LAPORAN JUMLAH PASIEN NYERI PALIATIF

PUSKESMAS BALONGSARI
BULAN JANUARI 2023

NO NAMA UMUR DIAGNOSA ICD - X STADIUM NIK ALAMAT

1 BEJO 58 CA Nasopharynx C11.2 IIB '3524270201610004 BADUKIDUL
2 LELY 56 CA Mamae Dextra C50.1 IIB 3574036601690002 Jl Balongsari Tama Selatan 9B-11
3 LELY 65 CA Mamae Dextra C50.9 IIB 3574036601690002 Jl Balongsari Tama Selatan 9B-11
4 SUAIFAH 68 CA Mamae Dextra C50.9 IIB 3578284405680002 GREGES TIMUR III NO. 7
5 LELY 53 CA Mamae Dextra C50.9 IIB 3574036601690002 Jl Balongsari Tama Selatan 9B-11
6 LELY 74 CA Mamae Dextra C50.9 IIB 3574036601690002 Jl Balongsari Tama Selatan 9B-11
7 TITIN 42 CA Mamae Dextra C50.9 IB 3578146006750002 GADEL BARU I/18 TOWER
8 MUSTIKAWATI 28 CA Mamae Dextra C05.9 IB 3524055509740001 TUBANAN BARU D-14
9 CHULIFAH 28 CA Mamae Dextra C50.9 IB 3578144303680004 TANDES LOR GG.1/2-A
10 ENI HEKMAWATI 58 CA Mamae Dextra C50.9 IB 3578144103710003 BALONGSARI BLOK 5G/19
11 SITI KOLIMAH 19 CA Skin C43.9 IB 3578146405730003 BALONGSARI BLK 8-A/19

EMI HAYAH 66 CA connective and soft tissue of 3578285603500001 GREGES TIMUR III/24
12 abdomen
IIB
C49.4
13 TATIK RUJIATI 61 CA of Ovari C56 IIB 3578314705650003 BALONGSARI PRAJA 1/32
14 TRISYANI BOENTARAN 54 CA Rectum C20 IIB 3578146603580001 BALONGSARI MADYA 7-I/19

Surabaya, 30 Januari 2023

Mengetahui,
Kepala Puskesmas Balongsari
Penanggung jawab:

Dewi Solicha,Amd.Kep dr. Dewi Ayuning Asih

NIP Pembina IV A
NIP. 197911282006042028
 LAPORAN JUMLAH PASIEN NYERI PALIATIF
PUSKESMAS BALONGSARI
BULAN FEBRUARI 2023

NO NAMA UMUR DIAGNOSA ICD - X STADIUM NIK ALAMAT

1 BEJO 58 CA Nasopharynx C11.2 IIB '3524270201610004 BADUKIDUL
2 DIAYU PRIMASTA 33 Other Hodgkin's Diseases C81.7 IIB 3578144104890003 BALONGSARI TAMA BLOK 3-B/4
3 jihan alya fariha 16 CA Rectosigmoid C19 IIB 3522105806060003 gadel sari madya gg 3
4 SUAIFAH 68 CA Mamae Dextra C50.9 IIB 3578284405680002 GREGES TIMUR III NO. 7
5 TITIN 42 CA Mamae Dextra C50.9 IB 3578146006750002 GADEL BARU I/18 TOWER
6 MUSTIKAWATI 28 CA Mamae Dextra C05.9 IB 3524055509740001 TUBANAN BARU D-14
7 CHULIFAH 28 CA Mamae Dextra C50.9 IB 3578144303680004 TANDES LOR GG.1/2-A
8 ENI HEKMAWATI 58 CA Mamae Dextra C50.9 IB 3578144103710003 BALONGSARI BLOK 5G/19
9 SITI KOLIMAH 19 CA Skin C43.9 IB 3578146405730003 BALONGSARI BLK 8-A/19

EMI HAYAH 66 CA connective and soft tissue of 3578285603500001 GREGES TIMUR III/24
10 abdomen
IIB
C49.4
11 TATIK RUJIATI 61 CA of Ovari C56 IIB 3578314705650003 BALONGSARI PRAJA 1/32
12 TRISYANI BOENTARAN 54 CA Rectum C20 IIB 3578146603580001 BALONGSARI MADYA 7-I/19

