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DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

NO TANGGAL NO KUNJUNGAN NO KARTU NAMA PESERTA SEX JENIS PESERTA DIAGNOSA DIRUJUK

1 28-02-2018 132212010218Y001549 0000024696483 SUNARMI P PNS DAERAH Myalgia Berobat Jalan

2 28-02-2018 132212010218Y001394 0000098525215 KATMINAH P PNS DAERAH Portal hypertension Rujuk Lanjut

3 28-02-2018 132212010218Y001558 0000098555376 AKSAN L PENERIMA PENSIUN Influenza with other Berobat Jalan
PNS respiratory manifestations,
virus not identified

4 28-02-2018 132212010218Y001446 0000098667663 WINARTI P PNS DAERAH Portal hypertension Rujuk Lanjut

5 28-02-2018 132212010218Y001400 0000098730999 M. YUNUS L PNS DAERAH Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
6 28-02-2018 132212010218Y001425 0000098811303 SIH KADARMAN L PENERIMA PENSIUN Unspecified diabetes Rujuk Lanjut
PNS mellitus without

7 28-02-2018 132212010218Y001556 0000099405933 SUWARIJADI L PENERIMA PENSIUN Headache Berobat Jalan


PNS
8 28-02-2018 132212010218Y001557 0000099405944 KASINING P PENERIMA PENSIUN Non-insulin-dependent Berobat Jalan
PNS diabetes mellitus without

9 28-02-2018 132212010218Y001534 0000099476717 TRINAH AL TRIYONO L PENERIMA PENSIUN Headache Berobat Jalan
PNS
10 28-02-2018 132212010218Y001540 0000723757803 SITI ALINAH P PBI (APBN) Headache Berobat Jalan

11 28-02-2018 132212010218Y001554 0000723757803 SITI ALINAH P PBI (APBN) Other specified Berobat Jalan
noninflammatory disorders

12 28-02-2018 132212010218Y001501 0000723770471 SARTIYAh P PBI (APBN) Portal hypertension Berobat Jalan

13 28-02-2018 132212010218Y001502 0000723771584 gladyola aura iknesia P PBI (APBN) Fever of other and Berobat Jalan
unknown origin
14 28-02-2018 132212010218Y001545 0000723827619 HANDRI. A L PBI (APBN) Depressive episode, Berobat Jalan
unspecified
15 28-02-2018 132212010218Y001496 0000723847342 SANTOSO L PBI (APBN) Fever, unspecified Berobat Jalan

16 28-02-2018 132212010218Y001570 0000723980463 KUSMARNO L PBI (APBN) Fever, unspecified Berobat Jalan

17 28-02-2018 132212010218Y001631 0000724609034 SITI ROHMATHUL UMROH P PBI (APBN) Fever, unspecified Sembuh

18 28-02-2018 132212010218Y001535 0000724609034 SITI ROHMATHUL UMROH P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

19 28-02-2018 132212010218Y001543 0000724748073 MINSRI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

20 28-02-2018 132212010218Y001566 0000724804953 SUMARMIATI P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

21 28-02-2018 132212010218Y001417 0000724823561 RUMINAH P PBI (APBN) Excessive and frequent Rujuk Lanjut
menstruation with irregular

22 28-02-2018 132212010218Y001447 0000724844507 LINA ANGGRAINI P PBI (APBN) Injury, unspecified Berobat Jalan

23 28-02-2018 132212010218Y001404 0000724854892 JAMAL L PBI (APBN) Non-insulin-dependent Rujuk Lanjut


diabetes mellitus without

24 28-02-2018 132212010218Y001405 0000725036332 URIP L PBI (APBN) Arthrosis, unspecified Rujuk Lanjut

25 28-02-2018 132212010218Y001450 0000725151025 BAGUS R L PBI (APBN) Chronic sinusitis, Rujuk Lanjut
unspecified
26 28-02-2018 132212010218Y001547 0000725262816 TRI SUSANTI P PBI (APBN) Headache Berobat Jalan

27 28-02-2018 132212010218Y001552 0000725273662 SUROSO L PBI (APBN) Myalgia Berobat Jalan

28 28-02-2018 132212010218Y001551 0000725274257 SULATI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

29 28-02-2018 132212010218Y001539 0000725305555 SUPIYEM P PBI (APBN) Myalgia Berobat Jalan

30 28-02-2018 132212010218Y001435 0000725414387 AJENG ANGGRAINI P PBI (APBN) Visual disturbances Rujuk Lanjut

31 28-02-2018 132212010218Y001538 0000725431847 KASIAMI P PBI (APBN) Myalgia Berobat Jalan

32 28-02-2018 132212010218Y001564 0000725467768 TASMI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
33 28-02-2018 132212010218Y001527 0000725523794 M MAULANA R L PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

34 28-02-2018 132212010218Y001497 0000725528935 NURUL WIJAYANTI P PBI (APBN) Fetus and newborn Rujuk Lanjut
affected by
malpresentation before

35 28-02-2018 132212010218Y001398 0000725559085 PARNING P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

36 28-02-2018 132212010218Y001550 0000725564845 SUNTORO L PBI (APBN) Myalgia Berobat Jalan

37 28-02-2018 132212010218Y001393 0000725647127 SITI SOFIAH P PBI (APBN) Prolonged pregnancy Rujuk Lanjut

38 28-02-2018 132212010218Y001548 0000725730276 SULIMAH P PBI (APBN) Myalgia Berobat Jalan


DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

39 28-02-2018 132212010218Y001630 0000725730276 SULIMAH P PBI (APBN) Fever, unspecified Sembuh

40 28-02-2018 132212010218Y001568 0000725765038 EKA AINUN NIA AGUSTIN P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
41 28-02-2018 132212010218Y001555 0000725789248 M ALI M L PBI (APBN) Fever, unspecified Berobat Jalan

42 28-02-2018 132212010218Y001528 0000725836026 SOLICHATIN P PBI (APBN) Headache Berobat Jalan

43 28-02-2018 132212010218Y001388 0000725958988 NINUK SUSILOWATI P PBI (APBN) Pre-eclampsia, Rujuk Lanjut
unspecified
44 28-02-2018 132212010218Y001396 0000726465655 PUJIONO L PBI (APBN) Dyspepsia Rujuk Lanjut

45 28-02-2018 132212010218Y001560 0000726564565 ARINI AYU L P PBI (APBN) Fever of other and Berobat Jalan
unknown origin
46 28-02-2018 132212010218Y001559 0001043724431 FARHAN SYAHRUL L PBI (APBN) Fever, unspecified Berobat Jalan

47 28-02-2018 132212010218Y001530 0001043728661 RINY SUNDARTI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

48 28-02-2018 132212010218Y001541 0001043729289 SUDARWATI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

49 28-02-2018 132212010218Y001500 0001081805455 qisya raya adiba P PNS DAERAH Fever of other and Berobat Jalan
unknown origin
50 28-02-2018 132212010218Y001567 0001130383989 CHOIRIYAH P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
51 28-02-2018 132212010218Y001533 0001272887605 SUNDARI P PEKERJA MANDIRI Myalgia Berobat Jalan

52 28-02-2018 132212010218Y001537 0001399544559 SHINTA OKTAVIA P PEKERJA MANDIRI Headache Berobat Jalan

53 28-02-2018 132212010218Y001569 0001539923308 ZHAFIRA NAJWA SALSABILA P PEGAWAI SWASTA Fever, unspecified Berobat Jalan

54 28-02-2018 132212010218Y001424 0001730088088 IRENA NUR ZALFA NAZHIFAH P PEKERJA MANDIRI Other specified dermatitis Rujuk Lanjut

55 28-02-2018 132212010218Y001406 0001792067321 SUKIADI L PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut


diabetes mellitus without

56 28-02-2018 132212010218Y001401 0001848421956 olyvia sanindita P PEGAWAI SWASTA Excessive and frequent Rujuk Lanjut
menstruation with regular

57 28-02-2018 132212010218Y001565 0002045193412 saiful L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
58 28-02-2018 132212010218Y001532 0002195215907 AZALEA DZAHIN WIBOWO P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
59 28-02-2018 132212010218Y001544 0002222359187 SUFIYAH P PEKERJA MANDIRI Headache Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

60 28-02-2018 132212010218Y001546 0002222359986 FATHIYA NUR FAIZAH P PEKERJA MANDIRI Other specified dermatitis Berobat Jalan

61 28-02-2018 132212010218Y001395 0002227170295 WULIYO L PEKERJA MANDIRI Heart disease, unspecified Rujuk Lanjut

62 28-02-2018 132212010218Y001553 0002240050375 venia putri valencia P PBI (APBN) Need for immunization Berobat Jalan
against tuberculosis [BCG]

63 28-02-2018 132212010218Y001449 0002273667939 TATOK HERMAWAN L PEKERJA MANDIRI Dislocation, sprain and Rujuk Lanjut
strain of unspecified body

64 28-02-2018 132212010218Y001531 0002304189123 ATIK WIJAYANTI P PEKERJA MANDIRI Myalgia Berobat Jalan

65 28-02-2018 132212010218Y001445 0002306871167 DEVANDA SYAPUTRA L PEKERJA MANDIRI Epilepsy, unspecified Rujuk Lanjut

66 28-02-2018 132212010218Y001536 0002313079582 HAFIZAH SALSABILA P PEGAWAI SWASTA Need for immunization Berobat Jalan
against tuberculosis [BCG]

67 28-02-2018 132212010218Y001529 0002315756237 SYAUQI MAULANA ISHAQ putra L PEGAWAI PEMERINTAH Influenza with other Berobat Jalan
al fanno NON PNS respiratory manifestations,
virus not identified

68 28-02-2018 132212010218Y001448 0002318273379 TISHA ADREENA PUTRI P PEGAWAI SWASTA Slow feeding of newborn Rujuk Lanjut
DAFIYANTO
69 28-02-2018 132212010218Y001542 0002420008468 LULUK MAF'ULAH P PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

70 28-02-2018 132212010218Y001407 0002428434033 TAUCHIYAT L PEKERJA MANDIRI Chronic renal failure, Rujuk Lanjut
unspecified
71 27-02-2018 132212010218Y001349 0000098553431 SRI WULANINGSIH P PNS DAERAH Arthrosis, unspecified Rujuk Lanjut

72 27-02-2018 132212010218Y001350 0000098553442 GATOT PRAYUGO L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

73 27-02-2018 132212010218Y001506 0000098667663 WINARTI P PNS DAERAH Gingival recession Berobat Jalan

74 27-02-2018 132212010218Y001362 0000098673592 NOERIADI L PENERIMA PENSIUN Heart disease, unspecified Rujuk Lanjut
PNS
75 27-02-2018 132212010218Y001360 0000098809356 HJ. ARIFAH, BA P PENERIMA PENSIUN Chronic obstructive Rujuk Lanjut
PNS pulmonary disease,

76 27-02-2018 132212010218Y001361 0000098812528 URIP MULYONO L PENERIMA PENSIUN Fracture of femur, part Rujuk Lanjut
PNS unspecified
77 27-02-2018 132212010218Y001507 0000099784089 ALIF FAHTILATUN U. P PNS PUSAT Erosion of teeth Berobat Jalan

78 27-02-2018 132212010218Y001344 0000210659321 SLIMAH P PNS DAERAH Dyspepsia Rujuk Lanjut


DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

79 27-02-2018 132212010218Y001511 0000724238379 ANDRIAN NIKO WAHYU L PBI (APBN) Erosion of teeth Berobat Jalan
PRATAMA
80 27-02-2018 132212010218Y001392 0000724698101 SUMINTEN P PBI (APBN) Injury, unspecified Berobat Jalan

81 27-02-2018 132212010218Y001389 0000724849075 INDRIYANTI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
82 27-02-2018 132212010218Y001336 0000724890069 NADI L PBI (APBN) Hyperplasia of prostate Rujuk Lanjut

83 27-02-2018 132212010218Y001521 0000724972375 KUNAYATI P PBI (APBN) Pure Berobat Jalan


hypercholesterolaemia
84 27-02-2018 132212010218Y001348 0000725145197 PATUKAH P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

85 27-02-2018 132212010218Y001519 0000725176293 SARMI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
86 27-02-2018 132212010218Y001347 0000725185978 MUSRIPAH P PBI (APBN) Myopia Rujuk Lanjut

87 27-02-2018 132212010218Y001333 0000725194901 YULIANA N P PBI (APBN) Benign neoplasm of breast Rujuk Lanjut

88 27-02-2018 132212010218Y001518 0000725196374 MUNIK Setyowati P PBI (APBN) Headache Berobat Jalan

89 27-02-2018 132212010218Y001382 0000725324027 SARI L PBI (APBN) Gastritis, unspecified Berobat Jalan

90 27-02-2018 132212010218Y001504 0000725332882 SITI ILCHORIAH P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
91 27-02-2018 132212010218Y001321 0000725389323 siti poniroh P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
92 27-02-2018 132212010218Y001352 0000725433142 SUPARMAN L PBI (APBN) Fractures of other parts of Rujuk Lanjut
lower leg
93 27-02-2018 132212010218Y001340 0000725475846 OYIK L PBI (APBN) Myopia Rujuk Lanjut

94 27-02-2018 132212010218Y001355 0000725483891 SAMARI L PBI (APBN) Portal hypertension Rujuk Lanjut

95 27-02-2018 132212010218Y001332 0000725487219 KHOLIPAH P PBI (APBN) Chronic renal failure, Rujuk Lanjut
unspecified
96 27-02-2018 132212010218Y001524 0000725577906 SAGI T L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

97 27-02-2018 132212010218Y001354 0000725632007 RUSMAN SUJADI L PBI (APBN) Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

98 27-02-2018 132212010218Y001345 0000725697099 NUR HAYATI P PBI (APBN) Thyrotoxicosis, Rujuk Lanjut
unspecified
99 27-02-2018 132212010218Y001520 0000725700341 NIA AFNI R P PBI (APBN) Fever, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

100 27-02-2018 132212010218Y001517 0000725774444 UMI FITRIANA P PBI (APBN) Myalgia Berobat Jalan

101 27-02-2018 132212010218Y001376 0000726113823 TIARAH P PBI (APBN) Injury, unspecified Berobat Jalan

102 27-02-2018 132212010218Y001359 0000726123093 LIYA WULANDARI P PBI (APBN) Unspecified maternal Rujuk Lanjut
hypertension
103 27-02-2018 132212010218Y001339 0000726556634 YENI DISMAWATI P PBI (APBN) Supervision of pregnancy Rujuk Lanjut
with grand multiparity
104 27-02-2018 132212010218Y001377 0000726564767 FAHMI IDRIS L PBI (APBN) Injury, unspecified Berobat Jalan

105 27-02-2018 132212010218Y001381 0000726847097 KUSNUL CHOTIMAH P PBI (APBN) Dyspepsia Berobat Jalan

106 27-02-2018 132212010218Y001346 0001043728479 JUMILAH P PBI (APBN) Surveillance of Rujuk Lanjut
(intrauterine) contraceptive

107 27-02-2018 132212010218Y001391 0001043731989 AMINATUN P PBI (APBN) Asthma, unspecified Berobat Jalan

108 27-02-2018 132212010218Y001341 0001043733688 NINING PUSPOSARI P PBI (APBN) Endometriosis Rujuk Lanjut

109 27-02-2018 132212010218Y001512 0001256293181 SUPARMI P PEKERJA MANDIRI Myalgia Berobat Jalan

110 27-02-2018 132212010218Y001523 0001327588165 ADDIN NINA Z. IMRONA P PNS DAERAH Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

111 27-02-2018 132212010218Y001356 0001535801973 MOCHAMMAD ABIZAR FAIQ L PEGAWAI SWASTA Other physical therapy Rujuk Lanjut
RAMADHAN
112 27-02-2018 132212010218Y001379 0001537311712 SUMIATI P PEGAWAI SWASTA Portal hypertension Berobat Jalan

113 27-02-2018 132212010218Y001378 0001537495154 ALI SUMITRO L PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
114 27-02-2018 132212010218Y001337 0001787701746 SATUNI P PEKERJA MANDIRI Senile cataract Rujuk Lanjut

115 27-02-2018 132212010218Y001505 0001800410837 VIDYA EKA JUNIWATI P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
116 27-02-2018 132212010218Y001510 0001819257884 AQILA AULIA NAFISAH P PNS DAERAH Erosion of teeth Berobat Jalan

117 27-02-2018 132212010218Y001513 0001821126936 SAUTI P PEKERJA MANDIRI Myalgia Berobat Jalan

118 27-02-2018 132212010218Y001516 0001861546173 DIDIK SUKARMANTO L PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

119 27-02-2018 132212010218Y001343 0001896053422 sunarmi P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

120 27-02-2018 132212010218Y001526 0001898371642 TAKAT L PEKERJA MANDIRI Myalgia Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

121 27-02-2018 132212010218Y001342 0001959241375 JAMAL L PEKERJA MANDIRI Headache Rujuk Lanjut

122 27-02-2018 132212010218Y001358 0002013788553 MOCH MANSYUR L PBI (APBN) Hyphaema Rujuk Lanjut

123 27-02-2018 132212010218Y001390 0002016170943 LALI L PBI (APBN) Asthma, unspecified Berobat Jalan

124 27-02-2018 132212010218Y001335 0002042483455 SUTOYO L PEKERJA MANDIRI Chronic obstructive Rujuk Lanjut
pulmonary disease,

125 27-02-2018 132212010218Y001508 0002049673522 ANDI SHALAT L PEGAWAI SWASTA Gingival recession Berobat Jalan

126 27-02-2018 132212010218Y001509 0002050962063 alif handa nugroho L PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

127 27-02-2018 132212010218Y001357 0002216531744 SITI KOLIPAH P PEKERJA MANDIRI Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
128 27-02-2018 132212010218Y001503 0002216531744 SITI KOLIPAH P PEKERJA MANDIRI Noninflammatory disorder Berobat Jalan
of vagina, unspecified

129 27-02-2018 132212010218Y001514 0002232529086 MASLIHAH P PEKERJA MANDIRI Other acute gastritis Berobat Jalan

130 27-02-2018 132212010218Y001522 0002256321431 NIKITA AULIA PUTRI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

131 27-02-2018 132212010218Y001515 0002293344011 SESILLYA OKTAVIA VANESA P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

132 27-02-2018 132212010218Y001338 0002303813261 UMI FASIKAH P PEKERJA MANDIRI Low back pain Rujuk Lanjut

133 27-02-2018 132212010218Y001351 0002309765185 SITI KHOIROTUN P PEKERJA MANDIRI Pre-eclampsia, Rujuk Lanjut
unspecified
134 27-02-2018 132212010218Y001380 0002309765185 SITI KHOIROTUN P PEKERJA MANDIRI Myalgia Berobat Jalan

135 27-02-2018 132212010218Y001334 0002419471045 SA'I L PEKERJA MANDIRI Chronic obstructive Rujuk Lanjut
pulmonary disease,

136 27-02-2018 132212010218Y001525 0002419471585 SUDARSINI P PEKERJA MANDIRI Myalgia Berobat Jalan

137 27-02-2018 132212010218Y001353 0002427915969 sukarno L PEKERJA MANDIRI Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
138 26-02-2018 132212010218Y001227 0000098487832 IVA ALVINA P PNS PUSAT Erosion of teeth Berobat Jalan

139 26-02-2018 132212010218Y001202 0000098534092 INDIATI P PNS DAERAH Calculus of kidney and Rujuk Lanjut
ureter
140 26-02-2018 132212010218Y001168 0000098557615 NAYLA ARDHIA PRAMESTY P PNS DAERAH Dyspepsia Rujuk Lanjut

141 26-02-2018 132212010218Y001230 0000098619884 ABDUL SHOMAD L PENERIMA PENSIUN Acute periodontitis Berobat Jalan
PNS
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

142 26-02-2018 132212010218Y001204 0000098810054 SUYATI P PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

143 26-02-2018 132212010218Y001207 0000098810537 KASIATI P PENERIMA PENSIUN Portal hypertension Rujuk Lanjut
PNS
144 26-02-2018 132212010218Y001169 0000099532719 ENY FATNATIEN DWI WAHYUNI P PNS DAERAH Dyspepsia Rujuk Lanjut

145 26-02-2018 132212010218Y001188 0000102188902 DEBORA SUSIANI P PNS DAERAH Fracture of lower end of Rujuk Lanjut
tibia
146 26-02-2018 132212010218Y001243 0000723967064 SARIMAN L PBI (APBN) Chronic periodontitis Berobat Jalan

147 26-02-2018 132212010218Y001218 0000724254669 MISNAH P PBI (APBN) Cough Berobat Jalan

148 26-02-2018 132212010218Y001223 0000724592575 LISWATI P PBI (APBN) Fever, unspecified Berobat Jalan

149 26-02-2018 132212010218Y001211 0000724592968 INTANA P PBI (APBN) Conjunctivitis Rujuk Lanjut

150 26-02-2018 132212010218Y001214 0000724698101 SUMINTEN P PBI (APBN) Gangrene, not elsewhere Berobat Jalan
classified
151 26-02-2018 132212010218Y001228 0000724806336 SAROPAH P PBI (APBN) Myalgia Berobat Jalan

152 26-02-2018 132212010218Y001209 0000724900847 VIDAYANTIK P PBI (APBN) Delivery by caesarean Rujuk Lanjut
section, unspecified
153 26-02-2018 132212010218Y001203 0000725085494 RIYANTO L PBI (APBN) Heart disease, unspecified Rujuk Lanjut

154 26-02-2018 132212010218Y001244 0000725086247 MINARSIH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

155 26-02-2018 132212010218Y001197 0000725096035 MESTIANI P PBI (APBN) Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

156 26-02-2018 132212010218Y001229 0000725149416 MUHAMMAD RAFLI AFANDI L PBI (APBN) Conjunctivitis, unspecified Berobat Jalan

157 26-02-2018 132212010218Y001245 0000725176293 SARMI P PBI (APBN) Cough Berobat Jalan

158 26-02-2018 132212010218Y001205 0000725186619 NURAHMI P PBI (APBN) Asthma, unspecified Berobat Jalan

159 26-02-2018 132212010218Y001172 0000725198343 TRI WAHYUNI P PBI (APBN) Pre-eclampsia, Rujuk Lanjut
unspecified
160 26-02-2018 132212010218Y001247 0000725202426 ANDIK SISWANTO L PBI (APBN) Depressive episode, Berobat Jalan
unspecified
161 26-02-2018 132212010218Y001184 0000725202819 AKHMAD SUUDI L PBI (APBN) Low back pain Rujuk Lanjut

162 26-02-2018 132212010218Y001249 0000725306286 LAILATUL INSIYAH P PBI (APBN) Fever, unspecified Berobat Jalan

163 26-02-2018 132212010218Y001632 0000725306286 LAILATUL INSIYAH P PBI (APBN) Fever, unspecified Sembuh
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

164 26-02-2018 132212010218Y001235 0000725336818 SUKARIYANTO L PBI (APBN) Cough Berobat Jalan

165 26-02-2018 132212010218Y001217 0000725403655 SIYATI P PBI (APBN) Headache Berobat Jalan

166 26-02-2018 132212010218Y001179 0000725444109 SUWANDI L PBI (APBN) Arthrosis, unspecified Rujuk Lanjut

167 26-02-2018 132212010218Y001306 0000725511699 IDA MAYANTI P PBI (APBN) Slow fetal growth, Rujuk Lanjut
unspecified
168 26-02-2018 132212010218Y001221 0000725527192 MINARTI P PBI (APBN) Cough Berobat Jalan

169 26-02-2018 132212010218Y001240 0000725551751 SUPIYAH P PBI (APBN) Dyspnoea Berobat Jalan

170 26-02-2018 132212010218Y001196 0000725553483 TITIK SUHERMIN P PBI (APBN) Threatened abortion Rujuk Lanjut

171 26-02-2018 132212010218Y001248 0000725554978 HENDRIK WIBISONO L PBI (APBN) Erosion of teeth Berobat Jalan

172 26-02-2018 132212010218Y001375 0000725559873 SUWANDI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

173 26-02-2018 132212010218Y001170 0000725598505 ROHMAN L PBI (APBN) Schizophrenia, unspecified Rujuk Lanjut

174 26-02-2018 132212010218Y001194 0000725668255 SETI P PBI (APBN) Injury, unspecified Berobat Jalan

175 26-02-2018 132212010218Y001233 0000725691813 SITI WULANDARI P PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

176 26-02-2018 132212010218Y001241 0000725692544 SUMALI L PBI (APBN) Myalgia Berobat Jalan

177 26-02-2018 132212010218Y001242 0000725693747 MUSINAH P PBI (APBN) Myalgia Berobat Jalan

178 26-02-2018 132212010218Y001423 0000725721186 RIFQI IFANTRI L PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

179 26-02-2018 132212010218Y001178 0000725755015 SUYANTI P PBI (APBN) Delivery by caesarean Rujuk Lanjut
section, unspecified
180 26-02-2018 132212010218Y001215 0000725789013 TUTIK YULIATI P PBI (APBN) Myalgia Berobat Jalan

181 26-02-2018 132212010218Y001210 0000725792128 SRI HANDAYANI P PBI (APBN) Fever, unspecified Rujuk Lanjut

182 26-02-2018 132212010218Y001208 0000725914258 KASIRAH P PBI (APBN) Myopia Rujuk Lanjut

183 26-02-2018 132212010218Y001212 0000726077349 RIDWAN L PBI (APBN) Injury, unspecified Berobat Jalan

184 26-02-2018 132212010218Y001201 0000726149531 SULIKAH P PBI (APBN) Gangrene, not elsewhere Rujuk Lanjut
classified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

185 26-02-2018 132212010218Y001216 0000726196342 SAPUAH P PBI (APBN) Benign lipomatous Rujuk Lanjut
neoplasm of skin and
subcutaneous tissue of

186 26-02-2018 132212010218Y001220 0000726493937 SRI UTAMI P PBI (APBN) Other specified dermatitis Berobat Jalan

187 26-02-2018 132212010218Y001219 0000726495445 YULI SETYOWATI P PBI (APBN) Fever, unspecified Berobat Jalan

188 26-02-2018 132212010218Y001224 0000726507639 SUPARJO L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

189 26-02-2018 132212010218Y001231 0001043728918 SUMIAH P PBI (APBN) Headache Berobat Jalan

190 26-02-2018 132212010218Y001373 0001043734331 WENI PURWANTI P PBI (APBN) Dyspepsia Berobat Jalan

191 26-02-2018 132212010218Y001171 0001105930012 SULISTYORINI P PENERIMA PENSIUN TNI Predominantly allergic Rujuk Lanjut
asthma
192 26-02-2018 132212010218Y001191 0001272887605 SUNDARI P PEKERJA MANDIRI Myalgia Berobat Jalan

193 26-02-2018 132212010218Y001234 0001434113313 karsudi L PEKERJA MANDIRI Other specified dermatitis Berobat Jalan

194 26-02-2018 132212010218Y001239 0001481908634 SUYANTO L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

195 26-02-2018 132212010218Y001195 0001806389122 MUJIATI P PEKERJA MANDIRI False labour before 37 Rujuk Lanjut
completed weeks of

196 26-02-2018 132212010218Y001305 0001812635111 ahmad nur imam baihaqi L PEKERJA MANDIRI Depressive episode, Rujuk Lanjut
unspecified
197 26-02-2018 132212010218Y001180 0001813233161 IIN IKMAINI P PEKERJA MANDIRI Endometriosis Rujuk Lanjut

198 26-02-2018 132212010218Y001232 0001826309428 DESTIAN ARMADA DWI L PEKERJA MANDIRI Fever, unspecified Berobat Jalan
SUDIBYO
199 26-02-2018 132212010218Y001238 0001867426119 suyanto L PEKERJA MANDIRI Headache Berobat Jalan

200 26-02-2018 132212010218Y001236 0001867427188 SITI MUKAIYAH P PEKERJA MANDIRI Seronegative rheumatoid Berobat Jalan
arthritis
201 26-02-2018 132212010218Y001190 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Keloid scar Berobat Jalan

