 1 1 DGN PRE EKLAMSIA O80.0
32 01-004278 18.25 ANI FADHILA P 35 RINGINREJO 1/1 1 35050456038800030003276030971 1 HEG O21 PASANG INF, INJ 1 1 1 1
33 09-009373 KHOMARA NURIN AZZAHRA W 15 TAMBIMARON 3/2 1 1 1 OTITIS MEDIA H60 RAWAT JALAN
34 07-002729 6/10/2023 07.43 ZAHRA ADELIA P P 8 SUMBERARUM 2/1 1 1 3505206111150001 0002044181013 1 ISPA J06 RAWAT JALAN
35 04-002743 07.53 SENO L 73 WATES 3/4 1 1 3505202809500001 0000669026261 1 V.APP T14 RAWAT LUKA 1
36 01-008466 08.01 WIJIATI P 39 RINGINANYAR 3/3 1 1 3505205512830002 0003503585619 1 V.APP T14 RAWAT LUKA 1
37 08-009169 09.17 MENIK P 62 BANYUURIP 6/2 1 1 3505204107610097 0003011826712 1 ULKUS DIABETIKUM E11.62 RAWAT LUKA 1
38 04-000391 11.00 LEVINO JULIANSYAH L 9 WATES 13/15 1 1 3505201906140002 1 V.APP T14 RAWAT LUKA, HEACTING 70000 1
39 05-009386 11.36 LAMIRAN L 71 TULUNGREJO 3/2 1 1 1 BPH N40 PASANG DC 1
40 04-009389 15.15 REGINA MELAWATI P 12 WATES 4/4 1 1 1 SERUMEN T62 PENGAMBILAN SERUMEN 1
41 08-000802 11/6/2023 01.30 GIYAR L 70 MOJOREJO 23/15 1 1 35052002084800010000670483629 1 OBS PENEMONIA J45 PASANG INF, INJ 1 1 1 1
42 08-000231 09.00 LUCKY ASTIANA P 27 BANYUURIP 15/3 1 0001701893823 1 ASMA J45 NEBULIZER 1
43 08-000231 18.00 LUCKY ASTIANA P 27 BANYUURIP 15/3 1 1 0001701893823 1 ASMA J45 NEBULIZER 1
44 08-007922 6/12/2023 19.13 YASMI P 61 BANYUURIP 1/1 1 1 3505204107620012 0000668492763 1 CEPHALGIYA G44 RAWAT JALAN
45 09-009469 19.25 VIONA PUTRI RAHAYU P 1 BALEREJO II 2/1 1 1 1 KDS R56
46 01-008466 6/13/2023 08.00 WIJIATI P 39 RINGINANYAR 3/3 1 1 3505205512830002 0003503585619 1 V.APP T14 RAWAT LUKA 1
47 08-003187 09.00 SUPARTO L 69 MOJOREJO 25/5 1 1 3505200908540002 0002905792694 1 VAPP T14 RAWAT LUKA 1
48 10-009275 22.00 RETI ARDIANTI P 27 KALISANGRAH 30/7 1 1 3507014301960006 1 HEG O21 RAWTA JALAN
49 04-000391 11.00 LEVINO JULIANSYAH L 9 WATES 13/15 1 1 3505201906140002 0003012423805 1 V.APP T14 RAWAT JALAN 1
50 01-009531 10.15 ICHA ALSANDY AULIA P 14 RINGINANYAR 2/1 1 1 3505204403090001 1 ABDOMINAL PAIN R10.9 PASANG INF, INJ 1
51 08-007610 12.10 DINDA RAHMAWATI P 16 MOJOREJO 23/5 1 1 3505204603070002 0002970555794 1 GE A09
52 04-002780 6/14/2023 18.15 SUHERMAN L 55 SIDOMULYO 2/1 1 1 350520060568004 0002242582661 1 ISPA J06.9 RAWAT JALAN
53 01-001077 16.30 ILHAM SARIPUDIN L 26 RINGINANYAR 2/3 1 1 3505200501970001 0002414272228 1 ISPA J96 RAWAT JALAN
54 01-006381 18 KENNETH DELFIAN PRAWARA L 2 RINGINSARI 2/1 1 1 3505200105210002 0003081277326 1 VOMITING R11
55 04-003888 6/15/2023 16.00 SUKAIMI P 39 WATES 1/4 1 1 3514216708840001 1 V.APP T14 RAWAT LUKA 1
56 08-009456 13.12 NADEEVA NOURA AZKEE P 4 SUMBERURIP 1/1 1 1 1 GASTRITIS K29 RAWAT JALAN
57 08-009455 15 GURIT WIDHI ANJUNARI P 28 BANYUURIP 10/2 1 1 35052068119500010000977213665 1 VERTIGO H81 RAWAT JALAN
58 08-006375 6/16/2023 13.00 SOINI P 49 MOJOREJO 23/5 1 1 3505204107740029 0002970546974 1 DISENTRI A06 RAWAT JALAN
59 01-003217 07.00 MUHAMMAD FAJAR MAULANA L 6 RINIGINSARI 1/4 1 1 3505200603170002 1 OF R50.9
60 01-009545 07.00 ATTA HALILINTAR L 1 RINGINSARI 1/4 1 1 1 TF A01.0
61 01-008466 6/17/2023 08.00 WIJIATI P 39 RINGINYAR 3/3 1 1 3505205512830002 0003503585619 1 V.APP T14 RAWAT LUKA 1
62 03-009461 9.20 S.MARIYOTO L 77 TUGUREJO 4/1 1 1 35052001074600490002680922799 1 S.CVA Z03.5+I63.9 RAWAT JALAN
63 05-009410 8.20 SRIUTAMI P 56 TULUINGREJO 1/3 1 1 35052041076700010003177177164 1 POST DM HT Z09.8+E11+I10
64 01-001077 9.20 ILHAMI SARIPUDIN L 26 RINGINANYAR 3/3 1 1 3505200501970001 1 VAPP T14 RAWAT LUKA 1
65 02-001479 16.25 ZAENAL AZIZ L 54 SUKOREJO 5/1 1 1 3505202002690001 0000107774583 1 HT I10 RAWAT JALAN
66 01-004391 6/19/2023 00.30 MELINA WAHYU P 22 RINGINANOM 2/2 1 1 1 TYPOID A01 PASANG INF, INJ 1 1 1 1
67 01-009503 07.00 TAMA ALVIA PRATIWI P 10 RINGINSARI 2/1 1 1 1 GASTRITIS K29 PASANG INF, INJ 1 1 1 1
68 01-001077 09.00 ILHAM SARIPUDIN L 2 RINGINANYAR 2/3 1 1 1 V.APP T14 RAWAT LUKA 1
69 03-006973 01.45 EVA ANRILA SUSANTI P 23 BEJIREJO 19/4 1 1 35052044020000002 0000669300524 1 G2P1AB0 UK 38-39MM O80.0 PASANG INF, INJ
70 04-009543 17.00 RUKINEM P 85 WATES 3/2 1 1 3505205212320001 1 VOMITING R11
71 04-009492 19.00 AGUS SUPRIANTO L 25 WATES 3/1 1 1 1 V.APP T14 RAWAT LUKA 1
72 03-009462 6/20/2023 10.00 SAMIRAN L 72 TUGUREJO 8/2 1 1 3505200107510089 1 DM+ Proderma L08 Rawat Luka 50000 1
73 04-001424 15.00 EZEKIEL GEOFFREY L 9 MOJOREJO 14/3 1 1 1 DIGIGIT KUCING W55 Rawat Luka 1
74 03-009462 6/20/2023 10.00 SAMIRAN L 72 TUGUREJO 8/2 1 1 3505200107510089 1 DM+ Proderma L08 RAWAT JALAN 1
75 10-000041 6/21/2023 09.00 MULADI L 85 SUMBEROTO 3/2 1 1 1 BPH N40 PASANG DC 1 1
76 01-001077 09.00 ILHAM SARIPUDIN L 2 RINGINANYAR 2/3 1 1 1 V.APP T14 RAWAT LUKA 1
77 08-009544 13.30 TUKIJO L 71 MOJOREJO 14/3 1 1 3505200405520001 0002970551338 1 VERTIGO H81.4
78 07-009445 6/22/2023 10.00 RETNO SRI RAHAYU P 35 SUMBERARUM, 2/2 1 1 3505206207880001 1 HEG O21 PASANG INF INJ 1 1 1 1
79 02-003146 6/23/2023 19.30 ANANG RIYANTORO L 30 SUKOREJO 5/2 1 1 3578141306930001 1 SNAKE BITE T63.0 PASANG INFUS, DRIP BISA NS, INJ DEXA, INJ NORAGES 1 1
80 10-009502 18.30 USWATUN KHASANAH P 24 JARA`AN 20/5 1 1 3507236609990002 1 DUB N93.1 PIL KB KOMBINASI, PAMOL 45000
81 03-009508 6/24/2023 01.30 SESI MARLENA P 29 TUGUREJO 8/2 1 1 3505206404940002 0000669485518 1 GE A09 RAWAT JALAN ( ATTAPULGIT, PCT, OMZ, ANTASID)
82 10-009532 13.30 DWI RENDRA GRAHA L 21 JUNREJO 5/1 1 1 3573041907020006 1 ASMA BRONCHIALE J45 SALBUTAMOL, B. COMP, CTM
83 06-009522 6/26/2023 10.00 KIMAH P 91 SMBERDADI 1/3 1 1 0000669825696 1 MELINA, DM TIPE 2, K29.1 LAB DL GDA
84 01-001077 10.30 ILHAMI SARIPUDIN L 25 RINGINANYAR 3/3 1 1 3505200501970001 0002414272228 1 V.APP T14 RAWAT LUKA 1
BANDULAN BARAT 308 1/1,
85 10-009534 12.50 JUNAEDI L 34 SUKUN KOTA MALANG 1 1 0000785114638 1 HIV + EFUSI PEURA B20 PASANG INF, INJEKSI 1 1 1 1
86 04-005251 18.10 EVI ROSITA P 36 WATES 1/1 1 1 3505204603870002 3114907402 1 KEJU LINU M13 ASMEF 3X1
