LAPORAN KEPERAWATAN HARIAN

BULAN 01-01-2023 - 31-12-2023

Total : 524
Sist Dias
No Tanggal No RM Nama Desa NIK Tgl Lahir Ruangan ICD-10 Diagnosa ole tole
1 02/01/2023 15489 ISTOYO BAGI '3519082007700003 20/07/1970 POLI UMUM E11.8 Non-insulin- 120 80
dependent diabetes
mellitus with
2 02/01/2023 3184 FABELLA FINANDATYAN BANJARSARI '3519086512980002 25/12/1998 POLI UMUM Z00 General 110 80
NUGRAHENNY examination and
investigation of
3 02/01/2023 15624 ETIK SRI LESTARI BAGI '3519087005730003 30/05/1973 POLI UMUM M79.1 Myalgia 130 50
4 02/01/2023 2007 LESTARI DEMPELAN '3519084405590001 04/05/1959 POLI UMUM I25.9 Chronic ischaemic 130 80
heart disease,
5 02/01/2023 2764 SUJIATI TIRON '3519087006560025 30/06/1956 POLI UMUM M79.1 Myalgia 120 80
6 02/01/2023 8033 SUPARTI BANJARSARI '3519085012700002 12/10/1970 POLI UMUM H40.0 Glaucoma suspect 120 80
7 02/01/2023 1860 JUMIRAH BANJARSARI '3519085806570001 18/06/1957 POLI UMUM I25.9 Chronic ischaemic 120 80
heart disease,
8 02/01/2023 16175 CUCUK YESTER TAPELAN '3519086508970002 25/08/1997 POLI UMUM Z00 General 120 70
examination and
investigation of
9 02/01/2023 16 LAMINI BANJARSARI '3519085001690002 10/01/1969 POLI UMUM R51 Headache 100 70
10 02/01/2023 796 SUKATMI NGLAMES '3519086012570003 20/12/1957 POLI UMUM T14 Injury of unspecified 140 80
11 02/01/2023 12644 EKO EDI PURWANTO SUMBEREJO '3519081008680002 08/10/1968 POLI UMUM I25.9 Chronic ischaemic 120 80
heart disease,
12 02/01/2023 11494 SURATMINI NGLAMES '3314144812820029 08/12/1982 POLI UMUM R73.9 Hyperglycaemia, 120 80
13 02/01/2023 16176 RIZQI AMELIA PUTRI TIRON '3519076108000001 21/08/2000 POLI UMUM R69 Unknown and 110 70
unspecified causes
14 02/01/2023 4199 NOVITA YUNI SUMBEREJO '3519085111970002 11/11/1991 POLI UMUM Z00 General 120 80
examination and
investigation of
15 02/01/2023 8743 KAMIRAH SUMBEREJO '3519087112600011 31/12/1960 POLI UMUM M79.1 Myalgia 160 80
16 02/01/2023 16179 INTAN PRATAMAWATI SUMBEREJO '3519084706980002 06/07/1998 POLI UMUM Z00 General 110 80
examination and
investigation of
17 02/01/2023 8008 ANIS ANGSHORI BANJARSARI '3519080907950002 09/07/1995 POLI UMUM J06.9 Acute upper 120 80
respiratory
18 02/01/2023 1835 SUMINAH SUMBEREJO '3519084206680005 02/06/1968 POLI UMUM R73.9 Hyperglycaemia, 120 80
19 02/01/2023 4748 SUMINEM BANJARSARI '3519086906610001 29/06/1961 POLI UMUM M79.1 Myalgia 120 80
20 02/01/2023 1744 SUWARNO GUNUNGSARI '3519081610530001 16/10/1953 POLI UMUM M79.1 Myalgia 120 80
21 02/01/2023 410 KASMI SUMBEREJO '3519087006510043 30/06/1951 POLI UMUM I10 Essential (primary) 137 70
22 02/01/2023 6850 RIRIN SUSANTI DEMPELAN '3519085407840001 14/07/1984 POLI UMUM J06.9 Acute upper 120 80
respiratory
23 02/01/2023 16181 AJENG PUTRI MUTIARA BETEK '3519084904960002 04/09/1996 POLI UMUM Z00 General 110 70
examination and
investigation of
24 02/01/2023 3212 MANDRAWATI NGLAMES '3519085303660100 13/03/1966 POLI UMUM Z00 General 120 80
examination and
investigation of
25 02/01/2023 261 LAMINEM TIRON '3519086006550004 20/06/1955 POLI UMUM I10 Essential (primary) 130 70
26 02/01/2023 1016 SUMIATI SUMBEREJO '3519086508670002 25/08/1967 POLI UMUM M79.1 Myalgia 120 80
27 02/01/2023 717 MUJIATI TIRON '3519085007630001 10/07/1963 POLI UMUM I99 Other and 150 80
unspecified
28 02/01/2023 10546 HARSONO TIRON '3519082006550001 20/06/1955 POLI UMUM L20.9 Atopic dermatitis, 120 80
29 02/01/2023 67 YUDO PRASTYO GUNUNGSARI '3519081504790004 15/04/1979 POLI UMUM H54.5 Low vision, one eye 120 80
30 02/01/2023 6368 MARYATUN TIRON '3519084204800004 02/02/1980 POLI UMUM I11.9 Hypertensive heart 110 80
disease without
31 03/01/2023 172 SUHARTO SUMBEREJO '3519081505640002 15/05/1964 POLI UMUM F20 Schizophrenia 120 80
32 03/01/2023 15993 MUSILAH TIRON '3519085004590001 04/10/1959 POLI UMUM I99 Other and 180 90
unspecified
33 03/01/2023 2807 MARSONO SUMBEREJO '3519082604570002 26/04/1957 POLI UMUM I10 Essential (primary) 135 70
34 03/01/2023 878 MARIYEM NGLAMES '3519085112600001 11/12/1960 POLI UMUM M79.1 Myalgia 110 80
35 03/01/2023 15147 EVA RACHAINI SUGIHWARAS '3519126303580003 23/03/1958 POLI UMUM E11.9 Non-insulin- 120 70
dependent diabetes
36 03/01/2023 689 KASINEM TIRON '3519084105650002 01/05/1965 POLI UMUM M79.1 Myalgia 120 70
37 03/01/2023 5393 JAMI NGLAMES '3519086510690001 25/10/1969 POLI UMUM J06.9 Acute upper 110 80
respiratory
38 03/01/2023 3728 RAFIF AQRIIL AL AQIN BANJARSARI '3519080104170002 01/04/2017 POLI UMUM J06.9 Acute upper 100 70
respiratory
39 03/01/2023 6 SITI KHOTIJAH BANJARSARI '3519084507830006 05/07/1983 POLI UMUM R50.9 Fever, unspecified 120 70
40 03/01/2023 16183 MARSYA OCTA NUR ALIIFAH KEBONAGUN '3519106110080001 21/10/2008 POLI UMUM J06.9 Acute upper 110 70
G respiratory
41 03/01/2023 804 WARIDI BANJARSARI '3519080304640100 03/04/1964 POLI UMUM N18 Chronic kidney 120 70
42 03/01/2023 160 SUWANDI BANJARSARI '3519082505610001 25/05/1961 POLI UMUM E11.9 Non-insulin- 150 80
dependent diabetes
43 03/01/2023 6603 HIMMAWAN BAGUS TIRON '3519081609030001 16/09/2003 POLI UMUM Z00 General 120 70
NUGROHO examination and
investigation of
44 01/02/2023 66 LASINEM TIRON '3519087112570009 31/12/1957 POLI UMUM K30 Dyspepsia 150 78

45 01/02/2023 172 SUHARTO SUMBEREJO '3519081505640002 15/05/1964 POLI UMUM F20.9 Schizophrenia, 120 70
unspecified
46 01/02/2023 15574 EDI BUDIANTO NGLAMES '3519082004760002 20/04/1976 POLI UMUM N18 Chronic kidney 120 70
disease
47 01/02/2023 13000 NANIK HARINI, IR NGLAMES '351908 02/11/1967 POLI UMUM M13 Other arthritis 120 70
48 01/02/2023 16350 REVA AYUNINGTYAS BAGI ' 23/12/2007 POLI UMUM J00 Acute 100 70
nasopharyngitis
[common cold]
49 01/02/2023 16351 PARMIN BAGI ' 03/09/1973 POLI UMUM J06.9 Acute upper 130 70
respiratory
infection,
unspecified
50 01/02/2023 8474 DENI SETIAWAN TIRON ' 01/08/1993 POLI UMUM L60.8 Other nail disorders 120 70
3519140108930001
51 01/02/2023 13193 REZA WAHYU FEBRIANA SUMBEREJO '3519084102020002 02/01/2002 POLI UMUM Z00 General 100 70
examination and
investigation of
persons without
complaint and
reported diagnosis

52 01/02/2023 2459 SUWADI BANJARSARI '3519080208670001 02/08/1967 POLI UMUM Z00 General 130 78
examination and
investigation of
persons without
complaint and
reported diagnosis

53 01/02/2023 3387 BEJO NGLAMES '3519081111520002 11/11/1952 POLI UMUM J06.9 Acute upper 120 70
respiratory
infection,
unspecified
54 01/02/2023 3386 SUMARNI NGLAMES '3519084407530001 04/07/1953 POLI UMUM J06.9 Acute upper 110 70
respiratory
infection,
unspecified
55 01/02/2023 2058 TUMINI SUMBEREJO '3519086007510001 20/07/1951 POLI UMUM I10 Essential (primary) 130 70
hypertension
56 01/02/2023 2054 SUMIATI SUMBEREJO '3519084407770003 04/07/1977 POLI UMUM Z00 General 110 70
examination and
investigation of
persons without
complaint and
reported diagnosis

57 01/02/2023 3691 MUZAKI AHMAD BANJARSARI '- 03/08/2017 POLI UMUM R50 Fever of other and 90 70
unknown origin

58 01/02/2023 864 MURNANINGSIH BAGI '3519086908710004 21/08/1971 POLI UMUM E11.0 Non-insulin- 120 70
dependent diabetes
mellitus with coma

59 01/02/2023 1425 JARNI TIRON '3519085010750004 10/10/1975 POLI UMUM M79.1 Myalgia 90 70

60 01/02/2023 11968 MARJONO GUNUNGSARI '3519081102810001 11/02/1981 POLI UMUM K30 Dyspepsia 120 70

61 01/02/2023 1570 SURATMI TIRON '3519086507710002 25/07/1971 POLI UMUM I10 Essential (primary) 170 70
hypertension

62 01/02/2023 4842 AULIYA BERLIANA YOARY TIRON '3519085212090002 12/12/2009 POLI UMUM R50.9 Fever, unspecified 120 70

63 01/02/2023 16356 KEVIN JUNIKO JAMAR SUMBEREJO ' 09/06/2010 POLI UMUM L20.9 Atopic dermatitis, 100 70
PUTRA unspecified
64 01/02/2023 16357 ANDRA FERNIAWAN NGLAMES '3519081206980001 06/12/1998 POLI UMUM Z00 General 110 70
PURNOMO examination and
investigation of
persons without
complaint and
reported diagnosis

65 01/02/2023 14782 CILA ERFENDY NGLAMES ' 06/01/1987 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

66 01/02/2023 16358 SRIYANAH NGLAMES '3509125001770003 10/01/1977 POLI UMUM N30 Cystitis 130 70

