Feb 19 PDF

PUSKESMAS KECAMATAN KELAPA GADING
JL. PELEPAH ELOK BLOK HF 7, KELURAHAN KELAPA GADING BARAT, KECAMATAN KELAPA GADING, JAKARTA UTARA 14240
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Periode : 01 February 2019 00: s/d 28 February 2019 00:
No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan
Poli Imunisasi
MUHAMMAD RAFIF ILHAM, BY (L) JL. KOMP BEACUKAI BLOK Q 5 NO 17 Z27.8 - Need for immunization against other
combinations of infectious diseases
Tgl Lahir : 02-Jan-2019 ( 0 Thn 8 Bln 7 Hr )
1 NIK : 3172040201190001
No. RM : 01-084526 BPJS : 0002738249289
Tgl Diagnosis : 01 February 2019 9:15 AM
RABIATUL ADAWIYAH, BY (L) JL. PEJUANG V NO. 102 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
diphtheria-tetanus-pertussis with
Tgl Lahir : 21-Nov-2018 ( 0 Thn 9 Bln 19 Hr ) poliomyelitis [DTP + polio]
2 NIK : -
No. RM : 02-005006 BPJS : 0002509720727
ARYA WIRAGUNA, BY (L) PEGANGSAAN DUA Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
Tgl Lahir : 02-Dec-2018 ( 0 Thn 9 Bln 7 Hr ) poliomyelitis [DTP + polio]
3 NIK : 317201212170047
No. RM : 01-082165 BPJS : 0002499760956
RAFANDRA ATHALLA YUNANTO (L) JL CEKATAN II NO 31 Z27.4 - Need for immunization against PARASETAMOL SYR 120 MG/5 ML
measles-mumps-rubella [MMR]
Tgl Lahir : 28-Apr-2018 ( 1 Thn 4 Bln 12 Hr )
4 NIK : 3172060901094818
No. RM : 01-069695 BPJS : 0002450873957
DHAFA ALFARIZKI, BY (L) TANAH MERAH RT 01 RW 07 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
5 NIK : 3172041901097224
No. RM : 01-083516 BPJS : 0002621238941
Tgl Diagnosis : 01 February 2019 1:11 PM
SAYHAN RIZKI ZAVIER .AN (L) JL BANGUN CIPTA SARANA Z27.1 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
diphtheria-tetanus-pertussis, combined
Tgl Lahir : 18-Sep-2018 ( 0 Thn 11 Bln 22 Hr ) [DTP]
6 NIK : 3172061301160016
No. RM : 01-079392 BPJS : 0002493477022
2019-09-09 13:37 Hal. 1 dari 1322

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ADREENA QUEEN MARION, BY (P) PERUM BERMIS JL ANGGREK NO 7 Z27.8 - Need for immunization against other
Tgl Lahir : 21-Dec-2018 ( 0 Thn 8 Bln 19 Hr )
7 NIK : 3172066112180006
No. RM : 01-086327 BPJS : 0002626199188
MUHAMMAD HANAN ATTAQI (L) KP RAWA INDAH RT 04/03 Z27.8 - Need for immunization against other
8 NIK : 3172061507160012
No. RM : 01-069690 BPJS : 0002454904539
MUSA ADNAN PRASOJO, BY (L) JL HARAPAN 3 NO 10 Z27.3 - Need for immunization against
9 NIK : 3172060202170024
No. RM : 01-080695 BPJS : 0002611438121
ARSYILA NAMIRAH FEIRUS (P) JL. PULAU REMPANG II NO. 176/9 Z27.4 - Need for immunization against
KELAPA GADING BARAT JAKARTA measles-mumps-rubella [MMR]
10 UTARA
No. RM : 01-078346
Tgl Diagnosis : 01 February 2019 5:23 PM NIK : -
ALISHA KHAYLA ALMIRA, BY (P) JL BCS NO RT 5 RW 5 Z27.8 - Need for immunization against other
11 NIK : -
No. RM : 01-084066 BPJS : 0002615717485
SILVINA PERMATASARI, AN (P) KP RAWA INDAH RT 004/03 PGSN II Z27.4 - Need for immunization against
12 NIK : 3172065104180002
No. RM : 01-068066 BPJS : 0002355394555
RAFAEL MARASI CRESSANDO JL JANUR HIJAU XII TP I/4 RT 05/15 Z27.4 - Need for immunization against
Tgl Lahir : 19-Jul-2017 ( 2 Thn 1 Bln 21 Hr )
13 NIK : 3172061907170001
No. RM : 01-050234 BPJS : 000225792703
2019-09-09 13:37 Hal. 2 dari 1322

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MUHAMMAD ZAYN ALFATIH (L) RAWA SENGON NO. 2 Z38.6 - Other multiple, born in hospital

14 NIK : 3172061402180006
No. RM : 01-084341 BPJS : 0002737466379
AMELIA RAHMAWATI, BY (P) DK GANDRING Z27.1 - Need for immunization against
Tgl Lahir : 02-Oct-2018 ( 0 Thn 11 Bln 7 Hr ) [DTP]
15 NIK : 3325052402073575
No. RM : 01-078746 BPJS : 0002497039525
FARHAN ABDILLAH MALAWAT, BY (L) JL TELUK BAYUR BLOK G NO7 Z27.3 - Need for immunization against
16 NIK : 3172040411180009
No. RM : 01-081000 BPJS : 0002510779926
ALIKHA KAMILA HAFLANI, BY (P) JL. BANGUN CIPTA SARANA GG Z27.3 - Need for immunization against
MASJID ARRAHMAN diphtheria-tetanus-pertussis with
Tgl Lahir : 27-Oct-2018 ( 0 Thn 10 Bln 13 Hr ) poliomyelitis [DTP + polio]
17
No. RM : 01-080944 NIK : 3172061201091636
Tgl Diagnosis : 01 February 2019 6:09 PM BPJS : 0002503343305
ALMEIRHA SAQUEENA ANUGRAH, BY (P) JL T MERAH RT 8/7 Z27.4 - Need for immunization against
18 NIK : 3303131001180010
No. RM : 01-071344 BPJS : 0002434926238
RIFAT KHAIRY SUBAGYO (L) J. BCS RT 05/05 Z27.4 - Need for immunization against
19 NIK : -
No. RM : 01-037679 BPJS : 0002247099906
AHMAD KARIM RAMADHAN, AN (L) JL DAHLIA II NO.16 006/003 BERMIS Z27.4 - Need for immunization against
Tgl Lahir : 07-Jun-2017 ( 2 Thn 3 Bln 2 Hr )
20 NIK : 3172060706170003
No. RM : 01-045441 BPJS : 0002250666663
2019-09-09 13:37 Hal. 3 dari 1322

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RABIZA ASHALINA GUNAWAN, AN (P) JL PERJUANGAN II Z27.8 - Need for immunization against other
21 NIK : 3172031511170000
No. RM : 01-084259 BPJS : 0002737776903
GABRIEL HAN WILLIAM, BY (L) APT GADING NIAS C/8/JJ Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
Tgl Lahir : 12-Sep-2018 ( 0 Thn 11 Bln 28 Hr ) poliomyelitis [DTP + polio]
22 NIK : 3275041209180002
No. RM : 01-079380 BPJS : 0002378721003
INAYA MAULIDA RIZKI, BY (P) PGS 2 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
23 NIK : -
No. RM : 01-080457 BPJS : 0002610618805M
AZZAM KHALIF KOZA HERMAWAN (L) JL. INSPEKSI KALI SUNTER Z27.1 - Need for immunization against PARASETAMOL SYR 120 MG/5 ML
Tgl Lahir : 06-Aug-2017 ( 2 Thn 1 Bln 3 Hr ) [DTP]
24 NIK : -
No. RM : 01-049919 BPJS : 0002137116914
DANIEL CHRISTOPHER MARTUZ JL TUGU PERJUANGAN NO 50 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
25 NIK : 3276050910180001
No. RM : 01-080778 BPJS : 0002613787569
GEBBY FEBIOLLA NAPITUPULU, AN (P) JL PERJUNGAN 004/007 Z27.1 - Need for immunization against PARASETAMOL SYR 120 MG/5 ML
Tgl Lahir : 21-Jul-2017 ( 2 Thn 1 Bln 19 Hr ) [DTP]
26 NIK : 3172036107170001
No. RM : 01-048708 BPJS : 0002327729769
MONA RACHEL SIRINGORINGO, BY (P) JLN LESTARI 9 KP SUKAPURA TR 02 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
RW 10 diphtheria-tetanus-pertussis with
27
No. RM : 01-086892 NIK : 3172044111180004
Tgl Diagnosis : 08 February 2019 10:34 AM BPJS : 0002738275604
2019-09-09 13:37 Hal. 4 dari 1322

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PUTRI ALIA SAFIKA, BY (P) KGT RT005/004 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
diphtheria-tetanus-pertussis with IMUNISASI TT UNTUK IBU
28 NIK : 3172062507180018
No. RM : 01-079386 BPJS : 0002489334107
ARLAN MAULANA HAMKA (L) JL KAYU MAS UTARA Z27.8 - Need for immunization against other
29 NIK : 3305211101190002
No. RM : 01-086899 BPJS : 0002613056545
DESIYANTI, BY (P) JL. RAWA SENGON BLOK I Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
30 NIK : 3172064312180001
No. RM : 01-084472 BPJS : 0002620703428
ALYA SAHIRA, BY (P) JL. BLV RAYA BLOK FF NO 11 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
31 NIK : 3304112706180001
No. RM : 01-080276 BPJS : 0002485924661
ZAIN KEANU ISMAR (L) JL.LUMBA LUMBA II NO.11 Z27.4 - Need for immunization against
32 NIK : -
No. RM : 01-047301 BPJS : 0002260440775
RADITYA NAUFAL DARRY, BY (L) JL KUDA LUMPING BLOK U 20 Z27.8 - Need for immunization against other
33 NIK : -
No. RM : 01-086903 BPJS : 0002742425594
ZEVANNYA ALFAZA, BY (P) JL TANJAKAN PULO GEBANG Z27.8 - Need for immunization against other
34 NIK : -
No. RM : 01-086895 BPJS : 0002741590888
2019-09-09 13:37 Hal. 5 dari 1322

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KHAISANU WIKAN LEKSANA,BY (L) JL. HARAPAN RAYA NO. 26 Z27.8 - Need for immunization against other
35 NIK : -
No. RM : 01-085959 BPJS : 0002509392688
MUHAMMAD ALFI DWI FAREL, AN (L) JL KLP PUAN BLOK NC 8 NO 15 Z27.4 - Need for immunization against
Tgl Lahir : 05-Feb-2018 ( 1 Thn 7 Bln 4 Hr )
36 NIK : -
No. RM : 01-079662 BPJS : 0002883852707
KEN ANDRIANI (P) JL RAWA SENGON BLOK A RT 1 RW 8 Z27.8 - Need for immunization against other
37 NIK : 3172064501190002
No. RM : 01-085146 BPJS : 0002738742805
ARIANA SALSABILA, BY (P) JL PUSKESMAS NO 46 RT 5 RW 6 Z27.8 - Need for immunization against other
38 NIK : -
No. RM : 01-086054 BPJS : 0002626677358
GIANELLA ANJANETTE BUNARDI, BY (P) APT GADING NIAS TWR CHRYSANT Z27.3 - Need for immunization against
L19 JL diphtheria-tetanus-pertussis with
39
No. RM : 01-082333 NIK : -
AL FANDI, BY (L) PULO NANGKA BARAT 2 RT 5 RW 16 Z27.8 - Need for immunization against other
NO 33 combinations of infectious diseases
40
No. RM : 01-086519 NIK : -
ADIBA NUR AZZAHRA, BY (L) JL. RAWA SENGON BLOK A Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
41 NIK : 3172062912141012
No. RM : 01-082992 BPJS : 0002620495462
2019-09-09 13:37 Hal. 6 dari 1322

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RAIYSA HALIMAH ADZKIA, BY (P) JL. PGS II 006/002 Z27.3 - Need for immunization against PARASETAMOL SYR 120 MG/5 ML
42 NIK : 3172066809180001
No. RM : 01-078036 BPJS : 0002626161669
BRIAN IMMANUEL HUTAGALUNG, AN (L) JL PERJANGAN RAYA NO 39 RT 04/07 Z00.1 - Routine child health examination

43 NIK : 3172030201180002
No. RM : 01-061645 BPJS : 0002326066356
MICHAEL JOSH LOWIS, BY (L) JL. PERJUANGAN NO. 31 Z27.3 - Need for immunization against
44 NIK : -
No. RM : 01-084901 BPJS : 0002765967895
ARZAURA MIKHAYLA SIREGAR, BY (P) JL.PEJUANG IV RT.04/04 KGT Z27.3 - Need for immunization against
45 NIK : -
No. RM : 01-081439 BPJS : 0002510582872
ABRAHAM REYNAND PRASTI, AN (L) JL. INSP KALI SUNTER RT 009/013 Z00.1 - Routine child health examination
Tgl Lahir : 04-Aug-2018 ( 1 Thn 1 Bln 5 Hr )

46 NIK : 3172030309151028
No. RM : 01-075898 BPJS : 0002480041067
ARBI SATRIA KUSUMANEGARA, AN (L) KUNING MAS D.4/5 Z27.1 - Need for immunization against
47 NIK : 3172062007170001
No. RM : 01-049517 BPJS : 0002267716847
QADDAFA LIANDRA HERMAWAN, BY (L) KP RAWA INDAH RT 02/03 Z27.8 - Need for immunization against other
48 NIK : 3172060606111043
No. RM : 01-084892 BPJS : 0002740101535
2019-09-09 13:37 Hal. 7 dari 1322

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AFZAR HAZIQ MUSYAFFA, AN (L) JL RUSUN SUKAPURA RT 010/07 Z27.4 - Need for immunization against
Tgl Lahir : 16-May-2018 ( 1 Thn 3 Bln 24 Hr )
49 NIK : 3172041803111055
No. RM : 01-070836 BPJS : 0002459821803
LUNA ANGGRAINI, BY (P) KP BOGOR NO 52 TARUNA JAYA Z27.3 - Need for immunization against RETRIBUSI KLINIK KIA
50 NIK : -
No. RM : 01-087552 BPJS : 0002511954516
RAFFA AZKA TRISTIAN (L) JL TARUNA UJUNG NO 3 RT 07 RW 2 Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
51 NIK : 3301141308180006
No. RM : 01-084158 BPJS : 0002621567463
KIMBERLY EMMANUELLA, AN (P) APT GREN PALACE TOWER G UNIT 1 Z27.1 - Need for immunization against RETRIBUSI KLINIK KIA
G diphtheria-tetanus-pertussis, combined
Tgl Lahir : 26-Sep-2018 ( 0 Thn 11 Bln 14 Hr ) [DTP]
52
No. RM : 01-078295 NIK : 3603070605150000
RIHANA DELISHA, BY (P) JL KMP SUKAPURA JAYA Z27.3 - Need for immunization against PARASETAMOL SYR 120 MG/5 ML
53 NIK : 3172044111180003
No. RM : 01-087563 BPJS : 0002739234137
RAFA ALFARIZI IRTIZA, BY (L) KP BEND.BATIK Z27.3 - Need for immunization against RETRIBUSI KLINIK KIA
54 NIK : -
No. RM : 01-079615 BPJS : 0002498561785
ATTHAYA AMAZHIA JAQUEEN KAKUNSI, BY JL. PERJUANGAN I Z27.8 - Need for immunization against other RETRIBUSI KLINIK KIA
55 NIK : -
No. RM : 01-084846 BPJS : 0002501408417
2019-09-09 13:37 Hal. 8 dari 1322

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SYAKILA, BY (P) JL. SYMPONI V Z27.1 - Need for immunization against
Tgl Lahir : 03-Oct-2018 ( 0 Thn 11 Bln 6 Hr ) [DTP]
56 NIK : 3172064310180001
No. RM : 01-079571 BPJS : 0002497651727
CLAUDYA FELICIA (P) kp rawa indah Z27.8 - Need for immunization against other
57 NIK : 3172061010160014
No. RM : 01-087575 BPJS : 0002738599233
MENTARI PUTRI APRILIANI, BY (P) RW INDAH RT 5/3 Z27.4 - Need for immunization against
58 NIK : 3172065804180001
No. RM : 01-068793 BPJS : 0002451312663
ARDI GREY NOVALDI, BY (L) JL. MELATI Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
59 NIK : 3207151608180002
No. RM : 01-087579 BPJS : 0002612612147
KHAWABILA RATRI ALMAHYRA, BY (P) JL WALANG BARU 1/11 Z27.3 - Need for immunization against
60 NIK : 3201024410180003
No. RM : 01-080781 BPJS : 0002497514152
ANDITO SITUMORANG, BY (L) JL.MURAI I E.3/19 E46 - Unspecified protein-energy
malnutrition
61 NIK : -
No. RM : 01-071815 BPJS : 0002441041547
MAXWELL FRITS HENOKH NGANTUNG (L) JL WISMA GADING PERMAI TWR B LT Z27.1 - Need for immunization against
III NO.19 diphtheria-tetanus-pertussis, combined
62
No. RM : 01-048547 NIK : -
2019-09-09 13:37 Hal. 9 dari 1322

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DENING SATYA PAMARTA (L) APT GADING NIAS RESIDANCE Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
TOWER CHRISASNT 11 HH diphtheria-tetanus-pertussis with
63
No. RM : 01-085373 NIK : -
MELODY STEPHANIE PUTRI PASARIBU (P) JL TELUK BONTAN A1 NO 8A Z27.1 - Need for immunization against
64 NIK : 3172021512160031
No. RM : 01-055899 BPJS : 0002277516778
GEVARIEL FERGUSON MARUANAYA, AN (L) RAWA SENGON BLOK A /34 Z27.3 - Need for immunization against
65 NIK : -
No. RM : 01-081621 BPJS : 0002752748998
KAMILA KHANZA FITRI YANI, AN (P) DANAU INDAH BARAT BLOK A 2NO 4 Z00.1 - Routine child health examination

66 NIK : -
No. RM : 01-046490 BPJS : 0002763112779
FADLI AL GHIFARI (L) RAWA SENGON BLOK G NO. 82 Z27.8 - Need for immunization against other
67 NIK : 3172062406131027
No. RM : 01-088246 BPJS : 0002741299931
FIKRI KHALIS MULTAZAM (L) JL SUKAPURA RT 2/03 Z27.4 - Need for immunization against
68 NIK : 3172042102170012
No. RM : 01-073335 BPJS : 0002226570412
KHAWLA AL AZWAR (P) GADING MAS BARAT A.8/11 Z27.4 - Need for immunization against PARASETAMOL SYR 120 MG/5 ML
Tgl Lahir : 20-Mar-2018 ( 1 Thn 5 Bln 20 Hr )
69 NIK : 3209316003180002
No. RM : 01-073510 BPJS : 0002485458742
2019-09-09 13:37 Hal. 10 dari 1322

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CORNELITA ALEXANDRA SIREGAR, AN (P) JL CAMAR III BLOK C 2 NO 6 Z27.4 - Need for immunization against RETRIBUSI KLINIK KIA
70 NIK : 3172041310170090
No. RM : 01-074653 BPJS : 0002443936893
DISTYA AYRA ZHARIFA (P) TANAH MERAH 008/007 NO. 1 Z27.4 - Need for immunization against
71 NIK : -
No. RM : 01-066209 BPJS : 0002437562924
LEONARD, AN (L) JL. RAWA SENGON RT 07/022 Z27.4 - Need for immunization against PARASETAMOL SYR 120 MG/5 ML
Tgl Lahir : 27-Nov-2017 ( 1 Thn 9 Bln 13 Hr )
72 NIK : 3172012711170001
No. RM : 01-059085 BPJS : 0002315879324
DEVANIA ANJANI RAHMAN (L) PERUMAHAN GRAND MALAKA NO. 47 Z27.3 - Need for immunization against
73 NIK : 3172040307180023
No. RM : 01-081637 BPJS : 0002492007311
ZEVANNYA ALFAZA, BY (P) JL TANJAKAN PULO GEBANG Z27.8 - Need for immunization against other
74 NIK : -
No. RM : 01-086895 BPJS : 0002741590888
BY NY RONA INDRIANI (L) JL. GARUDA I NO.99 KAYU TINGGI Z27.8 - Need for immunization against other
75 NIK : 3175060610160052
No. RM : 01-085205 BPJS : 0002741353391
M.B DONITA MAU (P) APT GADING NIAS TW CRISSAN 3 Z27.1 - Need for immunization against
76 NIK : -
No. RM : 01-051665 BPJS : 0002509730763
2019-09-09 13:37 Hal. 11 dari 1322

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BEN SABAM PANJAITAN, AN (L) JL PERJUANGAN RAYA NO 01 RT Z27.4 - Need for immunization against
08/07 measles-mumps-rubella [MMR]
77
No. RM : 01-066571 NIK : 3275060503180002
ABILA REZFAN AZKADINA, AN (P) JANUR HIJAU I TK.I/I Z27.1 - Need for immunization against
78 NIK : 3172061603110037
No. RM : 01-053936 BPJS : 0002278667294
MEYSHA ADEEVA PUTRI (P) JL PERJUANGAN RT 08/07 Z27.4 - Need for immunization against
79 NIK : 3172062703121042
No. RM : 01-069696 BPJS : 0002456054368
LANAYA ALTARIK (P) JL BONGO I BLOK F NO.12A Z27.8 - Need for immunization against other
80 NIK : 3172062806180001
No. RM : 01-083915 BPJS : 0002610824016
NAYLA RABIATUL ADAWIYAH, BY (P) JL. BANGUN CIPTA SARANA GG. Q Z27.8 - Need for immunization against other
NO. 42 combinations of infectious diseases
81
No. RM : 01-088254 NIK : 340315150810002
LUDGERUS JUVENCIO ELRICK (L) TAMAN PEGSN INDAH C/02 KELAPA Z27.3 - Need for immunization against
GADING JAKAKUT diphtheria-tetanus-pertussis with
Tgl Lahir : 29-Jun-2018 ( 1 Thn 2 Bln 11 Hr ) poliomyelitis [DTP + polio]
82
No. RM : 01-077417 NIK : 3172062906180002
NEDIVAH ELIORA THOMAS (P) JLN RAWA SENGON 1 BLOK E NO.27 Z27.3 - Need for immunization against RETRIBUSI KLINIK KIA
diphtheria-tetanus-pertussis with PARASETAMOL DROP 60 MG/0,6 ML
83 NIK : -
No. RM : 01-079137 BPJS : 0002482819817
2019-09-09 13:37 Hal. 12 dari 1322

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HAIDAR ASAD ALI, BY (L) JL. PERJUANGAN NO. 83 Z27.3 - Need for immunization against
84 NIK : 3172061109180002
No. RM : 02-005009 BPJS : 0002622958323
RADEA DESWITA ADELIN (P) JL. DUKUH TANAH MERAH Z27.3 - Need for immunization against PARASETAMOL DROP 60 MG/0,6 ML
85 NIK : 3172041001095305
No. RM : 01-084471 BPJS : 0002624883322
NABILAH SETIANIPUTRI HANDOKO, AN (P) JL PERINTIS KEMERDEKAAN Z27.1 - Need for immunization against
RT005/004 KGT diphtheria-tetanus-pertussis, combined
Tgl Lahir : 24-May-2017 ( 2 Thn 3 Bln 16 Hr ) [DTP]
86
No. RM : 01-069544 NIK : 3172066405170001
Poli KB
WARTI (P) DK. GANDRING 012/006 KALIREJO Z35.8 - Supervision of other high-risk KOMBINASI BESI (II) SULFAT 200 MG,
pregnancies ASAM FOLAT 0,25 MG
1 NIK : 3325054806780002
No. RM : 01-064268 BPJS : 0000609828052
SUPRAPTI, NY (P) JL.PERINTIS III NO.105 01/04 KGT Z30.0 - General counselling and advice on
contraception
Tgl Lahir : 07-Sep-1985 ( 34 Thn 0 Bln 2 Hr )
2 NIK : 3501114709850004
No. RM : 01-071809 BPJS : 0001150909953
WENY RADIANTI, NY (P) INFEKSI KALI SUNTER RT 09/13 Z30.9 - Contraceptive management,
unspecified
3 NIK : 3172065004970004
No. RM : 01-015369 BPJS : 0000378234099
2019-09-09 13:37 Hal. 13 dari 1322

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RANI AZZAHRA, NY (P) KOM.BPP SUKAPURAJL TELUK BAYUR Z30.5 - Surveillance of (intrauterine)
BLOK G/7 contraceptive device
4
No. RM : 01-008033 NIK : 3172066809931001
MIFTAHUL JANAH, NY (P) TANAH MERAH RT07/08 Z30.0 - General counselling and advice on
contraception
5 NIK : 3329066505870008
No. RM : 01-010545 BPJS : 0002355602578
ANA SARIPAH, NY (P) TANAH MERAH RT 08/07 Z30.5 - Surveillance of (intrauterine)
contraceptive device
6 NIK : 3327065611770002
No. RM : 01-000297 BPJS : 0002212412321
IRMAWATI (P) JLN PEREJUANGAN RAYA GG Z30.1 - Insertion of (intrauterine)
DEMOKRASI NO 61 RT 19/07 contraceptive device
Tgl Lahir : 31-Oct-1980 ( 38 Thn 10 Bln 9 Hr )
7
No. RM : 01-004385 NIK : 3175076110800006
DIAN APRIANI, NY (P) KEL. SUNTER JAYA Z30.9 - Contraceptive management,

unspecified
8 NIK : 180113590493002
No. RM : 01-000941 BPJS : 0001966935025
AULIA ISLAMIATI (P) JL PGS II RT 001/004 Z30.9 - Contraceptive management,
unspecified
9 NIK : 3172065012970007
No. RM : 01-055335 BPJS : 0001740750568
RHODOTUL JANAH (P) DUMELING 4/1 BREBES Z30.9 - Contraceptive management,
unspecified
10 NIK : 3329084207910017
No. RM : 01-021003 BPJS : 0001607600575
2019-09-09 13:37 Hal. 14 dari 1322

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ESTHER NOOR CAHYANI, NY (P) JL RAYA GADING PERMAI BLOK DE Z30.9 - Contraceptive management,
NO 12A unspecified
11
No. RM : 01-016815 NIK : 0000093895334
JUMYATI, NY (P) JL. RAWA INDAH 005/003 Z30.1 - Insertion of (intrauterine) ASAM MEFENAMAT KAPS 500
12 NIK : 317206500980003
No. RM : 01-054259 BPJS : 0002143702528
SRI BANIYATUN (P) TNH MERAH 011/007 Z30.1 - Insertion of (intrauterine)
13 NIK : 3172026003830020
No. RM : 01-015578 BPJS : 0001829881438
RINA KORTINA, NY (P) PEGANGSAAN 06/02 Z30.9 - Contraceptive management,
unspecified
14 NIK : 3172066410841001
No. RM : 01-003781 BPJS : 0001427077517
SUPRAPTI, NY (P) JL.PERINTIS III NO.105 01/04 KGT Z30.9 - Contraceptive management, ASAM MEFENAMAT KAPS 500
unspecified
15 NIK : 3501114709850004
No. RM : 01-071809 BPJS : 0001150909953
DIAN OCTAVIANI, NY (P) KP WARUNG JENGKOL RT 05/13 Z30.5 - Surveillance of (intrauterine)
16 NIK : 3172065210890002
No. RM : 01-003348 BPJS : 0001224828066
HARYATI, NY (P) JL. PGS II 006/022 Z30.9 - Contraceptive management,
unspecified
17 NIK : 1801144507840009
No. RM : 01-041158 BPJS : 0000340899851
2019-09-09 13:37 Hal. 15 dari 1322

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SUSIANI (P) JL PGS II RT 08/02 Z30.9 - Contraceptive management,
unspecified
18 NIK : 3314065411870001
No. RM : 01-001290 BPJS : 0001223506179
HERWINI SAVITRI, NY (P) JL. TANGGUH I NO. 02 Z30.5 - Surveillance of (intrauterine)
19 NIK : 3172036009840003
No. RM : 01-087272 BPJS : 0001622322933
MAYANG ANGGARAWATI (P) KP PULO GADUNG RT 003/005 PGS II Z30.9 - Contraceptive management,
unspecified
20 NIK : 3173064811860001
No. RM : 02-004074 BPJS : 0001296267175
NENI DIANA (P) JL RAWA SENGON BLOK C RT 03/02 Z30.9 - Contraceptive management,
unspecified
21 NIK : 3172064801900004
No. RM : 01-030419 BPJS : 0000378259828
TITIN SUHARTINI (P) RAWA INDAH 004/003 Z30.9 - Contraceptive management,
unspecified
22 NIK : 3172065406840003
No. RM : 01-028835 BPJS : 000378476291
INDAH MEI WULANDARI NY (P) TANAH MERAH 008/007 TUGU Z30.9 - Contraceptive management,
SELATAN unspecified
23
No. RM : 01-035923 NIK : 3318035705970001
ALIENDA APRILLIANI (P) JL KEPU NO 63 RT 004/001 Z30.0 - General counselling and advice on
contraception
24 NIK : 3272026404980022
No. RM : 01-072235 BPJS : 0001859072736
2019-09-09 13:37 Hal. 16 dari 1322