202 26-02-2018 132212010218Y001250 0002016165104 SUPAIRAN L PBI (APBN) Headache Berobat Jalan

203 26-02-2018 132212010218Y001206 0002016168862 MACHFUD L PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

204 26-02-2018 132212010218Y001182 0002016171066 RIBUT MARGONO L PBI (APBN) Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
205 26-02-2018 132212010218Y001173 0002016171099 WIRADITA P PBI (APBN) Dyspepsia Rujuk Lanjut
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

206 26-02-2018 132212010218Y001374 0002023951061 JUMADI L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
207 26-02-2018 132212010218Y001189 0002046624603 rania shabirah P PEKERJA MANDIRI Asthma, unspecified Berobat Jalan

208 26-02-2018 132212010218Y001226 0002199997427 AHMAD JUBAiRI L PEKERJA MANDIRI Headache Berobat Jalan

209 26-02-2018 132212010218Y001193 0002206992047 JUWARIYAH P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

210 26-02-2018 132212010218Y001633 0002212152715 RUPANAH P PEKERJA MANDIRI Fever, unspecified Sembuh

211 26-02-2018 132212010218Y001192 0002212530761 INDAH KURNIAWATI P PEKERJA MANDIRI False labour before 37 Rujuk Lanjut
completed weeks of

212 26-02-2018 132212010218Y001246 0002220888159 JUMA'IYAH P PEKERJA MANDIRI Headache Berobat Jalan

213 26-02-2018 132212010218Y001181 0002227551928 azka alfarizky hariyanto L PEKERJA MANDIRI Congenital absence, Rujuk Lanjut
atresia and stenosis of

214 26-02-2018 132212010218Y001386 0002240151085 MUHAMMAD OMAR HAKEEM L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
AL-GHAZALI infection, unspecified
215 26-02-2018 132212010218Y001200 0002263696672 EKO SRI RAHAYU P PEKERJA MANDIRI Care and examination Rujuk Lanjut
immediately after delivery
216 26-02-2018 132212010218Y001199 0002281197453 KHUROTA AKYUN ZAHRA P PEKERJA MANDIRI Chronic sinusitis Rujuk Lanjut

217 26-02-2018 132212010218Y001237 0002290294203 NURIYA P PEKERJA MANDIRI Cough Berobat Jalan

218 26-02-2018 132212010218Y001225 0002303813261 UMI FASIKAH P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

219 26-02-2018 132212010218Y001222 0002304194128 IKA ROSITA P PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

220 26-02-2018 132212010218Y001198 0002312966283 sunarti P PEGAWAI SWASTA Portal hypertension Rujuk Lanjut

221 26-02-2018 132212010218Y001213 0002327470953 MUHAMAD REZA ARDIANSYAH L PEKERJA MANDIRI Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

222 26-02-2018 132212010218Y001183 0002425702882 RUSMIATI P PEKERJA MANDIRI Dyspepsia Rujuk Lanjut

223 26-02-2018 132212010218Y001185 0002427199255 miftakhul ilmiyah P PEKERJA MANDIRI Iron deficiency anaemia Rujuk Lanjut

224 25-02-2018 132212010218Y001629 0000724982938 NUR YANI P PBI (APBN) Fever, unspecified Sembuh

225 25-02-2018 132212010218Y001186 0000725149416 MUHAMMAD RAFLI AFANDI L PBI (APBN) Conjunctivitis, unspecified Berobat Jalan

226 25-02-2018 132212010218Y001165 0000726564767 FAHMI IDRIS L PBI (APBN) Headache Berobat Jalan

227 25-02-2018 132212010218Y001187 0001305785406 SUWITO L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
228 25-02-2018 132212010218Y001166 0002083288781 SERYZ IBNATI ALEAZIZA P PEGAWAI SWASTA Fever, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

229 25-02-2018 132212010218Y001167 0002212152715 RUPANAH P PEKERJA MANDIRI Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

230 24-02-2018 132212010218Y001082 0000098559448 SUTIASIH P PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

231 24-02-2018 132212010218Y001101 0000202565867 SETO SUMARMIN L PENERIMA PENSIUN TNI Headache Berobat Jalan

232 24-02-2018 132212010218Y001091 0000724290265 KUNCORO L PBI (APBN) Asthma, unspecified Berobat Jalan

233 24-02-2018 132212010218Y001155 0000724565507 SITI ROHMAH P PBI (APBN) Dyspepsia Berobat Jalan

234 24-02-2018 132212010218Y001090 0000724844507 LINA ANGGRAINI P PBI (APBN) Injury, unspecified Berobat Jalan

235 24-02-2018 132212010218Y001159 0000724844801 SUNTORO L PBI (APBN) Dyspepsia Berobat Jalan

236 24-02-2018 132212010218Y001499 0000725186845 KANAH P PBI (APBN) Fever, unspecified Sembuh

237 24-02-2018 132212010218Y001104 0000725230214 DEVANDRA RIZKYA P PBI (APBN) Fever, unspecified Berobat Jalan

238 24-02-2018 132212010218Y001158 0000725245615 MINARSIH P PBI (APBN) Myalgia Berobat Jalan

239 24-02-2018 132212010218Y001098 0000725254569 SUMILAH P PBI (APBN) Fever, unspecified Berobat Jalan

240 24-02-2018 132212010218Y001088 0000725292674 SENAN L PBI (APBN) Dyspepsia Rujuk Lanjut

241 24-02-2018 132212010218Y001162 0000725336818 SUKARIYANTO L PBI (APBN) Dyspepsia Berobat Jalan

242 24-02-2018 132212010218Y001157 0000725375597 RIFKY CAHYO L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
243 24-02-2018 132212010218Y001154 0000725429272 NUNUK SUPRIYATI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
244 24-02-2018 132212010218Y001498 0000725543504 FIDIA RETA SARI P PBI (APBN) Dyspepsia Sembuh

245 24-02-2018 132212010218Y001081 0000725551738 SAKUR L PBI (APBN) Senile incipient cataract Rujuk Lanjut

246 24-02-2018 132212010218Y001096 0000725553483 TITIK SUHERMIN P PBI (APBN) Other acute gastritis Berobat Jalan

247 24-02-2018 132212010218Y001387 0000725553483 TITIK SUHERMIN P PBI (APBN) Irregular menstruation, Berobat Jalan
unspecified
248 24-02-2018 132212010218Y001095 0000725577603 NOVIANTI P PBI (APBN) Other specified dermatitis Berobat Jalan

249 24-02-2018 132212010218Y001094 0000725578031 FIKATU R P PBI (APBN) Fever, unspecified Berobat Jalan

250 24-02-2018 132212010218Y001084 0000725588087 KASERI L PBI (APBN) Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
251 24-02-2018 132212010218Y001107 0000725610745 AZZAHRA AL KARIMA SEPTIA P PBI (APBN) Fever, unspecified Berobat Jalan
RAMADHANI
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

252 24-02-2018 132212010218Y001106 0000725624076 PONITI L PBI (APBN) Gastritis, unspecified Berobat Jalan

253 24-02-2018 132212010218Y001422 0000725718104 RIATUN P PBI (APBN) Portal hypertension Berobat Jalan

254 24-02-2018 132212010218Y001103 0000725811276 TUNI P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

255 24-02-2018 132212010218Y001160 0000726077349 RIDWAN L PBI (APBN) Injury, unspecified Berobat Jalan

256 24-02-2018 132212010218Y001097 0000726386218 SUJIATI P PBI (APBN) Myalgia Berobat Jalan

257 24-02-2018 132212010218Y001089 0000726439498 WARNI P PBI (APBN) Injury, unspecified Berobat Jalan

258 24-02-2018 132212010218Y001100 0000740540406 komarudin L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

259 24-02-2018 132212010218Y001163 0001288629876 KIKY AISTIYAS P PEGAWAI SWASTA Acute periodontitis Berobat Jalan

260 24-02-2018 132212010218Y001161 0001475019729 AKHMAD NANDA TRI L PENERIMA PENSIUN TNI Acute upper respiratory Berobat Jalan
PRASETYO infection, unspecified
261 24-02-2018 132212010218Y001085 0001478311198 PRASETYA DWI ABRIYANTI P PEKERJA MANDIRI Depressive episode, Rujuk Lanjut
unspecified
262 24-02-2018 132212010218Y001099 0001483968442 bryan meitri bagus sadewa L PNS DAERAH Fever, unspecified Berobat Jalan

263 24-02-2018 132212010218Y001092 0001537311745 ELLIS DWI OKTAVIANTI P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
264 24-02-2018 132212010218Y001105 0001540009348 ANA NURFAIDAH L PEGAWAI SWASTA Fever, unspecified Berobat Jalan

265 24-02-2018 132212010218Y001102 0001732820297 RAHMAD AMINULLOH L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

266 24-02-2018 132212010218Y001083 0002195320252 SOLIKAH P PEKERJA MANDIRI Senile incipient cataract Rujuk Lanjut

267 24-02-2018 132212010218Y001156 0002205489431 KEISYA SAFAATUL MARWAH P PEKERJA MANDIRI Gastritis, unspecified Berobat Jalan

268 24-02-2018 132212010218Y001080 0002221471708 SAIPUL ANAM L PEKERJA MANDIRI Schizophrenia, unspecified Rujuk Lanjut

269 24-02-2018 132212010218Y001164 0002263290939 muhammad rafif ridho anwar L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
270 24-02-2018 132212010218Y001093 0002282114531 LAWI L PEKERJA MANDIRI Headache Berobat Jalan

271 24-02-2018 132212010218Y001087 0002424917226 SUMARNI P PEKERJA MANDIRI Thyrotoxicosis with toxic Rujuk Lanjut
multinodular goitre
272 24-02-2018 132212010218Y001086 0002428355215 KASIANAH P PEKERJA MANDIRI Fracture of shaft of tibia Rujuk Lanjut

273 23-02-2018 132212010218Y001456 0000098497124 LILIK ALIMURTI P PNS DAERAH Portal hypertension Sembuh
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

274 23-02-2018 132212010218Y001453 0000098498362 MUINI P PNS DAERAH Non-insulin-dependent Sembuh


diabetes mellitus without

275 23-02-2018 132212010218Y001452 0000098505101 SUTIYAH P PNS DAERAH Portal hypertension Sembuh

276 23-02-2018 132212010218Y001267 0000098562789 PRI HARTATI P PENERIMA PENSIUN Portal hypertension Sembuh
PNS
277 23-02-2018 132212010218Y001034 0000098619884 ABDUL SHOMAD L PENERIMA PENSIUN Chronic periodontitis Berobat Jalan
PNS
278 23-02-2018 132212010218Y001252 0000098683334 TIYAMI P PENERIMA PENSIUN Portal hypertension Sembuh
PNS
279 23-02-2018 132212010218Y001254 0000098705889 SUNDARI P PENERIMA PENSIUN Non-insulin-dependent Sembuh
PNS diabetes mellitus with

280 23-02-2018 132212010218Y000998 0000098711537 NUR'ANA P PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

281 23-02-2018 132212010218Y001040 0000098711548 RYCHO AGUSTYAN TRI L PNS DAERAH Fever, unspecified Berobat Jalan
PAMUNGKAS
282 23-02-2018 132212010218Y001487 0000098810054 SUYATI P PENERIMA PENSIUN Non-insulin-dependent Sembuh
PNS diabetes mellitus without

283 23-02-2018 132212010218Y001481 0000098810739 SITI RAHAYU NINGSIH P PENERIMA PENSIUN Portal hypertension Sembuh
PNS
284 23-02-2018 132212010218Y001019 0000098811281 SERANG L PENERIMA PENSIUN Chronic periodontitis Berobat Jalan
PNS
285 23-02-2018 132212010218Y001461 0000098812372 SITI AMINAH P PENERIMA PENSIUN Portal hypertension Sembuh
PNS
286 23-02-2018 132212010218Y001004 0000098812697 ZAENAL ABIDIN L PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

287 23-02-2018 132212010218Y001003 0000098812708 SHOLIHAH P PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

288 23-02-2018 132212010218Y001269 0000099311872 ARI KUSFARIDA P PNS DAERAH Non-insulin-dependent Sembuh
diabetes mellitus with

289 23-02-2018 132212010218Y001473 0000099382994 MARSISWATI P PENERIMA PENSIUN Non-insulin-dependent Sembuh


PNS diabetes mellitus without

290 23-02-2018 132212010218Y001035 0000099784089 ALIF FAHTILATUN U. P PNS PUSAT Erosion of teeth Berobat Jalan

291 23-02-2018 132212010218Y001451 0000100079831 SUMIARSIH P PNS DAERAH Portal hypertension Sembuh
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

292 23-02-2018 132212010218Y001470 0000723770471 SARTIYAh P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

293 23-02-2018 132212010218Y001014 0000724206306 SAINEM P PBI (APBN) Myopia Rujuk Lanjut

294 23-02-2018 132212010218Y001023 0000724254669 MISNAH P PBI (APBN) Acute obstructive laryngitis Berobat Jalan
[croup] and epiglottitis

295 23-02-2018 132212010218Y001475 0000724536685 REPI P PBI (APBN) Portal hypertension Sembuh

296 23-02-2018 132212010218Y001468 0000724559848 LULUK MARDIATI P PBI (APBN) Portal hypertension Sembuh

297 23-02-2018 132212010218Y001479 0000724565507 SITI ROHMAH P PBI (APBN) Portal hypertension Sembuh

298 23-02-2018 132212010218Y001261 0000724748769 SRIGATI P PBI (APBN) Portal hypertension Sembuh

299 23-02-2018 132212010218Y001273 0000724769965 SAMUAH L PBI (APBN) Portal hypertension Sembuh

300 23-02-2018 132212010218Y001465 0000724868943 ASIYAH P PBI (APBN) Portal hypertension Sembuh

301 23-02-2018 132212010218Y001460 0000724879405 KHOLIPAH P PBI (APBN) Portal hypertension Sembuh

302 23-02-2018 132212010218Y001039 0000724904076 DWI SAYAGOS L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

303 23-02-2018 132212010218Y001016 0000724952417 SULIYAH P PBI (APBN) Myalgia Berobat Jalan

304 23-02-2018 132212010218Y001153 0000725009657 SUNARTI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
305 23-02-2018 132212010218Y001022 0000725089476 M NAWAWI YAHYA L PBI (APBN) Erosion of teeth Berobat Jalan

306 23-02-2018 132212010218Y001472 0000725096035 MESTIANI P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

307 23-02-2018 132212010218Y001256 0000725159441 KUSTIYANAH P PBI (APBN) Portal hypertension Sembuh

308 23-02-2018 132212010218Y001469 0000725180422 SAINI P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

309 23-02-2018 132212010218Y001488 0000725209942 KUMA'IYAH P PBI (APBN) Portal hypertension Sembuh

310 23-02-2018 132212010218Y001038 0000725256641 NGATENI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

311 23-02-2018 132212010218Y001260 0000725260948 MARIYATI P PBI (APBN) Portal hypertension Sembuh

312 23-02-2018 132212010218Y000985 0000725267632 JUWITO L PBI (APBN) Headache Rujuk Lanjut
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

313 23-02-2018 132212010218Y001482 0000725344582 RUSMIATUN P PBI (APBN) Portal hypertension Sembuh

314 23-02-2018 132212010218Y001483 0000725350533 JAMIAH P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

315 23-02-2018 132212010218Y001012 0000725357913 YULI ASTUTIK P PBI (APBN) Preterm labour and Rujuk Lanjut
delivery
316 23-02-2018 132212010218Y001078 0000725373606 IMAM L PBI (APBN) Myalgia Berobat Jalan

317 23-02-2018 132212010218Y001077 0000725375597 RIFKY CAHYO L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
318 23-02-2018 132212010218Y001007 0000725422149 ULUM CHOIRIYAH P PBI (APBN) Pregnancy-related Rujuk Lanjut
condition, unspecified
319 23-02-2018 132212010218Y001454 0000725424614 SUKARNI P PBI (APBN) Non-insulin-dependent Sembuh
diabetes mellitus without

320 23-02-2018 132212010218Y001477 0000725478445 KASRIATI P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

321 23-02-2018 132212010218Y001266 0000725482934 SUMIATI P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus with

322 23-02-2018 132212010218Y001030 0000725483024 SITI SA'ADAH T P PBI (APBN) Gastritis, unspecified Berobat Jalan

323 23-02-2018 132212010218Y001490 0000725514783 SITI KHOSIAH P PBI (APBN) Non-insulin-dependent Sembuh
diabetes mellitus without

324 23-02-2018 132212010218Y001258 0000725542694 LILIK KUSNIATI P PBI (APBN) Portal hypertension Sembuh

325 23-02-2018 132212010218Y001478 0000725577118 MARIA U P PBI (APBN) Portal hypertension Sembuh

326 23-02-2018 132212010218Y001257 0000725595142 HARTININGSIH P PBI (APBN) Portal hypertension Sembuh

327 23-02-2018 132212010218Y001464 0000725595737 AINUR JANAH P PBI (APBN) Portal hypertension Sembuh

328 23-02-2018 132212010218Y001272 0000725610183 SITI MUSOFAH P PBI (APBN) Portal hypertension Sembuh

329 23-02-2018 132212010218Y001079 0000725610745 AZZAHRA AL KARIMA SEPTIA P PBI (APBN) Fever, unspecified Berobat Jalan
RAMADHANI
330 23-02-2018 132212010218Y001467 0000725626811 SUWANIK P PBI (APBN) Portal hypertension Sembuh

331 23-02-2018 132212010218Y001494 0000725633504 SEMIATI P PBI (APBN) Portal hypertension Sembuh

332 23-02-2018 132212010218Y001263 0000725638408 ALFIAH P PBI (APBN) Portal hypertension Sembuh

333 23-02-2018 132212010218Y001002 0000725673532 SIMPEN P PBI (APBN) Dyspepsia Rujuk Lanjut

334 23-02-2018 132212010218Y001025 0000725722525 SITI NUR KASANAH P PBI (APBN) Fever, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

335 23-02-2018 132212010218Y001253 0000725743416 HESTIN ATASASIH P PBI (APBN) Portal hypertension Sembuh

336 23-02-2018 132212010218Y001259 0000725791601 ETTY NUR SINARSIATI P PBI (APBN) Portal hypertension Sembuh

337 23-02-2018 132212010218Y001264 0000725814922 RIANA P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

338 23-02-2018 132212010218Y001474 0000725819624 M SOLEH L PBI (APBN) Portal hypertension Sembuh

339 23-02-2018 132212010218Y001037 0000725888171 SITI PARTIMAH P PBI (APBN) Headache Berobat Jalan

340 23-02-2018 132212010218Y001458 0000726063669 MISNI P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

341 23-02-2018 132212010218Y001492 0000726088634 TAMI P PBI (APBN) Portal hypertension Sembuh

342 23-02-2018 132212010218Y001484 0000726115599 SATIKAH P PBI (APBN) Portal hypertension Sembuh

343 23-02-2018 132212010218Y001476 0000726155493 WARTI P PBI (APBN) Portal hypertension Sembuh

344 23-02-2018 132212010218Y001462 0000726163132 TUNI P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus without

345 23-02-2018 132212010218Y001251 0000726198838 FATOYAH P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus with

346 23-02-2018 132212010218Y001463 0000726237483 SUPARTI P PBI (APBN) Portal hypertension Sembuh

347 23-02-2018 132212010218Y001255 0000726388558 SITI MASLUKHAH P PBI (APBN) Non-insulin-dependent Sembuh
diabetes mellitus with

348 23-02-2018 132212010218Y001485 0000726472552 MISNIWATI P PBI (APBN) Portal hypertension Sembuh

349 23-02-2018 132212010218Y001268 0000726475307 SUBINI P PBI (APBN) Non-insulin-dependent Sembuh


diabetes mellitus with

350 23-02-2018 132212010218Y001017 0000726758065 YUNANTI DWI ASIH P PBI (APBN) Other specified dermatitis Berobat Jalan

351 23-02-2018 132212010218Y001495 0001263270047 SITI AISYAH P PEKERJA MANDIRI Portal hypertension Sembuh

352 23-02-2018 132212010218Y001489 0001266023709 SATUMI P PEKERJA MANDIRI Non-insulin-dependent Sembuh


diabetes mellitus without

353 23-02-2018 132212010218Y001471 0001421498237 ASLIKAH P PEKERJA MANDIRI Portal hypertension Sembuh

354 23-02-2018 132212010218Y001001 0001424084422 SUPIATUN P PEKERJA MANDIRI Other and unspecified Rujuk Lanjut
cirrhosis of liver
355 23-02-2018 132212010218Y001026 0001446236572 MUHAMMAD ALI AFIFUDDIN L PNS DAERAH Other specified dermatitis Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

356 23-02-2018 132212010218Y001480 0001537571327 SUSRIATI P PEKERJA MANDIRI Non-insulin-dependent Sembuh


diabetes mellitus without

357 23-02-2018 132212010218Y001174 0001543989172 PUTRI LINDYAWATI P PEKERJA MANDIRI Premature rupture of Rujuk Lanjut
membranes, unspecified
358 23-02-2018 132212010218Y001032 0001629567909 UMIANI P PENERIMA PENSIUN Myalgia Berobat Jalan
SWASTA
359 23-02-2018 132212010218Y001031 0001629568236 MUCHAMMAD NOFAN L PENERIMA PENSIUN Influenza with other Berobat Jalan
NURDIANSYAH SWASTA respiratory manifestations,
virus not identified

360 23-02-2018 132212010218Y001383 0001702488431 RUMANIK P PEGAWAI SWASTA Irregular menstruation, Berobat Jalan
unspecified
361 23-02-2018 132212010218Y001486 0001706041574 YUNANIK P PEGAWAI SWASTA Portal hypertension Sembuh

362 23-02-2018 132212010218Y001008 0001832760303 isyunarwan L PEKERJA MANDIRI Senile nuclear cataract Rujuk Lanjut

363 23-02-2018 132212010218Y001459 0001852356227 muryanti P PEKERJA MANDIRI Portal hypertension Sembuh

364 23-02-2018 132212010218Y001005 0001858604725 SUPAMI P PEKERJA MANDIRI Senile nuclear cataract Rujuk Lanjut

365 23-02-2018 132212010218Y001000 0001895874761 KUSNUL IRFANI P PEKERJA MANDIRI Congenital malformation of Rujuk Lanjut
lung, unspecified
366 23-02-2018 132212010218Y001493 0001969172335 MULYONO L PEKERJA MANDIRI Portal hypertension Sembuh

367 23-02-2018 132212010218Y001024 0001971544601 sumenik P PEKERJA MANDIRI Headache Berobat Jalan

368 23-02-2018 132212010218Y001015 0002016166781 SAIFUL ARIFIN L PBI (APBN) Depressive episode, Rujuk Lanjut
unspecified
369 23-02-2018 132212010218Y001466 0002016167049 RANIK SUGIRAH P PBI (APBN) Non-insulin-dependent Sembuh
diabetes mellitus without

370 23-02-2018 132212010218Y001275 0002016169492 SITI WAKIAH P PBI (APBN) Portal hypertension Sembuh

371 23-02-2018 132212010218Y001018 0002025417216 YAMINI P PBI (APBN) Myalgia Berobat Jalan

372 23-02-2018 132212010218Y001013 0002033969501 HALIMATUS SA'DIYAH P PEKERJA MANDIRI Pregnancy-related Rujuk Lanjut
condition, unspecified
373 23-02-2018 132212010218Y001028 0002034973247 hadi sucipto L PEKERJA MANDIRI Erosion of teeth Berobat Jalan

374 23-02-2018 132212010218Y001270 0002041556534 imam asy'ari L PNS DAERAH Non-insulin-dependent Sembuh
diabetes mellitus with

375 23-02-2018 132212010218Y001457 0002079861208 UTOMO L PEKERJA MANDIRI Non-insulin-dependent Sembuh


diabetes mellitus without

376 23-02-2018 132212010218Y001455 0002079861546 DAMA'IYAH P PEKERJA MANDIRI Portal hypertension Sembuh
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

377 23-02-2018 132212010218Y001020 0002083277193 PURNOMO HIDAYAT L PNS DAERAH Myalgia Berobat Jalan

378 23-02-2018 132212010218Y001021 0002083277215 FAISAL ADI PRATAMA L PNS DAERAH Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

379 23-02-2018 132212010218Y001006 0002089854797 KURDI L PEKERJA MANDIRI Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
380 23-02-2018 132212010218Y001009 0002206992047 JUWARIYAH P PEKERJA MANDIRI Arthrosis, unspecified Rujuk Lanjut

381 23-02-2018 132212010218Y001384 0002214613585 EKA NUR FADILAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
382 23-02-2018 132212010218Y001010 0002222359986 FATHIYA NUR FAIZAH P PEKERJA MANDIRI Other specified dermatitis Rujuk Lanjut

383 23-02-2018 132212010218Y001011 0002238471933 MUHAMMAD REHAN IFHAMMUL L PEKERJA MANDIRI Sialoadenitis Rujuk Lanjut
HAQ
384 23-02-2018 132212010218Y000986 0002239168083 MARINI DWI MALASARI P PEKERJA MANDIRI Chronic renal failure, Rujuk Lanjut
unspecified
385 23-02-2018 132212010218Y001385 0002252527751 MUHAMMAD FAHREZA L PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
HERDIANSYAH infection, unspecified
386 23-02-2018 132212010218Y001491 0002268877915 MISKAN L PEKERJA MANDIRI Non-insulin-dependent Sembuh
diabetes mellitus without

387 23-02-2018 132212010218Y001036 0002290294203 NURIYA P PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

388 23-02-2018 132212010218Y001027 0002307281501 WADAH P PEKERJA MANDIRI Myalgia Berobat Jalan

389 23-02-2018 132212010218Y000999 0002311359298 MARIANA IKA KURNIAWATI P PEKERJA MANDIRI Nonspecific lymphadenitis, Rujuk Lanjut
unspecified

390 23-02-2018 132212010218Y001033 0002421735625 M. SOFI'I L PEKERJA MANDIRI Seronegative rheumatoid Berobat Jalan
arthritis
391 23-02-2018 132212010218Y001029 0002429026683 SITI MAIMUNAH P PEKERJA MANDIRI Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

392 22-02-2018 132212010218Y000852 0000098491656 ADI PRASETYO L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

393 22-02-2018 132212010218Y000866 0000098497315 MUHAMMAD NUR WIDYA L PNS DAERAH Headache Rujuk Lanjut
BAHARI
394 22-02-2018 132212010218Y000860 0000098738829 PIANI P PNS DAERAH Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

395 22-02-2018 132212010218Y000850 0000099523899 AGUS ROKIM L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

396 22-02-2018 132212010218Y000884 0000168115241 SINGGIH PRASETYA L PNS DAERAH Fever, unspecified Berobat Jalan
KHARISMAWAN
397 22-02-2018 132212010218Y000854 0000171518398 HENDERINA TABITA P PNS DAERAH Chronic periodontitis Rujuk Lanjut

398 22-02-2018 132212010218Y000869 0000210961629 SUHARI L PNS DAERAH Heart disease, unspecified Rujuk Lanjut

399 22-02-2018 132212010218Y000889 0000724254669 MISNAH P PBI (APBN) Cough Berobat Jalan

400 22-02-2018 132212010218Y000877 0000724834708 SUPARMI P PBI (APBN) Myalgia Berobat Jalan

401 22-02-2018 132212010218Y000873 0000724932393 NENENG INDRAWATI P PBI (APBN) Myopia Rujuk Lanjut

402 22-02-2018 132212010218Y000890 0000725086247 MINARSIH P PBI (APBN) Dyspepsia Berobat Jalan

403 22-02-2018 132212010218Y000980 0000725102021 LILIS SINGGIH INDRAWATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
404 22-02-2018 132212010218Y001151 0000725213136 SUNANTIK P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
405 22-02-2018 132212010218Y000879 0000725237829 BANEM P PBI (APBN) Cough Berobat Jalan

406 22-02-2018 132212010218Y000862 0000725271524 RULI ANTIKASARI P PBI (APBN) Burns involving 30-39% of Rujuk Lanjut
body surface
407 22-02-2018 132212010218Y000887 0000725289423 SUWARNI P PBI (APBN) Myalgia Berobat Jalan