67 01/02/2023 3059 ENI WIJAYANTI NGLAMES '3519135112900002 11/12/1990 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

68 01/02/2023 8602 KRHISNA RAMA ERFENDY NGLAMES '3519132507100001 25/07/2010 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis
69 01/02/2023 714 ENY ARIANTI TIRON '3519084603780003 06/03/1978 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

70 01/02/2023 13587 SUYONO TIRON '3519080305700004 05/03/1970 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

71 02/02/2023 3184 FABELLA FINANDATYAN BANJARSARI '3519086512980002 25/12/1998 POLI UMUM Z00 General 120 80
NUGRAHENNY examination and
investigation of
persons without
complaint and
reported diagnosis

72 02/02/2023 4117 AMIRAH BAGI '3519085005730003 10/05/1973 POLI UMUM M79.1 Myalgia 120 80

73 02/02/2023 6266 PARSINI SUMBEREJO '3519085702710001 17/02/1971 POLI UMUM M13 Other arthritis 120 80

74 02/02/2023 14495 GABY ANGELIN TANELI NGLAMES '3172025301050003 13/01/2005 POLI UMUM A15 Respiratory 120 80
tuberculosis,
bacteriologically and
histologically
confirmed
75 02/02/2023 796 SUKATMI NGLAMES '3519086012570003 20/12/1957 POLI UMUM I10 Essential (primary) 120 70
hypertension

76 02/02/2023 12200 MARJIANTO BAGI '3519082103690002 21/03/1969 POLI UMUM M79.1 Myalgia 140 70

77 02/02/2023 16249 SITI SUPRIYANDINI MOJOREJO '3577035709730002 17/09/1973 POLI UMUM M79.1 Myalgia 120 70

78 02/02/2023 13620 MURJANI TIRON '3519084903440001 03/09/1944 POLI UMUM J06.9 Acute upper 140 70
respiratory
infection,
unspecified
79 02/02/2023 2279 YAYUK KATMININGSIH NGLAMES '3519084804730002 08/04/1973 POLI UMUM K80.8 Other cholelithiasis 120 80

80 02/02/2023 11494 SURATMINI NGLAMES '3314144812820029 08/12/1982 POLI UMUM R73.9 Hyperglycaemia, 140 70
unspecified
81 02/02/2023 5842 SRI WAHYUNI SUMBEREJO '3519081902090002 27/06/1999 POLI UMUM G44.0 Cluster headache 110 70
syndrome
82 02/02/2023 1131 SUJITNO BANJARSARI '- 15/05/1952 POLI UMUM J06.9 Acute upper 160 78
respiratory
infection,
unspecified
83 02/02/2023 303 AMIRATUN SUMBEREJO '3519085602570001 16/02/1957 POLI UMUM E11.8 Non-insulin- 150 80
dependent diabetes
mellitus with
unspecified
complications
84 02/02/2023 304 SUTOMO SUMBEREJO '3519080811570001 08/11/1957 POLI UMUM E11.8 Non-insulin- 120 80
dependent diabetes
mellitus with
unspecified
complications
85 02/02/2023 3063 WINIH NGLAMES '3519085608590001 16/08/1959 POLI UMUM I10 Essential (primary) 120 70
hypertension

86 02/02/2023 3972 BAYU DWI SANTOSO TIRON '3519082305850001 23/05/1985 POLI UMUM A15 Respiratory 120 80
tuberculosis,
bacteriologically and
histologically
confirmed
87 02/02/2023 1654 SUYONO GUNUNGSARI '3519082412740001 24/12/1974 POLI UMUM L23 Allergic contact 150 70
dermatitis
88 02/02/2023 10056 ARIF RAHMAN TIRON '3519081807730001 18/07/1973 POLI UMUM M79.1 Myalgia 150 70

89 01/03/2023 12598 SUMARTIN GUNUNGSARI '3519084402680001 02/04/1968 POLI UMUM A15 Respiratory 120 70
tuberculosis,
bacteriologically and
histologically
confirmed
90 01/03/2023 4435 REGITA SHAFIYUL NUR AINI TIRON '3519086305060001 23/05/2006 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

91 01/03/2023 874 JINARTI TIRON '3519084702780001 07/02/1978 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis
92 01/03/2023 4557 NURUL SRI UTAMI TIRON '3519086602760001 26/02/1976 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

93 01/03/2023 167 SRIATUN tiron rt 02 '- 30/12/1960 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

94 01/03/2023 95 ABELIA YUNIAR PUTRI SUMBEREJO '- 13/01/2011 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

95 01/03/2023 10086 NYAMI BAGI '3519084607620001 06/07/1962 POLI UMUM H10 Conjunctivitis 140 80

96 01/03/2023 6800 OTNIEL KHARISMA TIRON '3519082810900001 28/10/1990 POLI UMUM Z00 General 120 80
YUDHISTIRA K examination and
investigation of
persons without
complaint and
reported diagnosis
97 01/03/2023 9113 SUNARTI TANJUNGREJ '- 06/11/1967 POLI UMUM I10 Essential (primary) 130 70
O hypertension

98 01/03/2023 776 DARSI SUMBEREJO '3519087006330006 30/06/1933 POLI UMUM R33 Retention of urine 120 70

99 01/03/2023 1848 SRIATUN BANJARSARI '3519085009520002 11/12/1947 POLI UMUM N84.1 Polyp of cervix uteri 120 70

100 01/03/2023 15800 YUSUF SYARIF BANJARSARI ' 08/08/2012 POLI UMUM K30 Dyspepsia 100 70
HIDAYATULLAH
101 01/03/2023 1422 TUMINEM SUMBEREJO '3519085603690002 16/03/1969 POLI UMUM E11.9 Non-insulin- 110 70
dependent diabetes
mellitus without
complications

102 01/03/2023 926 MARIYAM NGLAMES '3519085406510002 14/06/1951 POLI UMUM I10 Essential (primary) 120 70
hypertension

103 01/03/2023 1327 TAMINEM BANJARSARI '3519085206600001 12/06/1960 POLI UMUM I69.4 Sequelae of stroke, 140 70
not specified as
haemorrhage or
infarction

104 01/03/2023 2524 ANISA PUTRI SULISTIYANI BAGI '3519085204990001 12/04/1999 POLI UMUM Z00 General 90 60
examination and
investigation of
persons without
complaint and
reported diagnosis
105 01/03/2023 5328 RISKA WAHYU SEPTIANA BAGI '3519086909010005 29/09/2001 POLI UMUM Z00 General 100 70
examination and
investigation of
persons without
complaint and
reported diagnosis

106 01/03/2023 16535 MIRAH TIRON '3519084910480001 10/09/1948 POLI UMUM A09 Diarrhoea and 150 80
gastroenteritis of
presumed infectious
origin
107 01/03/2023 6485 SURATMI TIRON '3519085607780001 16/07/1978 POLI UMUM I99 Other and 160 80
unspecified
disorders of
circulatory system
108 01/03/2023 1195 SLAMET ARIYADI SUMBEREJO '3519081304650001 13/04/1965 POLI UMUM I64 Stroke, not specified 160 80
as haemorrhage or
infarction

109 01/03/2023 5911 ABILA JEFANYA AZZAHRA BAGI '3519086301180001 23/01/2018 POLI UMUM J06.9 Acute upper 90 60
respiratory
infection,
unspecified
110 01/03/2023 390 MURTINI SUMBEREJO '3519085212740002 12/12/1974 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis
111 01/03/2023 324 CELFYN ADITYA BAGI '3519080612090001 06/12/2009 POLI UMUM Z00 General 0 0
CANDRAWINATA examination and
investigation of
persons without
complaint and
reported diagnosis

112 01/03/2023 16049 SUNARKO BAGI '3519081312820001 13/12/1982 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

113 01/03/2023 13032 RISNA ANDARI GUNUNGSARI '3519084607600001 07/06/1960 POLI UMUM J00 Acute 140 80
nasopharyngitis
[common cold]
114 01/03/2023 196 SRI ISMIATI TIRON '3519087103700002 31/03/1970 POLI UMUM J00 Acute 110 70
nasopharyngitis
[common cold]
115 01/03/2023 716 SUMARDI SUMBEREJO '3519082412670001 24/12/1967 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

116 01/03/2023 1651 WARSITI TIRON '3519085907590001 19/07/1959 POLI UMUM L20.9 Atopic dermatitis, 120 75
unspecified
117 01/03/2023 3925 YUZA ISRA AL-MAHENDRA TIRON '3519081003120002 10/03/2012 POLI UMUM R50 Fever of other and 90 60
unknown origin

118 01/03/2023 15259 IVANYA MANISHA AZZAHRA TIRON '3519084309060001 09/03/2006 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

119 01/03/2023 16537 REZA FAUZAN DWI BANJARSARI '3519081511090001 15/11/2009 POLI UMUM S52.2 Fracture of shaft of 100 70
SAPUTRA ulna
120 01/03/2023 1333 TIKA PUTRI LESTARI BANJARSARI '3519084409000001 04/09/2000 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

121 01/03/2023 3319 RHOBET PUGUH PRAKOSO TIRON '3519080501000001 05/01/2000 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis
122 01/03/2023 9232 MARDJOKO GUNUNGSARI '3519082505530001 25/05/1953 POLI UMUM Z00 General 0 0
examination and
investigation of
persons without
complaint and
reported diagnosis

123 02/03/2023 16511 AHMAD IZZAT MUHARRIR KUWU '3519101804080002 18/04/2008 POLI UMUM D21.0 Other benign 100 90
neoplasm of
connective and
other soft tissue of
head, face and neck

124 02/03/2023 7340 LASMINI TIRON '3519085711660002 17/11/1966 POLI UMUM I11 Hypertensive heart 130 70
disease
125 02/03/2023 2666 SUWARNO SUMBEREJO '3519081904630001 19/04/1963 POLI UMUM A15 Respiratory 120 80
tuberculosis,
bacteriologically and
histologically
confirmed
126 02/03/2023 2010 KARMI PUJI ASTUTI BANJARSARI '3519086701830002 27/01/1983 POLI UMUM R33 Retention of urine 120 80

127 02/03/2023 6580 SAMIDIN NGLAMES '3519080101700001 01/01/1970 POLI UMUM M79.1 Myalgia 100 70

128 02/03/2023 16544 WARTI TIRON '3519084306660002 06/03/1966 POLI UMUM M79.1 Myalgia 130 70

129 02/03/2023 475 FARRIS FERDINANDZA TIRON '3519082205130001 22/05/2013 POLI UMUM J00 Acute 100 60
FAUZI nasopharyngitis
[common cold]
130 02/03/2023 16545 MAHFUD SIDIK BANJAREJO '3521141701960001 17/01/1996 POLI UMUM J06.9 Acute upper 120 70
respiratory
infection,
unspecified
131 02/03/2023 6762 SUMINI TIRON '3519085508650001 15/08/1965 POLI UMUM K30 Dyspepsia 110 70

132 02/03/2023 15291 JEMANI SENDANG '3502020403940004 04/03/1994 POLI UMUM J06.9 Acute upper 120 70
respiratory
infection,
unspecified
133 01/04/2023 11 YULI ASTUTI BAGI '3519087001900001 30/01/1990 POLI UMUM R69 Unknown and 135 78
PURWANINGRUM unspecified causes
of morbidity