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TUTI RAKHMAWATI (P) JL. MARAMBA NO 47 Z30.9 - Contraceptive management,
unspecified
25 NIK : 3329104906930002
No. RM : 01-058606 BPJS : 0001611309418
ASLAMIAH (P) APT PARK VIEW TW AD 25/10 Z30.9 - Contraceptive management,
unspecified
26 NIK : 7371144201880001
No. RM : 01-051484 BPJS : 0001301427382
RITA S, NY (P) JL. KAMPUNG SAWAH 009/008 Z12.4 - Special screening examination for
neoplasm of cervix
27 NIK : 3172065702850005
No. RM : 01-033309 BPJS : 0000377202666
NENI SUPARWATI (P) PEGANGSAAN DUA RT 02/02 Z30.9 - Contraceptive management,
unspecified
28 NIK : 3302075602880006
No. RM : 04-001197 BPJS : 0001775013388
KUSWATI (P) JL RAWA SENGON BLOK E 005/022 Z30.9 - Contraceptive management, ASAM MEFENAMAT KAPS 500
unspecified
29 NIK : 3172035907800001
No. RM : 01-009364 BPJS : 0001607859178
JUMYATI, NY (P) JL. RAWA INDAH 005/003 Z30.9 - Contraceptive management,
unspecified
30 NIK : 317206500980003
No. RM : 01-054259 BPJS : 0002143702528
LITA MELITA ARVIANY (P) APT GADING NIAS RT 2/3 Z30.1 - Insertion of (intrauterine)
31 NIK : 3275124712920005
No. RM : 01-063254 BPJS : 0002032222757
2019-09-09 13:37 Hal. 17 dari 1322

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RONA INDRIANI (P) JL PATUHA SELATAN 7 BLOK 15 NO 39 Z30.1 - Insertion of (intrauterine)
32 NIK : 32575044509830017
No. RM : 01-025681 BPJS : 0001721152001
TIYAS SUJIARTI (P) KAYUMAS UTARA 0609 Z30.8 - Other contraceptive management

33 NIK : 3328046108910008
No. RM : 01-048785 BPJS : 0001634311991
EKA NURBAETI, NY (P) RAWA INDAH RT 02/03 Z30.8 - Other contraceptive management

34 NIK : -3212256809870002
No. RM : 01-000081 BPJS : 0001607559726
ESPERANZA INTI BANZUELA (P) JL KELAPA PUAN TMR III ND 4/26 Z30.5 - Surveillance of (intrauterine) ASAM MEFENAMAT KAPS 500
35 NIK : 3172064108700001
No. RM : 01-088594 BPJS : 0002332752131
WAHYU AMBARSARI, NY (P) JL PGS II RT 05/02 Z30.5 - Surveillance of (intrauterine)
36 NIK : 3175075008910009
No. RM : 01-059624 BPJS : 0001307183624
Poli KIA
MEILANI EKA WAHYUNI, NY (P) RAWA SENGON RT 006/022 KELAPA Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
GADING BARAT JAKARTA UTARA unspecified KOMBINASI BESI (II) SULFAT 200 MG,
1 ASAM FOLAT 0,25 MG
No. RM : 01-074880 NIK : 3172065405001001 SIANOKOBALAMIN (VITAMIN B12) 50
Tgl Diagnosis : 01 February 2019 8:26 AM BPJS : 0001877821222 MCG
RETRIBUSI KLINIK KIA
2019-09-09 13:37 Hal. 18 dari 1322

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IRAH, NY (P) JL TANAH MERAH RT 001/007 Z34.8 - Supervision of other normal SIANOKOBALAMIN (VITAMIN B12) 50
pregnancy MCG
Tgl Lahir : 14-Dec-1986 ( 32 Thn 8 Bln 26 Hr ) KALSIUM LAKTAT (KALK) 500 MG
2 NIK : 3276075412860000
No. RM : 01-037368 BPJS : 0001631361036 SIANOKOBALAMIN (VITAMIN B12) 50
Tgl Diagnosis : 01 February 2019 4:36 PM MCG
IMROATUL MAHMUDAH, NY (P) JL MASJID ALJIHAD RT 002/004 Z34.9 - Supervision of normal pregnancy,
unspecified
3 NIK : 3321036004910004
No. RM : 02-004331 BPJS : 0000598715976
IRMAYANTI AZIS, NN (P) JANUR ELOK BLOK8WF9/6 Z34.0 - Supervision of normal first
pregnancy
4 NIK : 7371076208940003
No. RM : 01-082136 BPJS : 0000945249131
KARISA RATIH NATALIA.NY (P) KEALAP NIAS II PC.4/12A Z34.0 - Supervision of normal first
pregnancy
5 NIK : 6471045009930001
No. RM : 01-014181 BPJS : 0000121641208
LINDA PURWANTI, NY (P) JL KEPU RT 4/1 Z34.9 - Supervision of normal pregnancy,
unspecified
6 NIK : 3172065707941002
No. RM : 01-035524 BPJS : 0001225627301
DIANA ELFRIDA SIMORANGKIR, NY (P) TANAH MERAH RT 07 RW 14 Z30.9 - Contraceptive management,
unspecified
7 NIK : 3175024303840001
No. RM : 01-086315 BPJS : 0001792497868
ARNITA MARIANNA, NY (P) KP PULO GADUNG Z34.0 - Supervision of normal first
pregnancy
8 NIK : 3172064407880005
No. RM : 01-081466 BPJS : 0001149858099
2019-09-09 13:37 Hal. 19 dari 1322

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INDA BELGRADE LATUKOLAN, NY (P) KOMP PERTANIAN RT 002/016 Z34.0 - Supervision of normal first ASAM FOLAT 1 MG
pregnancy ASAM ASKORBAT (VITAMIN C) 50 MG
9 NIK : 3172035908890001 SIANOKOBALAMIN (VITAMIN B12) 50
No. RM : 01-058958 BPJS : 0001653576355 MCG
CARYATI, NY (P) TANAH MERAH UJUNG RT 02/06 Z34.9 - Supervision of normal pregnancy,
unspecified
10 NIK : 3172035212830006
No. RM : 01-008403 BPJS : 0001451223988
RENI PURWANINGSIH (P) KP PEDONGKELAN RT 02/15 KAYU Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
PUTIH pregnancy MCG
Tgl Lahir : 25-Nov-1995 ( 23 Thn 9 Bln 15 Hr ) KALSIUM LAKTAT (KALK) 500 MG
11
No. RM : 01-057743 NIK : 3175026411940005 KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Diagnosis : 04 February 2019 9:37 AM BPJS : 0001838490996 ASAM FOLAT 0,25 MG
TITIN CARTINI, NY (P) JL. KELAPA MOLEK 5 T2 NO. 16 Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
unspecified SIANOKOBALAMIN (VITAMIN B12) 50
12 NIK : 3208204310820003 MCG
No. RM : 01-086499 BPJS : 0002737969863 KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Diagnosis : 04 February 2019 9:40 AM ASAM FOLAT 0,25 MG
WAHYUNI, NY (P) TANAH MERAH 04/08 RAWA BADAK Z34.9 - Supervision of normal pregnancy,
SELATAN unspecified
13
No. RM : 01-048416 NIK : 3171085302880005
SALAMAH, NY (P) JL. PULO NANGKA BARAT II O48 - Prolonged pregnancy

14 NIK : 3175024708900001
No. RM : 01-080094 BPJS : 0001139577309
TRI INDAH TANJUNGSARI, NY (P) JL PULAU PENYENGAT IV NO 25 RT Z34.0 - Supervision of normal first
003/003 pregnancy
15
No. RM : 01-073481 NIK : 3172066409810003
2019-09-09 13:37 Hal. 20 dari 1322

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DENI REPTASARI, NY (P) JL TIPAR CAKUNG GG SALON Z34.0 - Supervision of normal first
pregnancy
16 NIK : 1812036001960003
No. RM : 01-084604 BPJS : 0000356560547
IKA EVA WAHYUNI, NY (P) JL.BCS 01/05 PGS DUA Z34.0 - Supervision of normal first
pregnancy
17 NIK : 3216025005970008
No. RM : 01-084224 BPJS : 0002739805738
SANTI NURCAHYANI, NY (P) JL H OYAR RT 004/002 Z34.9 - Supervision of normal pregnancy,
unspecified
18 NIK : 3201125811920004
No. RM : 01-015780 BPJS : 0001737320466
SITI ROHANI, NY (P) TANAH MERAH ATAS JL DUKA RT Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
06/08 unspecified SIANOKOBALAMIN (VITAMIN B12) 50
19 MCG
AYU EKATNITI, NY (P) BOULEVARD HIJAU I 5 NO 9 BEKASI Z34.0 - Supervision of normal first
UTARA pregnancy
20
No. RM : 01-058820 NIK : 6213026705910001
YUNILAWATI, NY (P) JL RAWA INDAH NO 13 RT 07/03 Z34.9 - Supervision of normal pregnancy,

unspecified
21 NIK : 3172065208880001
No. RM : 01-034347 BPJS : 0001200416016
SAFITRI NOVARITA, NY (P) JL PEGANGSAAN DUA NO 18 Z34.0 - Supervision of normal first KALSIUM LAKTAT (KALK) 500 MG
RT003/004 pregnancy SIANOKOBALAMIN (VITAMIN B12) 50
22 MCG
2019-09-09 13:37 Hal. 21 dari 1322

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EKA SETIANA (P) KELAPA GADING TIMUR RT 03/04 Z34.9 - Supervision of normal pregnancy,
unspecified
23 NIK : 3172066611910001
No. RM : 01-008476 BPJS : 0001225412864
IRMAWATI, NY (P) BCS NO 73 Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
unspecified KOMBINASI BESI (II) SULFAT 200 MG,
24 NIK : 3209014707940010 ASAM FOLAT 0,25 MG
Tgl Diagnosis : 04 February 2019 11:05 AM MCG
LINA HERLINA, NY (P) JL TEGUH V NO.7 007/001 O99.0 - Anaemia complicating pregnancy, KALSIUM LAKTAT (KALK) 500 MG
childbirth and the puerperium SIANOKOBALAMIN (VITAMIN B12) 50
Tgl Lahir : 11-Jan-1978 ( 41 Thn 7 Bln 29 Hr ) Z34.9 - Supervision of normal pregnancy,
25 NIK : 3172065101780001 MCG
No. RM : 01-040456 BPJS : 0001466198965 unspecified KOMBINASI BESI (II) SULFAT 200 MG,
SINTA YANUARTI DEWI, NY (P) JL.MAHONI BLOK GG.IV/6 Z34.9 - Supervision of normal pregnancy,
unspecified
26 NIK : 3172035301890005
No. RM : 01-063465 BPJS : 0001622412202
ATIN HANDAYANI, NY (P) JL DARMA RAYA MK 6 RT 12/2 O99.0 - Anaemia complicating pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
childbirth and the puerperium MCG
Tgl Lahir : 10-Oct-1991 ( 27 Thn 10 Bln 30 Hr ) KALSIUM LAKTAT (KALK) 500 MG
27 NIK : 3206284309920001
No. RM : 01-035144 BPJS : 0001850199254 ASAM ASKORBAT (VITAMIN C) 50 MG
Tgl Diagnosis : 04 February 2019 11:59 AM KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
YANI ZAENAH, NY (P) KELAPA PUYUH V BLOK KG NO 8 Z34.9 - Supervision of normal pregnancy, TIAMIN (VITAMIN B1) 50 MG
unspecified PIRIDOKSIN (VITAMIN B6) 10 MG
No. RM : 01-002412 BPJS : 0002135490974 MCG
Tgl Diagnosis : 04 February 2019 12:07 PM ASAM FOLAT 1 MG
DWI CITRA SITI HANNA, NY (P) KOMP WALIKOTA JL MURAI I BLOK D Z34.9 - Supervision of normal pregnancy,
3/18 unspecified
29
No. RM : 01-082847 NIK : 3172045211960014
2019-09-09 13:37 Hal. 22 dari 1322

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LIA KHALIDAZIA NY (P) JL. JANUR KUNING 8 BLOK WN2 NO.11 Z34.0 - Supervision of normal first
pregnancy
30 NIK : 3328115608940007
No. RM : 01-072052 BPJS : 0002737471241
JUNIATY TANUJAYA, NY (P) HARAPAN INDAH CLUSTER ALARIA Z30.5 - Surveillance of (intrauterine)
HY 30 NO 33 HARAPAN INDAH contraceptive device
31 CLUSTER ALARIA HY 30 NO 33
No. RM : 01-069283
Tgl Diagnosis : 04 February 2019 2:16 PM NIK : 3172015706840011
DEWI SUSANTI, NY (P) JL.TIPAR CAKUNG RT.01 RW.09 KEL Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
CAKUNG BARAT unspecified MCG
Tgl Lahir : 03-Apr-1989 ( 30 Thn 5 Bln 6 Hr ) PIRIDOKSIN (VITAMIN B6) 10 MG
32
No. RM : 01-076640 NIK : 3328064304890011 ASAM FOLAT 1 MG
MASHILLA MAULINA, NY (P) JL P REMPANG RT 6/9 Z34.8 - Supervision of other normal KALSIUM LAKTAT (KALK) 500 MG
pregnancy KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Lahir : 20-Aug-1994 ( 25 Thn 0 Bln 20 Hr ) Z34.9 - Supervision of normal pregnancy,
33 NIK : 3172036008940005 ASAM FOLAT 0,25 MG
No. RM : 01-074314 BPJS : 0001304329713 unspecified SIANOKOBALAMIN (VITAMIN B12) 50
MARTHA SEPTRINA, NY (P) APT GADING TWR A LT 3DB O82.9 - Delivery by caesarean section, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 20-Sep-1988 ( 30 Thn 11 Bln 20 Hr ) KALSIUM LAKTAT (KALK) 500 MG
34 NIK : 3175036009880008
RATU MUNJAH, NY (P) JL RAWA SENGON BLOK D NO 67 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 06-Jun-1969 ( 50 Thn 3 Bln 3 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
35 NIK : 3604274606900137
No. RM : 01-077557 BPJS : 0001676262655 ASAM FOLAT 0,25 MG
KALSIUM LAKTAT (KALK) 500 MG
LILIS FITRIANI, NY (P) KELAPA GADING TIMUR RT 04/04 Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
pregnancy MCG
Tgl Lahir : 22-Jan-2000 ( 19 Thn 7 Bln 18 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
36 NIK : 3172066201000003
2019-09-09 13:37 Hal. 23 dari 1322

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PIPIT NURWULAN, NY (P) PSR IMPRESS KGT Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
37 NIK : 3215066606900001 MCG
No. RM : 01-079901 BPJS : 0001965480388 KALSIUM LAKTAT (KALK) 500 MG
Tgl Diagnosis : 06 February 2019 12:02 PM KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
SITI LAELA SARI,NY (P) PLUMPANG B 08/08 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
38 NIK : 3202225910980003
Tgl Diagnosis : 06 February 2019 12:56 PM ASAM FOLAT 0,25 MG
ERNA WIDIASTUTI, NY (P) KP WARUNG JENGKOL RT 005/013 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
39 NIK : 3172066301810006
REZQINA SYAHIDA, NY (P) JL BCS 002/005 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
40 NIK : 1803095208970002 MCG
ASAM FOLAT 0,25 MG
SRI ASIH, NY (P) KP. RAWA INDAH Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 08-May-1991 ( 28 Thn 4 Bln 1 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
41 NIK : 3328174805910011
PIRIDOKSIN (VITAMIN B6) 10 MG
ANDREA GINA KARIMA, NY (P) KELAPA PUYUH V KB/18 Z34.0 - Supervision of normal first ASAM FOLAT 1 MG
pregnancy SIANOKOBALAMIN (VITAMIN B12) 50
42 NIK : 3275034101950026 MCG
No. RM : 01-015950 BPJS : 0001884667869 PIRIDOKSIN (VITAMIN B6) 10 MG
2019-09-09 13:37 Hal. 24 dari 1322

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ROSIANA (P) RW SENGON BLOK E NO 21 Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
pregnancy MCG
Tgl Lahir : 17-Mar-2000 ( 19 Thn 5 Bln 23 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
43 NIK : 3175025703000005
RETNO SETIA WARDIYANTI, NY (P) JL. P NANGKA BRT II 006/016 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 28-Oct-1987 ( 31 Thn 10 Bln 12 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
44 NIK : 3376026810870002
LENI, NY (P) JL PERINTIS KEMERDEKAAN Z34.9 - Supervision of normal pregnancy,
unspecified
45 NIK : 3217076001830008
No. RM : 01-086692 BPJS : 0002332695126
NUR FITRIANIH, NY (P) JL PERINTIS KEMERDEKAAN RT 5/4 Z34.9 - Supervision of normal pregnancy,
unspecified
46 NIK : 3172065502970001
No. RM : 01-047474 BPJS : 0000378084666
ELGA CINTYA HAPSARI, NY (P) JL JANUR ELOK V QC 11 NO 9 Z34.0 - Supervision of normal first
pregnancy
47 NIK : 32172065607980001
No. RM : 01-012053 BPJS : 0002332768195
MARIAH, NY (P) TANAH MERAH 07/07 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 07-Mar-1979 ( 40 Thn 6 Bln 2 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
48 NIK : 3172064703790006
APRILIA ANJATRI, NY (P) JL PULAU PENYENGAT II NO 7 7/3 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 25-Apr-1988 ( 31 Thn 4 Bln 15 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
49 NIK : 3404026504880001
2019-09-09 13:37 Hal. 25 dari 1322

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YUYUN YUNITA UNTO, NY (P) RAWA SENGON BLK B 002/022 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 27-Jan-1993 ( 26 Thn 7 Bln 13 Hr ) KALSIUM LAKTAT (KALK) 500 MG
50 NIK : 3172066701931003
WANIARTI (P) KP PULO GADUNG O82.9 - Delivery by caesarean section,

unspecified
51 NIK : 3328085407840004
No. RM : 05-002340 BPJS : 0002424368799
ATIKA WULANDARI, NY (P) JL RAWA INDAH RT 07/03 Z34.0 - Supervision of normal first
pregnancy
52 NIK : 172066910970003
No. RM : 01-013842 BPJS : 0001225404933
DEVI MARDIA (P) JL HJ OYAR RT 01/02 Z34.9 - Supervision of normal pregnancy,
unspecified
53 NIK : 3175024802920001
No. RM : 04-000691 BPJS : 0002054084815
SRI ANINGSIH, NY (P) JL DAHLIA 1 NO 15 RT 005/003 Z34.9 - Supervision of normal pregnancy,
unspecified
54 NIK : 320902670192000
No. RM : 01-001339 BPJS : 0001859829895
SUNARTI, NY (P) JL.KINTAMANI I NO.24 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
55 NIK : 3316015504820006
IGNATIA RADEGUNDA BIEKO (P) RAWASENGON 02/22 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 31-Jul-1996 ( 23 Thn 1 Bln 9 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
56 NIK : 5303087107960002
2019-09-09 13:37 Hal. 26 dari 1322

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SITI JUARIYAH (P) WAY RILAU RT 000/000 PEKON MON Z34.0 - Supervision of normal first
pregnancy
57 NIK : 1804165509970001
No. RM : 01-073650 BPJS : 0000333336295
SITI AISAH (P) P.NANGKA BARAT 01/16 Z34.9 - Supervision of normal pregnancy,
unspecified
58 NIK : 3209386704880001
No. RM : 01-072731 BPJS : 0002066245301
NOVITASARI, NY (P) JL. PGS II 005/002 O82.9 - Delivery by caesarean section, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 02-Feb-1983 ( 36 Thn 7 Bln 7 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
59 NIK : 3172024202830004
DENI REPTASARI, NY (P) JL TIPAR CAKUNG GG SALON Z34.0 - Supervision of normal first
pregnancy
60 NIK : 1812036001960003
No. RM : 01-084604 BPJS : 0000356560547
APRILIA LANJAR SITI SURYANI (P) JL PASAR INPRES RT 006/006 NO 60 Z34.9 - Supervision of normal pregnancy,
unspecified
61 NIK : 3172064106890004
No. RM : 02-004176 BPJS : 0001617935106
YANI ZAENAH, NY (P) KELAPA PUYUH V BLOK KG NO 8 Z34.9 - Supervision of normal pregnancy,
unspecified
62 NIK : 3304065902890004
No. RM : 01-002412 BPJS : 0002135490974
PITRIA WININGSIH, NY (P) JL PEGANGSAAN DUA Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
63 NIK : 3173036701950005 MCG
2019-09-09 13:37 Hal. 27 dari 1322

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MURNIATI MAR'ATUSH SHOLIKHAH (P) JL PGS II Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 22-Nov-1994 ( 24 Thn 9 Bln 18 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
64 NIK : -
MAZAYA NOVERIWA PUSPA, NY (P) APT GADING NIAS TWR ALAMANDA 11 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
AK unspecified SIANOKOBALAMIN (VITAMIN B12) 50
65 MCG
No. RM : 01-080443 NIK : 3275065411930007 KALSIUM LAKTAT (KALK) 500 MG
Tgl Diagnosis : 11 February 2019 8:42 AM BPJS : 0001639188775 KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
ANA ROYANI, NY (P) JL PEGANGSAAN DUA RT 06/02 Z34.0 - Supervision of normal first
pregnancy
66 NIK : 31720641099310010
No. RM : 01-027869 BPJS : 0002098049051
MIA MELINDA (P) KP WARUNG JENGKOL NO. 108 Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
unspecified ASAM FOLAT 0,25 MG
Tgl Lahir : 23-May-1996 ( 23 Thn 3 Bln 17 Hr ) KALSIUM LAKTAT (KALK) 500 MG
67 NIK : 3172066305960003
DINITA APRILIA,NY (P) GG. PEJUANG V NO. 105 Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
pregnancy
68 NIK : 317306504950002
No. RM : 01-084423 BPJS : 000162413559
SANTI NURCAHYANI, NY (P) JL H OYAR RT 004/002 Z34.9 - Supervision of normal pregnancy, RUJUKAN
unspecified
69 NIK : 3201125811920004
No. RM : 01-015780 BPJS : 0001737320466
WAHYUNI, NY (P) TANAH MERAH 04/08 RAWA BADAK Z34.9 - Supervision of normal pregnancy,
SELATAN unspecified
70
No. RM : 01-048416 NIK : 3171085302880005
2019-09-09 13:37 Hal. 28 dari 1322

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LISA BUDIARTI (P) RAWA SENGON RT 01 RW 22 Z34.9 - Supervision of normal pregnancy,
unspecified
71 NIK : 330916601929001
No. RM : 01-041263 BPJS : 0001287397978
ELIS SRI MULYANTI, NY (P) PERINTIS II NO 94 E RT 006/004 KGT Z35.9 - Supervision of high-risk pregnancy, ASAM FOLAT 1 MG
72 NIK : 3172060911100004 MCG
ASAM FOLAT 0,25 MG
IIN NOVITASARI, NY (P) JL H OYAR RT 04/02 PEGANGSAAN Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
DUA unspecified MCG
73
No. RM : 01-006373 NIK : 3172066711920006 ASAM FOLAT 0,25 MG
BPJS : 0002332881044 KALSIUM LAKTAT (KALK) 500 MG
KURNIASIH, NY (P) JL. TIPAR SELATAN 12 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
74 NIK : 3327135711910002
AYU ANGGRAENI, NY (P) JL. APRT GADING NIAS RESIDENSCES O82.9 - Delivery by caesarean section,
BLK DAHLIA LT 19LDl unspecified
75
No. RM : 01-048234 NIK : -
RUNIAH, NY (P) RW SENGON RT 5/22 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 08-Sep-1987 ( 32 Thn 0 Bln 1 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
76 NIK : 3208054809860005
KUNI, NY (P) JL DEMAK BLOK M5/24 SUKAPURA Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
pregnancy
77 NIK : 329226005910003
No. RM : 01-079106 BPJS : 0002743163649
2019-09-09 13:37 Hal. 29 dari 1322

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RISTIYANTI, NY (P) H.OYAR 01/02 Z34.9 - Supervision of normal pregnancy,
unspecified
78 NIK : 3172066505920003
No. RM : 01-058197 BPJS : 0001224939429
CARSIAH ,NY (P) KELAP MOLEK VII O.2/16 Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
79 NIK : 3208065006970001 MCG
ASAM FOLAT 0,25 MG
SITTI LUTFIYAH, NY (P) JL MERAH DELIMA B 2/33 RT 4/10 O32.1 - Maternal care for breech SIANOKOBALAMIN (VITAMIN B12) 50
presentation MCG
Tgl Lahir : 23-Feb-1983 ( 36 Thn 6 Bln 17 Hr ) O82.9 - Delivery by caesarean section, KALSIUM LAKTAT (KALK) 500 MG
80 NIK : 3172066302830003
No. RM : 01-035099 BPJS : 0001621463545 unspecified KOMBINASI BESI (II) SULFAT 200 MG,
DESSY MONIKA LESTARI (P) KAMPBETING SAWAHNO35 Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
pregnancy MCG
81 NIK : 3172074912940002
MASITHA LESTARI (P) SUKAPRRA KOMP MWALILOTA RT O82.9 - Delivery by caesarean section, KOMBINASI BESI (II) SULFAT 200 MG,
B012/;06 unspecified ASAM FOLAT 0,25 MG
Tgl Lahir : 13-Mar-1990 ( 29 Thn 5 Bln 27 Hr ) KALSIUM LAKTAT (KALK) 500 MG
82
No. RM : 01-052614 NIK : - SIANOKOBALAMIN (VITAMIN B12) 50
Tgl Diagnosis : 12 February 2019 12:11 PM BPJS : 0002072039444 MCG
VERAWATI (P) JL LOMBOK BLOK A 7 NO 15 Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
SUKAPURA pregnancy MCG
83
No. RM : 01-070352 NIK : 1671064202870019
IDA JUBAEDAH (P) JL. BENDUNGAN MELAYU NO.25 K Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
005/001 pregnancy MCG
84
No. RM : 01-050522 NIK : -
2019-09-09 13:37 Hal. 30 dari 1322

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RICHA DWI ASTUTI, NY (P) JL TABAH RAYA NIO.14 001/009 Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
pregnancy
85 NIK : 3172065309920002
No. RM : 01-079993 BPJS : 0002210393553
ROHMAYATI, NY (P) JL PEGANGSAAN DUA RT 04/02 Z34.9 - Supervision of normal pregnancy,
unspecified
86 NIK : 3172065201870001
No. RM : 04-000989 BPJS : 0001225683011
RUNTINAH, NY (P) RAWA INDAH 01/03 O32.9 - Maternal care for malpresentation of
fetus, unspecified
87 NIK : 3172064512820003
No. RM : 01-077821 BPJS : 0001225715894
DARMIYAH ACHMAD (P) INPEKSI KALI SUNTER RT 02/04 KGB O82.9 - Delivery by caesarean section, KALSIUM LAKTAT (KALK) 500 MG
88 NIK : 3172064911860001 MCG
No. RM : 01-074942 BPJS : 0001717204408 ASAM FOLAT 1 MG
CARYATI, NY (P) TANAH MERAH UJUNG RT 02/06 O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
childbirth and the puerperium ASAM FOLAT 0,25 MG
Tgl Lahir : 12-Dec-1983 ( 35 Thn 8 Bln 28 Hr ) SIANOKOBALAMIN (VITAMIN B12) 50
89 NIK : 3172035212830006
No. RM : 01-008403 BPJS : 0001451223988 MCG
RIBKA, NY (P) SABA DUSUN TATA SAMA Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
pregnancy MCG
90 NIK : 6108135106980003
NOVA GAIYATRI (P) JL PERINTIS I RT 001/006 KLP GADING Z34.9 - Supervision of normal pregnancy,
TIMUR unspecified
91
No. RM : 02-004855 NIK : 3312036311910001
2019-09-09 13:37 Hal. 31 dari 1322

P : 021-45853300 F : 021-45853301
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ISNIWATI, NY (P) JL. KAYU MAS UTARA O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
92 NIK : -
No. RM : 01-082220 BPJS : 0002340112871
SOPIAWATI, NY (P) SUKAPURA RT 005/10 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
93 NIK : 3201185606900008 MCG
ASAM FOLAT 0,25 MG
YUNILAWATI, NY (P) JL RAWA INDAH NO 13 RT 07/03 Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified RETRIBUSI KLINIK KIA
94 NIK : 3172065208880001 KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Diagnosis : 13 February 2019 10:51 AM SIANOKOBALAMIN (VITAMIN B12) 50
MCG
ELLA EFRINA SHAHAB, NY (P) JL.TEGUH VIII NO.2 KODAMAR O99.0 - Anaemia complicating pregnancy,
childbirth and the puerperium
95 NIK : 1971026704860002
No. RM : 01-078396 BPJS : 0001144726648
SANTI SUSILAWATI, NY (P) JL.RAYA PEGANGSAAN II 06/02 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
96 NIK : 3172062212090023
NOVI ANDRIYANI, NY (P) JL BOULEVARD A2 NO 9 O99.0 - Anaemia complicating pregnancy,
97 NIK : 3301125011920008
No. RM : 01-076319 BPJS : 0000518074391
2019-09-09 13:37 Hal. 32 dari 1322