408 22-02-2018 132212010218Y000863 0000725350342 DARSI P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

409 22-02-2018 132212010218Y001152 0000725435188 IRAWATI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
410 22-02-2018 132212010218Y001421 0000725536146 LENI MARLINA P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

411 22-02-2018 132212010218Y000859 0000725540837 ISNAN L PBI (APBN) Other specified dermatitis Rujuk Lanjut

412 22-02-2018 132212010218Y000875 0000725573957 SUDARTI P PBI (APBN) Fever, unspecified Berobat Jalan

413 22-02-2018 132212010218Y001149 0000725577412 FAHMI NUR M L PBI (APBN) Fever, unspecified Berobat Jalan

414 22-02-2018 132212010218Y000992 0000725588381 SUNARTI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
415 22-02-2018 132212010218Y000888 0000725892164 TRI PUSPITO AYU W P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

416 22-02-2018 132212010218Y000988 0000726069172 MUTILUL HIDAYAH P PBI (APBN) Dermatitis, unspecified Berobat Jalan

417 22-02-2018 132212010218Y000991 0000726070228 SUGENG JOYO L L PBI (APBN) Acute tonsillitis, Berobat Jalan
unspecified
418 22-02-2018 132212010218Y000880 0000726078756 KASTI P PBI (APBN) Myalgia Berobat Jalan

419 22-02-2018 132212010218Y000878 0000726079105 DIYAH P PBI (APBN) Myalgia Berobat Jalan

420 22-02-2018 132212010218Y000861 0000726126557 MARYAM P PBI (APBN) Other specified dermatitis Rujuk Lanjut

421 22-02-2018 132212010218Y001119 0000726136749 GIRAN L PBI (APBN) Myalgia Berobat Jalan

422 22-02-2018 132212010218Y001150 0001043725083 MARKAMAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
423 22-02-2018 132212010218Y000981 0001043729289 SUDARWATI P PBI (APBN) Other specified Berobat Jalan
noninflammatory disorders

424 22-02-2018 132212010218Y000871 0001043732158 FATIMAH P PBI (APBN) Faecal incontinence Rujuk Lanjut

425 22-02-2018 132212010218Y001627 0001130379074 SITI MARIA ULFA P PEGAWAI SWASTA Single spontaneous Sembuh
delivery, unspecified
426 22-02-2018 132212010218Y000886 0001256293181 SUPARMI P PEKERJA MANDIRI Myalgia Berobat Jalan

427 22-02-2018 132212010218Y000876 0001322402409 KISWATI P PEKERJA MANDIRI Pure Berobat Jalan
hypercholesterolaemia
428 22-02-2018 132212010218Y000851 0001386701177 HARYONO TJANDRA L PEKERJA MANDIRI Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
429 22-02-2018 132212010218Y000872 0001425431057 ASMAIDAH P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

430 22-02-2018 132212010218Y000885 0001540179786 MISNI P PEGAWAI SWASTA Non-insulin-dependent Berobat Jalan
diabetes mellitus with

431 22-02-2018 132212010218Y000977 0001703349584 SUMARDIYA NINGSIH P PEGAWAI SWASTA Contraceptive Berobat Jalan
management, unspecified
432 22-02-2018 132212010218Y000979 0001798134096 IKA NUR INDAH SARI P PEGAWAI SWASTA Pregnancy-related Berobat Jalan
condition, unspecified
433 22-02-2018 132212010218Y000881 0001861208021 siti nur laelah P PEGAWAI SWASTA Seronegative rheumatoid Berobat Jalan
arthritis
434 22-02-2018 132212010218Y000883 0001861546173 DIDIK SUKARMANTO L PEKERJA MANDIRI Cough Berobat Jalan

435 22-02-2018 132212010218Y000870 0001884094481 untung samsi dhuka L PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

436 22-02-2018 132212010218Y000849 0001897992786 khafid khanafi L PEKERJA MANDIRI Depressive episode, Rujuk Lanjut
unspecified
437 22-02-2018 132212010218Y000874 0001898846245 suwaji L PEKERJA MANDIRI Myalgia Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

438 22-02-2018 132212010218Y000867 0001898846482 ATMIASIH P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

439 22-02-2018 132212010218Y000882 0002016164046 SUMARLIK P PBI (APBN) Gastritis, unspecified Berobat Jalan

440 22-02-2018 132212010218Y000868 0002016168715 SITI ROMELAH P PBI (APBN) Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
441 22-02-2018 132212010218Y000853 0002066958999 suyanah P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

442 22-02-2018 132212010218Y000865 0002066959361 IDA KARISMA ULVA P PEKERJA MANDIRI Candidiasis, unspecified Rujuk Lanjut

443 22-02-2018 132212010218Y000994 0002083277215 FAISAL ADI PRATAMA L PNS DAERAH Acute upper respiratory Berobat Jalan
infection, unspecified
444 22-02-2018 132212010218Y000993 0002083288781 SERYZ IBNATI ALEAZIZA P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
445 22-02-2018 132212010218Y000978 0002197566628 MUCHAMMAD AYUB ALHABSHY L PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
446 22-02-2018 132212010218Y000989 0002246112134 MUHAMMAD ALFAN NUR L PBI (APBN) Acute upper respiratory Berobat Jalan
HAMDANI infection, unspecified
447 22-02-2018 132212010218Y000864 0002283835375 JAMARI L PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

448 21-02-2018 132212010218Y000837 0000098555376 AKSAN L PENERIMA PENSIUN Portal hypertension Berobat Jalan
PNS
449 21-02-2018 132212010218Y000797 0000098557389 NIK AMAH P PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

450 21-02-2018 132212010218Y000773 0000098559933 JAYADI L PNS DAERAH Unspecified haemorrhoids Rujuk Lanjut
without complication

451 21-02-2018 132212010218Y000811 0000098563228 SATUMI P PNS DAERAH Gastritis, unspecified Berobat Jalan

452 21-02-2018 132212010218Y000776 0000098670238 GUNAWAN BUDIONO L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

453 21-02-2018 132212010218Y000779 0000098809007 MUKTI P PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

454 21-02-2018 132212010218Y000793 0000171846911 A.FATONI L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

455 21-02-2018 132212010218Y000769 0000207026526 CHOLIFAH JD MINTO AKSOMO P PENERIMA PENSIUN Heart disease, unspecified Rujuk Lanjut
PNS
456 21-02-2018 132212010218Y000785 0000723964994 CHATMINAH P PBI (APBN) Portal hypertension Rujuk Lanjut

457 21-02-2018 132212010218Y000816 0000724217027 SUCIATI P PBI (APBN) Headache Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

458 21-02-2018 132212010218Y000806 0000724259777 SANIK P PBI (APBN) Portal hypertension Rujuk Lanjut

459 21-02-2018 132212010218Y000796 0000724284426 SALMAH P PBI (APBN) Chronic renal failure, Rujuk Lanjut
unspecified
460 21-02-2018 132212010218Y000786 0000724300582 SITI KUMAIDAH P PBI (APBN) Portal hypertension Rujuk Lanjut

461 21-02-2018 132212010218Y000825 0000724782723 IMAM MUFTADI L PBI (APBN) Non-insulin-dependent Berobat Jalan
diabetes mellitus with

462 21-02-2018 132212010218Y000803 0000724844507 LINA ANGGRAINI P PBI (APBN) Injury, unspecified Berobat Jalan

463 21-02-2018 132212010218Y000855 0000724860641 SULIYONO L PBI (APBN) Injury, unspecified Berobat Jalan

464 21-02-2018 132212010218Y000831 0000725112426 KASNI P PBI (APBN) Headache Berobat Jalan

465 21-02-2018 132212010218Y000975 0000725150294 DENOK ANGGRAYNI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
466 21-02-2018 132212010218Y000810 0000725168417 KASIATI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

467 21-02-2018 132212010218Y000788 0000725179318 SUPARDI L PBI (APBN) Herpesviral [herpes Rujuk Lanjut
simplex] infections
468 21-02-2018 132212010218Y001147 0000725179454 WARTI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
469 21-02-2018 132212010218Y000833 0000725196093 NURUL MASJIDAH P PBI (APBN) Fever, unspecified Berobat Jalan

470 21-02-2018 132212010218Y000834 0000725196881 SHELVIA NURITA SARI P PBI (APBN) Fever, unspecified Berobat Jalan

471 21-02-2018 132212010218Y000823 0000725220876 DWI PREMATA S P PBI (APBN) Fever, unspecified Berobat Jalan

472 21-02-2018 132212010218Y001110 0000725220876 DWI PREMATA S P PBI (APBN) Fever, unspecified Sembuh

473 21-02-2018 132212010218Y000857 0000725237829 BANEM P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
474 21-02-2018 132212010218Y000818 0000725414398 WIWIK INDRIWATI P PBI (APBN) Myalgia Berobat Jalan

475 21-02-2018 132212010218Y000817 0000725431847 KASIAMI P PBI (APBN) Myalgia Berobat Jalan

476 21-02-2018 132212010218Y000782 0000725470514 PAINAH P PBI (APBN) Thyrotoxicosis, Rujuk Lanjut
unspecified
477 21-02-2018 132212010218Y000775 0000725478489 RINI NOVIA KURNIAWAN P PBI (APBN) Pregnancy-related Rujuk Lanjut
condition, unspecified
478 21-02-2018 132212010218Y000813 0000725543504 FIDIA RETA SARI P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

479 21-02-2018 132212010218Y000800 0000725547148 MUSRIPAH P PBI (APBN) Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

480 21-02-2018 132212010218Y000826 0000725564845 SUNTORO L PBI (APBN) Erosion of teeth Berobat Jalan

481 21-02-2018 132212010218Y000802 0000725583341 ATMINARSIH P PBI (APBN) Dyspepsia Rujuk Lanjut

482 21-02-2018 132212010218Y000821 0000725737162 KHOLIMAH FIR R P PBI (APBN) Fever, unspecified Berobat Jalan

483 21-02-2018 132212010218Y000766 0000725811175 SARIPIN L PBI (APBN) Gout, unspecified Rujuk Lanjut

484 21-02-2018 132212010218Y000835 0000725811276 TUNI P PBI (APBN) Seronegative rheumatoid Berobat Jalan
arthritis
485 21-02-2018 132212010218Y000770 0000725913235 MAHARANI A P PBI (APBN) Amenorrhoea, unspecified Rujuk Lanjut

486 21-02-2018 132212010218Y000836 0000725941541 AYU MUSLCHAHWATI P PBI (APBN) Fever, unspecified Berobat Jalan

487 21-02-2018 132212010218Y000784 0000726083627 ASIH P PBI (APBN) Dyspepsia Rujuk Lanjut

488 21-02-2018 132212010218Y000801 0000726149531 SULIKAH P PBI (APBN) Gangrene, not elsewhere Berobat Jalan
classified
489 21-02-2018 132212010218Y000767 0000726152657 MISTIANI P PBI (APBN) Dyspepsia Rujuk Lanjut

490 21-02-2018 132212010218Y000815 0000726406165 AFFAN SHIRODJUDDIN L PBI (APBN) Fever, unspecified Berobat Jalan

491 21-02-2018 132212010218Y000781 0000726760539 LAILIL MAHFUDHOH P PBI (APBN) Diffuse brain injury Rujuk Lanjut

492 21-02-2018 132212010218Y000824 0001163523251 LALA VONNY NURSYIFA' P PEGAWAI SWASTA Chronic periodontitis Berobat Jalan

493 21-02-2018 132212010218Y000822 0001273688201 BADRIYAH P PEKERJA MANDIRI Erosion of teeth Berobat Jalan

494 21-02-2018 132212010218Y000820 0001276271043 NUR KHOLIS L. M. L PEGAWAI SWASTA Fever, unspecified Berobat Jalan

495 21-02-2018 132212010218Y000787 0001297987446 MISTRI P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

496 21-02-2018 132212010218Y000778 0001386953853 VINA SITI FATIMAH P PEKERJA MANDIRI Epilepsy Rujuk Lanjut

497 21-02-2018 132212010218Y000777 0001428629951 irawan ompu L PEKERJA MANDIRI Dyspepsia Rujuk Lanjut

498 21-02-2018 132212010218Y000829 0001432568597 SRINAWATI P PEKERJA MANDIRI Gastritis, unspecified Berobat Jalan

499 21-02-2018 132212010218Y000828 0001434113313 karsudi L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

500 21-02-2018 132212010218Y000812 0001450622766 SUDARMIATIN P PEKERJA MANDIRI Non-insulin-dependent Berobat Jalan
diabetes mellitus with

501 21-02-2018 132212010218Y000789 0001729090203 SAMSUL HUDA L PEKERJA MANDIRI Chronic renal failure, Rujuk Lanjut
unspecified
502 21-02-2018 132212010218Y000804 0001851808397 sutopo L PEKERJA MANDIRI Senile cataract Rujuk Lanjut
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

503 21-02-2018 132212010218Y000805 0001851809455 satumin P PEKERJA MANDIRI Senile cataract Rujuk Lanjut

504 21-02-2018 132212010218Y000772 0001881358446 supono L PEKERJA MANDIRI Leprosy, unspecified Rujuk Lanjut

505 21-02-2018 132212010218Y000799 0001881909358 kasir L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

506 21-02-2018 132212010218Y000771 0001965940986 SUPIYATI P PEKERJA MANDIRI Acute renal failure, Rujuk Lanjut
unspecified
507 21-02-2018 132212010218Y000858 0001968352255 angga evantyo L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

508 21-02-2018 132212010218Y001148 0002071997021 AHMAD FADHIL ARDIANSYAH L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
509 21-02-2018 132212010218Y000830 0002072631969 MOCH. BADRUS SHOLEH L PEGAWAI SWASTA Fever, unspecified Berobat Jalan

510 21-02-2018 132212010218Y000856 0002195215907 AZALEA DZAHIN WIBOWO P PEGAWAI SWASTA Gastritis, unspecified Berobat Jalan

511 21-02-2018 132212010218Y000809 0002217502045 SUTIYO L PEKERJA MANDIRI Myalgia Berobat Jalan

512 21-02-2018 132212010218Y000827 0002217502438 USDEKIYANA P PEKERJA MANDIRI Myalgia Berobat Jalan

513 21-02-2018 132212010218Y000783 0002248901831 MARIA ULFA P PEKERJA MANDIRI Threatened abortion Rujuk Lanjut

514 21-02-2018 132212010218Y000976 0002256353728 MEILIANA DWI KHOIRUNNISAK P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
515 21-02-2018 132212010218Y001109 0002260720438 ALIF WIPA ARJUNA ABIDIN L PEGAWAI SWASTA Fever, unspecified Sembuh

516 21-02-2018 132212010218Y000814 0002274839649 SUMINI P PEKERJA MANDIRI Cough Berobat Jalan

517 21-02-2018 132212010218Y000780 0002284818581 LAMINI P PEKERJA MANDIRI Benign neoplasm of breast Rujuk Lanjut

518 21-02-2018 132212010218Y000832 0002293958237 PURWONINGSIH P PEKERJA MANDIRI Myalgia Berobat Jalan

519 21-02-2018 132212010218Y000774 0002305413876 IMAM SOFI'I L PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

520 21-02-2018 132212010218Y000768 0002324326768 KADAM L PEKERJA MANDIRI Calculus of kidney Rujuk Lanjut

521 21-02-2018 132212010218Y000819 0002327309381 eko cahyono L PBI (APBN) Headache Berobat Jalan

522 21-02-2018 132212010218Y000798 0002327485443 SUGIYONO L PEKERJA MANDIRI Senile incipient cataract Rujuk Lanjut

523 21-02-2018 132212010218Y000790 0002421732453 AISYAH AZZAHRA P PEKERJA MANDIRI Malignant neoplasm of Rujuk Lanjut
posterior wall of

524 20-02-2018 132212010218Y000708 0000098528332 SULIKAH L PNS DAERAH Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
525 20-02-2018 132212010218Y000744 0000098558954 SITI KHOLIFAH P PENERIMA PENSIUN Portal hypertension Rujuk Lanjut
PNS
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

526 20-02-2018 132212010218Y000747 0000098685279 MARUKI L PENERIMA PENSIUN Tuberculosis of lung, Berobat Jalan
PNS confirmed by sputum
microscopy with or without

527 20-02-2018 132212010218Y000727 0000098705351 MARIYAM P PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

528 20-02-2018 132212010218Y000714 0000098811281 SERANG L PENERIMA PENSIUN Dizziness and giddiness Rujuk Lanjut
PNS
529 20-02-2018 132212010218Y000721 0000098811303 SIH KADARMAN L PENERIMA PENSIUN Non-insulin-dependent Rujuk Lanjut
PNS diabetes mellitus without

530 20-02-2018 132212010218Y000755 0000099423876 FREDRIKA M.JD. GASPER LEO P PENERIMA PENSIUN TNI Myalgia Berobat Jalan

531 20-02-2018 132212010218Y000724 0000099523901 SUPARTININGSIH P PNS DAERAH Heart disease, unspecified Rujuk Lanjut

532 20-02-2018 132212010218Y000710 0000198238893 WIWIK WINARSIH P PENERIMA PENSIUN TNI Pure Rujuk Lanjut
hypercholesterolaemia
533 20-02-2018 132212010218Y000974 0000724583777 SUNDARI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
534 20-02-2018 132212010218Y000758 0000724815731 MISTIN P PBI (APBN) Headache Berobat Jalan

535 20-02-2018 132212010218Y000759 0000724816539 ALVIN FAKULA AKBAR L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

536 20-02-2018 132212010218Y001616 0000724869494 SAMAT L PBI (APBN) Myalgia Berobat Jalan

537 20-02-2018 132212010218Y000756 0000725136041 ALIS HANDAYANI P PBI (APBN) Myalgia Berobat Jalan

538 20-02-2018 132212010218Y000741 0000725186957 SARINTEN P PBI (APBN) Heart disease, unspecified Rujuk Lanjut

539 20-02-2018 132212010218Y000968 0000725187666 LUDYA PRATIWI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
540 20-02-2018 132212010218Y000971 0000725187993 LIA DEVI NUR F P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
541 20-02-2018 132212010218Y000719 0000725200132 MISNO L PBI (APBN) Injury, unspecified Berobat Jalan

542 20-02-2018 132212010218Y000973 0000725234174 SAMIASIH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
543 20-02-2018 132212010218Y000705 0000725263435 PAINTEN P PBI (APBN) Fracture of lower end of Rujuk Lanjut
tibia
544 20-02-2018 132212010218Y000749 0000725309133 NANDA ISFAHRUDIN L PBI (APBN) Fever, unspecified Berobat Jalan

545 20-02-2018 132212010218Y000757 0000725350342 DARSI P PBI (APBN) Headache Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

546 20-02-2018 132212010218Y000740 0000725388153 ERI ROSITA P PBI (APBN) Other headache Rujuk Lanjut
syndromes
547 20-02-2018 132212010218Y000751 0000725403183 MARET MULYADI L PBI (APBN) Fever, unspecified Berobat Jalan

548 20-02-2018 132212010218Y000765 0000725415704 AMELIA SHINTA NUR P PBI (APBN) Gastritis, unspecified Berobat Jalan
KRISTANTI
549 20-02-2018 132212010218Y000753 0000725438439 SUYATIM P PBI (APBN) Dermatitis, unspecified Berobat Jalan

550 20-02-2018 132212010218Y000760 0000725456801 ST KHASANAH P PBI (APBN) Headache Berobat Jalan

551 20-02-2018 132212010218Y000763 0000725475846 OYIK L PBI (APBN) Myalgia Berobat Jalan

552 20-02-2018 132212010218Y000728 0000725477455 SAMIN L PBI (APBN) Diarrhoea and Rujuk Lanjut
gastroenteritis of
presumed infectious origin

553 20-02-2018 132212010218Y000734 0000725494263 DIAN YENI APRILINA L PBI (APBN) Benign mammary Rujuk Lanjut
dysplasia
554 20-02-2018 132212010218Y000718 0000725509719 RATENO L PBI (APBN) Pleural effusion, not Rujuk Lanjut
elsewhere classified
555 20-02-2018 132212010218Y000706 0000725516739 SUGIATI P PBI (APBN) False labour before 37 Rujuk Lanjut
completed weeks of

556 20-02-2018 132212010218Y001146 0000725577118 MARIA U P PBI (APBN) Non-insulin-dependent Berobat Jalan
diabetes mellitus without

557 20-02-2018 132212010218Y000743 0000725586647 PAINI P PBI (APBN) Excessive and frequent Rujuk Lanjut
menstruation with regular

558 20-02-2018 132212010218Y000707 0000725601846 PARMI P PBI (APBN) Benign neoplasm of breast Rujuk Lanjut

559 20-02-2018 132212010218Y001420 0000725654092 PIANI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

560 20-02-2018 132212010218Y000745 0000725678537 ELly sABET KURNIAwati P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

561 20-02-2018 132212010218Y000739 0000725743563 SITI ROMLAH P PBI (APBN) Pterygium Rujuk Lanjut

562 20-02-2018 132212010218Y000713 0000725756962 KARINTEN P PBI (APBN) Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

563 20-02-2018 132212010218Y001617 0000725806901 HAYKAL ALASYAH P L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

564 20-02-2018 132212010218Y000969 0000725894291 RATNA UMI F P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
565 20-02-2018 132212010218Y000725 0000725910952 LIA NOVITA SARI P PBI (APBN) Chest pain, unspecified Rujuk Lanjut

566 20-02-2018 132212010218Y000716 0000726133151 SITI ROCHMAH P PBI (APBN) Calculus of gallbladder Rujuk Lanjut
without cholecystitis
567 20-02-2018 132212010218Y000748 0000726133612 M IQBAL FAZERI L PBI (APBN) Fever, unspecified Berobat Jalan

568 20-02-2018 132212010218Y000712 0000726183887 SUPARNI P PBI (APBN) Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

569 20-02-2018 132212010218Y000742 0000726217648 ASTRELIA DIAH PUTRI P PBI (APBN) Other specified anaemias Rujuk Lanjut

570 20-02-2018 132212010218Y000752 0000726293722 FANI ALIYA NINGSIH P PBI (APBN) Seronegative rheumatoid Berobat Jalan
arthritis
571 20-02-2018 132212010218Y001444 0001043725983 ATIK DIANA P P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
572 20-02-2018 132212010218Y001443 0001043725994 MUHAMMAD FAREL L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

573 20-02-2018 132212010218Y001615 0001043730538 MUNAWAROH P PBI (APBN) Myalgia Berobat Jalan

574 20-02-2018 132212010218Y000736 0001269404842 ISMAIL L PEKERJA MANDIRI Hyperplasia of prostate Rujuk Lanjut

575 20-02-2018 132212010218Y000735 0001274730208 MUHAMMAD SIDDIKHUN L PEKERJA MANDIRI Epilepsy, unspecified Rujuk Lanjut

576 20-02-2018 132212010218Y000726 0001289988472 ARIEF MISDIANTO L PEKERJA MANDIRI Depressive episode, Rujuk Lanjut
unspecified
577 20-02-2018 132212010218Y000746 0001297987446 MISTRI P PEKERJA MANDIRI Myalgia Berobat Jalan

578 20-02-2018 132212010218Y000794 0001299293392 DIAN NOVITTA P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
579 20-02-2018 132212010218Y000795 0001335135159 WILMAN ANWAR L PENERIMA PENSIUN Fever, unspecified Berobat Jalan
SWASTA
580 20-02-2018 132212010218Y000709 0001385259142 SUTIYANI P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

581 20-02-2018 132212010218Y000723 0001425431057 ASMAIDAH P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

582 20-02-2018 132212010218Y000729 0001434564009 SUMANI P PEKERJA MANDIRI Follow-up examination Rujuk Lanjut
after other treatment for

583 20-02-2018 132212010218Y000722 0001478579365 IDA LUSIANA P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

584 20-02-2018 132212010218Y000970 0001543989172 PUTRI LINDYAWATI P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
585 20-02-2018 132212010218Y000761 0001839642805 ahmad hasan basoriyah L PEKERJA MANDIRI Seronegative rheumatoid Berobat Jalan
arthritis
586 20-02-2018 132212010218Y000730 0001843678326 MUSALLAMAH P PEKERJA MANDIRI Chronic obstructive Rujuk Lanjut
pulmonary disease,

587 20-02-2018 132212010218Y000762 0001850716181 ERY SUSANTO L PEGAWAI SWASTA Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

588 20-02-2018 132212010218Y000720 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Keloid scar Berobat Jalan

589 20-02-2018 132212010218Y000750 0001960333571 DARSI P PEKERJA MANDIRI Non-insulin-dependent Berobat Jalan
diabetes mellitus with

590 20-02-2018 132212010218Y000791 0002016163089 MUSLIKAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

591 20-02-2018 132212010218Y000792 0002016172462 MISDI L PBI (APBN) Headache Berobat Jalan

592 20-02-2018 132212010218Y000715 0002053119969 SUNARI L PEKERJA MANDIRI Vertigo of central origin Rujuk Lanjut

593 20-02-2018 132212010218Y000754 0002074052215 TITIK NAWANGSIH P PEKERJA MANDIRI Portal hypertension Berobat Jalan

594 20-02-2018 132212010218Y000711 0002121391337 MOCH. RIDWAN L PBI (APBN) Fracture of lower end of Rujuk Lanjut
tibia
595 20-02-2018 132212010218Y000732 0002195898164 HERMIN P PEKERJA MANDIRI Pure Rujuk Lanjut
hypercholesterolaemia
596 20-02-2018 132212010218Y000966 0002223318936 AQILA ERRYNA MEYTHAZAHRA P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
597 20-02-2018 132212010218Y000967 0002246112134 MUHAMMAD ALFAN NUR L PBI (APBN) Acute upper respiratory Berobat Jalan
HAMDANI infection, unspecified
598 20-02-2018 132212010218Y000733 0002305782314 SUTIK P PEKERJA MANDIRI Arthrosis, unspecified Rujuk Lanjut

599 20-02-2018 132212010218Y000737 0002311271109 SUWARIYAH P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

600 20-02-2018 132212010218Y000738 0002316058784 SUTOPO L PEKERJA MANDIRI Hemiplegia, unspecified Rujuk Lanjut

601 20-02-2018 132212010218Y000764 0002316934631 SRI ENDANG P PEKERJA MANDIRI Premature rupture of Rujuk Lanjut
membranes, unspecified
602 20-02-2018 132212010218Y000717 0002419707429 AKIYAK L PEKERJA MANDIRI Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
603 20-02-2018 132212010218Y000972 0002421732453 AISYAH AZZAHRA P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

604 20-02-2018 132212010218Y000731 0002421736029 SITI JUWARIYAH P PEKERJA MANDIRI Thyrotoxicosis, Rujuk Lanjut
unspecified
605 19-02-2018 132212010218Y000627 0000034419633 SURI SAMSIKIN L PENERIMA PENSIUN TNI Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
606 19-02-2018 132212010218Y000623 0000098497135 DASAN L PNS DAERAH Myopia Rujuk Lanjut

607 19-02-2018 132212010218Y000602 0000098559652 GINARTI P PNS DAERAH Other specified dermatitis Rujuk Lanjut

608 19-02-2018 132212010218Y000658 0000098562655 PAIKAN L PNS DAERAH Chronic obstructive Rujuk Lanjut
pulmonary disease,

609 19-02-2018 132212010218Y000629 0000098702076 ROKHANIK P PENERIMA PENSIUN Arthrosis, unspecified Rujuk Lanjut
PNS
610 19-02-2018 132212010218Y000613 0000098776225 SUKARNO L PNS DAERAH Depressive episode, Rujuk Lanjut
unspecified
611 19-02-2018 132212010218Y000606 0000098782389 SOEDARTIK P PENERIMA PENSIUN TNI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