134 01/04/2023 3309 DASRI GUNUNGSARI '3519085002720001 10/02/1972 POLI UMUM R69 Unknown and 136 78
unspecified causes
of morbidity

135 01/04/2023 3309 DASRI GUNUNGSARI '3519085002720001 10/02/1972 POLI UMUM R69 Unknown and 135 69
unspecified causes
of morbidity

136 01/04/2023 3309 DASRI GUNUNGSARI '3519085002720001 10/02/1972 POLI UMUM R69 Unknown and 123 88
unspecified causes
of morbidity

137 01/04/2023 8364 SAWI GUNUNGSARI ' 19/02/1942 POLI UMUM R69 Unknown and 135 88
unspecified causes
of morbidity
138 01/04/2023 9552 PUNGKY DEWI SETIYANI GUNUNGSARI '3519086907970001 29/07/1997 POLI UMUM R69 Unknown and 135 88
unspecified causes
of morbidity

139 01/04/2023 7642 HADI WIYONO TIRON '- 17/09/1946 POLI UMUM R69 Unknown and 130 80
unspecified causes
of morbidity

140 01/04/2023 13071 KUSMANTO TIRON '3519080701700001 01/07/1970 POLI UMUM J20.0 Acute bronchitis due 150 70
to Mycoplasma
pneumoniae

141 01/04/2023 1049 WINARSIH NGLAMES '3519085308650003 13/08/1965 POLI UMUM I10 Essential (primary) 120 70
hypertension

142 01/04/2023 10584 DIAN PANCA KURNIAWATI BAGI '3519086105850001 21/05/1985 POLI UMUM A09 Diarrhoea and 120 70
gastroenteritis of
presumed infectious
origin
143 01/04/2023 2666 SUWARNO SUMBEREJO '3519081904630001 19/04/1963 POLI UMUM I10 Essential (primary) 110 70
hypertension

144 01/04/2023 638 LILIK HARTATIK NGLAMES '3519086509670001 25/09/1967 POLI UMUM I10 Essential (primary) 110 70
hypertension

145 01/04/2023 2265 PURWATI WULANDARI TIRON '3519086307020002 23/07/2002 POLI UMUM R50 Fever of other and 100 70
unknown origin

146 01/04/2023 1147 APRILIA SUMBEREJO '3519086104950001 21/04/1995 POLI UMUM K30 Dyspepsia 90 60
147 01/04/2023 1961 SAKAT TIRON '3519081209510003 12/09/1951 POLI UMUM L23 Allergic contact 120 70
dermatitis
148 01/04/2023 13421 SUMARNI TIRON '3519084205710002 05/02/1971 POLI UMUM R69 Unknown and 135 78
unspecified causes
of morbidity

149 01/04/2023 433 KUSTINI NGLAMES '3519085302630001 13/02/1963 POLI UMUM H40 Glaucoma 130 80

150 01/04/2023 8769 KUSNO SUMBEREJO '3519083006520016 30/06/1952 POLI UMUM J00 Acute 120 70
nasopharyngitis
[common cold]
151 01/04/2023 16694 ANNISA NUR RAHMAWATI PANDEAN '3519084411040003 11/04/2004 POLI UMUM Z00 General 100 70
examination and
investigation of
persons without
complaint and
reported diagnosis

152 01/04/2023 15050 SUYANTO BAGI '3519082601680004 26/01/1968 POLI UMUM I25.9 Chronic ischaemic 110 70
heart disease,
unspecified
153 01/04/2023 7287 MINTEN SUMBEREJO '3519087006580016 30/06/1958 POLI UMUM R69 Unknown and 135 82
unspecified causes
of morbidity

154 01/04/2023 13281 SUMIATI TIRON '3519085501540001 15/01/1954 POLI UMUM R69 Unknown and 125 75
unspecified causes
of morbidity

155 01/04/2023 1654 SUYONO GUNUNGSARI '3519082412740001 24/12/1974 POLI UMUM M79.1 Myalgia 130 90
156 01/04/2023 5053 SRI MARIYANI SUMBEREJO '3519084703710001 03/07/1971 POLI UMUM I84.8 Unspecified 170 90
haemorrhoids with
other complications

157 01/04/2023 8455 MUHAMMAD RISKY TIRON '3519082403990001 24/03/1999 POLI UMUM R50 Fever of other and 90 60
SUHARTONO unknown origin

158 01/04/2023 4435 REGITA SHAFIYUL NUR AINI TIRON '3519086305060001 23/05/2006 POLI UMUM R69 Unknown and 110 78
unspecified causes
of morbidity

159 01/04/2023 874 JINARTI TIRON '3519084702780001 07/02/1978 POLI UMUM R69 Unknown and 135 78
unspecified causes
of morbidity

160 01/04/2023 4557 NURUL SRI UTAMI TIRON '3519086602760001 26/02/1976 POLI UMUM R69 Unknown and 128 78
unspecified causes
of morbidity

161 01/04/2023 167 SRIATUN tiron rt 02 '- 30/12/1960 POLI UMUM R69 Unknown and 145 87
unspecified causes
of morbidity

162 01/04/2023 95 ABELIA YUNIAR PUTRI SUMBEREJO '- 13/01/2011 POLI UMUM R69 Unknown and 100 78
unspecified causes
of morbidity

163 01/04/2023 4019 HERI SUSANTO PURWOREJO '3519032108690001 21/08/1969 POLI UMUM R69 Unknown and 123 70
unspecified causes
of morbidity
164 01/04/2023 5301 DALILAH LUTHFIYYAH PURWOREJO '3519035508020003 15/08/2002 POLI UMUM R69 Unknown and 125 78
JANNAH. N unspecified causes
of morbidity

165 01/04/2023 1 SUGINEM BANJARSARI '3519085106660001 11/06/1966 POLI UMUM R69 Unknown and 135 83
unspecified causes
of morbidity

166 01/04/2023 1994 PARTINI SUMBEREJO '3519086803780001 28/03/1978 POLI UMUM R69 Unknown and 136 79
unspecified causes
of morbidity

167 01/04/2023 3194 GARJITO SUMBEREJO '3519083006760019 30/06/1976 POLI UMUM R69 Unknown and 135 88
unspecified causes
of morbidity

168 01/04/2023 6 SITI KHOTIJAH BANJARSARI '3519084507830006 05/07/1983 POLI UMUM R69 Unknown and 130 78
unspecified causes
of morbidity

169 01/04/2023 3625 ADILLA ARAYA AQBAR BANJARSARI '3519082009090002 20/09/2009 POLI UMUM R69 Unknown and 100 70
PRATAMA unspecified causes
of morbidity

170 01/04/2023 9642 SUGIONO BANJARSARI '3519081710830002 17/10/1983 POLI UMUM R69 Unknown and 145 77
unspecified causes
of morbidity
171 01/04/2023 7 PAKUN BAGI '3519080505560002 05/05/1956 POLI UMUM R69 Unknown and 145 89
unspecified causes
of morbidity

172 01/04/2023 9520 BAINEM BAGI '3519084411560001 11/04/1956 POLI UMUM I10 Essential (primary) 120 71
hypertension

173 03/04/2023 9768 DWI INDAH ASTUTI SENDANGREJ '3519084111730001 11/01/1973 POLI UMUM K30 Dyspepsia 100 70
O
174 03/04/2023 12552 MUHAMMAD SYAUQI TIRON '3516081402090003 14/02/2009 POLI UMUM K50 Crohn disease 100 70
RAMA ABDILLAH [regional enteritis]

175 03/04/2023 16697 LUKI DWI CAHYONO BAGI '3519082205870001 22/05/1987 POLI UMUM G51.0 Bell`s palsy 110 70

176 03/04/2023 572 FADHIL APRILINO BANJARSARI '3519082704100001 27/04/2010 POLI UMUM J00 Acute 90 60
ARDIANSYAH nasopharyngitis
[common cold]
177 02/05/2023 15574 EDI BUDIANTO NGLAMES '3519082004760002 20/04/1976 POLI UMUM N18 Chronic kidney 140 70
disease
178 02/05/2023 1341 SARDJONO GUNUNGSARI '3519082908550001 29/08/1955 POLI UMUM I25.9 Chronic ischaemic 110 70
heart disease,
unspecified
179 02/05/2023 6056 DARIANI BAGI '3519084106760002 06/01/1976 POLI UMUM J44 Other chronic 110 70
obstructive
pulmonary disease

180 02/05/2023 103 SOIYEM GADING '3519105011640002 10/11/1964 POLI UMUM R73.9 Hyperglycaemia, 120 70
unspecified
181 02/05/2023 9107 DJUWARIYANTO NGLAMES '3519080203560001 03/02/1956 POLI UMUM J44 Other chronic 120 70
obstructive
pulmonary disease

182 02/05/2023 12200 MARJIANTO BAGI '3519082103690002 21/03/1969 POLI UMUM I99 Other and 140 70
unspecified
disorders of
circulatory system
183 02/05/2023 105 MAIMUN BANJARSARI '3519082904540002 29/04/1954 POLI UMUM J00 Acute 120 70
nasopharyngitis
[common cold]
184 02/05/2023 4618 DAFFA FRAUZI NUGRAHA NGLAMES '3519080808070001 08/08/2007 POLI UMUM G40.9 Epilepsy, 120 70
unspecified
185 02/05/2023 1961 SAKAT TIRON '3519081209510003 12/09/1951 POLI UMUM R69 Unknown and 120 80
unspecified causes
of morbidity

186 02/05/2023 2807 MARSONO SUMBEREJO '3519082604570002 26/04/1957 POLI UMUM I10 Essential (primary) 135 78
hypertension

187 02/05/2023 12644 EKO EDI PURWANTO SUMBEREJO '3519081008680002 08/10/1968 POLI UMUM I25.9 Chronic ischaemic 120 70
heart disease,
unspecified
188 02/05/2023 5212 ASHTIKA NUR HAFIZA TIRON '- 05/01/2018 POLI UMUM R69 Unknown and 0 0
unspecified causes
of morbidity

189 02/05/2023 3321 GADINGTAMA YODIYA GUNUNGSARI '3519080412140002 04/12/2014 POLI UMUM J00 Acute 0 0
SETYANINGPRANG nasopharyngitis
[common cold]
190 02/05/2023 726 YULI SETIANI GUNUNGSARI '3519084407790003 04/07/1979 POLI UMUM L23 Allergic contact 140 70
dermatitis
191 02/05/2023 538 DEKI PRIYAGUNG GUNUNGSARI '3519081102760001 11/02/1976 POLI UMUM J06.9 Acute upper 120 70
SETYANINGPRANG respiratory
infection,
unspecified
192 02/05/2023 10853 WISNU CANDRA BANJARSARI '- 01/07/2007 POLI UMUM Z00 General 100 70
KURNIAWAN examination and
investigation of
persons without
complaint and
reported diagnosis

193 02/05/2023 13582 MARPUNGAH BANJARSARI '3519086708500002 27/08/1950 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

194 02/05/2023 8164 AGUS DARMINTO BANJARSARI ' - 06/03/1972 POLI UMUM Z00 General 120 80
examination and
investigation of
persons without
complaint and
reported diagnosis