P : 021-45853300 F : 021-45853301
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RATNA WIJAYANTI, NY (P) PGS DUA RT 4/5 Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
unspecified
98 NIK : 3275024505890042
No. RM : 05-000732 BPJS : 0001745510477
TETI YOHANA, NY (P) JL TNH MERAH GG MAWAR NO.53 Z34.9 - Supervision of normal pregnancy, TIAMIN (VITAMIN B1) 50 MG
99 NIK : 31720636608870010 MCG
Tgl Diagnosis : 14 February 2019 9:09 AM PIRIDOKSIN (VITAMIN B6) 10 MG
YUSMINA YULIANA ATAUPAH (P) JL HARPA III CC 21 RT 007/009 O32.2 - Maternal care for transverse and
oblique lie
100 NIK : 5301254207790001
No. RM : 02-004405 BPJS : 0002738735785
NORKOMALA, NY (P) JL PERINTIS KEMERDEKAAN NO 112 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
RT 011/004 unspecified MCG
101
MARTINI, NY (P) SUKAPURA RT 08/04 Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified KALSIUM LAKTAT (KALK) 500 MG
MCG
AYU PURWANTI, NY (P) JL. RAW INDAH N83.2 - Other and unspecified ovarian cysts KALSIUM LAKTAT (KALK) 500 MG
Z34.0 - Supervision of normal first KOMBINASI BESI (II) SULFAT 200 MG,
103 NIK : 3175077008910009 pregnancy ASAM FOLAT 0,25 MG
RANI PUTRI YANI, NY (P) JL. PULAU NANGKA BARAT 021/001 Z34.0 - Supervision of normal first TIAMIN (VITAMIN B1) 50 MG
104 NIK : 1806045104930001 MCG
Tgl Diagnosis : 14 February 2019 10:21 AM ASAM FOLAT 1 MG
2019-09-09 13:37 Hal. 33 dari 1322

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IDA MARTINI (P) JL KUNING TUA BLOK D NO 12 Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
pregnancy MCG
Tgl Lahir : 08-Aug-1992 ( 27 Thn 1 Bln 1 Hr ) KALSIUM LAKTAT (KALK) 500 MG
105 NIK : 3674054808920001
PARJINI, NY (P) JL SENTOSA BARAT NO 4 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 18-Apr-1977 ( 42 Thn 4 Bln 22 Hr ) KALSIUM LAKTAT (KALK) 500 MG
106 NIK : 3172065804771001
DEWI TRI HANDAYANI, NY (P) JL. HARAPAN II NO. 9 Z34.9 - Supervision of normal pregnancy,
unspecified
107 NIK : 317206500282002
No. RM : 01-087432 BPJS : 0002332694496
TIO MARIA MAGDALENA SITANGGANG (P) KLP MUDA 5 BLOK S NO 26 Z34.9 - Supervision of normal pregnancy,
unspecified
108 NIK : -
No. RM : 01-087258 BPJS : 0002046412631
ALISYAH HANDAYANI,ny (P) JL INSPEKSI X SUNTER RT002/04 KGB Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
109 NIK : - MCG
WIWI RISTONI, NY (P) JL PERJUANGAN 03 RT 003/004 KGT Z34.9 - Supervision of normal pregnancy, PIRIDOKSIN (VITAMIN B6) 10 MG
110 NIK : 3328075102830002 MCG
APRILIA ANJATRI, NY (P) JL PULAU PENYENGAT II NO 7 7/3 Z34.9 - Supervision of normal pregnancy,
unspecified
111 NIK : 3404026504880001
No. RM : 01-022573 BPJS : 0002095925859
2019-09-09 13:37 Hal. 34 dari 1322

P : 021-45853300 F : 021-45853301
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NUR BAETI, NY (P) JL TELUKLADA NO 14 C RT 06/08 Z34.9 - Supervision of normal pregnancy,
unspecified
112 NIK : 3172044909860004
No. RM : 01-010506 BPJS : 0001829768488
SITI AISAH (P) P.NANGKA BARAT 01/16 Z34.9 - Supervision of normal pregnancy,
unspecified
113 NIK : 3209386704880001
No. RM : 01-072731 BPJS : 0002066245301
MUGIHARMI (P) JL RAWA SENGON RT 02/022 O82.9 - Delivery by caesarean section,
unspecified
114 NIK : 3172065103810003
No. RM : 01-076031 BPJS : 0001225833074
RIA AGUSTIN, NY (P) GG. PERJUANG 6 Z34.0 - Supervision of normal first
pregnancy
115 NIK : 3327084308980142
No. RM : 01-086160 BPJS : 0002626036345
RISMA RAHAYU, NY (P) PEGANGSAAN DUA RT 04/05 Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
pregnancy MCG
116 NIK : 3520075910950001
SONIA ANGELINA NATASHA N, NY (P) JL ANCOL SELATAN II Z34.0 - Supervision of normal first
pregnancy
117 NIK : 3172024906920008
No. RM : 01-081559 BPJS : 0001647238329
ASTUTI SUMIATI, NY (P) JL PGS II RT 002/005 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 25-Jul-1986 ( 33 Thn 1 Bln 15 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
118 NIK : 3301156507860001
2019-09-09 13:37 Hal. 35 dari 1322

P : 021-45853300 F : 021-45853301
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CICA FITRIYANI (P) PULO NANGKA Z34.9 - Supervision of normal pregnancy,
unspecified
119 NIK : 1605185010920006
No. RM : 01-010382 BPJS : 0002449477787
ROHIMAH ,NY (P) JL. TUGU SELATAN 002/007 Z34.9 - Supervision of normal pregnancy,
unspecified
120 NIK : 3202085012840002
No. RM : 01-073395 BPJS : 0001639075342
SAFITRI NOVARITA, NY (P) JL PEGANGSAAN DUA NO 18 Z34.0 - Supervision of normal first
RT003/004 pregnancy
121
No. RM : 01-083543 NIK : 1471116409910001
ARNITA MARIANNA, NY (P) KP PULO GADUNG Z34.9 - Supervision of normal pregnancy,

unspecified
122 NIK : 3172064407880005
No. RM : 01-081466 BPJS : 0001149858099
MARSELINA WALE RITAN, NY (P) JL. DUKUH TANAH MERAH Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified
123 NIK : 5306024309840001
No. RM : 01-085359 BPJS : 0002519137282
UNA FALENTINA (P) P. KEMERDEKAAN RT. 005/010 PULO Z30.9 - Contraceptive management,
GADUNG unspecified
124
No. RM : 01-002432 NIK : 3301064812720001
LIA KHALIDAZIA NY (P) JL. JANUR KUNING 8 BLOK WN2 NO.11 Z34.0 - Supervision of normal first
pregnancy
125 NIK : 3328115608940007
No. RM : 01-072052 BPJS : 0002737471241
2019-09-09 13:37 Hal. 36 dari 1322

P : 021-45853300 F : 021-45853301
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LINDA PURWANTI, NY (P) JL KEPU RT 4/1 Z34.9 - Supervision of normal pregnancy,
unspecified
126 NIK : 3172065707941002
No. RM : 01-035524 BPJS : 0001225627301
PARTINAH (P) PERUM VILLA ARTHA GADING BLOK E Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
NO 53 pregnancy
127
No. RM : 01-076505 NIK : 3326015105920005
DESSY MONIKA LESTARI (P) KAMPBETING SAWAHNO35 Z34.0 - Supervision of normal first
pregnancy
128 NIK : 3172074912940002
No. RM : 01-080859 BPJS : 0001623200141
UNTARI, NY (P) RAWA SENGON RT 03/22 O99.0 - Anaemia complicating pregnancy,
129 NIK : 3172066207820004
No. RM : 01-000289 BPJS : 0001225599557
WAHYUNI, NY (P) TANAH MERAH 04/08 RAWA BADAK Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
SELATAN unspecified MCG
Tgl Lahir : 13-Feb-1988 ( 31 Thn 6 Bln 27 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
130
HERNI SAITIN (P) JL. GADING INDAH RAYA KV 8 NO 009 Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified
131 NIK : 3201375704890008
No. RM : 01-043981 BPJS : 0002620083824
NASRIDA BETTA (P) JL RAWA SENGON BLOK B NO 115 Z34.9 - Supervision of normal pregnancy, PIRIDOKSIN (VITAMIN B6) 10 MG
132 NIK : 7314114107870157 MCG
2019-09-09 13:37 Hal. 37 dari 1322

P : 021-45853300 F : 021-45853301
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SITI RAHAYU, NY (P) JL H OYAR Z34.9 - Supervision of normal pregnancy,
unspecified
133 NIK : 3172066712920003
No. RM : 05-002017 BPJS : 0001225383276
DIAH, NY (P) JL. PELUMPANG Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
134 NIK : 1807114306840008 MCG
WASIYANTI, NY (P) KELAA HIBRIDA VI RT 06/015 PGSN II Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
135 NIK : 3175065904810016
ASAM ASKORBAT (VITAMIN C) 50 MG
LISA BUDIARTI (P) RAWA SENGON RT 01 RW 22 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 20-Jan-1992 ( 27 Thn 7 Bln 20 Hr ) ASAM ASKORBAT (VITAMIN C) 50 MG
136 NIK : 330916601929001
MARDIAH, NY (P) KP. PULO GADUNG RT 002/005 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
137 NIK : 317206511190002 MCG
ASAM FOLAT 0,25 MG
R YANTI BT SUMIHLAT, NY (P) JL RAWA SENGON RAYA BLOK D NO Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
53 unspecified SIANOKOBALAMIN (VITAMIN B12) 50
138 MCG
Tgl Diagnosis : 18 February 2019 11:42 AM BPJS : 0001207547627 KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
2019-09-09 13:37 Hal. 38 dari 1322

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EVIANAH, NY (P) RAWA INDAH RT 03/03 PGS II Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified
139 NIK : 3172066109920003
No. RM : 01-020627 BPJS : 0000379385651
UTI SUSANTI, NY (P) JLN GENTENG NO 4 GG BUNTU RT Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
03/01 unspecified KOMBINASI BESI (II) SULFAT 200 MG,
WINDA WIDIA, NY (P) APT GADING NIAS TOWER TRISANT Z34.0 - Supervision of normal first KOMBINASI BESI (II) SULFAT 200 MG,
23 GB pregnancy ASAM FOLAT 0,25 MG
141
No. RM : 01-080668 NIK : - MULTIVITAMIN DEWASA
Tgl Diagnosis : 18 February 2019 12:26 PM BPJS : 0001218981227 RETRIBUSI KLINIK KIA
DIAH RACHMAN, NY (P) KP WARUNG JENGKOL RT 04/013 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
142 NIK : 31710585810900002 MCG
ASAM FOLAT 0,25 MG
SUMI NARTI, NY (P) APT MOI LION GORDEN Z34.9 - Supervision of normal pregnancy,
unspecified
143 NIK : 3309166008820003
No. RM : 01-085290 BPJS : 0002320165124
JUNI EKA SARI TANJUNG NY (P) RAWA SENGON RT008/022KGB Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
pregnancy PIRIDOKSIN (VITAMIN B6) 10 MG
No. RM : 01-067041 BPJS : 0002612149525 MCG
SARI NOVI, NY (P) JL. RAWA SENGON BLOK H Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
145 NIK : - ASAM FOLAT 1 MG
2019-09-09 13:37 Hal. 39 dari 1322

P : 021-45853300 F : 021-45853301
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WIWIK SUSILOWATI, NY (P) JL PEGANGSAAN DUA RT 03/04 Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified
146 NIK : 3578074101900001
No. RM : 04-001064 BPJS : 0000787643763
SHERLI OKTAVIA (P) PERINTIS KEMERDEKAAN RT5 011/004 O82.9 - Delivery by caesarean section, KOMBINASI BESI (II) SULFAT 200 MG, (0116R029) Rumah Sakit
unspecified ASAM FOLAT 0,25 MG Hermina
(OBG) Podomoro
OBGYN - (19) obgyn - (0)
Tgl Lahir : 20-Jun-1988 ( 31 Thn 2 Bln 20 Hr ) O99.0 - Anaemia complicating pregnancy, KALSIUM LAKTAT (KALK) 500 MG
147 NIK : 3172036006880011 Telah Diberikan :
No. RM : 01-032249 BPJS : 0002213009638 childbirth and the puerperium SIANOKOBALAMIN (VITAMIN B12) 50 Faskes : (0116R029) Rumah
Tgl Diagnosis : 19 February 2019 2:33 PM MCG Sakit Hermina Podomoro
RUJUKAN Alamat : JL. DANAU AGUNG 2
RUJUKAN BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Cabang : JAKARTA UTARA
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 08:00 - 13:00,
18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
RETNO SETIA WARDIYANTI, NY (P) JL. P NANGKA BRT II 006/016 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
148 NIK : 3376026810870002
DIAN ELVIANI, NY (P) JL MLUR TUGU IV NO 0222 RT 05/09 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 24-Feb-1989 ( 30 Thn 6 Bln 16 Hr ) TIAMIN (VITAMIN B1) 50 MG
149 NIK : 3172036402890001
SEPTI SILANI (P) KP RAWA INDAH RT 02/03 O32.1 - Maternal care for breech
presentation
150 NIK : 3306075709930002
No. RM : 01-037928 BPJS : 0000544727586
2019-09-09 13:37 Hal. 40 dari 1322

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KARISA RATIH NATALIA.NY (P) KEALAP NIAS II PC.4/12A Z34.0 - Supervision of normal first
pregnancy
151 NIK : 6471045009930001
No. RM : 01-014181 BPJS : 0000121641208
ANGRIANA TAHUN, NY (P) JL RAWA SENGON BLOK B RT 02/22 O99.0 - Anaemia complicating pregnancy, KALSIUM LAKTAT (KALK) 500 MG
childbirth and the puerperium KOMBINASI BESI (II) SULFAT 200 MG,
152 NIK : 3172065507881002 ASAM FOLAT 0,25 MG
WIWIT WIJIYANTI, NY (P) JL. RAWA SENGON RT.002 RW.022 Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Lahir : 08-Mar-1995 ( 24 Thn 6 Bln 1 Hr ) SIANOKOBALAMIN (VITAMIN B12) 50
153 NIK : 1802194803940001
No. RM : 01-084010 BPJS : 0001292382628 MCG
MUTIAH, NY (P) JL BNAGUN CIPTA SARANA Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
154 NIK : 31720661711860005
NURUL MA'UNAH (P) JL PEJUANG V/26 RT 3/4 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
unspecified KALSIUM LAKTAT (KALK) 500 MG
No. RM : 01-027318 BPJS : 0002332923579 MCG
ASAM FOLAT 0,25 MG
ADE AMELIA OCTAVIA SIREGAR, NY (P) KOMPLEK PLN BLOK B/36 RT 005/014 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
156 NIK : 3172065910890002
ISNIWATI, NY (P) JL. KAYU MAS UTARA O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
157 NIK : -
2019-09-09 13:37 Hal. 41 dari 1322

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IIS APRIYANTI, NY (P) JL PERINTIS KEMERDEKAAN RT 11/4 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
158 NIK : 3172066604860007 MCG
No. RM : 01-048433 BPJS : 0002097450652 TIAMIN (VITAMIN B1) 50 MG
Tgl Diagnosis : 20 February 2019 2:28 PM PIRIDOKSIN (VITAMIN B6) 10 MG
YANTHI YUSVITA SARI, NY (P) GADING RAYA II NO 12 RT 01/05 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
159 NIK : 3175024701920005
ELGA CINTYA HAPSARI, NY (P) JL JANUR ELOK V QC 11 NO 9 Z34.0 - Supervision of normal first KALSIUM LAKTAT (KALK) 500 MG
pregnancy KOMBINASI BESI (II) SULFAT 200 MG,
160 NIK : 32172065607980001 ASAM FOLAT 0,25 MG
HERLINAH,NY (P) PEGANGSAAN DUA RT 01/04 Z34.9 - Supervision of normal pregnancy,

unspecified
161 NIK : 3172065604840002
No. RM : 01-024269 BPJS : 0000378889075
WANIARTI (P) KP PULO GADUNG O82.9 - Delivery by caesarean section,
unspecified
162 NIK : 3328085407840004
No. RM : 05-002340 BPJS : 0002424368799
ROHIMAH ,NY (P) JL. TUGU SELATAN 002/007 Z34.0 - Supervision of normal first
pregnancy
163 NIK : 3202085012840002
No. RM : 01-073395 BPJS : 0001639075342
2019-09-09 13:37 Hal. 42 dari 1322

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IRAH, NY (P) JL TANAH MERAH RT 001/007 Z34.9 - Supervision of normal pregnancy,
unspecified
164 NIK : 3276075412860000
No. RM : 01-037368 BPJS : 0001631361036
IDA FITRIYANY, NY (P) JL. RAWA SENGON BLOK G RT. Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
07/022 KELAPA GADING BARAT KEC. pregnancy MCG
Tgl Lahir : 04-Feb-1998 ( 21 Thn 7 Bln 5 Hr ) KALSIUM LAKTAT (KALK) 500 MG
165 KELAPA GADING
No. RM : 01-078335 KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Diagnosis : 21 February 2019 2:18 PM NIK : 3172064402981002 ASAM FOLAT 0,25 MG
ERNES TINA TINCE, NY (P) JL RAWA SENGON BLOK A RT 01/022 Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
166 NIK : 5310036512890127
CICA FITRIYANI (P) PULO NANGKA Z34.9 - Supervision of normal pregnancy,

unspecified
167 NIK : 1605185010920006
No. RM : 01-010382 BPJS : 0002449477787
SITI FATIMAH ZAHRO, NY (P) GADING MAS RAYA BLOK A8 NO. 11 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
168 NIK : 3209316801960001 ASAM FOLAT 0,25 MG
Tgl Diagnosis : 22 February 2019 9:36 AM RETRIBUSI KLINIK KIA
SRI KURNIASIH (P) KLP GADING TIMUR RT 003/04 Z30.0 - General counselling and advice on PARASETAMOL TAB 500 MG
contraception
169 NIK : -
No. RM : 01-075734 BPJS : 0002066554811
ITA WARDIANTI (P) BOULEVARD TIMUR RAYA BLOK NB Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
1/55 unspecified ASAM FOLAT 0,25 MG
170
No. RM : 01-081845 NIK : 3213244403830001 RETRIBUSI KLINIK KIA
2019-09-09 13:37 Hal. 43 dari 1322

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KASTOYAH, NY (P) TANAH MERAH NO. 7 Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
171 NIK : 3321084507870002 ASAM FOLAT 0,25 MG
YEYEN NURAENI (P) JL. RAYA CENTEX GG. FIRMAN O14.9 - Pre-eclampsia, unspecified KALSIUM LAKTAT (KALK) 500 MG
Z34.0 - Supervision of normal first KOMBINASI BESI (II) SULFAT 200 MG,
172 NIK : 3172066908940004 pregnancy ASAM FOLAT 0,25 MG
No. RM : 01-088252 BPJS : 0002332738686 RETRIBUSI KLINIK KIA
RIBKA, NY (P) SABA DUSUN TATA SAMA Z34.9 - Supervision of normal pregnancy,
unspecified
173 NIK : 6108135106980003
No. RM : 01-084701 BPJS : 0000875911162
TIA HETIATI, NY (P) JL.PUSKESMAS N0 10 RT 006/06 KLP Z34.9 - Supervision of normal pregnancy,
GGADING TIMUR unspecified
174
No. RM : 01-076298 NIK : -
RISTIYANTI, NY (P) H.OYAR 01/02 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 25-May-1992 ( 27 Thn 3 Bln 15 Hr ) KOMBINASI BESI (II) SULFAT 200 MG,
175 NIK : 3172066505920003
ANA ROYANI, NY (P) JL PEGANGSAAN DUA RT 06/02 Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
pregnancy
176 NIK : 31720641099310010
No. RM : 01-027869 BPJS : 0002098049051
UNTARI, NY (P) RAWA SENGON RT 03/22 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
Tgl Lahir : 22-Jul-1982 ( 37 Thn 1 Bln 18 Hr ) KALSIUM LAKTAT (KALK) 500 MG
177 NIK : 3172066207820004
2019-09-09 13:37 Hal. 44 dari 1322

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SUMIYATI NY (P) PGS DUA RT 6/5 Z34.9 - Supervision of normal pregnancy,
unspecified
178 NIK : 3172064505851002
No. RM : 05-002064 BPJS : 0001773695013
SULASTRI, NY (P) PULAU NANGKA BARAT 2/2 Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified
179 NIK : 3203175007960019
No. RM : 01-022286 BPJS : 0000401733101
AMALIA HUMAEROH, NY (P) KP. PURWODADI TIMUR Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
180 NIK : 3602034909900004 MCG
SITI ROHANI, NY (P) TANAH MERAH ATAS JL DUKA RT Z34.9 - Supervision of normal pregnancy,
06/08 unspecified
181
No. RM : 01-001175 NIK : 3172036803860004
VERAWATI (P) JL LOMBOK BLOK A 7 NO 15 Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
SUKAPURA pregnancy MCG
182
No. RM : 01-070352 NIK : 1671064202870019
MARIAH, NY (P) TANAH MERAH 07/07 Z34.9 - Supervision of normal pregnancy,

unspecified
183 NIK : 3172064703790006
No. RM : 01-042539 BPJS : 0001794085716
SITI AISYAH, NY (P) SUNTER JAYA RT 17/06 Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
184 NIK : 320202600489003 MCG
No. RM : 01-021857 BPJS : 0001733262748
2019-09-09 13:37 Hal. 45 dari 1322

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YANI ZAENAH, NY (P) KELAPA PUYUH V BLOK KG NO 8 Z34.9 - Supervision of normal pregnancy, PIRIDOKSIN (VITAMIN B6) 10 MG
185 NIK : 3304065902890004 MCG
TUWIATI, NY (P) TIPAR AKUNG RT 04/04 Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
186 NIK : 3305214805960002 MCG
FITRIAS TUTI (P) JL. INSPEKSI KALI SUNTER NO. 09 Z34.0 - Supervision of normal first RETRIBUSI KLINIK KIA
pregnancy
187 NIK : 3173065003940003
No. RM : 01-088471 BPJS : 0001293415773
MIA MELINDA (P) KP WARUNG JENGKOL NO. 108 Z34.9 - Supervision of normal pregnancy,
unspecified
188 NIK : 3172066305960003
No. RM : 05-001896 BPJS : 0001226220254
CASYATI (P) JL. TIPAR SELATAN 12 NO. 7 Z34.0 - Supervision of normal first KALSIUM LAKTAT (KALK) 500 MG
No. RM : 01-088481 BPJS : 0002434579108 MCG
YUNI LESTIYANI, NY (P) KP RAWA INDAH RT 007/003 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
190 NIK : 3172064406890001
KAREN LUWINDA RAHARDJA, NY (P) JL CIPINANG INDAH II RT 14/03 O82.9 - Delivery by caesarean section,
unspecified
191 NIK : 317507660680009
No. RM : 01-055808 BPJS : 0001658139669
2019-09-09 13:37 Hal. 46 dari 1322

P : 021-45853300 F : 021-45853301
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KURNIASIH, NY (P) JL. TIPAR SELATAN 12 Z34.9 - Supervision of normal pregnancy,
unspecified
192 NIK : 3327135711910002
No. RM : 01-085032 BPJS : 0000622987053
TATAP SEREPINA O, NY (P) JL PATIMURA NO 11 RT 06/03 Z12.4 - Special screening examination for
neoplasm of cervix
193 NIK : 317505691260009
No. RM : 01-015694 BPJS : 0001224745885
SAWATI (P) JL. PEGANGSAN DUA Z34.9 - Supervision of normal pregnancy,
unspecified
194 NIK : 3526185209620002
No. RM : 01-088496 BPJS : 0002332704183
RUSTI AGUSTINA, NY (P) RAWA SENGON 01/22 Z39.2 - Routine postpartum follow-up

195 NIK : 3327084503900061
No. RM : 01-077736 BPJS : 0001469094827
SUEMI NOPITASARI, NY (P) JL PEJUANG II RT 2 RW 4 O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Lahir : 06-Jun-1993 ( 26 Thn 3 Bln 3 Hr ) KALSIUM LAKTAT (KALK) 500 MG
196 NIK : 3328184606930004
MINKHATUL KHAJJAH, NY (P) PULO JAHE RT 012/012 JATINEGARA Z34.0 - Supervision of normal first SIANOKOBALAMIN (VITAMIN B12) 50
JAKARTA TIMUR pregnancy MCG
197
FATONA IRVANA NY (P) JL KESADARAN NO 3 Z34.9 - Supervision of normal pregnancy,
unspecified
198 NIK : 3171036107840001
No. RM : 01-040187 BPJS : 0001225739856
2019-09-09 13:37 Hal. 47 dari 1322

P : 021-45853300 F : 021-45853301
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NIKEN SETIANINGSIH, NY (P) JL. PERINTIS KEMERDEKAAN 005/004 Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
199 NIK : 3172067009941002 MCG
SRI ANINGSIH, NY (P) JL DAHLIA 1 NO 15 RT 005/003 Z34.9 - Supervision of normal pregnancy, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
200 NIK : 320902670192000
BELLA ARIYANTI, NY (P) JL. SWASEMBADA BARAT XIX NO. 40 Z34.9 - Supervision of normal pregnancy, TIAMIN (VITAMIN B1) 50 MG
201 NIK : - SIANOKOBALAMIN (VITAMIN B12) 50
No. RM : 01-088708 BPJS : 0002239012978 MCG
Tgl Diagnosis : 27 February 2019 11:21 AM ASAM FOLAT 1 MG
DEWI TRI HANDAYANI, NY (P) JL. HARAPAN II NO. 9 O98.8 - Other maternal infectious and RETRIBUSI KLINIK KIA
parasitic diseases complicating pregnancy,
Tgl Lahir : 10-Feb-1982 ( 37 Thn 6 Bln 30 Hr ) childbirth and the puerperium
202 NIK : 317206500282002
No. RM : 01-087432 BPJS : 0002332694496
WASIYANTI, NY (P) KELAA HIBRIDA VI RT 06/015 PGSN II Z34.9 - Supervision of normal pregnancy, RETRIBUSI KLINIK KIA
unspecified
203 NIK : 3175065904810016
No. RM : 01-074004 BPJS : 0001743085541
DARMIYAH ACHMAD (P) INPEKSI KALI SUNTER RT 02/04 KGB Z34.9 - Supervision of normal pregnancy,
unspecified
204 NIK : 3172064911860001
No. RM : 01-074942 BPJS : 0001717204408
Poli Nifas
2019-09-09 13:37 Hal. 48 dari 1322

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CHICHIEK SRIE MUNTARSIH (P) JL PGS II NO 22 Z30.9 - Contraceptive management,
unspecified
Tgl Lahir : 04-Mar-1985 ( 34 Thn 6 Bln 5 Hr ) Z39.2 - Routine postpartum follow-up
1 NIK : 3172064403850001
No. RM : 01-082875 BPJS : 0001653476354 Z39.2 - Routine postpartum follow-up
NUR KHALIFATUS SYADIAH, NY (P) KP PULO GADUNG RT 02/05 Z39.2 - Routine postpartum follow-up KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
2 NIK : 3172065801940002
No. RM : 01-021420 BPJS : 0000377697497
KEISHA ZAHRA ANISSA (L) JL. TNH MERAH Z38.0 - Singleton, born in hospital

3 NIK : 3172032410180035
No. RM : 01-086668 BPJS : 0002619334517
NOVI LUKITA (P) JL PGS II Z39.2 - Routine postpartum follow-up KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
4 NIK : 3172064410930001
No. RM : 01-081984 BPJS : 0001225822511
FILLIO FARZANA FIRDAUS (L) PGS II NO 63 Z38.0 - Singleton, born in hospital

5 NIK : 3172060501190002
No. RM : 01-084542 BPJS : 0002614395903
SOPIAH (P) PGS RT006/005 Z39.2 - Routine postpartum follow-up

6 NIK : 3317105208860003
No. RM : 01-080758 BPJS : 0002099674844
CHICHIEK SRIE MUNTARSIH (P) JL PGS II NO 22 Z39.2 - Routine postpartum follow-up

7 NIK : 3172064403850001
No. RM : 01-082875 BPJS : 0001653476354
2019-09-09 13:37 Hal. 49 dari 1322

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ROSIANA (P) RW SENGON BLOK E NO 21 Z39.2 - Routine postpartum follow-up

8 NIK : 3175025703000005
No. RM : 01-079616 BPJS : 0001282253139
MILA ALKARIMAH, NY (P) PGS DUA RT 2/5 Z39.2 - Routine postpartum follow-up

9 NIK : 3172066702940001
No. RM : 05-002076 BPJS : 0000377910562
FARZANA AIYRA SHEZA, BY (P) PGS DUA RT 2/5 P59.9 - Neonatal jaundice, unspecified
Z36.9 - Antenatal screening, unspecified
10 NIK : -
No. RM : 01-087221 BPJS : 0002744994813
EKA SETIANA (P) KELAPA GADING TIMUR RT 03/04 Z39.2 - Routine postpartum follow-up

11 NIK : 3172066611910001
No. RM : 01-008476 BPJS : 0001225412864
SALAMAH, NY (P) JL. PULO NANGKA BARAT II Z39.2 - Routine postpartum follow-up

12 NIK : 3175024708900001
No. RM : 01-080094 BPJS : 0001139577309
APRILIA LANJAR SITI SURYANI (P) JL PASAR INPRES RT 006/006 NO 60 Z39.2 - Routine postpartum follow-up

