<table class='tabel' width='90%'>

<tr class="form">
<td align="center" colspan="9">
<big><big><span style="font-weight: bold;">
LAPORAN UNIVERSAL POLI UMUM<br>
BULAN 01-01-1970 - 01-01-1970 </span></big></big>
</td>
</tr>
</table>
<table align='center'>
<tr>
<td>Total</td>
<td>:</td>
<td>49</td>
</tr>
</table>
<table align="center" width="98%" border="1">
<tr class="row1">
<td width='3%'>No</td>
<td width='6%'>Tanggal</td>
<td width='6%'>No RM</td>
<td width='10%'>Nama</td>
<td width='6%'>Desa</td>
<td width='5%'>Kecamatan</td>
<td width='5%'>Kabupaten</td>
<td width='6%'>Umur</td>
<td width='2%'>L/P</td>
<td width='7%'>Pekerjaan</td>
<td width='7%'>Ruangan</td>
<td width='4%'>Status</td>
<td>Kasus</td>
<td>Cara Bayar</td>
<td>Biaya</td>
<td>Diagnosa</td>
</tr>

<tr align="left" valign="top">

<td>1</td>
<td>27-04-2017</td>
<td>003960</td>
<td>BASIRAN</td>
<td>JOGODAYUH</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >55 T-1 B-26 H</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020417Y001006</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

 <tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>2</td>
<td>22-05-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020517Y000762</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>3</td>
<td>21-06-2017</td>
<td>005597</td>
<td>ISMIATI</td>
<td>JOGODAYUH</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >44 T-2 B-5 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
 5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>4</td>
<td>09-05-2017</td>
<td>004523</td>
<td>SUPRATINI</td>
<td>KRANGGAN</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >74 T-7 B-5 H</td>
<td>P</td>
<td>-</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020517Y000313</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>5</td>
<td>02-06-2017</td>
<td>000102</td>
<td>NUR HIDAYATI </td>
<td>SIRAPAN</td>
<td>MADIUN</td>
<td> MADIUN</td>
<td >21 T-3 B-17 H</td>
<td>P</td>
<td>Karyawan Swasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
 <td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
15000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>6</td>
<td>03-07-2017</td>
<td>005720</td>
<td>PRIBADI</td>
<td>KERTOSARI</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >31 T-9 B-29 H</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS <br>PEKERJA MANDIRI<br> <font
color='red'>130703020717Y000010</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>7</td>
<td>16-05-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
 <td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020517Y000536</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>8</td>
<td>12-06-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020617Y000334</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>9</td>
<td>31-03-2017</td>
<td>002619</td>
 <td>RIFKI AF DILLA</td>
<td>SAMBIREJO</td>
<td>MADIUN</td>
<td> </td>
<td >12 T-5 B-5 H</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020317Y001383</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>10</td>
<td>20-05-2017</td>
<td>004829</td>
<td>BAIHAQI</td>
<td>PUTAT</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >2017 T-7 B-6 H</td>
<td>L</td>
<td>-</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>
 <tr align="left" valign="top">
<td>11</td>
<td>20-06-2017</td>
<td>005565</td>
<td>DWI HANDAYANI</td>
<td>PUTAT</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >13 T-0 B-16 H</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020617Y000527</font></td>

<td>
15000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>12</td>
<td>27-04-2017</td>
<td>002842</td>
<td>MUKINAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >88 T-0 B-6 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020417Y001005</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>
 </table>
</td>

</tr>

<tr align="left" valign="top">

<td>13</td>
<td>09-05-2017</td>
<td>004509</td>
<td>SUKIRAN</td>
<td>NGLANDUNG</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >67 T-11 B-1 H</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>14</td>
<td>30-05-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020517Y001101</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
 <td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>15</td>
<td>23-06-2017</td>
<td>005565</td>
<td>DWI HANDAYANI</td>
<td>PUTAT</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >13 T-0 B-16 H</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020617Y000640</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>16</td>
<td>16-05-2017</td>
<td>000820</td>
<td>CHOIRUL ANAM</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >25 T-7 B-23 H</td>
<td>L</td>
<td>-</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020517Y000540</font></td>