195 02/05/2023 16830 SULISTIYO BAGI '3519081103790001 03/11/1979 POLI UMUM H81.3 Other peripheral 110 70
vertigo
196 02/05/2023 3859 SURI LELA TANJUNGREJ '3519084507790002 05/07/1979 POLI UMUM H81.3 Other peripheral 120 70
O vertigo
197 02/05/2023 9708 SUKIS SUPRIANTO TIRON '3519080410800005 10/04/1980 POLI UMUM L23 Allergic contact 100 70
dermatitis
198 02/05/2023 2666 SUWARNO SUMBEREJO '3519081904630001 19/04/1963 POLI UMUM I10 Essential (primary) 120 70
hypertension

199 02/05/2023 16831 KASMINAH BARONGAN '3528045109660140 11/09/1966 POLI UMUM E11.8 Non-insulin- 110 70
dependent diabetes
mellitus with
unspecified
complications
200 02/05/2023 14148 WAGIYEM TIRON ' 30/06/1959 POLI UMUM M79.1 Myalgia 130 70
201 02/05/2023 15484 DARMO WIYONO TANJUNGREJ '3519080204500001 02/04/1950 POLI UMUM J06.9 Acute upper 140 70
O respiratory
infection,
unspecified
202 02/05/2023 2081 SUPARTI SUMBEREJO '3519085708570002 17/08/1957 POLI UMUM R50 Fever of other and 110 70
unknown origin

203 02/05/2023 2478 YUDI SRI UTAMI BANJARSARI '3519084609750001 06/09/1975 POLI UMUM Z00 General 110 70
examination and
investigation of
persons without
complaint and
reported diagnosis
204 02/05/2023 10383 BASIR BANJARSARI '3519081708530001 01/08/1953 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

205 02/05/2023 13316 DJANTI MULJANI BANJARSARI '3519084205600002 28/05/1960 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

206 02/05/2023 252 DJUWARNI GUNUNGSARI '3519085304630001 13/04/1963 POLI UMUM E11.8 Non-insulin- 120 80
dependent diabetes
mellitus with
unspecified
complications
207 02/05/2023 15845 YUNIATI SENDANGREJ '3324045703040001 17/03/2004 POLI UMUM K29.7 Gastritis, 80 60
O unspecified
208 02/05/2023 5689 SUKATMI NGLAMES '3519087006600016 30/06/1960 POLI UMUM I63 Cerebral infarction 130 70

209 02/05/2023 16832 WIWIT AGUS SUSANTI TIRON '3519086408940002 24/08/1994 POLI UMUM Z00 General 90 60
examination and
investigation of
persons without
complaint and
reported diagnosis
210 02/05/2023 16067 GUNARIYO BANJARSARI ' 20/09/1962 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

211 02/05/2023 16068 GINARTI BANJARSARI ' 22/05/1968 POLI UMUM Z00 General 110 70
examination and
investigation of
persons without
complaint and
reported diagnosis

212 02/05/2023 16236 ANINDITA KUSUMA DEWI BANJARSARI '3519086311980002 23/11/1997 POLI UMUM H25 Senile cataract 140 70

213 02/05/2023 2651 ERY WIDIYANTO BANJARSARI '3519082604810001 26/04/1981 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

214 02/05/2023 1688 MOURISH ANISYA SEFINA BANJARSARI '3519084302090001 03/02/2009 POLI UMUM K29.7 Gastritis, 90 60
unspecified
215 02/05/2023 1369 ARLEN LEONARDA NGLAMES '3519081608020001 16/08/2002 POLI UMUM Z09.8 Follow-up 100 70
PURNAMA examination after
other treatment for
other conditions
216 02/05/2023 914 SUYATI TIRON '3519085710640001 01/01/1970 POLI UMUM E11.8 Non-insulin- 120 80
dependent diabetes
mellitus with
unspecified
complications
217 02/05/2023 14061 SLAMET RIYADI BAGI ' 16/07/1981 POLI UMUM L20.9 Atopic dermatitis, 130 70
unspecified
218 02/05/2023 3978 SUTINAH BAGI '- 01/02/1962 POLI UMUM Z00 General 150 78
examination and
investigation of
persons without
complaint and
reported diagnosis

219 02/05/2023 2359 AYUDIA INARA ISDIANTO SUMBEREJO '3519086103170002 21/03/2017 POLI UMUM J06.9 Acute upper 0 0
respiratory
infection,
unspecified
220 02/05/2023 379 SUWONDO NGLAMES '3519080203550001 02/03/1955 POLI UMUM I10 Essential (primary) 138 75
hypertension

221 03/06/2023 13183 DJUMARI TIRON '3519083006640025 30/06/1964 POLI UMUM C64 Malignant neoplasm 120 70
of kidney, except
renal pelvis
222 03/06/2023 16998 SRI ROEKMINI SUMBEREJO '3519084108610002 08/01/1961 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

223 03/06/2023 796 SUKATMI NGLAMES '3519086012570003 20/12/1957 POLI UMUM C50.9 Malignant neoplasm 135 70
of breast,
unspecified

224 03/06/2023 19 LASMINTEN TIRON '3519084411530001 04/11/1953 POLI UMUM E11.4 Non-insulin- 120 70
dependent diabetes
mellitus with
neurological
complications
225 03/06/2023 9076 SURATI BANJARSARI ' 05/12/1970 POLI UMUM L23 Allergic contact 120 70
dermatitis
226 03/06/2023 1674 GATOT WARMINTO GUNUNGSARI '3519080501840001 05/01/1984 POLI UMUM R50.9 Fever, unspecified 100 60

227 03/06/2023 2938 ENDANG SULASTRI NGLAMES '3519085307720002 13/07/1972 POLI UMUM M79.1 Myalgia 120 70

228 03/06/2023 1341 SARDJONO GUNUNGSARI '3519082908550001 29/08/1955 POLI UMUM M79.2 Neuralgia and 120 70
neuritis, unspecified

229 03/06/2023 1522 MUNARI TIRON '3519081603550002 16/03/1955 POLI UMUM J00 Acute 140 80
nasopharyngitis
[common cold]
230 03/06/2023 99 DJAIZ BASHARUDIN TIRON '3519081202600002 12/02/1960 POLI UMUM I69.4 Sequelae of stroke, 120 80
not specified as
haemorrhage or
infarction

231 03/06/2023 12227 ZAHRUDDIN TIRON '3577012611740002 26/11/1974 POLI UMUM H52.5 Disorders of 120 80
accommodation
232 03/06/2023 220 SAMSIATI TIRON '3519086104610001 21/04/1961 POLI UMUM I10 Essential (primary) 110 70
hypertension

233 03/06/2023 3128 FAIZA NAYLA LATIFA TIRON '3519084204140001 02/04/2014 POLI UMUM J00 Acute 120 70
nasopharyngitis
[common cold]
234 03/06/2023 12511 APRI LUSIYANTI BANJARSARI '3519085404820002 14/04/1982 POLI UMUM I99 Other and 140 70
unspecified
disorders of
circulatory system
235 03/06/2023 582 SUMI BAGI '3519084803630001 08/03/1963 POLI UMUM I10 Essential (primary) 120 70
hypertension

236 03/06/2023 10274 KUSMI LESTARI TIRON '3519085212690003 12/12/1969 POLI UMUM M54.5 Low back pain 130 70

237 03/06/2023 4994 SITI AMINAH TIRON '3519087006700013 30/06/1970 POLI UMUM M79.1 Myalgia 120 70

238 03/06/2023 14575 DIANA NOVITA BANJARSARI '3520055311990001 13/11/1999 POLI UMUM R50.9 Fever, unspecified 120 70

239 03/06/2023 5186 FARIS GHANI SAPUTRA BANJARSARI '3519081305170001 13/05/2017 POLI UMUM J03.9 Acute tonsillitis, 120 70
unspecified
240 03/06/2023 10026 ELSA RISMA APRILIANA BAGI '3519085304000003 13/04/2000 POLI UMUM H00 Hordeolum and 90 60
chalazion
241 03/06/2023 2154 MAINEM SUMBEREJO '3519085101580002 11/01/1958 POLI UMUM I25.9 Chronic ischaemic 110 78
heart disease,
unspecified
242 03/06/2023 4889 SUTINI TIRON '3519085809520001 18/09/1952 POLI UMUM J00 Acute 110 70
nasopharyngitis
[common cold]
243 03/06/2023 6122 KUDWAH SHOLIKHAH, GUNUNGSARI '3519086003720001 20/03/1972 POLI UMUM I10 Essential (primary) 120 70
A.MD.KEB hypertension

244 03/06/2023 10853 WISNU CANDRA BANJARSARI '- 01/07/2007 POLI UMUM Z00 General 100 70
KURNIAWAN examination and
investigation of
persons without
complaint and
reported diagnosis

245 03/06/2023 16067 GUNARIYO BANJARSARI ' 20/09/1962 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis

246 03/06/2023 16068 GINARTI BANJARSARI ' 22/05/1968 POLI UMUM Z00 General 120 70
examination and
investigation of
persons without
complaint and
reported diagnosis
247 03/06/2023 12286 SUROTO BANJARSARI '3519080108790002 01/08/1979 POLI UMUM Z00 General 110 70
examination and
investigation of
persons without
complaint and
reported diagnosis

248 03/06/2023 16886 SUKIRAN BANJARSARI ' 11/11/1963 POLI UMUM Z00 General 120 70
3519081111630002 examination and
investigation of
persons without
complaint and
reported diagnosis

249 03/06/2023 13536 ANIK SUCIATI BANJARSARI '3519084404690003 04/04/1969 POLI UMUM Z00 General 90 70
examination and
investigation of
persons without
complaint and
reported diagnosis

250 05/06/2023 17004 DIAH TRI WINDARTI, SPD TIRON '3519084209720002 02/09/1972 POLI UMUM I69.4 Sequelae of stroke, 110 70
not specified as
haemorrhage or
infarction

251 05/06/2023 6171 SALSABILA AYU HANIFA BAGI '3519081502120016 27/03/2018 POLI UMUM J06.9 Acute upper 90 60
respiratory
infection,
unspecified
252 05/06/2023 1654 SUYONO GUNUNGSARI '3519082412740001 24/12/1974 POLI UMUM J44 Other chronic 120 70
obstructive
pulmonary disease

253 05/06/2023 9113 SUNARTI TANJUNGREJ '- 06/11/1967 POLI UMUM I10 Essential (primary) 120 70
O hypertension

254 05/06/2023 5010 RUSDIATUN NGLAMES '3519086803660001 28/03/1966 POLI UMUM I10 Essential (primary) 120 70
hypertension

255 05/06/2023 959 PURWATI BANJARSARI '3519086610600001 26/10/1960 POLI UMUM F20.9 Schizophrenia, 120 70
unspecified
256 05/06/2023 14933 DARIYANTO BANJARSARI ' 02/02/1968 POLI UMUM H40 Glaucoma 120 70

257 05/06/2023 4301 SUMINI TIRON '3519084102700001 01/02/1970 POLI UMUM D32.9 Benign neoplasm of 120 70
meninges,
unspecified
258 05/06/2023 17005 DANAR RULIYANTO GUNUNGSARI '3519080303920001 03/03/1992 POLI UMUM Z09.8 Follow-up 120 70
examination after
other treatment for
other conditions

259 05/06/2023 2666 SUWARNO SUMBEREJO '3519081904630001 19/04/1963 POLI UMUM i10 Essential (primary) 120 70
hypertension

