Lampiran 2

LAMPIRAN 2
DATA INFORMASI PESERTA TERDAFTAR PROLANIS
NAMA KLUB : PROLANIS DIABETES MELITUS PUSKESMAS CIPINANG MUARA
NAMA FKTP : Puskesmas Cipinang Muara
PESERTA TERDAFTAR : 63 orang
NAMA DOKTER PROLANIS : dr. Nalini Kastoriani
No. Nama Peserta No. Kartu Mulai Terdaftar Alamat No. Telp Diagnosa
1 Sudarmedi 310001191144 4/12/2016 CM 2/8 DM, HT
2 Chairiyah 0001213603582 5/12/2015 CM 9/6 082213605444 DM
3 Kardinah 0000044752094 9/8/2015 CM 12/15 021-8560378 DM, HT
4 Zulkifli 0001215685596 2/12/2018 CM 7/8 081291598488 DM, HT

LAMPIRAN 2
5 Ermawat 0001309016531 11/10/2015 CM 12/4 DM, HT
6 Mariyah 0001300688122 7/12/2016 CM 13/15 021-851-5807 DM, HT
7 Ani Rohaiza 0000042171399 5/12/2015 CM 9/3 081219284438 DM
8 Mujiono 0000040993817 1/10/2017 Klender 10/3 082122208060 DM
9 Tumino 0000041940325 11/13/2018 Pd. Bambu 7/2 021-8627949 DM
10 Slamet Partono 0001675294795 10/10/2017 CM 12/15 087780492950 DM
11 Anak Agung 0000044010191 4/12/2016 CM 12/10 021-8520809 DM, HT
12 Menak Kumari 0001216022174 12/11/2018 CM 5/4 081285602962 DM
13 Suparman 0000036159794 6/13/2017 021-857-9251 DM
14 Puri Kusdarini 2/13/2015 CM 6/8 089506034401 DM

0000038924965
15 Muhsin 3100016600728 4/11/2017 CM 11/15 081285517882 DM, HT
16 Rustam 0000044758629 9/13/2016 CM 7/4 021-85900226 DM, HT
17 Rahmat 0001215316585 12/11/2018 CM 11/15 08981386939077 DM, HT
18 Diyah Haryani 0001215751127 4/11/2017 CM 15/4 081288651899 DM, HT
19 Hj. Sumarni 3100005093442 8/11/2015 CM 6/15 021-85906465 DM, HT

LAMPIRAN 2
20 Eviyant 0001290111208 5/12/2015 CM DM, HT
21 Neng Sulastri 0001214748641 8/9/2016 CM 5/3 089631616849 DM
22 Retno Madurini 0001214335009 5/8/2018 CM 6/11 DM
23 Makiyah 0001608908793 12/11/2018 CM 6/3 08159409448 DM
24 Dedeh Wartni 0001217482672 8/9/2016 CM 7/11 085777545659 DM, HT
25 Mohamad Daim 0001335168055 6/5/2018 021-8515084 DM
26 Sumarni 0001282965096 5/12/2015 CM 6/15 021-85906465 DM, HT
27 Kesih 0000044780218 1/10/2017 CM 13/4 021-8578658 DM
28 Jariyah 3100011657502 10/11/2016 CM 10/15 DM, HT
29 Sumirah 0001214557121 4/10/2018 CM 13/8 DM, HT
30 Sardiyono 0001215537355 8/12/2015 CM 6/4 081590815879 DM, HT
31 Sanawiyah 001214761645 6/9/2015 CM 5/3 081806174790 DM
32 Moh. Dayat Sutsna 0001275592105 5/12/2015 DM, HT
33 Tut Asih 0001280116091 4/9/2017 CM 7/14 081314357079 DM, HT
34 Waginah 0001298068198 8/11/2015 CM 10/15 081519004820 DM

LAMPIRAN 2
35 Nurkhasan 3100016055791 12/9/2016 CM 13/15 087788898522 DM
36 Jumini 0001631092059 9/10/2017 CM 14/1 081314474527 DM
37 Parilah 00003689280444 1/10/2017 CM 2/4 081314590674 DM
38 I Wayan Tapa 0000037317767 8/12/2015 CM 5/11 021-8573951 DM, HT
39 Sarini Wahyuni 0000039571514 7/10/2018 CM 11/15 081310515828 DM, HT
40 Nurbait 0001275592318 5/12/2015 CM 13/4 021-95443157 DM, HT
41 Sarmui 0001217582886 4/12/2016 CM 11/1 DM, HT
42 Sohiran 0001335193896 4/12/2016 CM 1/4 021-8501606 DM
43 Mashudah 0001336089644 5/12/2015 CM 6/3 DM
44 Kartni 0001215458897 2/9/2016 CM 4/15 021-8510811 DM, HT
45 Zahroh 0001605747892 5/12/2015 CM 13/3 DM
46 Pawuh 0001214534384 8/11/2015 CM 10/15 081285518744 DM
47 Sukilah 0001335483202 4/10/2018 DM, HT
48 Sumiyat 0000369013724 9/8/2015 CM 14/4 DM
49 Hj, Muryani 0001335193907 6/9/2015 CM 1/4 021-8501606 DM