13 NIK : 3172064106890004
No. RM : 02-004176 BPJS : 0001617935106
SOPIAH (P) PGS RT006/005 Z39.2 - Routine postpartum follow-up

14 NIK : 3317105208860003
No. RM : 01-080758 BPJS : 0002099674844
2019-09-09 13:37 Hal. 50 dari 1322

P : 021-45853300 F : 021-45853301
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DHIANA ISABELLA, BY (P) JL. KOMPI UDIN Z38.0 - Singleton, born in hospital

15 NIK : 330216278140012
No. RM : 01-087555 BPJS : 0002742060554
FELISITA ILONA NATHANIELA AMARISA, BY JL. GADING SENGON V BLOK E NO. 17 Z38.3 - Twin, born in hospital

16 NIK : -
No. RM : 01-087578 BPJS : 0002744953413
SUPRIYATIN, NY (P) VILLA GADING INDAH M/14 Z39.2 - Routine postpartum follow-up

17 NIK : 3314026810780001
No. RM : 01-048514 BPJS : 0001635749774
DEVI MARDIA (P) JL HJ OYAR RT 01/02 Z39.2 - Routine postpartum follow-up KALSIUM LAKTAT (KALK) 500 MG
SIANOKOBALAMIN (VITAMIN B12) 50
18 NIK : 3175024802920001 MCG
MAHREEN ATAYA AN HAKIM (P) JL. H. OYAR Z38.0 - Singleton, born in hospital

19 NIK : -
No. RM : 01-087643 BPJS : 0002886006238
SANTI NURCAHYANI, NY (P) JL H OYAR RT 004/002 Z39.2 - Routine postpartum follow-up

20 NIK : 3201125811920004
No. RM : 01-015780 BPJS : 0001737320466
SONYA DEVI MAHARANI, NY (P) APT GADING NIAS TW DAHLIA LT 8 Z39.2 - Routine postpartum follow-up

21 NIK : 3172065109011002
No. RM : 01-071669 BPJS : 0002518266519
2019-09-09 13:37 Hal. 51 dari 1322

P : 021-45853300 F : 021-45853301
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MILA ALKARIMAH, NY (P) PGS DUA RT 2/5 Z38.0 - Singleton, born in hospital

22 NIK : 3172066702940001
No. RM : 05-002076 BPJS : 0000377910562
APRILIA LANJAR SITI SURYANI (P) JL PASAR INPRES RT 006/006 NO 60 Z39.2 - Routine postpartum follow-up

23 NIK : 3172064106890004
No. RM : 02-004176 BPJS : 0001617935106
KAYLA RIZNITAMA AZZAHRA, BY (P) JL DEMAK BLOK M5/24 SUKAPURA Z38.0 - Singleton, born in hospital
Z38.0 - Singleton, born in hospital
24 NIK : 3172045602190004
No. RM : 01-087714 BPJS : 0002749553976
KUNI, NY (P) JL DEMAK BLOK M5/24 SUKAPURA Z39.2 - Routine postpartum follow-up

25 NIK : 329226005910003
No. RM : 01-079106 BPJS : 0002743163649
SULIKAH (P) RAWA SENGON BLOK F NO.21 06/022 Z39.2 - Routine postpartum follow-up

26 NIK : 332217520285000
No. RM : 01-036493 BPJS : 0001857134632
APRILIA ANJATRI, NY (P) JL PULAU PENYENGAT II NO 7 7/3 Z39.2 - Routine postpartum follow-up

27 NIK : 3404026504880001
No. RM : 01-022573 BPJS : 0002095925859
SHIFA SILVANA, NY (P) JL. RAWA SENGON BLOK B NO. 115 Z30.1 - Insertion of (intrauterine)
28 NIK : 3175065211970010
No. RM : 01-085501 BPJS : 0002341754447
2019-09-09 13:37 Hal. 52 dari 1322

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KUNI, NY (P) JL DEMAK BLOK M5/24 SUKAPURA Z39.2 - Routine postpartum follow-up

29 NIK : 329226005910003
No. RM : 01-079106 BPJS : 0002743163649
SINTA YANUARTI DEWI, NY (P) JL.MAHONI BLOK GG.IV/6 Z39.2 - Routine postpartum follow-up

30 NIK : 3172035301890005
No. RM : 01-063465 BPJS : 0001622412202
ALMIRA DELISHA (P) JL. SARANG BANGO NO.27A Z38.0 - Singleton, born in hospital

31 NIK : -
No. RM : 01-088454 BPJS : 0002510160658
RETNO SETIA WARDIYANTI, NY (P) JL. P NANGKA BRT II 006/016 Z39.2 - Routine postpartum follow-up

32 NIK : 3376026810870002
No. RM : 01-053285 BPJS : 0001335924865
KAYLA RIZNITAMA AZZAHRA, BY (P) JL DEMAK BLOK M5/24 SUKAPURA Z38.0 - Singleton, born in hospital

33 NIK : 3172045602190004
No. RM : 01-087714 BPJS : 0002749553976
FADHIL EZHAR FARID, BY (L) JL P KEMERDEKAAN, PULO NANGKA Z38.0 - Singleton, born in hospital
BARAT
34
No. RM : 01-088010 NIK : -
SITI AISAH (P) P.NANGKA BARAT 01/16 Z39.2 - Routine postpartum follow-up

35 NIK : 3209386704880001
No. RM : 01-072731 BPJS : 0002066245301
2019-09-09 13:37 Hal. 53 dari 1322

P : 021-45853300 F : 021-45853301
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SANTI NURCAHYANI, NY (P) JL H OYAR RT 004/002 Z39.2 - Routine postpartum follow-up

36 NIK : 3201125811920004
No. RM : 01-015780 BPJS : 0001737320466
MAHREEN ATAYA AN HAKIM (P) JL. H. OYAR Z38.0 - Singleton, born in hospital

37 NIK : -
No. RM : 01-087643 BPJS : 0002886006238
ROSIANA (P) RW SENGON BLOK E NO 21 Z39.2 - Routine postpartum follow-up

38 NIK : 3175025703000005
No. RM : 01-079616 BPJS : 0001282253139
AYU EKATNITI, NY (P) BOULEVARD HIJAU I 5 NO 9 BEKASI Z39.2 - Routine postpartum follow-up
UTARA
39
No. RM : 01-058820 NIK : 6213026705910001
NOVIA DEWI SUCININGATI, NN (P) JL H OYAR NO 120 Z39.2 - Routine postpartum follow-up

40 NIK : 3171036911940001
No. RM : 01-082336 BPJS : 0000371933943
HAIDAR NOFRIANDI AZWAR, (L) JL. H OYAR NO.12 Z38.0 - Singleton, born in hospital

41 NIK : 3172061211180010
No. RM : 01-088598 BPJS : 0002746406946
SONYA DEVI MAHARANI, NY (P) APT GADING NIAS TW DAHLIA LT 8 Z39.2 - Routine postpartum follow-up

42 NIK : 3172065109011002
No. RM : 01-071669 BPJS : 0002518266519
2019-09-09 13:37 Hal. 54 dari 1322

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WAHYUNI, NY (P) TANAH MERAH 04/08 RAWA BADAK Z39.2 - Routine postpartum follow-up
SELATAN
43
No. RM : 01-048416 NIK : 3171085302880005
dr. Anita Ratna Ningrum

IVONNE ROSLINA KUSOY (P) TAMAN PEGANGSAAN INDAH BLOK J K04.0 - Pulpitis AMOKSISILIN 500 MG
8 ASAM MEFENAMAT KAPS 500
1 DEKSAMETASON 0,5 MG
No. RM : 01-024567 NIK : 317205509870002
SRI MULASIH, NY (P) PERINTIS KEMERDEKAAN RT 5/4 I10 - Essential (primary) hypertension PIROKSIKAM 10 MG
M54.57 - Low back pain, lumbosacral region DEKSAMETASON 0,5 MG
No. RM : 01-027124 BPJS : 0001476001877 MCG
Tgl Diagnosis : 01 February 2019 4:43 PM TIAMIN (VITAMIN B1) 50 MG
AMLODIPIN 10 MG
KAPTOPRIL 25 MG
SAKIRA CLARIS ADELIN, AN (P) KOMP BEACUKAI 006/007 SUKAPURA J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
KLORFENIRAMIN MALEAT (CTM) TAB 4
3 NIK : 3172046004121005 MG
No. RM : 01-006120 BPJS : 0001468115324 DEKSAMETASON 0,5 MG
Tgl Diagnosis : 01 February 2019 4:50 PM AMBROKSOL TAB 30 MG
RIZKA NUR FAZRI, NN (P) P. NANGKA RT 09/016 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
4 NIK : 3175025601971001 KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-011554 BPJS : 0001853760532 MG
NINA SUNJAYA, NY (P) JL ALUR LAUT BLK MMNO.38 006/007 J02.9 - Acute pharyngitis, unspecified ANTASIDA DOEN
PARASETAMOL TAB 500 MG
5 NIK : 3172034511610005
No. RM : 01-035455 BPJS : 0001438339522
2019-09-09 13:37 Hal. 55 dari 1322

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KINANTI ANDIFA GINANDARI, AN (L) JL TEGUH 1 NO 7 RT 5/1 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
6 NIK : - MG
No. RM : 01-062134 BPJS : 0002319311597 PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
BETAMETASON KRIM 0,5MG/G
ADILA NISA ARDANI, BY (P) JL KOMPI UDIN J18.0 - Bronchopneumonia, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN SYR KERING 125 MG/5ML
7 NIK : - PARASETAMOL DROP 60 MG/0,6 ML
No. RM : 05-001949 BPJS : 0002490442929 KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Diagnosis : 01 February 2019 5:32 PM MG
DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
MURNIATI, NY (P) JL PERINTIS KEMERDEKAAN H81.1 - Benign paroxysmal vertigo PIROKSIKAM 10 MG
8 NIK : 3172064203880003 MCG
Tgl Diagnosis : 01 February 2019 6:01 PM ANTASIDA DOEN
RETRIBUSI LAYANAN SIAGA 24 JAM
SETIAWAN ATMAJA, TN (L) PGSN DUA PONDOK GADING I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4
L30.9 - Dermatitis, unspecified MG
Tgl Lahir : 21-Jan-1960 ( 59 Thn 7 Bln 19 Hr ) DEKSAMETASON 0,5 MG
9 NIK : 3172062101600002
No. RM : 01-071343 BPJS : 000234589631 BETAMETASON KRIM 0,5MG/G
Tgl Diagnosis : 01 February 2019 6:04 PM AMLODIPIN 10 MG
FAIIZ RIFAI AVIQURROHMAN, AN (L) TANAH MERAH RT 6/7 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-036806 BPJS : 0002102726891 MG
HENDRA, TN (L) JL. JANUR ELOK LB 06 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
No. RM : 01-075323 BPJS : 0002316129895 MG
Tgl Diagnosis : 01 February 2019 6:13 PM AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 56 dari 1322

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DRS RUSTAM, TN (L) JL SUNTER II/24 RT 008/014 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
12 NIK : 3172031802370001 MG
No. RM : 01-009186 BPJS : 0001326652042 AMBROKSOL TAB 30 MG
ANGGUN AVERA ANINDITA, AN (P) JL TEKUN NO 33 RT 02/03 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-013417 BPJS : 0001825441209 MG
Tgl Diagnosis : 01 February 2019 7:38 PM DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
Pifri Nur Handayani (P) JL RAYA PEGANGSAAN DUA RT 02/06 O91.2 - Nonpurulent mastitis associated with PARASETAMOL TAB 500 MG
childbirth AMOKSISILIN 500 MG
14 NIK : 3172065701030003 GENTAMISIN SALEP KULIT
No. RM : 01-070309 BPJS : 0001223487696 RETRIBUSI LAYANAN SIAGA 24 JAM
JIANG LIANTI IZARI (P) JL PGS II NO.35 RT 05/05 J02.9 - Acute pharyngitis, unspecified KOTRIMOKSAZOL DOEN I (DEWASA)
N39.0 - Urinary tract infection, site not (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 05-Apr-2003 ( 16 Thn 5 Bln 4 Hr ) TRIMETOPRIM 80 MG)
15 NIK : 3172062104111025 specified
No. RM : 01-012652 BPJS : 0001226041514 ASAM MEFENAMAT KAPS 500
Tgl Diagnosis : 01 February 2019 7:48 PM KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
FUZIATI ,NY (P) JL PGS II RT 005/005 R51 - Headache ASAM MEFENAMAT KAPS 500
16 NIK : 3172066403770003 MCG
No. RM : 01-046838 BPJS : 0001226041391
RAYHAN RABBANI ALAM, AN (L) PEGANGSAAN DUA 03/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
17 NIK : 3172060804170001 DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 57 dari 1322

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NATASYA RIZKY ALAM, AN (P) PGS II RT 003/002 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
18 NIK : - MG
SRI MARINTEN, NY (P) JL. INSPEKSI KALI SUNTER 003/004 I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
KLP GADING BARAT R60.0 - Localized oedema DEKSAMETASON 0,5 MG
19 SIANOKOBALAMIN (VITAMIN B12) 50
No. RM : 01-066307 NIK : - MCG
Tgl Diagnosis : 01 February 2019 7:56 PM BPJS : 0000378280192 AMLODIPIN 5 MG
KAPTOPRIL 12,5 MG
NABILA RAHMADANI BR SEMBIRING, AN (P) TANAH MERAH J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
20 NIK : - MG
SHIVA MAHARANI, NN (P) JL GAMELAN BLOK A/6 RT 002/007 N39.3 - Stress incontinence KOTRIMOKSAZOL DOEN I (DEWASA)
(SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 17-Dec-1995 ( 23 Thn 8 Bln 23 Hr ) TRIMETOPRIM 80 MG)
21 NIK : 3172065712950002
DHIKA IBNU RAMA FADILAH (L) JL PULO GADUNG 002/005 A09 - Diarrhoea and gastroenteritis of GARAM ORALIT KOMBINASI
presumed infectious origin KLORFENIRAMIN MALEAT (CTM) TAB 4
22 NIK : 3172062806151002 MG
ARIO DELI PRATAMA (L) RUKAN ARTHA GADING BLOK A NO 8- J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
9 PARASETAMOL TAB 500 MG
No. RM : 01-070457 NIK : 1673080911970005 KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Diagnosis : 01 February 2019 8:21 PM BPJS : 0000327157031 MG
2019-09-09 13:37 Hal. 58 dari 1322

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M TOYIB, TN (L) JL INSPEKSI KALI SUNTER RT 09/13 I50.9 - Heart failure, unspecified FUROSEMID 40 MG
KAPTOPRIL 12,5 MG
24 NIK : 3172060807670001 DIGOKSIN 0,25 MG
No. RM : 01-065526 BPJS : 0000377243649
ISHAK ,TN (L) JL PERINTIS KEMERDEKAAN RT I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
005/004 J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
25 AMBROKSOL TAB 30 MG
No. RM : 01-074691 NIK : 3172061208560004 AMLODIPIN 10 MG
UNTUNG SUDARSONO (L) KELAPA HYBRIDA VII RA.21/5 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
presumed infectious origin (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 17-Aug-1956 ( 63 Thn 0 Bln 23 Hr ) TRIMETOPRIM 80 MG)
26 NIK : 3172061002
No. RM : 01-065248 BPJS : 0000038264905 KOMBINASI KAOLIN 550 MG, PEKTIN 20
MG TAB
RANITIDIN 150 MG
HENDRYANA SUDARSONO, TN (L) KELAPA HIBRIDA VII RA 2/05 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
presumed infectious origin MG TAB
Tgl Lahir : 08-Dec-1984 ( 34 Thn 9 Bln 1 Hr ) KOTRIMOKSAZOL DOEN I (DEWASA)
27 NIK : 3172060812840001
No. RM : 01-006006 BPJS : 0001265967189 (SULFAMETOKSAZOL 400 MG +
TRIMETOPRIM 80 MG)
RANITIDIN 150 MG
ANTASIDA DOEN
SRI TUTI HENDRASWATI, NY (P) JL KELAPA HIBRIDA VII RA 21/5 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Lahir : 25-Oct-1960 ( 58 Thn 10 Bln 15 Hr ) TRIMETOPRIM 80 MG)
28 NIK : 3172066510600001
Tgl Diagnosis : 01 February 2019 8:33 PM KOMBINASI KAOLIN 550 MG, PEKTIN 20
MG TAB
RANITIDIN 150 MG
AMBROKSOL TAB 30 MG
AMLODIPIN 5 MG
2019-09-09 13:37 Hal. 59 dari 1322

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MUSTOFA (L) JL.KEPU 04/01 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
29 NIK : 3325112308910002 AMBROKSOL TAB 30 MG
DEWI (P) JL RW SENGON BLOK G K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
30 NIK : 3172035608830012
No. RM : 01-083836 BPJS : 0001225382286
PARJINI, NY (P) JL SENTOSA BARAT NO 4 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
31 NIK : 3172065804771001
No. RM : 01-028234 BPJS : 0001225665178
AMBRUSIO TUNGGA DINATA (L) JL PULOA PENYENGAT II NO 50 L01.0 - Impetigo [any organism] [any site] AMOKSISILIN KAPS 250 MG
GENTAMISIN SALEP KULIT
32 NIK : 3172062405080003 PARASETAMOL TAB 500 MG
MG
WAWAN HADI SAPUTRA (L) MALL ARTHA GADING BASEMENT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-023274 BPJS : 0002063900103 MG
SAMIATI ,NY (P) JL. RAWA INDAH RT 04/03 I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
34 NIK : 3172066612750005 MCG
No. RM : 01-040551 BPJS : 0002098687904 AMLODIPIN 5 MG
MARCHELLA AGATHA, AN (P) KELAPA CENGKIR BARAT III FJ 1 NO J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
16 KLORFENIRAMIN MALEAT (CTM) TAB 4
35 MG
No. RM : 01-037912 NIK : 3175074203151009 DEKSAMETASON 0,5 MG
Tgl Diagnosis : 01 February 2019 9:08 PM BPJS : 0002092633942 AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 60 dari 1322

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AMOKSISILIN KAPS 250 MG
SUYITNO , TN (L) PGS2 RT005/02 L30.8 - Other specified dermatitis KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 06-Apr-1980 ( 39 Thn 5 Bln 3 Hr ) DEKSAMETASON 0,5 MG
36 NIK : 3172060604800005
VANI ARDILA RISKY, NY (P) PS INPRES RT007/6 KGT I10 - Essential (primary) hypertension AMLODIPIN 10 MG
PIROKSIKAM 10 MG
No. RM : 01-075931 BPJS : 0001629705791 MCG
Tgl Diagnosis : 01 February 2019 9:12 PM RETRIBUSI LAYANAN SIAGA 24 JAM
UNAFA APRILIA, AN (P) KMP SUKAPURA JAYA 001/010 K30 - Dyspepsia PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
38 NIK : 3172045904101008 ANTASIDA DOEN
No. RM : 01-007392 BPJS : 0000378246971
IDA FARIDA, NY (P) KP.SUKAPURA 04/04 J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
No. RM : 01-006299 BPJS : 0001623572785 AMOKSISILIN 500 MG
MG
LUKMAN NG, TN (L) JL.BELLYRA II BLOK M\2 RT 06\08 I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
PGS2 J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
No. RM : 01-066521 NIK : 3172060710570001 ASAM MEFENAMAT KAPS 500
AMLODIPIN 5 MG
ABYAN PRASETYA, AN (L) TANAH MERAH 11/07 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
41 NIK : 3171031507121002 MG
2019-09-09 13:37 Hal. 61 dari 1322

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PARASETAMOL SYR 120 MG/5 ML
KHAYRUL FURQON (L) JL RAWA INDAH RT 004/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
42 NIK : 317206140160004 MG
AYU WIDYANINGRUM, NN (P) JL GADING IV NO.6 KOMP KODAMAR T23.1 - Burn of first degree of wrist and hand AMOKSISILIN 500 MG
03/05NO.6 DEKSAMETASON 0,5 MG
No. RM : 01-024822 NIK : 3172066305960001
LEMBANG PUJI LESTARI, NY (P) GADING MAS TIMU III RT012/10 T78.4 - Allergy, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 19-Feb-1986 ( 33 Thn 6 Bln 21 Hr ) DEKSAMETASON 0,5 MG
44 NIK : 3216025902860009
CHANDRA,TN (L) JL BCS RT 5/6 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
45 NIK : 3172060107750004 MG
DEBORA DWI RUJIANTI, NY (P) TNH MERAH JL PERJUANGAN KOJA I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
No. RM : 01-005923 BPJS : 0001830336974 MG
Tgl Diagnosis : 01 February 2019 10:00 PM PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 62 dari 1322

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MAYANG NOVEM PROSKUNEO HABAKUK, JL. PERJUANGAN GG BERKAH TANAH J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
MERAH DEKSAMETASON 0,5 MG
No. RM : 01-085649 NIK : - MG
Tgl Diagnosis : 01 February 2019 10:03 PM BPJS : 0002089220354 AMBROKSOL TAB 30 MG
SUDIRO, TN (L) JL. PERJUANGAN TANAH MERAH I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
J02.9 - Acute pharyngitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
48 NIK : - MG
AMOKSISILIN 500 MG
AMLODIPIN 5 MG
KOMBINASI KAOLIN 550 MG, PEKTIN 20
MG TAB
GENDIS JUNAY PROSKUNEO YEMIMA, AN (P) JL. PERJUANGAN TANAH MERAH J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-086387 BPJS : 0001835145134 MG
SUPRIYANI ,NY (P) PGS DUA RT 05/02 NO 15A J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
50 NIK : 3316145506830003 MG
NURROHMAH, NN (P) JL H OYAR RT 01/02 T78.4 - Allergy, unspecified BEDAK SALISIL 2 %

51 NIK : 3172064510000002 MG
SOPIAH (P) KALI SUNTER 10/04 L03.9 - Cellulitis, unspecified ASAM MEFENAMAT KAPS 500
AMOKSISILIN 500 MG
No. RM : 01-039765 BPJS : 0001154522103
2019-09-09 13:37 Hal. 63 dari 1322

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JUMYATI,NY (P) JL. RAWA INDAH 001/003 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
53 NIK : 3172064205760007 AMLODIPIN 5 MG
ABDUL AZIZ, AN (L) KP RAWA INDAH RT 001/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
54 NIK : 3172062812070002 AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
KINANTI KYLE, AN (P) P.KEMERDEKAAN 02/05 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
55 NIK : 3309195403170001 MG
MARKUS (L) JL SUMANGGUNG 1 A4 NO 16 A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
presumed infectious origin KOTRIMOKSAZOL DOEN I (DEWASA)
56 NIK : - (SULFAMETOKSAZOL 400 MG +
No. RM : 02-005498 BPJS : 0002139423906 TRIMETOPRIM 80 MG)
Tgl Diagnosis : 01 February 2019 10:34 PM RANITIDIN 150 MG
ANTASIDA DOEN
KRIS YULIAN, TN (L) GG SALON SUKAPURA A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 19-Mar-1983 ( 36 Thn 5 Bln 21 Hr ) ANTASIDA DOEN
57 NIK : 3172041903830013
No. RM : 01-014478 BPJS : 0001740739239
SITI FAHRANI, AN (P) GG SALON RT 02/03 J02.9 - Acute pharyngitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 07-Aug-2012 ( 7 Thn 1 Bln 2 Hr ) DEKSAMETASON 0,5 MG
58 NIK : 3172044807121010
2019-09-09 13:37 Hal. 64 dari 1322

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FAJAR SUBKHI, AN (L) GG SALON SUKAPURA J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-014477 BPJS : 0001740739252 MG
AMBROKSOL TAB 30 MG
MUHAMMAD EDUAR RAMADHAN, TN (L) JL RAYA PGS II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-086389 BPJS : 0002332751883
SLAMET BADRUDIN, TN (L) KELAPA NIAS IV PB.8/3 Z03.0 - Observation for suspected AMOKSISILIN 500 MG
tuberculosis PARASETAMOL TAB 500 MG
No. RM : 01-025768 BPJS : 0001326541588
M IQBAL RAMADHAN, AN (L) KP SUKAPURA RT 04/10 J02.9 - Acute pharyngitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 18-Jun-2014 ( 5 Thn 2 Bln 22 Hr ) DEKSAMETASON 0,5 MG
62 NIK : 3172041806141007
NOVA RIYANTI, NY (P) JL KP RAWA INDAH RT 02/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
63 NIK : 3172065110840005 MG
ANIS SANTIKA (P) DUSUN CIPUTAT N39.0 - Urinary tract infection, site not RETRIBUSI LAYANAN SIAGA 24 JAM
specified KOTRIMOKSAZOL DOEN I (DEWASA)
64 NIK : 3208045409990001 (SULFAMETOKSAZOL 400 MG +
Tgl Diagnosis : 01 February 2019 10:54 PM ASAM MEFENAMAT KAPS 500
HARRY SAPUTRA, TN (L) JLN . HIBRIDA 7 RB 14/5/ PGSN 2 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
I62.1 - Nontraumatic extradural ANTIHEMOROID DOEN
65 NIK : 3216060808640001 haemorrhage PIROKSIKAM 10 MG
No. RM : 01-009000 BPJS : 0001446345909
2019-09-09 13:37 Hal. 65 dari 1322

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MULYADI, TN (L) JL RAYA PEGANGSAAN DUA RT 05/02 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
HIDROKLORTIAZID 25 MG
66 NIK : 3172060104840003
No. RM : 01-020088 BPJS : 0000379342732
M TOYIB, TN (L) RAWA INDAH 004/010 A69.0 - Necrotizing ulcerative stomatitis AMOKSISILIN 500 MG
BORAK GLYSEROL 5% LARUTAN
No. RM : 01-014604 BPJS : 0001672405479
ALLAHRAKHA, TN (L) METRO SUNTER APARTEMEN, J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
PAPANGGO KLORFENIRAMIN MALEAT (CTM) TAB 4
68 MG
No. RM : 01-071372 NIK : - DEKSAMETASON 0,5 MG
Tgl Diagnosis : 01 February 2019 11:36 PM BPJS : 0002295887409 PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
FEDERICK CHRISTIAN, TN (L) JL. DISKO BLOK RT 03 RW 08 KGT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
69 NIK : 3172061912820004
No. RM : 02-001356 BPJS : 0001226177908
HARI MULYO DIONO (L) RW INDAH RT 003/03 I20.9 - Angina pectoris, unspecified ASAM ASETILSALISILAT 80 mg
(ASETOSAL)
Tgl Lahir : 02-Jan-1965 ( 54 Thn 8 Bln 7 Hr ) ISOSORBID DINITRAT 5 MG
70 NIK : -
No. RM : 01-057091 BPJS : 0001844551326 KAPTOPRIL 12,5 MG
KENZIE GYOVA ALBARR (L) JL KOMPLEK HI NO 80 RT 06/06 KGT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
Tgl Diagnosis : 02 February 2019 2:47 AM MG
SEPTIAN CAISAR PAMUNGKAS (L) JL. GANG PEJUANG VI RT 003/004 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
72 NIK : - MG
Tgl Diagnosis : 02 February 2019 4:56 AM AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 66 dari 1322

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LEA AUDREY FELICIA SUKAMTO, AN (P) GADING GRIYA LESTARI SUKAPURA J03.9 - Acute tonsillitis, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
No. RM : 01-081960 BPJS : 0001620102576 MG
Tgl Diagnosis : 02 February 2019 6:26 AM DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
QUEEN ADIVA QINARA (P) KGT RT 001/004 H60.5 - Acute otitis externa, noninfective PARASETAMOL SYR 120 MG/5 ML
J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-030058 BPJS : 0002100955375 MG
AMBROKSOL TAB 30 MG
KLORAMFENIKOL TT 3%
UMI BAROKAH, NY (P) JL PGS II B00.9 - Herpesviral infection, unspecified ASIKLOVIR 400 MG
ASIKLOVIR KRIM 5%
75 NIK : 3207194712830001 NATRIUM DIKLOFENAK TAB 25 MG
No. RM : 01-086396 BPJS : 0002518493152
ENDRIYANTO, TN (L) KAMPUNG MANGGA NO 44 RT 03/03 A01.0 - Typhoid fever CEFIXIME
TUGU SELATAN KOJA PARASETAMOL TAB 500 MG
76
No. RM : 01-066834 NIK : 3172032508790002
OBILIA SUBIYANTO, NN (P) MERAH DELIMA B.3/19 R51 - Headache PIROKSIKAM 10 MG

ANTASIDA DOEN
77 NIK : 3575036210940001
No. RM : 01-061615 BPJS : 0002356027841
JILLIAN TIFFANY NICOLAS, AN (P) JL HIBRIDA RAYA QG10/12 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-062357 BPJS : 0001730703431 MG
2019-09-09 13:37 Hal. 67 dari 1322