260 05/06/2023 2163 MUDJIATI SUMBEREJO '3519086505620001 25/05/1962 POLI UMUM M79.1 Myalgia 120 70

261 05/06/2023 998 RINI DYAH SETYOWATI SUMBEREJO '3519085706870002 17/06/1987 POLI UMUM R50.9 Fever, unspecified 120 70
262 05/06/2023 582 SUMI BAGI '3519084803630001 08/03/1963 POLI UMUM I25.9 Chronic ischaemic 120 70
heart disease,
unspecified
263 05/06/2023 14917 DWI HARI BUDIANTO NGLAMES ' 16/10/1957 POLI UMUM E11.8 Non-insulin- 120 70
dependent diabetes
mellitus with
unspecified
complications
264 05/06/2023 1049 WINARSIH NGLAMES '3519085308650003 13/08/1965 POLI UMUM I10 Essential (primary) 130 70
hypertension

265 01/07/2023 6393 EDY KARYONO TIRON '3519080803640001 03/08/1964 POLI UMUM J00 Acute 120 80
nasopharyngitis
266 01/07/2023 17208 ARZEL CHRISTANTIARNO BAGI '3519081711070003 17/11/2007 POLI UMUM Z00 General 100 70
examination and
267 01/07/2023 2666 SUWARNO SUMBEREJO '3519081904630001 19/04/1963 POLI UMUM I99 Other and 110 70
unspecified
268 01/07/2023 16894 BUDI SULISTIO TIRON '3515180505830003 05/05/1983 POLI UMUM D36 Benign neoplasm of 100 70
other and
269 01/07/2023 16836 ABDULLAH ARFAN TIRON '3314032509160001 26/09/2016 POLI UMUM A15 Respiratory 110 70
FATHURRAHMAN tuberculosis,
270 01/07/2023 15586 SUKAMTO BCHK BANJARSARI '3519080502470001 02/05/1947 POLI UMUM N21.0 Calculus in bladder 110 70

271 01/07/2023 2487 SUKARNI NGLAMES '3519081706580002 17/06/1958 POLI UMUM B00.9 Herpesviral 110 70
272 01/07/2023 17212 VIRGI SAMODRA BANJARSARI '3519082503030001 25/03/2003 POLI UMUM Z00 infection,
General 110 70
BRAMATIO examination and
273 01/07/2023 14689 DJAMAN TIRON '3519083006510007 30/06/1951 POLI UMUM F20 Schizophrenia 110 70

274 01/07/2023 357 TARMUJI GUNUNGSARI '3519080112710001 01/12/1971 POLI UMUM J00 Acute 130 90
nasopharyngitis
275 01/07/2023 4414 DWI BUDI UTOMO. BANJARSARI '3519081612830004 16/12/1983 POLI UMUM Z00 General 110 70
examination and
276 01/07/2023 1231 TITIS SULISTIAWATI BANJARSARI '3519086504840004 25/04/1984 POLI UMUM Z00 General 100 70
277 01/07/2023 7710 FATIMAH AZ ZAHRA BANJARSARI '3519084603080001 06/03/2008 POLI UMUM Z00 examination
General and 90 60
examination and
278 01/07/2023 5187 SHOLIHAH HASNA AZ BANJARSARI '3519087012160001 30/12/2016 POLI UMUM Z00 General 80 60
ZAHRA examination and
279 03/07/2023 17213 UGIK SUGIARTO TIRON '3519081806780002 18/06/1978 POLI UMUM K30 Dyspepsia 120 70

280 03/07/2023 13927 KADAR SUMBEREJO '3519080302530001 02/03/1953 POLI UMUM I99 Other and 120 70
281 03/07/2023 2066 SUMINI SUMBEREJO '3519085702510001 17/02/1951 POLI UMUM J00 unspecified
Acute 120 70
nasopharyngitis
282 03/07/2023 37 ZAHRA AISHA RAHMAN NGLAMES '3519087009020002 30/09/2002 POLI UMUM R69 Unknown and 110 74
unspecified causes
283 03/07/2023 5420 BANUN BANJARSARI '3519081910510001 19/10/1951 POLI UMUM M79.1 Myalgia 120 70

284 03/07/2023 14923 IVAN JULIANSYAH DENTRIS BANJARSARI '3215250207060004 02/07/2006 POLI UMUM L23 Allergic contact 120 70
dermatitis
285 03/07/2023 12200 MARJIANTO BAGI '3519082103690002 21/03/1969 POLI UMUM J44.9 Chronic obstructive 120 70
pulmonary disease,
286 03/07/2023 8815 EHAN FAIZUL ANWAR TIRON '3519082212120001 22/12/2012 POLI UMUM Z00 General 120 70
287 03/07/2023 17214 DADANG SETIAWAN BANJARSARI '3577032912970003 29/12/1997 POLI UMUM J00 examination
Acute and 120 70
nasopharyngitis
288 03/07/2023 8918 MARIJUN SUMBEREJO '3519083006530049 30/06/1953 POLI UMUM J00 Acute 120 70
289 03/07/2023 10782 KARYONO SUMBEREJO '3519080305820001 01/05/1982 POLI UMUM Z09.8 nasopharyngitis
Follow-up 120 70
examination after
290 03/07/2023 182 CANDRA LIKGANAMARDA BAGI '3519081206860003 12/06/1986 POLI UMUM F20.9 Schizophrenia, 120 70
unspecified
291 03/07/2023 16874 SUPARJO GUNUNGSARI '3519080110640001 01/10/1964 POLI UMUM K40 Inguinal hernia 120 70

292 03/07/2023 12262 SRI UMINI BAGI ' 15/05/1971 POLI UMUM I64Stroke, not specified 120 70
as haemorrhage or
293 03/07/2023 9241 PARNI TIRON '3519081710460001 17/10/1946 POLI UMUM J00 Acute 120 70
294 03/07/2023 548 RIZKY RAMADHAN TIRON '3519080509070001 05/09/2007 POLI UMUM Z00 nasopharyngitis
General 120 70
examination and
295 03/07/2023 2666 SUWARNO SUMBEREJO '3519081904630001 19/04/1963 POLI UMUM G40 Epilepsy 120 70
296 03/07/2023 17215 DWI ANANTO SUMBEREJO '1115051905700002 19/05/1970 POLI UMUM H10 Conjunctivitis 120 70

297 03/07/2023 17216 DWIYANTO TIRON '3519081403680001 14/03/1968 POLI UMUM A16 Respiratory 120 70
298 03/07/2023 5911 ABILA JEFANYA AZZAHRA BAGI '3519086301180001 23/01/2018 POLI UMUM J00 Acute 90 70
nasopharyngitis
299 03/07/2023 1174 EKO HARTOYO BANJARSARI '3519082303820001 23/03/1982 POLI UMUM J00 Acute 120 70
300 03/07/2023 9708 SUKIS SUPRIANTO TIRON '3519080410800005 10/04/1980 POLI UMUM M54.5 nasopharyngitis
Low back pain 120 70

301 03/07/2023 3556 MUJIATI TIRON '3519084608630004 06/08/1963 POLI UMUM I99 Other and 120 70
302 03/07/2023 11494 SURATMINI NGLAMES '3314144812820029 08/12/1982 POLI UMUM E11.8 unspecified
Non-insulin- 120 70
dependent diabetes
303 03/07/2023 17217 LILIS ENDAH KLEGEN '3577016401070002 24/01/2007 POLI UMUM Z00 General 100 70
PUSPITANINGRUM examination and
investigation of
304 03/07/2023 940 AULIA ELSABRINA TIRON '3519084206160002 02/06/2016 POLI UMUM J03 Acute tonsillitis 100 70

305 03/07/2023 5421 WIJI SULASTRI SUMBEREJO '3519085005730004 05/10/1973 POLI UMUM J00 Acute 120 70
nasopharyngitis
306 03/07/2023 382 SETYOWATI NGLAMES '3519084405650002 04/05/1965 POLI UMUM E11.8 Non-insulin- 120 70
dependent diabetes
307 03/07/2023 17220 MUHAMMAD FAUDIO GUNUNGSARI ' 08/08/2008 POLI UMUM Z00 General 100 70
RADITAMA 3519080908080002 examination and
investigation of
308 01/08/2023 8300 LUCKY KURNIAWAN BAGI '3519080509120003 05/09/2012 POLI UMUM J00 Acute 100 70
nasopharyngitis
309 01/08/2023 17553 SUGENG SUKARJIMAN NGLAMES '3577010709700004 07/09/1970 POLI UMUM H59.9 Postprocedural 120 70
disorder of eye and
310 01/08/2023 16836 ABDULLAH ARFAN TIRON '3314032509160001 26/09/2016 POLI UMUM A15 Respiratory 100 70
FATHURRAHMAN tuberculosis,
311 01/08/2023 5702 ARI SOEPRAPTO PURWOSARI '3519150610720002 06/10/1972 POLI UMUM J00 Acute 130 70
nasopharyngitis
312 01/08/2023 1341 SARDJONO GUNUNGSARI '3519082908550001 29/08/1955 POLI UMUM I25.9 Chronic ischaemic 120 70
heart disease,
313 01/08/2023 2815 NURANI MUFAROHAH BAGI '3519086011970001 20/11/1997 POLI UMUM E05.9 Thyrotoxicosis, 120 70
unspecified
314 01/08/2023 1317 LASTRI TIRON '- 31/07/1958 POLI UMUM E11.8 Non-insulin- 120 70
dependent diabetes
315 01/08/2023 4987 DEMES GUNUNGSARI '3519087006540063 30/06/1954 POLI UMUM I11.9 Hypertensive heart 100 70
disease without
316 01/08/2023 17213 UGIK SUGIARTO TIRON '3519081806780002 18/06/1978 POLI UMUM J06.9 Acute upper 110 70
317 01/08/2023 6492 SULASTRI TIRON '3519085209590001 09/12/1959 POLI UMUM E11.8 respiratory
Non-insulin-
120 80
dependent diabetes
318 01/08/2023 82 MAHMUDATUN TIRON '3524094711730002 30/11/1973 POLI UMUM M79.1 Myalgia 120 80