Surabaya, 28 Februari 2023

Mengetahui,
Kepala Puskesmas Balongsari
Penanggung jawab:

Dewi Solicha,Amd.Kep dr. Dewi Ayuning Asih

NIP Pembina IV A
NIP. 197911282006042028
 LAPORAN JUMLAH PASIEN NYERI PALIATIF
PUSKESMAS BALONGSARI
BULAN MARET 2023

NO NAMA UMUR DIAGNOSA ICD - X STADIUM NIK ALAMAT

1 IR. MUSTOFA 72 CA Rectum C20 IIB 3578141001510002 BALONGSARI BLOK 6H/18

Ca of connective and soft tissue

2 SUYADI 30 C49.2 IIB 3578142304920003 TUBANAN BARU BLOK D-30
of lower limb, including hip
3 TAN SOAN NIO-SYLVIA 67 CA of thyroid gland C73 IIB 3578276805550001 SATELITE INDAH 7/DN-16

4 SRI RICHANAH 56 CA of endometrium C54.1 IIB 3578145907660002 KARANGPOH 06/45

5 WORO SUKO EKSI 69 CA Mamae Dextra C50.9 IB 3578146102540003 JL.TMN.DARMO INDAH SEL.V/EE-40

6 RINA FEBRIYANTI 29 Chronic myeloid leukaemia C92.1 IB 3526074102940003 KALIANAK BARAT 80

7 NURANI 56 CA of border of tongue C02.1;K04.5 IB 3578144112660006 BALONGSARI BLOK 8C/13

8 HOLIFAH 42 CA Mamae Dextra C50.9 IB 3527086007800007 TUBANAN LAMA

9 LELY 54 CA Mamae Dextra C50.9 IB 3574036601690002 Jl Balongsari Tama Selatan 9B-11

10 MARIYONO, BA 74 CA of bronchus or lung C34.9 IIB 3578142305480003 BALONGSARI BLOK 5I/17

11 R. ZAHRA BA. 64 CA of tongue C02.9 IIB 3578144503590001 BALONGSARI PRAJA 4/2

12 SUAIFAH 54 CA Mamae Dextra C50.9 IIB 3578284405680002 GREGES TIMUR III NO. 7

Surabaya, 31 Maret 2023

Mengetahui,
Kepala Puskesmas Balongsari
Penanggung jawab:

Dewi Solicha,Amd.Kep dr. Dewi Ayuning Asih

NIP Pembina IV A
NIP. 197911282006042028
 LAPORAN JUMLAH PASIEN NYERI PALIATIF
PUSKESMAS BALONGSARI
BULAN APRIL 2023

NO NAMA UMUR DIAGNOSA ICD - X

1 IR. MUSTOFA 72 CA Rectum C20

SUYADI 30 Ca of connective and soft tissue C49.2

2
of lower limb, including hip
3 TAN SOAN NIO-SYLVIA 67 CA of thyroid gland C73

4 SRI RICHANAH 56 CA of endometrium C54.1

5 WORO SUKO EKSI 69 CA Mamae Dextra C50.9

6 RINA FEBRIYANTI 29 Chronic myeloid leukaemia C92.1

7 NURANI 56 CA of border of tongue C02.1;K04.5

8 HOLIFAH 42 CA Mamae Dextra C50.9

9 LELY 54 CA Mamae Dextra C50.9

10 MARIYONO, BA 74 CA of bronchus or lung C34.9

11 R. ZAHRA BA. 64 CA of tongue C02.9

12 SUAIFAH 54 CA Mamae Dextra C50.9

Penanggung jawab:

Dewi Solicha,Amd.Kep
NIP
ASIEN NYERI PALIATIF
BALONGSARI
PRIL 2023

STADIUM NIK ALAMAT

IIB 3578141001510002 BALONGSARI BLOK 6H/18

IIB 3578142304920003 TUBANAN BARU BLOK D-30

IIB 3578276805550001 SATELITE INDAH 7/DN-16

IIB 3578145907660002 KARANGPOH 06/45

IB 3578146102540003 JL.TMN.DARMO INDAH SEL.V/EE-40

IB 3526074102940003 KALIANAK BARAT 80

IB 3578144112660006 BALONGSARI BLOK 8C/13

IB 3527086007800007 TUBANAN LAMA

IB 3574036601690002 Jl Balongsari Tama Selatan 9B-11

IIB 3578142305480003 BALONGSARI BLOK 5I/17

IIB 3578144503590001 BALONGSARI PRAJA 4/2

IIB 3578284405680002 GREGES TIMUR III NO. 7

Surabaya, 31 Maret 2023

Mengetahui,
Kepala Puskesmas Balongsari

dr. Dewi Ayuning Asih

Pembina IV A
NIP. 197911282006042028
 LAPORAN JUMLAH PASIEN NYERI PALIATIF
PUSKESMAS BALONGSARI
BULAN MEI 2023

NO NAMA UMUR DIAGNOSA ICD - X

1 ENI HEKMAWATI 58 CA Mamae Dextra C50.9

SUYADI 30 Ca of connective and soft tissue C49.2

2
of lower limb, including hip
3 TAN SOAN NIO-SYLVIA 67 CA of thyroid gland C73

4 SRI RICHANAH 56 CA of endometrium C54.1

5 WORO SUKO EKSI 69 CA Mamae Dextra C50.9

6 RINA FEBRIYANTI 29 Chronic myeloid leukaemia C92.1

7 NURANI 56 CA of border of tongue C02.1;K04.5

8 HOLIFAH 42 CA Mamae Dextra C50.9

9 LELY 54 CA Mamae Dextra C50.9

10 MARIYONO, BA 74 CA of bronchus or lung C34.9

11 R. ZAHRA BA. 64 CA of tongue C02.9

12 SUAIFAH 54 CA Mamae Dextra C50.9

Penanggung jawab:

Dewi Solicha,Amd.Kep
NIP. 198703052023212004
ASIEN NYERI PALIATIF
BALONGSARI
MEI 2023

STADIUM NIK ALAMAT

IIB 3578144103710003 BALONGSARI BLOK 5G/19

IIB 3578142304920003 TUBANAN BARU BLOK D-30

IIB 3578276805550001 SATELITE INDAH 7/DN-16

IIB 3578145907660002 KARANGPOH 06/45

IIB 3578146102540003 JL.TMN.DARMO INDAH SEL.V/EE-40

IB 3526074102940003 KALIANAK BARAT 80

IB 3578144112660006 BALONGSARI BLOK 8C/13

IB 3527086007800007 TUBANAN LAMA

IB 3574036601690002 Jl Balongsari Tama Selatan 9B-11

IIB 3578142305480003 BALONGSARI BLOK 5I/17

IIB 3578144503590001 BALONGSARI PRAJA 4/2

IIB 3578284405680002 GREGES TIMUR III NO. 7

Surabaya, 28 Mei 2023

Mengetahui,
Kepala Puskesmas Balongsari

dr. Dewi Ayuning Asih

Pembina IV A
NIP. 197911282006042028
 LAPORAN JUMLAH PASIEN NYERI PALIAT
PUSKESMAS BALONGSARI
BULAN JUNI 2023

NO NAMA UMUR DIAGNOSA ICD - X

1 MUJAINI 46 CA Mamae Dextra C50.9

2 WORO SUKO EKSI 69 CA Mamae Dextra C50.9

3 IR. MUSTOFA 72 CA Rectum C20

4 SRI RICHANAH 56 CA of endometrium C54.1

Penanggung jawab:

Dewi Solicha,Amd.Kep
NIP. 198703052023212004
ASIEN NYERI PALIATIF
BALONGSARI
JUNI 2023

STADIUM NIK ALAMAT

IIB 3578147006760023 KARANGPOH INDAH BARAT GG I NO.7

IIB 3578146102540003 JL.TMN.DARMO INDAH SEL.V/EE-40

IIB 3578141001510002 BALONGSARI BLOK 6H/18

IIB 3578145907660002 KARANGPOH 06/45

Surabaya, 28 Juni 2023

Mengetahui,
Kepala Puskesmas Balongsari

dr. Dewi Ayuning Asih

Pembina IV A
NIP. 197911282006042028
 LAPORAN JUMLAH PASIEN NYERI PALIATIF
PUSKESMAS BALONGSARI
BULAN JULI 2023

NO NAMA UMUR DIAGNOSA ICD - X STADIUM NIK ALAMAT

1 ALFIAH 70 Ca Mouth C06.8 IIB 3578146204530001 JL. GADEL TENGAH I NO.31
2 R. ZAHRA BA. 64 Ca of tongue C02.9 IIB 3578144503590001 BALONGSARI PRAJA 4/2
3 SUHARTATIK 57 Ca CX C53.9 3578314502660001 LEMPUNG MULYA UTARA