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MARIAM, NY (P) JL PERINTIS KEMERDEKAAN RT J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
011/004 KLORFENIRAMIN MALEAT (CTM) TAB 4
79 MG
No. RM : 01-016521 NIK : 3175024308510002 PARASETAMOL TAB 500 MG
Tgl Diagnosis : 05 February 2019 8:56 AM BPJS : 0001224504066 SIANOKOBALAMIN (VITAMIN B12) 50
MCG
ANTASIDA DOEN
MOCH MARDJUKI, TN (L) H.OYAR 03/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
HAMLIAH TURRIZQI, NY (P) H.OYAR 03/02 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
ARFAN SULAIMAN (L) RT03/13 PEGANGSAAN DUA J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
82 NIK : 3172062302180001 MG
BERTAWATI, NY (P) KP EARUNG JENGKOL RT 001/013 B01.9 - Varicella without complication ASIKLOVIR KRIM 5%
PGS II ASIKLOVIR 400 MG
MG
OMAR HAMZAH, AN (L) LESTARI IX NO 27 RT 003/010 B08.8 - Other specified viral infections RETRIBUSI LAYANAN SIAGA 24 JAM
characterized by skin and mucous KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 28-Sep-2015 ( 3 Thn 11 Bln 12 Hr ) membrane lesions
84 NIK : 3172048209151002 MG
Tgl Diagnosis : 05 February 2019 9:43 AM BORAK GLYSEROL 5% LARUTAN
2019-09-09 13:37 Hal. 68 dari 1322

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MUHASAN, TN (L) JL RAYA EPEGANGSAAN DUA RT Z48.9 - Surgical follow-up care, unspecified
05/02 TOILET MATA / WOUND TOILET
85 GENTAMISIN SALEP KULIT
No. RM : 01-058887 NIK : 3172061501820001 AMOKSISILIN 500 MG
ASAM MEFENAMAT KAPS 500
LEPAS JAHITAN
WARITAH, NY (P) BANGU CIPTA SARAA GG.L N0.7-A RT A09.9 - GASTROENTERITIS AND COLITIS PARASETAMOL TAB 500 MG
005/005 OF UNSPECIFIED ORIGIN RANITIDIN 150 MG
86 ANTASIDA DOEN
No. RM : 01-030569 NIK : 3175024805770009 RETRIBUSI LAYANAN SIAGA 24 JAM
MARWAH LATIFA NUR HASANA, AN (P) JL H OYAR RT 004/002 J45.9 - Asthma, unspecified INHALASI (UGD)
87 NIK : 3172065710170001 PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-054982 BPJS : 0002139572248 AMOKSISILIN SYR KERING 125 MG/5ML
Tgl Diagnosis : 05 February 2019 9:57 AM KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
DIAN SEPTIANI, NN (P) TANAH MERAT RT 07/08 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-005834 BPJS : 0001467778555 MG
MEY HANI MAGHFIROH, NN (P) KREMAN J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
89 NIK : 3328177005970003 MG
Tgl Diagnosis : 05 February 2019 10:02 AM AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
MARYANI, NY (P) KP RAWA INDAH RT 002/03 PGSN II J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-057557 BPJS : 0002224697512 RANITIDIN 150 MG
2019-09-09 13:37 Hal. 69 dari 1322

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WATINI, NY (P) KAYU TINGGI RT 01/011 O21.9 - Vomiting of pregnancy, unspecified PIRIDOKSIN (VITAMIN B6) 10 MG
ANTASIDA DOEN
91 NIK : 3172035506810006 RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-061759 BPJS : 0001170328443
REZA AJI PRASETYO, AN (L) APART GD NIAS TOWER DAHLIA LT 22 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
KM PARASETAMOL SYR 120 MG/5 ML
92 AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-061212 NIK : 3175061202160015 AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
MG
SABRINA NAHDA AFANDA, AN (P) KP SUKAPURA RT 4/10 A09 - Diarrhoea and gastroenteritis of GARAM ORALIT KOMBINASI
93 NIK : 3172044207170001 MG
AGUS RIYANTO, TN (L) KP MANGGA RT 3 RW 2 Z48.9 - Surgical follow-up care, unspecified TOILET MATA / WOUND TOILET
AMOKSISILIN 500 MG
94 NIK : 3172020708790009 METRONIDAZOL 500 MG
HJ EMMY LISTIANI, NY (P) JL JAMRUD I BK H6 003/006 H81.1 - Benign paroxysmal vertigo PIROKSIKAM 10 MG
K30 - Dyspepsia ANTASIDA DOEN
95 NIK : 31720348085410001 AMLODIPIN 5 MG
No. RM : 01-007183 BPJS : 0000202073139
JAVIER JOEL LONGKUTOY, AN (L) JL MELODI MAS RAYA BL A 8/01 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
ANTASIDA DOEN
No. RM : 01-001344 BPJS : 0001279338502 MG
OBH SIRUP 100 ML
2019-09-09 13:37 Hal. 70 dari 1322

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SULIASTUTI, NY (P) JL KESATRUAAN RT 4/5 M79.17 - Myalgia, ankle and foot ASAM MEFENAMAT KAPS 500
DEKSAMETASON 0,5 MG
No. RM : 01-014860 BPJS : 0002332105154 MCG
Tgl Diagnosis : 05 February 2019 10:45 AM RETRIBUSI LAYANAN SIAGA 24 JAM
BENEDIKTUS DEGHO, TN (L) JL KESATRIAAN RT 04/05 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
MUHAMMAD FADHLUR ROHMAN, AN (L) KP PULO GADUNG RT 01/05 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
99 NIK : 3172061004091004 MG
No. RM : 01-016519 BPJS : 0001853453171 OBH SIRUP 100 ML
Tgl Diagnosis : 05 February 2019 10:49 AM AMOKSISILIN KAPS 250 MG
DEKSAMETASON 0,5 MG
MARIANUS LEO, AN (P) JL KESATRIAAN RT 04/05 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
Tgl Diagnosis : 05 February 2019 10:52 AM PARASETAMOL TAB 500 MG
MG
WIWIT WIDIATI, NY (P) KAMPUNG PULO GADUNG J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
101 NIK : - DEKSAMETASON 0,5 MG
RAYYAN ABDUL ROHIM, AN (L) KP. PULO GADUNG J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
102 NIK : - KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 05-002926 BPJS : 0002136409536 MG
2019-09-09 13:37 Hal. 71 dari 1322

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AMBROKSOL TAB 30 MG
BALIALLO RUNTUK DRS .MM, TN (L) JL TERAMPIL I NO.29 005/002 S81.9 - Open wound of lower leg, part RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified INSISI SILANG
103 NIK : 3515182711510001 INJEKSI (UGD)
Tgl Diagnosis : 05 February 2019 11:32 AM ASAM MEFENAMAT KAPS 500
RAHMAD HANDAYA DS, TN (L) JL BANYO II NO 13-14 A15.0 - Tuberculosis of lung, confirmed by
sputum microscopy with or without culture
104 NIK : 3172061811860004
No. RM : 03-001022 BPJS : 0002739794242
TAUFIK IMAWAN, TN (L) P TEMIANG III NO 2 RT 13/3 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
J02.9 - Acute pharyngitis, unspecified AMLODIPIN 10 MG
105 NIK : 3172062005750004 HIDROKLORTIAZID 25 MG
MG
DEKSAMETASON 0,5 MG
ROHAENI, NY (P) RW SENGON BLOK B RT 2/22 B35.6 - Tinea cruris KETOKONAZOL 200 MG
MIKONAZOL KRIM 2 %
No. RM : 01-018089 BPJS : 0002332726569 MG
MUHAMMAD HAIDAR, AN (L) JL CEKATAN II NO 52 RT 01/02 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin PARASETAMOL TAB 500 MG
107 NIK : 3172060801095080 GARAM ORALIT KOMBINASI
No. RM : 01-010303 BPJS : 0001225245464 ANTASIDA DOEN
Tgl Diagnosis : 05 February 2019 11:41 AM RANITIDIN 150 MG
2019-09-09 13:37 Hal. 72 dari 1322

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SULTAN MUHAMMAD AL FATIH, AN (L) KP JEMBATAN RT 09/012 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-075680 BPJS : 0002471891185 MG
AMBROKSOL TAB 30 MG
RICHIE DEVAN SATRIA, AN (L) JL. KP JEMBATAN 009/012 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
PENGGILINGAN KLORFENIRAMIN MALEAT (CTM) TAB 4
109 MG
Tgl Diagnosis : 05 February 2019 11:47 AM BPJS : 0001811819812 AMBROKSOL TAB 30 MG
FATIN NAKIBA, AN (P) JLPGS II RT 06/02 L04.2 - Acute lymphadenitis of upper limb AMOKSISILIN SYR KERING 125 MG/5ML
110 NIK : - MG
Tgl Diagnosis : 05 February 2019 11:51 AM PARASETAMOL SYR 120 MG/5 ML
MUHAMMAD RAIHAN RAMADHAN, TN (L) JL. HARPA V BLOK EE/20 Z48.9 - Surgical follow-up care, unspecified ASAM MEFENAMAT KAPS 500
VITAMIN B KOMPLEKS
111 NIK : - LEPAS JAHITAN
No. RM : 05-002748 BPJS : 0001226384245 TOILET MATA / WOUND TOILET
NAFISAH ALFIANI, BY (P) JL RAYA PGS DUA RT 06/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL DROP 60 MG/0,6 ML
No. RM : 01-072096 BPJS : 0002357289977 MG
AMBROKSOL TAB 30 MG
NIGELA SATIVA (P) JL PEGANGSAAN DUA RT 04/04 NO J03.9 - Acute tonsillitis, unspecified AMOKSISILIN 500 MG
20c DEKSAMETASON 0,5 MG
No. RM : 04-000101 NIK : - KLORFENIRAMIN MALEAT (CTM) TAB 4
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 73 dari 1322

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DEVIOLITA RIZA, NY (P) JL. BOULEFRA RAYA PERUM HIBRIDA J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
8 BLK. RA.22/12A BORAK GLYSEROL 5% LARUTAN
No. RM : 01-078618 NIK : 1601144912890003 MG
Tgl Diagnosis : 05 February 2019 12:07 PM BPJS : 0001633106621 DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
ANTASIDA DOEN
WARYA BIN DAKIM, TN (L) JL RAWA SENGON BLOK G RT 07/022 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
MILCAH EMILLY CHRISTINE MARPAUNG, AN JL.PAJAJARAN Q/2 SUKAPURA J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
116 NIK : - MG
ELLIOTT NATHANIEL CHRISTIAN JL. PAJAJARAN BLOK Q NO. 2 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
SUKAPURA AMBROKSOL TAB 30 MG
RUNIAH, NY (P) RW SENGON RT 5/22 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-065775 BPJS : 0002332920576 MG
SUMARNI, NY (P) PASAR INPRES RT 6/6 P96.4 - Termination of pregnancy, fetus and
newborn
119 NIK : 3307046302830002
No. RM : 01-048891 BPJS : 0000547424897
2019-09-09 13:37 Hal. 74 dari 1322

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DIKI DERMANSYAH, TN (L) KP PULOGADUNG RT 004/005 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
120 NIK : 3171031508880003
MG TAB
RANITIDIN 150 MG
ANTASIDA DOEN
AMBROKSOL TAB 30 MG
ROMENAH, NY (P) PERJUANGAN RT. 02/04 KGT S81.9 - Open wound of lower leg, part RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified PARASETAMOL TAB 500 MG
FADHILLA KAPSYA KASIYA, BY (P) JL PERJUANGAN III Q20.9 - Congenital malformation of cardiac
chambers and connections, unspecified
122 NIK : -
No. RM : 01-085260 BPJS : 0002626914802
CARMINAH, NY (P) KOMP WALIOTA JL SRIGUNTING RT K30 - Dyspepsia PARASETAMOL TAB 500 MG
007/006 ANTASIDA DOEN
123 RANITIDIN 150 MG
No. RM : 01-000269 NIK : 3212246707830006
M. YUSUF, AN (L) RAWA INDAH RT 04/03 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
MG
AMBROKSOL TAB 30 MG
TUHFATUL MUHTAZIRRIDHONI, TN (L) BLOK JATI CININI Z03.0 - Observation for suspected AMOKSISILIN 500 MG
tuberculosis AMBROKSOL TAB 30 MG
No. RM : 01-081501 BPJS : 0000465996982
2019-09-09 13:37 Hal. 75 dari 1322

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ARVINO FAEYZA ANSORI, BY (L) JL CEKATAN RAYA NO 46 RT 02 RW 3 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-084995 BPJS : 0002464322679 MG
AMBROKSOL TAB 30 MG
PARASETAMOL DROP 60 MG/0,6 ML
YATI RUSIYANI,NY (P) JLN PERINTRIS KEMERDEKAAN J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-093763 BPJS : 0001606728587 MG
AMBROKSOL TAB 30 MG
AFIAH NURI MAULIDYA, AN (P) PGS II RT 2/01 L01.0 - Impetigo [any organism] [any site] PARASETAMOL SYR 120 MG/5 ML
ZAFRAN ALI FIRDAUS, AN (L) KP RAWA INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified GENTAMISIN SALEP KULIT
L01.0 - Impetigo [any organism] [any site] PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-017280 BPJS : 0002095933487 MG
WILDAN EKA CAKTI, AN (L) JL H MURTADO CII/12 RT 010/012 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
L01.0 - Impetigo [any organism] [any site] KLORFENIRAMIN MALEAT (CTM) TAB 4
130 NIK : 3172031111910001 MG
SUSI WARDANI, NY (P) JL SENTOSA II/13 RT 09/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 76 dari 1322

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HIRANEYSA AYUMAYDA, AN (P) JL SENTOSA II/13 RT 09/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMBROKSOL TAB 30 MG
TRIYANTO, TN (L) JL SENTOSA II/13 RT 09/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
K30 - Dyspepsia DEKSAMETASON 0,5 MG
No. RM : 01-027817 BPJS : 0001455122801 MG
ANTASIDA DOEN
RANITIDIN 150 MG
JASMINE AGNIYA KAMAL (P) KP.WARUNG JENGKOL 05/13 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
SITI FAIZAH, NY (P) KP WARUNG JENGKOL RT005/013 I10 - Essential (primary) hypertension AMBROKSOL TAB 30 MG
No. RM : 01-005824 BPJS : 0000210640779 MG
AMLODIPIN 10 MG
NENGSIH, NY (P) KP WARUNG JENGKOL 004/013 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 77 dari 1322

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RADITYA PUTRA, TN (L) JL. KELAPA MOLEK 6 BLOK Z1 NO. 2 A15.7 - Primary respiratory tuberculosis,
confirmed bacteriologically and histologically
137 NIK : 3172062604950001
No. RM : 01-085436 BPJS : 0002332804162
NOVIA RAMADHANI ASTUTI, NN (P) JL.P.RAYA NO.1 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
138 NIK : - AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
BANY AGUSTIN SUHARYADI, TN (L) JL. APRT KHARISMA BLK AI NO.1 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
139 NIK : 330305040930001 MG
CHRIS PAUL LESMANA (L) JL GADING PUSPA BLOK A 1 NO 38 M79.1 - Myalgia RETRIBUSI LAYANAN SIAGA 24 JAM
PIROKSIKAM 10 MG
MUNASIH, NY (P) JL JANUR INDAH 13 LB 16/3 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
fitri dwika (P) JL. TEGUH 2 NO115 RT 05 RW 01 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
No. RM : 06-000602 BPJS : 0001225749688
NUNUNG NURJANAH (P) GADING ECON TWR C NO 9 W57.0 - BITTEN OR STUNG BY KLORFENIRAMIN MALEAT (CTM) TAB 4
NONVENOMOUS INSECT AND OTHER MG
Tgl Lahir : 01-Feb-1980 ( 39 Thn 7 Bln 8 Hr ) NONVENOMOUS ARTHROPODS, HOME DEKSAMETASON 0,5 MG
143 NIK : 3208176102800001
No. RM : 01-086976 BPJS : 0000442393931 BETAMETASON 0,1%,KRIM
Tgl Diagnosis : 09 February 2019 9:32 AM PIROKSIKAM 10 MG
2019-09-09 13:37 Hal. 78 dari 1322

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VANIA SURYADI (P) JL KELAPA NIAS IV PC 8/3 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
RIZKI KUSUMA PRASETIYANTO (L) JL. H. OYAR NO 03 RT 04/04 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
ANTASIDA DOEN
145 NIK : 317206021100000002 RANITIDIN 150 MG
No. RM : 01-027766 BPJS : 0001225837181 DOMPERIDON TAB 10 MG
FEZAN NABAWI (L) JL RAWA INDAH A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 06-Sep-1981 ( 38 Thn 0 Bln 3 Hr ) L30.9 - Dermatitis, unspecified
Tgl Diagnosis : 09 February 2019 9:42 AM ANTASIDA DOEN
RANITIDIN 150 MG
MG TAB
BETAMETASON 0,1%,KRIM
HOLIPAH (P) JL PEGANGSAAN DUA J02.9 - Acute pharyngitis, unspecified ABOCATH NO24
No. RM : 01-086978 BPJS : 0000797267632 GLISERIL GUAIAKOLAT (GG) 100 MG
MG
AHMAD RASYID ALFAQIH, AN (L) RAWA INDAH 002/003 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Diagnosis : 09 February 2019 9:56 AM DOMPERIDON TAB 10 MG
BERLIANA NAPITUPULU (P) KP DUA DALAM NO.134 002/021 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
BEKASI presumed infectious origin (SULFAMETOKSAZOL 400 MG +
149
No. RM : 01-078894 NIK : 3275024210920016 KOMBINASI KAOLIN 550 MG, PEKTIN 20
BPJS : 0002421816399 MG TAB
ANTASIDA DOEN
2019-09-09 13:37 Hal. 79 dari 1322

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GADING MARVELL CESAREO SITUMORANG JL PULO PENYENGAT III NO 25 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
150 NIK : 3172061612150002
No. RM : 01-080504 BPJS : 0002301958541
HENRY (L) JL P PENYENGAT III NO 25 M79.1 - Myalgia PIROKSIKAM 10 MG
151 NIK : - MCG
GAVRIEL CIRRILLO TRYSTAN SITUMORANG PUKAU PENYENGAT J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-086979 BPJS : 0002292838648 MG
SUNOKO NUGROHO SAMIADJI, TN (L) JL. KLP KOPYOR RT 003/009 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 5 MG
No. RM : 01-029286 BPJS : 0001741314778 MCG
HARIJATI (P) GADING INDAH UTARA IV BLOK NH M79.2 - Neuralgia and neuritis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
7/12 PIROKSIKAM 10 MG
SITI CHAMIDAH (P) KP RAWA INDAH B35.4 - Tinea corporis KETOKONAZOL 200 MG
M79.1 - Myalgia KLORFENIRAMIN MALEAT (CTM) TAB 4
155 NIK : 3172065707850004 MG
No. RM : 01-086981 BPJS : 0001225841769 MIKONAZOL KRIM 2 %
2019-09-09 13:37 Hal. 80 dari 1322

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MCG
JAYA GUNAWAN YANTO (L) JL GADING UTARA III NH V NO 6 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Lahir : 06-Mar-1976 ( 43 Thn 6 Bln 3 Hr ) J02.9 - Acute pharyngitis, unspecified TRIMETOPRIM 80 MG)
156 NIK : 187108063760006
MG TAB
AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
ANTASIDA DOEN
MEY HELEN ARITONANG, NY (P) PGS II RT 06/02 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
JOEL RISKY LEONARDO GULTOM, AN (L) PEGANGSAAN DUA 06/02 K30 - Dyspepsia PARASETAMOL SYR 120 MG/5 ML
ANTASIDA DOEN SUSPENSI
158 NIK : - RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-024388 BPJS : 0002099425904
HARRI BUDIYANTO (L) JL TIPAR CAKUNG GG H KARI J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-086985 BPJS : 0002358792066 MG
ANTASIDA DOEN
JABIRUN PADANG (L) JL BCS GANG L N39.0 - Urinary tract infection, site not ASAM MEFENAMAT KAPS 500
specified ANTASIDA DOEN
160 NIK : 1207260604570002 RANITIDIN 150 MG
No. RM : 01-086986 BPJS : 0000009610659
2019-09-09 13:37 Hal. 81 dari 1322

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KOTRIMOKSAZOL DOEN I (DEWASA)
TRIMETOPRIM 80 MG)
HANNY A RUNTU, TN (L) TAMAN PEGANGSAAN INDAH F/21 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
L30.9 - Dermatitis, unspecified AMLODIPIN 10 MG
No. RM : 01-024809 BPJS : 0002139334075 MG
Tgl Diagnosis : 09 February 2019 11:09 AM BETAMETASON 0,1%,KRIM
HJ NURSIAH KANANG, NY (P) JL.GAMBIR ANOM F-6/13 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
No. RM : 01-009474 BPJS : 0002035549888 MCG
SRI SUTOMI ASRI (P) JL. TRAMPIL 1 NO. 33 RT. 004/022 KGB I10 - Essential (primary) hypertension AMLODIPIN 10 MG
163 NIK : 31720671074500001
No. RM : 01-024983 BPJS : 0000046003105
IR. AWIT SARKAWIT (L) JL. TRAMPIL 1 NO. 33 RT. 004/022 KGB I10 - Essential (primary) hypertension AMLODIPIN 10 MG
BAMBANG RAHARDJO (L) JL GADING ELOK TMR IIX BLOK BQ 2 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
NO 11 AMBROKSOL TAB 30 MG
No. RM : 01-086987 NIK : - MG
Tgl Diagnosis : 09 February 2019 11:24 AM BPJS : 0001775055879 PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 82 dari 1322

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MUHAMMAD AZHAM ABYAN (L) JL TELUK TERATAI IV NO 2F J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
166 NIK : 3172060906141006 ANTASIDA DOEN SUSPENSI
No. RM : 01-086988 BPJS : 0002241876036
THERESIA RINDU PUTRI KINANTI, AN (P) GG KANCIL 003/04 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG

167 NIK : -
No. RM : 01-009132 BPJS : 0002232327701
SUHARNO, TN (L) JL RAWA SENGON BLOK E RT 05/022 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
L28.2 - Other prurigo PARASETAMOL TAB 500 MG
JONES SIMBOLON, TN (L) KP PULO GADUNG GG L RT 04/05 E11.9 - Non-insulin-dependent diabetes RETRIBUSI LAYANAN SIAGA 24 JAM
mellitus without complications AMLODIPIN 5 MG
Tgl Lahir : 09-Feb-1966 ( 53 Thn 7 Bln 0 Hr ) I10 - Essential (primary) hypertension
169 NIK : 3172060902660002 METFORMIN TAB 500 MG
No. RM : 01-021926 BPJS : 0001827709705 GLIBENKLAMIDA 5 MG
MCG
TURINIH, NY (P) JL PGS II RT 5/2 I10 - Essential (primary) hypertension METFORMIN TAB 500 MG
GLIBENKLAMIDA 5 MG
170 NIK : 3172065102700006 AMLODIPIN 10 MG
SUBAWI, TN (L) KAYMAS TENGAH 1RT10/04 I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
171 NIK : 3175021604720011 AMLODIPIN 5 MG
HELLY LUCIANNA WUNTU (P) RAWA INDAH 05/03 M79.1 - Myalgia DEKSAMETASON 0,5 MG
172 NIK : 3172015005680012 MCG
2019-09-09 13:37 Hal. 83 dari 1322

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FAITH ESTERICA HUTASOIT, AN (P) JL PEGANGSAAN B34.9 - Viral infection, unspecified PARASETAMOL DROP 60 MG/0,6 ML
DOMPERIDON TAB 10 MG
No. RM : 01-086991 BPJS : 0002473552697
INDRIJATI (P) KLP SAWIT 03 CC NO.20 RT.07/017 H81.1 - Benign paroxysmal vertigo ASAM MEFENAMAT KAPS 500
KGT ANTASIDA DOEN
No. RM : 01-007867 NIK : 0951064509460040
REVIANA MANIK (P) JL. YAKOBUS ATAU GIRSANG SIPANG K30 - Dyspepsia RANITIDIN 150 MG
BOLON SUMUT DOMPERIDON TAB 10 MG
175 ANTASIDA DOEN
No. RM : 01-075890 NIK : 1208165604960002
HERMAN ATMADJAJA (L) JL KELAPA SAWIT III NO 20 RT 7/17 K30 - Dyspepsia RANITIDIN 150 MG
176 NIK : 3172061307440001
No. RM : 01-011437 BPJS : 0001812435129
MASYUNAH, NY (P) JL GADING V 4/5 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
177 NIK : 3172065512390001
No. RM : 01-015048 BPJS : 0000159392496
RAVINDRA KUMAR MOONA, TN (L) JL WALANG TIMUR 3 RT 09/12 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
178 NIK : 3172031701450003 AMLODIPIN 10 MG
No. RM : 01-018681 BPJS : 0001326433408
MOONA JYOTSNA RAVINDRA, NY (P) JL WALANG TIMUR III 009/012 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 84 dari 1322

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AMLODIPIN 5 MG
ABDUL ROHIMI (L) JL. PEJUANG 2 NO. 12 M54.57 - Low back pain, lumbosacral region ASAM MEFENAMAT KAPS 500
DEKSAMETASON 0,5 MG
No. RM : 02-005034 BPJS : 0001291394406 MCG
GITA M MASAEL,NY (P) JLN RW SENGON RT 03/022 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
RIZKIA MAHIRA (P) JL BAKTI ABRI NO 96 RT 02/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
KUSNUL RAVI HIDAYATTULLOH (L) KP RAWA INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
Tgl Diagnosis : 09 February 2019 2:21 PM BETAMETASON 0,1%,KRIM
ROSMA NURHASANAH, NY (P) JL RAWA INDAH RT 003/003 R51 - Headache ASAM MEFENAMAT KAPS 500
ANTASIDA DOEN
No. RM : 01-055286 BPJS : 0000377482094 MCG
2019-09-09 13:37 Hal. 85 dari 1322

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ATHAFARIZ SYAWAL SETIAWAN, AN (L) KP RAWA INDAH RT 03/03 L22 - Diaper [napkin] dermatitis BETAMETASON 0,1%,KRIM
185 NIK : 3172062306180004 MG
MARTINA RAJA GUK GUK, NY (P) JL PERJANGAN RAYA RT 03/07 G56.0 - Carpal tunnel syndrome RETRIBUSI LAYANAN SIAGA 24 JAM
186 NIK : 3172044803790013 MCG
MARIA MAGDALENA TAMPUBOLON, AN (P) JL PERJUANGANRAYA TANAH MERAH J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-031385 BPJS : 0001264922998 MG
AMBROKSOL TAB 30 MG
MESHACH LEMUEL ALCANDER T, AN (L) HIBRIDA UJUNG RT 1/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
188 NIK : 3172031606170002 MG
NENG ALMIA, AN (P) RW INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
189 NIK : 3172065503111002 MG
AHMAD ANDI PUTRA (L) JL H OYAR RT 2/4 K30 - Dyspepsia ANTASIDA DOEN
No. RM : 01-012085 BPJS : 0002453594231
2019-09-09 13:37 Hal. 86 dari 1322

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ELLIOTT NATHANIEL CHRISTIAN JL. PAJAJARAN BLOK Q NO. 2 J02.8 - Acute pharyngitis due to other AMOKSISILIN 500 MG
SUKAPURA specified organisms KLORFENIRAMIN MALEAT (CTM) TAB 4
191 MG
No. RM : 01-069921 NIK : - AMBROKSOL TAB 30 MG
YULIARDI BINUAN (L) APRT GADING NIAS RESINDECE BLK I10 - Essential (primary) hypertension AMLODIPIN 5 MG
TRISAN LT 9 JE RETRIBUSI LAYANAN SIAGA 24 JAM
192
No. RM : 01-035453 NIK : 3172051007630008
ANTO SANTOSO, tn (L) KP SUKAPURA 02/10 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
193 NIK : 3172042405840019 RANITIDIN 150 MG
HIMEKO COLIN (P) TAMAN HOLIS INDAH RT 002/14 ( APT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
GADING NIAS LT 2 BLOK E/2SB DEKSAMETASON 0,5 MG
No. RM : 01-019344 NIK : 3273154904890013
YATI ,NY (P) JL. RAWA SENGON BLOK B RT. 002 / I10 - Essential (primary) hypertension AMLODIPIN 5 MG
195 RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-046605 NIK : 3172035007670014
HANNISA PUTRI DESVIANTI, AN (P) JL PERINTIS KEMERDEKAAN RT 11/04 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
MG
VENTI SULISTIO DEWI, NY (P) JL PERINTIS KEMERDEKAAN 011-004 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
197 NIK : 3172026912700012 MG
2019-09-09 13:37 Hal. 87 dari 1322

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JESSIE PATRICIA HALIM SH (P) JL KELAPA CENGKIR BARAT VI J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
198 NIK : 3172066911860001 MG
SERAPHIN JUSTICIA BENGKAL (P) JL KLP CENGKIR BRT VI FM 1/19 RT J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
07/011 AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-071614 NIK : 3172064609151003 MG
AMBROKSOL TAB 30 MG
YENY RISNAWATI, NY (P) KOMP HII A26 L50.0 - Allergic urticaria RETRIBUSI LAYANAN SIAGA 24 JAM
200 NIK : 3172065312770001 MG
KOSONG (P) RAWA INDAH 003/003 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-023530 BPJS : 0002136794545 MG
AMBROKSOL TAB 30 MG
PIBINA INAKAIRIN, AN (P) JL H. OYAR J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
YENNY HIMAWAN, NY (P) JL. KLPA CENGKIR BRT I FH I NO.7 I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
002/011 M79.1 - Myalgia DEKSAMETASON 0,5 MG
No. RM : 01-046896 NIK : 3172065612490001 MCG
2019-09-09 13:37 Hal. 88 dari 1322