612 19-02-2018 132212010218Y000691 0000098782582 SUNARTI P PENERIMA PENSIUN TNI Seronegative rheumatoid Berobat Jalan
arthritis
613 19-02-2018 132212010218Y000663 0000098809481 ELLY RUSIJATI P PENERIMA PENSIUN Portal hypertension Rujuk Lanjut
PNS
614 19-02-2018 132212010218Y000605 0000098810008 M. MASRUR L PENERIMA PENSIUN Dyspepsia Rujuk Lanjut
PNS
615 19-02-2018 132212010218Y000604 0000098810019 SITI UMMI KULTSUM P PENERIMA PENSIUN Dyspepsia Rujuk Lanjut
PNS
616 19-02-2018 132212010218Y000616 0000098830721 SUNARTI P PENERIMA PENSIUN Dyspepsia Rujuk Lanjut
PNS
617 19-02-2018 132212010218Y000670 0000194926735 MUHAMMAD CHESTA AIRELL L PNS DAERAH Chronic periodontitis Berobat Jalan

618 19-02-2018 132212010218Y000690 0000198540573 RAHMAD REHAN ZAKI L PNS DAERAH Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

619 19-02-2018 132212010218Y000615 0000199697242 SUPIK'ANAH P PNS DAERAH Epilepsy, unspecified Rujuk Lanjut

620 19-02-2018 132212010218Y000635 0000724266189 JAMA'IYAH P PBI (APBN) Fracture of shaft of ulna Rujuk Lanjut

621 19-02-2018 132212010218Y000681 0000724281175 SUPINAH N P PBI (APBN) Non-insulin-dependent Berobat Jalan
diabetes mellitus with

622 19-02-2018 132212010218Y000612 0000724281546 ALFI DWI KARTIKA SARI P PBI (APBN) Congenital Rujuk Lanjut
dyserythropoietic anaemia
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

623 19-02-2018 132212010218Y001144 0000724650039 EKA SURYANINGSIH P PBI (APBN) Other maternal diseases Berobat Jalan
classifiable elsewhere but
complicating pregnancy,
childbirth and the
puerperium
624 19-02-2018 132212010218Y000653 0000724781889 SYAFIIN NUR C L PBI (APBN) Sleep disorder, Rujuk Lanjut
unspecified
625 19-02-2018 132212010218Y000622 0000724798405 KANAPI L PBI (APBN) Senile incipient cataract Rujuk Lanjut

626 19-02-2018 132212010218Y000619 0000724808169 SUDIYONO L PBI (APBN) Portal hypertension Rujuk Lanjut

627 19-02-2018 132212010218Y000634 0000724868357 NUR LATIFAH P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

628 19-02-2018 132212010218Y000601 0000724868943 ASIYAH P PBI (APBN) Thyrotoxicosis, Rujuk Lanjut
unspecified
629 19-02-2018 132212010218Y000682 0000724878505 SUTIA MIRAH P PBI (APBN) Fever, unspecified Berobat Jalan

630 19-02-2018 132212010218Y001143 0000725064895 DENY YUNITA SARI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
631 19-02-2018 132212010218Y000620 0000725095271 MARYANI L PBI (APBN) Malignant neoplasm of Rujuk Lanjut
thyroid gland
632 19-02-2018 132212010218Y000983 0000725116263 MARIYAM P PBI (APBN) Fever, unspecified Sembuh

633 19-02-2018 132212010218Y000701 0000725117264 NGATIRAN L PBI (APBN) Myalgia Berobat Jalan

634 19-02-2018 132212010218Y000673 0000725120853 PERLY LUCKY K P PBI (APBN) Other specified dermatitis Berobat Jalan

635 19-02-2018 132212010218Y001611 0000725130808 SITI KHOTIMAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

636 19-02-2018 132212010218Y000683 0000725186619 NURAHMI P PBI (APBN) Portal hypertension Berobat Jalan

637 19-02-2018 132212010218Y000679 0000725245615 MINARSIH P PBI (APBN) Pure Berobat Jalan
hypercholesterolaemia
638 19-02-2018 132212010218Y000633 0000725256887 SEMIATI P PBI (APBN) Other cholelithiasis Rujuk Lanjut

639 19-02-2018 132212010218Y000626 0000725262974 HAYATI P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

640 19-02-2018 132212010218Y000628 0000725267632 JUWITO L PBI (APBN) Gastritis, unspecified Rujuk Lanjut

641 19-02-2018 132212010218Y000648 0000725284348 SUPRAPTI P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

642 19-02-2018 132212010218Y000689 0000725284462 MUTA'AVIVI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

643 19-02-2018 132212010218Y000678 0000725333444 SATUWI L PBI (APBN) Pure Berobat Jalan
hypercholesterolaemia
644 19-02-2018 132212010218Y000669 0000725350342 DARSI P PBI (APBN) Cough Berobat Jalan

645 19-02-2018 132212010218Y000688 0000725380378 SUWANTO L PBI (APBN) Myalgia Berobat Jalan

646 19-02-2018 132212010218Y001322 0000725389222 sukardi L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
647 19-02-2018 132212010218Y001108 0000725403655 SIYATI P PBI (APBN) Fever, unspecified Sembuh

648 19-02-2018 132212010218Y000700 0000725423646 SUPINI P PBI (APBN) Cough Berobat Jalan

649 19-02-2018 132212010218Y000614 0000725464855 SITI NURHAYATI P PBI (APBN) Surveillance of Rujuk Lanjut
(intrauterine) contraceptive

650 19-02-2018 132212010218Y001111 0000725471504 PRIDI HARNOWO L PBI (APBN) Fever, unspecified Sembuh

651 19-02-2018 132212010218Y000990 0000725477455 SAMIN L PBI (APBN) Fever, unspecified Sembuh

652 19-02-2018 132212010218Y000647 0000725491697 ROKEMAH P PBI (APBN) Orthopaedic follow-up Rujuk Lanjut
care, unspecified
653 19-02-2018 132212010218Y000702 0000725534065 M ANGGA SAPUTRA L PBI (APBN) Erosion of teeth Berobat Jalan

654 19-02-2018 132212010218Y000687 0000725549365 ROMAASAH P PBI (APBN) Erosion of teeth Berobat Jalan

655 19-02-2018 132212010218Y000599 0000725552054 SUPRIYATIN P PBI (APBN) Pre-eclampsia, Rujuk Lanjut
unspecified
656 19-02-2018 132212010218Y001612 0000725558297 MOH SODIQ L PBI (APBN) Myalgia Berobat Jalan

657 19-02-2018 132212010218Y001613 0000725559287 YULAIKAH P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
658 19-02-2018 132212010218Y001614 0000725561109 ZASKIA NABILA A P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
659 19-02-2018 132212010218Y001142 0000725577906 SAGI T L PBI (APBN) Asthma Berobat Jalan

660 19-02-2018 132212010218Y001419 0000725582676 MUHAMAD NUR HUDAH L PBI (APBN) Fever of other and Berobat Jalan
unknown origin
661 19-02-2018 132212010218Y000667 0000725595737 AINUR JANAH P PBI (APBN) Fever, unspecified Berobat Jalan

662 19-02-2018 132212010218Y000677 0000725668255 SETI P PBI (APBN) Injury, unspecified Berobat Jalan

663 19-02-2018 132212010218Y000657 0000725676895 SUKARI L PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

664 19-02-2018 132212010218Y000621 0000725699586 MIFTAHUL ULFAH P PBI (APBN) Surveillance of Rujuk Lanjut
(intrauterine) contraceptive

665 19-02-2018 132212010218Y000674 0000725719858 TOYO L PBI (APBN) Fever, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

666 19-02-2018 132212010218Y000695 0000725731839 SOFI'AH P PBI (APBN) Myalgia Berobat Jalan

667 19-02-2018 132212010218Y000625 0000725732651 NIKMATUN W P PBI (APBN) Benign neoplasm of Rujuk Lanjut
urinary organs
668 19-02-2018 132212010218Y000640 0000725746498 MI'AN L PBI (APBN) Unilateral or unspecified Rujuk Lanjut
inguinal hernia, without

669 19-02-2018 132212010218Y000651 0000725751123 DWI WIJAYANTI P PBI (APBN) Benign neoplasm of breast Rujuk Lanjut

670 19-02-2018 132212010218Y000636 0000725777706 GIMAH P PBI (APBN) Pterygium Rujuk Lanjut

671 19-02-2018 132212010218Y000693 0000725819624 M SOLEH L PBI (APBN) Myalgia Berobat Jalan

672 19-02-2018 132212010218Y000680 0000725934251 NURIYANTI P PBI (APBN) Erosion of teeth Berobat Jalan

673 19-02-2018 132212010218Y000698 0000725956457 NGATMINAH P PBI (APBN) Other specified dermatitis Berobat Jalan

674 19-02-2018 132212010218Y000699 0000725956762 SEBA PRARETNO S P PBI (APBN) Other specified dermatitis Berobat Jalan

675 19-02-2018 132212010218Y000662 0000725958988 NINUK SUSILOWATI P PBI (APBN) Pre-eclampsia, Rujuk Lanjut
unspecified
676 19-02-2018 132212010218Y000659 0000726106173 KASIYATI P PBI (APBN) Heart disease, unspecified Rujuk Lanjut

677 19-02-2018 132212010218Y000694 0000726113823 TIARAH P PBI (APBN) Non-insulin-dependent Berobat Jalan
diabetes mellitus with

678 19-02-2018 132212010218Y000965 0000726123093 LIYA WULANDARI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
679 19-02-2018 132212010218Y000675 0000726396129 MISTARI L PBI (APBN) Myalgia Berobat Jalan

680 19-02-2018 132212010218Y000641 0000726476951 DEWI SALAMIAH P PBI (APBN) False labour before 37 Rujuk Lanjut
completed weeks of

681 19-02-2018 132212010218Y000697 0000726820604 INDAH YULIATIN P PBI (APBN) Gastritis, unspecified Berobat Jalan

682 19-02-2018 132212010218Y001441 0001043726207 SRI LESTARI P PBI (APBN) Gastritis, unspecified Berobat Jalan

683 19-02-2018 132212010218Y001442 0001043726297 SITI MASULAH P PBI (APBN) Headache Berobat Jalan

684 19-02-2018 132212010218Y000600 0001043730336 DIDIK PURNOMO L PBI (APBN) Headache Rujuk Lanjut

685 19-02-2018 132212010218Y000684 0001043731091 RIFQI MAULANA LINRING L PBI (APBN) Fever, unspecified Berobat Jalan

686 19-02-2018 132212010218Y000652 0001043734228 NOVIA BUDIARI P PBI (APBN) Thyrotoxicosis, Rujuk Lanjut
unspecified
687 19-02-2018 132212010218Y000631 0001043735049 KARTI P PBI (APBN) Myopia Rujuk Lanjut

688 19-02-2018 132212010218Y000661 0001203738502 KHOIROTUN NIZAK P PEGAWAI SWASTA Iron deficiency anaemia Rujuk Lanjut
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

689 19-02-2018 132212010218Y000607 0001262658936 SUMIANI P PEKERJA MANDIRI Chronic obstructive Rujuk Lanjut
pulmonary disease,

690 19-02-2018 132212010218Y000624 0001263270047 SITI AISYAH P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

691 19-02-2018 132212010218Y000664 0001315516083 RULIYATI P PEKERJA MANDIRI Depressive episode, Rujuk Lanjut
unspecified
692 19-02-2018 132212010218Y000666 0001340055562 YENI KRISTANTI P PEKERJA MANDIRI Myopia Rujuk Lanjut

693 19-02-2018 132212010218Y000611 0001382194675 ROBBIYAN SYAH L PEKERJA MANDIRI Nonsuppurative otitis Rujuk Lanjut
media, unspecified
694 19-02-2018 132212010218Y000685 0001445497053 WASIAH P PEKERJA MANDIRI Pure Berobat Jalan
hypercholesterolaemia
695 19-02-2018 132212010218Y000692 0001535351196 NADYA FINANDA SETYORINI P PEGAWAI SWASTA Fever, unspecified Berobat Jalan

696 19-02-2018 132212010218Y000603 0001540011003 YUDI SISWANTO L PEGAWAI SWASTA Low back pain Rujuk Lanjut

697 19-02-2018 132212010218Y000645 0001706951777 SITI JUWARIYAH ASMA ULFA P PEGAWAI SWASTA Injury of muscle and Rujuk Lanjut
tendon of abdomen, lower

698 19-02-2018 132212010218Y000703 0001728701739 SUTRAMI P PEKERJA MANDIRI Non-insulin-dependent Berobat Jalan
diabetes mellitus with

699 19-02-2018 132212010218Y000637 0001786867108 LASIANAH P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

700 19-02-2018 132212010218Y000655 0001821237759 BAMBANG HARIYADI L PEKERJA MANDIRI Chorioretinal inflammation Rujuk Lanjut

701 19-02-2018 132212010218Y000630 0001822657781 SAMUJIONO L PEGAWAI SWASTA Pure Rujuk Lanjut
hypercholesterolaemia
702 19-02-2018 132212010218Y000671 0001822660738 SUSWATI P PEGAWAI SWASTA Headache Berobat Jalan

703 19-02-2018 132212010218Y000654 0001826309428 DESTIAN ARMADA DWI L PEKERJA MANDIRI Fracture of upper end of Rujuk Lanjut
SUDIBYO tibia
704 19-02-2018 132212010218Y000665 0001835075024 YUNITA WIDYA MAYASARI P PEKERJA MANDIRI Myopia Rujuk Lanjut

705 19-02-2018 132212010218Y000608 0001866569387 YAYUK SUTIANINGSIH P PEKERJA MANDIRI Other cholelithiasis Rujuk Lanjut

706 19-02-2018 132212010218Y000618 0001875547596 SUPRIYADI L PEKERJA MANDIRI Calculus of kidney Rujuk Lanjut

707 19-02-2018 132212010218Y000609 0001906036593 KOTIMAH P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

708 19-02-2018 132212010218Y000676 0001906178681 NURUL MAZIKHAH P PEGAWAI SWASTA Fever, unspecified Berobat Jalan

709 19-02-2018 132212010218Y000660 0002016166893 WANAJI L PBI (APBN) Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

710 19-02-2018 132212010218Y000617 0002016167332 TITIK HIDAYATUR R P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

711 19-02-2018 132212010218Y000672 0002016168715 SITI ROMELAH P PBI (APBN) Fever, unspecified Berobat Jalan

712 19-02-2018 132212010218Y000642 0002016168862 MACHFUD L PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

713 19-02-2018 132212010218Y000704 0002016171099 WIRADITA P PBI (APBN) Headache Berobat Jalan

714 19-02-2018 132212010218Y000632 0002058038706 achmad ali fauzi L PEKERJA MANDIRI Fever, unspecified Rujuk Lanjut

715 19-02-2018 132212010218Y000649 0002066495905 MILA P PNS DAERAH Chronic obstructive Rujuk Lanjut
pulmonary disease,

716 19-02-2018 132212010218Y001323 0002077326562 cuplik wati P PEKERJA MANDIRI Headache Berobat Jalan

717 19-02-2018 132212010218Y000686 0002198175287 suma'iyah P PEKERJA MANDIRI Headache Berobat Jalan

718 19-02-2018 132212010218Y001145 0002205489352 ALFIYAH P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
719 19-02-2018 132212010218Y000610 0002239436024 MUCHID HASAN BISRI L PEKERJA MANDIRI Malignant neuroleptic Rujuk Lanjut
syndrome
720 19-02-2018 132212010218Y000696 0002256415997 SUTRISNO L PEKERJA MANDIRI Erosion of teeth Berobat Jalan

721 19-02-2018 132212010218Y000644 0002270035495 SITI DEWI ASTUTIK P PEKERJA MANDIRI Threatened abortion Rujuk Lanjut

722 19-02-2018 132212010218Y001371 0002285943772 AHMAD RAFFA AMIRULLOH L PBI (APBN) Need for immunization Berobat Jalan
against
diphtheria-tetanus-pertussi

723 19-02-2018 132212010218Y000643 0002301416076 INWIDYASTUTI P PEKERJA MANDIRI Myopia Rujuk Lanjut

724 19-02-2018 132212010218Y000639 0002311373979 YAHDI L PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

725 19-02-2018 132212010218Y000656 0002311517103 pinanggeh yugo lanang L PBI (APBN) Down's syndrome, Rujuk Lanjut
unspecified
726 19-02-2018 132212010218Y000638 0002318110277 qiana arsyila candramarta P PEKERJA MANDIRI Kernicterus, unspecified Rujuk Lanjut

727 19-02-2018 132212010218Y000668 0002318779809 FATIMATUZ ZAHROH P PEKERJA MANDIRI Cough Berobat Jalan

728 19-02-2018 132212010218Y000646 0002424759568 AULIA PUTRI CAHYANI P PEKERJA MANDIRI Diffuse brain injury, with Rujuk Lanjut
SUKARTO open intracranial wound
729 19-02-2018 132212010218Y000650 0002425207206 BENNY SATRIA WICAKSONO L PEKERJA MANDIRI Benign neoplasm of other Rujuk Lanjut
specified sites
730 19-02-2018 132212010218Y000982 0002430897039 RAWAT KARTINI P PENERIMA PENSIUN Other anaemias Sembuh
PNS
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

731 18-02-2018 132212010218Y000591 0000098711559 TASYA GALUH MAHARANI P PNS DAERAH Acute upper respiratory Berobat Jalan
infection, unspecified
732 18-02-2018 132212010218Y000593 0000098761533 RATNANINGSIH P PNS DAERAH Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

733 18-02-2018 132212010218Y000598 0000725120853 PERLY LUCKY K P PBI (APBN) Fever, unspecified Berobat Jalan

734 18-02-2018 132212010218Y000592 0000726798677 TAUFIKQURRAHMAN L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
735 18-02-2018 132212010218Y000597 0002016172462 MISDI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

736 18-02-2018 132212010218Y000596 0002085776212 RISKY EKA YULIANTO L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
737 18-02-2018 132212010218Y000595 0002424085435 SUPARDI L PEKERJA MANDIRI Myalgia Berobat Jalan

738 18-02-2018 132212010218Y000594 0002424086245 SUTIANI P PEKERJA MANDIRI Portal hypertension Berobat Jalan

739 17-02-2018 132212010218Y000530 0000098563961 SUMAJI L PNS DAERAH Myopia Rujuk Lanjut

740 17-02-2018 132212010218Y000542 0000098623045 K. ISTIHANAH P PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
741 17-02-2018 132212010218Y000533 0000098673592 NOERIADI L PENERIMA PENSIUN Status asthmaticus Rujuk Lanjut
PNS
742 17-02-2018 132212010218Y000538 0000098690793 RR.ARMANIJATI P PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
743 17-02-2018 132212010218Y000541 0000098772884 RIYAYININGSIH P PNS DAERAH Erosion of teeth Berobat Jalan

744 17-02-2018 132212010218Y000544 0000098811617 SOERIP L PENERIMA PENSIUN TNI Headache Berobat Jalan

745 17-02-2018 132212010218Y000540 0000723827619 HANDRI. A L PBI (APBN) Depressive episode, Berobat Jalan
unspecified
746 17-02-2018 132212010218Y000539 0000724252015 NURSIYANTO L PBI (APBN) Portal hypertension Berobat Jalan

747 17-02-2018 132212010218Y000515 0000724860011 MIFLIKAH P PBI (APBN) Contraceptive Rujuk Lanjut
management, unspecified
748 17-02-2018 132212010218Y001141 0000725000681 KHOIRINA PUTRI ARIFIN P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
749 17-02-2018 132212010218Y000521 0000725172096 KHOIRUL ANANG L PBI (APBN) Burns involving 10-19% of Berobat Jalan
body surface
750 17-02-2018 132212010218Y000546 0000725216523 KERTO ADI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

751 17-02-2018 132212010218Y000545 0000725220876 DWI PREMATA S P PBI (APBN) Fever, unspecified Berobat Jalan

752 17-02-2018 132212010218Y000519 0000725267632 JUWITO L PBI (APBN) Hyperplasia of prostate Rujuk Lanjut

753 17-02-2018 132212010218Y000528 0000725474169 SITI RODIYAH P PBI (APBN) Malignant neoplasm of Rujuk Lanjut
thyroid gland
754 17-02-2018 132212010218Y000543 0000725513207 SANDI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

755 17-02-2018 132212010218Y001418 0000725551132 SITI RUKAYAH P PBI (APBN) Dyspnoea Berobat Jalan

756 17-02-2018 132212010218Y000536 0000725553483 TITIK SUHERMIN P PBI (APBN) Fever, unspecified Berobat Jalan

757 17-02-2018 132212010218Y001140 0000725588245 RATEMI P PBI (APBN) Other rheumatoid arthritis Berobat Jalan

758 17-02-2018 132212010218Y000524 0000725648681 JUMAIYAH P PBI (APBN) Thyrotoxicosis with toxic Rujuk Lanjut
multinodular goitre
759 17-02-2018 132212010218Y000527 0000725669346 DIFSRI YAYUGI P PBI (APBN) Other polyp of sinus Rujuk Lanjut

760 17-02-2018 132212010218Y000987 0000725819703 CHUSNUL CHOTIMAH P PBI (APBN) Fever, unspecified Sembuh

761 17-02-2018 132212010218Y000534 0000725933283 INDAH FITRIYANI P PBI (APBN) Headache Berobat Jalan

762 17-02-2018 132212010218Y000535 0000725935083 MAYA NUR ALIEFA P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

763 17-02-2018 132212010218Y000508 0000726082075 ENI YULIATI P PBI (APBN) Depressive episode, Rujuk Lanjut
unspecified
764 17-02-2018 132212010218Y000590 0000726149531 SULIKAH P PBI (APBN) Gangrene, not elsewhere Berobat Jalan
classified
765 17-02-2018 132212010218Y000547 0000726439498 WARNI P PBI (APBN) Myalgia Berobat Jalan

766 17-02-2018 132212010218Y001440 0001043726196 SLAMET AGUS SUYATNO L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
767 17-02-2018 132212010218Y000587 0001043728672 ABEL MEI KUMALA P PBI (APBN) Fever, unspecified Berobat Jalan

768 17-02-2018 132212010218Y000589 0001327289714 IKA SETYOWATI P PEGAWAI SWASTA Headache Berobat Jalan

769 17-02-2018 132212010218Y000529 0001407976198 IWAN MAULANA L PEGAWAI SWASTA Nausea and vomiting Berobat Jalan

770 17-02-2018 132212010218Y000526 0001422363115 MULYANI L PEKERJA MANDIRI Dyspepsia Rujuk Lanjut

771 17-02-2018 132212010218Y000509 0001436919682 NURKAYADI L PEKERJA MANDIRI Other specified dermatitis Rujuk Lanjut

772 17-02-2018 132212010218Y000517 0001471735934 SUWATI P PEKERJA MANDIRI Dyspepsia Rujuk Lanjut

773 17-02-2018 132212010218Y000522 0001847587825 ARIF BUDI ARNO L PEKERJA MANDIRI Depressive episode, Rujuk Lanjut
unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

774 17-02-2018 132212010218Y000548 0001851808397 sutopo L PEKERJA MANDIRI Pure Rujuk Lanjut
hypercholesterolaemia
775 17-02-2018 132212010218Y000549 0001851809455 satumin P PEKERJA MANDIRI Acute serous otitis media Rujuk Lanjut

776 17-02-2018 132212010218Y000531 0001870608238 KHOTIMAH P PEKERJA MANDIRI Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
777 17-02-2018 132212010218Y000523 0001906583387 SUKIRAN L PEKERJA MANDIRI Heart disease, unspecified Rujuk Lanjut

778 17-02-2018 132212010218Y000532 0002016171595 SUMAIYAH L PBI (APBN) Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
779 17-02-2018 132212010218Y000995 0002079861208 UTOMO L PEKERJA MANDIRI Diarrhoea and Sembuh
gastroenteritis of
presumed infectious origin

780 17-02-2018 132212010218Y000964 0002091222595 retno P PBI (APBN) Puerperal sepsis Berobat Jalan

781 17-02-2018 132212010218Y000588 0002197566628 MUCHAMMAD AYUB ALHABSHY L PEGAWAI SWASTA Dyspepsia Berobat Jalan

782 17-02-2018 132212010218Y000537 0002228877134 EDI PRAYITNO L PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

783 17-02-2018 132212010218Y000510 0002229179354 IKA SYAFA'ATIN P PEKERJA MANDIRI Other anaemias Rujuk Lanjut

784 17-02-2018 132212010218Y000518 0002229199413 MUKAMMAD L PEKERJA MANDIRI Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
785 17-02-2018 132212010218Y000586 0002252527751 MUHAMMAD FAHREZA L PEGAWAI SWASTA Fever, unspecified Berobat Jalan
HERDIANSYAH
786 17-02-2018 132212010218Y000525 0002264990038 NGATMININGSEH P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

787 17-02-2018 132212010218Y000507 0002421046563 ERIS NURSAVITRI P PEKERJA MANDIRI Benign lipomatous Rujuk Lanjut
neoplasm of skin and
subcutaneous tissue of

788 17-02-2018 132212010218Y000520 0002428542055 MARSUDI SUSENO L PEKERJA MANDIRI Heart disease, unspecified Rujuk Lanjut

789 16-02-2018 132212010218Y000438 0000198540573 RAHMAD REHAN ZAKI L PNS DAERAH Acute pharyngitis, Berobat Jalan
unspecified
790 16-02-2018 132212010218Y000516 0000725592712 MIA OLIVIA CHINTYA P PBI (APBN) Allergy, unspecified Berobat Jalan

791 16-02-2018 132212010218Y000512 0000725695479 SUNTAJI L PBI (APBN) Dyspepsia Berobat Jalan

792 16-02-2018 132212010218Y000435 0000725746498 MI'AN L PBI (APBN) Unilateral or unspecified Berobat Jalan
inguinal hernia, without
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

793 16-02-2018 132212010218Y000514 0001256293181 SUPARMI P PEKERJA MANDIRI Myalgia Berobat Jalan

794 16-02-2018 132212010218Y000511 0001906583387 SUKIRAN L PEKERJA MANDIRI Heart disease, unspecified Berobat Jalan

795 16-02-2018 132212010218Y000434 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Keloid scar Berobat Jalan

796 16-02-2018 132212010218Y000436 0002016171099 WIRADITA P PBI (APBN) Gastritis, unspecified Berobat Jalan

797 16-02-2018 132212010218Y000437 0002035705331 zaris feriansyah L PEKERJA MANDIRI Nausea and vomiting Berobat Jalan

798 16-02-2018 132212010218Y000513 0002203143221 DAFFA MUHAMMAD FAREL L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

799 16-02-2018 132212010218Y000439 0002287058038 NIATRI ANANDAR P PEKERJA MANDIRI Injury, unspecified Berobat Jalan
MEGANINGRUM
800 15-02-2018 132212010218Y000452 0000098556175 GUNAWAN L PNS DAERAH Myalgia Berobat Jalan

801 15-02-2018 132212010218Y000409 0000098670238 GUNAWAN BUDIONO L PNS DAERAH Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
802 15-02-2018 132212010218Y000413 0000098710165 SUMEDI L PNS DAERAH Myopia Rujuk Lanjut

803 15-02-2018 132212010218Y000445 0000098718862 RAHAYU NINGSIH P PENERIMA PENSIUN Seronegative rheumatoid Berobat Jalan
PNS arthritis
804 15-02-2018 132212010218Y000455 0000098732845 AZZAHRA FIRDA ERINAPUTRI P PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

805 15-02-2018 132212010218Y000430 0000099476717 TRINAH AL TRIYONO L PENERIMA PENSIUN Injury, unspecified Berobat Jalan
PNS
806 15-02-2018 132212010218Y000456 0000168082986 MASRULIYAH P PNS DAERAH Fever, unspecified Berobat Jalan

807 15-02-2018 132212010218Y000952 0000210659321 SLIMAH P PNS DAERAH Contraceptive Berobat Jalan
management, unspecified
808 15-02-2018 132212010218Y000432 0000723957153 WARSI P PBI (APBN) Injury, unspecified Berobat Jalan

809 15-02-2018 132212010218Y000461 0000724259777 SANIK P PBI (APBN) Myalgia Berobat Jalan