87 01-006587 6/28/2023 05.30 PONIRIN L 72 RINGINSARI 2/1 1 3505200506540001 1 VERTIGO H81 PASANG INFUS, INJ ONDAN, DIPHEN,RANIT 1 1 1 1 1 1
88 02-007944 11.09 SRIATI NINGSIH P 60 SUKOREJO 4/1 1 1 3505204508650001 0003514587164 1 GEA A09 PAMOL,ATTAPULGIT,BC,DOMPE
89 04-007910 16.30 MUHAJIR L 58 WATES 3/5 1 1 3505200107600178 0003275543261 1 GASTRITIS K29 ANTASIDA, PAMOL, OMZ
90 04-002242 6/29/2023 15.45 NABILA SHAZIA P 4 WATES 2/5 1 1 3505205701190001 00002912287151 1 COLIC ABDOMEN R10.83 PASANG INFUS, INJEKSI NORAGES, ONDAN 1 1 1 1 1 1 1
91 06-000037 21.00 HAFIZH PUTRA MAULANA L 5 SUMBERDADI 2/3 PURWOREJO 1 1 3505202511180001 0002680924263 1 OTITIS MEDIA H66 PAMOL, AMOX, CTM
92 02-005477 6/30/2023 10.00 KATIYEM P 68 SIDOREJO 3/1 SUKOREJO 1 1 3505204107620051 - 1 SNAKE BITE T63 ASMEF, PREDNISON 1
93 04-000133 14.00 PRAMBUDI SUGIARTO L 56 WATES 2/3 1 1 3505202208670001 0002198668072 1 GASTRITIS K29 DOMPE, OMZ, PCT
94 08-000802 15.45 GIAR L 75 MOJOREJO 23/5 1 1 3505200208480001 0000670483629 1 VOMITING R11 PASANG INFUS, INJ NORAGES, RANIT,ONDAN 1 1 1 1 1 1 1
95 08-003647 02.30 IKLIMATUL ROHMAH P 32 MOJOREJO 18/4 1 1 3505204503910001 0000107774458 1 G2P1ABO UK 38-39 M 42.9 RAWAT INAP
100 0
STATUS PELAYANAN
JAM
TANGGAL KUNJUNGAN
NON KODE TERAPI INFORMED IC UMUM IC KEDOK IC PENOLK M. ASTHSI IC RUJUK RJK RS RISK DWSA RISK PDRTI HASIL LAB PULG PAKSA
NO NO. RM KUNJUNGAN DINAS DINAS NAMA PASIEN JK USIA UMUM BPJS NIK NO. BPJS RAJAL RANAP RUJUK DIAGNOSA DX TINDAKAN CONSENT ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK ADA TDK
1 01-003207 7/1/2023 13.15 HERMIN P 42 1 3505205612810001 0000669485193 1 MYALGIA M79 PCT, VIT B
2 02-009599 18.00 ENI AFRIANI P 56 1 3505204904670001 0001703594586 1 LEMAS DAN OF R50 INFUS RL, NORAGES,RANIT 1 1 1
3 08-009559 7/2/2023 07.45 DASEMI P 80 1 3505205611430001 0000670483809 1 HT CEPHALGIA I10, R51 PAMOL, AMLO 10MG
4 02-003510 09.20 ANDIK PRIYANTO P 42 1 3505202610810001 00031011003234 1 OF R50 PCT
5 01-005130 22.00 SUSIATI P 72 1 3505204112510004 0002884773284 1 PNEMONIA J18 NEBULIZER,SALBUTAMOL, PCT 1
6 04-001168 7/3/2023 08.00 MARUKI L 72 1 1 ASMA J45 NEBULIZER,SALBUTAMOL,, METIL 1
7 10-000041 09.00 MULADI L 85 1 1 BPH + HT N40 + I10 PASANG DC, PCT, AMOX, AMLO 10 1
8 03-009570 16.00 SLAMET L 67 1 3505202107560001 1 V.APP T14 RAWAT LUKA, HECTING 1
9 08-007856 19.00 TRI AGUNG SAPUTRO L 24 1 3505201608990001 0000670265346 1 EPILEPSI G40 PASANG INF, DIAZ 1 1 1
10 04-007242 7/4/2023 08.00 REGA FADIL VIRGIAWAN J.S L 13 1 3505201309100001 0000669062619 1 KONTROL CIRCUM SISI T14 RAWAT LUKA, HECTING 1
11 10-003049 09.00 NATTASYA KHARISMA P P 18 1 1 V.APP T14 RAWAT LUKA 1
12 01-009574 10.00 IRWAN EKA SAPUTRA L 10 1 1 V.APP T14 RAWAT LUKA 1
13 01-009093 10.30 WINARKO L 49 1 1 ABSES L02 RAWAT LUKA 1
14 06-006435 11.40 SULTHAN ABIZAR M L 1 1 0003262683058 1 BRONCOPNEMONIA J44 OBAT JALAN
15 05-001020 18.15 SUMIATI P 41 1 3505204207830001 1037371904 1 VERTIGO H81 BETAHISTIN 3X1, PAMOL 3X1, DOMPERIDON 3X1, AMLODIPIN 1X10MG
16 06-000037 7/5/2023 14.00 HAFIZH PUTRA MAULANA L 4 1 3505202511180001 1 ISPA J06 SYR ALPARA
17 01-001370 7/6/2023 08.00 LUKENYO L 72 3505201801510001 1 BPH + HT N40 + I10 PASANG DC, AMOX, SURAT RUJUKAN MEDIKA POLI URO 1
18 10-003049 09.00 NATTASYA KHARISMA P P 18 1 1 V.APP T14 AMOX, PCT, RUJUK POLI GIGI 1
21 01-009597 10.00 SUPRIHATIN P 53 1 1 V.APP T14 AMOX, PCT
22 04-009650 14.00 GILANG ADISTA SAPUTRA L 2 1 3505200709210001 1 VOMITING K29
23 04-000754 10.00 YONATAN L 18 1 1 V.APP T14 AMOX, PCT
24 01-006033 19.15 SUPANI P 61 1 1 VOMITING K29 GLIBEN, DOMPE, ANTASID
25 10-009651 7/7/2023 16.30 SUGIYEM P 56 1 3507014101670037 000286523352 1 EPILEPSI G40
26 02-002920 7/8/2023 SUWAJI ALI SAID L 50 1 3505201208730001 0003012423849 1 COLIC RENAL N24 INFUS RL, NORAGES,RANIT 1
27 05-000215 7/9/2023 08.00 SALMA JUWITA P 5 1 3505204303180001 2300938648 1 OF R50 PCT, CTM, METILPRED
28 04-009653 19.25 SUSI ANIK P 44 1 3505204806790003 0003113638661 1 VERTIGO H81
29 03-009570 7/10/2023 08.30 SLAMET L 60 1 1 V.APP T14 AMOX, PCT
30 05-003019 09.56 WATINI P 44 1 3505206202790002 1 GASTRITISS k29
31 04-007502 21.10 FIFI FEBIANI P 19 1 3505205706040003 0000669013378 1 ASHMA J45
32 03-009611 10.00 ERLIO MUHAMMAD KURNIA L 17 1 1 KERATITIS H16 OBAT TETES MATA, IRIGASI MATA
33 01-009617 11.30 SISWOYO L 37 1 1 COMBUSTIO T36 AMOX, PCT, BCOM
34 04-006993 14.00 TARMI P 67 1 3505204711560001 0000668955969 1 ASTHMA J45 SALBUTAMOL 2MG, VIT BC, AMBROXOL
35 04-006993 19.00 TARMI P 67 1 3505204711560001 0000668955969 1 ASTHMA J45 SALBUTAMOL 2MG, VIT BC, AMBROXOL
36 04-007910 19.00 MUHAJIR L 63 1 3505200107600178 0003275543261 1 DYSPEPSIA K30 ANTASIDA, OMZ, PAMOL
37 10-000510 14.15 KATINEM P 74 1 3507014101490016 0000676983339 1 ARTHRITIS K29 NADIC, VIT BC, ANTASIDA
38 04-005155 20.00 TARMI P 67 1 3505204711560001 0000668955969 1 ASTHMA J45 SALBUTAMOL 2MG, VIT BC, AMBROXOL, NEBUL 1
39 07-007502 21.00 FIFI FEBIANI P 18 1 1 ASTHMA J45 NEBUL, SALBU 1
40 04-009631 11-07-2023 16.30 AGHA QINDI IZZATUL TANAYA L 12 1 3505041603110001 0000669912208 1 VOMIT K29 INF.RL 20 TPM, INJ ONDAN 2X4MG K/P, PCT, ZINC, ANTASIDA 1
41 05-000215 04.30 SALMA JUWITA P 5 1 3505204303180001 0002300938648 1 OF R50.9
42 09-006937 7/12/2023 08.00 MUHAMAD EKA PRADI PUTRA L 20 1 3505180102030001 0000669304899 1 SUSP INTOKSIKASI VOMIT K29 INF NS, INJEKSI ONDAN,. RANIT, NORA 1
43 01-009617 10.00 SISWOYO L 37 1 1 COMBUSTIO T36 AMOX, PCT, BCOM
44 06-005907 01.00 FITRI LESTARI P 29 1 35055206503940001 0003510049419 1 PARTUS NORMAL 080.0
47 10-000510 12.37 KATINEM P 82 1 3507014101490016 0000676983339 1 MYALGIA M79 NADI, BCOM
48 10-009644 12.37 BOIMIN L 83 1 350701010140055 0000676983262 1 RBBB L45 INF NS, 1
49 08-003984 23.00 SUKARTI P 60 1 1 INSECT BITE T14 ASMEF, AMLODIPIN, METILPRED
04-004851 ERNAWATI P 31 1 1 PARTUS NORMAL O 80.0
50 03-009654 13/7/2023 10.00 ANTIK SULANIGSIH P 37 1 3505205101870001 1 PARANOKIA L03 METRO, IBUPROFEN, VIT C 1