LAMPIRAN 2
50 Jusri 0001376445554 11/13/2018 CM 12/4 DM
51 Sukarsih 0001888827873 2/9/2016 CM 7/8 081511116745 DM
52 Edi Sudjono 0001218493956 5/8/2018 CM 14/4 021-8500988 DM, HT
53 Suwanah 0001674613372 4/11/2017 CM 13/8 DM, HT
54 Bustomi 0001328106701 7/10/2018 CM 13/4 DM
55 Samad 0001218275583 7/10/2018 CM 9/15 081284599279 DM
56 Nur Aida Aly 0002214928449 4/11/2017 CM 7/6 021-8507063 DM, HT
57 H. Tholib 0001218274031 11/7/2017 CM 12/6 021-8514652 DM, HT
58 Suminah 0001673494167 12/14/2016 CM 14/6 021-8520488 DM, HT
59 Oyoh Rukiah 0000044709041 5/12/2015 CM 6/6 DM, HT
60 Zubaidah 0000369274691 6/9/2015 DM
61 Marman 0000040822672 5/8/2018 CM 5/13 081290122798 DM
62 Sri Luwih 0001617909805 1/8/2019 DM
63 Murtningsih 0000044767045 2/12/2019 DM
Ketentuan
LAMPIRAN 2
Mulai Bergabung : Diisi "Bulan" saat Peserta mulai mengikut kegiatan
Keterangan : Diisi keterangan Peserta Contoh : Pindah, Meninggal, Baru,Pasif (Untuk Peserta >3 bulan tdak hadir)
Total Peserta : Diisi dengan Total Peserta terdaftar dalam 1 bulan

LAMPIRAN 2
TA TERDAFTAR PROLANIS
LITUS PUSKESMAS CIPINANG MUARA
Keterangan (diisi dengan

keterangan
Nama Obat Jumlah Obat aktif/pasif/baru/meninggal/pin
dah
Metformin, Glimepiride, Concor, Miniaspi 90,30,30,30 Aktf
Metformin, Glimepiride, Acarbose 90,30,90 Aktf
Metformin, Acarbose, Noverten, Glucodex 90.90.30.30 Aktf
Metformin, Glimepiride, Acarbose, Amlodopine 90.30.30.30 Aktf

LAMPIRAN 2
Metformin, Amlodipine, Glimepiride, Acrbose, Simvastatn 90.30.30.30.30 Aktf
Metformin, Glimepiride, Candesartan 30.30.30 Aktf
Metformin 90 Aktf
Metformin, Acarbose, Simvastatn 90.60.30 Aktf
Metformin 60 Aktf
Metformin, Acarbose, Glimepiride 90.60.30 Aktf
Glimepiride, Bisoprolol, Acarbose, Miniaspi, Amlodipine 30.30.60.30.30 Aktf
Metformin, Glipiride, Acarbose 90.30.90 Aktf
Glimepiride 30 Aktf
Metformin, Glimepiride 90.3 Aktf
Amlodipine, Metfirmin, Glimepiride, Acarbose 30.90.30.90 Aktf
Metformin, Amlodipine 30.30 Aktf
Metformin, Amlodipine 60.30 Aktf
Metformin, Concor, Candesartan, Adalat Oros, Amlodipine 90.30.30.30.30 Aktf
Metformin, Amlodipine, Glimepiride 90.30.30 Aktf

LAMPIRAN 2
Metformin, Captopril, Glimepiride, Acarbose 90.30.30.30 Aktf
Metformin, Gliquidone 90.60 Aktf
Metformin, Glimepiride, Acarbose 90.30.90 Aktf
Metformin, Glimepiride, Amlodipine, Valsartan, Simvasatn 90.30.30.30.30 Aktf
Amlodipin, Metformin, Glimepiride, Acarbose 30.90.30.60 Aktf
Captopril, Metformin, Glimepiride 60.90.30 Aktf
Metformin, Acarbose 90.90 Aktf
Metformin 60 Aktf
Metformin, Glibenclamide, Simvastatn, Amlodipine 90.30.30.30 Aktf
Amlodipine, Metformin, Glimepiride 30.90.30 Aktf
Metformin, Glimepiride, Aspilet, Candesartam, Simvastatn 90.30.30.30.30 Aktf
Metformin, Acarbose, Amlodipine 60.60.30 Aktf
Metformin, Glimepiride, Amlodipine, Captopril 90.30.30.30 Pasif (8 bulan)
Metformin, Glimepiride 60.30 Pasif (8 bulan)

LAMPIRAN 2
Glimepiride 30 Aktf
Amlodipine, Simvastatn, Glimepiride 30.30.30 Aktf
Metformin, Acarbose, Amlodipine, Glimepiride 90.60.30.30 Aktf
Metformin, Gliquidone, Candesartan, Amlidopine, Simvasatn, Allopurinol 90.30.30.30.30.30 Aktf
Metformin, Glimepiride, Valsartan 90.30.30 Aktf
Metformin, Glimepiride, Acarbose 90.30.90 Aktf
Metformin, Amlodipine, Glimepiride, Allopurinol 90.30.30.30 Aktf
Metformin, Gliquidone, Acarbose 90.60.90 Aktf
Metformin, Acarbose, Glimepiride 90.90.30 Aktf

LAMPIRAN 2
Metformin 60 Aktf
Metformin, Glimepiride, Gliquidone, Simvastatn 90.30.30.30 Aktf
Metformin, Glimepiride, Amlodipine, Acarbose 90.30.30.90 Aktf
Metformin, Gliquidone, Amlodipine 60.60.30 Aktf
Metformin, Gliquidone, Acarbose 90.60.60 Aktf
Gliquidone, Metformin, Adalt Oros, Bisoprolol, Micardis 90.90.30.30.30 Aktf
Metformin, Glimepiride, Amlodipine 90.30.30 Aktf
Metformin, Glimepiride, Amlodipine 60.30.30 Meninggal
Metformin, Glimepiride, Amlodipine, Simvastatn 90.30.30.30 Aktf
Metformin, Glimepiride, Allopurinol 90.30.30 Aktf
Glimepiride, Valsartan, Acarbose, Metformin 30.30.30.90 Pasif (5 bulan)
Metformin 60 Baru
Metformin 60 Baru
LAMPIRAN 2
(Untuk Peserta >3 bulan tdak hadir)