<td>
 5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>17</td>
<td>10-06-2017</td>
<td>005381</td>
<td>SUCIPTO</td>
<td>JATISARI</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >40 T-2 B-17 H</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>18</td>
<td>06-03-2017</td>
<td>000447</td>
<td>BASUKI</td>
<td>KRANGGAN</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >29 T-6 B-23 H</td>
<td>L</td>
<td>Karyawan Swasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
 <td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020317Y000224</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>F20.0</td>
<td >Paranoid schizophrenia</td>
</tr>
<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>19</td>
<td>20-05-2017</td>
<td>000524</td>
<td>YULIATI ENY RAHAYU</td>
<td>PUTAT</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >51 T-3 B-22 H</td>
<td>P</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PNS DAERAH<br> <font
color='red'>130703020517Y000706</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>20</td>
<td>19-06-2017</td>
<td>005553</td>
<td>TRI WULAN AGENG</td>
 <td>SAMBIREJO</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >10 T-5 B-29 H</td>
<td>P</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>21</td>
<td>22-04-2017</td>
<td>003758</td>
<td>OKTA GUNTUR SEPTIAWAN</td>
<td>KRANGGAN</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >8 T-9 B-19 H</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020417Y000825</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

 <td>22</td>
<td>09-05-2017</td>
<td>000820</td>
<td>CHOIRUL ANAM</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >25 T-7 B-23 H</td>
<td>L</td>
<td>-</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020517Y000275</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>23</td>
<td>30-05-2017</td>
<td>005071</td>
<td>SAHRI</td>
<td>KRANGGAN</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >56 T-10 B-24 H</td>
<td>L</td>
<td>Tukang Batu</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020517Y001081</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
 </td>

</tr>

<tr align="left" valign="top">

<td>24</td>
<td>22-06-2017</td>
<td>000449</td>
<td>RIRIN RETNO AMBAR SARI</td>
<td>KERTOSARI</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >43 T-1 B-16 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020617Y000613</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>25</td>
<td>15-05-2017</td>
<td>004509</td>
<td>SUKIRAN</td>
<td>NGLANDUNG</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >67 T-11 B-1 H</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
 <td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>26</td>
<td>08-06-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020617Y000192</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>27</td>
<td>03-03-2017</td>
<td>000247</td>
<td>YULIANTO</td>
<td>SANGEN</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >47 T-0 B-1 H</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>
 <table width='100%' border='1'>
<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>28</td>
<td>19-05-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020517Y000678</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>29</td>
<td>17-06-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020617Y000463</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>30</td>
<td>10-04-2017</td>
<td>003247</td>
<td>SARMINI</td>
<td>KERTOSARI</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >51 T-2 B-13 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI APBN<br> <font color='red'></font></td>

<td>
20000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>31</td>
<td>05-05-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
 <td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020517Y000172</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>32</td>
<td>29-05-2017</td>
<td>005063</td>
<td>DENY YOGO CAHYONO</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >31 T-7 B-3 H</td>
<td>L</td>
<td>Wiraswasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>33</td>
<td>22-06-2017</td>
<td>005628</td>
<td>SADINEM</td>
<td>KAIBON</td>
<td>GEGER</td>
 <td> MADIUN</td>
<td >65 T-0 B-6 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>34</td>
<td>04-07-2017</td>
<td>005757</td>
<td>IVAN HENDARTO</td>
<td>KERTOSARI</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >7 T-5 B-5 H</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020717Y000122</font></td>

<td>
15000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>35</td>
<td>13-05-2017</td>
 <td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020517Y000420</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>36</td>
<td>08-06-2017</td>
<td>005318</td>
<td>THOIFUL MUSLIMIN</td>
<td>NGLANDUNG</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >59 T-6 B-5 H</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020617Y000185</font></td>