51 10-009741 13.30 WAGIRIN L 75 1 3507011209480002 0000678123011 1 ASMA J45 NEBUL, SALBU, METIL 1
52 06-008420 14.00 KARDI L 56 1 3505200102360001 00002939048919 1 BPH N40 PASANG DC 1
53 01-002891 14/7/2023 03.00 BINTANG NOVIANSAH L 18 1 3505202511050001 0000669316443 1 OF R50 INF NS, NORAGES 1
54 02-006166 08.00 PONIMAN L 67 1 3505200107550069 1 CORPUS ALINEUM T16.9 AMOX, PCT, BCOM
55 09-009712 14.30 MUGIANTO L 53 1 3505160107700091 0003340070054 1 HEPATITIS B B19
57 08-009663 12.00 JAROT WALESNO L 46 1 3505202901770002 0002773888986 1 GASTRITISS K29 INF NS, INJEKSI RANIT 1
58 02-007129 7/15/2023 10.00 RAVANO WAFAA OKTARA L 13 1 3505200610090001 0002456131577 1 V.APP T14 RAWAT LUKA, AMOX, PCT 1
59 05-000041 12.00 MISWANTO L 69 1 3276051111540001 1 SYOK HIPOVOLEMI R57
60 08-000802 15.40 GIAR L 75 1 3505200208480001 670483629 1 MYALGIA M79 IBUPROFEN, B 12
61 10-006995 16.15 MUHAMMAD KHLIFA IBRAHIM L 3 1 3329141405200002 2933992372 1 HIDUNG KEMASUKKAN BEND T17 MENGELUARKAN BENDA DARI HIDUNG
62 03-001339 17.00 DEBORA LARASATI P 7 1 3505206911160002 20822030008 1 DEMAM R50 PAMOL, BC, CTM
63 01-004098 16-07-2023 09.15 ALI KURNIAWAN L 37 1 3505202206860001 3276031184 1 KENA PAKU r50 PAMOL, METILPRED
HAMIL DGN HT,PRM,
64 03-006034 12.00 NYAMIEM P 37 1 350206103860001 0000669307217 1 GEMELI JANIN 80
65 01-009093 7/17/2023 08.00 WINARKO L 49 1 3505200209730001 0000669982511 1 ABSES L02 RAWAT LUKA 1
66 08-005296 7/18/2023 09.00 ROY EKA CANDRA L 3 1 3505200602190001 0002974790957 1 KLL V09.1 PARACETAMOL, LYTACUR, RAWAT LUKA
67 03-009672 11.00 SHAFIRA AYYARA ASSYAHIDAH P 8 bulan 1 3505205011220001 1 Dyspneu ec Susp Bronkopneum J.18 Infus Kaen 3B, Nebul Meprovent, O2 2 lpm NC
68 04-000181 12.00 MESIJAH P 68 1 3505204107550041 0000669903614 1 VOMITING HT GR2 K29 CAPT 25, DOMPERIDONE, BCOM
69 03-008530 7/19/2023 10.30 ENNI L 74 1 3505206707490001 0002803212472 1 DM E11 PAMOL, BC
70 03-007244 16.30 PUJI LESTARI p 23 1 3505205804000002 0002876427639 1 KALA SATU FASE LATEN O80
71 01-003207 11.00 HERMIN P 42 1 3505205612810001 0000669485193 1 DM E11 GLIBEN, PCT, AMOX
72 04-009678 11.30 MARMI P 54 1 3505206310620001 1 SNAKE BITE T36 AMOX, ASMEF, METHYL
73 06-009681 7/20/2023 08.00 PAIDI L 53 1 3505201017700080 1 V.APP T14 HECTING, 1
74 01-009093 08.00 WINARKO L 49 1 3505200209730001 0000669982511 1 ABSES L02 RAWAT LUKA 1
75 07-009682 11.00 MUHAMMAD RIZAL L 24 1 1 V.APP T14 HEACTING, ATS 1
76 01-008551 06.30 MUHAMMAD RIFKI FADHILAH L 10 1 3505202105300001 0002414272386 1 OTITIS EKSTERNAL H60
77 06-006139 21.30 SOIMAN L 63 1 3505201407600003 0002878148316 1 VERTIGO H81 NS, Ranitidin, Ondan, Dipen, Pamol, Amlodipin 1
78 04-002385 7/21/2023 06.00 SOIJEM P 66 1 1 VERTIGO H81 NS, Ranitidin, Ondan, Dipen, Betahistin, Amlodipin, OMZ 1
79 10-009684 08.00 TUKIMI P 59 1 3507014101640048 1 V.APP T14 AMOX, PCT
80 10-000041 09.30 MULADI L 86 1 3507015508450002 0000676964788 1 BPH N40 PASANG DC, AMOX, PCT, AMLO 10 MG 1
81 04-004919 11.00 WAJIANTO L 63 3505200107690008 0002970553318 1 GEA A09 METRO, ATTAPULGITE
10-009703 7/22/2023 14.15 SUMARMI P 46 1 1 VULNUS LACERATUM j06
7/24/2023 04.00 MESIJAH P 68 1 3505204107550041 0000669903614 1 MELENA,ANEMIA K92.1,D64 IVFD NS,RANIT,ONDAN
82 10-000510 06.30 KATINEM P 74 1 0000676983339 1 GEA A09 ATTAPULGITE, OMZ
83 06-008056 11.00 MISDI L 79 1 3505200812430001 1 V.APP T14 RAWAT LUKA, AMOX, PCT 1
84 02-008069 13.30 ZAHRA NUR AYUNING WIDYA P 7 1 3505206709160001 0002088499814 1 GINGVITIS K06.8 PCT, AMOX
85 10-009684 7/25/2023 09.00 TUKIMIN P 59 1 3507014101640048 1 V.APP T14 Rawat Luka, Angkat Jahitan 1
86 07-009682 7/25/2023 09.30 MUHAMMAD RIZAL L 24 1 305200703990001 1 V.APP T14 Metronidazole, vit C 1
87 04-008237 7/25/2023 09.45 TUMIRAH P 65 1 3505204107540134 0002612591021 1 Asma Attack + DM J45 Nebul Meprovent, salbutamol, ambroxol, metilpred, cetirizine, metf 1
88 03-001325 SURYONO L 44 1 350520609780001 1 GASTRITISS K29 PCT, ANTASID
89 02-009724 08.00 HARTOYO L 80 1 3505200107430066 0002680923014 1 V,APP T14 RAWAT LUKA, AMOX, PCT 1
90 02-009525 09.30 SUYAHMI P 78 1 3505204107450107 0000669190217 1 SUSP CVA I63.9 PASANG INF, INJ RANIT, NORAGES 1
91 02-009728 11.00 MAHMUD SOLIHUDIN WAHID L 25 1 3505201101980001 0003533838131 1 V.APP T14 ANGKAT JAHITAN, PCT, NEO SALF 1
92 01-003207 7/26/2023 15.30 HERMIN P 42 1 3505205612810001 0000669485193 1 DM E11 PARACETAMOL, GLIBENCLAMID
93 17.15 MUHAMMAD RAZIDAN L 1 1 1 VOMIT K29 Kaen, Ondan, Pct 1
94 06-009730 7/27/2023 01.30 PAIMAN L 68 1 1 ASMA J45 SALBUTAMOL
95 04-009744 7/27/2023 02.23 JAPAR L 93 1 3505200802300001 0000669748184 1 PPOK J44 IVFD RL, NEBUL MEPROVEN, SALBUTAMOL,RANIT 1 1 1
96 03-005323 7/27/2023 18.50 MESENO L 42 1 3505200608680001 0002970548616 1 V.APP T14 INJEKSI ATS 1
97 07-009682 10.00 MUHAMMAD RIZAL L 24 1 1 V.APP T14 RAWAT LUKA 1
98 01-009743 10.30 KADI TUKENI L 70 1 1 BPH N40 AMBROXOL, PCT. BCOM 1
99 05-005179 11.00 MUHAMMAD NUR REHANSYAH L 10 1 3505200109150001 0002893699282 1 GEA A09 NEOCAMINAL PECTIN SYR
100 02-009724 11.00 HARTOYO L 80 1 3505200107430066 0002680923014 1 V,APP T14 RAWAT LUKA, AMOX, PCT 1
101 7/28/2023 LAILATUL FITRI MUNAWAROH P 19 1 3505207011030002 1 ISPA J06 ALPARA
102 04-008804 21.30 MUHAMMAD RAYYAN ELZIO L 17 BLN 1 1 OF R50 PCT, BC
06-009730 23.40 PAIMIN L 69 1 3505200911540001 1 ALO
103 06-005776 22.00 ALESHA ZAHRA NUR PRAMISWARI P 3.5 1 3505204811190001 0002904923384 1 OF R50 PCT, VIT C, METILPRED
104 04-000107 29/7/2023 11.00 SUJIN L 60 1 0002207000968 1 VULL.APP + HT i10 AMOX,PCT, AMLO 10MG, BETAHISTIN
105 02-009756 17.00 WANDA MARCELIA P 21 1 3505205203020002 0003510056384 1 ASMA j45 SALBUTAMOL, AMBROXOL, METHYLPREDNISOLON
106 04-004936 30-07/2023 01.37 SUPIYAH P 40 1 1 OF H2 R50 Paracetamol, BC, metilpred
107 06-005790 09.30 PONIRAN L 73 1 3505202101500001 0002155897765 1 HT R50 PASANG INFUS
108 04-006762 12.30 LAILATUL FITRI MUNAWAROH P 20 1 3505207011030002 0000669813164 1 ISPA J06 CEFAD,SALBUTAMOL,ALPARA 1