LAMPIRAN 2
Hasil Pemeriksaan September 2018 Hasil Pemeriksaan Oktober 201
PRB+Prolanis/Prolanis Saja Tekanan Darah

GDP GDPP HBA1C TB BB GDP GDPP HBA1C
Sistole Diastole
Prolanis 270
Prolanis 245 140 90 158 70 103
Prolanis 131
Prolanis 128
LAMPIRAN 2
Prolanis 153 208 99 163 60 131
Prolanis 93
Prolanis 119 110 80 147 49
Prolanis 116 110 70 165 57 137
Prolanis
Prolanis 144 90 60 177 49 143
Prolanis 174 130 80 162 62 174
Prolanis
Prolanis 107 120 80 168 63 82
Prolanis 101 130 80 165 71 91
Prolanis 151 130 70 170 64 161
Prolanis 113 140 90 160 55 102
Prolanis
Prolanis 112 140 90 150 74 112
Prolanis 123 170 120 158 69 157

LAMPIRAN 2
Prolanis 217 180 100 158 89 178
Prolanis 161 120 80 155 61
Prolanis 411
Prolanis
Prolanis 144 140 90 160 64 117
Prolanis 115 170 100 150 61 134
Prolanis 94 120 70 152 79 109
Prolanis 130 120 80 155 54 135
Prolanis 125
Prolanis
Prolanis 167 140 90 178 85 125
Prolanis 127 150 80 152 45
Prolanis 116 120 80 172 88 114
Prolanis
Prolanis
LAMPIRAN 2
Prolanis 87
Prolanis 148 120 80 150 82 149
Prolanis 389 110 80 160 61 299
Prolanis 87 150 80 170 70 83
Prolanis 146 120 80 149 64
Prolanis 131 120 80 160 56 336
Prolanis 93 150 90 160 65 86
Prolanis 78 120 70 165 61 84
Prolanis 114 130 80 151 54 144
Prolanis 107 120 80 150 68 109
Prolanis 162 110 70 160 62 99
Prolanis 169 110 80 168 64 159
Prolanis 181 150 100 145 52 131
Prolanis 331 120 80 155 56 201
Prolanis 101 160 80 150 75 89

LAMPIRAN 2
Prolanis
Prolanis 205 160 90 153 70 166
Prolanis 199 100 60 167 52 131
Prolanis 104 120 80 160 64 212
Prolanis 179 130 80 165 68 213
Prolanis 107 140 90 165 76 108
Prolanis 208 170 100 153 73 135
Prolanis 188 120 70 165 59 63
Prolanis 97 130 90 155 54 110
Prolanis 98 160 80 145 39 101
Prolanis 137 120 80 151 58
Prolanis 223 180 90 164 54
Prolanis
Prolanis
LAMPIRAN 2
Hasil Pemeriksaan Oktober 2018 Hasil Pemeriksaan November 2018 Hasil Pemeriksaan D
Tekanan Darah Tekanan Darah

TB BB GDP GDPP HBA1C TB BB GDP GDPP
Sistole Diastole Sistole Diastole
130 80 173 65 284 130 80 173 67 341
130 90 158 71 266 120 70 158 70 164
140 90 140 57 114 130 80 140 47 196
120 80 165 62 109 130 80 165 62 123

LAMPIRAN 2
150 100 163 61 200 140 90 163 60 114
120 80 155 79 112 130 80 155 79 139
94 110 80 147 46 130
130 80 165 58 139 140 90 165 58 142
174 140 90 155 66 108
80 60 177 47 148 110 70 177 47 131
120 80 162 62 185 130 90 162 61 156
212
100 80 168 64 88 110 70 168 61 97
120 80 165 71 95 110 80 165 72 94
130 80 170 63 104 120 70 170 64 134
120 80 160 56
128
120 80 150 73 102 120 80 150 73 108
160 100 158 69 115

LAMPIRAN 2
130 80 158 89 231 110 80 158 86 250
202 120 80 155 60 161
100 70 155 64 157 120 80 155 58 227
206
140 90 160 63 154 130 80 160 65 165
150 100 150 60 112 150 90 150 60 97
140 80 152 80 103 120 80 152 81
100 70 155 54 127 120 80 155 52
100 60 155 45 140 130 80 155 46
130 80 178 86 157 130 80 178 84 119
202 140 90 152 46 84
130 80 172 90 117 120 80 172 88 200

LAMPIRAN 2
120 80 170 70 87 120 70 170 71 80
120 80 150 82 134 130 80 150 80 112
120 80 160 61 273 120 70 160 62 249
120 80 170 70 118 160 100 170 71 96
116 110 80 149 64 173
110 80 160 57 353 110 80 160 55 168
130 90 160 67 82 140 90 160 65 80
110 80 165 65 109 130 80 165 65 102
100 80 151 54 220 120 70 151 53 140
120 80 150 68 98 130 80 150 68 116
110 70 160 62 217 120 80 160 62 206
100 60 168 66 173 120 80 168 66 179
100 60 145 53 185 150 90 145 51 167
110 80 155 57 92 110 80 155 57 195
130 80 155 79 112 110 80 155 79 101