319 01/08/2023 1597 MISRI NGLAMES '3519084103670002 01/03/1967 POLI UMUM I10 Essential (primary) 130 70
hypertension
320 01/08/2023 8224 AFDHAL ABID NAUFAL AL GUNUNGSARI '3519082706090001 27/06/2009 POLI UMUM J06.9 Acute upper 100 70
FARIZI respiratory
infection,
321 01/08/2023 5196 SUGINO GUNUNGSARI '3519083006630037 30/06/1963 POLI UMUM I25.9 Chronic ischaemic 120 80
heart disease,
322 01/08/2023 6896 KAMIJAH TIRON '3519085212650002 12/12/1965 POLI UMUM E11.8 Non-insulin- 130 90
dependent diabetes
323 01/08/2023 1340 PAINEM BANJARSARI '3519087006500058 30/06/1950 POLI UMUM I10 Essential (primary) 130 70
hypertension
324 01/08/2023 15927 SELVIA KRISTANTI BANJARSARI '3519086801940002 28/01/1994 POLI UMUM A09 Diarrhoea and 90 60
325 01/08/2023 5158 FARZA ANDINE ALMAIZA SUMBEREJO '3519082705140002 27/05/2014 POLI UMUM J06.9 gastroenteritis
Acute upper of 100 60
respiratory
326 01/08/2023 10494 SUKAMTO BAGI ' 11/12/1969 POLI UMUM R69 Unknown and 120 80
3519081211690001 unspecified causes
327 01/08/2023 11968 MARJONO GUNUNGSARI '3519081102810001 11/02/1981 POLI UMUM J06.9 Acute upper 130 90
respiratory
328 01/08/2023 3121 TRI SUKMA SUCI AVAN NGLAMES '3519080710050001 07/10/2005 POLI UMUM L20.9 Atopic dermatitis, 110 70
unspecified
329 01/08/2023 13602 ROHPENY CATUR UTARI NGLAMES '3518075112680001 11/12/1968 POLI UMUM R50 Fever of other and 120 70
unknown origin
330 01/08/2023 17555 SANTOSA TIRON '3519080902640001 09/02/1964 POLI UMUM Z00 General 100 70
examination and
331 01/08/2023 17556 SUDARNO TIRON '3519080512670001 12/05/1967 POLI UMUM Z00 General 140 90
examination and
332 01/08/2023 16885 SUKARMAN NGLAMES '3519081510670001 15/10/1967 POLI UMUM Z00 General 160 70
examination and
333 01/08/2023 3022 ILHAM YUSI FAUSAN TIRON '3519080505170001 05/05/2017 POLI UMUM J06.9 Acute upper 100 70
respiratory
334 01/08/2023 6236 SRI LESTARI TIRON '3519084408790001 04/08/1979 POLI UMUM L20.9 Atopic dermatitis, 110 70
unspecified
335 01/08/2023 12511 APRI LUSIYANTI BANJARSARI '3519085404820002 14/04/1982 POLI UMUM I99 Other and 140 90
unspecified
336 01/08/2023 4117 AMIRAH BAGI '3519085005730003 10/05/1973 POLI UMUM K29.7 Gastritis, 110 70
unspecified
337 01/08/2023 3096 MUHAMMAD RIJALIL SUMBEREJO '3519080911050001 09/11/2005 POLI UMUM J06.9 Acute upper 110 70
ABIDIN respiratory
infection,
338 01/08/2023 15178 SUPARNI SUMBEREJO '3519083006400052 30/06/1940 POLI UMUM J00 Acute 110 70
nasopharyngitis
339 01/08/2023 357 TARMUJI GUNUNGSARI '3519080112710001 01/12/1971 POLI UMUM I10 Essential (primary) 130 70
hypertension
340 02/08/2023 15296 SARIKUN BAGI ' 15/08/1961 POLI UMUM M79.1 Myalgia 120 70
341 02/08/2023 17599 RIDHO FAJAR ANTHONY BAGI '3519141410070001 14/10/2007 POLI UMUM T15.0 Foreign body in 120 70
VALENCIA cornea
342 02/08/2023 105 MAIMUN BANJARSARI '3519082904540002 29/04/1954 POLI UMUM J00 Acute 120 70
nasopharyngitis
343 02/08/2023 14933 DARIYANTO BANJARSARI ' 02/02/1968 POLI UMUM H40 Glaucoma 120 70

344 02/08/2023 16837 YUDIARTI KANUNG '3519144501750001 05/01/1973 POLI UMUM M17.0 Primary 120 70
345 02/08/2023 2713 KUSTOYO SUMBEREJO '3519080808570001 28/10/1957 POLI UMUM M79.1 gonarthrosis,
Myalgia 110 70

346 02/08/2023 2936 SUPRIYANTI TIRON '3519084807750002 08/07/1975 POLI UMUM Z09.8 Follow-up 140 70
examination after
347 02/08/2023 6987 SUPRIYANTI TIRON '3519085901770001 19/01/1977 POLI UMUM A09 Diarrhoea and 130 70
gastroenteritis of
348 02/08/2023 3588 SOETOWO TIRON '3519082108420001 21/08/1942 POLI UMUM M79.1 Myalgia 120 70

349 02/08/2023 386 BUDI HARTONO TIRON '3519080707590001 07/07/1959 POLI UMUM E11.9 Non-insulin- 110 70
dependent diabetes
350 02/08/2023 608 FURI WAHYUNI BANJARSARI '3519085906760001 19/06/1976 POLI UMUM M79.1 Myalgia 130 70
MAHARANING
351 01/09/2023 2684 SUPARNO NGLAMES '3519080406420001 04/06/1942 POLI UMUM J06.9 Acute upper 120 70
respiratory
352 01/09/2023 2066 SUMINI SUMBEREJO '3519085702510001 17/02/1951 POLI UMUM M79.1 Myalgia 120 70

353 01/09/2023 1058 SRIANI SUMBEREJO '3519087006650008 30/06/1965 POLI UMUM I10 Essential (primary) 120 70
hypertension
354 01/09/2023 15574 EDI BUDIANTO NGLAMES '3519082004760002 20/04/1976 POLI UMUM N18 Chronic kidney 110 70
disease
355 01/09/2023 4417 FAREL FAUZAN NUGRAHA NGLAMES '3519081710080001 17/10/2008 POLI UMUM J06.9 Acute upper 90 60
respiratory
356 01/09/2023 603 BANDA ARTANTO BANJARSARI '3519080401120001 04/01/2012 POLI UMUM J00 Acute 90 60
357 01/09/2023 3699 AGUS SUSANTO BANJARSARI '3519081811790001 18/11/1979 POLI UMUM J00 nasopharyngitis
Acute 100 60
nasopharyngitis
358 01/09/2023 8737 SUPARTI SUMBEREJO '- 11/09/1965 POLI UMUM R50.9 Fever, unspecified 130 70

359 01/09/2023 5718 VARA DWI RAHMAWATI SUMBEREJO '3519085510000001 15/10/2000 POLI UMUM J06.9 Acute upper 80 60
respiratory
360 01/09/2023 3512 DJIYONO GUNUNGSARI '3519081506620002 15/06/1962 POLI UMUM I25.9 Chronic ischaemic 120 70
heart disease,
361 01/09/2023 2961 JAHMIN TIRON '3519083006430027 30/06/1943 POLI UMUM M79.1 Myalgia 100 60

362 01/09/2023 14266 BAGAS ADITYA WICAKSANA TIRON '3519082112120001 21/12/2012 POLI UMUM H66.9 Otitis media, 90 60
unspecified
363 01/09/2023 1422 TUMINEM SUMBEREJO '3519085603690002 16/03/1969 POLI UMUM E11.8 Non-insulin- 110 70
dependent diabetes
364 01/09/2023 2314 NARWOTO SUMBEREJO '3519082101660002 21/01/1966 POLI UMUM Z00 General 120 70
365 01/09/2023 11744 SUMINI SUMBEREJO '3519086012760003 01/12/1976 POLI UMUM H66.3 Other chronic 120 70
366 01/09/2023 3775 ELIS DIANA TIRON '3519086005740001 20/05/1974 POLI UMUM T14 Injury of unspecified 130 70
367 01/09/2023 10174 SUKINI TIRON '3519087006510031 30/06/1951 POLI UMUM body
D36.9 Benign region of
neoplasm 130 70
unspecified site
368 01/09/2023 2525 DESWITA AZAHRANANDA NGLAMES '3525135112060003 11/12/2006 POLI UMUM R10.4 Other and 120 70
SALWA MECCA unspecified
abdominal pain
369 01/09/2023 10199 SUMARYANI BAGI '3521045412910002 14/12/1991 POLI UMUM I10 Essential (primary) 90 60
hypertension
370 01/09/2023 15864 KASMIATI TIRON ' 26/11/1969 POLI UMUM J06.9 Acute upper 120 70
respiratory
371 01/09/2023 16498 BINI TIRON '3519087112540017 31/12/1954 POLI UMUM H25 Senile cataract 150 70

372 01/09/2023 1124 MARDI BAGI '3519080609590001 06/09/1959 POLI UMUM M79.1 Myalgia 120 70

373 01/09/2023 5164 BINAH BAGI '3519086405690001 24/05/1969 POLI UMUM R50.9 Fever, unspecified 160 70

374 01/09/2023 3491 PARMI TIRON '3519084706670001 07/06/1967 POLI UMUM M79.1 Myalgia 120 70

375 01/09/2023 213 LAMI BANJARSARI '3519084701560001 07/01/1956 POLI UMUM J06.9 Acute upper 120 70
respiratory
376 01/09/2023 15383 WAFI RIZKY RAMADHAN GUNUNGSARI '3519082706160001 27/06/2016 POLI UMUM J06.9 Acute upper 110 70
respiratory
377 01/09/2023 17805 SITI LAMINI BAGI '3519084110660001 10/01/1966 POLI UMUM H11.0 infection,
Pterygium 120 70

378 01/09/2023 6049 MUNIF STIYAWAN BANJARSARI '3519081407970002 14/07/1997 POLI UMUM F20.9 Schizophrenia, 110 70
unspecified
379 01/09/2023 17826 LIDYA ALISIA ZAHRO GUNUNGSARI '3519084201160001 01/02/2016 POLI UMUM H61.2 Impacted cerumen 80 60

380 01/09/2023 5450 ELZHI AZELA PUTRI GUNUNGSARI '3519084407150001 07/04/2015 POLI UMUM H61.2 Impacted cerumen 0 0
PRASTYO
381 01/09/2023 16285 ADELLIA PUTRI YUMNA TIRON '3519086603120002 26/03/2012 POLI UMUM H61.2 Impacted cerumen 80 60
SALSABILA
382 01/09/2023 10571 BINARDI BANJARSARI '3519081711640001 01/11/1964 POLI UMUM J00 Acute 120 70
nasopharyngitis
383 01/09/2023 1285 SUPARMO BANJARSARI '3519080301470001 03/01/1947 POLI UMUM Z00 General 0 0
examination and
384 02/09/2023 1164 RUSMINAH SUMBEREJO '3519084707600002 07/07/1960 POLI UMUM M79.1 Myalgia 120 80

385 02/09/2023 4398 SUPRAPTI SUMBEREJO '3519085304650002 13/04/1965 POLI UMUM R73 Elevated blood 140 90
glucose level
386 02/09/2023 19 LASMINTEN TIRON '3519084411530001 04/11/1953 POLI UMUM E11.8 Non-insulin- 130 90
dependent diabetes
387 02/09/2023 2724 SURIPTO TIRON '3502181008450002 16/08/1945 POLI UMUM I25.9 Chronic ischaemic 130 90
heart disease,
388 02/09/2023 1049 WINARSIH NGLAMES '3519085308650003 13/08/1965 POLI UMUM I10 Essential (primary) 120 80
hypertension
389 02/09/2023 16836 ABDULLAH ARFAN TIRON '3314032509160001 26/09/2016 POLI UMUM A15 Respiratory 110 70
FATHURRAHMAN tuberculosis,
bacteriologically and
390 02/09/2023 7448 AULIA NUR WULANDARI NGLAMES '3519084705150001 07/05/2015 POLI UMUM J00 histologically
Acute 100 70
nasopharyngitis
391 02/09/2023 1195 SLAMET ARIYADI SUMBEREJO '3519081304650001 13/04/1965 POLI UMUM I64 Stroke, not specified 150 80
as haemorrhage or
392 02/09/2023 11829 LONNY MEGALATUNA TIRON '3519080305890004 03/05/1989 POLI UMUM J06.9 Acute upper 100 60
respiratory
393 02/09/2023 4774 AQILA MISHA VIONA NGLAMES '3519086802170001 28/02/2017 POLI UMUM L20.9 Atopic dermatitis, 110 70
MECCA unspecified
394 02/10/2023 4398 SUPRAPTI SUMBEREJO '3519085304650002 13/04/1965 POLI UMUM R73.9 Hyperglycaemia, 140 70
unspecified
395 02/10/2023 18084 IZZUL FIKRI GUNUNGSARI '3519080208960001 08/02/1996 POLI UMUM Z00 General 110 70
examination and
396 02/10/2023 4860 NARSIH SUMBEREJO '3519084301640001 03/01/1964 POLI UMUM I10 Essential (primary) 120 70
397 02/10/2023 9068 SUPAR BANJARSARI ' 23/01/1972 POLI UMUM A09 hypertension
Diarrhoea and 140 70
gastroenteritis of
398 02/10/2023 15843 SUTARJI GUNUNGSARI '3519082209760003 22/09/1976 POLI UMUM J00 Acute 140 70
nasopharyngitis
399 02/10/2023 8789 DAMI BANJARSARI ' 10/11/1969 POLI UMUM M79.1 Myalgia 120 70