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ISKANDAR, TN (L) JL INSPEKSI KALI SUNTER 003/004 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
S81.9 - Open wound of lower leg, part AMOKSISILIN 500 MG
204 NIK : 3172061002580001 unspecified DEKSAMETASON 0,5 MG
No. RM : 01-012364 BPJS : 0001320978521 GENTAMISIN SALEP KULIT
WARNIPAH, NY (P) INSF X SUNTER RT 3/ A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin AMOKSISILIN 500 MG
Tgl Lahir : 19-Mar-1960 ( 59 Thn 5 Bln 21 Hr ) J02.9 - Acute pharyngitis, unspecified
MG TAB
AMBROKSOL TAB 30 MG
MG
SIFA MARYAM, AN (P) JL INSPEKSI KALI SUNTER 003/004 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMBROKSOL TAB 30 MG
TYAS PUTRI HANDAYANI .AN (P) TANAH MERAH RT 006/007 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-055387 BPJS : 0002292321802 ZINC 20 MG
MG
DEKSAMETASON 0,5 MG
SUJAT MIKO RAMDANI (L) JL PGS II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 89 dari 1322

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ADE INDRA SUBEKTI ,AN (L) JL. PGS II RT 001/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
No. RM : 01-057454 BPJS : 0001901321267 MG
DEKSAMETASON 0,5 MG
ERPAN, TN (L) KMP SUKAPURA JAYA RT 06/10 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
SITI TILAWAH HISAN (P) KP.WARUNG JENGKOL 01/13 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-052263 BPJS : 0002356785538 MG
AMBROKSOL TAB 30 MG
ANGELA ALEXANDRA, AN (P) JL RW SENGON RT 7/22 K12.1 - Other forms of stomatitis RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-033682 BPJS : 0002139401373 MG
MCG
MUHAMAD FAZRI ,AN (L) RAWA INDAH 006/003 A09 - Diarrhoea and gastroenteritis of GARAM ORALIT KOMBINASI
213 NIK : - ZINC 20 MG
No. RM : 01-006912 BPJS : 0002098352283 DOMPERIDON SUSP 5 MG/5 ML
DIANA FELISIA PUTRI, AN (P) JL. PERSATUAN NO. 38 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
2019-09-09 13:37 Hal. 90 dari 1322

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RATNA PURI YUNIAR, NN (P) JL PEGANGSAAN DUA RT 03/04 M79.18 - Myalgia, other site ASAM MEFENAMAT KAPS 500

215 NIK : 3172064309990001
No. RM : 01-023615 BPJS : 0001225637458
JIHAN NABILA, NN (P) RT.06/05 PEGANGSAAN DUA J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
ANTASIDA DOEN
AMOKSISILIN 500 MG
UWAYS ABDULLAH AL KHAFI (-) JL. RW INDAH J18.0 - Bronchopneumonia, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-087084 BPJS : 0002327575937 MG
AMBROKSOL TAB 30 MG
INDAH TANUDJAJA, NY (P) APT GADING NAS RESIDENCES A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin KOMBINASI KAOLIN 550 MG, PEKTIN 20
218 NIK : 3175065302530006 MG TAB
ROHANDI PUTRA, TN (L) JL. TNH MERAH NO.30 L02.9 - Cutaneous abscess, furuncle and AMOKSISILIN 500 MG
carbuncle, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-087088 BPJS : 0001605877626
CATALEYA AZAHRA SALMIN, AN (P) JL KANTIL NO 12 RT 001-003 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
No. RM : 01-037381 BPJS : 0002274497932 MG
2019-09-09 13:37 Hal. 91 dari 1322

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Quantrun nada salsabila salmin, AN (P) JL KANTIL NO 12 KGB J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-055133 BPJS : 0002276911247 MG
AMBROKSOL TAB 30 MG
KHAIRUL AKBAR, AN (L) CIKAWUNG RT 03/0 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
222 NIK : 3302160204110003 MG
HILDA AMELIA, NN (P) RW INDAH RT 007/03 PGSN II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
223 NIK : 3172067007051001 MG
FEBRIYANTI KUSRUMAENI, AN (P) JL PERJUANGAN II RT 6/7 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
SITI APSAH, NN (P) JL. PERINTIS KEMERDEKAAN 002/006 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
225 NIK : 3172064904890003 RANITIDIN 150 MG
JOHANNA ESTERLITA, NN (P) JL BONGO BLOK F / 23 RT 01/08 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 92 dari 1322

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MG
EVI AFRIYANI, NN (P) JL DUKUH RT 12/07 K30 - Dyspepsia ANTASIDA DOEN

RANITIDIN 150 MG
227 NIK : 3172034204031002
No. RM : 01-044189 BPJS : 0002256702153
TUNI , NY (P) KP RAWA INDAH RT 3/3 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
No. RM : 01-014879 BPJS : 0000379355679 MG
AMLODIPIN 10 MG
KAPTOPRIL 12,5 MG
SRI ANINGSIH, NY (P) JL DAHLIA 1 NO 15 RT 005/003 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-001339 BPJS : 0001859829895
SUKARTO (L) JL DK GUDANG R10.4 - Other and unspecified abdominal RETRIBUSI LAYANAN SIAGA 24 JAM
pain KETOROLAC INJEKSI 30 MG/ML
230 NIK : 3327061705570002 INJEKSI (UGD)
No. RM : 01-087100 BPJS : 0002464763433 HIOSINA BUTILBROMIDA 10mg
Tgl Diagnosis : 10 February 2019 8:52 PM NATRIUM DIKLOFENAK 50 MG
ROY MESSI, AN (L) KODAMAR RT08/09 H16.2 - Keratoconjunctivitis AMOKSISILIN KAPS 250 MG
231 NIK : 3172061210090002 MG
2019-09-09 13:37 Hal. 93 dari 1322

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ALICIA MELANI, NY (P) JL PULAU BINTAN NO 4 RT 08/09 M79.1 - Myalgia SIANOKOBALAMIN (VITAMIN B12) 50
MCG
Tgl Lahir : 25-May-1987 ( 32 Thn 3 Bln 15 Hr ) RETRIBUSI LAYANAN SIAGA 24 JAM
232 NIK : 3172066505870002
ROSMINI, NY (P) JL TEGUH VIII NO 93 RT 09/01 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
ANTASIDA DOEN
RANITIDIN 150 MG
DAFFA AMSYAR ABQARY, AN, AN (L) TANAH MERAH RT 07/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
234 NIK : 3327061203110003 MG
MOINA MALAU (P) JL PERJUANGAN GG SIKILANG NO 25 J45.9 - Asthma, unspecified AMOKSISILIN 500 MG
RT 21/07 TUGU SELATAN DEKSAMETASON 0,5 MG
SALBUTAMOL 2 MG
MELVA BR SIAGIAN (P) TANAH MERAH JL PERJUANGA RT L50.0 - Allergic urticaria RETRIBUSI LAYANAN SIAGA 24 JAM
236 MG
Tgl Diagnosis : 10 February 2019 9:10 PM BPJS : 0000377242378 BETAMETASON 0,1%,KRIM
KASINI, NY (P) JL TAMPAK SIRING RAYA NO 14 H66.3 - Other chronic suppurative otitis RETRIBUSI LAYANAN SIAGA 24 JAM
media AMOKSISILIN 500 MG
MG
2019-09-09 13:37 Hal. 94 dari 1322

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NAZWA AMEERA RAMADHANY .AN (P) RAWA INDAH 003/003 J02.9 - Acute pharyngitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 27-Jul-2014 ( 5 Thn 1 Bln 13 Hr ) DEKSAMETASON 0,5 MG
238 NIK : 3172066707141001
MUHAMMAD IMAMUL AZKIYA, AN (L) JL RAWA SENGON BLOK H RT 08/22 A09 - Diarrhoea and gastroenteritis of ANTASIDA DOEN SUSPENSI
presumed infectious origin ZINC 20 MG
Tgl Lahir : 01-Jul-2014 ( 5 Thn 2 Bln 8 Hr ) J02.9 - Acute pharyngitis, unspecified
No. RM : 01-005679 BPJS : 0002282533108 PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
MG
MUHAMMAD NURUL ARSY, AN (L) JL RAWA SENGON BLOK H RT 08/22 A09 - Diarrhoea and gastroenteritis of PARASETAMOL SYR 120 MG/5 ML
EMAH, NY (P) JL RAWA SENGOM RT 12/14 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J02.9 - Acute pharyngitis, unspecified HIDROKLORTIAZID 25 MG
Tgl Diagnosis : 10 February 2019 9:40 PM SALBUTAMOL 2 MG
AMOKSISILIN 500 MG
MUHAMMAD HANAN ATTAQI (L) KP RAWA INDAH RT 04/03 B34.9 - Viral infection, unspecified PARASETAMOL DROP 60 MG/0,6 ML
242 NIK : 3172061507160012 MG
Muhamad rasya dhaifulloh (L) KP PULO GADUNG RT 02/05 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 95 dari 1322

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AGUS ISMAIL, TN (L) JL H.OYAR RT 002/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
244 NIK : 3172061708860007 MG
SAID (L) jl BCS RT 04/05 PGS II J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-056620 BPJS : 0002102048616 MG
AMBROKSOL TAB 30 MG
IBNU FADILAH RACHMADHAN,AN (L) KP RAWA INDAH RT 02/03 J02.9 - Acute pharyngitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
246 NIK : 3172062607141001
YULIANA NUR AZIZAH, NN (P) JL PGS DUA RT 003/04 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
MG
ELON MAIHATAKESU (L) JL WARAKAS IV GG 7 NO.62 S11.9 - Open wound of neck, part AMOKSISILIN 500 MG
unspecified ASAM MEFENAMAT KAPS 500
248 NIK : 8102031905910003 TOILET MATA / WOUND TOILET
No. RM : 01-087106 BPJS : 0002298950605 HECTING BESAR, TENDON, PASANG
Tgl Diagnosis : 11 February 2019 12:32 AM SPALK KECIL (UGD)
MUNYATI, NY (P) KP TNH MERAH JL PLUMPANG B A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 24-Mar-1992 ( 27 Thn 5 Bln 16 Hr ) PARASETAMOL TAB 500 MG
249 NIK : 3172066403921001
2019-09-09 13:37 Hal. 96 dari 1322

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HARiYATI, NY (P) JL H OYAR RT 2/4 A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
presumed infectious origin DOMPERIDON TAB 10 MG
250 NIK : 3172065010640006 RANITIDIN 150 MG
QILA VICKY RIZKIA, AN (P) JLN. SEMARANG D /37 SUKA PURA J02.9 - Acute pharyngitis, unspecified FENOL GLISEROL TT 10%
No. RM : 01-010997 BPJS : 0002037084355 MG
AMBROKSOL TAB 30 MG
ILHAM FATAHILLA ATHAR, AN (L) RAWASENGON 07/22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-053483 BPJS : 0002764658035 MG
AMBROKSOL TAB 30 MG
ZAHIRA AMBAR WARJITO (P) JL. SENTOSAN II RT 09/010 S01.8 - Open wound of other parts of head PARASETAMOL SYR 120 MG/5 ML
253 NIK : 3172061312101000
No. RM : 01-051842 BPJS : 0002277468898
KRIS OWEN NAPITUPULU, AN (L) PEGANGSAAN II RT 05/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
DHEA IRNANDITA PRAMESWARI, NN (L) KP P GADUNG RT 2/5 K30 - Dyspepsia PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
255 NIK : 3172064304010001 DOMPERIDON TAB 10 MG
2019-09-09 13:37 Hal. 97 dari 1322

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FIRMAN SYAH, TN (L) JL P JAYAKARTA DALAM NO 24 M79.17 - Myalgia, ankle and foot NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
256 NIK : 3174080302820007 MULTIVITAMIN DEWASA
DEWI SURIA NAZARA (P) JL. PELEPAH KUNING III BLOK WE 2 T30.2 - Burn of second degree, body region GENTAMISIN SALEP KULIT
NO 4 unspecified ASAM MEFENAMAT KAPS 500
257 AMOKSISILIN 500 MG
NYAI TARMILAH, NY (P) KLP ASWIT 8 BF N0 19 M79.1 - Myalgia ANTASIDA DOEN

RANITIDIN 150 MG
258 NIK : 3210064105560041 ASAM MEFENAMAT KAPS 500
No. RM : 01-029569 BPJS : 0002143479519 VITAMIN B KOMPLEKS
SYARAS SYAPUTRI, NN (P) WARAKAS 05 GG 07 RT 09 / 09 K30 - Dyspepsia RANITIDIN 150 MG
ANTASIDA DOEN
IGNATIO YUNANTA, TN (L) JL PEGANGSAAN DUA RW 004 Z48.9 - Surgical follow-up care, unspecified GENTAMISIN SALEP KULIT
LEPAS HECTING
JOSHUA FELMAN,TN (L) RAWA SENGON NO 80 L50.0 - Allergic urticaria KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 05-Nov-2000 ( 18 Thn 10 Bln 4 Hr ) DEKSAMETASON 0,5 MG
261 NIK : 3172030511001001
RYZNI JEYNI TENDEAN, NY (P) RGTC BLK CENDANA NO.502 004/010 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ASAM FOLAT 1 MG
262 NIK : 3175066501880007
No. RM : 01-023310 BPJS : 0002062303165
2019-09-09 13:37 Hal. 98 dari 1322

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MASTINAH, NY (P) JL INSPEKSI KLAI SUNTER 006/004 K30 - Dyspepsia PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
HAIDAR AJI, BY (L) JL. TELUK RATAI IV NO. 15 006/010 B34.9 - Viral infection, unspecified PARASETAMOL DROP 60 MG/0,6 ML
DOMPERIDON SUSP 5 MG/5 ML
No. RM : 01-074932 BPJS : 0002466266321
BETTY HANDAYANI, NY (P) JL. TELUK RATAI IV NO. 15 006/010 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
SYIN LUDJENG, TN (L) RAWA INDAH 02/03 M79.1 - Myalgia MULTIVITAMIN DEWASA
MUHAMMAD YUSUF ISMAIL, TN (L) JL KGT 004/004 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
ELLEN OEY, NY (P) JL PELEPAH INDAH II LA 22/5 010/018 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
268 NIK : 3172066812530001 MCG
2019-09-09 13:37 Hal. 99 dari 1322

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MUHAMMAD ARSEN ARNATA (L) JL.P.REMPANG IV/11 K59.0 - Constipation PARASETAMOL SYR 120 MG/5 ML
ZINC 20 MG
No. RM : 01-010893 BPJS : 0002047910938
SANI EFFENDY TANZIL (L) JL GADING INDAH UTR RT 22/12 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J02.9 - Acute pharyngitis, unspecified SIMVASTATIN 10 MG
No. RM : 01-058486 BPJS : 0001732363749 MG
GIOKY INDIARNI SUTIONO, NY (P) JL GADING INDAH RT 22/12 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
AMLODIPIN 10 MG
SAUT HARAPAN (L) VILLA STR MAS TIMUR F BLOK S UTR K30 - Dyspepsia PARASETAMOL TAB 500 MG
RT 9/8 ANTASIDA DOEN
NADYA NURULLITA, an (P) JL H OYAR RT 3/02 J02.0 - Streptococcal pharyngitis DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
MG
AMBROKSOL TAB 30 MG
AMIRA AINUN MAHYA, AN (P) JL BCS 003/005 GG NN NO.92 J00 - Acute nasopharyngitis [common cold] PARASETAMOL SYR 120 MG/5 ML
274 NIK : 3172066607141001 MG
2019-09-09 13:37 Hal. 100 dari 1322

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SUDARMI, NY (P) KP PULO GADUNG RT 3/5 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
J06.9 - Acute upper respiratory infection, AMLODIPIN 10 MG
275 NIK : 3172065403530001 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
MUHAMMAD ILHAM BADRUSSALAM, AN (P) JL. PERINTIS KEMERDEKAAN 009/004 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
276 NIK : 3172062106101003 MG
ASKIRANA APRILIA PUTRI, AN (P) PGSN DUA RT 04/02 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
277 NIK : 3172065904131001 MG
FIRDA AMELLIYAH, NY (P) KP WARUNG JENGKOL J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
278 NIK : 3172064405960001 MG
ANDI KUNIAWAN, TN (L) SUKAPURA RT 6/2 H66.9 - Otitis media, unspecified KLORAMFENIKOL TT 3%
279 NIK : 3324071004920001 PREDNISON 5 MG
FAUZAN RAMADHAN, AN (L) KP RW INDAH RT 006/003 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 08-Jun-2016 ( 3 Thn 3 Bln 1 Hr ) GLISERIL GUAIAKOLAT (GG) 100 MG
280 NIK : 3172060806160004
2019-09-09 13:37 Hal. 101 dari 1322

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AMOKSISILIN 500 MG
LISNA SUSANTI, NY (P) JL KLP HIBRIDA I RA 4/1 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
IMAM SAFEI, TN (L) JL INSP KALI SUNTER RT 09/013 J02.9 - Acute pharyngitis, unspecified VITAMIN B KOMPLEKS
MG
WITDIYONO, TN (L) JL GIRING2 BLOK R NO 22 Z48.9 - Surgical follow-up care, unspecified GENTAMISIN SALEP KULIT
LEPAS JAHITAN
GINI SRIJATI, NY (P) PONDOK PEKAYON INDAH RT 005/018 J02.9 - Acute pharyngitis, unspecified KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Lahir : 23-May-1962 ( 57 Thn 3 Bln 17 Hr ) TRIMETOPRIM 80 MG)
284 NIK : 3275046305620011
DEKSAMETASON 0,5 MG
MG
MA JOY VILLANUEVA MOLENO, NY (L) JANUR ASRI 3 BLOK QJ 15 NO 18 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
L30.9 - Dermatitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
285 NIK : - MG
2019-09-09 13:37 Hal. 102 dari 1322

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RR. RINA DIAH NARYATI, NY (P) JL. GADING ELOK TMR III M 1 NO 3 E78.0 - Pure hypercholesterolaemia SIMVASTATIN 10 MG
ASAM ASETILSALISILAT 80 mg
286 NIK : 6371024208670004 (ASETOSAL)
FITRI RAMADHANI, AN (P) JL EKXPOR RT 4/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
No. RM : 01-065156 BPJS : 0002140044142 MG
TASYA AINUR ROHMAH, AN (P) JL MUSIK RAYA NO 17 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
288 NIK : 3275017005110002 MG
No. RM : 01-087396 BPJS : 0002140044153 AMBROKSOL SYR 15MG/5ML 60 ML
ANDIKA SATRIA, TN (L) P REMPANG III N0 20 RT 007/009 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
CLEOVA FLAVIA WULUR LUMONGDONG, AN GADING MAS BARAT V A/31 001/011 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
290 NIK : 3172064705151003 MG
CLAUDIA AUDREY LUMONGDONG (P) JL. GADINGMAS BARAT V BLOK A NO J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
No. RM : 01-087402 NIK : 3172061304111012 MG
Tgl Diagnosis : 13 February 2019 8:40 PM BPJS : 0002084752045 PARASETAMOL SYR 120 MG/5 ML
2019-09-09 13:37 Hal. 103 dari 1322

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JORDI LABA DAMANIK, AN (L) JL. GG DAME I NO.11 014/007 TNH J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
MERAH AMBROKSOL TAB 30 MG
No. RM : 01-052680 NIK : 3172031501097353 MG
MUHAMMAD RAFIF HAKIM, AN (L) KP WARUNG JEGNKOL RT 01/013 J02.9 - Acute pharyngitis, unspecified

293 NIK : 3172060707160001
No. RM : 01-014759 BPJS : 0002095425663
MUHAMMAD BAJURI (L) KP WARUNG JEGNKOL RT 01/013 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
ACHMAD AFANDI, TN (L) PEGANGSAAN DUA 01/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-011722 BPJS : 0001225928362 MG
AMOKSISILIN 500 MG
PURWANI SEJATI NING UTAMI, NY (P) KP WARUNG JEGNKOL RT 01/013 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-014712 BPJS : 0001673984518 MG
AMOKSISILIN 500 MG
AIKO SHARON TSAMARA B (P) GADING GRIYA LESTARI BLOK G 3/14 K35.8 - ACUTE APPENDICITIS, OTHER
AND UNSPECIFIED
297 NIK : 3172047010070011
No. RM : 01-087407 BPJS : 0001321172076
2019-09-09 13:37 Hal. 104 dari 1322

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DION ALVARO S, TN (L) JLN. H. TEN 04 NO 25 RT 06/01 B08.8 - Other specified viral infections RETRIBUSI LAYANAN SIAGA 24 JAM
characterized by skin and mucous AMOKSISILIN KAPS 250 MG
Tgl Lahir : 04-Dec-2014 ( 4 Thn 9 Bln 5 Hr ) membrane lesions
Tgl Diagnosis : 13 February 2019 9:03 PM GENTAMISIN SALEP KULIT
DEDE PUJIANTO (L) RT001/004 KGT J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
299 NIK : 3172062606870004 MG
AMOKSISILIN 500 MG
MUHAMAD RAFIF PRADIPTA NUGRAHA, AN KOMP BERMIS, JL MELATI NO 15 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-050343 BPJS : 0002069588305 MG
AMBROKSOL TAB 30 MG
RAYHAN RABBANI ALAM, AN (L) PEGANGSAAN DUA 03/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-041439 BPJS : 0002332915222 MG
WARFIAH BT ALWANI, NY (P) JL. H. OYAR I10 - Essential (primary) hypertension AMLODIPIN 10 MG

302 NIK : -
No. RM : 01-085639 BPJS : 0000377159692
NAIRA SYAHANNA PAHLEVI (P) PERUMAHAN SUNTER PRATAMA VII A08.4 - Viral intestinal infection, unspecified PARASETAMOL SYR 120 MG/5 ML
BLOK C NO 3 DOMPERIDON SUSP 5 MG/5 ML
303 ZINC 20 MG
No. RM : 01-087406 NIK : 3326056811170001
2019-09-09 13:37 Hal. 105 dari 1322

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TIMBUL PASARIBU, TN (L) JL. SMA 83 RT 003/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
304 NIK : 1201012711950005 MG
SANIRI, NY (P) JL MELATI RT 007/007 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
KAPTOPRIL 12,5 MG
305 NIK : 3212026005690002 AMLODIPIN 10 MG
SUTINIH, NY (P) JL RWA SENGON BLOK A J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
306 NIK : 3212025003850009 MG
DEFFANI ERFIYANA (P) JL RAWA SENGON 001/022 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
307 NIK : 3172025503031002 RANITIDIN 150 MG
ALFIAN NUR KHOLIFAH (L) KAYU MAS UTARA 07/09 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
308 NIK : 3305212710120002 MG
MUHAMAD PAHLEPI (L) JL. KAYUMAS UTARA H65.2 - Chronic serous otitis media PARASETAMOL TAB 500 MG
No. RM : 01-087409 BPJS : 0002479814447 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 106 dari 1322

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MUHAMAD DIANDRA KURNIAWAN, AN (L) JL PGS II A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN SUSPENSI
Tgl Lahir : 08-Dec-2017 ( 1 Thn 9 Bln 1 Hr ) J02.9 - Acute pharyngitis, unspecified TRIMETOPRIM 40 MG)
310 NIK : 3172060812170005
DEKSAMETASON 0,5 MG
MG
ZINC 20 MG
GARAM ORALIT KOMBINASI
SARIPAH (P) PEGANGSAAN DUA 01/04 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
No. RM : 01-038885 BPJS : 0000378477731 MCG
HANIFAH, AN (P) JL PGS II RT 001/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
312 NIK : 3172065711121003 MG
Tgl Diagnosis : 13 February 2019 10:22 PM AMBROKSOL SYR 15MG/5ML 60 ML
NUR FATMAHWATI AN (P) JL H OYAR RT 3/2 NO 77 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
313 NIK : 3172067105131001 MG
DIAN ALVI WILDAH, AN (P) H OYAR RT 03/02 A09 - Diarrhoea and gastroenteritis of PARASETAMOL SYR 120 MG/5 ML
Tgl Lahir : 03-Dec-2016 ( 2 Thn 9 Bln 6 Hr ) J18.0 - Bronchopneumonia, unspecified
314 NIK : 3172064312160002 MG
No. RM : 01-055769 BPJS : 0002099834774 SALBUTAMOL 2 MG
AMBROKSOL TAB 30 MG
ZINC 20 MG
2019-09-09 13:37 Hal. 107 dari 1322

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FEBBY AVRILLA (P) JL MANDOLIN 11 KAV 91 RT 14/7 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
EKO CAHYOMO, TN (L) JL KELAPA LILIN 4 NG 8 NO 1 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
ANTASIDA DOEN
SALMA NOOR SEPTIYANI, AN (P) RAWASENGON 06/22 L02.9 - Cutaneous abscess, furuncle and PARASETAMOL SYR 120 MG/5 ML
carbuncle, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-061390 BPJS : 0002332708198 MG
MUHAMMAD SHOHIBI SYAFAAT, AN (L) TANAH MERAH RT 9 RW 7 L50.0 - Allergic urticaria RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-045224 BPJS : 0002247284351 MG
ANI ROHANI, NY (P) JL H. OYAR RT 002/002 PGS II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-001319 BPJS : 0001774437862 MG
KOISAH, ny (P) KP TNH MERAH J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-053119 BPJS : 0001648552691 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 108 dari 1322

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AMOKSISILIN 500 MG
AIDIL ARIF HIDAYAH, AN (L) JL AGUNG UTARA 6D J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
ADNAN HALIM, AN (L) BCS RAYA BI 04-06 PGS II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
322 NIK : 3172061705080002 MG
VICTOR ARIE ANTONI LENZUN, TN (L) JL.WESEL A/16 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEWI RACHMAWATI, NY (P) JL WESEL BLOK A/6 RT 06/010 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
KUSYANTO, TN (L) JANUR ELOK V QB 15/2 A69.0 - Necrotizing ulcerative stomatitis RETRIBUSI LAYANAN SIAGA 24 JAM
J02.9 - Acute pharyngitis, unspecified BORAK GLYSEROL 5% LARUTAN
NASYWA SAKHA PUTRI, AN (P) JLN GADING RAYA 11 RT 01/05 KGB J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 109 dari 1322

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AMOKSISILIN 500 MG
RYAN SURYA SUHANDI (L) JL BARONG N0 10 RT 006/07 KGT A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin SIPROFLOKSASIN 500 MG
MG TAB
INJEKSI (UGD)
KETOROLAC INJEKSI 30 MG/ML
NELA MELANIA, AN (P) PGSN I RT 005/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
328 NIK : 3304036112070001 MG
MAERIOCE LATUPEIRISSA (P) TANAH MERAH RT06/022 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-007153 BPJS : 0001289119893 MG
ANTASIDA DOEN
ROHMAT, TN (L) JL KLP LILIN BLOK NC 8 NO 8 M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
DEKSAMETASON 0,5 MG
No. RM : 01-077390 BPJS : 0000796153555
MUHAMAD NURHADI (L) JL TANAH MERAH RT 06/07 K30 - Dyspepsia RANITIDIN 150 MG
ANTASIDA DOEN
2019-09-09 13:37 Hal. 110 dari 1322

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AIRIN SUHARDINI, NY (P) RT003/03 PEGANGSAAN DU J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
332 NIK : 3172025701830012 MG
RIZKI FAUZI (L) KP SUKAPURA J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
333 NIK : 3172041203960010 MG
AMOKSISILIN 500 MG
NURLAELA, NY (P) JL BCS GG N NO.58 003/005 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
334 NIK : 3175024808871001 MG
AMOKSISILIN 500 MG
AMLODIPIN 10 MG
FANNY SOEGIANTO (P) PELEPAH INDAH RAYA LB 24/26 K30 - Dyspepsia ANTASIDA DOEN
335 NIK : 3172064808650001 RANITIDIN 150 MG
No. RM : 01-011439 BPJS : 0001439936357
ECI DERAWATI, ny (P) JL BCS RT 4/5 A09.9 - GASTROENTERITIS AND COLITIS KOMBINASI KAOLIN 550 MG, PEKTIN 20
OF UNSPECIFIED ORIGIN MG TAB
Tgl Lahir : 13-Sep-1985 ( 33 Thn 11 Bln 27 Hr ) ANTASIDA DOEN
336 NIK : 3328074705890003
JAMALUDIN, TN (L) JL INSP KALI SUNTER RT 05/013 I21.9 - Acute myocardial infarction, ASAM ASETILSALISILAT 80 mg
unspecified (ASETOSAL)
337 NIK : 3172060507710005
No. RM : 01-075335 BPJS : 0000378177805
2019-09-09 13:37 Hal. 111 dari 1322