LAMPIRAN 2
291 110 70 168 77 128
130 90 153 70 179 140 80 153 68 249
110 80 167 52 135 120 70 168 53 249
100 60 160 65 97 120 80 160 69 100
120 80 165 70 366 140 90 165 68 353
150 100 167 75 124
130 80 153 72
130 90 165 57 155 110 80 165 58 137
120 80 155 53 151 130 80 155 53 84
120 80 145 39 104 160 100 145 39 105
206 110 80 151 46 150

LAMPIRAN 2
Hasil Pemeriksaan Desember 2018 Hasil Pemeriksaan Januari 2019 Hasil Pem
Tekanan Darah Tekanan Darah

HBA1C TB BB GDP GDPP HBA1C TB BB GDP
Sistole Diastole Sistole Diastole
120 80 173 63 153
110 70 158 71 303
130 70 140 47 196 130 70 140 47 363
140 80 165 64 105 130 80 165 61 105

LAMPIRAN 2
150 90 163 62 111 160 80 163 61 251
130 80 155 79 122 130 90 155 72 221
110 80 147 46 115 120 80 147 46
130 80 165 61 127 130 80 165 61 142
130 80 155 66 99 160 90 155 65 99
90 70 177 46 123 80 60 177 47 151
110 80 162 63 178 120 80 162 60
110 70 160 63 137 110 70 160 62 141
110 70 168 61 114 120 80 168 61 106
110 80 165 73 104 130 90 165 75 107
120 80 170 65 107 120 70 170 65 110
125 130 80 160 54 96
130 90 168 74 128 140 90 168 74
110 70 150 74 103 110 70 150 73 103
160 100 158 69 188 180 90 158 69 166

LAMPIRAN 2
130 90 158 88 219 150 90 158 88 272
120 80 155 61 207 130 90 155 61
110 70 155 65 283 110 70 155 63 271
120 80 150 40 202 120 80 150 39 165
140 90 160 65 175
130 80 150 60 112
123 150 90 152 82 135
139 120 70 155 52 154
128 110 70 155 47
190 130 80 155 64 180
140 80 178 85 149 140 90 178 86 117
130 90 152 45 140
120 70 172 89 123 130 90 172 90 146

LAMPIRAN 2
120 70 170 74 91 110 70 170 74 88
130 90 150 82 154 150 100 150 81 154
120 80 160 64 208 110 60 160 63 200
130 90 170 74 118 140 80 170 72 109
170 100 149 65 205 140 90 149 61 205
110 70 160 57 162 110 70 160 55 225
140 90 160 66 108 140 90 160 64 106
130 80 165 66 112 110 80 165 63 110
140 90 151 55 199 110 70 151 52 171
120 80 150 70 105 130 90 150 69 102
120 70 160 64 264 100 60 160 65
120 70 168 66 327 140 80 168 65 185
150 90 145 52 204 110 70 145 49 170
120 80 155 56 98 120 70 155 56 200
140 80 155 80 86 120 80 155 79 129

LAMPIRAN 2
120 70 168 79 289 130 80 168 77 179
130 80 153 70 276 130 80 153 69 232
130 80 167 56 127 110 70 167 53 113
120 80 160 71 142 120 80 160 72 106
130 80 165 70 195 120 80 165 69 353
140 80 165 74 124 150 80 165 74 124
173 140 90 153 72 60
110 70 165 62
150 90 155 54 117 140 90 155 55 84
140 90 145 40 108 130 80 145 40 103
120 80 155 58 108 130 80 155 58 126
111 130 90 150 70 148
112
LAMPIRAN 2
Hasil Pemeriksaan Februari 2019
Tekanan Darah
GDPP HBA1C TB BB
Sistole Diastole
130 80 173 64
150 90 158 70
120 80 155 58
130 80 165 61
LAMPIRAN 2
140 90 163 61
140 90 155 76
130 80 165 61
140 90 155 64
80 60 177 46
90 60 160 63
120 80 168 60
130 80 165 73
130 80 170 65
140 90 160 34
130 80 150 74
130 80 158 69
LAMPIRAN 2
130 80 158 87
120 80 155 62
120 80 150 38
170 100 160 61
150 90 150 60
90 60 152 78
120 80 155 53
150 90 155 63
130 80 178 87
140 90 152 42
150 90 172 90
LAMPIRAN 2
130 80 170 75
140 90 150 81
100 70 160 63
140 90 170 71
120 80 149 61
130 90 160 56
140 90 160 66
100 80 165 64
110 80 151 54
150 90 150 63
130 90 168 66
120 80 145 52
130 80 155 58
130 80 155 80
LAMPIRAN 2
150 80 168 73
130 80 153 70
120 80 167 54
100 80 160 74
130 80 165 70
130 80 165 70
150 90 155 54
130 80 145 41
110 80 155 57
120 80 150 69
100 70 149 53
LAMPIRAN 2
DATA INFORMASI PESERTA TERDAFTAR PROLANIS
NAMA KLUB : PROLANIS HIPERTENSI PUSKESMAS CIPINANG MUARA
NAMA FKTP : Puskesmas Cipinang Muara
PESERTA TERDAFTAR : 65 orang
NAMA DOKTER PROLANIS : dr. Nalini Kastoriani
No. Nama Peserta No. Kartu Mulai Terdaftar Alamat No. Telp Diagnosa
1 Dede Aena 0001214006488 12/8/2015 CM 7/8 81808371478 HT
2 Simin R 0001218517064 13-5-2015 CM 10/15 no.39 HT
3 Tut Warsit 0001214474005 10/9/2015 CM 7/4 021-8514309 HT
4 Edy Santoso 0001284512343 10/9/2015 CM 8/6 no.18 021-8571629 HT