810 15-02-2018 132212010218Y000848 0000724980644 TITIN ARISTIYANI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
811 15-02-2018 132212010218Y000415 0000724984132 FIVA AMALIYA P PBI (APBN) Fever, unspecified Rujuk Lanjut

812 15-02-2018 132212010218Y000407 0000725004189 MUNIK PARTIANI P PBI (APBN) Myopia Rujuk Lanjut

813 15-02-2018 132212010218Y000959 0000725102021 LILIS SINGGIH INDRAWATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
814 15-02-2018 132212010218Y001606 0000725151251 UMI UMAIYAH P PBI (APBN) Atopic dermatitis, Berobat Jalan
unspecified
815 15-02-2018 132212010218Y001607 0000725152476 A KHUSNI Z L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
816 15-02-2018 132212010218Y001439 0000725209277 SUWARIYAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

817 15-02-2018 132212010218Y001610 0000725212091 SUDJARWO L PBI (APBN) Myalgia Berobat Jalan

818 15-02-2018 132212010218Y000418 0000725232835 SITI MAHMUDAH P PBI (APBN) Heart disease, unspecified Rujuk Lanjut

819 15-02-2018 132212010218Y000448 0000725271524 RULI ANTIKASARI P PBI (APBN) Other specified dermatitis Berobat Jalan

820 15-02-2018 132212010218Y000440 0000725332691 PRIYONO L PBI (APBN) Myalgia Berobat Jalan

821 15-02-2018 132212010218Y000414 0000725424939 KUSNUL KOTIMAH P PBI (APBN) Chronic renal failure, Rujuk Lanjut
unspecified
822 15-02-2018 132212010218Y000446 0000725438439 SUYATIM P PBI (APBN) Other specified dermatitis Berobat Jalan

823 15-02-2018 132212010218Y000460 0000725480673 SUTARTI P PBI (APBN) Cough Berobat Jalan

824 15-02-2018 132212010218Y000997 0000725499347 SITI NUR ANDINI P PBI (APBN) Dyspepsia Sembuh

825 15-02-2018 132212010218Y000442 0000725499347 SITI NUR ANDINI P PBI (APBN) Headache Berobat Jalan

826 15-02-2018 132212010218Y000462 0000725565622 DULKALIM L PBI (APBN) Seronegative rheumatoid Berobat Jalan
arthritis
827 15-02-2018 132212010218Y000459 0000725577906 SAGI T L PBI (APBN) Seronegative rheumatoid Berobat Jalan
arthritis
828 15-02-2018 132212010218Y000984 0000725577906 SAGI T L PBI (APBN) Fever, unspecified Sembuh

829 15-02-2018 132212010218Y001628 0000725583341 ATMINARSIH P PBI (APBN) Melaena Rujuk Lanjut

830 15-02-2018 132212010218Y001139 0000725587154 ANIFAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
831 15-02-2018 132212010218Y000450 0000725710555 SUTIAH P PBI (APBN) Myalgia Berobat Jalan

832 15-02-2018 132212010218Y001416 0000725719915 SITI ROMLAH P PBI (APBN) Fever of other and Berobat Jalan
unknown origin
833 15-02-2018 132212010218Y000449 0000725732651 NIKMATUN W P PBI (APBN) Other specified dermatitis Berobat Jalan

834 15-02-2018 132212010218Y001300 0000725738883 SULIMAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

835 15-02-2018 132212010218Y000431 0000725819624 M SOLEH L PBI (APBN) Non-insulin-dependent Berobat Jalan
diabetes mellitus without

836 15-02-2018 132212010218Y000410 0000725830222 SUYONO L PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

837 15-02-2018 132212010218Y001608 0000725847783 RIANI P PBI (APBN) Noninfective Berobat Jalan
gastroenteritis and colitis,

838 15-02-2018 132212010218Y001609 0000725848751 RIYAN DWI Z L PBI (APBN) Gastritis, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

839 15-02-2018 132212010218Y001118 0000725977315 SULIYAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

840 15-02-2018 132212010218Y001302 0000726049157 SARIATI P PBI (APBN) Fever, unspecified Berobat Jalan

841 15-02-2018 132212010218Y001303 0000726052634 ASRIK P PBI (APBN) Portal hypertension Berobat Jalan

842 15-02-2018 132212010218Y001299 0000726115926 INTAN PURNAMASARI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
843 15-02-2018 132212010218Y001301 0000726136198 SRIAMAH P PBI (APBN) Allergy, unspecified Berobat Jalan

844 15-02-2018 132212010218Y001304 0000726185237 SUMNI P PBI (APBN) Myalgia Berobat Jalan

845 15-02-2018 132212010218Y000464 0000726522592 DEVINZA ADY NUR AINI P PBI (APBN) Fever, unspecified Berobat Jalan

846 15-02-2018 132212010218Y000953 0000726564701 MUTMAINAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
847 15-02-2018 132212010218Y000441 0001043731091 RIFQI MAULANA LINRING L PBI (APBN) Fever, unspecified Berobat Jalan

848 15-02-2018 132212010218Y000411 0001286807714 SAUMAR L PEKERJA MANDIRI Neurotic disorder, Rujuk Lanjut
unspecified
849 15-02-2018 132212010218Y000458 0001316936992 PAI L PEKERJA MANDIRI Myalgia Berobat Jalan

850 15-02-2018 132212010218Y000451 0001439784077 MASLIKAH P PEGAWAI SWASTA Myalgia Berobat Jalan

851 15-02-2018 132212010218Y000447 0001470197384 FARIT IRAWATI P PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

852 15-02-2018 132212010218Y000465 0001540945732 M. BAIHAKI SYA'BANA L PEKERJA MANDIRI Conjunctivitis, unspecified Berobat Jalan
ALFARUQ
853 15-02-2018 132212010218Y000962 0001704622487 SUSANTI KOSASIH P PBI (APBD) Pregnancy-related Berobat Jalan
condition, unspecified
854 15-02-2018 132212010218Y001117 0001704622566 SAUDATUN P PBI (APBD) Gastritis, unspecified Berobat Jalan

855 15-02-2018 132212010218Y000453 0001728701739 SUTRAMI P PEKERJA MANDIRI Seronegative rheumatoid Berobat Jalan
arthritis
856 15-02-2018 132212010218Y000416 0001832224487 soponyono L PEKERJA MANDIRI Other specified dermatitis Rujuk Lanjut

857 15-02-2018 132212010218Y000408 0001874474414 SABIL HERNOVIANTO L PEKERJA MANDIRI Paratyphoid fever, Rujuk Lanjut
unspecified
858 15-02-2018 132212010218Y000457 0001900297326 wiwik kusmiasih P PNS DAERAH Other specified dermatitis Berobat Jalan

859 15-02-2018 132212010218Y000957 0001903395161 AURORA ADZANA KANAYA P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
PUTRI infection, unspecified
860 15-02-2018 132212010218Y000420 0002016164169 TUMIATI SUMIATI P PBI (APBN) Pterygium Rujuk Lanjut

861 15-02-2018 132212010218Y000955 0002016167049 RANIK SUGIRAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
862 15-02-2018 132212010218Y000951 0002033969501 HALIMATUS SA'DIYAH P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

863 15-02-2018 132212010218Y000954 0002037118983 hamizan ahmad fayi L PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
864 15-02-2018 132212010218Y000463 0002079861546 DAMA'IYAH P PEKERJA MANDIRI Myalgia Berobat Jalan

865 15-02-2018 132212010218Y000433 0002089854797 KURDI L PEKERJA MANDIRI Stroke, not specified as Berobat Jalan
haemorrhage or infarction
866 15-02-2018 132212010218Y000443 0002092881666 ZULAIKHAH P PEKERJA MANDIRI Myalgia Berobat Jalan

867 15-02-2018 132212010218Y000428 0002195847584 JIHAN SINTANIA P PEKERJA MANDIRI Dyspepsia Rujuk Lanjut

868 15-02-2018 132212010218Y000417 0002198831646 athifah nurul ramadhaniah P PNS DAERAH Bronchopneumonia, Rujuk Lanjut
unspecified
869 15-02-2018 132212010218Y000963 0002198831646 athifah nurul ramadhaniah P PNS DAERAH Puerperal sepsis Berobat Jalan

870 15-02-2018 132212010218Y000958 0002232106503 nur auliya kharisma P PNS DAERAH Puerperal sepsis Berobat Jalan

871 15-02-2018 132212010218Y000444 0002238138617 WIWIK DARIATI P PEKERJA MANDIRI Headache Berobat Jalan

872 15-02-2018 132212010218Y000961 0002265968384 WAHIDATUL HASANAH P PEKERJA MANDIRI Benign neoplasm of breast Berobat Jalan

873 15-02-2018 132212010218Y000960 0002313079582 HAFIZAH SALSABILA P PEGAWAI SWASTA Puerperal sepsis Berobat Jalan

874 15-02-2018 132212010218Y000956 0002326462367 SYAREefAH SHEZA KAFFAH P PEKERJA MANDIRI Acute upper respiratory Rujuk Lanjut
BILHUDA infection, unspecified
875 15-02-2018 132212010218Y000419 0002419707429 AKIYAK L PEKERJA MANDIRI Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
876 15-02-2018 132212010218Y000454 0002425092502 MUHAMMAD AZZAM L PEKERJA MANDIRI Erosion of teeth Berobat Jalan
ALFARIZQY
877 15-02-2018 132212010218Y000429 0002426569852 ASPAN L PEKERJA MANDIRI Unspecified abdominal Rujuk Lanjut
hernia without obstruction

878 15-02-2018 132212010218Y000412 0002429895238 TEMU P PEKERJA MANDIRI Benign lipomatous Rujuk Lanjut
neoplasm
879 14-02-2018 132212010218Y000480 0000098670947 IMAM TAREH L PNS DAERAH Headache Berobat Jalan

880 14-02-2018 132212010218Y001603 0000098680779 MUNAFIAH P PNS DAERAH Myalgia Berobat Jalan

881 14-02-2018 132212010218Y000425 0000098711559 TASYA GALUH MAHARANI P PNS DAERAH Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

882 14-02-2018 132212010218Y001602 0000098811641 SOETINEM P PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
883 14-02-2018 132212010218Y000481 0000099784089 ALIF FAHTILATUN U. P PNS PUSAT Erosion of teeth Berobat Jalan

884 14-02-2018 132212010218Y000476 0000171846911 A.FATONI L PNS DAERAH Cough Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

885 14-02-2018 132212010218Y001137 0000723418323 PUTRI LAILIA FITRI P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

886 14-02-2018 132212010218Y000491 0000724198149 IFTIHA ADILYANA P PBI (APBN) Headache Berobat Jalan

887 14-02-2018 132212010218Y000486 0000724216061 MUSTOFA L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

888 14-02-2018 132212010218Y000475 0000724290309 MARIANA P PBI (APBN) Headache Berobat Jalan

889 14-02-2018 132212010218Y000483 0000724889204 NURIYATI P PBI (APBN) Headache Berobat Jalan

890 14-02-2018 132212010218Y000484 0000724986101 GIYANTO L PBI (APBN) Myalgia Berobat Jalan

891 14-02-2018 132212010218Y000492 0000725048807 WAGIAH P PBI (APBN) Myalgia Berobat Jalan

892 14-02-2018 132212010218Y000493 0000725099242 SUPARTI P PBI (APBN) Fever, unspecified Berobat Jalan

893 14-02-2018 132212010218Y000422 0000725100039 MOCH. GALIH PRASETYO L PBI (APBN) Acne Berobat Jalan

894 14-02-2018 132212010218Y001296 0000725150294 DENOK ANGGRAYNI P PBI (APBN) Gastritis, unspecified Berobat Jalan

895 14-02-2018 132212010218Y000498 0000725172906 ARYA AKBAR F L PBI (APBN) Chronic periodontitis Berobat Jalan

896 14-02-2018 132212010218Y000421 0000725232835 SITI MAHMUDAH P PBI (APBN) Portal hypertension Berobat Jalan

897 14-02-2018 132212010218Y000488 0000725275923 WULAN INDAH PERMATASARI P PBI (APBN) Cough Berobat Jalan

898 14-02-2018 132212010218Y001319 0000725334467 RADI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

899 14-02-2018 132212010218Y001320 0000725336032 MUNASIR L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
900 14-02-2018 132212010218Y000949 0000725336627 TRI YULIA PUSPITASARI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
901 14-02-2018 132212010218Y000495 0000725366261 SARMI P PBI (APBN) Headache Berobat Jalan

902 14-02-2018 132212010218Y000426 0000725385958 EKA YULIA KHOIRUN NISA' P PBI (APBN) Gastritis, unspecified Berobat Jalan

903 14-02-2018 132212010218Y001073 0000725444561 RENI INDARTI P PEGAWAI SWASTA Gastritis, unspecified Berobat Jalan

904 14-02-2018 132212010218Y001076 0000725455989 JUMANI P PBI (APBN) Atopic dermatitis, Berobat Jalan
unspecified
905 14-02-2018 132212010218Y001601 0000725471177 ANINDA P P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
906 14-02-2018 132212010218Y001075 0000725506604 SUNARNI P PBI (APBN) Gastritis, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

907 14-02-2018 132212010218Y001138 0000725528395 PONISAH P PBI (APBN) Headache Berobat Jalan

908 14-02-2018 132212010218Y001294 0000725560569 PARTI P PBI (APBN) Gastritis, unspecified Berobat Jalan

909 14-02-2018 132212010218Y000489 0000725573957 SUDARTI P PBI (APBN) Cough Berobat Jalan

910 14-02-2018 132212010218Y001112 0000725583341 ATMINARSIH P PBI (APBN) Melaena Rujuk Lanjut

911 14-02-2018 132212010218Y000472 0000725583341 ATMINARSIH P PBI (APBN) Melaena Sembuh

912 14-02-2018 132212010218Y001605 0000725598922 M RIO WAHYUDI L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
913 14-02-2018 132212010218Y000482 0000725682508 WARSI P PBI (APBN) Chronic periodontitis Berobat Jalan

914 14-02-2018 132212010218Y001072 0000725744327 SUPARTI P PBI (APBN) Myalgia Berobat Jalan

915 14-02-2018 132212010218Y000497 0000725756962 KARINTEN P PBI (APBN) Headache Berobat Jalan

916 14-02-2018 132212010218Y001298 0000725814753 SADI L PBI (APBN) Allergy, unspecified Berobat Jalan

917 14-02-2018 132212010218Y001297 0000725814922 RIANA P PBI (APBN) Myalgia Berobat Jalan

918 14-02-2018 132212010218Y001293 0000726237483 SUPARTI P PBI (APBN) Headache Berobat Jalan

919 14-02-2018 132212010218Y001295 0000726238416 SUSI SUMIATI P PBI (APBN) Allergy, unspecified Berobat Jalan

920 14-02-2018 132212010218Y000948 0000726266709 INAYAH P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
921 14-02-2018 132212010218Y000473 0000726471876 SUGIATI P PBI (APBN) Myalgia Berobat Jalan

922 14-02-2018 132212010218Y000496 0000726823449 YURAHATI P PBI (APBN) Seronegative rheumatoid Berobat Jalan
arthritis
923 14-02-2018 132212010218Y001074 0001043733745 EVI KHUSNUL H P PBI (APBN) Atopic dermatitis, Berobat Jalan
unspecified
924 14-02-2018 132212010218Y000471 0001269404842 ISMAIL L PEKERJA MANDIRI Headache Berobat Jalan

925 14-02-2018 132212010218Y000423 0001307630711 DWI MUSLIKH CAHYONO L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
926 14-02-2018 132212010218Y000424 0001307644637 SALWA NASY'A NI'AMI L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
927 14-02-2018 132212010218Y000487 0001436919682 NURKAYADI L PEKERJA MANDIRI Seronegative rheumatoid Berobat Jalan
arthritis
928 14-02-2018 132212010218Y000404 0001451525095 MARFUAH P PEKERJA MANDIRI Encephalocele, Rujuk Lanjut
unspecified
929 14-02-2018 132212010218Y001438 0001468194085 MARGIYATI P PEGAWAI SWASTA Other specified dermatitis Berobat Jalan

930 14-02-2018 132212010218Y000478 0001470197384 FARIT IRAWATI P PEKERJA MANDIRI Erosion of teeth Berobat Jalan

931 14-02-2018 132212010218Y000494 0001792072203 SITI MARIYAM P PEKERJA MANDIRI Myalgia Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

932 14-02-2018 132212010218Y000474 0001801953189 sukarto L PEGAWAI SWASTA Other specified dermatitis Berobat Jalan

933 14-02-2018 132212010218Y000477 0001809772604 LINDA YUNI PRATIWI P PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

934 14-02-2018 132212010218Y000406 0001901133696 SUHARTINI P PEKERJA MANDIRI Injury, unspecified Berobat Jalan

935 14-02-2018 132212010218Y001604 0002037118083 amalia callysta rosida P PEKERJA MANDIRI Acute nasopharyngitis Berobat Jalan
[common cold]
936 14-02-2018 132212010218Y000405 0002039853958 GOZALI NUR MUSLIM L PEGAWAI SWASTA Other tetanus Berobat Jalan

937 14-02-2018 132212010218Y000950 0002309765185 SITI KHOIROTUN P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
938 14-02-2018 132212010218Y000947 0002309796066 MAMIK HARIANTI P PEKERJA MANDIRI Pregnancy-related Rujuk Lanjut
condition, unspecified
939 14-02-2018 132212010218Y000427 0002424086245 SUTIANI P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
940 13-02-2018 132212010218Y001070 0000097839336 NABILA GHUFRIANA IMAMI P PNS DAERAH Fever, unspecified Berobat Jalan

941 13-02-2018 132212010218Y000371 0000098557839 RUSLAN L PNS DAERAH Conjunctivitis, unspecified Berobat Jalan

942 13-02-2018 132212010218Y000379 0000098613527 WARNOTO L PNS DAERAH Myalgia Berobat Jalan

943 13-02-2018 132212010218Y000389 0000098629209 SYAMSUL HADI L PENERIMA PENSIUN Influenza with other Berobat Jalan
PNS respiratory manifestations,
virus not identified

944 13-02-2018 132212010218Y001064 0000098658371 ASNIFAH P PENERIMA PENSIUN Headache Berobat Jalan
PNS
945 13-02-2018 132212010218Y000388 0000098680487 MAKRIFAH P PNS DAERAH Arrested dental caries Berobat Jalan

946 13-02-2018 132212010218Y001069 0000098808546 ABD. HADI, DRS. L PENERIMA PENSIUN Gastritis, unspecified Berobat Jalan
PNS
947 13-02-2018 132212010218Y000358 0000098808715 ACHMAD SOEWADI L PENERIMA PENSIUN Heart disease, unspecified Rujuk Lanjut
PNS
948 13-02-2018 132212010218Y000357 0000098808726 WAGINTEN P PENERIMA PENSIUN Dyspepsia Rujuk Lanjut
PNS
949 13-02-2018 132212010218Y000362 0000098808985 M. ICHWAN L PENERIMA PENSIUN Other specified dermatitis Rujuk Lanjut
PNS
950 13-02-2018 132212010218Y000361 0000098811178 SARIAH P PENERIMA PENSIUN Portal hypertension Rujuk Lanjut
PNS
951 13-02-2018 132212010218Y000373 0000099405235 CHUSSOTIEN JD BOERHAM P PENERIMA PENSIUN Seronegative rheumatoid Berobat Jalan
PNS arthritis
952 13-02-2018 132212010218Y000378 0000099405257 ASIJAH P PENERIMA PENSIUN Headache Berobat Jalan
PNS
953 13-02-2018 132212010218Y000353 0000099516341 MIFTAHUL ULUM L PNS DAERAH Chronic sinusitis, Rujuk Lanjut
unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

954 13-02-2018 132212010218Y000376 0000724291942 SOLIKIN L PBI (APBN) Headache Berobat Jalan

955 13-02-2018 132212010218Y000363 0000724743178 SUMARDIONO L PBI (APBN) Heart disease, unspecified Rujuk Lanjut

956 13-02-2018 132212010218Y000380 0000724744642 ARLEN YANTI P PBI (APBN) Myalgia Berobat Jalan

957 13-02-2018 132212010218Y000383 0000724759694 ARIS SUGIARTO L PBI (APBN) Depressive episode, Berobat Jalan
unspecified
958 13-02-2018 132212010218Y000382 0000724759828 ARIF SUSANTO L PBI (APBN) Depressive episode, Berobat Jalan
unspecified
959 13-02-2018 132212010218Y000384 0000724798405 KANAPI L PBI (APBN) Dyspnoea Berobat Jalan

960 13-02-2018 132212010218Y000347 0000724799878 SUGIYANTO L PBI (APBN) Heart disease, unspecified Rujuk Lanjut

961 13-02-2018 132212010218Y000368 0000724844531 SUTI P PBI (APBN) Myalgia Berobat Jalan

962 13-02-2018 132212010218Y000381 0000724893941 SUPANG JADI L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

963 13-02-2018 132212010218Y000398 0000724936206 MAS'UDDINUR L PBI (APBN) Fever, unspecified Berobat Jalan

964 13-02-2018 132212010218Y000370 0000725072534 UMIYAH P PBI (APBN) Portal hypertension Berobat Jalan

965 13-02-2018 132212010218Y000401 0000725093234 MEI RIA ADE RESFIKA P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

966 13-02-2018 132212010218Y001372 0000725108218 ENDANG RIWAYANTI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
967 13-02-2018 132212010218Y000356 0000725186619 NURAHMI P PBI (APBN) Status asthmaticus Rujuk Lanjut

968 13-02-2018 132212010218Y000394 0000725191176 PONITI P PBI (APBN) Myalgia Berobat Jalan

969 13-02-2018 132212010218Y000400 0000725245615 MINARSIH P PBI (APBN) Pure Berobat Jalan
hypercholesterolaemia
970 13-02-2018 132212010218Y001316 0000725341454 SUPIYAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
971 13-02-2018 132212010218Y000367 0000725343658 UNTUNG WULIONO L PBI (APBN) Gastritis, unspecified Berobat Jalan

972 13-02-2018 132212010218Y000467 0000725388028 SIAMAN L PBI (APBN) Diarrhoea and Sembuh
gastroenteritis of
presumed infectious origin

973 13-02-2018 132212010218Y001368 0000725389323 siti poniroh P PBI (APBN) Gastritis, unspecified Berobat Jalan

974 13-02-2018 132212010218Y001370 0000725391562 SUNALI L PBI (APBN) Portal hypertension Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

975 13-02-2018 132212010218Y000468 0000725412701 KATIN P PBI (APBN) Diarrhoea and Sembuh
gastroenteritis of
presumed infectious origin

976 13-02-2018 132212010218Y000364 0000725424939 KUSNUL KOTIMAH P PBI (APBN) Chronic renal failure, Rujuk Lanjut
unspecified
977 13-02-2018 132212010218Y000397 0000725436112 SUPARMI P PBI (APBN) Pure Berobat Jalan
hypercholesterolaemia
978 13-02-2018 132212010218Y001061 0000725436325 SITI ZULAIKAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

979 13-02-2018 132212010218Y001066 0000725455304 SUMAIYAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

980 13-02-2018 132212010218Y001600 0000725469489 NURIAH P PBI (APBN) Noninfective Berobat Jalan
gastroenteritis and colitis,

981 13-02-2018 132212010218Y001071 0000725470806 WINGKOMIDAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

982 13-02-2018 132212010218Y000576 0000725473394 SUWARNI P PBI (APBN) Dyspepsia Berobat Jalan

983 13-02-2018 132212010218Y001318 0000725481786 ANANG SUYANTO L PBI (APBN) Gastritis, unspecified Berobat Jalan

984 13-02-2018 132212010218Y001317 0000725491214 SENIWATI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
985 13-02-2018 132212010218Y001598 0000725496333 DAVA MAULANA S L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
986 13-02-2018 132212010218Y001063 0000725501924 KASIANI P PBI (APBN) Gastritis, unspecified Berobat Jalan

987 13-02-2018 132212010218Y000349 0000725513365 KATIJAH P PBI (APBN) Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

988 13-02-2018 132212010218Y000577 0000725541276 SUMANI P PBI (APBN) Fever, unspecified Berobat Jalan

989 13-02-2018 132212010218Y000941 0000725541906 ZULFATUL AULIA P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
990 13-02-2018 132212010218Y000387 0000725545067 WATINI P PBI (APBN) Headache Berobat Jalan

991 13-02-2018 132212010218Y001135 0000725598268 MISENAH P PBI (APBN) Conjunctivitis, unspecified Berobat Jalan

992 13-02-2018 132212010218Y000402 0000725605121 LILIS RETNOWATI P PBI (APBN) Portal hypertension Berobat Jalan

993 13-02-2018 132212010218Y001136 0000725663452 KRISPIANTI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
994 13-02-2018 132212010218Y001367 0000725693229 SRI NARTI P PBI (APBN) Adverse effects in the Berobat Jalan
therapeutic use of cholera

995 13-02-2018 132212010218Y000943 0000725712849 ANIS FITRIANI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

996 13-02-2018 132212010218Y000403 0000725717441 ELVINA DAMAYANTI P PBI (APBN) Fever, unspecified Berobat Jalan

997 13-02-2018 132212010218Y000942 0000725736756 NUR HAYATI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
998 13-02-2018 132212010218Y000366 0000725757963 SINDI DEVI WULANDARI P PBI (APBN) Gastritis, unspecified Berobat Jalan

999 13-02-2018 132212010218Y001437 0000725783411 FITA FAJAR DAMAYANTI P PBI (APBN) Gastritis, unspecified Berobat Jalan

1000 13-02-2018 132212010218Y001068 0000725783578 SUNYOTO L PBI (APBN) Gastritis, unspecified Berobat Jalan

1001 13-02-2018 132212010218Y001067 0000725784041 PIAH P PBI (APBN) Headache Berobat Jalan

1002 13-02-2018 132212010218Y000945 0000725826914 SOLIKHAH P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1003 13-02-2018 132212010218Y000374 0000725831987 SEMIN L PBI (APBN) Conjunctivitis, unspecified Berobat Jalan

1004 13-02-2018 132212010218Y000372 0000725834709 PUTRI NIVA W P PBI (APBN) Fever, unspecified Berobat Jalan

1005 13-02-2018 132212010218Y001599 0000725847614 HARNOTO L PBI (APBN) Myalgia Berobat Jalan

1006 13-02-2018 132212010218Y001597 0000725848841 RISA WIJAYANTI P PBI (APBN) Gastritis, unspecified Berobat Jalan

1007 13-02-2018 132212010218Y000578 0000725865085 SUMIATI P PBI (APBN) Migraine, unspecified Berobat Jalan

1008 13-02-2018 132212010218Y000469 0000726054568 ANISA'UL KHOIROH P PBI (APBN) Typhoid and paratyphoid Sembuh
fevers
1009 13-02-2018 132212010218Y000396 0000726054568 ANISA'UL KHOIROH P PBI (APBN) Fever, unspecified Berobat Jalan

1010 13-02-2018 132212010218Y000350 0000726106173 KASIYATI P PBI (APBN) Portal hypertension Rujuk Lanjut

1011 13-02-2018 132212010218Y000847 0000726190661 SARIMIN L PBI (APBN) Portal hypertension Berobat Jalan

1012 13-02-2018 132212010218Y001062 0000726377668 RENDA RISMAWATI P PBI (APBN) Atopic dermatitis, Berobat Jalan
unspecified
1013 13-02-2018 132212010218Y000352 0000726807745 ELI PRAMUDITA P PBI (APBN) Dyspepsia Rujuk Lanjut

1014 13-02-2018 132212010218Y000395 0000976198059 MISBAHUDIN FAUZI L PNS DAERAH Headache Berobat Jalan

1015 13-02-2018 132212010218Y000348 0001127289857 UNTUNG MARGONO L PEKERJA MANDIRI Acute tubulo-interstitial Rujuk Lanjut
nephritis
1016 13-02-2018 132212010218Y000583 0001132607946 KHUSWATUN Khasanah P PEGAWAI SWASTA Single spontaneous Sembuh
delivery, unspecified
1017 13-02-2018 132212010218Y000575 0001272887605 SUNDARI P PEKERJA MANDIRI Myalgia Berobat Jalan