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MEZAYA REZKI (L) JL. KOMP HII BLK C NO.13 003/005 H61.2 - Impacted cerumen FENOL GLISEROL TT 10%
KGT
338
No. RM : 01-020170 NIK : 3172060507111005
IAN KURNIAWAN RAMADHAN (L) JL GADING GRIA LESTARI JL Z48.9 - Surgical follow-up care, unspecified AMOKSISILIN 500 MG
CEMPAKA I BLOK E 2 NO 7 ASAM MEFENAMAT KAPS 500
339 TOILET MATA / WOUND TOILET
No. RM : 01-087644 NIK : - LEPAS HECTING
RITAWATI NATADJAJA, NY (P) JL PERMATA BIRU BLK I 2/2 002/002 L02.9 - Cutaneous abscess, furuncle and AMOKSISILIN 500 MG
carbuncle, unspecified GENTAMISIN SALEP KULIT
No. RM : 01-008434 BPJS : 0001260215651
JAYA GUNAWAN YANTO (L) JL GADING UTARA III NH V NO 6 J18.90 - COMMUNITY ACQUIRED RETRIBUSI LAYANAN SIAGA 24 JAM
PNEUMONIA SIPROFLOKSASIN 500 MG
No. RM : 01-086983 BPJS : 0001795799597 MG
AMBROKSOL TAB 30 MG
NUR LAILA AGUSTINA .AN (P) RAWA SENGON RT008/22 KGB J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
No. RM : 01-019181 BPJS : 0001313671577
MEISYA KANZA SAPUTRI (P) JL RAWA INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
ARIE PALUPI (P) DUKUH ZAMRUD RT 009/012 R60.0 - Localized oedema NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
344 NIK : 3275115310840001
No. RM : 01-028701 BPJS : 0001623366922
2019-09-09 13:37 Hal. 112 dari 1322

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AQILA NISHA HASANAH (P) JL RAWA SENGON BLOK I A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
SRI SURIANI (P) APT PALADIAN PARK TWR F 502 RT K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
04/020 RANITIDIN 150 MG
346 ANTASIDA DOEN
No. RM : 01-013761 NIK : 3173064608360002
B. SOEROSO, TN (L) PENYENGAT RAYA NO 6 RT 2/3 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
L29.8 - Other pruritus HIDROKLORTIAZID 25 MG
No. RM : 01-008337 BPJS : 0000045887938 MG
RIZKI KUSUMA PRASETIYANTO (L) JL. H. OYAR NO 03 RT 04/04 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MULYADI, TN (L) JL RAYA PEGANGSAAN DUA RT 05/02 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
AMOKSISILIN 500 MG
AMLODIPIN 10 MG
CIOE LEH CU, NY (P) KELAPAMPUAN TIMUR III NP 4/30 RT I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
10/12 AMLODIPIN 10 MG
No. RM : 01-009757 NIK : 3172066709450002 RANITIDIN 150 MG
2019-09-09 13:37 Hal. 113 dari 1322

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FAUZAN RAMADHAN, AN (L) KP RW INDAH RT 006/003 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN SUSPENSI
Tgl Lahir : 08-Jun-2016 ( 3 Thn 3 Bln 1 Hr ) TRIMETOPRIM 40 MG)
351 NIK : 3172060806160004
No. RM : 01-018780 BPJS : 0002295925064 ZINC 20 MG
Tgl Diagnosis : 16 February 2019 9:51 AM GARAM ORALIT KOMBINASI
ASMAROH BT ASMAT, NY (P) RAWA INDAH RT 6/3 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 05-Dec-1950 ( 68 Thn 9 Bln 4 Hr ) SIPROFLOKSASIN 500 MG
352 NIK : 3172064512590002
No. RM : 01-009850 BPJS : 0001225768408
RAMA PRATAMA (L) PEGANGSAAN DUA SIMPONI VI B01.9 - Varicella without complication ASIKLOVIR 400 MG
353 NIK : 1602132603000001 ASIKLOVIR KRIM 5%
No. RM : 01-087652 BPJS : 0000989676088
NUR RIZKA FITRIANA,AN (P) JL KOMPLEK PT HII RT 06/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
354 NIK : - MG
SAVIRA, NN (P) JL. PUSPA GADING BLOK A-1 NO. 38 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MULTIVITAMIN DEWASA
No. RM : 01-045919 BPJS : 0001432594541
MICHAELA IRENE GRACIA PANJAITAN (P) JL PERUM PEMDA BLOK C 4 NO 18 RT J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
001/011 AMBROKSOL TAB 30 MG
Tgl Diagnosis : 16 February 2019 10:09 AM BPJS : 0001900082485 MG
2019-09-09 13:37 Hal. 114 dari 1322

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AGUSTINI, NY (P) JL PROYEK SUKAPURA A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
presumed infectious origin RANITIDIN 150 MG
Tgl Diagnosis : 16 February 2019 10:12 AM MG TAB
ANTASIDA DOEN
MUHAMMAD ABQORI RUNAKO ARSENIO JL PEPAYA I NO 22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-087655 BPJS : 0002507214947 MG
AMBROKSOL TAB 30 MG
NADINE PUTRI SALSABILA, AN (P) KOMP PLN BLK E NO.98 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
No. RM : 01-041499 BPJS : 0001225769174 MG
AMBROKSOL TAB 30 MG
NURUL ANISA (P) KP BOGOR Z00.0 - General medical examination

360 NIK : 3216014508960003
No. RM : 01-087657 BPJS : 0001841412431
SUMARDI, TN (L) KP BOGOR RT 01/10 BEKASI I10 - Essential (primary) hypertension KAPTOPRIL 25 MG
361 NIK : 3216013011650003 RUJUKAN
No. RM : 01-025203 BPJS : 0001841411608
YAYAT ISMAWAN (L) KP. RAWA INDAH Z03.0 - Observation for suspected RETRIBUSI LAYANAN SIAGA 24 JAM
tuberculosis AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 115 dari 1322

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YUSAK ADRIAN ALFONZ RAHARJA, TN (L) JL KELAPA NIAS VI PB-13/12 Z03.0 - Observation for suspected AMOKSISILIN 500 MG
tuberculosis DEKSAMETASON 0,5 MG
No. RM : 01-087658 BPJS : 0001633697267
SILVIA KOSWARA, AN (P) KP TANAH MERAHRT 03/08 NO 30D J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
ROSI V HARIANJA, NN (P) JL. GOTONG ROYONG TNH MERAH J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
ATAS 009/007 KLORFENIRAMIN MALEAT (CTM) TAB 4
365 MG
Tgl Diagnosis : 16 February 2019 10:35 AM BPJS : 0001172351068 AMOKSISILIN 500 MG
GAVRIEL THEODORE KRISTIYAN, BY (L) KELAPA GADING TIMUR 03/04 J18.0 - Bronchopneumonia, unspecified PARASETAMOL DROP 60 MG/0,6 ML
366 NIK : - MG
ANGGITA FEBRIYANY (P) JL KELAPA SAWIT II BLOK II NO 08 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-034668 BPJS : 0001278045461 MG
AMBROKSOL TAB 30 MG
SUPARLIN SIBARANI, TN (L) JL SUNGAI KAMPAR 10 TERUSAN NO A15.0 - Tuberculosis of lung, confirmed by
22 sputum microscopy with or without culture
368
No. RM : 01-075196 NIK : 3172040611770015
2019-09-09 13:37 Hal. 116 dari 1322

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RESINI, NY (P) KELAPA HIBRIDA V RB 11 / 11 E11.9 - Non-insulin-dependent diabetes RETRIBUSI LAYANAN SIAGA 24 JAM
mellitus without complications PIROKSIKAM 10 MG
Tgl Lahir : 07-Jan-1967 ( 52 Thn 8 Bln 2 Hr ) I10 - Essential (primary) hypertension
No. RM : 01-006986 BPJS : 0001207693765 M79.1 - Myalgia METFORMIN TAB 500 MG
Tgl Diagnosis : 16 February 2019 10:55 AM AMLODIPIN 5 MG
ALI ZAINUL MUTTAQIN, AN (L) RAWA INDAH 02/03 L01.0 - Impetigo [any organism] [any site] PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-042829 BPJS : 0002260573086 MG
GRACE NATALIN TJIETRA (P) JL. APRT GD NIAS TWR D BLK X LG J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
No. RM : 01-056978 BPJS : 0001468264059 MG
AMBROKSOL TAB 30 MG
MASRINI, NY (P) JLN BCS RT 05/06 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
No. RM : 01-011583 BPJS : 0001450519762 MCG
RD SRI YUNISAPTA MULIAWATI, NY (P) JL PULAU REMPANG III NO 20 RT J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
373 MG
MUHAMMAD RAIHAN DAENG M, AN (L) KMP SUKAPURA GG SALIN RT 009/003 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Diagnosis : 16 February 2019 11:24 AM BORAK GLYSEROL 5% LARUTAN
2019-09-09 13:37 Hal. 117 dari 1322

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YUSMAWATI (P) KP SUKPURA GG SALON 009/003 R60.0 - Localized oedema RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-020323 BPJS : 0001313660801
KUNI, NY (P) JL DEMAK BLOK M5/24 SUKAPURA O26.9 - Pregnancy-related condition,
unspecified
376 NIK : 329226005910003
No. RM : 01-079106 BPJS : 0002743163649
ACHMAD MAULANA RAHMANSYAH (L) JL PSR IMPRES 006/006 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMBROKSOL TAB 30 MG
PUPUT NURHAYATI (P) LABUHAN RATU III LAMPUNG TIMUR K30 - Dyspepsia RANITIDIN 150 MG
378 NIK : - ANTASIDA DOEN
MOH SAEPULLOH (L) JL H OYAR J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
No. RM : 01-027551 BPJS : 0001225558539 MG
AMBROKSOL TAB 30 MG
YANI (P) P KEMERDEKAAN RT 011/04 K12.1 - Other forms of stomatitis ASAM ASKORBAT (VITAMIN C) 50 MG
VITAMIN B KOMPLEKS
380 NIK : 3172066504620003 BORAK GLYSEROL 5% LARUTAN
2019-09-09 13:37 Hal. 118 dari 1322

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EDI WALUYO (L) JLN LESTARI 10 NO 34 RT 04/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
No. RM : 01-011011 BPJS : 0002036032672 MG
SUNENCIH (P) KAMPUNG RAWA INDAH RT 04/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
382 NIK : 32120351119000001 MG
M ABBAS JANUAR (L) PGS II RT 4/3 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
No. RM : 01-013363 BPJS : 0001965529001 MG
AMBROKSOL TAB 30 MG
ZASKIA RENA YULIANTI (P) JL KP WARUNG JENGKOL J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
ROBBY RIEDIV KIERNADI (L) JL. GGL BLOK B 3 NO 57 B07 - Viral warts AMOKSISILIN 500 MG
No. RM : 01-043642 BPJS : 0001805868448
2019-09-09 13:37 Hal. 119 dari 1322

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MARIA VERONICA HILMI (P) PELEPAH RAYA WU 1 / 4 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
GO TJUN HONG (P) JL KACA KACA BUNTU NO 49 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-086830 BPJS : 0001828840026 MG
DEKSAMETASON 0,5 MG
GO TJIOE LAN (P) JL KACA KACA BUNTU NO 49 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 10-Oct-1934 ( 84 Thn 10 Bln 30 Hr ) J02.9 - Acute pharyngitis, unspecified
MG TAB
ANTASIDA DOEN
DAMIA SYAZWINA HALWA (P) JL GADING RAYA II NO.12 001/005 KGB J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-020152 BPJS : 0001880634069 MG
AMBROKSOL TAB 30 MG
Saaharah Putri Hidayat (P) JL PEGANGSAAN DUA RT 03/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
390 NIK : 3172067008121001 MG
GRANT CHRISTIO M TJAHJONO (L) JL KELAPA PUAN TIMUR VI NB 6/24 RT S81.8 - Open wound of other parts of lower INJEKSI (UGD)
06/12 leg RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 120 dari 1322

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MCG
SAA QIRAH PUTRA HIDAYAT (P) JL PEGANGSAAN DUA RT 03/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
392 NIK : 3172065802170005 MG
JULIANA SAFITRI (P) JL TPI BLOK A31 B35.4 - Tinea corporis KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
393 NIK : -
No. RM : 01-087668 BPJS : 0002332733815 KETOKONAZOL 200 MG
Tgl Diagnosis : 16 February 2019 2:08 PM MIKONAZOL KRIM 2 %
SANTY WHANOWATY, NY (P) JL PULAU JAGA UTARA BLOK E 15/9 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
RT 15/03 KGB PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
ALOPURINOL 100 MG
NATRIUM DIKLOFENAK TAB 25 MG
JOHANIS RANDAN DUAPADANG SE, TN (L) JL PULAU JAGA UTARA BLOK E 15/9 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
RT 15/03 KGB DEKSAMETASON 0,5 MG
395 MULTIVITAMIN DEWASA
NAZWA AMEERA RAMADHANY .AN (P) RAWA INDAH 003/003 J03.9 - Acute tonsillitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 121 dari 1322

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BAMBANG NURDIANSYAH (L) JL RAWA IONDAH RT 007/003 K30 - Dyspepsia RANITIDIN 150 MG
No. RM : 01-004964 BPJS : 0001286557266 RUJUKAN
MUHAMAD EKI BALDIANSYAH (L) JL RAWA IDAH J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
No. RM : 01-087669 BPJS : 0001286558572 MG
ANTASIDA DOEN
EFI FARIDA (P) KP RAWA INDAH RT 3/3 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-041850 BPJS : 0001157319437
AYI S (L) JL TANAH MERAH no 029 / RM SARI K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
LAUT RANITIDIN 150 MG
400 DOMPERIDON TAB 10 MG
No. RM : 01-057054 NIK : 3203202406870002 ANTASIDA DOEN
FATIHA ZIKRA MULYANA, BY (P) GADING SENGON 9 RT 03/022 KGB A09 - Diarrhoea and gastroenteritis of DOMPERIDON SUSP 5 MG/5 ML
presumed infectious origin AMOKSISILIN SYR KERING 125 MG/5ML
401 NIK : 3172065807180001
No. RM : 01-074159 BPJS : 0002474674762
MUHAMMAD ALI, TN (L) JL H OYAR .004/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 122 dari 1322

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MUHAMMAD HAIDAR, AN (L) JL CEKATAN II NO 52 RT 01/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
RAZIEQ HANAN, AN (L) JL SENTOSA 2 NO 20 RT 9/10 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
No. RM : 01-064505 BPJS : 0002419821832 MG
CLARA AURELIA SETIADY (P) PELEPAH KUNING 2 WT 2 NO 02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
405 NIK : 3172066808050001 MG
MARSHANDRA ADELIA PUTERI (P) KOMP PERUMAHAN HI NO B48 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
406 NIK : - MG
MUHALIH (L) RAWA INDAH J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
407 NIK : 3172061507730002 MG
SYLVIA SULISTIO (P) JL JANUR ASRI VI QK RT 13/22 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 123 dari 1322

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ALISHA ZAHIRAH, AN (P) KOMP WALI KOTA JL MURAI I BLOK G3 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
NO 20 AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-085520 NIK : 3172046608111014 MG
AMBROKSOL TAB 30 MG
SUKARMIATI, NY (P) JL PULO REMPANG III NO 22 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
ALMIRA NAJLA, AN (P) JL H OYAR RT 1/2 PGS II J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
411 NIK : 3172064210131001 MG
SERIANNA GIRSANG, NY (P) JL PUTIH SALJU D 5 NO 11 R51 - Headache PIROKSIKAM 10 MG
412 NIK : 317206484610003 MCG
FITRIAHNINGRUM SARI (P) JL SMA 45 KGT I H60.8 - Other otitis externa FENOL GLISEROL TT 10%
H61.2 - Impacted cerumen ASAM MEFENAMAT KAPS 500
SUNIATI, NY (P) KP RAWA INDAH RT 02/03 I10 - Essential (primary) hypertension PIROKSIKAM 10 MG
M79.17 - Myalgia, ankle and foot DEKSAMETASON 0,5 MG
No. RM : 01-007828 BPJS : 0001225673289 MCG
2019-09-09 13:37 Hal. 124 dari 1322

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ANGGI RACHMA CIPTA RAMADHANI, NN (P) JL RAWA SENGON BLOK A RT 01/022 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMBROKSOL TAB 30 MG
KHAYLA ALMIRA MARITZA (P) RW SENGON RT 1/22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
MG
DJURIAH, NY (P) PEGANGSAAN DUA RT 02/04 S81.8 - Open wound of other parts of lower RETRIBUSI LAYANAN SIAGA 24 JAM
leg AMOKSISILIN 500 MG
Tgl Diagnosis : 19 February 2019 6:10 PM SPALK KECIL (UGD)
TAMBAHAN HECTING (4 DST)
TOILET MATA / WOUND TOILET
PETTY PRATIWI UGUY, NN (P) JL BONGO IV BLOK J/4 RT 04/08 J03.9 - Acute tonsillitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
No. RM : 01-050864 BPJS : 0002332715264
WITA SITI HERLIYANTI, NY (P) JL GADING IV NO 5 RT 03/05 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-010831 BPJS : 0001224131196 MCG
IROH SITI ROHAENI, NY (P) JL PULO NANGKA RT 06/16 N39.0 - Urinary tract infection, site not RETRIBUSI LAYANAN SIAGA 24 JAM
specified SIPROFLOKSASIN 500 MG
No. RM : 01-008551 BPJS : 0001788551425
2019-09-09 13:37 Hal. 125 dari 1322

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RULIYANTO, AN (L) JL KOMPI UDIN Z03.0 - Observation for suspected AMBROKSOL TAB 30 MG
tuberculosis DEKSAMETASON 0,5 MG
421 NIK : 3212261407030003
No. RM : 01-087509 BPJS : 0002332913422
TINNEKE HADIATI SUHELI, NY (P) JL KELAPA LILIN X BLOK NI - 9 / 10 RT M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
30/12 DEKSAMETASON 0,5 MG
No. RM : 01-007004 NIK : 3172066712670005 MCG
LIEM RONNY SUHENDRO, TN (L) JL KLAPA LILIN X BLOK NI 8/10 J02.9 - Acute pharyngitis, unspecified ASAM ASKORBAT (VITAMIN C) 50 MG
DEKSAMETASON 0,5 MG
423 NIK : 3172062701640004
No. RM : 01-029552 BPJS : 0001307669354
MUHAMMAD AHDA ALFIAN MAUZA, AN (L) GG PERINTIS I NO 67 K41.9 - Unilateral or unspecified femoral RETRIBUSI LAYANAN SIAGA 24 JAM
hernia, without obstruction or gangrene PARASETAMOL SYR 120 MG/5 ML
424 NIK : -
No. RM : 01-052136 BPJS : 0002283219371
MICHAEL PANDU ATMOJO, TN (L) JL. CAMAR PULOMAS I10 - Essential (primary) hypertension KAPTOPRIL 12,5 MG
No. RM : 01-077873 BPJS : 0002136576587 MCG
SAHAT HAMONANGAN MUNTHE, TN (L) RW SENGON BLOK E RT 5/22 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
426 NIK : 3172031001630016 MG
AMLODIPIN 10 MG
LUTFI HAKIM ARIJO, AN (L) TANAH MERAH RT 02/06 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
427 NIK : 3172031802121009 MG
2019-09-09 13:37 Hal. 126 dari 1322

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UMBARWATI (P) TANAH MERAH RT005/007 K05.0 - Acute gingivitis AMOKSISILIN 500 MG
428 NIK : 3172034506651001 RANITIDIN 150 MG
CHALISTA DWI PUTRI, AN (P) JL TEGUH VII NO 81 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
429 NIK : 3172065308050001` AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
RITA YUNINGSIH (P) JL. MERAH DELIMA B 3 NO 11 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
SALBUTAMOL 2 MG
TRISTAN SAVIER OXAZE, AN (L) KP RAWA SAWAH NO 2 RT 4/ 2 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
431 NIK : 3171080606131004 MG
SALBUTAMOL 2 MG
M ILYAS HARDIYANTO, AN (L) JL SIMPONI V RT 10/08 H11.3 - Conjunctival haemorrhage

432 NIK : -
No. RM : 01-049268 BPJS : 0000378850724
ROSITA (P) JL SIMPONI MAS V RT 10/08 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
433 NIK : 3172065807840007 MG
ANTASIDA DOEN
2019-09-09 13:37 Hal. 127 dari 1322

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TITIEK DIANANINGRUM, NY (P) JL KELAP LILIN 9 NI 6 NO 15 M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
434 NIK : 3172064506430003 MG
MARIO STEPHANUS AGUS P.S (L) JL. KELAPA LILIN 6/15 030/012 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
435 NIK : 3172061508790004 MCG
ANATASIA SRI HARTATI, NY (P) JL, SWADAYA NO:51B,RT005/RW006 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
TOGU MARPAUNG, TN (L) JL YAPONG NO.15 003/006 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
RANITIDIN 150 MG
ASINAH BT NUSIN (P) JL. PGS II RT J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMBROKSOL TAB 30 MG
No. RM : 05-001841 BPJS : 0000377705744 MG
SUPRATMANTO, TN (L) JL PERJUANGAN 3 RT 3/4 H00.0 - Hordeolum and other deep ASAM MEFENAMAT KAPS 500
inflammation of eyelid DEKSAMETASON 0,5 MG
No. RM : 01-036032 BPJS : 0000659596588 KLORAMFENIKOL 1 % SM
MUHAMMAD RADITYAS, AN (L) KGT RT 3/4 J45.9 - Asthma, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
SALBUTAMOL 2 MG
2019-09-09 13:37 Hal. 128 dari 1322

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AMOKSISILIN 500 MG
SAMARIA SIBURIAN, NY (P) JL YAPONG NO.15003/006 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
ABOCATH NO24
MG
RAOKAH, NY (P) JL RAWA SENGON BLOK G RT 07/022 L30.9 - Dermatitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
442 NIK : 3172066203751001 MG
ANDRA SETIANTO, AN (L) JL RAWA SENGON RT 07/22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
R MESTERJAN AGUS KARNO (L) JL CIPINANG BESAR SELATAN RT J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
13/01 JL PANCAWARGA DEKSAMETASON 0,5 MG
No. RM : 01-045085 NIK : - ASAM ASKORBAT (VITAMIN C) 50 MG
NIKE INDRIYANI (P) JL KOMPI UDIN RT 06/05 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
ANTASIDA DOEN
445 NIK : 332808500501001 RANITIDIN 150 MG
NUNING, NY (P) JL PEGANGSAAN DUA RT 04/02 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
446 NIK : 3172065010630001 RANITIDIN 150 MG
2019-09-09 13:37 Hal. 129 dari 1322

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OKI ISWANTO, TN (L) JL PEGANGSAAN DUA RT 04/02 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 18-Sep-1993 ( 25 Thn 11 Bln 22 Hr ) K30 - Dyspepsia RANITIDIN 150 MG
447 NIK : -
MG
DEKSAMETASON 0,5 MG
ROHMAN, TN (L) JL SUMAGUNG III T78.4 - Allergy, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 06-May-1990 ( 29 Thn 4 Bln 3 Hr ) DEKSAMETASON 0,5 MG
448 NIK : 3302130605900001
WINDA ANDRIYANI (P) JL PGS II 004/001 J02.9 - Acute pharyngitis, unspecified ANTASIDA DOEN
NUR HOLIS, TN (L) JL. PGS II RT 04/01 B35.4 - Tinea corporis KETOKONAZOL 200 MG
450 NIK : 3172061402830007 MG
ARIQAH ZAHRATUN NISA (P) JL PULO NANGKA BARAT II RT 04/016 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DISTRINOVA, NY (P) JL RAWA INDAH RT 04/03 L02.1 - Cutaneous abscess, furuncle and RETRIBUSI LAYANAN SIAGA 24 JAM
carbuncle of neck AMOKSISILIN 500 MG
Tgl Diagnosis : 19 February 2019 9:54 PM SIANOKOBALAMIN (VITAMIN B12) 50
MCG
2019-09-09 13:37 Hal. 130 dari 1322

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HANDOKO ANGGARA BAYU M (L) JL. RAWA INDAH 004/003 J03.9 - Acute tonsillitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DELINA WIDITYA (P) JL PGS II 003/002 NO.76 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
454 NIK : - DOMPERIDON TAB 10 MG
TARTI, NY (P) JL BANGUN CIPTA SARANA RT 04/05 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
GG L DEKSAMETASON 0,5 MG
AISYAH RAMADHANI (P) KOMP BEA CUKAI JL. TOBA BLK. D7 L02.9 - Cutaneous abscess, furuncle and RETRIBUSI LAYANAN SIAGA 24 JAM
NO. 22 RT. 010/007 SUKAPURA carbuncle, unspecified AMOKSISILIN 500 MG
OBH SIRUP 100 ML
WAODE MARDIAH, NY (P) JL. PELANGI RT 06 RW 10 KGT H81.1 - Benign paroxysmal vertigo PIROKSIKAM 10 MG
457 NIK : -
No. RM : 02-000768 BPJS : 0001226057578
2019-09-09 13:37 Hal. 131 dari 1322

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ADHISTY PUJI LESTARI (P) JL PELANGI B1 NO 37 RT 6/10 J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
OBH SIRUP 100 ML
458 NIK : 3172065210910001
No. RM : 01-057016 BPJS : 0001226057591
HASBY NIZAR RAMADHAN (L) KAYUMAS UTARA 06/09 NO.10 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-010364 BPJS : 0001207533756 OBH SIRUP 100 ML
MG
RICKY KURNIADI (L) KP BEND BETIK NO. 78 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
460 NIK : - PARASETAMOL TAB 500 MG
No. RM : 01-087997 BPJS : 0001225346095 BORAK GLYSEROL 5% LARUTAN
MCG
JOSHUA PHOENG, TN (L) JL. KLP NIAS VII PB 16 NO 5 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
ANTASIDA DOEN
IRENE LIERA (P) JL JANUR INDAH VII LB 6/3 RT 5/18 J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
No. RM : 01-032796 BPJS : 0001785968605 MCG
KARPUD (L) KP TARAJU J03.9 - Acute tonsillitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-088004 BPJS : 0000792135426 MCG
2019-09-09 13:37 Hal. 132 dari 1322

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JANUAR USWADI, TN (L) JL POLKA 12A RT 5/07 I10 - Essential (primary) hypertension

464 NIK : 3172062501650001
No. RM : 01-035138 BPJS : 0001637741924
NOVADIYAH LESTARI (P) KP PULO GADUNG J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
MG
ANTASIDA DOEN
ARTO SARTONO (L) PGS II RT 06/02 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Lahir : 17-Jul-1961 ( 58 Thn 1 Bln 23 Hr ) TRIMETOPRIM 80 MG)
466 NIK : 3172061110111027
MG TAB
RANITIDIN 150 MG
MUNAWIR, TN (L) KP GUNUNG BATU II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
K30 - Dyspepsia DEKSAMETASON 0,5 MG
WIDAYATI, NY (P) JL PGS II 006/005 K30 - Dyspepsia PARASETAMOL TAB 500 MG
HIOSINA BUTILBROMIDA 10mg
MAI AUDRI (L) JL PGS II 006/005 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
No. RM : 01-042410 BPJS : 0000377462463
2019-09-09 13:37 Hal. 133 dari 1322

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W HERMON BD SUREGAR, TN (L) RGTC BLOK MERANTI NO 203 K30 - Dyspepsia PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
IMELDA M HEUMASSE (P) RW SENGON BLOK D RT 4/22 M15.4 - Erosive (osteo)arthrosis NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
No. RM : 01-021372 BPJS : 0001264789236 MCG
Tgl Diagnosis : 19 February 2019 11:23 PM METRONIDAZOL 500 MG
DAVID LEONARDO AYAL, TN (L) JL RAWA SENGON BLOK D NO 61 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
No. RM : 01-053822 BPJS : 0001264789899 MG
DEKSAMETASON 0,5 MG
ZEKY PIMPIN (L) JL. SIAK A 5 NO 8 L23.7 - Allergic contact dermatitis due to RETRIBUSI LAYANAN SIAGA 24 JAM
plants, except food BETAMETASON 0,1%,KRIM
No. RM : 01-009023 BPJS : 0000905899544 MG
KISATNA LAKANU DZALIKA CANEDI, an (P) HIJAU DAUN D.7/21 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
474 NIK : 3171052309110010 RANITIDIN 150 MG
PRAYITNO, TN (L) PGS2 RT06/02 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
K30 - Dyspepsia KLORFENIRAMIN MALEAT (CTM) TAB 4
475 NIK : 3316123112490064 MG
ANTASIDA DOEN
2019-09-09 13:37 Hal. 134 dari 1322

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MUHAMMAD RASYA AL FATHIR (L) JL KOMPI UDIN RT 06/05 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
MOH, BOHARI (L) TANAH MERAH N39.3 - Stress incontinence ASAM MEFENAMAT KAPS 500
SIPROFLOKSASIN 500 MG
477 NIK : -
No. RM : 01-086528 BPJS : 0001794982779
TAUFIK IMAWAN, TN (L) P TEMIANG III NO 2 RT 13/3 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
No. RM : 01-006859 BPJS : 0001224123085
NANIK PURWANTI (P) P TEMIANG III NO 2 RT 13/3 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMBROKSOL TAB 30 MG
BUDIYANI, NY (P) JL KP RAWA INDAH RT 002/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
No. RM : 01-088009 BPJS : 0002332879626 MG
YUYUN WAHYUNI, NN (P) JL SERDANG BARU RT 8/5 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 135 dari 1322