109 02-009724 7/31/2023 11.00 HARTOYO L 80 1 3505200107430066 0002680923014 1 V,APP T14 RAWAT LUKA, AMOX, PCT 1
110 02-008054 15.00 MESIYEM P 78 1 3505204107450106 0002049421083 1 DYSPEPSIA K30 PASANG INFUS 1
111 05-007175 19.00 TUNGGER P 65 1 3505205602580001 0002752018378 1 VOMITING K29 1
112 04-004936 01.37 SUPIYAH P 40 1 3505204107500156 1 OF R50
113 04-007754 18.00 IMA YULIANA P 37 1 1 POSTE DATE O48 PASANG INFUS 1
114 53
115
116
117
118 1
JAM
TANGGAL KUNJUNGAN
NON
NO NO. RM KUNJUNGAN DINAS DINAS NAMA PASIEN JK
1 01-009734 8/1/2023 09.20 SUKAMTO L
2 01-009753 07.30 SUHARIYANTO L
3 05-001725 19.00 ERNAWATI P
4 06-009767 2/8/2023 01.00 ATIM P
5 08-002864 12.00 VARISHA AZZAHRA P
6 08-004654 12.30 SUNARIYANTO L
7 04-007447 13.00 WIWIK WIRAYATI P
8 06-005790 09.00 PONIRAN L
9 03-007778 17.00 SUKIRAN L
10 01-009775 3/8/2023 08.00 M.ANDIKA ASPRIADI L
11 04-005237 10.08 TUMIRAH P
12 03-000636 19.00 JOSUA VICTORY PUTRA MULYONO L
13 04-009800 21.05 JUMIATI P
14 01-009743 18.45 KADI TUKENI L
15 09-001697 17.00 MUHAMMAD ASKA AL HUZAINI L
16 04-009233 8/4/2023 16.30 RICKY JULIAN PRATAMA L
17 03-007778 5/8/2023 08.30 SUKIRAN L
18 08-009336 09.00 HARIANTO L
19 08-009789 ANTONIUS RIYO KURNIAWAN L
20 01-007093 13.00 RIKA RISMAWATI P
21 08-009169 09.00 MENIK P
22 01-009775 10.30 M.ANDIKA ASPRIADI L
23 02-009792 17.17 ENDANG SRININGSIH P
24 03-006852 18.00 YUDI ADE PRATAMA L
25 04-000072 6/8/2023 05.30 SUYONO L
26 02-009793 19.55 MUHARI L
27 04-009850 8/7/2023 15.30 NURYANI P
28 04-009233 16.00 RICKY JULIAN PRATAMA L
29 01-009632 18.30 ISMINTARSIH P
30 08-008978 10.00 SANTI NOVITA SARI p
31 03-008590 18.00 SAPTIANI NINGTYAS P
32 01-008466 11.30 WIJIATI P
33 01-002264 13.30 MESIKEM P
34 04-000072 19.40 SUYONO L
35 07-005628 8/8/2023 07.30 NURYANTI P
36 08-009336 09.00 HARIANTO L
37 08-009169 09.00 MENIK P
38 10-000041 09.00 MULADI L
39 01-009775 10.30 M.ANDIKA ASPRIADI L
40 04-002770 17.30 SARIYATI P
41 05-009806 8/9/2023 04.00 GHANIA AQILA WIBOWO P
42 03-007778 08.30 SUKIRAN L
43 02-009832 15.30 DJITO L
10-004561 19.00 WAGIRAN L
44 01-009990 8/10/2023 07.00 SISWANTO L
45 02-009793 09.15 MUHARI L
46 04-009822 10.00 GUNAWAN L
47 05-009824 10.00 RAKIMIN L
48 08-001267 10.00 ADI PRIANTO L
49 02-005166 10.00 PONIMAN L
50 08-009845 07.00 MUHAMMAD ROGER AL FATIH L
51 02-005104 10.40 KASTIYAH P
52 04-009831 15.15 ANANG TRIWIJAYANTO L
53 06-007182 8/11/2023 10.00 SLAMET RIYADI L
54 07-009833 10.00 MUHAMMAD RAYHAN ABYANTO L
55 04-004254 10.00 ANTON VIDIANTORO L
56 02-009843 8/12/2023 09.00 MUNIR L
57 08-009336 10.00 HARIANTO L
58 08-009169 10.20 MENIK P
59 07-000792 12.00 HAFIZH ABID ABYAN L
60 03-009846 12.45 ANTON AFRIJA L
61 03-009119 13.50 MUJIONO P
62 03-009111 22.00 MUNTIANI P
63 01-009847 22.30 MARYANI P
64 04-003601 13-08-2023 10.00 KATENI CATUR WIYONO L
65 02-005645 10.30 SUSILAH P
66 05-006888 15.45 SUTARMI P
67 06-009730 8/14/2023 01.00 PAIMAN L
68 05-009851 02.00 WARIS L
69 10-000510 05.30 KATINEM P
70 08-009789 08.00 ANTONIUS RIYO KURNIAWAN L
71 08-009336 10.00 HARIANTO L
72 08-009169 10.00 MENIK P
73 07-009896 13.00 KATEMI P
74 04-007910 15.30 MUHAJIR L
75 07-000792 16.30 HAFIZH ABID ABYAN L
76 02-008533 8/15/2023 02.30 MESINI P
77 01-009743 11.00 KADI/TUKENI L
79 03-009111 12.30 MUNTIANI P
80 04-009869 13.00 ANGGI WULANSARI P
81 04-005237 08.00 TUMIRAH P
82 03-009867 13.30 WARNO L
83 01-009879 23.30 SUBUR TRI SUTRISNO L
84 04-003601 16/8/2023 09.00 KATENI CATUR WIYONO L
85 05-009880 16.00 SAMITI W
86 02-009893 17.00 RAYYAN YUSUF LUKMAN L
87 05-008545 16.00 SAMITRI P
88 01-009894 17/8/2023 12.45 SHAREEN AGHNIA P
89 10-009895 13.00 RIDWAN L
90 06-009897 18/8/2023 08.00 YATUN P
91 05-004007 10.30 DIAS AFRUL NANDA DELA P
92 01-009715 8/19/2023 09.00 SUDARMI P
94 01-003168 10.30 MURTIAH P
95 05-010125 11.30 LASINI P
96 04-007910 15.15 MUHAJIR L
97 01-009900 18.00 MUNARYANTO P
98 02-003210 20-08-2023 04.00 WAGIRAN L
99 04-009428 07.00 ANGELINA PUTRI ISMAIL P
100 05-003066 15.00 TUKIYEM P
101 10-003526 21-8-2023 09.00 SUNARDI L
102 01-009526 08.00 MUHARI L
103 07-009920 15.00 ZULFATUL SALSABILA W
104 03-009912 12.00 LULUK ISMIATI P
105 05-001020 17.30 SUMIATI W
106 08-009923 22-08-2023 03.30 RISKI L
107 09-004057 09.30 SUDARMAJI L
108 02-009922 11.33 SUNARMI P
109 04-009924 13.30 MURSIMIN L
110 08-009923 01.30 RISKI MUHAMMAD ILZAM L
111 06-009746 18.00 JULIAN ADI SAPUTRA L
04-004102 RINA UTAMI P
112 02-005454 17.30 RENO JANUAR RESA DWI SAPUTR L
113 01-003168 8/23/2023 08.30 MURTIAH P
114 04-005237 09.00 TUMIRAH P
115 08-005633 11.00 SUPINI P
116 02-001674 17.15 MUHAMMAD IRSYADDUL IBAD L
117 02-003210 22.15 WAGIRAN L
118 03-001832 8/24/2023 02.00 KATIMIN L
119 02-000699 13.40 MELIA NILNA MUNA P
120 01-009374 08.30 BANI L
121 05-009934 19.00 SUMI P
122 08-009169 8/25/2023 08.30 MENIK P
123 08-009336 08.30 HARIANTO L
124 08-005633 09.00 SUPINI P
125 08-009936 10.00 BOINEM P
126 10-000041 10.00 MULADI L
128 01-009939 10.45 ALINGGA SURYA MUKTI P
129 03-008786 23.00 KLARA ADINDA MAHARANI P
130 03-001832 11.00 KATIMIN L
131 07-002255 16.00 NAMIKA ISLAMIA DAMAYANTI P
132 04-006762 16.30 LAILATUL FITRI MUNAWAROH P
133 10-009940 8/26/2023 08.00 MUHAMMAD NUR AMIN L
134 02-001585 09.00 ALYA FITRIANI P
135 01-001982 10.00 FELIK SLAMET L
136 02-009497 12.30 MUSRI L
137 04-009343 8/27/2023 16.00 RESHILLA RAHMA PUTRI P
138 02-000359 19.30 SYAIFUDIN L
139 02-001585 8/28/2023 09.00 ALYA FITRIANI P
140 05-009138 13.17 JUMIATUN P
141 06-007348 29/08/2023 09.00 SUKATRI P
142 02-000178 11.00 SUMADI L
143 05-005349 15.30 SEPTANEO TAGAR SONYA L
144 04-009958 16.16 MARCHELINO ALIF MAHARDIKA L
145 02-009793 19.45 MUHARI L
146 01-005839 8/30/2023 09.20 MINI ASTUTIK P
147 10-009965 13.00 PUTRI AGWINDIA OKTAVIA P
148 02-009966 13.40 NASIRODIN L
149 02-006181 11.50 FBRIAN YAHYA HARDYANTO L
150 10-009977 12.00 KENI C L
151 02-006181 11.50 BRIAN YAHYU HARDYANTO L
152 8/31/2023 09.00 SUDARMI P
153 06-009967 09.00 EGI WILSON FIRNANDO L
154 09-009976 10.00 REDY DARMAWAN L
JENIS KASUS STATUS