1018 13-02-2018 132212010218Y000351 0001316529639 AMENAH P PEKERJA MANDIRI Calculus of kidney Rujuk Lanjut

1019 13-02-2018 132212010218Y000579 0001424441575 LILIS SAMPIANI P PEKERJA MANDIRI Other specified dermatitis Berobat Jalan

1020 13-02-2018 132212010218Y000369 0001535998252 SRI WULANDARI P PEKERJA MANDIRI Chronic periodontitis Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1021 13-02-2018 132212010218Y001065 0001717016196 SITI CHOTIJAH P PEGAWAI SWASTA Gastritis, unspecified Berobat Jalan

1022 13-02-2018 132212010218Y000355 0001896281278 mariatin P PEKERJA MANDIRI Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
1023 13-02-2018 132212010218Y000392 0001906036593 KOTIMAH P PEKERJA MANDIRI Non-insulin-dependent Berobat Jalan
diabetes mellitus with

1024 13-02-2018 132212010218Y000345 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Keloid scar Berobat Jalan

1025 13-02-2018 132212010218Y000365 0001959241375 JAMAL L PEKERJA MANDIRI Headache Rujuk Lanjut

1026 13-02-2018 132212010218Y000399 0001966337752 TRI WAHYU WIDYANTORO L PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

1027 13-02-2018 132212010218Y000386 0002033969837 lailatul imtikhana P PEKERJA MANDIRI Other specified dermatitis Berobat Jalan

1028 13-02-2018 132212010218Y000346 0002039853958 GOZALI NUR MUSLIM L PEGAWAI SWASTA Other tetanus Berobat Jalan

1029 13-02-2018 132212010218Y000385 0002050962063 alif handa nugroho L PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

1030 13-02-2018 132212010218Y000375 0002058878935 SUNDARI P PEKERJA MANDIRI Headache Berobat Jalan

1031 13-02-2018 132212010218Y000354 0002121391337 MOCH. RIDWAN L PBI (APBN) Fracture of lower end of Rujuk Lanjut
tibia
1032 13-02-2018 132212010218Y000344 0002198175287 suma'iyah P PEKERJA MANDIRI Malignant neoplasm of Rujuk Lanjut
rectosigmoid junction
1033 13-02-2018 132212010218Y000944 0002205238195 ZAHROTUL FADHILAH P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
1034 13-02-2018 132212010218Y000359 0002238138909 HIDAYATUR ROHMAN L PEKERJA MANDIRI Epilepsy, unspecified Rujuk Lanjut

1035 13-02-2018 132212010218Y001369 0002244028184 MUHAMMAD DADANG L PBI (APBN) Influenza with other Berobat Jalan
SAIPULLOH respiratory manifestations,
virus not identified

1036 13-02-2018 132212010218Y000390 0002257603391 BUDIRAH P PEKERJA MANDIRI Myalgia Berobat Jalan

1037 13-02-2018 132212010218Y000341 0002262047229 intan ika fitria P PEKERJA MANDIRI Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
1038 13-02-2018 132212010218Y000391 0002305127507 MUHAMMAD KHOIRUL MUZAKI L PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1039 13-02-2018 132212010218Y001363 0002310760732 ahmad maulana aziz L PBI (APBN) Need for immunization Berobat Jalan
against
diphtheria-tetanus-pertussi

1040 13-02-2018 132212010218Y000393 0002318779809 FATIMATUZ ZAHROH P PEKERJA MANDIRI Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1041 13-02-2018 132212010218Y000946 0002421732453 AISYAH AZZAHRA P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1042 13-02-2018 132212010218Y000377 0002421736029 SITI JUWARIYAH P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1043 13-02-2018 132212010218Y000940 0002424683891 FANNY APRILIA PUSPITASARI P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
1044 13-02-2018 132212010218Y000360 0002429026683 SITI MAIMUNAH P PEKERJA MANDIRI Chronic obstructive Rujuk Lanjut
pulmonary disease,

1045 12-02-2018 132212010218Y000295 0000098619884 ABDUL SHOMAD L PENERIMA PENSIUN Retention of urine Rujuk Lanjut
PNS
1046 12-02-2018 132212010218Y000294 0000098619895 SITI CHUZAIMAH P PENERIMA PENSIUN Pure Rujuk Lanjut
PNS hypercholesterolaemia
1047 12-02-2018 132212010218Y000282 0000098809716 KARTOJO L PENERIMA PENSIUN Otitis media, unspecified Berobat Jalan
PNS
1048 12-02-2018 132212010218Y000339 0000098810357 HJ. CHOIRIYAH P PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
1049 12-02-2018 132212010218Y000293 0000098811202 SARIJONO L PENERIMA PENSIUN Chronic obstructive Rujuk Lanjut
PNS pulmonary disease,

1050 12-02-2018 132212010218Y000287 0000098812596 WARDI SUSANTO L PENERIMA PENSIUN Unilateral or unspecified Rujuk Lanjut
PNS inguinal hernia, without

1051 12-02-2018 132212010218Y000297 0000099476717 TRINAH AL TRIYONO L PENERIMA PENSIUN Injury, unspecified Berobat Jalan
PNS
1052 12-02-2018 132212010218Y000306 0000099532607 ELY ROSYIDAH P PNS DAERAH Dyspepsia Rujuk Lanjut

1053 12-02-2018 132212010218Y000286 0000173497476 SULICHA P PENERIMA PENSIUN Rheumatoid arthritis, Rujuk Lanjut
PNS unspecified
1054 12-02-2018 132212010218Y000470 0000722848509 MU'AROFAH P PBI (APBN) Disorders of vestibular Sembuh
function
1055 12-02-2018 132212010218Y000305 0000723785095 WIWIN RAKHMAWATI P PBI (APBN) Paraplegia, unspecified Rujuk Lanjut

1056 12-02-2018 132212010218Y000318 0000724588481 SAGI L PBI (APBN) Myalgia Berobat Jalan

1057 12-02-2018 132212010218Y000933 0000724588885 SALIMAH P PBI (APBN) Benign neoplasm of breast Berobat Jalan

1058 12-02-2018 132212010218Y001132 0000724597345 PRETI PRIANTINI P PBI (APBN) Caries limited to enamel Berobat Jalan

1059 12-02-2018 132212010218Y000921 0000724900847 VIDAYANTIK P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1060 12-02-2018 132212010218Y000323 0000724932393 NENENG INDRAWATI P PBI (APBN) Cough Berobat Jalan

1061 12-02-2018 132212010218Y000926 0000724949919 ANGGYNA SARI P PBI (APBN) Pregnancy-related Rujuk Lanjut
condition, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1062 12-02-2018 132212010218Y000934 0000724957751 MIFTAKUL J P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1063 12-02-2018 132212010218Y001594 0000725195542 SUTIANI P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
1064 12-02-2018 132212010218Y000326 0000725205633 SAGI L L PBI (APBN) Myalgia Berobat Jalan

1065 12-02-2018 132212010218Y000317 0000725216523 KERTO ADI L PBI (APBN) Cough Berobat Jalan

1066 12-02-2018 132212010218Y001595 0000725242397 SUPRIYATIN P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
1067 12-02-2018 132212010218Y001596 0000725242948 SANTOSO L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
1068 12-02-2018 132212010218Y000996 0000725254569 SUMILAH P PBI (APBN) Portal hypertension Sembuh

1069 12-02-2018 132212010218Y000343 0000725315084 REVANDA JULIA HARYANTI P PBI (APBN) Injury, unspecified Berobat Jalan

1070 12-02-2018 132212010218Y000325 0000725421205 SUNARTI P PBI (APBN) Cough Berobat Jalan

1071 12-02-2018 132212010218Y000935 0000725423433 MIFTAKHUL ULUMIYAH P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1072 12-02-2018 132212010218Y001133 0000725453796 FITRI KHASANAH P PBI (APBN) Portal hypertension Berobat Jalan

1073 12-02-2018 132212010218Y001314 0000725460052 NENENG SITI FARIDA P PBI (APBN) Gastritis, unspecified Berobat Jalan

1074 12-02-2018 132212010218Y001315 0000725460298 AHMAT FERDIANSYAH L PBI (APBN) Allergy, unspecified Berobat Jalan

1075 12-02-2018 132212010218Y000336 0000725468646 MUHAMAD IRZAM L PBI (APBN) Chronic periodontitis Berobat Jalan

1076 12-02-2018 132212010218Y000324 0000725504545 DUKRO L PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1077 12-02-2018 132212010218Y001313 0000725527091 ASEP L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1078 12-02-2018 132212010218Y000574 0000725539408 SANTI P PBI (APBN) Portal hypertension Berobat Jalan

1079 12-02-2018 132212010218Y000300 0000725540837 ISNAN L PBI (APBN) Myopia Rujuk Lanjut

1080 12-02-2018 132212010218Y000573 0000725540938 SUPENO L PBI (APBN) Dyspepsia Berobat Jalan

1081 12-02-2018 132212010218Y000328 0000725633943 RATNA KUSUMA W P PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1082 12-02-2018 132212010218Y000846 0000725665498 SUYATI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1083 12-02-2018 132212010218Y001365 0000725670843 DARSIYAH P PBI (APBN) Portal hypertension Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1084 12-02-2018 132212010218Y001364 0000725671798 MAYANG SARI P PBI (APBN) Headache Berobat Jalan

1085 12-02-2018 132212010218Y000327 0000725719858 TOYO L PBI (APBN) Cough Berobat Jalan

1086 12-02-2018 132212010218Y000927 0000725740209 FARIDATUS SHOLIKHAH P PBI (APBN) Pregnancy-related Rujuk Lanjut
condition, unspecified
1087 12-02-2018 132212010218Y000322 0000725740211 WINDI ERWINDIAN L PBI (APBN) Fever, unspecified Berobat Jalan

1088 12-02-2018 132212010218Y000928 0000725755015 SUYANTI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1089 12-02-2018 132212010218Y000331 0000725785626 MUNAWAROH P PBI (APBN) Headache Berobat Jalan

1090 12-02-2018 132212010218Y000572 0000725812413 YULI WILUJENG P PBI (APBN) Myalgia Berobat Jalan

1091 12-02-2018 132212010218Y000320 0000726054568 ANISA'UL KHOIROH P PBI (APBN) Headache Berobat Jalan

1092 12-02-2018 132212010218Y000930 0000726115926 INTAN PURNAMASARI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1093 12-02-2018 132212010218Y000283 0000726149531 SULIKAH P PBI (APBN) Gangrene, not elsewhere Berobat Jalan
classified
1094 12-02-2018 132212010218Y000924 0000726280481 SRI RAHAYU P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1095 12-02-2018 132212010218Y000340 0000726396129 MISTARI L PBI (APBN) Myalgia Berobat Jalan

1096 12-02-2018 132212010218Y001366 0000726745353 KUSTINI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1097 12-02-2018 132212010218Y000466 0001043725173 SUTRISNO L PBI (APBN) Fever, unspecified Sembuh

1098 12-02-2018 132212010218Y000332 0001043725173 SUTRISNO L PBI (APBN) Gastritis, unspecified Rujuk Lanjut

1099 12-02-2018 132212010218Y001436 0001043725871 IMRON ROSIDIN L PBI (APBN) Dental caries Berobat Jalan

1100 12-02-2018 132212010218Y000329 0001043728661 RINY SUNDARTI P PBI (APBN) Fever, unspecified Berobat Jalan

1101 12-02-2018 132212010218Y001593 0001043730099 AMIN ATUN P PBI (APBN) Myalgia Berobat Jalan

1102 12-02-2018 132212010218Y000309 0001043731989 AMINATUN P PBI (APBN) Headache Berobat Jalan

1103 12-02-2018 132212010218Y000342 0001256293181 SUPARMI P PEKERJA MANDIRI Myalgia Berobat Jalan

1104 12-02-2018 132212010218Y000292 0001263270047 SITI AISYAH P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

1105 12-02-2018 132212010218Y000330 0001284311665 SRI DIKARINI RAHAYU P PEKERJA MANDIRI Headache Berobat Jalan

1106 12-02-2018 132212010218Y000311 0001445994167 AKMAL FADHLU RAHMAN L PEKERJA MANDIRI Influenza with other Berobat Jalan
SASMITO respiratory manifestations,
virus not identified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1107 12-02-2018 132212010218Y000310 0001445994257 KAYYISA ADHWA LAIQA P PEKERJA MANDIRI Influenza with other Berobat Jalan
SASMITO respiratory manifestations,
virus not identified

1108 12-02-2018 132212010218Y000314 0001471735934 SUWATI P PEKERJA MANDIRI Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1109 12-02-2018 132212010218Y000307 0001545386207 SITI KOTIJAH P PEKERJA MANDIRI Non-insulin-dependent Berobat Jalan
diabetes mellitus without

1110 12-02-2018 132212010218Y000308 0001702488442 LUKMAN HARI PRAMONO L PEGAWAI SWASTA Headache Berobat Jalan

1111 12-02-2018 132212010218Y000925 0001802734727 ning sukartini P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
1112 12-02-2018 132212010218Y000291 0001828392693 SUPIYAH P PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

1113 12-02-2018 132212010218Y000923 0001832936859 ACHMAD FATICHUL ANWAR AL L PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
FALAcH infection, unspecified
1114 12-02-2018 132212010218Y000299 0001852356227 muryanti P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1115 12-02-2018 132212010218Y000506 0001874474414 SABIL HERNOVIANTO L PEKERJA MANDIRI Fever, unspecified Sembuh

1116 12-02-2018 132212010218Y000290 0001886656127 sa'i L PEKERJA MANDIRI Chronic renal failure, Rujuk Lanjut
unspecified
1117 12-02-2018 132212010218Y000312 0001886765387 gustian aldy pratama L PEKERJA MANDIRI Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1118 12-02-2018 132212010218Y000337 0001886991434 KHOLIQ L PEGAWAI SWASTA Fever, unspecified Berobat Jalan

1119 12-02-2018 132212010218Y000321 0001889752059 ngatmini P PEKERJA MANDIRI Myalgia Berobat Jalan

1120 12-02-2018 132212010218Y000335 0001896281278 mariatin P PEKERJA MANDIRI Myalgia Berobat Jalan

1121 12-02-2018 132212010218Y000338 0001897992786 khafid khanafi L PEKERJA MANDIRI Depressive episode, Berobat Jalan
unspecified
1122 12-02-2018 132212010218Y000939 0001903395161 AURORA ADZANA KANAYA P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
PUTRI infection, unspecified
1123 12-02-2018 132212010218Y000931 0001906178681 NURUL MAZIKHAH P PEGAWAI SWASTA Pregnancy-related Berobat Jalan
condition, unspecified
1124 12-02-2018 132212010218Y000313 0001966337752 TRI WAHYU WIDYANTORO L PEKERJA MANDIRI Headache Berobat Jalan

1125 12-02-2018 132212010218Y000922 0002016162426 KURNIASIH P PBI (APBN) Pregnancy-related Rujuk Lanjut
condition, unspecified
1126 12-02-2018 132212010218Y000319 0002016164046 SUMARLIK P PBI (APBN) Cough Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1127 12-02-2018 132212010218Y000289 0002016165104 SUPAIRAN L PBI (APBN) Abdominal and pelvic pain Rujuk Lanjut

1128 12-02-2018 132212010218Y000285 0002016165194 KHOTIB L PBI (APBN) Heart disease, unspecified Rujuk Lanjut

1129 12-02-2018 132212010218Y000284 0002016167332 TITIK HIDAYATUR R P PBI (APBN) Chronic obstructive Rujuk Lanjut
pulmonary disease,

1130 12-02-2018 132212010218Y000932 0002016173103 AMINAH YENI W P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1131 12-02-2018 132212010218Y000298 0002042483455 SUTOYO L PEKERJA MANDIRI Heart disease, unspecified Rujuk Lanjut

1132 12-02-2018 132212010218Y000296 0002042484906 tri siswami P PEKERJA MANDIRI Chronic obstructive Rujuk Lanjut
pulmonary disease,

1133 12-02-2018 132212010218Y001415 0002075435368 SURADI L PEKERJA MANDIRI Dyspnoea Berobat Jalan

1134 12-02-2018 132212010218Y000303 0002089841859 MAISAROH P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1135 12-02-2018 132212010218Y000937 0002089895376 zealking arzona sasmito L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1136 12-02-2018 132212010218Y000929 0002198831646 athifah nurul ramadhaniah P PNS DAERAH Acute upper respiratory Berobat Jalan
infection, unspecified
1137 12-02-2018 132212010218Y000302 0002202642527 PUTRI NURANITA MAHARANI P PEKERJA MANDIRI Other brachial plexus birth Rujuk Lanjut
HERMAWAN injuries
1138 12-02-2018 132212010218Y000334 0002241884125 SUNARTI P PEKERJA MANDIRI Dyspnoea Berobat Jalan

1139 12-02-2018 132212010218Y000936 0002262047229 intan ika fitria P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
1140 12-02-2018 132212010218Y000304 0002285391352 SOLIKIN L PEKERJA MANDIRI Dyspepsia Rujuk Lanjut

1141 12-02-2018 132212010218Y000938 0002293770609 ASSYFA PUTRI AURA ZASKIA P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
1142 12-02-2018 132212010218Y001134 0002296800988 safatuzahira P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1143 12-02-2018 132212010218Y000301 0002304188739 SUWANDI L PEKERJA MANDIRI Dizziness and giddiness Rujuk Lanjut

1144 12-02-2018 132212010218Y000333 0002313214751 KARTINI P PEKERJA MANDIRI Myalgia Berobat Jalan

1145 12-02-2018 132212010218Y000315 0002316668229 SAMAD L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1146 12-02-2018 132212010218Y000316 0002419471585 SUDARSINI P PEKERJA MANDIRI Headache Berobat Jalan

1147 12-02-2018 132212010218Y000288 0002422254003 SARNI P PEKERJA MANDIRI Arthrosis, unspecified Rujuk Lanjut

1148 11-02-2018 132212010218Y000276 0000724290265 KUNCORO L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1149 11-02-2018 132212010218Y000280 0000725271693 EKA NAFISAH Z P PBI (APBN) Dyspepsia Berobat Jalan

1150 11-02-2018 132212010218Y000272 0000725391562 SUNALI L PBI (APBN) Vertigo of central origin Berobat Jalan

1151 11-02-2018 132212010218Y000274 0000726054568 ANISA'UL KHOIROH P PBI (APBN) Fever, unspecified Berobat Jalan

1152 11-02-2018 132212010218Y000281 0000726564194 DIMAS ABDUL FATAH L PBI (APBN) Constipation Berobat Jalan

1153 11-02-2018 132212010218Y001176 0001050177971 NIKEN NURMA sugesti P PBI (APBN) Pre-eclampsia, Rujuk Lanjut
unspecified
1154 11-02-2018 132212010218Y000273 0001327248606 FIRDA FAIRUZ ZAHIRA P PEGAWAI SWASTA Fever, unspecified Berobat Jalan

1155 11-02-2018 132212010218Y000277 0001706614918 SUGENG HARIYANTO L PEKERJA MANDIRI Other gastritis Berobat Jalan

1156 11-02-2018 132212010218Y000278 0002016162505 SITI AISYAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1157 11-02-2018 132212010218Y000279 0002016162617 ROCHMAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1158 11-02-2018 132212010218Y000275 0002079861546 DAMA'IYAH P PEKERJA MANDIRI Dyspepsia Berobat Jalan

1159 11-02-2018 132212010218Y001177 0002220888159 JUMA'IYAH P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1160 10-02-2018 132212010218Y000252 0000098676055 HELLIYUS HERAWATY P PNS DAERAH Cough Berobat Jalan

1161 10-02-2018 132212010218Y000259 0000098740912 FATMARIKKA PUTRI TOSANA P PNS DAERAH Cough Berobat Jalan

1162 10-02-2018 132212010218Y000255 0000099533619 MISTIYAH P PNS DAERAH Myalgia Berobat Jalan

1163 10-02-2018 132212010218Y000253 0000724280365 SRIYATUN P PBI (APBN) Headache Berobat Jalan

1164 10-02-2018 132212010218Y000261 0000725050337 SUPARI L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1165 10-02-2018 132212010218Y000256 0000725055873 PIPIT INDAH SARI P PBI (APBN) Conjunctivitis, unspecified Berobat Jalan

1166 10-02-2018 132212010218Y000267 0000725271693 EKA NAFISAH Z P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1167 10-02-2018 132212010218Y000263 0000725595783 MOHAMMAD KHOIRON AFANDI L PBI (APBN) Fever, unspecified Berobat Jalan

1168 10-02-2018 132212010218Y000251 0000725684321 BAIDI L PBI (APBN) Headache Berobat Jalan

1169 10-02-2018 132212010218Y000264 0000725725552 SARMIAN L PBI (APBN) Myalgia Berobat Jalan

1170 10-02-2018 132212010218Y000249 0000725740211 WINDI ERWINDIAN L PBI (APBN) Fever, unspecified Berobat Jalan

1171 10-02-2018 132212010218Y001175 0000725755094 IRAWATI P PBI (APBN) Prolonged pregnancy Rujuk Lanjut
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1172 10-02-2018 132212010218Y000258 0000725950833 SITI KOTIMAH P PBI (APBN) Fever, unspecified Berobat Jalan

1173 10-02-2018 132212010218Y000262 0000726114418 RAMADHAN YOGA Novianto L PBI (APBN) Other specified dermatitis Berobat Jalan

1174 10-02-2018 132212010218Y001434 0001043726275 TANTI SARASWATI P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1175 10-02-2018 132212010218Y000254 0001315194478 FIKRI KURNIA WANTORO L PNS PUSAT Fever, unspecified Berobat Jalan

1176 10-02-2018 132212010218Y001131 0001450135743 SAODAH P PEKERJA MANDIRI Myalgia Berobat Jalan

1177 10-02-2018 132212010218Y000807 0001461970034 SITI KHOLIFATUR ROSIDAH P PEKERJA MANDIRI Prolonged first stage (of Rujuk Lanjut
labour)
1178 10-02-2018 132212010218Y000269 0001832936859 ACHMAD FATICHUL ANWAR AL L PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
FALAcH infection, unspecified
1179 10-02-2018 132212010218Y000257 0001874474414 SABIL HERNOVIANTO L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1180 10-02-2018 132212010218Y000250 0001882463207 SAPARI L PEKERJA MANDIRI Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1181 10-02-2018 132212010218Y000247 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Keloid scar Berobat Jalan

1182 10-02-2018 132212010218Y000920 0002016168625 WAGIYAH P PBI (APBN) Uterovaginal prolapse, Rujuk Lanjut
unspecified
1183 10-02-2018 132212010218Y000268 0002016172462 MISDI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1184 10-02-2018 132212010218Y000260 0002066752495 PONASRI P PEKERJA MANDIRI Myalgia Berobat Jalan

1185 10-02-2018 132212010218Y001414 0002075433434 TEMU P PEKERJA MANDIRI Fever of other and Berobat Jalan
unknown origin
1186 10-02-2018 132212010218Y000248 0002083277193 PURNOMO HIDAYAT L PNS DAERAH Fever, unspecified Berobat Jalan

1187 10-02-2018 132212010218Y000266 0002092881666 ZULAIKHAH P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1188 10-02-2018 132212010218Y000265 0002092882285 MUHAMMAD DANIYAL L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
HAFIZUDDIN infection, unspecified
1189 10-02-2018 132212010218Y000271 0002241884125 SUNARTI P PEKERJA MANDIRI Myalgia Berobat Jalan

1190 10-02-2018 132212010218Y000919 0002256353728 MEILIANA DWI KHOIRUNNISAK P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1191 10-02-2018 132212010218Y000270 0002319831022 FIFIT NUR AINI P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1192 09-02-2018 132212010218Y001129 0000098555815 DEWI SUUTDAH P PNS DAERAH Acute upper respiratory Berobat Jalan
infection, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1193 09-02-2018 132212010218Y000240 0000098563228 SATUMI P PNS DAERAH Non-insulin-dependent Berobat Jalan
diabetes mellitus with

1194 09-02-2018 132212010218Y000237 0000098685279 MARUKI L PENERIMA PENSIUN Tuberculosis of lung, Berobat Jalan
PNS confirmed by sputum
microscopy with or without

1195 09-02-2018 132212010218Y000242 0000099405573 SADIMAN L PENERIMA PENSIUN TNI Myalgia Berobat Jalan

1196 09-02-2018 132212010218Y000916 0000725102021 LILIS SINGGIH INDRAWATI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1197 09-02-2018 132212010218Y000231 0000725131383 M ILHAM S L PBI (APBN) Erosion of teeth Berobat Jalan

1198 09-02-2018 132212010218Y000584 0000725211279 ERVINDA SUSIATININGSIH P PBI (APBN) Preterm labour and Rujuk Lanjut
delivery
1199 09-02-2018 132212010218Y000234 0000725332601 DJUMA'IYAH P PBI (APBN) Non-insulin-dependent Berobat Jalan
diabetes mellitus with

1200 09-02-2018 132212010218Y000239 0000725332825 WIWIK P PBI (APBN) Myalgia Berobat Jalan

1201 09-02-2018 132212010218Y000243 0000725475846 OYIK L PBI (APBN) Myalgia Berobat Jalan

1202 09-02-2018 132212010218Y000845 0000725668593 SULIKAH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1203 09-02-2018 132212010218Y000232 0000725682137 SITI RODIYAH P PBI (APBN) Chronic periodontitis Berobat Jalan

1204 09-02-2018 132212010218Y000917 0000725740209 FARIDATUS SHOLIKHAH P PBI (APBN) Pregnancy-related Rujuk Lanjut
condition, unspecified
1205 09-02-2018 132212010218Y000246 0000725806901 HAYKAL ALASYAH P L PBI (APBN) Fever, unspecified Berobat Jalan

1206 09-02-2018 132212010218Y000233 0000725830481 SOLIKAN L PBI (APBN) Pure Berobat Jalan
hypercholesterolaemia
1207 09-02-2018 132212010218Y000844 0000725892221 DEVI MEILINA P PBI (APBN) Conjunctivitis, unspecified Berobat Jalan

1208 09-02-2018 132212010218Y000236 0000726113823 TIARAH P PBI (APBN) Myalgia Berobat Jalan

1209 09-02-2018 132212010218Y001060 0000726396175 PIANAH P PBI (APBN) Myalgia Berobat Jalan

1210 09-02-2018 132212010218Y000843 0000726534011 YAHMI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1211 09-02-2018 132212010218Y001130 0001043725476 HARIYANTI P PBI (APBN) Allergy, unspecified Berobat Jalan

1212 09-02-2018 132212010218Y000238 0001043726681 SOPI'I L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1213 09-02-2018 132212010218Y000918 0001050177971 NIKEN NURMA sugesti P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1214 09-02-2018 132212010218Y000235 0001484521806 ANANG HARIYANTO L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1215 09-02-2018 132212010218Y000245 0001728701752 HELMI MADIWA KADHAFI L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1216 09-02-2018 132212010218Y000241 0001818501772 FENDIKA SADAM SETIAWAN L PENERIMA PENSIUN TNI Erosion of teeth Berobat Jalan

1217 09-02-2018 132212010218Y000915 0001970485762 GALANG IRFANDI NATHA L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1218 09-02-2018 132212010218Y000244 0002079861546 DAMA'IYAH P PEKERJA MANDIRI Myalgia Berobat Jalan

1219 09-02-2018 132212010218Y001413 0002280224002 ERI ENJELI P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1220 08-02-2018 132212010218Y000165 0000098557839 RUSLAN L PNS DAERAH Conjunctivitis, unspecified Berobat Jalan

1221 08-02-2018 132212010218Y000154 0000098560045 SYAIFUL ANWAR L PNS DAERAH Myalgia Berobat Jalan