LAMPIRAN 2
5 Sukarno 0000044035547 11/11/2015 CM 8/8 021-8571533 HT
6 Sunart 0000044035571 11/11/2015 CM 8/8 021-8571534 HT
7 Rosdiana 0001213949081 12/8/2015 CM 5/15 021-8572629 HT
8 Sit Aisyah 0001216586559 8/12/2015 CM 9/6 HT
9 Antmah 0000369777767 11/11/2015 CM 13/3 021-58908974 HT
10 Anwar 0001217587342 11/11/2015 CM 2/11 081293222014 HT
11 Chamami 0001214015589 9/9/2015 CM 6/1 085778177667 HT
12 Sri Sutjiat 0001217192646 11/11/2015 CM 8/8 021-8571565 HT
13 Aries Susilo 0001217380735 11/11/2015 CM 11/8 no.23 021-8519146 HT
14 Masudah 0001215495685 11/11/2015 CM 13/8 no.44 HT
15 Sukirah 0001288786612 11/11/2015 CM 5/11 no.40 0817534067 HT
16 E. Tri Wahyuni P 0001456091921 11/11/2015 CM 16/6 021-8198964 HT
17 Nani Nuraini 0001290131223 11/11/2015 CM 17/3 HT
18 Ani Chunaeni 0001218494013 9/9/2015 CM 14/4 08562045470 HT
19 Iwan Darwin 0001462596603 11/11/2015 CM 4/16 0816740170 HT

LAMPIRAN 2
20 Sit Masripah 0001218802184 11/11/2015 CM 2/15 no.10 087880804687 HT
21 Triyono 0001213705269 11/11/2015 CM 7/11 HT
22 Tut 0001217315384 10/12/2015 CM 14/3 no.29 081282194841 HT
23 Sa'diah 0001217738643 15/6/2016 CM III 4/8 no.55 021-85908618 HT
24 Ratmah 0001215888399 13-4-2016 CM 14/6 no.28 HT
25 Sutyardi 0000039581605 13-4-2016 CM 5/10 no.51 85959426685 HT
26 Tukinah 0001214497809 13-4-2016 CM 6/8 no.28 81210201277 HT
27 Sutariyem 0001217588916 13-4-2016 CM 2/11 no.6 021-85906284 HT
28 Karmi Media Wat 0001439902315 2/8/2017 CM 3/4 087877175068 HT
29 Evi Kamilasari 0001217587421 13-4-2016 CM 2/11 no.33 021-91847164 HT
30 Gustnar 0000205038505 13-4-2016 SMP 148 81319573774 HT
31 Soetrisno Hadipurnomo 0001217192848 13-4-2016 CM 8/8 no.22 021-8571565 HT
32 Raswi 0000369251763 13-4-2015 CM 13/15 HT
33 Sadini 0001217652366 12/8/2015 CM 13/4 021-85906235 HT
34 Sit Murdaningsih 0000044753084 11/11/2015 CM 6/15 8129859448 HT

LAMPIRAN 2
35 Tirah Sit 0001218224417 12/8/2015 CM 10/4 HT
36 Sunardi 0001214574052 15-10-2015 CM 10/15 HT
37 Puji Astut 0001217243338 15-10-2015 CM 10/15 no.86 81282747505 HT
38 Sutrisno 0000370724297 14-9-2016 CM 7/8 no.8 87878742928 HT
39 Sumirah 0000044774943 13-7-2016 CM 4/11 no.46 HT
40 Rohanih 0001214050419 11/1/2017 CM 7/4 no. 7A 0895364227521 HT
41 Hoiriyah 0001439902315 08/02/2017 CM 3/4 no.7 087877175068 HT
42 Sudarsono 0001217200678 08/02/2017 CM 13/15 no. 3A 021-8518324 HT
43 Roslina 0001217782541 3/8/2017 CM 2/15 NO. 37 081223525224 HT
44 Kalisah 0001215540911 3/8/2017 CM 14/6 NO.25 021-8516073 HT
45 Mundjiyah 0000162558955 1/10/2018 CM 14/8 087877572298 HT
46 Sopiah 0001218372399 4/12/2017 CM 5/8 021-8519224 HT
47 Nurhayani 0001218275649 5/10/2017 CM 9/15 HT
48 Tarmadji 3100021538229 5/10/2017 CM 07/03 085284840611 HT
49 Lely Nurella 0000044738458 4/11/2018 CM 14/2 No. 20 085717567996 HT

LAMPIRAN 2
50 Sulart 0001215882336 5/10/2017 CM 11/15 081285517882 HT
51 Jubaedah 0002340514732 7/11/2018 CM 10/6 08164855296 HT
52 Belman 0001482890264 7/11/2018 CM 8/11 081290770134 HT
53 Surtnah 0000044775077 5/10/2017 CM 6/4 087877615238 HT
54 Ni Komang 0000037317778 8/8/2018 CM 5/11 085921197655 HT
55 Stella Paat 0001306409444 5/10/2017 CM komplek PWI 085210405762 HT
56 Dalil 0001906700826 6/14/2017 CM 08/11 no 93 083804074710 HT
57 Sukart Soerono 0001339703594 7/12/2017 CM 5/6 021-8194982 HT
58 Tuminem 0001218809248 9/5/2018 CM. 3/11 021-85797734 HT
59 Kusmaryat 0001335189982 11/12/2018 CM 8/8 No. 11 - HT
60 Mustofa Hasan 0001467035112 11/14/2018 CM 6/14 HT
61 Paridah 14811440205 12/12/2018 HT
62 Tidjo Basuki 00012150869017 12/12/2018 HT
63 Mumbiyat 0001214049778 12/12/2018 Duren Sawit 085778177667 HT
64 Hasanah 0001213758966 2/13/2019 HT