50 RINGINANYAR 2/1 1 1
50 RINGINAYAR 2/1 1 1
24 TULUNGREJO 4/1 1 1 3505206702990001
5 BANYUURIP 10/02,MOJOREJO 1 1 350520471070001
83 MOJOREJO 18/04, 1 1 3505201103400001
32 WATES 04/04,WATES 1 1 3505166301910002
43 WATES 3/1 1 1 3505204107580134
8 WONOSARI 27/06,TUGUREJO 1 1 3505202905150002
61 WATES 1/4 1 1 3505206804620001
71 RINGINANYAR 1// 1 1 3505200112520001
6 BALEREJO II 03/01, PANGGUNGREJO 1 1 3505132712160001
6 WONOREJO 5/1 1 1
35 BANYUURIP 6/2 1 1 3505200412880002
24 RINGINREJO 1/2 1 1 3505205209990001
62 BANYUURIP 6/2 1 1 3505204107610097
49 SUKOREJO 5/1 WATES 1 1 3604095308730002
25 TUGUREJO 6/2 WATES 1 1 3505202512970001
57 TRIKUNDI 4/4 WATES, WATES 1 1 3506200808650008
58 SUKOREJO 2/2 WATES 1 1 350200412560001
66 SIDOMULYO 3/1 WATES 1 1 3505204107570148
6 WONOREJO 5/1 1 1
35 RINGINANYAR 2/3 1 1 3324114110880003
24 MOJOREJO 17/4, 1 1
28 TUGUREJO 7/2 1 1 3507014701950003
39 RINGINANYAR 3/3 1 1 3505205512830002
73 RINGINANOM 3/1 1 3505206101500001
57 TRIKUNDI 4/4 WATES, WATES 1 1 3506200808650008
54 SUMBERARUM 03/02 1 1 3505204608690001
35 BANYUURIP 6/2 1 1 3505200412880002
62 BANYUURIP 6/2 1 1 3505204107610097
53 SIDOMULYO 2/1 WATES 1 1 3505205504700001
4.5 TULUNGREJO 02/03 WATES 1 1
71 SUKOREJO 5/5 1 1 3505200107520085
75 DONOMULYO 31/7 1 1
32 RINGINANYAR 2/1 1 1 3505200311910001
67 Sukorejo 2/2 1 1 350200412560001
47 SIDOMULYO 3/3 1 1 3505200505760002
74 SIDODADI 3/1 1 1
36 BANYUURIP 4/1 1 1 3507290107870002
68 SUKOREJO KRAJAN 5/2 1 1
1 BANYUURIP 4/1 1 1 3505202803220002
81 SUKOREJO 3/2 1 1 3505204107420079
49 SIDOMULYO 3/1 1 1 3505201007750001
65 SUMBERJO 2/1 1 1 3505191604590002
2.5 SUMBERARUM 4/1 1 1 3505201512210001
34 WATES 3/1 1 1 3505200808890001
65 SIDOREJO 2/2 1 3505204107580103
6 SUMBERARUM 6/1 1 1 3505202407170001
33 BEJIREJO 17/4 1 1 3507010404900001
70 BEJIREJO 24/05 1 1 3505202007630002
52 TUGUREJO 1/1 1 1 3505205010720002
69 RINGINANOM 3/1 1 1 3505205212740001
57 SIDOMULYO 2/1 WATES 1 1 3505200107660010
70 SUKOREJO KRAJAN 1/3 1 1 350520410753011
67 TULUNGREJO 1/2 1 1 3505204603660002
68 SUMBERASRI 3/2 WATES 1 1 3505200911540001
43 TULUNGREJO 1/2 WATES BLITAR 1 1 3505200307790001
74 SUMBEROTO 1/1, DONOMULYO 1 1 3507014101490016
35 BANYUURIP 6/2 1 1 3505200412880002
62 BANYUURIP 6/2 1 1 3505204107610097
83 SUMBERARUM 6/1 1 1 3505204107400003
63 WATES 3/5 1 1 3505200107600178
6 SUMBERARUM 6/1 1 3505202407170001
75 SUKOREJO 1/3 1 1 3505205808470001
70 RINGINANYAR 1/1, RINGINREJO 1 1 3505200112520001
50 TUGUREJO 1/1 1 1 350520501720002
16 WATES 2/3 1 1 3505166703070001
65 WATES 3/1 1 1
78 BEJIREJO 24/5 1 1 3505201403650001
40 RINGINANYAR 3/3 1 1 3505202801830001
57 SIDOMULYO 2/1 WATES 1 3505200107660010
32 SIDODADI 2/1 TULUNGREJO 1 1 3505204107910030
13 SUKOREJO 5/1 WATES 1 1
32 SIDODADI 2/1 1 1
2 RINGINSARI 1 1 3505206202210001
80 DESA SISIR 1/3 KOTA BATU 1 1 3579010101330014
71 DSN BANYUURIP 3/1 DESA PURWOREJ 1 1 3505204107520043
24 JL.ANGGREK 4/02,SUMBERARUM WATE 1 1 3505204204990001
48 RINGINANYAR 03/02,RINGINREJO WAT 1 1 3505184711740001
60 Tulungrejo 1/2 1 1 3505204107630104
63 WATES 3/5 1 1 3505200107600178
59 RINGINSARI 1/1, RINGINREJO, WATES, 1 1 3505200805640001
69 SUKOREJO 02/03,SUKOREJO WATES 1 1 3505201505540002
7 SIDOMULYO 3/3 WATES 1 1
63 TULUNGREJO 4/1 TULUNGREJO 1 1 3505204102600001
48 KARANGREJO 14/23 1 1 3507012707580001
67 SUKOREJO 2/2 1 1
10 BULUREJO 1/2 1 1 3507244307130001
58 BEJIREJO 24/5 1 1 3505204107650199
39 TULUNGREJO 1/2 1 1 3505204207830001
24 BANYUURIP 11/3 1 1 3505202410970003
39 SAMBIGEDE 3/3 BINANGUN 1 1 3505162003840003
63 SUKOREJO KRAJAN 1/3 1 1 3505204107600124
65 WATES 4/4 1 1 3505201005580001
16 SUMBEREJO 3/1 1 1 3505131607070002
1 MIRIGEDE 1/1 1 1 3505200701220001
48 RINGINANYAR 03/02,RINGINREJO WATES 1 1 3505184711740001
65 WATES 3/1 1 1
63 BANYUURIP 08/02 1 1 3505205211590001
12 SUKOREJO 4/2 1 1 3505202912110001
59 SUKOREJO 2/3 SUKOREJO 1 1 3505201505540002
66 TUGUREJO 01/01 TUGUREJO 1 1 3505200607570001
19 SUKOREJO 4/2 SUKOREJO 1 1 3505204905040001
74 RINGINREJO 3/1, RINGINREJO, 1 1
53 SIDODADI 4/2TULUNGREJO 1 1 3505205609700001
63 BANYUURIP 08/02 1 1 3505205211590001
60 BANYUURIP 01/01,MOJOREJO WATES 1
2.5 RINGINREJO 3/1, RINGINREJO, 1 1 3505202703210001
22 TUGUREJO 1/1 1 1 3505205704010001
66 TUGUREJO 01/01 TUGUREJO 1 1 3505200607570001
19 SUMBERARUM 3/2 1 1 3505204608040003
18 WATES 1/2 WATES 1 1 3505207011030002
15 BULUREJO 2/5 1 1
13 SIDOREJO 4/2 1 1 3505204503100001
62 RINGINREJO 1 1 3505200101610001
52 SIDOREJO 2/2 SUKOREJO 1 1 3205204107710042
4 SIDOMULYO 1/3, WATES, 1 1 3505206903170001
58 SUKOREJO 5/1 WATES 1 1 3505200107650122
13 SIDOREJO 04/01 1 1 3505204503100001
48 TULUNGREJO 1/1 1 1 3505206205750001
58 PURWOREJO 1 1 3505204810640002
52 SUKOREJO 01/02 1 1 3505202411690002
4 TULUNGREJO 02/02, WATES 1 1 3505202109180001
11 SIDOMULYO 01/03,WATES 1 1 3505201508120002
67 SUKOREJO KRAJAN 02/02 1 1 3505200412560001
21 KARANGREJO 12/09, DONOMULYO 1 1 3507016811020001
50 SUKOREJO KRAJAN 05/02 1 1 3505201207730001
10 SUKOREJO 4/2 1 1
13 SUMBEROTO 1/1, DONOMULYO 1 1 1275031007010001
10 SUKOREJO 4/2 1 1
45 RINGINSARI 2/1, RINGINREJO 1 3505205904780002
13 SUMBERJO 2/1, PURWOREJO, 1 1 3505121302110002
38 NGADIREJO 1/5, GENENGAN, DOKO 1 1 3505191704850003
PELAYANAN
KODE
NO. BPJS RAJAL RANAP RUJUK DIAGNOSA DX
1 MYALGIA M79
1 SELULITIS PEDIS L03
1 GEA A09
1 VOMITING K29
0002294829393 1 GEA A09
1 PPOK J45
1 ISPA J06
1 S.CVA I63.9
1 V.APP T14
1 V.APP T14
1 ASMA J45
0002227199578 1 KONSTIPASI K50
0002478465472 1 VOMITING R11
0002803212178 1 OF R50.9
1 OF R50
1 VAPP
1 V.APP T14
0002678318054 1 GANGREN A48
1 T14
0003538948083 1 PARTUS NORMAL O80.0
0003011826712 1 GANGREN A48
1 V.APP T14
0001608729748 1 ISPA J06
0000669743471 1 ISPA J06
1 PPOK J45
0001703594452 1 HT I10
0000668948005 1 V.APP T14
V.APP T14
1 PARTUS NORMAL O80.0
0002678317795 1 PARANOKIA L03
0000676915569 1 PARTUS NORMAL O80.0
0003503585619 1 PARANOKIA L03
0000669712612 1 HT I10
1 PPOK J45
"0003011824708 1 GEA+ GASTRITIS A09 + K29
0002678318054 1 GANGREN A48
0003011826712 1 GANGREN A48
1 BPH + HT N40 + I10
1 V.APP T14
0002242583482 1 ISPA J06
1 ISPA J06
1 V.APP T14
000331682919 1 SNAKE BITE T14
1 ASHMA
ABSES J45
0000669473774 1 PERIODONTOGENIK K04
0001703594452 1 FU post gigitan kucing+ I10
0000668785263 1 VULL APP T14
1 SUSP CVA I63.9
1 VULL APP T14
1 VULL APP T14
1 KDS R56
0000669182242 1 GEA A09
1 OF R50
1 DM E11
1 HMD B08.4
TF A01
1 SNAKE BITE T63
1 DM E11
1 DM E11
1 HFMD B08.4
1 OF R50
0003337985441 1 OF R50
1 VULL.LACERATUM T14
0000668836236 1 HT I10
0000669216655 1 VULL.APP T14
0000669216655 1 VERTIGO H81
0000670302426 1 HT I10
1 PPOK J45
0001037371893 1 GASTRITIS K29
0000676983339 1 GEA A09
1 V.APP T14
0002678318054 1 GANGREN A48
0003011826712 1 GANGREN A48
0002678316344 1 OF R50
0003275543261 1 GASTRITIS K29
1 HFMD B08.4
0002771999223 1 HT I10
0002803212178 1 BPH N40
1 VULL.APP T14
1 CHEST PAIN R07
1 MYALGIA M79
0003327888712 1 HEADACHE J06
0001037366379 1 VOMITING K29
1 EC TUMOR THORAX M79
MYALGIA
000352012963 1 +SUSPECT PNEUMONIA R06
0000976668895 1 ISPA
CA THORAX J06
1 +S.PNEUMONIA J45
1 DEMAM R50
0002732994415 1 DEMAM R50
0002970549066 1 ANEMIA + LEUKOSIT D64.9 +D72
0001717358051 1 ASMA J45
1 E11 E11
1 V.APP T14
1 V.APP T14
0001037372005 1 HT I10
0003275543261 1 TUMOR DADA, EFUSI K29
GASTRITIS
0002598052825 1 PLEURA, ANEMIA J91
00025997689 1 ASMA J45
1 OF R50
- 1 HT I10
- 1 MYALGIA M70
1 MYALGIA M79
1 FARINGITIS J02
1 TB+HIV A19.9
0001037371904 1 HT I10
1 OF R50
1 V.ABRATIO T14.3
0000669201647 1 VOMITING K29
0003011826194 1 GEA A09
1 OF DAY 4 R50
0002155895695 1 SNAKE BITE T63.9
1 PARTUS O80.0
0003130070152 1 ISPA J06
1 V,APP T14
1 ASMA J45
0002970545681 1 DI GIGIT KUCING W55
0002316249077 1 ISPA J06
00025997689 1 ASMA J45
1 PPOK J45
1 VOMITING K29
1 PPOK J45
0002159897455 1 ASMA J45
1 DM E10
DM E10
0002970545681 1 MAMALIA BITE w55
1 SUSP CVA I63
1 BPH + HT N40 + I10
1 V.APP T14
1 DEMAM R50
1 PROM K29
1 PPOK J45
0000668384302 1 TYPOID A01
0000669813164 1 VOMITING K29
1 V.APP T14
0002678311708 1 OF R50
0002326723143 1 SNAKE BITE T63.9
0000669231955 1 VERTIGO H81
0003219595446 1 ISPA J06
- 1 VERTIGO H81
0002678311708 1 LEUKOPENIA + OF R50
0002235297833 1 CEPHALGIA G44
0002519776923 1 PARANOKIA L03
0001037367371 1 DHF A91
1 VOMITING K29
0003533964052 1 ISPA J06
0001703594452 1 VULL.APP T14
1 S.PNEOMUNIA Z03+J18
0003337468492 1 CEPHALGIA G44
0003122645657 1 HEMOROID K64
1 ISPA J06
1 DERMATITIS L30
1 R50
0002468754898 1 V.APP T14
1 COB S06
0000671062342 1 V.APP T14
PEMAKAIAN
ALAT IGD
TERAPI
TINDAKAN TARIF MA MI RL NS KN D5 D10 ASERING 20 22 24 26
AMOX, PCT, VIT C
PASANG INFUS, METRO, PCT 105,000 1 1 1
PASANG INFUS. INJ RANIT.ONDAN 1 1 1
DOMPERIDONE 25000
ANTASIDA, ATTAPULGITE
NEBUL,SALBUTAMOL, AMBROXOL
ALPARA,BC
PASANG INF INJ
HECTING, RAWAT LUKA, AMOX, PCT GRATIS
RAWAT LUKA, AMOX 250MG, PCT 50,000
NEBUL, SALBUTAMOL 50000
DULCOLAX SUPP
INF RL, INNJ
INF RL, INNJ
PCT, AMOX, ANTASID
RAWAT LUKA, AMOX 250MG, PCT