1222 08-02-2018 132212010218Y000155 0000098619884 ABDUL SHOMAD L PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
1223 08-02-2018 132212010218Y000156 0000098619895 SITI CHUZAIMAH P PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
1224 08-02-2018 132212010218Y000230 0000171528941 REYVANT JULIAN RISTIANTO L PNS DAERAH Atopic dermatitis, Berobat Jalan
unspecified
1225 08-02-2018 132212010218Y000153 0000452816245 SUNENGSIH P PBI (APBN) Malignant neoplasm of Rujuk Lanjut
vagina
1226 08-02-2018 132212010218Y000172 0000725080274 SUPRIYADI L PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1227 08-02-2018 132212010218Y000159 0000725158247 SISKA HERMA Y P PBI (APBN) Headache Berobat Jalan

1228 08-02-2018 132212010218Y001591 0000725190311 IVA SETIA N P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
1229 08-02-2018 132212010218Y001288 0000725209942 KUMA'IYAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1230 08-02-2018 132212010218Y001592 0000725212574 PRANOTO L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
1231 08-02-2018 132212010218Y000157 0000725228392 SOBIRIN L PBI (APBN) Chronic periodontitis Berobat Jalan

1232 08-02-2018 132212010218Y001291 0000725367622 IKA NUR UTAMI P PBI (APBN) Allergy, unspecified Berobat Jalan

1233 08-02-2018 132212010218Y000913 0000725376611 NANING SURYATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1234 08-02-2018 132212010218Y000158 0000725493532 YETI surhatini P PBI (APBN) Erosion of teeth Berobat Jalan

1235 08-02-2018 132212010218Y001292 0000725498932 SITI AMINAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1236 08-02-2018 132212010218Y000161 0000725542481 JUMAIN L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1237 08-02-2018 132212010218Y000167 0000725564845 SUNTORO L PBI (APBN) Myalgia Berobat Jalan

1238 08-02-2018 132212010218Y000567 0000725565082 SULASTRI P PBI (APBN) Portal hypertension Berobat Jalan

1239 08-02-2018 132212010218Y000162 0000725588706 SUPIATI P PBI (APBN) Other specified dermatitis Berobat Jalan

1240 08-02-2018 132212010218Y000568 0000725647296 SUNARMI P PBI (APBN) Myalgia Berobat Jalan

1241 08-02-2018 132212010218Y000569 0000725648409 DADANG SETIAWAN L PBI (APBN) Fever, unspecified Berobat Jalan

1242 08-02-2018 132212010218Y001433 0000725659929 PIANI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1243 08-02-2018 132212010218Y000570 0000725660447 SUWARNI P PBI (APBN) Migraine, unspecified Berobat Jalan

1244 08-02-2018 132212010218Y000160 0000725690237 WHISNU TRI AGUNG L PBI (APBN) Fever, unspecified Berobat Jalan
RUDYAWAN
1245 08-02-2018 132212010218Y000174 0000725700341 NIA AFNI R P PBI (APBN) Fever, unspecified Berobat Jalan

1246 08-02-2018 132212010218Y001289 0000726005777 SUPINAH P PBI (APBN) Fever, unspecified Berobat Jalan

1247 08-02-2018 132212010218Y001287 0000726051205 MARTINI P PBI (APBN) Myalgia Berobat Jalan

1248 08-02-2018 132212010218Y001625 0000726091121 NUR HAYATI S P PBI (APBN) Influenza due to other Berobat Jalan
identified influenza virus
1249 08-02-2018 132212010218Y000171 0000726095946 ASIYAH P PBI (APBN) Myalgia Berobat Jalan

1250 08-02-2018 132212010218Y001286 0000726136301 SATIYAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1251 08-02-2018 132212010218Y001116 0000726136749 GIRAN L PBI (APBN) Myalgia Berobat Jalan

1252 08-02-2018 132212010218Y000571 0000726204194 SARMI L PBI (APBN) Dyspepsia Berobat Jalan

1253 08-02-2018 132212010218Y000566 0000726311428 REGAL DWI S L PBI (APBN) Fever, unspecified Berobat Jalan

1254 08-02-2018 132212010218Y000173 0000726495445 YULI SETYOWATI P PBI (APBN) Cough Berobat Jalan

1255 08-02-2018 132212010218Y000163 0000726523481 EVA ROSDIANA DEWI P PEGAWAI SWASTA Other specified dermatitis Berobat Jalan

1256 08-02-2018 132212010218Y000166 0000726807745 ELI PRAMUDITA P PBI (APBN) Gastritis, unspecified Berobat Jalan

1257 08-02-2018 132212010218Y001624 0000726863815 KADI L PBI (APBN) Myalgia Berobat Jalan

1258 08-02-2018 132212010218Y000164 0001043726602 ROHMAN L PBI (APBN) Myalgia Berobat Jalan

1259 08-02-2018 132212010218Y000169 0001704622858 KAMI P PBI (APBD) Myalgia Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1260 08-02-2018 132212010218Y000175 0001789359344 LISTIN DWI ISNANIN LAILUT P PEGAWAI SWASTA Seronegative rheumatoid Berobat Jalan
FRISCHA arthritis
1261 08-02-2018 132212010218Y000912 0001809772604 LINDA YUNI PRATIWI P PEKERJA MANDIRI Contraceptive Rujuk Lanjut
management, unspecified
1262 08-02-2018 132212010218Y000911 0001850371885 ERNAWATI P PNS PUSAT Dermatitis, unspecified Rujuk Lanjut

1263 08-02-2018 132212010218Y000170 0001861140216 AYU FARISA NUR SALIM P PEGAWAI SWASTA Other specified dermatitis Berobat Jalan

1264 08-02-2018 132212010218Y001290 0002016163539 KARMIANI P PBI (APBN) Headache Berobat Jalan

1265 08-02-2018 132212010218Y000914 0002121391732 JUJUK SULIYANTI P PBI (APBN) Contraceptive Rujuk Lanjut
management, unspecified
1266 08-02-2018 132212010218Y000168 0002212489787 DARMI P PEKERJA MANDIRI Headache Berobat Jalan

1267 08-02-2018 132212010218Y000842 0002254107115 ANIK MUZAIYANAH P PEGAWAI SWASTA Caries limited to enamel Berobat Jalan

1268 08-02-2018 132212010218Y000909 0002281573743 VIRZA DWI PERMANA L PNS DAERAH Acute upper respiratory Rujuk Lanjut
infection, unspecified
1269 08-02-2018 132212010218Y000910 0002319198603 SHERLY NORAINE HEYMAN P PEKERJA MANDIRI Pre-eclampsia, Rujuk Lanjut
unspecified
1270 07-02-2018 132212010218Y000181 0000098627951 DUWIK AMININ L PNS PUSAT Fever, unspecified Berobat Jalan

1271 07-02-2018 132212010218Y000199 0000098810212 MUGIHARJO L PENERIMA PENSIUN Non-insulin-dependent Berobat Jalan
PNS diabetes mellitus with

1272 07-02-2018 132212010218Y000180 0000098812596 WARDI SUSANTO L PENERIMA PENSIUN Dyspnoea Berobat Jalan
PNS
1273 07-02-2018 132212010218Y000195 0000173497476 SULICHA P PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
1274 07-02-2018 132212010218Y000150 0000723720407 MUTMAINAH P PBI (APBN) Status asthmaticus Berobat Jalan

1275 07-02-2018 132212010218Y001622 0000724262602 LAWANTORO L PBI (APBN) Other acute gastritis Berobat Jalan

1276 07-02-2018 132212010218Y000187 0000725072534 UMIYAH P PBI (APBN) Portal hypertension Berobat Jalan

1277 07-02-2018 132212010218Y001329 0000725094461 SAYUTI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1278 07-02-2018 132212010218Y000192 0000725131383 M ILHAM S L PBI (APBN) Erosion of teeth Berobat Jalan

1279 07-02-2018 132212010218Y000907 0000725150294 DENOK ANGGRAYNI P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1280 07-02-2018 132212010218Y001587 0000725193516 SUYADI L PBI (APBN) Myalgia Berobat Jalan

1281 07-02-2018 132212010218Y001588 0000725194023 SUSANA P PBI (APBN) Gastritis, unspecified Berobat Jalan

1282 07-02-2018 132212010218Y001589 0000725195463 YANUAR KURNIAWAN L PBI (APBN) Noninfective Berobat Jalan
gastroenteritis and colitis,
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1283 07-02-2018 132212010218Y001590 0000725204013 RIBUT RUDIANTO L PBI (APBN) Atopic dermatitis, Berobat Jalan
unspecified
1284 07-02-2018 132212010218Y001432 0000725250892 SUPARMI P PBI (APBN) Seropositive rheumatoid Berobat Jalan
arthritis, unspecified
1285 07-02-2018 132212010218Y000149 0000725269533 RISA PUTRI HARNIASARI P PBI (APBN) Otitis media, unspecified Berobat Jalan

1286 07-02-2018 132212010218Y000203 0000725332825 WIWIK P PBI (APBN) Myalgia Berobat Jalan

1287 07-02-2018 132212010218Y000563 0000725394047 SARJI L PBI (APBN) Dyspepsia Berobat Jalan

1288 07-02-2018 132212010218Y000564 0000725394374 PARTIMA P PBI (APBN) Dyspepsia Berobat Jalan

1289 07-02-2018 132212010218Y000906 0000725427279 SITI NOR KHOLIFAH P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1290 07-02-2018 132212010218Y000177 0000725435998 MOCHAMMAD ZAINaL ABIDIN L PBI (APBN) Erosion of teeth Berobat Jalan

1291 07-02-2018 132212010218Y000186 0000725473449 SITI MUISAH P PBI (APBN) Dyspnoea Berobat Jalan

1292 07-02-2018 132212010218Y001059 0000725494241 SITI ROMLAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1293 07-02-2018 132212010218Y001562 0000725524738 SRI HARTINI P PBI (APBN) Headache Berobat Jalan

1294 07-02-2018 132212010218Y001561 0000725541276 SUMANI P PBI (APBN) Severe pre-eclampsia Rujuk Lanjut

1295 07-02-2018 132212010218Y000179 0000725633943 RATNA KUSUMA W P PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1296 07-02-2018 132212010218Y000565 0000725644427 SIYONO L PBI (APBN) Myalgia Berobat Jalan

1297 07-02-2018 132212010218Y000562 0000725644631 MUSYAROFAH P PBI (APBN) Migraine, unspecified Berobat Jalan

1298 07-02-2018 132212010218Y001412 0000725656083 SARIFA RAMADHANI P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1299 07-02-2018 132212010218Y000197 0000725682137 SITI RODIYAH P PBI (APBN) Erosion of teeth Berobat Jalan

1300 07-02-2018 132212010218Y001285 0000725691396 TITIK SRI W P PBI (APBN) Headache Berobat Jalan

1301 07-02-2018 132212010218Y000200 0000725696594 SRI UTARI P PBI (APBN) Non-insulin-dependent Berobat Jalan
diabetes mellitus with

1302 07-02-2018 132212010218Y001284 0000725699362 WULYONO L PBI (APBN) Allergy, unspecified Berobat Jalan

1303 07-02-2018 132212010218Y001331 0000725707686 SATUNING P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1304 07-02-2018 132212010218Y000190 0000725715944 WATIYAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1305 07-02-2018 132212010218Y001056 0000725769641 SALAMAH P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1306 07-02-2018 132212010218Y001057 0000725791601 ETTY NUR SINARSIATI P PBI (APBN) Gastritis, unspecified Berobat Jalan

1307 07-02-2018 132212010218Y000185 0000725846714 SUSIANA P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1308 07-02-2018 132212010218Y001623 0000726030641 YATMININGSIH P PBI (APBN) Other specified Berobat Jalan
noninflammatory disorders

1309 07-02-2018 132212010218Y001283 0000726155493 WARTI P PBI (APBN) Anogenital herpesviral Berobat Jalan
infection, unspecified
1310 07-02-2018 132212010218Y001330 0000726198838 FATOYAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1311 07-02-2018 132212010218Y000188 0000726202236 HERNIAWATI P PBI (APBN) Gingival and edentulous Berobat Jalan
alveolar ridge lesions

1312 07-02-2018 132212010218Y001328 0000726208637 SENITI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1313 07-02-2018 132212010218Y001282 0000726235694 ANI WINDARTI P PBI (APBN) Allergy, unspecified Berobat Jalan

1314 07-02-2018 132212010218Y000201 0000726386556 SITI MUSLIMAH P PBI (APBN) Chronic periodontitis Berobat Jalan

1315 07-02-2018 132212010218Y001058 0000726396129 MISTARI L PBI (APBN) Atopic dermatitis, Berobat Jalan
unspecified
1316 07-02-2018 132212010218Y001055 0000726396175 PIANAH P PBI (APBN) Myalgia Berobat Jalan

1317 07-02-2018 132212010218Y000148 0000726765895 SAMIAJI L PBI (APBN) Dyspepsia Berobat Jalan

1318 07-02-2018 132212010218Y001621 0000726823449 YURAHATI P PBI (APBN) Other acute gastritis Berobat Jalan

1319 07-02-2018 132212010218Y000198 0000976852067 RINDRI DHINI SAFITRI P PNS DAERAH Chronic periodontitis Berobat Jalan

1320 07-02-2018 132212010218Y000178 0001043733677 YUSANTI P PBI (APBN) Erosion of teeth Berobat Jalan

1321 07-02-2018 132212010218Y000183 0001272887605 SUNDARI P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1322 07-02-2018 132212010218Y000202 0001540841398 JUWARTO L PEGAWAI SWASTA Headache Berobat Jalan

1323 07-02-2018 132212010218Y000841 0001616686492 MOHAMMAD ILMI ALKHOFFI L PEGAWAI SWASTA Fever, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1324 07-02-2018 132212010218Y000151 0001791881144 nurhayati dwi indriyani P PEKERJA MANDIRI Gastritis, unspecified Berobat Jalan

1325 07-02-2018 132212010218Y000193 0001901600785 SUMADI L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1326 07-02-2018 132212010218Y000191 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Injury, unspecified Berobat Jalan

1327 07-02-2018 132212010218Y001128 0002016170616 YULI SUKOMAROH P PBI (APBN) Myalgia Berobat Jalan

1328 07-02-2018 132212010218Y000194 0002016171099 WIRADITA P PBI (APBN) Headache Berobat Jalan

1329 07-02-2018 132212010218Y000182 0002052150636 RUWATI P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1330 07-02-2018 132212010218Y000502 0002052150636 RUWATI P PEKERJA MANDIRI Typhoid and paratyphoid Sembuh
fevers
1331 07-02-2018 132212010218Y000196 0002262096641 SUTISNI P PEKERJA MANDIRI Myalgia Berobat Jalan

1332 07-02-2018 132212010218Y000908 0002265968384 WAHIDATUL HASANAH P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
1333 07-02-2018 132212010218Y000176 0002273668176 LAILUL KHOMSATUN P PEKERJA MANDIRI Cough Berobat Jalan

1334 07-02-2018 132212010218Y000905 0002297164138 DAFIN RAKHA DWIANSYAH L PEGAWAI SWASTA Need for immunization Berobat Jalan
against
diphtheria-tetanus-pertussi

1335 07-02-2018 132212010218Y000189 0002303812912 CHAMDAN L PEKERJA MANDIRI Erosion of teeth Berobat Jalan

1336 07-02-2018 132212010218Y000184 0002421046563 ERIS NURSAVITRI P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1337 06-02-2018 132212010218Y000207 0000098534092 INDIATI P PNS DAERAH Myalgia Berobat Jalan

1338 06-02-2018 132212010218Y000224 0000098557176 SULISTIANI P PNS DAERAH Headache Berobat Jalan

1339 06-02-2018 132212010218Y000215 0000098559448 SUTIASIH P PENERIMA PENSIUN Headache Berobat Jalan
PNS
1340 06-02-2018 132212010218Y000902 0000099324448 KUSNUL LIK AYATI P PNS DAERAH Pregnancy-related Berobat Jalan
condition, unspecified
1341 06-02-2018 132212010218Y001052 0000099405257 ASIJAH P PENERIMA PENSIUN Myalgia Berobat Jalan
PNS
1342 06-02-2018 132212010218Y000152 0000723827619 HANDRI. A L PBI (APBN) Depressive episode, Berobat Jalan
unspecified
1343 06-02-2018 132212010218Y001620 0000724261432 SUSILOWATI P PBI (APBN) Myalgia Berobat Jalan

1344 06-02-2018 132212010218Y000221 0000724742256 MISDI L PBI (APBN) Myalgia Berobat Jalan

1345 06-02-2018 132212010218Y000228 0000724949436 ROCHAYANAH P PBI (APBN) Injury, unspecified Berobat Jalan

1346 06-02-2018 132212010218Y000504 0000725051103 ARUM vidya oktaviani P PBI (APBN) Fever, unspecified Sembuh

1347 06-02-2018 132212010218Y000561 0000725131091 M FARID L PBI (APBN) Other specified dermatitis Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1348 06-02-2018 132212010218Y001281 0000725199557 ULIYAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1349 06-02-2018 132212010218Y001277 0000725212585 KAYATI P PBI (APBN) Gastritis, unspecified Berobat Jalan

1350 06-02-2018 132212010218Y001271 0000725219054 JAENAB P PBI (APBN) Anogenital herpesviral Berobat Jalan
infection, unspecified
1351 06-02-2018 132212010218Y000214 0000725229314 SULIYATI P PBI (APBN) Myalgia Berobat Jalan

1352 06-02-2018 132212010218Y000211 0000725247584 FERDIAZ ARIEL MAULANA P PBI (APBN) Gastritis, unspecified Berobat Jalan

1353 06-02-2018 132212010218Y000205 0000725252916 SUDARNI P PBI (APBN) Myalgia Berobat Jalan

1354 06-02-2018 132212010218Y001311 0000725343546 WATIN P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1355 06-02-2018 132212010218Y000209 0000725386228 MARCHEL DWI CAHYO L PBI (APBN) Fever, unspecified Berobat Jalan

1356 06-02-2018 132212010218Y001049 0000725402766 SITI SOFIYAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1357 06-02-2018 132212010218Y001324 0000725448273 SUNARIYO L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1358 06-02-2018 132212010218Y001048 0000725450894 KARTI P PBI (APBN) Myalgia Berobat Jalan

1359 06-02-2018 132212010218Y001310 0000725462324 MARIATI P PBI (APBN) Portal hypertension Berobat Jalan

1360 06-02-2018 132212010218Y001050 0000725470637 PAIMAH P PBI (APBN) Myalgia Berobat Jalan

1361 06-02-2018 132212010218Y001312 0000725491809 ERNAWATI P PBI (APBN) Allergy, unspecified Berobat Jalan

1362 06-02-2018 132212010218Y000899 0000725493047 FATKHATUL AZIZAH P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1363 06-02-2018 132212010218Y000212 0000725496401 MUKHAIYAH P PBI (APBN) Fever, unspecified Berobat Jalan

1364 06-02-2018 132212010218Y000220 0000725497222 UMIDAH P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1365 06-02-2018 132212010218Y000503 0000725503871 MOCHAMMAD RIFAI L PBI (APBN) Typhoid and paratyphoid Sembuh
fevers
1366 06-02-2018 132212010218Y001279 0000725512105 DARSI P PBI (APBN) Fever, unspecified Berobat Jalan

1367 06-02-2018 132212010218Y001309 0000725515132 SUPIATI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1368 06-02-2018 132212010218Y000145 0000725532884 A ARIEL A L PBI (APBN) Fever, unspecified Berobat Jalan

1369 06-02-2018 132212010218Y001278 0000725583273 SITI SUMAIYAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1370 06-02-2018 132212010218Y000227 0000725588087 KASERI L PBI (APBN) Injury, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1371 06-02-2018 132212010218Y000560 0000725595737 AINUR JANAH P PBI (APBN) Portal hypertension Berobat Jalan

1372 06-02-2018 132212010218Y000210 0000725605457 GIMAN L PBI (APBN) Cough Berobat Jalan

1373 06-02-2018 132212010218Y000219 0000725662675 MARTA P PBI (APBN) Fever, unspecified Berobat Jalan

1374 06-02-2018 132212010218Y000218 0000725686222 ABDUL WAHIB L PBI (APBN) Myalgia Berobat Jalan

1375 06-02-2018 132212010218Y001053 0000725731479 WAGIAH P PBI (APBN) Myalgia Berobat Jalan

1376 06-02-2018 132212010218Y000208 0000725806901 HAYKAL ALASYAH P L PBI (APBN) Fever, unspecified Berobat Jalan

1377 06-02-2018 132212010218Y000558 0000725819624 M SOLEH L PBI (APBN) Unspecified diabetes Berobat Jalan
mellitus without

1378 06-02-2018 132212010218Y001431 0000725830918 JUWANAH ARIYANTI P PBI (APBN) Dental caries Berobat Jalan

1379 06-02-2018 132212010218Y000147 0000725846714 SUSIANA P PBI (APBN) Nausea and vomiting Berobat Jalan

1380 06-02-2018 132212010218Y001274 0000726145097 RAENI L PBI (APBN) Fever, unspecified Berobat Jalan

1381 06-02-2018 132212010218Y000903 0000726148427 PIATI P PBI (APBN) Pre-eclampsia, Rujuk Lanjut
unspecified
1382 06-02-2018 132212010218Y001280 0000726148855 HERMIN SITI HARTATIK P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1383 06-02-2018 132212010218Y000557 0000726203125 SUTIK P PBI (APBN) Migraine, unspecified Berobat Jalan

1384 06-02-2018 132212010218Y000146 0000726213745 BUASIR L PBI (APBN) Dyspepsia Berobat Jalan

1385 06-02-2018 132212010218Y000217 0000726807745 ELI PRAMUDITA P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1386 06-02-2018 132212010218Y001619 0000726864039 KASMAD L PBI (APBN) Myalgia Berobat Jalan

1387 06-02-2018 132212010218Y001618 0000726864401 TIRU P PBI (APBN) Myalgia Berobat Jalan

1388 06-02-2018 132212010218Y000840 0001043724464 SUMARTIK P PBI (APBN) Fever, unspecified Berobat Jalan

1389 06-02-2018 132212010218Y000223 0001163459002 AFIT AFANDI L PEGAWAI SWASTA Fever, unspecified Berobat Jalan

1390 06-02-2018 132212010218Y000229 0001444485677 SINI ASTUTIK P PEKERJA MANDIRI Pure Berobat Jalan
hypercholesterolaemia
1391 06-02-2018 132212010218Y000216 0001445497053 WASIAH P PEKERJA MANDIRI Headache Berobat Jalan

1392 06-02-2018 132212010218Y000225 0001470197384 FARIT IRAWATI P PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

1393 06-02-2018 132212010218Y001054 0001540009348 ANA NURFAIDAH L PEGAWAI SWASTA Myalgia Berobat Jalan

1394 06-02-2018 132212010218Y000204 0001540841422 A FERI FIRMANSYAH L PEGAWAI SWASTA Injury, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1395 06-02-2018 132212010218Y000901 0001542225846 EARLYTA NUR SALSABILA P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
1396 06-02-2018 132212010218Y000505 0001704622252 PATILAH P PBI (APBD) Portal hypertension Sembuh

1397 06-02-2018 132212010218Y000900 0001806389122 MUJIATI P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
1398 06-02-2018 132212010218Y000213 0001887166451 ZAINI L PEKERJA MANDIRI Headache Berobat Jalan

1399 06-02-2018 132212010218Y001276 0002016163719 DARWATI P PBI (APBN) Allergy, unspecified Berobat Jalan

1400 06-02-2018 132212010218Y000206 0002016168715 SITI ROMELAH P PBI (APBN) Headache Berobat Jalan

1401 06-02-2018 132212010218Y000559 0002016169492 SITI WAKIAH P PBI (APBN) Portal hypertension Berobat Jalan

1402 06-02-2018 132212010218Y000144 0002052150636 RUWATI P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1403 06-02-2018 132212010218Y001051 0002089770265 NINIK INDAYATI P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1404 06-02-2018 132212010218Y001327 0002208459464 aqila nathania fadhilah P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1405 06-02-2018 132212010218Y001325 0002212085799 fabrizio gefa qutbie runako L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1406 06-02-2018 132212010218Y001626 0002212152715 RUPANAH P PEKERJA MANDIRI Fever, unspecified Rujuk Lanjut

1407 06-02-2018 132212010218Y000904 0002221708623 RISKHAH FIDIA TIKA SARI DEWI P PEGAWAI SWASTA Pregnancy-related Berobat Jalan
condition, unspecified
1408 06-02-2018 132212010218Y000222 0002241757091 MOH. RIFALDO DIMAS L PEKERJA MANDIRI Headache Berobat Jalan
SAPUTRA
1409 06-02-2018 132212010218Y001326 0002285943772 AHMAD RAFFA AMIRULLOH L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1410 06-02-2018 132212010218Y000226 0002318779809 FATIMATUZ ZAHROH P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1411 05-02-2018 132212010218Y000120 0000098556006 ENY SUKMAWATI P PNS DAERAH Erosion of teeth Berobat Jalan

1412 05-02-2018 132212010218Y000127 0000098563228 SATUMI P PNS DAERAH Myalgia Berobat Jalan

1413 05-02-2018 132212010218Y000552 0000098683334 TIYAMI P PENERIMA PENSIUN Unspecified diabetes Berobat Jalan
PNS mellitus without

1414 05-02-2018 132212010218Y000133 0000098811617 SOERIP L PENERIMA PENSIUN TNI Other and unspecified Berobat Jalan
gastroenteritis and colitis

1415 05-02-2018 132212010218Y000898 0000165560916 NURUL AFRI LIANA P PEKERJA MANDIRI Pregnancy-related Berobat Jalan
condition, unspecified
1416 05-02-2018 132212010218Y000100 0000723957153 WARSI P PBI (APBN) Myalgia Berobat Jalan

1417 05-02-2018 132212010218Y000103 0000724216329 SUPARMI P PBI (APBN) Conjunctivitis, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1418 05-02-2018 132212010218Y001577 0000724791025 ASENAH P PBI (APBN) Fever, unspecified Berobat Jalan

1419 05-02-2018 132212010218Y000122 0000724799878 SUGIYANTO L PBI (APBN) Fever, unspecified Berobat Jalan

1420 05-02-2018 132212010218Y000141 0000724840751 SUTIANI P PBI (APBN) Portal hypertension Berobat Jalan

1421 05-02-2018 132212010218Y000095 0000724904076 DWI SAYAGOS L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1422 05-02-2018 132212010218Y000109 0000724949493 MUJIB SYARWANI L PBI (APBN) Headache Berobat Jalan

1423 05-02-2018 132212010218Y000138 0000725051103 ARUM vidya oktaviani P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1424 05-02-2018 132212010218Y000094 0000725102493 IKA PUJI ASTUTIK P PBI (APBN) Dyspnoea Berobat Jalan

1425 05-02-2018 132212010218Y000112 0000725115238 WARTIAYAH L PBI (APBN) Myalgia Berobat Jalan

1426 05-02-2018 132212010218Y000556 0000725120919 IZZATUL MEIKA P P PBI (APBN) Fever, unspecified Berobat Jalan

1427 05-02-2018 132212010218Y001576 0000725209143 MIMIK SUNARTI P PBI (APBN) Fever, unspecified Berobat Jalan

1428 05-02-2018 132212010218Y001585 0000725212271 SUGAWATI P PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
1429 05-02-2018 132212010218Y001586 0000725212978 AYUNING WULAN R P PBI (APBN) Gastritis, unspecified Berobat Jalan

1430 05-02-2018 132212010218Y000142 0000725252916 SUDARNI P PBI (APBN) Myalgia Berobat Jalan

1431 05-02-2018 132212010218Y000111 0000725254569 SUMILAH P PBI (APBN) Portal hypertension Berobat Jalan

1432 05-02-2018 132212010218Y000501 0000725254569 SUMILAH P PBI (APBN) Portal hypertension Sembuh

1433 05-02-2018 132212010218Y001044 0000725412701 KATIN P PBI (APBN) Gastritis, unspecified Berobat Jalan

1434 05-02-2018 132212010218Y001045 0000725423444 MUFARIKHAH P PBI (APBN) Headache Berobat Jalan