400 02/10/2023 17993 ERLINDA ZIVANA PUTRI TIRON '3519084612090001 12/06/2009 POLI UMUM L20.9 Atopic dermatitis, 80 60
unspecified
401 02/10/2023 416 TATIK HERAWATI SUMBEREJO '3519085007790001 10/07/1979 POLI UMUM G40 Epilepsy 110 70

402 02/10/2023 7676 SUGIYANTO TIRON '3519080610600001 06/10/1960 POLI UMUM M79.1 Myalgia 100 60

403 02/10/2023 13625 PRIYATUN TIRON '3519085202690001 02/12/1969 POLI UMUM E11.8 Non-insulin- 170 80
dependent diabetes
404 02/10/2023 11968 MARJONO GUNUNGSARI '3519081102810001 11/02/1981 POLI UMUM J00 Acute 120 70
nasopharyngitis
405 02/10/2023 18086 TULIS SETYORINI GUNUNGSARI '3519084406780001 06/04/1978 POLI UMUM M79.1 Myalgia 120 70

406 02/10/2023 303 AMIRATUN SUMBEREJO '3519085602570001 16/02/1957 POLI UMUM E11.8 Non-insulin- 130 70
dependent diabetes
407 02/10/2023 304 SUTOMO SUMBEREJO '3519080811570001 08/11/1957 POLI UMUM E11.8 Non-insulin- 120 70
dependent diabetes
408 02/10/2023 12823 MUHAMMAD ABDUL TIRON '3519080802000001 08/02/2000 POLI UMUM J00 Acute 100 60
HAFIIDH nasopharyngitis
[common cold]
409 02/10/2023 13477 SULANI SUMBEREJO '3519083006580040 30/06/1958 POLI UMUM J06.9 Acute upper 120 70
respiratory
410 02/10/2023 9835 MIFTAHUL NUR JANAH SUMBEREJO '3519084801160001 08/01/2016 POLI UMUM E11.8 Non-insulin- 120 70
MUSTOFA dependent diabetes
411 02/10/2023 16973 DJOJO NARI GUNUNGSARI '3519080610420001 06/10/1942 POLI UMUM J00 mellitus
Acutewith 130 70
nasopharyngitis
412 02/10/2023 7612 WARSINAH TIRON '- 04/05/1953 POLI UMUM I51.7 Cardiomegaly 120 80
413 02/10/2023 1413 TIYEM SUMBEREJO '3519086401540001 24/01/1954 POLI UMUM M79.1 Myalgia 180 80

414 02/10/2023 2161 PAINAH SUMBEREJO '3519087006480033 30/06/1948 POLI UMUM I10Essential (primary) 130 70
hypertension
415 02/10/2023 6269 SULIS SETYOWATI NGLAMES '3519085012790001 10/12/1979 POLI UMUM M79.1 Myalgia 100 60

416 02/10/2023 9463 SUYAHMIN SUMBEREJO '3519082607680003 26/07/1968 POLI UMUM I69.4 Sequelae of stroke, 100 60
not specified as
haemorrhage or
417 02/10/2023 18088 SURATI TIRON '3519085401680002 14/01/1968 POLI UMUM I99 Other and 160 60
unspecified
418 02/10/2023 16861 MUHAMMAD AZHIM GUNUNGSARI ' 06/08/2015 POLI UMUM R50.9 Fever, unspecified 110 70
SAPUTRA
419 02/10/2023 3423 SUWARNO TIRON '3519080707600001 07/07/1960 POLI UMUM A15 Respiratory 120 70
tuberculosis,
420 02/10/2023 1654 SUYONO GUNUNGSARI '3519082412740001 24/12/1974 POLI UMUM J00 Acute 120 70
nasopharyngitis
421 02/10/2023 11827 NUR SULISTIYASARI PUCANGREJO '3519086809900001 28/09/1990 POLI UMUM K30 Dyspepsia 120 70

422 02/10/2023 5272 NATASYA KURNIA SUMBEREJO '3519086908130002 28/10/2013 POLI UMUM L23 Allergic contact 90 60
RACHMAWATI dermatitis
423 02/10/2023 10195 NATASYA SYIFA ALFARIZQ TIRON '3519085412090001 14/12/2009 POLI UMUM J06.9 Acute upper 90 60
respiratory
424 02/10/2023 4129 SULIATIN NGLAMES '3519084606590001 06/06/1959 POLI UMUM E11.8 Non-insulin- 90 60
dependent diabetes
425 02/10/2023 18056 NURUL HUDA BUKUR '3504030107820005 07/01/1982 POLI UMUM M79.1 Myalgia 100 60

426 02/10/2023 11679 SUTIYONO TIRON '3519080207990001 02/07/1999 POLI UMUM S52.5 Fracture of lower 120 70
end of radius
427 02/10/2023 6171 SALSABILA AYU HANIFA BAGI '3519081502120016 27/03/2018 POLI UMUM K29.7 Gastritis, 90 60
unspecified
428 02/10/2023 2359 AYUDIA INARA ISDIANTO SUMBEREJO '3519086103170002 21/03/2017 POLI UMUM J00 Acute 90 60
nasopharyngitis
429 02/10/2023 5046 AYU SULISTIYANI BAGI '3519088480694000 01/06/1994 POLI UMUM Z00 General 90 60
1 examination and
430 02/10/2023 17723 EKO PURNOMO TIRON '3519081202980002 12/02/1998 POLI UMUM Z00 General 100 60
examination and
431 02/10/2023 18089 MINI NGLANDUK '3519077012540004 30/12/1954 POLI UMUM A09 Diarrhoea and 110 70
gastroenteritis of
432 02/10/2023 1183 ANNAFISA NADHIF TIRON '3519086509140002 25/09/2014 POLI UMUM A09 Diarrhoea and 100 70
CHANDRA A gastroenteritis of
433 03/10/2023 172 SUHARTO SUMBEREJO '3519081505640002 15/05/1964 POLI UMUM F20.9 presumed infectious
Schizophrenia, 120 70
unspecified
434 03/10/2023 16423 DJARWATI TIRON '3519085111610001 11/11/1961 POLI UMUM M79.1 Myalgia 120 70

435 03/10/2023 15114 GATOT SUDARTO SUGIHWARAS '3519121109590002 09/11/1959 POLI UMUM E11.8 Non-insulin- 130 70
dependent diabetes
436 03/10/2023 10240 NUKY DWI ASTRI AFRIANTI SUMBEREJO '3519084304940002 03/04/1994 POLI UMUM D36.9 Benign neoplasm of 120 70
unspecified site
437 01/11/2023 2635 AISSYA NOOR LITASARI TIRON '3519085208910002 12/08/1991 POLI UMUM H54.1 Blindness, one eye, 110 70
low vision other eye
438 01/11/2023 1286 SUMINAH SUMBEREJO '3519085605610002 16/05/1961 POLI UMUM E11.9 Non-insulin- 150 70
dependent diabetes
439 01/11/2023 1642 GANDIYAH BANJARSARI '3519084708510002 07/08/1951 POLI UMUM H25 Senile cataract 120 70

440 01/11/2023 1956 SUNARTI TIRON '- 09/01/1955 POLI UMUM I51.7 Cardiomegaly 110 70
441 01/11/2023 630 ISMINI BANJARSARI '3519084707780003 07/07/1978 POLI UMUM J02.9 Acute pharyngitis, 110 70
unspecified
442 01/11/2023 9646 SUMARNI BAGI '3519084410760002 04/10/1976 POLI UMUM I69.4 Sequelae of stroke, 140 70
not specified as
443 01/11/2023 6054 GINEM BANJARSARI '3519086303500001 23/03/1950 POLI UMUM I10 Essential (primary) 130 70
hypertension
444 01/11/2023 13070 PAIMUN TIRON '3519082207540002 22/07/1954 POLI UMUM R69 Unknown and 118 78
unspecified causes
445 01/11/2023 2657 SUMARTI SUMBEREJO '3519085106700001 11/06/1970 POLI UMUM R69 Unknown and 118 78
unspecified causes
446 01/11/2023 7336 JOKO SUSILO BAGI '3519082109660001 21/09/1966 POLI UMUM R69 Unknown and 118 79
unspecified causes
447 01/11/2023 16328 NOVITASARI GUNUNGSARI '3519084311800001 11/03/1980 POLI UMUM R69 Unknown and 118 79
unspecified causes
448 01/11/2023 1611 DJAYEM GUNUNGSARI '3519086801710002 28/01/1971 POLI UMUM R69 Unknown and 112 78
449 01/11/2023 15489 ISTOYO BAGI '3519082007700003 20/07/1970 POLI UMUM R69 unspecified
Unknowncauses
and 118 79
450 01/11/2023 15945 DEWANGGA TAHTA BAGI '3519081101000001 01/11/2000 POLI UMUM R69 unspecified
Unknowncauses
and 118 79
KALINGGA AKBAR unspecified causes
451 01/11/2023 8558 TRI WULANDARI BAGI '3519084405880003 04/05/1988 POLI UMUM K30 Dyspepsia 110 70
452 01/11/2023 6313 ASEP SETIAWAN TIRON '3519080904080001 09/04/2008 POLI UMUM D23.2 Other benign 90 70
neoplasm of skin of
453 01/11/2023 9149 SUTI BAGI '3519085604650001 16/04/1965 POLI UMUM I99 Other and 140 80
unspecified
454 01/11/2023 5418 SUPARDI NGLAMES '3519081007570002 07/10/1957 POLI UMUM M79.0 Rheumatism, 140 70
unspecified
455 01/11/2023 540 KASMIATI TIRON '3519086810690001 28/10/1969 POLI UMUM M19 Other arthrosis 100 80

456 01/11/2023 213 LAMI BANJARSARI '3519084701560001 07/01/1956 POLI UMUM M54.5 Low back pain 129 80