RAWAT LUKA, METFORMIN

ALPARA,BC
AMOX, ALPARA, BC
ASMA
AMLO, AMOX
INJEKSI ATS
RAWAT LUKA
RAWAT LUKA
CIPRO, ASMEF
NEBUL, SALBUTAMOL
INF RL, INJ RANIT ONDAN,
PASANG DC, PCT, AMOX, AMLO 10
ALPARA. AMLODIPIN 10MG, VIT B12
NEBULIZER, SALBUTAMOL, METHYL
NEBUL
INF. RL, INJ. NORAGES 1 3 1
Asmef, antacid, tx selanjutnya dilanjut
AMOX, IBUPROFEN, ANTASIDA
AMOX, ASMEF
AMOX, PGT, AMLO 5 MG
INF. NS 1 1 2
OMZ, PCT, BCOM
PARACETAMOL. CTM, VIT C

PASANG INFUS 1 1
PASANG INFUS, INJEKSI 1 1 2
RAWAT LUKA
RAWAT LUKA
AMOX SYR, IBUPROFEN SYR, VITAMIN
IBUPROFEN, METHYL 25000
AMOX, PARACATAMOL, METHYL,B12
HEACTING, AMOX, PARACETAMOL 95000
PAMOL,VIT B12, AMLO 10MG,BETAHISTIN
HEACTING, AMOX, PAMOL 75000
PASANG INFUS,INJEKSI 1 1 1
PAMOL, AMLO 10MG, ANTASIDA
NEBULIZER, OBSERVASI 75,000
PCT, OMZ
ZINK, ATTAPULGITE
RAWAT LUKA, IBUPROFEN, VIT C
OMEPRAZOLE,PCT,BCOM
LEPAS KATETER
KONTROL LUKA 50000
PAMOL, BC 25000
NADIC, BC
AMOX, PCT, VIT C
NASAL KANUL, NS, INJ NORAGES 1 1 1
ALPARA, BC
PCT, TRUVIT 25000

PCT, TRUVIT
SALBUTAMOL, AMBROXOL, CTM
RAWAT LUKA
Amlodipin, furosemi, paracetamol
ANTASIDA, OMZ, PAMOL
PASANG INF, INJ, APS 1 1 1
NEBUL, SALBUTAMOL, CTM, AMBROXOL
INF KAEN 3B, INJ NORAGES, PCT 3X1/2 1 1 1
PASANG INF 1 1 1
25000
AMOX,ALPARA,BC
AMLO,PARA,ANTASID,OMZ
NS, ranitidin, norages, dexa, ondan, pct, antasida 1 1 1
RAWAT LUKA, AMOX, PCT, NEO
PASANG INFUS 1 1 1
PASANG INFUS 1 1 1
PASANG INFUS
PASANG INFUS DRIP SABU, INJEKSI 1 1 1
AMOX, PCT, CAPTOPRIL

SALBUTAMOL, DEXA
RAWAT LUKA, AMOX, PCT, NEO
ALPARA.SALBUTAMOL 2MG
PASANG INFUS.PASANG 02, NEBULIZER 1 1 1
NEBUL, METHYL, SALBU, ALPARA
PASANG INFUS,INJEKSI
NEBUL, AMBROXOL, SALBU, AMLO
RAWAT LUKA
RAWAT LUKA
RAWAT LUKA
PASANG INF, INJ DIPEN, RANIT 1 1
PASANG DC, PCT, AMOX, AMLO 10
RAWAT LUKA
PASANG INF,, INJ 1 1 2
PASANG INF, NEBUL, INJ 1 1 2

PASANG INFUS 1 1 1
PASANG INFUS 1 1 1
RAWAT LUKA
CEFADROXIL, PCT
ANTIBISA, PSG INF, INJ DEXA 1 1 1
BETAHISTIN,PCT,BC,ANTASIDA
PCT,CTM, AMBROXOL
PASANG INFUS 1 1 1
PASANG INF 1 1 1
IBUPROFEN, VIT B.C
IBUPROFEN, GENTASALF
PASANG INFUS,PASANG DC 1 1 1
PASANG INFUS 1 1 1
ALPARA, VIT BC
RAWAT LUKA, IBUPROFEN,BC,CIPRO
PCT,ANTASIDA,DOMPERIDONE
ASMEF, DEXA, ANTIHEMOROID SUPP
RAWAT LUKA
RAWAT LUKA
CATETER
INFORMED
16 18 CONSENT
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
90
JAM
KUNJUNGAN
TANGGAL NON
NO NO. RM KUNJUNGAN DINAS DINAS NAMA PASIEN JK USIA
1 08-009336 1/9/2023 09.00 HARIANTO L 35
2 08-009169 09.00 MENIK P 62
3 06-000599 2/9/2023 11.30 SITI ULFADILLAH P 8
4 05-003867 17.05 VALENTINA MARGARETA P 14
5 02-009641 3/8/2023 22.10 SUPARMI P 66
6 03-001519 4/9/2023 13.30 EFFIN AGUSANDI L 25
7 08-009998 17.30 REVI JAYANTI P 8
9 08-004654 14.59 SUNARIYANTO L 83
8 06-009730 5/9/2023 03.30 PAIMIN L 69
10-001769 19.30 MANIRAN L 78
11 07-008747 9/6/2023 12.10 DINA DWI FIRSTIKA P 19
12 01-006131 13.45 YULIANTO L 35
13 01-008320 9/7/2023 07.00 WINARSIH P 47
14 01-006045 07.00 YAIJO L 63
15 01-009715 09.00 SUDARMI P 45
16 08-003916 15.45 DEFANTA BAYU RAMADHANA L 28
17 01-001928 11.00 FITRIANI P 29
18 10-003971 9/8/2023 08.00 SURANI L 68
19 04-010019 08.00 SITI MARTI'AH P 52
20 01-001573 15.3 FRISKA NURISTYA P 13
21 10-000148 9/9/2023 11.00 SOIJEM P 76
22 02-010036 07.00 MESINI P 75
23 04-000091 08.00 SAERI L 67
24 04-007910 15.15 MUHAJIR L 63
25 09-010039 15.00 MUJI HARJO L 27
26 03-001338 15.30 DEBORA LARASATI W 6
27 9/10/2023 23.30 ARDEL ARSYALAN PRATAMA L 7
28 10-003971 9/11/2023 08.30 SURANI L 68
29 06-002193 14.00 MIRATUN P 46
30 05-006888 15.20 SUTARMI P 57
31 04-005251 17.00 EVI ROSITA P 36
32 9/12/2023 04.00 TUKIRAH P 80
33 10-000041 09.30 MULADI L 78
34 04-001605 10.20 MARIDI L 49
35 10-007122 13/9/2023 04.30 MOZZA ANURIYAH ARIFIN P 7
36 03-000200 9.22 TANTO SUTARI L 73
37 02-009229 10.00 GIYANTI P 59
38 04-007000 9/14/2023 13.20 KENI AGUS L 63
39 04-005237 11.30 TUMIRAH P 65
04-009916 18.00 AGYSTA NOVA RAMADHANY P 12
05-009301 18.15 SUTRIANI P 53
08-009336 9/15/2023 08.15 HARIANTO L 36
09.00 SUWARNI P 63
09.10 WARAS SANTOSO L 40
10.00 JULIA YASINTA P 26
03-003746 10.15 NASHIHAH SAKINA AZKADINA P 3
05-005146 10.20 WITRI NUR'AINI P 36
02-009229 10.30 GIYANTI P 59
02-001979 14.30 SUKARTI P 63
08-010083 18.00 SUSIANI P 52
06-006194 14.3 ERIKA P 23
01-010085 20.00 ARTATIK HARDIANA LESTARI P 46
04-009739 12.30 SUKO WIYONO L 24
04-009739 16/9/2023 00.30 SUKO WIYONO L 24
08.00 MUHAMMAD FAATAHUL ALIM P 24
03-000200 13.40 TANTO SUTARI L 73
10-010090 17.30 SURIP L 84
02-010091 21.30 SUNARMI P 65
04-004631 09.00 WASITO P 49
01-000499 9/17/2023 13.30 SITIN P 66
08-000653 9/18/2023 09.24 SAMI P 63
08-010079 09.37 SUWARNI P 63
02-010138 SUYONO L 85
02-009207 20.00 DIAH AZZAHRA PUTRI P 17
06-003616 9/19/2023 14.00 GATHAN EKA KUSUMA L 15
07-000858 17.30 GRESCYA ZAHRA KIRANA P 12
06-004580 20/9/2023 07.30 NINIK SUWANTI P 57
09-009223 09.00 KUMIANTO L 76
10-004714 12.30 MUHAMMAD UMAR HADIF L 6
01-010127 16.45 SUTRIS L 68
04-010128 17.00 JOKO L 30
06-008027 9/21/2023 16.17 KLARISA OKTAVIANI P 23
16.15 TADJI L 74
9/22/2023 08.00 SUSIANI P 52
08-009336 08.15 HARIANTO L 36
03-000200 09.00 TANTO SUTARI L 73
05-007655 11.00 ZAEEM GHIFARI ALFARASYA L 1
05-006015 NUR MIFTAHUL JANNAH P 30
02-006625 13.00 SLAMET L 51
04-000131 18.30 SUMAJI L 56
08-010145 9/23/2023 08.00 RENI APRILIAWATI P 13
07-010149 08.30 SUGIAT BIANTO L 63
10-008174 11.30 KOSMAS ROMEO MARIA CYCA L 1
08-010153 15.00 ARSEN IVANDER L 7
05-010152 15.30 JOKO SUYITNO L 60
08-010150 16.00 YENI WULANDARI P 35
10-010151 16.15 AHMAD ABDUL WAHID L 17
04-001622 9/24/2023 01.30 KATIMAH P 48
04-005251 06.45 EVI ROSITA P 36
08-000653 9/25/2023 09.24 SAMI P 63
10-008175 06.45 DAMIANUS REGIO MARIA CYCA L 1
01-004560 `15.00 BUNYANI L 73
01-006319 22.16 ZAHIDATUL MARIFAH P 18
09-010165 26/9/2023 07.00 GAGUK SUSENO L 24
05-008564 11.30 MUJIONO L 50
02-010181 13.30 SARKUN L 81
03-010212 14.30 TUMINI P 88
03-010180 19.00 AGUS RIDWAN L 23
04-000131 11.00 SUMAJI L 56
02-010182 9/27/2023 10.00 RESKY SURYA ADITYA L 14
05-000292 08.00 SUMARTININGSIH P 60
05-004584 12.30 SUWAHONO L 37
03-010194 14.50 SUPIYAH P 58
21.00 IZAM ARKANA KAFI L 1
08-001058 9/28/2023 14.00 YATIMAN L 81
07-008314 16.10 SIHMIATI P 52
10-010151 17.00 AHMAD ABDUL WAHID L 19
06-010173 9/29/2023 08.00 SUHUD L 69
08-000653 08.15 SAMI P 63
04-003387 06.30 WIJIANTO L 49
04-005237 08.35 TUMIRAH P 65
02-010182 15.00 RESKY SURYA ADITYA L 14
10-000041 9/30/2023 09.10 MULADI L 78
04-008714 09.35 SUKARJI L 54
05-005179 10.15 M. NUR REHANSYAH L 8
06-010268 13.00 EGI DWI KURNIAWAN L 12
01-010143 9/30/2023 19.00 TADIJI L 76
05-010204 19.15 RENI FIJI LESTARI P 37
05-010205 19.15 KATIKEM P 57
JENIS KASUS STATUS
ALAMAT B L UMUM BPJS NIK