LAMPIRAN 2
65 Rosmawat 0000998478843 HT
LAMPIRAN 2
G MUARA
Hasil Pemeriksaan Agustus 2

Keterangan (diisi
dengan keterangan
Nama Obat Jumlah Obat PRB+Prolanis/Prolanis Saja Tekanan Darah
aktif/pasif/baru/menin
ggal/pindah
Sistole Diastole
Amlodipine 30 Aktf Prolanis 120 80
Amlodipine, Irbesartan 30.30 Aktf Prolanis 140 90
Candesartan 30 Aktf Prolanis 110 80
Amlodipine, Candesartan 30.30 Aktf Prolanis 140 90

LAMPIRAN 2
Amlodipine, Bisoprolol 30.30 Aktf Prolanis 110 80
Amlodipine, Bisoprolol, Irbesartan, Spironolakton 30.30.30.30 Aktf Prolanis 140 80
Amlodipine 30 Aktf Prolanis
Amlodipine, Captopril, HCT 30.90.30 Aktf Prolanis 120 80
Amlodipine, Valsartan 30.30 Aktf Prolanis 120 80

LAMPIRAN 2
Amlodipine 30 Pasif (3 bulan) Prolanis 150 100
Amlodipine, Aspilet, simvastatn 30.30.30 Aktf Prolanis 130 80
Amlodipine, Simvastatn 30.30 Aktf Prolanis 130 80
Amlodipine 30 Pasif (3 bulan) Prolanis
Amlodipine 5mg 30 Aktf Prolanis 130 90

LAMPIRAN 2
Amlodipine, Captopril 30.60 Pasif (4 bulan) Prolanis 140 90
Amlodipine, Captopril 30.30 Aktf Prolanis 140 90
Candesartang, Bisoprolol 30.30 Aktf Prolanis 120 80
Concor, Amlodipine 30.30 Aktf Prolanis 110 70
Captopril 30 Aktf Prolanis 130 80
Captopril , Amlodipine 30.30 Aktf Prolanis 130 80

LAMPIRAN 2
Amlodipinee 30 Pasif (5 bulan) Prolanis
Adalat, Valsartan 30.30 Aktf Prolanis
Amlodipine, Valsartan, Miniaspi, ISDN 30.30.30.30 Aktf Prolanis 110 80
Amlodipinee 30 Aktf Prolanis
Amlodipinee 30 Aktf Prolanis
Amlodipine, Candesartan, Miniaspi 30.30.30 Aktf Prolanis
Amlodipine, Bisoprolol 30.30 Baru Prolanis

LAMPIRAN 2
Amlodipine, Captopril, Bisoprolol 30.90.30 Baru Prolanis

LAMPIRAN 2
Pemeriksaan Agustus 2018 Hasil Pemeriksaan September 2018 Hasil Pemeriksaan Oktober 2018 Hasil Pemeriksaan November 2018
Tekanan Darah Tekanan Darah Tekanan Darah

TB BB TB BB TB BB TB
Sistole Diastole Sistole Diastole Sistole Diastole
160 54 140 90 160 54 130 80 160 54 120 80 160
165 68 140 90 165 66 140 90 165 65 130 80 165
162 60 130 70 162 70 110 70 162 89 140 80 162
171 72 150 90 171 71

LAMPIRAN 2
161 60 110 70 161 60 120 80 161 59 120 80 161
150 47 140 90 150 48 140 90 150 47 140 80 150
160 61 120 80 160 64 120 80 160 61 90 60 160
120 80 155 47 140 80 155
155 54 110 80 155 54 110 70 155
170 100 155 60 120 80 155
163 46 140 90 163 45 130 90 163
162 62 140 90 162 63 140 90 150 61 140 80 150
160 57 130 80 160 58 150 90 160 56 130 80 160
152 55 140 90 152 55
150 54 140 90 150 54 120 80 150 53 110 70 150
155 55 140 90 155 54 140 80 155 54 140 80 155
154 66 150 90 154 66 140 90 154 69 120 80 154
120 80 150 68 100 70 150 68 140 90 150
165 77 130 80 165 75 120 80 165 78 110 70 165

LAMPIRAN 2
158 86 120 70 158
170 90 170 78 140 90 170 78 130 80 170
162 60 120 80 162 59 110 70 162 59 120 80 162
155 51 130 80 155 50 130 80 155
150 47 120 80 150 48 110 80 150 46 140 80 150
170 63 170 100 170 65 150 80 170
155 70 160 100 155 72 120 80 155 69 120 80 155
155 70 110 80 155 72 120 80 155
150 45 100 80 150 46 110 70 150
140 90 146 57 150 90 146
162 71 120 80 162 69 130 80 162
168 77 140 90 468 76 110 70 168 76 110 70 168
150 40 120 70 150 44 120 80 150 41 140 80 150
150 40 120 70 150 40 110 80 150 40 110 70 150
150 37 120 80 150 39 140 80 150