1435 05-02-2018 132212010218Y001046 0000725449454 NUR JANAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1436 05-02-2018 132212010218Y000104 0000725468646 MUHAMAD IRZAM L PBI (APBN) Erosion of teeth Berobat Jalan

1437 05-02-2018 132212010218Y000107 0000725475846 OYIK L PBI (APBN) Myalgia Berobat Jalan

1438 05-02-2018 132212010218Y000130 0000725483452 ATIM FRENKI C L PBI (APBN) Fever, unspecified Berobat Jalan

1439 05-02-2018 132212010218Y000126 0000725503871 MOCHAMMAD RIFAI L PBI (APBN) Fever, unspecified Berobat Jalan

1440 05-02-2018 132212010218Y001126 0000725534008 SRI UTAMI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1441 05-02-2018 132212010218Y000581 0000725550221 NYAMI' WIDIASIH P PBI (APBN) Prolonged pregnancy Rujuk Lanjut
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1442 05-02-2018 132212010218Y000106 0000725551738 SAKUR L PBI (APBN) Erosion of teeth Berobat Jalan

1443 05-02-2018 132212010218Y000097 0000725562729 HARIYONO L PBI (APBN) Headache Berobat Jalan

1444 05-02-2018 132212010218Y000124 0000725564845 SUNTORO L PBI (APBN) Seronegative rheumatoid Berobat Jalan
arthritis
1445 05-02-2018 132212010218Y001580 0000725570199 M RAFI OKTA T L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1446 05-02-2018 132212010218Y001579 0000725578255 SRI NURIASIH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1447 05-02-2018 132212010218Y000123 0000725583341 ATMINARSIH P PBI (APBN) Headache Berobat Jalan

1448 05-02-2018 132212010218Y000136 0000725598382 A ZULFAN D L PBI (APBN) Other forms of stomatitis Berobat Jalan

1449 05-02-2018 132212010218Y000551 0000725631377 KAHFITAN FADHILA L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1450 05-02-2018 132212010218Y000093 0000725636417 ROMIA AHMAD F L PBI (APBN) Fever, unspecified Berobat Jalan

1451 05-02-2018 132212010218Y000102 0000725652527 SUGIHARJO L PBI (APBN) Chronic periodontitis Berobat Jalan

1452 05-02-2018 132212010218Y001411 0000725655249 SULIKAH P PBI (APBN) Portal hypertension Berobat Jalan

1453 05-02-2018 132212010218Y001127 0000725657938 SUPIATI P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1454 05-02-2018 132212010218Y000135 0000725676895 SUKARI L PBI (APBN) Cough Berobat Jalan

1455 05-02-2018 132212010218Y001265 0000725689067 SUTONO L PBI (APBN) Portal hypertension Berobat Jalan

1456 05-02-2018 132212010218Y001262 0000725689282 NYINTA P PBI (APBN) Myalgia Berobat Jalan

1457 05-02-2018 132212010218Y000115 0000725691813 SITI WULANDARI P PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1458 05-02-2018 132212010218Y001430 0000725703941 SITI AROFATIN P PBI (APBN) Gastritis, unspecified Berobat Jalan

1459 05-02-2018 132212010218Y000116 0000725708079 LINGGAR AMUKTI L PBI (APBN) Other specified dermatitis Berobat Jalan

1460 05-02-2018 132212010218Y000101 0000725710926 SITI FATIMAH P PBI (APBN) Headache Berobat Jalan

1461 05-02-2018 132212010218Y001043 0000725717777 SITI FATIMAH P PBI (APBN) Headache Berobat Jalan

1462 05-02-2018 132212010218Y000090 0000725719858 TOYO L PBI (APBN) Cough Berobat Jalan

1463 05-02-2018 132212010218Y000131 0000725758209 SUNARYAH P PBI (APBN) Headache Berobat Jalan

1464 05-02-2018 132212010218Y001578 0000725770247 NANIK YULIATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1465 05-02-2018 132212010218Y001042 0000725770372 USWATUN HASANAH P PBI (APBN) Gastritis, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1466 05-02-2018 132212010218Y001047 0000725784311 NUR KOFIFAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1467 05-02-2018 132212010218Y000553 0000725788686 RAWATI P PBI (APBN) Portal hypertension Berobat Jalan

1468 05-02-2018 132212010218Y001429 0000725821075 TIASIH P PBI (APBN) Essential (primary) Berobat Jalan
hypertension
1469 05-02-2018 132212010218Y001575 0000725956863 PAINI P PBI (APBN) Myalgia Berobat Jalan

1470 05-02-2018 132212010218Y000894 0000726149035 DEWI ANJARSARI WAHYU D. P PBI (APBN) Pregnancy-related Berobat Jalan
condition, unspecified
1471 05-02-2018 132212010218Y000085 0000726149531 SULIKAH P PBI (APBN) Gangrene, not elsewhere Berobat Jalan
classified
1472 05-02-2018 132212010218Y000089 0000726186071 SAMMMY DAVID S L PBI (APBN) Headache Berobat Jalan

1473 05-02-2018 132212010218Y001041 0000726387816 MUKHAIYAH P PBI (APBN) Myalgia Berobat Jalan

1474 05-02-2018 132212010218Y000092 0000726464485 RUDIYAH P PBI (APBN) Headache Berobat Jalan

1475 05-02-2018 132212010218Y000555 0000726475307 SUBINI P PBI (APBN) Unspecified diabetes Berobat Jalan
mellitus without

1476 05-02-2018 132212010218Y000096 0000726507639 SUPARJO L PBI (APBN) Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1477 05-02-2018 132212010218Y000895 0000726556634 YENI DISMAWATI P PBI (APBN) Pre-eclampsia, Rujuk Lanjut
unspecified
1478 05-02-2018 132212010218Y000137 0000726559064 ICIK NUR AINI P PBI (APBN) Injury, unspecified Berobat Jalan

1479 05-02-2018 132212010218Y000086 0000726764117 FRIKAYANTI NUR LAILI P PBI (APBN) Myalgia Berobat Jalan

1480 05-02-2018 132212010218Y000110 0001043732158 FATIMAH P PBI (APBN) Erosion of teeth Berobat Jalan

1481 05-02-2018 132212010218Y000134 0001152823601 WAGINO L PEGAWAI SWASTA Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1482 05-02-2018 132212010218Y000098 0001263270047 SITI AISYAH P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1483 05-02-2018 132212010218Y000099 0001272564641 suyanah P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1484 05-02-2018 132212010218Y000125 0001321546375 sri puji rahayu P PEGAWAI SWASTA Pure Berobat Jalan
hypercholesterolaemia
1485 05-02-2018 132212010218Y000105 0001424442881 MAT SAYUDAN L PEKERJA MANDIRI Chronic periodontitis Berobat Jalan

1486 05-02-2018 132212010218Y000129 0001822572325 TRI MUKTI P PEKERJA MANDIRI Headache Berobat Jalan

1487 05-02-2018 132212010218Y000117 0001824959946 IKHMAL ALIEF PUTRA ARNIZA L PEGAWAI SWASTA Fever, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1488 05-02-2018 132212010218Y000893 0001826054381 WIJAYANTI NUGRAINI P PEGAWAI SWASTA Pregnancy-related Rujuk Lanjut
condition, unspecified
1489 05-02-2018 132212010218Y000119 0001832760303 isyunarwan L PEKERJA MANDIRI Non-insulin-dependent Berobat Jalan
diabetes mellitus with

1490 05-02-2018 132212010218Y000118 0001832760999 suliyah P PEKERJA MANDIRI Myalgia Berobat Jalan

1491 05-02-2018 132212010218Y000121 0001895350612 siti daumah P PEKERJA MANDIRI Headache Berobat Jalan

1492 05-02-2018 132212010218Y000088 0001901600785 SUMADI L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1493 05-02-2018 132212010218Y000139 0001907258319 bayu adi santoso L PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1494 05-02-2018 132212010218Y000140 0001907258894 bella rohmatur royyani P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1495 05-02-2018 132212010218Y000550 0001959357925 RAMIANTI P PEKERJA MANDIRI Dyspepsia Berobat Jalan

1496 05-02-2018 132212010218Y000084 0002032778261 eko prastyo L PEKERJA MANDIRI Benign lipomatous Rujuk Lanjut
neoplasm of skin and
subcutaneous tissue of

1497 05-02-2018 132212010218Y000091 0002051187298 wakinah P PEKERJA MANDIRI Myalgia Berobat Jalan

1498 05-02-2018 132212010218Y000896 0002089770265 NINIK INDAYATI P PEKERJA MANDIRI Pregnancy-related Rujuk Lanjut
condition, unspecified
1499 05-02-2018 132212010218Y000554 0002214457571 NGATMIRAH P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1500 05-02-2018 132212010218Y000897 0002250603573 RAZIQ HANAN L PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1501 05-02-2018 132212010218Y000087 0002293958439 VEBRYANTI DWI SAPUTRI P.S. P PEKERJA MANDIRI Low back pain Berobat Jalan

1502 05-02-2018 132212010218Y000128 0002303812912 CHAMDAN L PEKERJA MANDIRI Erosion of teeth Berobat Jalan

1503 05-02-2018 132212010218Y000143 0002311536014 QONITA QURRATU AINI L PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
1504 05-02-2018 132212010218Y000108 0002324326353 DILLA RAHMATUL P PEKERJA MANDIRI Other specified dermatitis Berobat Jalan
MULYANINGSIH
1505 05-02-2018 132212010218Y000113 0002419471045 SA'I L PEKERJA MANDIRI Cough Berobat Jalan

1506 05-02-2018 132212010218Y000114 0002419471585 SUDARSINI P PEKERJA MANDIRI Myalgia Berobat Jalan

1507 05-02-2018 132212010218Y000132 0002421046563 ERIS NURSAVITRI P PEKERJA MANDIRI Myalgia Berobat Jalan

1508 04-02-2018 132212010218Y000075 0000723418402 TIMIUS YIKWA L PBI (APBN) Acute periodontitis Berobat Jalan

1509 04-02-2018 132212010218Y000580 0000725211279 ERVINDA SUSIATININGSIH P PBI (APBN) Antepartum haemorrhage, Rujuk Lanjut
unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1510 04-02-2018 132212010218Y000083 0000725436922 WAHYU MUKTI WIBOWO L PBI (APBN) Neonatal jaundice from Rujuk Lanjut
other specified causes
1511 04-02-2018 132212010218Y000081 0000725475846 OYIK L PBI (APBN) Myalgia Berobat Jalan

1512 04-02-2018 132212010218Y000582 0000726280481 SRI RAHAYU P PBI (APBN) Premature rupture of Rujuk Lanjut
membranes
1513 04-02-2018 132212010218Y000082 0000726514075 SUGITO L PBI (APBN) Dyspnoea Berobat Jalan

1514 04-02-2018 132212010218Y000080 0001043728672 ABEL MEI KUMALA P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1515 04-02-2018 132212010218Y000079 0001409480054 OKTAVIA TRI RAMADHAYANI P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
1516 04-02-2018 132212010218Y000078 0001792404707 eniek sih winarni P TNI ANGKATAN DARAT Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1517 04-02-2018 132212010218Y000077 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Keloid scar Berobat Jalan

1518 04-02-2018 132212010218Y000499 0002212152715 RUPANAH P PEKERJA MANDIRI Non-insulin-dependent Sembuh


diabetes mellitus without

1519 04-02-2018 132212010218Y000808 0002254096528 MAWAR NIATI P PEKERJA MANDIRI Prolonged first stage (of Rujuk Lanjut
labour)
1520 04-02-2018 132212010218Y000076 0002306209959 SELFIYANA P PEKERJA MANDIRI Acute upper respiratory Berobat Jalan
infection, unspecified
1521 04-02-2018 132212010218Y000585 0002419737693 SUSANTI P PEKERJA MANDIRI Myopia Rujuk Lanjut

1522 03-02-2018 132212010218Y000061 0000098555376 AKSAN L PENERIMA PENSIUN Portal hypertension Berobat Jalan
PNS
1523 03-02-2018 132212010218Y000058 0000098557086 M SANTOSO L PNS DAERAH Portal hypertension Berobat Jalan

1524 03-02-2018 132212010218Y000067 0000098559448 SUTIASIH P PENERIMA PENSIUN Influenza with other Berobat Jalan
PNS respiratory manifestations,
virus not identified

1525 03-02-2018 132212010218Y000071 0000725247584 FERDIAZ ARIEL MAULANA P PBI (APBN) Dyspepsia Berobat Jalan

1526 03-02-2018 132212010218Y000063 0000725267452 INTAN N P PBI (APBN) Fever, unspecified Berobat Jalan

1527 03-02-2018 132212010218Y001125 0000725424625 KASIDAN L PBI (APBN) Otitis media, unspecified Berobat Jalan

1528 03-02-2018 132212010218Y000068 0000725476307 BENI MINARKO L PBI (APBN) Myalgia Berobat Jalan

1529 03-02-2018 132212010218Y000057 0000725503871 MOCHAMMAD RIFAI L PBI (APBN) Fever, unspecified Berobat Jalan

1530 03-02-2018 132212010218Y000069 0000725641299 JUMILAH P PBI (APBN) Gastritis, unspecified Berobat Jalan

1531 03-02-2018 132212010218Y000485 0000725918207 SOPI'I L PBI (APBN) Dyspepsia Sembuh


DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1532 03-02-2018 132212010218Y000064 0000726114418 RAMADHAN YOGA Novianto L PBI (APBN) Other specified dermatitis Berobat Jalan

1533 03-02-2018 132212010218Y000490 0000726150486 ANANDA SETYAWAN P L PBI (APBN) Fever, unspecified Sembuh

1534 03-02-2018 132212010218Y000500 0001043731989 AMINATUN P PBI (APBN) Acute upper respiratory Sembuh
infection, unspecified
1535 03-02-2018 132212010218Y000073 0001272887605 SUNDARI P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1536 03-02-2018 132212010218Y000059 0001386953853 VINA SITI FATIMAH P PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1537 03-02-2018 132212010218Y000062 0001470197384 FARIT IRAWATI P PEKERJA MANDIRI Arrested dental caries Berobat Jalan

1538 03-02-2018 132212010218Y000065 0001540841422 A FERI FIRMANSYAH L PEGAWAI SWASTA Injury, unspecified Berobat Jalan

1539 03-02-2018 132212010218Y000070 0002032778261 eko prastyo L PEKERJA MANDIRI Unspecified appendicitis Rujuk Lanjut

1540 03-02-2018 132212010218Y000072 0002055191859 fauzi rahman nurjaya L PEKERJA MANDIRI Dyspepsia Berobat Jalan

1541 03-02-2018 132212010218Y001410 0002075435638 SRIWATI P PEKERJA MANDIRI Dyspnoea Berobat Jalan

1542 03-02-2018 132212010218Y000891 0002198831646 athifah nurul ramadhaniah P PNS DAERAH Influenza, virus not Berobat Jalan
identified
1543 03-02-2018 132212010218Y000056 0002225715006 SITI AFIFAH P PEKERJA MANDIRI Gastritis, unspecified Rujuk Lanjut

1544 03-02-2018 132212010218Y000066 0002259734679 SUDARTO L PEGAWAI SWASTA Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1545 03-02-2018 132212010218Y000060 0002271794444 M. HUBBY FERDYANSAH L PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1546 03-02-2018 132212010218Y000892 0002305519165 NURUL HAFIDLOTUS SHOIMAH P PEGAWAI SWASTA Influenza, virus not Berobat Jalan
identified
1547 02-02-2018 132212010218Y001123 0000098557773 RUKMIWATI P PNS DAERAH Acute upper respiratory Berobat Jalan
infection, unspecified
1548 02-02-2018 132212010218Y000031 0000098606643 DWI SUSILOWARDANI P PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1549 02-02-2018 132212010218Y000034 0000098676044 SUJAMAL L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1550 02-02-2018 132212010218Y000042 0000168082839 DIDIK SUGIANTORO L PNS DAERAH Chest pain, unspecified Rujuk Lanjut

1551 02-02-2018 132212010218Y000050 0000723957153 WARSI P PBI (APBN) Injury, unspecified Berobat Jalan

1552 02-02-2018 132212010218Y000055 0000723957153 WARSI P PBI (APBN) Injury, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1553 02-02-2018 132212010218Y001403 0000724627045 AKHILA NUR ASSA P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1554 02-02-2018 132212010218Y000030 0000724800431 AZKAH ABDILLAH L PBI (APBN) Hereditary factor VIII Rujuk Lanjut
deficiency
1555 02-02-2018 132212010218Y000037 0000725245615 MINARSIH P PBI (APBN) Predominantly allergic Rujuk Lanjut
asthma
1556 02-02-2018 132212010218Y000048 0000725532142 M. ALI L PBI (APBN) Fever, unspecified Berobat Jalan

1557 02-02-2018 132212010218Y000039 0000725566926 LILIK SULASTRI L PBI (APBN) Hebephrenic Rujuk Lanjut
schizophrenia
1558 02-02-2018 132212010218Y000051 0000725708079 LINGGAR AMUKTI L PBI (APBN) Other specified dermatitis Berobat Jalan

1559 02-02-2018 132212010218Y001402 0000725925734 RUNTI P PBI (APBN) Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1560 02-02-2018 132212010218Y001115 0000726136749 GIRAN L PBI (APBN) Myalgia Berobat Jalan

1561 02-02-2018 132212010218Y000040 0000726529803 GISAN L PBI (APBN) Stroke, not specified as Rujuk Lanjut
haemorrhage or infarction
1562 02-02-2018 132212010218Y001428 0001043725904 SUMIATUN P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1563 02-02-2018 132212010218Y000035 0001293091751 SUWANI P PEKERJA MANDIRI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1564 02-02-2018 132212010218Y000038 0001389468227 siti yulaikah P PEKERJA MANDIRI Nonorganic insomnia Rujuk Lanjut

1565 02-02-2018 132212010218Y000049 0001444485677 SINI ASTUTIK P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1566 02-02-2018 132212010218Y000052 0001448311724 SUWONO L PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1567 02-02-2018 132212010218Y000047 0001702369067 SUSIATIK P PEGAWAI SWASTA Diarrhoea and Berobat Jalan
gastroenteritis of
presumed infectious origin

1568 02-02-2018 132212010218Y001124 0001704622252 PATILAH P PBI (APBD) Portal hypertension Berobat Jalan

1569 02-02-2018 132212010218Y000046 0001792724951 KUSWO L PEKERJA MANDIRI Tuberculosis of lung, Berobat Jalan
confirmed by sputum
microscopy with or without

1570 02-02-2018 132212010218Y001563 0001845937697 rizki ilma arifatus sholeha P PEGAWAI SWASTA Acute upper respiratory Berobat Jalan
infection, unspecified
1571 02-02-2018 132212010218Y000074 0001907441504 adi agus ponco asmoro L PEKERJA MANDIRI Injury, unspecified Berobat Jalan
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1572 02-02-2018 132212010218Y000041 0002010715806 CHURORIN P PBI (APBN) Dysmenorrhoea, Rujuk Lanjut
unspecified
1573 02-02-2018 132212010218Y000044 0002016163923 AIRIN YUNIA RAHMA P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1574 02-02-2018 132212010218Y000036 0002205489352 ALFIYAH P PEKERJA MANDIRI Pre-eclampsia, Rujuk Lanjut
unspecified
1575 02-02-2018 132212010218Y000032 0002239168083 MARINI DWI MALASARI P PEKERJA MANDIRI Chronic renal failure, Rujuk Lanjut
unspecified
1576 02-02-2018 132212010218Y000045 0002242111768 BAGAS TRI AL ALAMIN L PEKERJA MANDIRI Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1577 02-02-2018 132212010218Y000033 0002263696672 EKO SRI RAHAYU P PEKERJA MANDIRI Supervision of pregnancy Rujuk Lanjut
with grand multiparity
1578 02-02-2018 132212010218Y000043 0002324326768 KADAM L PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

1579 01-02-2018 132212010218Y000012 0000098557356 BUDIANIK P PENERIMA PENSIUN Portal hypertension Rujuk Lanjut
PNS
1580 01-02-2018 132212010218Y000010 0000098558695 PUDI L PNS DAERAH Chronic ischaemic heart Rujuk Lanjut
disease, unspecified
1581 01-02-2018 132212010218Y000016 0000098559112 SUKIYAN L PNS DAERAH Myalgia Berobat Jalan

1582 01-02-2018 132212010218Y000028 0000098559652 GINARTI P PNS DAERAH Portal hypertension Rujuk Lanjut

1583 01-02-2018 132212010218Y000004 0000098682748 SULIKAH L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1584 01-02-2018 132212010218Y000006 0000098782119 ISMANIK P PENERIMA PENSIUN TNI Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1585 01-02-2018 132212010218Y000008 0000098809356 HJ. ARIFAH, BA P PENERIMA PENSIUN Atherosclerotic heart Rujuk Lanjut
PNS disease
1586 01-02-2018 132212010218Y000019 0000098811955 SUNARI HADIPRANOTO,DRS P PENERIMA PENSIUN Headache Berobat Jalan
PNS
1587 01-02-2018 132212010218Y000029 0000099395537 TUTUT KARTINI P PENERIMA PENSIUN Other disorders of middle Rujuk Lanjut
PNS ear and mastoid in
diseases classified

1588 01-02-2018 132212010218Y000003 0000168082839 DIDIK SUGIANTORO L PNS DAERAH Non-insulin-dependent Rujuk Lanjut
diabetes mellitus without

1589 01-02-2018 132212010218Y000002 0000168083155 TIARA KUSUMAWARDANI L PNS DAERAH Acute serous otitis media Rujuk Lanjut
SUGIANTORO PUTRI
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1590 01-02-2018 132212010218Y001399 0000723767826 WARNI P PBI (APBN) Hypertensive heart Berobat Jalan
disease with (congestive)

1591 01-02-2018 132212010218Y001582 0000723958132 NYAMIK P PBI (APBN) Gastritis, unspecified Berobat Jalan

1592 01-02-2018 132212010218Y001581 0000723958582 PIPIT ESTU N L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
1593 01-02-2018 132212010218Y001574 0000724787111 SUTAMI P PBI (APBN) Myalgia Berobat Jalan

1594 01-02-2018 132212010218Y000024 0000724849211 M AFAN DRIKULLOH L PBI (APBN) Fever, unspecified Berobat Jalan

1595 01-02-2018 132212010218Y000001 0000724937905 DHINI ANINDA PUTRI P PBI (APBN) Premature rupture of Rujuk Lanjut
membranes, unspecified
1596 01-02-2018 132212010218Y000005 0000725141283 SARMI P PBI (APBN) Cutaneous abscess, Rujuk Lanjut
furuncle and carbuncle,

1597 01-02-2018 132212010218Y001572 0000725165706 SALVA RISVANA ELI YANA P PBI (APBN) Fever, unspecified Berobat Jalan

1598 01-02-2018 132212010218Y001121 0000725192943 SUNARTI P PBI (APBN) Rheumatoid arthritis, Berobat Jalan
unspecified
1599 01-02-2018 132212010218Y000027 0000725195507 MUNIK P PBI (APBN) Twin pregnancy Rujuk Lanjut

1600 01-02-2018 132212010218Y001584 0000725211325 HINDRO PRIWONO L PBI (APBN) Myalgia Berobat Jalan

1601 01-02-2018 132212010218Y000021 0000725262974 HAYATI P PBI (APBN) Cough Berobat Jalan

1602 01-02-2018 132212010218Y001397 0000725417831 ANDIEN J P PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1603 01-02-2018 132212010218Y001308 0000725460489 RIADI L PBI (APBN) Acute upper respiratory Berobat Jalan
infection, unspecified
1604 01-02-2018 132212010218Y000015 0000725475846 OYIK L PBI (APBN) Myalgia Berobat Jalan

1605 01-02-2018 132212010218Y001113 0000725476072 NGATEMI P PBI (APBN) Myalgia Berobat Jalan

1606 01-02-2018 132212010218Y001307 0000725481437 SALAM L PBI (APBN) Gastritis, unspecified Berobat Jalan

1607 01-02-2018 132212010218Y001571 0000725569604 SUTIYA P PBI (APBN) Fever, unspecified Berobat Jalan

1608 01-02-2018 132212010218Y000025 0000725605457 GIMAN L PBI (APBN) Dyspnoea Berobat Jalan

1609 01-02-2018 132212010218Y001120 0000725614569 SAMINTEN P PBI (APBN) Portal hypertension Berobat Jalan

1610 01-02-2018 132212010218Y000017 0000725634617 RISMA KRIMIARTI P PBI (APBN) Other specified dermatitis Berobat Jalan

1611 01-02-2018 132212010218Y000838 0000725682036 MUJIATI P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1612 01-02-2018 132212010218Y001408 0000725719858 TOYO L PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1613 01-02-2018 132212010218Y000023 0000725784298 EFENDI AFRILIYANTO L PBI (APBN) Depressive episode, Berobat Jalan
unspecified
1614 01-02-2018 132212010218Y001583 0000725850718 SUNARNO L PBI (APBN) Acute nasopharyngitis Berobat Jalan
[common cold]
1615 01-02-2018 132212010218Y000839 0000726148888 SUMIASIH P PBI (APBN) Contraceptive Berobat Jalan
management, unspecified
1616 01-02-2018 132212010218Y001426 0001043726049 SUPIATI P PBI (APBN) Headache Berobat Jalan

1617 01-02-2018 132212010218Y001427 0001043726106 SUPRIYADI L PBI (APBN) Seropositive rheumatoid Berobat Jalan
arthritis, unspecified
1618 01-02-2018 132212010218Y000020 0001043731989 AMINATUN P PBI (APBN) Influenza with other Berobat Jalan
respiratory manifestations,
virus not identified

1619 01-02-2018 132212010218Y001573 0001043734926 SRI HARTINI P PBI (APBN) Gastritis, unspecified Berobat Jalan

1620 01-02-2018 132212010218Y001122 0001319186316 juma'inah P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1621 01-02-2018 132212010218Y000053 0001319290479 SITI UMAIYAH P PEKERJA MANDIRI Acute periodontitis Berobat Jalan

1622 01-02-2018 132212010218Y000018 0001432013916 SADAYAH P PEKERJA MANDIRI Headache Berobat Jalan

1623 01-02-2018 132212010218Y000014 0001542751593 RETNO UTARI P PEGAWAI SWASTA Fetus and newborn Rujuk Lanjut
affected by
malpresentation before

1624 01-02-2018 132212010218Y000009 0001859191795 warsiti P PEKERJA MANDIRI Senile nuclear cataract Rujuk Lanjut

1625 01-02-2018 132212010218Y000479 0001895875345 fariza umairoh P PEKERJA MANDIRI Typhoid and paratyphoid Sembuh
fevers
1626 01-02-2018 132212010218Y000026 0001895875345 fariza umairoh P PEKERJA MANDIRI Fever, unspecified Berobat Jalan

1627 01-02-2018 132212010218Y001409 0001966565305 SURATI P PEKERJA MANDIRI Dyspnoea Berobat Jalan

1628 01-02-2018 132212010218Y000054 0002010715806 CHURORIN P PBI (APBN) Urinary tract infection, site Berobat Jalan
not specified
1629 01-02-2018 132212010218Y001114 0002077301259 arka widigda putra wibowo L PEKERJA MANDIRI Influenza, virus not Berobat Jalan
identified
1630 01-02-2018 132212010218Y000011 0002233372882 M. ALI SISWANTO L PEKERJA MANDIRI Portal hypertension Rujuk Lanjut

1631 01-02-2018 132212010218Y000007 0002274074278 ILHAFA P PEKERJA MANDIRI False labour before 37 Rujuk Lanjut
completed weeks of
DAFTAR KUNJUNGAN PESERTA SAKIT

Kantor Cabang : MOJOKERTO - 1307

FKTP : DLANGGU - 13221201

1632 01-02-2018 132212010218Y000022 0002293958237 PURWONINGSIH P PEKERJA MANDIRI Portal hypertension Berobat Jalan

1633 01-02-2018 132212010218Y000013 0002322564805 ASIYAH P PEKERJA MANDIRI Low back pain Rujuk Lanjut

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