BANYUURIP 6/2 1 1 3505200412880002
BANYUURIP 6/2 1 1 3505204107610097
SUMBERURIP 3/1 PURWOREJO 1 1 3505204410160002
TULUNGREJO 2/3 1 1 3505204603090001
SUKOREJO 1/3 1 1 3505204508570001
TUGUREJO 8/2 1 1 3505202108970001
BANYU URIP 13/3 1
MOJOREJO 18/4 1 1 3505201103400001
SUMBERASRI 3/2 PURWOREJO, 1 1 3505200911540001
KARANGREJO 25/14 DONOMULYO 1 1 3507011508450004
BULUREJO 3/2 1 1 3505206112040001
RINGINREJO 3/2 1 1 3505200207880001
RINGINREJO 3/2 1 1 3505204708760003
RINGINANYAR 1/2 1 1 3505200107600068
RINGINSARI 2/1 1 1 3505205904780002
BANYUURIP 10/02 1 1 3505203032950001
RINGINSARI 3/4 1 1 3505202711940001
KARANGREJO UTARA 25/14 1 1 3507010502550003
WATES 3/1 1 1
RINGIN ANOM 3/2 1 350520411100001
SUMBEROTO 1/2, DONOMULYO 1 1 3507016202470001
SUKOREJO KRAJAN 2/2 1 1
WATES 4/2 1 1 3505200108560001
WATES 3/5 1 1 3505200107600178
Binangun 2/1 1 1 3505161911960001
TUGUREJO 2/1 1 1 3505206911160002
SUMBEROTO 1/2, DONOMULYO 1 3507012305160001
KARANGREJO UTARA 25/14 1 1 3507010502550003
TULUNGREJO 1/2 1 1 3505204603660002
WATES 1/1 1 1 3505204603870002
TULUNGREJO 2/2 1 1
SUMBEROTO 4/2 1 1 3507011208360001
WATES 2/5 1 1 3505200107740058
SUMBEROTO 06/01 1 1 3507016202160001
TUGUREJO 4/1 1 1 350520030750002
SUKOREJO 4/3 1 3505204107640107
SIDOMULYO 3/1, WATES, WATES 1 3505151204600001
WATES 3/1 1 3505204107580134
WATES 1/3 1 1 3505205708110002
TULUNGREJO 2/2 1 1 3505204807630001
BANYUURIP 6/2 1 1 3505200412880002
MOJOREJO 1 3505205205600002
TULUNGREJO 1 1 3505200406830005
RINGINSARI 1 1 3505206407970001
TUGUREJO 10/02 1 1 3505204110200002
WATES 03/04,WATES 1 1 3575035703870002
SUKOREJO 4/3 1 3505204107640107
SIDOREJO 4/2 1 1 3505205107770001
BANYUURIP 05/01 1 1 3505204107710085
SUMBERURIP 1/2 1 1 3505205512000001
RINGINREJO 2/3, 1 1 350520520779003
WATES 1/2 1 1 3505200107990047
WATES 01/02, WATES 1 1 3505200107990047
L. BASUKI RAHMAD GG IV 1 1 6472033112980001
TUGUREJO 1 1 350520030750002
KARANGREJO 9/9 PURWOREJO 1 1 3507010304490001
SUKOREJO 01/02 1 1 3505204107580078
SIDOMULYO 4/1 1 1 3505201505740005
RINGINANOM 3/1 1 1 3505204806570002
MOJOREJO 19/4 1 1 3505204506600001
MOJOREJO 18/4 1 1 3505205205600002
SUKOREJO 2/3 1 1 3505200107380059
SUKOREJO 5/2 1 1 3505205511060002
SUMBERDADI 01/03, 1 1 3505202405080001
SUMBERARUM 6/1 1 1 3505204803110001
BALEREJO 02/01, PANGGUNGREJO 1 1 3505130704670002
NGRENDENG 16/04, DONOMULYO 1 1 3329140412170002
RINGINREJO 3/2 1 1 3505200101550006
WATES 1/4 1 1 3505203105930001
SUMBERDADI 1/2 1 1 3505204710000001
RINGINANYAR 1/3 1 1 3505203112470004
BANYUURIP 1 1 3505204107710085
BANYUURIP 6/2 1 1 3505200412880002
TUGUREJO 1 1 350520030750002
TULUNGREJO 01/01 1 1
TULUNGREJO 2/1 1 1 3505206609930002
SUKOREJO 05/01 1 1 3604091406720003
WATES 1/2 1 1 3505201006670002
SUMBERURIP 1 1 3505205604100001
SUMBERARUM 1 1
RINGINREJO 2/3, 1 1 3578100311220006
MOJOREJO 1 1
TULUNGREJO 04/02 1 1 3505200302630001
BANYUURIP
PURWOSARI05/01
4/1 MOJOREJO 1 1 3505205401820002
TEMANGGUNG,JATENG 1 1 3323132106040005
WATES 2/5 1 1 3505204107750089
WATES 1/1 1 1 3505204603870002
MOJOREJO 19/4 1 1 3505204506600001
DUKUH SETRO ,TAMBAKSAN 1 1 3578100311220007
RINGINREJO 1/1 1 1 3505200503560001
RINGINANYAR 02/01, 1 3505205504030002
BALEREJO II 02/01 PANGGUNGREJ 1 1 3505130512980001
TULUNGREJO 4/2 1 1 3508021202730001
SUKOREJO 3/1 1 1 3505200109420001
TUGUREJO 1/1 1 3505204107450041
BEJIREJO 21/5 1 1 3505202910000001
WATES 1/2 1 1 3505201006670002
MIRIGEDE 2/1, SUKOREJO, 1 1 3505202002090001
TULUNGREJO 4/1 1 1 3505205603630001
1 1 3505201710860002
BEJIREJO 23/5 TUGUREJO 1 1 3505204107650197
SIDOMULYO 3/2 1 1
MOJOREJO 5/1 1 1
JL. DAHLIA 3/1 SUMBERARUM 1 1 3505204807710001
TEMANGGUNG 4/1 PURWOSARI,KRANGGA 1 1 3323132106040005
SUMBERJO 1/2 3505200108540002
MOJOREJO 19/4 3505204506600001
SIDOMULYO 2/1 1 1 3505200809740002
WATES 3/1 3505204107580134
MIRIGEDE 2/1, SUKOREJO, 1 1 3505202002090001
SUMBEROTO 4/2 1 1 3507015508450002
SIDOMULYO 2/2 1 1 3505200612690001
TULUNGREJO 2/2 1 1 3505200109150001
SUMBERASRI 1/1 1 1 1607042210110001
RINGINANYAR 1/3 1 1 3505203112470004
TULUNGREJO 4/1 1 1 3573044201860005
TULUNGREJO 4/1 1 1 3505204107660094
PELAYANAN
KODE
NO. BPJS RAJAL RANAP RUJUK DIAGNOSA DX
0002678318054 1 GANGREN A48
0003011826712 1 GANGREN A48
0002603807921 1 TYPOID FEVER A01
0002159897859 1 DIARE AKUT A09
0003176737986 1 COLIC ABDOMEN R10
0002627388325 1 KERATITIS H16
1 VOMITING K29
0002970552003 1 HT I10
0003539431822 1 PNEMONIA J18
1 ASMA J44
0001037374571 1 DEPRESI &DYSPEPSIF32+K30
1 OF R50
0002874356098 1 COLIC ABDOMEN R10
0000669930849 1 VERTIGO H81
0002468754898 1 V.APP T14
0001652751279 1 VERTIGO H81
00023755555027 1 PARTUS O80.0
1 SRUDUK HEWAN SAPW55
1 SCORPION BITE T63
0001882754098 1 GASTRITIS K29
1 HT I10
1 OF R50
0000669890553 1 PPOK J44
0003275543261 1 GASTRITIS K29
1 HEMATOMA M79.81
0002082203008 1 NAUSEA VOMITTING R11
2842746028 1 VOMITTING R11
1 V.APP T14
0001037373502 1 VOMITTING R11
0000670302426 1 OBS. VOMITTING R11
0003114907402 1 OBS FEBRIS R50
1 VOMITTING R11
0000676964788 1 BPH N40
2285800266 1 V.APP T14
00002842743137 1 ISPA J06
0000107546657 1 V.APP T14
0002939216343 1 DM E11
0000670662134 1 CHEPALGIA G44
0002612591021 1 ASMA J45
0003219595435 1 ISPA J06
0003012019042 1 HT + DM I10
0002678318054 1 ULKUS DM E11
0000670471773 1 V.APP T14
0003526775447 1 GASTRITIS K29
1 V.APP T14
0003220872884 1 OF R50
0003526775447 MYALGIA M79
0002939216343 1 DM E11
1 OF R50
0000668974893 1 DM + HT I10
1 S.OLIGOHIDRAMNIONO43
0003340111263 1 SUSP CA SERVI Z03
1 COLIC ABDOMEN
- 1 COLIC ABDOMEN R10
1 V.APP T14
0000107546657 1 V.APP
OBS VOMITING T14
0000677607322 1 + VERTIGO R11
0003244553021 1 HIPOGLIKEMIA + HT E16
1 DYSPEPSIA SYNDROK30
0002155900162 1 DM E11
0002293244594 1 ULKUS DM E11
0000670471773 1 V.APP T14
1 VRTIGO H81.4
0003544519623 1 PROM R11
1 V.APP T14
0002729485326 1 ISPA J06
0002681020798 1 VERTIGO H81
0000668739723 1 S.CVA I63
0002316310299 1 KDS R56
00002803211921 1 GEA A09
0000669807898 1 OF R50
0003527690668 1 OF R50
1 HT I10
0000668974893 1 DM E11
0002678318054 1 ULKUS DM E11
0000107546657 1 V.APP T14
1 GEA A09
1 VOMITING
0001608728376 1 OF R50
0002857466935 1 VULL.APP T14
0002597306589 1 PARANOKIA L03
1 V.APP T14
1 ISPA J06
1 OF H2 R50
000107627444 1 VERTIGO H81
0002517534369 1 VULL.APP T14
0000604935101 1 ISK N39
0002285800727 1 COLIC ABDOMEN R10.83
0003114907402 1 BPPV H81.10
0002293244594 1 ULKUS DM E11
1 ISPA J06
0000158740885 1 1SPA J06
0002929119794 1 PARTUS O80
- 1 DF A91
0003176326168 1 ACCIDENT TRAFIC T14
0001008231851 1 ISK N39
0002678509642 1 HT I10
0000669505713 1 VULNUS T14
0002857466935 1 VULL.APP T14
1 ISPA J06
0002678314858 1 ISPA J06
1 OF R50
0000669634064 1 ISPA J06
1 VOMITTING R11
1 PJK I25
0002970544612 1 OBS. FEBRIS R50
0000604935101 1 ISK N39
0003327039404 1 V.APP T14
0002293244594 1 DM E11
0000172388261 1 OF R50.9
0002612591021 1 ASMA J45
1 V.APP T14
000067694788 1 BPH N40
0000669861527 1 V.APP T14
0002893699282 1 V.APP T14
0002159893539 1 OBS VOMITTING R10
0003316824606 1 HT+DYSPEPSIA SYN I10
0001534800587 1 ISPA J06
1 DYSPEPSIA SYNDROK30
PEMAKAIAN
ALAT IGD
INFUS SET CAIRAN
TERAPI
TINDAKAN TARIF MA MI RL NS KN D5 D10
PASANG INFUS 1 1
PASANG INFUS 1 1
PASANG INFUS 1 1
IRIGASI MATA, OBAT TTS
inf.kaen, inj. norages 200mg, ondan 2mgh, pct, truvit 1 1
FUROSEMIDE TAB
NEBUL, SALBUTAMOL 35000
INFS RL,INJ RANITIDIN,INJ ODAN
PASANG INFUS, RL 1 1
RAWAT LUKA, VIT B
PEMBERIAN TERAPI (PARACETAMOL, ANTASID)