<td>
15000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>
</tr>

<tr align="left" valign="top">

<td>37</td>
<td>01-03-2017</td>
<td>000074</td>
<td>AHMAD NURYANI</td>
<td>UTERAN</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >38 T-3 B-9 H</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>38</td>
<td>19-05-2017</td>
<td>004787</td>
<td>ALGY PUGUH SETYAWAN</td>
<td>NGLANDUNG</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >19 T-3 B-14 H</td>
<td>L</td>
<td>Karyawan Swasta</td>
<td>POLI UMUM</td>
<td>BARU</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>
 </table>
</td>

</tr>

<tr align="left" valign="top">

<td>39</td>
<td>14-06-2017</td>
<td>003088</td>
<td>ADITYA YUSUP</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >8 T-4 B-21 H</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>40</td>
<td>06-04-2017</td>
<td>003086</td>
<td>KATINEM</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >56 T-6 B-5 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020417Y000225</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
 <td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>
<tr valign="top">
<td width='20%'>J02.0</td>
<td >Streptococcal pharyngitis</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>41</td>
<td>02-05-2017</td>
<td>003960</td>
<td>BASIRAN</td>
<td>JOGODAYUH</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >55 T-1 B-26 H</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020517Y000014</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>42</td>
<td>24-05-2017</td>
<td>000487</td>
<td>ALIB THOIBAH</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >28 T-3 B-2 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
 <td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020517Y000882</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>43</td>
<td>21-06-2017</td>
<td>001304</td>
<td>DJUWARIYAH</td>
<td>NGLANDUNG</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >58 T-0 B-6 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS LAMA</td>
<td>BPJS <br>PBI (APBD)<br> <font
color='red'>130703020617Y000575</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>E11.4</td>
<td >Non-insulin-dependent diabetes mellitus with
neurological complications</td>
</tr>
<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>44</td>
<td>04-07-2017</td>
<td>005597</td>
 <td>ISMIATI</td>
<td>JOGODAYUH</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >44 T-2 B-5 H</td>
<td>P</td>
<td>Mengurus Rumah Tangga</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
15000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>45</td>
<td>12-05-2017</td>
<td>000820</td>
<td>CHOIRUL ANAM</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >25 T-7 B-23 H</td>
<td>L</td>
<td>-</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020517Y000403</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>
 <tr align="left" valign="top">
<td>46</td>
<td>05-06-2017</td>
<td>005235</td>
<td>ALEX SUHARTANTO</td>
<td>KAIBON</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >22 T-8 B-1 H</td>
<td>L</td>
<td>Karyawan Swasta</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PEGAWAI SWASTA<br> <font
color='red'>130703020617Y000082</font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>47</td>
<td>17-05-2017</td>
<td>004509</td>
<td>SUKIRAN</td>
<td>NGLANDUNG</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >67 T-11 B-1 H</td>
<td>L</td>
<td>Belum / Tidak Bekerja</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
 </td>

</tr>

<tr align="left" valign="top">

<td>48</td>
<td>13-06-2017</td>
<td>005445</td>
<td>TITO AGUNG PRASTYO</td>
<td>PUTAT</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >7 T-8 B-7 H</td>
<td>L</td>
<td>Pelajar / Mahasiswa</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KUNJUNGAN KASUS LAMA</td>
<td>BPJS <br>PBI (APBN)<br> <font
color='red'>130703020617Y000358</font></td>

<td>
15000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
<td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>

<tr align="left" valign="top">

<td>49</td>
<td>03-04-2017</td>
<td>002074</td>
<td>KUSNO</td>
<td>PUTAT</td>
<td>GEGER</td>
<td> MADIUN</td>
<td >43 T-2 B-2 H</td>
<td>L</td>
<td>Petani / Pekebun</td>
<td>POLI UMUM</td>
<td>LAMA</td>
<td>KASUS BARU</td>
<td>UMUM <br> <font color='red'></font></td>

<td>
5000 </td>
<td>

<table width='100%' border='1'>

<tr valign="top">
<td width='20%'>T14.1</td>
 <td >Open wound of unspecified body region</td>
</tr>

</table>
</td>

</tr>
</table>