LAMPIRAN 2
155 73 110 70 155 72
162 64 170 100 162 64 140 90 162 64 150 80 162
165 83 100 70 165 82 100 70 165 83 110 70 165
171 67 160 90 171 67 130 80 171
155 56 160 100 154 55 130 80 154 54 140 90 155
155 49 130 80 155 45 140 90 155 46 120 80 155
150 57 100 70 150 56 140 80 150
160 54 120 80 160 54 110 70 160 53 120 80 160
151 61 150 90 151 61 140 90 151 61 120 80 151
150 56 130 90 150 54 130 80 150 54 130 80 150
120 70 155 65 120 80 155 63 110 70 155
150 56 140 80 150 55 140 80 150
150 75 110 70 150 74 100 70 150 74 120 80 150
165 68 130 80 165 69 130 90 165 66 110 70 165
157 80 130 80 157 82 120 80 157 82 130 80 157

LAMPIRAN 2
155 60 130 80 155 60 150 90 155 61 140 80 155
155 50 110 70 155 50 120 80 155 49 140 80 155
168 71 120 80 168
155 47 110 80 155 49 110 80 155 49 110 70 155
160 61 140 90 160 67 160 100 160 66 150 58 160
130 80 155
180 100 160 65 140 80 160
156 43 120 80 156 44 110 80 156 43 110 70 156
150 90 155 66 120 80 155 66 130 80 155
130 70 150
120 80 170
LAMPIRAN 2
LAMPIRAN 2
n November 2018 Hasil Pemeriksaan Desember 2018 Hasil Pemeriksaan Januari 2019 Hasil Pemeriksaan Februari 2019
Tekanan Darah Tekanan Darah Tekanan Darah

BB TB BB TB BB TB BB
Sistole Diastole Sistole Diastole Sistole Diastole
55 130 90 160 54 150 60 155 53 160 100 165 64
67 130 90 165 66 130 90 165 67 130 90 165 66
89 130 90 162 89 110 70 162 85
160 100 171 76 150 90 171 68 170 90 171 69

LAMPIRAN 2
59 120 80 161 59 110 80 161 58 130 80 161 57
47 140 90 150 47 120 80 150 47 140 80 150 46
63 100 80 160 60 100 60 160 60 110 70 160 62
47 130 90 155 48 110 80 155 47 120 80 155 46
52 100 80 155 52
59
45 150 90 163 47 100 60 163 46 140 80 163 44
61 110 80 150 61 130 80 150 59 120 70 150 58
55 140 90 160 58 130 80 160 55 130 80 160 55
55 100 80 150 51 140 90 150 51
54 140 80 155 54 130 80 155 54 130 90 155 54
70 130 80 154 70 140 90 154 72 160 90 154 71
68 130 80 150 66 140 90 150 68 150 90 150 67
78 140 90 165 77 140 80 165 76

LAMPIRAN 2
86
77 140 90 170 77 120 80 170 78 140 90 170 76
60 140 90 162 60 130 80 162 59 140 90 162 60
49 120 80 155 49
46 130 80 150 45 130 90 150 46
65 150 90 170 63 150 90 170 64
69 130 80 155 68 130 90 155 66
71 130 80 155 70 120 80 155 70 120 80 155 70
46 110 70 150 46 100 60 150 46
57
69 130 80 162 69 150 90 162 69
77 140 90 168 76 120 80 168 75 120 80 168 72
42 110 70 150 42 100 50 142 44 150 70 142 41
40 110 80 150 41 130 80 150 40 110 70 150 40
38 140 80 150 38 140 90 150 37 130 80 150 38

LAMPIRAN 2
64 130 80 162 64 180 100 162 63 120 80 162 62
78 110 80 165 80 110 70 165 81 110 70 165 81
68 140 90 171 69 140 90 150 68 150 90 150 67
54 130 90 155 54 140 90 155 54 140 90 155 55
45 130 90 155 45 140 90 155 46 140 80 155 46
56 120 80 150 55 120 80 150 55 120 80 150 54
54 110 70 160 53 120 80 160 54 120 80 160 53
61 130 80 151 60 140 90 151 61 130 80 151 60
54 120 80 150 54 120 80 150 52
64 110 80 155 63 110 80 155 63 120 80 155 62
55 110 80 150 59 120 80 150 55 130 90 150 55
76 120 70 150 75 120 80 150 76 150 100 150 75
68 120 70 165 68 130 80 165 67
80 120 70 157 83 120 80 157 84 150 100 157 82

LAMPIRAN 2
60 140 90 155 60 130 80 155 60 150 100 155 62
49 110 80 155 50 130 80 155 49 120 80 155 49
71 120 80 168 71 120 80 168 71 130 100 168 71
50 140 90 155 50 110 80 155 49 110 60 155 49
66 150 90 160 65 160 100 160 65 170 90 160 65
67
67 130 90 160 67 110 80 160 66 150 80 160 67
44 120 70 156 43 100 60 156 44
65 120 80 155 66 140 90 155 67 140 90 155 67
44 160 100 150 44 150 100 150 43
71 80 60 170 72 120 90 173 69
140 90 155 55 120 80 155 55 130 90 155 55
130 80 173 104 150 100 173 105 150 90 173 102
130 80 150 52 120 20 150 52 150 90 150 51
150 90 158 66
LAMPIRAN 2
120 80 141 52

Lampiran 2

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Lampiran 2

Caricato da

Copyright:

Formati disponibili

LAMPIRAN 2

DATA INFORMASI PESERTA TERDAFTAR PROLANIS

NAMA KLUB : PROLANIS DIABETES MELITUS PUSKESMAS CIPINANG MUARA

NAMA FKTP : Puskesmas Cipinang Muara

PESERTA TERDAFTAR : 63 orang

NAMA DOKTER PROLANIS : dr. Nalini Kastoriani

1 Sudarmedi 310001191144 4/12/2016 CM 2/8 DM, HT

2 Chairiyah 0001213603582 5/12/2015 CM 9/6 082213605444 DM

3 Kardinah 0000044752094 9/8/2015 CM 12/15 021-8560378 DM, HT

4 Zulkifli 0001215685596 2/12/2018 CM 7/8 081291598488 DM, HT

5 Ermawat 0001309016531 11/10/2015 CM 12/4 DM, HT

6 Mariyah 0001300688122 7/12/2016 CM 13/15 021-851-5807 DM, HT

7 Ani Rohaiza 0000042171399 5/12/2015 CM 9/3 081219284438 DM

8 Mujiono 0000040993817 1/10/2017 Klender 10/3 082122208060 DM

9 Tumino 0000041940325 11/13/2018 Pd. Bambu 7/2 021-8627949 DM

10 Slamet Partono 0001675294795 10/10/2017 CM 12/15 087780492950 DM

11 Anak Agung 0000044010191 4/12/2016 CM 12/10 021-8520809 DM, HT

12 Menak Kumari 0001216022174 12/11/2018 CM 5/4 081285602962 DM

13 Suparman 0000036159794 6/13/2017 021-857-9251 DM

14 Puri Kusdarini 2/13/2015 CM 6/8 089506034401 DM

15 Muhsin 3100016600728 4/11/2017 CM 11/15 081285517882 DM, HT

16 Rustam 0000044758629 9/13/2016 CM 7/4 021-85900226 DM, HT

17 Rahmat 0001215316585 12/11/2018 CM 11/15 08981386939077 DM, HT

18 Diyah Haryani 0001215751127 4/11/2017 CM 15/4 081288651899 DM, HT

19 Hj. Sumarni 3100005093442 8/11/2015 CM 6/15 021-85906465 DM, HT

20 Eviyant 0001290111208 5/12/2015 CM DM, HT

21 Neng Sulastri 0001214748641 8/9/2016 CM 5/3 089631616849 DM

22 Retno Madurini 0001214335009 5/8/2018 CM 6/11 DM

23 Makiyah 0001608908793 12/11/2018 CM 6/3 08159409448 DM

24 Dedeh Wartni 0001217482672 8/9/2016 CM 7/11 085777545659 DM, HT

25 Mohamad Daim 0001335168055 6/5/2018 021-8515084 DM

26 Sumarni 0001282965096 5/12/2015 CM 6/15 021-85906465 DM, HT

27 Kesih 0000044780218 1/10/2017 CM 13/4 021-8578658 DM

28 Jariyah 3100011657502 10/11/2016 CM 10/15 DM, HT

29 Sumirah 0001214557121 4/10/2018 CM 13/8 DM, HT

30 Sardiyono 0001215537355 8/12/2015 CM 6/4 081590815879 DM, HT

31 Sanawiyah 001214761645 6/9/2015 CM 5/3 081806174790 DM

32 Moh. Dayat Sutsna 0001275592105 5/12/2015 DM, HT

33 Tut Asih 0001280116091 4/9/2017 CM 7/14 081314357079 DM, HT

34 Waginah 0001298068198 8/11/2015 CM 10/15 081519004820 DM

35 Nurkhasan 3100016055791 12/9/2016 CM 13/15 087788898522 DM

36 Jumini 0001631092059 9/10/2017 CM 14/1 081314474527 DM

37 Parilah 00003689280444 1/10/2017 CM 2/4 081314590674 DM

38 I Wayan Tapa 0000037317767 8/12/2015 CM 5/11 021-8573951 DM, HT

39 Sarini Wahyuni 0000039571514 7/10/2018 CM 11/15 081310515828 DM, HT

40 Nurbait 0001275592318 5/12/2015 CM 13/4 021-95443157 DM, HT

41 Sarmui 0001217582886 4/12/2016 CM 11/1 DM, HT

42 Sohiran 0001335193896 4/12/2016 CM 1/4 021-8501606 DM

43 Mashudah 0001336089644 5/12/2015 CM 6/3 DM

44 Kartni 0001215458897 2/9/2016 CM 4/15 021-8510811 DM, HT

45 Zahroh 0001605747892 5/12/2015 CM 13/3 DM

46 Pawuh 0001214534384 8/11/2015 CM 10/15 081285518744 DM

47 Sukilah 0001335483202 4/10/2018 DM, HT

48 Sumiyat 0000369013724 9/8/2015 CM 14/4 DM

49 Hj, Muryani 0001335193907 6/9/2015 CM 1/4 021-8501606 DM

50 Jusri 0001376445554 11/13/2018 CM 12/4 DM

51 Sukarsih 0001888827873 2/9/2016 CM 7/8 081511116745 DM

52 Edi Sudjono 0001218493956 5/8/2018 CM 14/4 021-8500988 DM, HT

53 Suwanah 0001674613372 4/11/2017 CM 13/8 DM, HT

54 Bustomi 0001328106701 7/10/2018 CM 13/4 DM

55 Samad 0001218275583 7/10/2018 CM 9/15 081284599279 DM

56 Nur Aida Aly 0002214928449 4/11/2017 CM 7/6 021-8507063 DM, HT

57 H. Tholib 0001218274031 11/7/2017 CM 12/6 021-8514652 DM, HT