AMLO,PCT 35000
PASANG INFUS 1 1
PASANG INF, INJ RANIT, ONDAN, O2
ANTASID, PAMOL
ANTASID, PAMOL, DOMPE, B12 25000
ANTASID, PA,MOL, DOMPE,CTM
KAEN,ONDAN,DOMPE SY,PCT,AMBROXOL,CETIRIZINE,DEXZ,CEFAD,T 1 1
AMOX, PCT
PAMOL, ANTASIDA, DOMPERIDON, B.COMP
PAMOL, ANTASIDA, OMZ, AMLODIPIN
B.COMP. DEXAMETHASONE, IBUPROFEN, AMBROXOL
PASANG INFUS 1 1
PASANG KATETER
RAWAT LUKA
30000
RAWAT LUKA,
RAWAT LUKA
PCT, BCOM
PASANG INFUS, INJEKSI 1
ALPARA, DEXA, BC
PASANG INFUS, INJEKSI 1 1
RAWAT LUKA
RAWAT LUKA
RAWAT LUKA 50000

PASANG INFUS 1 1
KETOPROFEN SUP, MELOXICAM TAB
RAWAT LUKA
ALPARA, ANTASID, DEXA
PASANG INFUS 1 1
PASANG INFUS RL
PASANG INFUS 1 1
PASANG INFUS 1 1
RAWAT LUKA, VIT C
CEKSET,
INF LUKA JAHITAN
RL, NS, I
NJ RANITIDIN, INJ ONDANCENTRON, INJ METAMIZOL 1 1
PASANG INFUS 1 1
PASANG INFUS RL
RAWAT LUKA, GDA 418, GLIBEN, METRO

RAWAT LUKA, ASMEF, AMOX
INFUS RL
HEACTING, AMOX, PCT 105000
ALPARA, BC, CETIRIZIN
PASANG INFUS 1 1
PASANG INFUS, PASANG OKSIGEN 1 1
PASANG INFUS 1 1
PASANG INFUS 1 1
PASANG INFUS 1 1
AMOX, PARA, BC
PARA, OMZ, CTM, AMLO 25000
RAWAT LUKA
RAWAT LUKA
CEK LUKA JAHITAN
ORALIT, ALPARA 25000
PASANG INFG, INJ NORAGES. DEXA 1 1

HEACTING, ASMEF, CIPRO
RAWAT LUKA
ATS 200000
ALAPARA RACIKAN 25000
PASANG INFUS 1 1
PASANG INFUS 1 1
AMOX, PCT
AMOX, PCT
PARA, ANTASID, OMZ
PARA, BETAHESTIN,BC
RAWAT LUKA, GDA 468, GLIBEN, METRO, METFORMIN
25000
1 1
PASANG INFUS 1 1
PASANG INF, HEACING
KATETER NO 16,URIEN BAG,ASMEF,BC
PASANG INFUS 1 1
AMOX,ASMEF,RAWAT LUKA
RAWAT LUKA, ASMEF, CIPRO
PASANG INF, INJ 1 1

PAMOL, AMBROXOL, B12
DOMPERIDON 25000
INJ. DEXA, OMZ, AMBROXOL 1 1
ALPARA, B12, ANTASIDA
CIPRO, PAMOL
RAWAT LUKA, AMOX, PCT
RAWAT LUKA. GLIBEN, METFORMIN
ASETYL
PCT 25000
KATETER,AMLO,PCT,AMOX
HEACTING, RAWAT LUKA,ASMEF,AMOX,BC
RAWAT LUKA,ASMEF,AMOX
PASANG INFUS RL 1 1
PARA, AMLO, ANTASID, OMZ
ALPARA,B12, AMOX
OMEPRAZOLE 25000
PEMAKAIAN
ALAT IGD
FOLEY
CATETER
CAIRAN INFLO
INFORMED
ASERING 20 22 24 26 16 18 CONSENT
1
1
1 1
1 1
1 1
1
1 1
1 1
1 1
1
1 1
1 1
2 1
1
1
1
1
1 1
1 1
1
1
1
1 1
1 1
1 1
1 1
1
1
1 1
1
1
1 1
1 1
2 1
1 1
1 1
1
1
1
1
1 1
1
1
2 1
1 1
1 1
1
1 1
1 1
1 1
1
1 1
1
1 2
1
1
1 1
1
1
1 1
62

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JENIS KASUS STATUS PELAYANAN PEMAKAIAN

JK USIA ALAMAT B L UMUM BPJS NIK

USIA ALAMAT B L UMUM BPJS NIK

USIA ALAMAT B L UMUM BPJS NIK

NO. BPJS RJ RI RJK DIAGNOSA

A01 PASANG INF, INJ 1 1 1

R50 PASANG INF, INJ 1 1 1

17 05-002839 5/5/2023 10.10 ZAINUR ROZIQIN L

21 04-002770 19.00 SARIYATI P

22 05-002903 20.00 NOVIA ROMADHONI P

USIA ALAMAT B L UMUM BPJS NIK

25 TULUNGREJO 4/1 1 1 3505201009970001

53 SIDOMULYO 2/1 1 1 3505205504700001

20 SIDODADI 5/1 1 1 3505204611030001

PASANG INF, INJ 1 1 1

PASANG INF, INJ 1 1 1

USIA ALAMAT B L UMUM BPJS NIK

RAWAT LUKA, AMOX 250MG, PCT

RAWAT LUKA, METFORMIN

PARACETAMOL. CTM, VIT C

PCT, TRUVIT 25000

AMOX, PCT, CAPTOPRIL

PASANG INF, NEBUL, INJ 1 1 2

ALAMAT B L UMUM BPJS NIK

INFUS SET CAIRAN

PEMBERIAN TERAPI (PARACETAMOL, ANTASID)

RAWAT LUKA 50000

RAWAT LUKA, GDA 418, GLIBEN, METRO

PASANG INFG, INJ NORAGES. DEXA 1 1

PASANG INF, INJ 1 1

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