457 01/11/2023 18219 BAMBANG PAMUJI GANDRI '- 17/01/1990 POLI UMUM Z00 General 120 80
examination and
458 01/11/2023 11233 YULI SETIYANI TIRON '3519087006640041 30/06/1964 POLI UMUM H54.2 Low vision, both 140 80
eyes
459 01/11/2023 470 AZKA ADITYA RAMADHAN SUMBEREJO '3519082306160001 23/06/2016 POLI UMUM J06.9 Acute upper 80 60
respiratory
460 01/11/2023 7454 YARAKHA NA`IL TIRON '3519082204110001 22/04/2011 POLI UMUM R50 Fever of other and 80 60
461 01/11/2023 1284 MOURIYANTO
DASIRAN GUNUNGSARI '3519083006550038 30/06/1955 POLI UMUM R69 unknown
Unknownorigin
and 118 79
unspecified causes
462 01/11/2023 3178 SRI WELAS ASIH TIRON '3519085309820100 13/09/1982 POLI UMUM R50 Fever of other and 110 70
unknown origin
463 01/11/2023 12227 ZAHRUDDIN TIRON '3577012611740002 26/11/1974 POLI UMUM R50 Fever of other and 130 70
unknown origin
464 01/11/2023 3179 PURWITO TIRON '3519081708690003 17/08/1969 POLI UMUM R69 Unknown and 118 78
unspecified causes
465 01/11/2023 3555 KRISNA WIKHI BAGUS TIRON '3519082508090003 25/08/2009 POLI UMUM R69 Unknown and 112 78
466 01/11/2023 9327 NUGROHO
MEGAN ATHA VIO TIRON '3519080908120002 09/08/2012 POLI UMUM R69 unspecified
Unknowncauses
and 118 78
467 01/11/2023 13802 RAMADHAN
MURTIANI TIRON '3519084310870002 10/03/1987 POLI UMUM R69 unspecified
Unknowncauses
and 118 79
unspecified causes
468 01/11/2023 5057 ARIANTO SUMBEREJO '3519081602870002 16/02/1987 POLI UMUM R69 Unknown and 118 79
unspecified causes
469 01/11/2023 5103 LIA NURUL HIDAYATI SUMBEREJO '- 16/07/1987 POLI UMUM R69 Unknown and 118 79
unspecified causes
470 01/11/2023 15819 HANIF FAUZAN SUMBEREJO '3519082910220002 29/10/2022 POLI UMUM R69 Unknown and 80 78
471 01/11/2023 1282 ALVARENDRA
GUNARI SUMBEREJO '3519080604730003 06/04/1973 POLI UMUM R69 unspecified
Unknowncauses
and 118 79
unspecified causes
472 01/11/2023 2743 EWA ARI IRWANSYAH SUMBEREJO '3519082005040001 20/05/2004 POLI UMUM R69 Unknown and 118 78
unspecified causes
473 01/11/2023 10768 EWI ARIAN ABIMANYU SUMBEREJO '3519081410170001 14/10/2017 POLI UMUM R69 Unknown and 118 78
unspecified causes
474 01/11/2023 1285 SUPARMO BANJARSARI '3519080301470001 03/01/1947 POLI UMUM R69 Unknown and 118 78
unspecified causes
475 01/11/2023 4430 SURATI NGLAMES '3519085112670002 12/11/1967 POLI UMUM R69 Unknown and 118 79
unspecified causes
476 01/11/2023 9719 YAYUK WIDIASTUTI NGLAMES '3519087001700001 30/01/1970 POLI UMUM R69 Unknown and 118 79
unspecified causes
477 01/11/2023 17693 SUTI BAGI '3519085604650001 16/04/1965 POLI UMUM R69 Unknown and 118 79
unspecified causes
478 01/11/2023 3202 URIP ROHIMAH TIRON '3519085609710002 16/09/1971 POLI UMUM R69 Unknown and 118 79
unspecified causes
479 01/11/2023 8222 YULIAN DWI HANDOKO TIRON '3519082307950002 23/07/1995 POLI UMUM R69 of morbidity
Unknown and 118 79
unspecified causes
480 01/11/2023 3947 NYAMIN TIRON '3519080407510001 04/07/1951 POLI UMUM R69 Unknown and 119 79
unspecified causes
481 01/12/2023 15754 SUDJI BANJARSARI '3519080604570001 04/06/1957 POLI UMUM R50 Fever of other and 110 70
unknown origin
482 01/12/2023 13071 KUSMANTO TIRON '3519080701700001 01/07/1970 POLI UMUM I99 Other and 140 70
unspecified
483 01/12/2023 172 SUHARTO SUMBEREJO '3519081505640002 15/05/1964 POLI UMUM F20.9 Schizophrenia, 110 70
unspecified
484 01/12/2023 17393 SUPARNI BANJARSARI '3519083007670001 30/07/1967 POLI UMUM R73.9 Hyperglycaemia, 120 70
unspecified
485 01/12/2023 5512 KAMILATUN BANJARSARI '3519085305720002 13/05/1972 POLI UMUM J00 Acute 130 75
nasopharyngitis
486 01/12/2023 13048 YATNO GUNUNGSARI '3519083006590009 30/06/1959 POLI UMUM M79.1 Myalgia 140 70

487 01/12/2023 4870 ENDANG SYARIATININGSIH NGLAMES '3519085502600001 15/02/1960 POLI UMUM E11.8 Non-insulin- 120 70
dependent diabetes
488 01/12/2023 5785 DIMAS DANAR ASTRADA NGLAMES '3519082410980002 24/10/1998 POLI UMUM R73.9 Hyperglycaemia, 110 70
unspecified
489 01/12/2023 4229 SRI WAHYUNI SUMBEREJO '3519084202720001 02/02/1972 POLI UMUM J00 Acute 110 70
nasopharyngitis
490 01/12/2023 3710 AYUN MEI AWARNI GUNUNGSARI '3519084205970001 02/05/1997 POLI UMUM A09 Diarrhoea and 100 70
gastroenteritis of
491 01/12/2023 261 LAMINEM TIRON '3519086006550004 20/06/1955 POLI UMUM I10 Essential (primary) 135 75
hypertension
492 01/12/2023 647 SURINI TIRON '3519087006400051 30/06/1940 POLI UMUM H10 Conjunctivitis 100 70

493 01/12/2023 4398 SUPRAPTI SUMBEREJO '3519085304650002 13/04/1965 POLI UMUM R73.9 Hyperglycaemia, 130 70
unspecified
494 01/12/2023 18342 YOPPY ABDHI ROCHIM BAGI '3519082610010002 26/10/2001 POLI UMUM Z00 General 110 70
examination and
495 01/12/2023 7126 KARUNIA AN NISA BANJARSARI '3519085103100001 03/11/2010 POLI UMUM R69 Unknown and 90 80
unspecified causes
496 01/12/2023 18000 FARIS AGUNG PRASTIYO BAGI '3519080605160002 05/06/2016 POLI UMUM R69 Unknown and 90 80
497 01/12/2023 7224 LAMINEM BAGI '3519087011540002 30/11/1954 POLI UMUM R69 unspecified
Unknowncauses
and 110 90
unspecified causes
498 01/12/2023 7526 SEPTIAN PUTRA TIRON '- 13/09/2018 POLI UMUM L20.9 Atopic dermatitis, 80 60
499 01/12/2023 7625 FRASSTYAWAN
SAMINEM TIRON '- 07/01/1976 POLI UMUM M79.1 unspecified
Myalgia 120 70
500 01/12/2023 3850 FARELIO HERDEWANTA GUNUNGSARI '- 14/10/2012 POLI UMUM J00 Acute 90 70
nasopharyngitis
501 01/12/2023 6634 MARSUDI SAPUTRO TIRON '3519080609740001 09/06/1974 POLI UMUM R69 Unknown and 110 80
unspecified causes
502 01/12/2023 89 SUYUN SUMBEREJO '3519082910550001 29/10/1955 POLI UMUM A09 Diarrhoea and 110 70
gastroenteritis of
503 01/12/2023 8661 BENNY NOEGROHO SUMBEREJO '- 26/01/1996 POLI UMUM R69 Unknown and 100 90
unspecified causes
504 01/12/2023 4280 JARWATIK TIRON '3519085111820002 11/11/1982 POLI UMUM H81.4 Vertigo of central 100 70
origin
505 01/12/2023 8641 ERVAN SETYO UTOMO BANJARSARI '3519081904860001 19/04/1986 POLI UMUM L20.9 Atopic dermatitis, 110 70
unspecified
506 01/12/2023 3210 KASIYADI NGLAMES '3519080905590002 09/05/1959 POLI UMUM R69 Unknown and 110 80
unspecified causes
507 01/12/2023 11829 LONNY MEGALATUNA TIRON '3519080305890004 03/05/1989 POLI UMUM A16 Respiratory 110 70
tuberculosis, not
508 01/12/2023 547 NISROCHAH DJAZULI BANJARSARI '3519084501040001 05/01/2004 POLI UMUM Z00 General 100 70
examination and
509 01/12/2023 9314 WARSINI GUNUNGSARI '3519086207600001 22/07/1960 POLI UMUM R69 Unknown and 100 90
unspecified causes
510 01/12/2023 12645 TATIK GUNUNGSARI '3519087004650001 30/04/1965 POLI UMUM R69 Unknown and 100 90
unspecified causes
511 01/12/2023 1177 SRI WAHYUNI SUMBEREJO '3519084805940001 08/05/1994 POLI UMUM J00 Acute 100 70
nasopharyngitis
512 01/12/2023 2385 ZAHRA NUR SUMBEREJO '3519086408110001 24/08/2011 POLI UMUM J00 Acute 90 70
NASYWANAJAH nasopharyngitis
513 01/12/2023 2307 DHIMETRIO CATUR NGLAMES '3519080204000001 02/04/2000 POLI UMUM K29.7 Gastritis, 100 70
MAHADI unspecified
514 01/12/2023 16198 PRISTIAWAN SUMBEREJO ' 12/04/1968 POLI UMUM T14 Injury of unspecified 130 70
3519080412680001 body region
515 01/12/2023 7448 AULIA NUR WULANDARI NGLAMES '3519084705150001 07/05/2015 POLI UMUM J00 Acute 80 60
516 01/12/2023 6411 MONICA CAHYANINGRUM TIRON '3519085005990001 10/05/1999 POLI UMUM nasopharyngitis
L20.9 Atopic dermatitis, 120 70
unspecified
517 01/12/2023 15479 SAMIN BAGI '3519083008480003 30/08/1948 POLI UMUM K29.7 Gastritis, 130 70
unspecified
518 01/12/2023 18059 LASMIATI BAGI '3519086306800001 23/06/1980 POLI UMUM M79.2 Neuralgia and 110 70
neuritis, unspecified
519 01/12/2023 849 SITI SAMPROHATIN BANJARSARI '3519085609730003 16/09/1973 POLI UMUM Z00 General 150 80
examination and
520 01/12/2023 15517 OCHITA SAKTIANA PUTRI SUMBEREJO '3519145903180001 19/03/2018 POLI UMUM J06.9 Acute upper 80 60
respiratory
521 02/12/2023 1281 TASMI SUMBEREJO '3519086710660001 27/10/1966 POLI UMUM R69 Unknown and 110 70
unspecified causes
522 02/12/2023 11903 BELLA KUSUMAWATI NGLAMES ' 09/03/2000 POLI UMUM K29.7 Gastritis, 110 70
unspecified
523 02/12/2023 689 KASINEM TIRON '3519084105650002 01/05/1965 POLI UMUM K29.7 Gastritis, 100 60
unspecified
524 02/12/2023 10274 KUSMI LESTARI TIRON '3519085212690003 12/12/1969 POLI UMUM M54.5 Low back pain 120 70