4 TITIN 48 Ca Mamae C50.9 3578146006750002 GADEL BARU I/18 TOWER

IB
Dextra
5 HOLIFAH 42 Ca Mamae C50.9 3527086007800007 TUBANAN LAMA
IB
Dextra
6 MUSTIKAWATI 48 Ca Palate C05.9 IB 3524055509740001 TUBANAN BARU D-14

7 SARIYEM 59 Ca Mamae C50.9 3578147006640014 JL.BIBIS TAMA 1-A/20

IB
Dextra
8 SURYONO 63 CA Cornea C69.1 IB 3578142509590001 BALONGSARI BLOK 6-A/19
9 RETNO DEWI 38 Ca CX C53.9 IIB 3578145908840004 BALONGSARI MADYA 7-I/1
10 TRISYANI BOENTARAN 65 Ca Rectum C20 IIB 3578146603580001 BALONGSARI MADYA 7-I/19

Surabaya, 28 Juli 2023

Mengetahui,
Kepala Puskesmas Balongsari
Penanggung jawab:

Dewi Solicha,Amd.Kep dr. Dewi Ayuning Asih

NIP. 198703052023212004 Pembina IV A
NIP. 197911282006042028
 LAPORAN JUMLAH PASIEN NYERI PALIATIF
PUSKESMAS BALONGSARI
BULAN NOVEMBER 2023

NO NAMA UMUR DIAGNOSA ICD - X STADIUM NIK ALAMAT

1 LELY 54 Ca skin C50.9 IIB 3574036601690002 Jl Balongsari Tama Selatan 9B-11

2 TITIN 48 Ca Mamae Dextra C50.9 IIB 3578146006750002 GADEL BARU I/18 TOWER

3 HOLIFAH 42 Ca Mamae Dextra C50.9 3527086007800007 TUBANAN LAMA

IIIB
TRISYANI
4 65 Ca Rectosigmoid 3578146603580001 BALONGSARI MADYA 7-I/19
BOENTARAN C20 IIIB
5 DJOKO 357814120780000
39 C69.0 BALONGSARI MADYA 7-E/3
PURWANTO Ca Conjungtiva IIB 3

6 C50.9 357814680871000
HARTI 40 Ca Mamae Dextra GADEL TIMUR GG.II/13
IB 4

7 SUYATON Ca bronchus or 357814700656007

66 C34.9 IB 9
JL.GADEL TENGAH GG.4 NO.30
lung
8 Ny. Trisyani 57 357814660358000
Boentaran
C19.0 IIIB 1
BALONGSARI MADYA 7I/9
Ca Rectosigmoid

9 Ny. Supartik 50 Ca Mamae Dextra C50.9 IIB 357814610663000 TANDES KIDUL 01/40
1

10 Ny. Dian 53 C50.9 357814520961000

Indahyani
Ca Mamae Dextra IIB 1
BALONGSARI PRAJA 1/44-B

11 50 BALONG SARI MADYA NO. 3 BLOK 7

JUBAIDAH Ca Thyroid Gland c73 IIB 520602440269000
J/7
4

12 Ny. Eni 34 C50.9

Hekmawati
Ca Mamae Dextra IIIB 357814410371000 BALONGSARI BLOK 5G/19
3

13 Ny.Tuwinatun 40 Ca CX C53.9 IIB 357814620172000 GADEL SARI BARAT 2/36

4

14 43 Adult Osteomalacia 357814500475000

Ny. Sampurti M83.9 IB 1
GADEL SARI TAMA 33

15 SISWANTO 50 357819100571000
Ca skin C76.0 IB 1
TENGGER REJO MULYO V-A / 01

16 Ny. Reni 46 Ca Mamae Dextra C50.9 IIB 357814500565000 GADEL JAYA TIMUR BB/05
2

Surabaya, 28 November 2023

Mengetahui,
Kepala Puskesmas Balongsari
Penanggung jawab:

Dewi Solicha,Amd.Kep dr. Dewi Ayuning Asih

NIP. 198703052023212004 Pembina IV A
NIP. 197911282006042028