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CLARISA INDAH SARI, AN (P) JL. RAWA INDAH RT 03/03 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-030664 BPJS : 0002455748469 MG
RATNA WIJAYANTI, NY (P) PGS DUA RT 4/5 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
OBH SIRUP 100 ML
483 NIK : 3275024505890042
No. RM : 05-000732 BPJS : 0001745510477
ALISYAH HANDAYANI,ny (P) JL INSPEKSI X SUNTER RT002/04 KGB Z35.4 - Supervision of pregnancy with grand
multiparity
484 NIK : -
No. RM : 01-054051 BPJS : 0002332793158
M. NAZRIL ALFALARIZKY, AN (L) GG PEJUANG 4 KLP GADING TIMUR J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
485 NIK : 3202090111090001 MG
URSULA YOLANDA HARTANTO, NY (P) JL. JANUR KUNING 6/BLOK WL2/24 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications TIAMIN (VITAMIN B1) 50 MG
486 NIK : 3172064608570001 PIRIDOKSIN (VITAMIN B6) 10 MG
GHIA PUTRI RHAMADANI (P) JL. PASAR INPRES J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
487 NIK : - GLISERIL GUAIAKOLAT (GG) 100 MG
MG
2019-09-09 13:37 Hal. 136 dari 1322

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DZIKRULLAH (L) SUKAPURA GG PANCONG J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-088317 BPJS : 0001774343913 MG
Tgl Diagnosis : 23 February 2019 8:38 AM GLISERIL GUAIAKOLAT (GG) 100 MG
DEKSAMETASON 0,5 MG
AQILLA NUR MEDINA (P) JL H OYAR RT 02/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
MG
ALI ZAINUL MUTTAQIN, AN (L) RAWA INDAH 02/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
490 NIK : - MG
SONYA INTAN SYAHRA, AN (P) JL KAYU JATI V RT 03/05 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-011199 BPJS : 0001831703073 MG
GLISERIL GUAIAKOLAT (GG) 100 MG
ROSMAWARTY (P) APT GADING RESORT RES CITY H10.3 - Acute conjunctivitis, unspecified KLORAMFENIKOL SALEP KULIT
HOUSER BLK E2 /23 Z48.9 - Surgical follow-up care, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
492 MG
No. RM : 01-038278 NIK : - GENTAMISIN SALEP KULIT
BOY PANDALEKE, TN (L) JL BONGO IV BLOK I/4 RT 004/008 I10 - Essential (primary) hypertension KAPTOPRIL 12,5 MG
Z48.9 - Surgical follow-up care, unspecified HIDROKLORTIAZID 25 MG
2019-09-09 13:37 Hal. 137 dari 1322

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TOILET MATA / WOUND TOILET
HOTIJAH (P) JL PGS II 005/002 L30.9 - Dermatitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
494 NIK : 3172064106770001 MG
HALIMAH (P) KP TANAH MERAH RT 012/09 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-038339 BPJS : 0000378922915 MG
MCG
ARIF SETIAWAN MAULANA (L) RAWA SENGON BLOK E RT 05/22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
496 NIK : - MG
ARSYLA LATISHA ZILFA, AN (P) JL. PGS 2 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
K12.1 - Other forms of stomatitis KOTRIMOKSAZOL DOEN SUSPENSI
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 138 dari 1322

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ROHIMAH ,NY (P) JL. TUGU SELATAN 002/007 Z35.4 - Supervision of pregnancy with grand
multiparity
498 NIK : 3202085012840002
No. RM : 01-073395 BPJS : 0001639075342
SULASTRI (P) KOMP UKA BLOK R/82 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
499 NIK : 3212236903800001 KOMBINASI KAOLIN 550 MG, PEKTIN 20
No. RM : 01-041583 BPJS : 0001882686914 MG TAB
DEVISHA QAILASYIFA (P) JL. KOMP UKA BLKMR NO.82 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-055458 BPJS : 0001742269127 MG
FIKY AGHNI QUEEN LESMANA (P) RAWA INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
501 NIK : - MG
Tgl Diagnosis : 23 February 2019 10:21 AM ASAM ASKORBAT (VITAMIN C) 50 MG
NENDEN HARUMSARI (P) RAWA INDAH 006/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
502 NIK : 3171056411901002 MG
Tgl Diagnosis : 23 February 2019 10:25 AM SIPROFLOKSASIN 500 MG
MUHAMMAD FARIS SHIDQI G (L) JL DISCO BLOK Q NO 10 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 139 dari 1322

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FX. TEGUH BUDIONO (L) JL. KLP LILIN VI BLOK NG 12 NO 4 H52.0 - Hypermetropia RETRIBUSI LAYANAN SIAGA 24 JAM
Z00.0 - General medical examination
504 NIK : 3305191401780002
No. RM : 01-035957 BPJS : 0002205790121
YUNUS AHMAD, TN (L) BCS GG N RT 1/5 J02.9 - Acute pharyngitis, unspecified RANITIDIN 150 MG
SYAIFI ALI (L) null J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
DEKSAMETASON 0,5 MG
No. RM : 04-000249 BPJS : 0002141799311 MG
MENTARI PUTRI APRILIANI, BY (P) RW INDAH RT 5/3 L02.9 - Cutaneous abscess, furuncle and RETRIBUSI LAYANAN SIAGA 24 JAM
carbuncle, unspecified AMOKSISILIN 500 MG
No. RM : 01-068793 BPJS : 0002451312663 MG
Tgl Diagnosis : 23 February 2019 10:54 AM GENTAMISIN SALEP KULIT
JONES SIMBOLON, TN (L) KP PULO GADUNG GG L RT 04/05 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications GLIBENKLAMIDA 5 MG
No. RM : 01-021926 BPJS : 0001827709705 MCG
FARIZ KENZIE HAMIZAN, AN (L) PGS II RT 03/01 J03.9 - Acute tonsillitis, unspecified PARASETAMOL SYR 120 MG/5 ML
509 NIK : 3172062901160001 MG
RENATA CHRISTIE EKEL, AN (P) JL ACORDIAN W1 NO 11 A09 - Diarrhoea and gastroenteritis of PARASETAMOL SYR 120 MG/5 ML
presumed infectious origin KOTRIMOKSAZOL DOEN SUSPENSI
2019-09-09 13:37 Hal. 140 dari 1322

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DARYUMI (P) JL. SUKAPURA RT 05/010 M54.57 - Low back pain, lumbosacral region NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
No. RM : 01-057352 BPJS : 0000518003188 MCG
PUTRI ANJANI, AN (P) KP RAWA INDAH 4/3 NO 8 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-011266 BPJS : 0001225712496 MG
Tgl Diagnosis : 23 February 2019 11:13 AM OBH SIRUP 100 ML
DEKSAMETASON 0,5 MG
NADILA ARUM NURAINI (P) JL RAWA INDAH RT 04/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
FADHLY FIRMANSYAH (L) JL. PEJUANG II J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-086750 BPJS : 0001772310611 MG
DEKSAMETASON 0,5 MG
ABD RAHMAT (L) JL H OYAR Z48.9 - Surgical follow-up care, unspecified TOILET MATA / WOUND TOILET
AMOKSISILIN 500 MG
RIDWAN SONDA TAYANG (L) JL. JANUR ELOK II BLOK IB NO.9 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
516 NIK : - MG
Tgl Diagnosis : 23 February 2019 12:07 PM GLISERIL GUAIAKOLAT (GG) 100 MG
AMOKSISILIN 500 MG
ANTASIDA DOEN
2019-09-09 13:37 Hal. 141 dari 1322

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RANITIDIN 150 MG
MOHAMAD DZAKKI PRATAMA (L) TANAH MERAH RT 01/077 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
Tgl Diagnosis : 23 February 2019 12:12 PM ANTASIDA DOEN SUSPENSI
WIWIT INDRIYANI, NY (P) GG BERKAH RT 06/07 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
R51 - Headache ASAM MEFENAMAT KAPS 500
518 NIK : 3172036905931003 RANITIDIN 150 MG
No. RM : 01-006589 BPJS : 0001224170335 ANTASIDA DOEN SUSPENSI
FARIDA, NY (P) JL GADING VII NO 1 RT 05/05 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Diagnosis : 23 February 2019 12:19 PM MG TAB
TRIMETOPRIM 80 MG)
NADILLA ANANDA (P) RAWA SENGON 03/22 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
MG
ANTASIDA DOEN
SAFFA PUTRI NURHIDAYATULLAH (P) JL. SIMPONI MAS VI RT 010/008 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
MG
2019-09-09 13:37 Hal. 142 dari 1322

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SUKMANATA JAYAWIJAYA, TN (L) JL GADING VII NO 1 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
MCG
REYHAN ASTI RAHMATULOH (L) JL RAWA SENGON BLOK C RT 003/022 K30 - Dyspepsia PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-001270 BPJS : 0001278051164
PUTRA SETIAWAN, AN (L) SUKAPURA JAYA RT 05/10 J03.9 - Acute tonsillitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
SUPARNO, TN (L) KP SUKAPURA JAYA RT 05/010 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
ANTASIDA DOEN
No. RM : 01-046134 BPJS : 0001289942561
KURNIAWAN (L) null Z48.9 - Surgical follow-up care, unspecified TOILET MATA / WOUND TOILET

526 NIK : 3172062207770005
No. RM : 01-080640 BPJS : 0001673783583
KIM REYNAND (L) JL.RAYA PERJAUNGAN 02/07 TNH J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MERAH PARASETAMOL SYR 120 MG/5 ML
MG
2019-09-09 13:37 Hal. 143 dari 1322

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SALBUTAMOL 2 MG
GRACIA VERONICA SAYOU (P) RT005/003 RW INDAH PGSN II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
528 NIK : 3172066411091002 MG
ANNISA DINDA HUMAIRAH (P) RAWASENGON 09/22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-063861 BPJS : 0002617110819 MG
BRYAN GO, AN (L) GADING MEDITERANIA RESIDENCE J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
TOWER A 15AA AMOKSISILIN 500 MG
No. RM : 01-012243 NIK : 3172012503151009 MG
ANISA FATINA YUMNA, AN (P) GD RAYA I/8 RT 01/05 K04.0 - Pulpitis PARASETAMOL SYR 120 MG/5 ML
531 NIK : 3172066708151003 MG
MARTHA RISTA SIMBOLON (P) JLN RAWA SENGON BLK B NO.83 RT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-045469 NIK : - DOMPERIDON TAB 10 MG
2019-09-09 13:37 Hal. 144 dari 1322

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MERRY SITUMORANG (P) RAWA SENGON RT 02/22/ NO 183 H81.1 - Benign paroxysmal vertigo ASAM MEFENAMAT KAPS 500
ANTASIDA DOEN
No. RM : 01-014285 BPJS : 0001281552592 MCG
HARYONO (L) NAGOMI RESTORAN J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
534 NIK : 3273200607700007 GLISERIL GUAIAKOLAT (GG) 100 MG
WONG OI JUNG (P) GADING NIRWANA BLOK PF 2/9 RT J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
535 SIMVASTATIN 10 MG
WIJAYA RAIS LAY (L) GADING NIRWANA BLOK PF 2/9 RT J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
08/23 K30 - Dyspepsia GLISERIL GUAIAKOLAT (GG) 100 MG
RANITIDIN 150 MG
RIYANTO, TN (L) RAWASENGON 08/22 Z48.9 - Surgical follow-up care, unspecified TOILET MATA / WOUND TOILET
537 NIK : 330512804840006
No. RM : 01-052720 BPJS : 0000541503224
ZAINUR LATIEF FULQOBIR (L) JL. RAWA INDAH J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Diagnosis : 23 February 2019 2:07 PM ASAM ASKORBAT (VITAMIN C) 50 MG
ABIZAR AL GHIFARI, AN (L) JL. PEGANGSAAN DUA NO. 65 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-084861 BPJS : 0002748939006 MG
Tgl Diagnosis : 23 February 2019 2:09 PM BORAK GLYSEROL 5% LARUTAN
2019-09-09 13:37 Hal. 145 dari 1322

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MULYADI (L) JL. P NANGKA BARAT 2 RT 002/016 H81.1 - Benign paroxysmal vertigo PIROKSIKAM 10 MG
RANITIDIN 150 MG
No. RM : 01-053753 BPJS : 0001376422659
HUI CHIAN (P) JL. GDING INDAH 4 BLOK NF 1 NO 50 J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
AMOKSISILIN 500 MG
MG
AZZALEA ZARA DAMAYANTI, AN (P) SUKA PURA JAYA RT004/010 J03.9 - Acute tonsillitis, unspecified PARASETAMOL SYR 120 MG/5 ML
542 NIK : 3172046510131007 MG
KOSONG (P) JL H OYAR 004/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
SUSATIO WIDIASUHARDJA (L) JL GADING PUTIH RT 011/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
544 NIK : 3172060907380001 MG
AMOKSISILIN 500 MG
RANI YULIANAH, NY (P) JL. H OYAR RT 004/002 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
545 NIK : 3172065907990005 MG
2019-09-09 13:37 Hal. 146 dari 1322

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GRACELINA ARACELI SUKENDRA, AN (P) JL P BESAR 1 RT 04/011 NO 21 K30 - Dyspepsia PARASETAMOL SYR 120 MG/5 ML
RANITIDIN 150 MG
No. RM : 01-049120 BPJS : 0002272746148 ANTASIDA DOEN SUSPENSI
OSKAR RICHARDO (L) JL SUNTER HIJAU IV BLK DII NO.21 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
006/010 AMLODIPIN 10 MG
547
No. RM : 01-079844 NIK : 3172020410620003
ESTIYOWATI PURNOMO BSC (P) JL JANUR HIJAU V BLK TF I NO.14 I84.9 - Unspecified haemorrhoids without ANTIHEMOROID DOEN
complication PIROKSIKAM 10 MG
No. RM : 02-003190 BPJS : 0001478978076
DESTIANA ANATASIA, NY (P) JL KLP HIBRIDA V BLOK 15/4 RT J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
005/015 AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
ANTASIDA DOEN
JESSICA WIDJAJA (P) JL KELAPA HIBRIDA V BLOK RA 15 NO J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
550 GLISERIL GUAIAKOLAT (GG) 100 MG
ALEYSIA CALYSTA (P) JL. KLP HYBRIDA 5 NO 4 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
No. RM : 01-053096 BPJS : 0002358468303 MG
ZINC 20 MG
2019-09-09 13:37 Hal. 147 dari 1322

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HERMAN WIDJAYA TN (L) JL KLP HIBRIDA RA 15/4 RT 5/15 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-057024 BPJS : 0001647897726 MG
LODI RAMADHAN (L) PEGANGSAAN DUA 02/02 L01.0 - Impetigo [any organism] [any site] AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-058003 BPJS : 0001225613924 MG
REPANA PUTRINA (P) INSFEKSI KALI SUNTER RT. 08/13 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
554 NIK : 3172065612080003 MG
SITI TOIPAH (P) INSFEKSI KALI SUTYER RT. 008/013 K04.0 - Pulpitis AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
VIKKI MELKY TOMBUKU (L) JL. RAWA SENGON BLOK A NO 30 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-088339 BPJS : 0002072027564 MG
FANIA AHSANA MAULIDA, AN (P) JL P KEMERDEKAAN NO 56 RT 11/04 R50.9 - Fever, unspecified PARASETAMOL SYR 120 MG/5 ML
KGB RANITIDIN 150 MG
2019-09-09 13:37 Hal. 148 dari 1322

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RAVINDRA KUMAR MOONA, TN (L) JL WALANG TIMUR 3 RT 09/12 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
AMLODIPIN 10 MG
MOONA JYOTSNA RAVINDRA, NY (P) JL WALANG TIMUR III 009/012 J18.0 - Bronchopneumonia, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
OBH SIRUP 100 ML
AMLODIPIN 10 MG
MCG
OBH SIRUP 100 ML
ARIS FIRDAUS (L) JL PULAU PENYENAGT I NO 46 N39.0 - Urinary tract infection, site not RETRIBUSI LAYANAN SIAGA 24 JAM
specified PARASETAMOL TAB 500 MG
560 NIK : 3172062205800004 SIPROFLOKSASIN 500 MG
Tgl Diagnosis : 23 February 2019 3:24 PM OBH SIRUP 100 ML
THIAN NJOEK SEN (L) HL TANAH TINGGI IV /16B RT 05/01 H10.9 - Conjunctivitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
ELY N (P) RT 06/05 PEGANGSAAN DUA I10 - Essential (primary) hypertension SIPROFLOKSASIN 500 MG
N39.0 - Urinary tract infection, site not ASAM MEFENAMAT KAPS 500
562 NIK : 3172065309750004 specified KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 05-001453 BPJS : 0000378060142 MG
AMLODIPIN 10 MG
ELSJE RUSLY, NY (P) JL KELAPA MOLEK VII BLOK N1/22 J02.9 - Acute pharyngitis, unspecified KAPTOPRIL 12,5 MG
15/15 AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 149 dari 1322

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NADYA AIZUL SEFTI (P) JL. KGT I 006/004 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
564 NIK : - MG
AMOKSISILIN 500 MG
MUHAMMAD KHOLIL (L) JL. PGS II 005/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
565 NIK : 3172060601170001 MG
ROKMAH, NY (P) JL. INSPEKJSI KALI SUNTER RT 07 RW R60.0 - Localized oedema ASAM MEFENAMAT KAPS 500
04 KGB DEKSAMETASON 0,5 MG
No. RM : 06-000217 NIK : 3212215612870003
NAUFAL ALFAHREZY DANIYAH, AN (L) JL H OYAR RT001/002 PGS2 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
MASMURAH, NY (L) JL. KLP MOLEK 5 BLOK N0 KGT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 150 dari 1322

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AHMAD KHOERUL FAHMI, AN (L) JL.KP.RAWA INDAH 006/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
569 NIK : 3172062601160001 MG
SUBROTO, TN (L) ASRAMA POLRI RT 01/07 K30 - Dyspepsia RANITIDIN 150 MG

VENSKA STEFANI, NN (P) JL SAYUTI NO 17 B6/6 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-084286 BPJS : 0001636338609 MG
AMOKSISILIN 500 MG
FRADELLA ARKADEWI (P) PGS II RT 5/2 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
572 NIK : 3172065602170002 MG
FITRA SAHARA, NN (P) RAWASENGON 08/22 A01.0 - Typhoid fever RETRIBUSI LAYANAN SIAGA 24 JAM
573 NIK : 3172026501010007 SIPROFLOKSASIN 500 MG
MG
LUSTI FERTA SARI, NY (P) JL. KEBUN KELAPA, LAMPUNG Z48.9 - Surgical follow-up care, unspecified TOILET MATA / WOUND TOILET

574 NIK : 1809075212890009
No. RM : 01-087973 BPJS : 0002198312357
2019-09-09 13:37 Hal. 151 dari 1322

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SHINTA SEPTIANTY SUNARYO, NN (P) JL PUSKESMAS NO 27 KGT J02.9 - Acute pharyngitis, unspecified GENTAMISIN SALEP KULIT
N39.0 - Urinary tract infection, site not SIPROFLOKSASIN 500 MG
575 NIK : 3175035309980007 specified GLISERIL GUAIAKOLAT (GG) 100 MG
ZAINI KARTIKAWATI (P) PGS DUA RT 6/6 J02.9 - Acute pharyngitis, unspecified ASAM MEFENAMAT KAPS 500
DEKSAMETASON 0,5 MG
576 NIK : - RANITIDIN 150 MG
SAMAH ASTUTI (P) JL. INSPEKSI KALI SUNTER 009/013 E11.9 - Non-insulin-dependent diabetes ANTASIDA DOEN
KLP GADING BARAT mellitus without complications RANITIDIN 150 MG
Tgl Lahir : 20-Aug-1965 ( 54 Thn 0 Bln 20 Hr ) I10 - Essential (primary) hypertension
577 AMLODIPIN 10 MG
No. RM : 01-063943 NIK : - J06.9 - Acute upper respiratory infection, METFORMIN TAB 500 MG
Tgl Diagnosis : 25 February 2019 5:53 PM BPJS : 0000378349187 unspecified
K30 - Dyspepsia
AMOKSISILIN 500 MG
OBH SIRUP 100 ML
AYU ZAHARA HASMA, AN (P) BCS RT 04/05 NO 73 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
unspecified AMOKSISILIN 500 MG
No. RM : 01-028982 BPJS : 0001225850185 MG
RISTA ARDIYANTI, AN (P) JL. RAYA KLP KOPYOR CE 2/9 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
No. RM : 01-018146 BPJS : 0002268030003 MG
DEKSAMETASON 0,5 MG
TRESNA JULIANA, NY (P) JL. RAWA BADUNG N39.0 - Urinary tract infection, site not ASAM MEFENAMAT KAPS 500
specified HIOSINA BUTILBROMIDA 10mg
No. RM : 01-088526 BPJS : 0002624566645
2019-09-09 13:37 Hal. 152 dari 1322

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YUANITA ANGGREINI, NY (P) KGT NO 15 RT 3/06 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-041097 BPJS : 0001225570566 MG
AMOKSISILIN 500 MG
FAMI MAULIDIA RUSDIANA (P) KELAPA GADING TIMUR 03/04 S81.9 - Open wound of lower leg, part SIPROFLOKSASIN 500 MG
ALVIAN HANNAN ARIFYANTO, AN (L) JL. PERJUANGAN RT 005/007 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
583 NIK : 3172031309131002 MG
DIAN HAERANI (L) RAWA BADAK RT 01/05 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
T78.4 - Allergy, unspecified DEKSAMETASON 0,5 MG
ANDRY WIJAYA, AN (L) JL KELAPA CENGKIR BARAT VII FO 02 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
NO 02 PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-064584 NIK : 1971011810080001 MG
SUTIATI, NY (P) JL PUSKESMAS NO.62 005/006 B35.6 - Tinea cruris KETOKONAZOL 200 MG
No. RM : 02-003138 BPJS : 0001226122402 MG
Tgl Diagnosis : 25 February 2019 7:54 PM MIKONAZOL KRIM 2 %
2019-09-09 13:37 Hal. 153 dari 1322

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JUNARI, NY (P) KMP SUKAPURA J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-088530 BPJS : 0001743499214 MG
DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
SUJADI, TN (L) KALIMAHA KULON RT 01/04 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
KAPTOPRIL 12,5 MG
588 NIK : 3303062012660001
No. RM : 01-008791 BPJS : 0001136887918
TAN MEILIANI, NY (P) GG LANGGAR 010/006 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
L03.1 - Cellulitis of other parts of limb SIPROFLOKSASIN 500 MG
Tgl Diagnosis : 25 February 2019 8:06 PM NATRIUM DIKLOFENAK TAB 25 MG
MARINGAN GULTOM, TN (L) JEMBATAN BARU NO.29 009/04 KGB J18.90 - COMMUNITY ACQUIRED RETRIBUSI LAYANAN SIAGA 24 JAM
PNEUMONIA PARASETAMOL TAB 500 MG
No. RM : 01-004076 BPJS : 0000046160919 SIPROFLOKSASIN 500 MG
MG
OBH SIRUP 100 ML
SALBUTAMOL 2 MG
SUYADI, TN (L) PGS II RT 04/02 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
ANTASIDA DOEN
KANIA ANANTHA VIRYA, AN (P) JL MASJID AL JIHAD RT 2/4 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-041879 BPJS : 0002068211891 MG
2019-09-09 13:37 Hal. 154 dari 1322

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RAINA NAILATUL IZZA, AN (P) KELAPA GADING TIMUR 02/04 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
MG
ANNISA RAHMAN, AN (P) TELUK RATAI 2 N0 53 KGB J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
594 NIK : 3172066509101003 MG
SALWA AISYAH AZAHRA, AN (P) JL PEGANGSAAN DUA RT 05/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
PUTRI SURYANINGSIH, NN (P) KP RAWA INDAH RT 01/03 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
No. RM : 01-034024 BPJS : 0000378197098
IBNU AFFAN F, TN (L) RAWA INDAH RT 05/03 Z48.9 - Surgical follow-up care, unspecified AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 155 dari 1322

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MUHAMAD IQBAL, AN (L) H.OYAR 003/002 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
L50.0 - Allergic urticaria KLORFENIRAMIN MALEAT (CTM) TAB 4
598 NIK : 3172060305131002 MG
ANNA LARASATI, nn (P) RW SENGON RT 5/22 D69.0 - Allergic purpura KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
599 NIK : 3172036707010003
BUDIYANI, NY (P) JL KP RAWA INDAH RT 002/003 J40 - Bronchitis, not specified as acute or SIPROFLOKSASIN 500 MG
chronic DEKSAMETASON 0,5 MG
600 NIK : 3673054611880002 OBH SIRUP 100 ML
SAHLAN AMRI, AN (L) RT 003/06 KLP GDNG TIMUR J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
601 NIK : 3172062307050004 RANITIDIN 150 MG
SURIATI, NY (P) RAWA INDAH 01/03 I10 - Essential (primary) hypertension ASAM ASETILSALISILAT 80 mg
K30 - Dyspepsia (ASETOSAL)
Tgl Lahir : 02-Aug-1971 ( 48 Thn 1 Bln 7 Hr ) AMLODIPIN 10 MG
602 NIK : 3175074208710007
No. RM : 01-061604 BPJS : 0001225679984 SIMVASTATIN 10 MG
ANTASIDA DOEN
ASMALI K (L) KP RAWA INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-046113 BPJS : 0001745630324 MG
2019-09-09 13:37 Hal. 156 dari 1322

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NISIRINA NABIHA PUTRI, AN (P) RAWA INDAH 01/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
604 NIK : 3172065108121001 MG
OCTAVIAN AGNI PRATAMA, AN (L) RW INDAH RT 2/3 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-057971 BPJS : 0002332879637 MG
SRI RAHAYU, AN (P) JL PERINTIS KEMERDEKAAN 011/004 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG

606 NIK : 3172064402050004
No. RM : 01-020325 BPJS : 0001225572917
TJIA KIM TJEN, NY (P) JL TIPAR CAKUNG NO 17 RT 06/06 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
607 NIK : 3172047005620003 KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Diagnosis : 25 February 2019 9:13 PM TRIMETOPRIM 80 MG)
DEKSAMETASON 0,5 MG
FERRY KUSNADI, TN (L) JL BCS NO 92 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-056104 BPJS : 0001376440312 MG
HASAN, TN (L) PEGANGSAAN DUA RT 02/01 I10 - Essential (primary) hypertension AMLODIPIN 10 MG

609 NIK : 3172031203670006
No. RM : 01-021928 BPJS : 0000998909785
2019-09-09 13:37 Hal. 157 dari 1322

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MUCHLISAH, NY (P) JL PGS II RT 006/005 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
unspecified DEKSAMETASON 0,5 MG
No. RM : 01-021197 BPJS : 0001226148028 MG
KARTIKA, NN (P) DSN PARUMPUNG, PARUNGSARI, J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
TELUK JAMBE DEKSAMETASON 0,5 MG
611
No. RM : 01-088535 NIK : 3215270606940002
YOHANA YENY ANDRIYANI, NY (P) JL PERJUANGAN RT 04/07 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
612 NIK : 3175065211757001 MG
YUSNELTI, NY (P) JL LOGISTIK BENDUNGAN BATIK RT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
07/04 NO 78 DEKSAMETASON 0,5 MG
No. RM : 01-003482 NIK : 3172035501700003 MG
Tgl Diagnosis : 25 February 2019 9:42 PM BPJS : 0001225346051 OBH SIRUP 100 ML
SONYA GRACIA CALISTA SINAGA, AN (P) JL. AGAPE NO. 54 011/007 TANAH J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
MERAH OBH SIRUP 100 ML
BENNY CHANDRA, TN (L) JL BEKASI TIMUR VI RT 03/013 T78.4 - Allergy, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM

615 NIK : 3175030106810003
No. RM : 01-030391 BPJS : 0001260800908
2019-09-09 13:37 Hal. 158 dari 1322

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DEWI KARTIKA, NY (P) JL H OYAR RT 001/002 Z48.9 - Surgical follow-up care, unspecified AMOKSISILIN 500 MG
No. RM : 01-045024 BPJS : 0000378020709
DERON RAINE ELEAZER, AN (L) JL TRAMPIL I NO 29 RT 005/002 K30 - Dyspepsia PARASETAMOL SYR 120 MG/5 ML
RANITIDIN 150 MG
No. RM : 01-005157 BPJS : 0001428100187
ISABEL ERNI SOMBOLINGGI, nn (P) JL NUSANTARA RT 07/06 RT 13/07 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
SUKAPURA KLORFENIRAMIN MALEAT (CTM) TAB 4
618 MG
Tgl Diagnosis : 25 February 2019 9:58 PM BPJS : 0001294668887 GLISERIL GUAIAKOLAT (GG) 100 MG
AMOKSISILIN 500 MG
MOINA MALAU (P) JL PERJUANGAN GG SIKILANG NO 25 J02.9 - Acute pharyngitis, unspecified OBH SIRUP 100 ML
RT 21/07 TUGU SELATAN DEKSAMETASON 0,5 MG
619 SIPROFLOKSASIN 500 MG
AHMAD ZAKIANDRA, AN (L) RW SENGON RT 2/58 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-046273 BPJS : 0002318130268 MG
EMILIA PANCANINGTYAS (P) JL. KOMP PERUM HII RT 004/005 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
621 NIK : 3172065307720002 MG
2019-09-09 13:37 Hal. 159 dari 1322

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WIDYAWATI AYUDIA INARA, AN (P) INS KALI SUNTER RT 9/13 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
622 NIK : 3172046109131002 MG
LANNY SARI, NY (P) JL KLP KOPYOR BARAT VI CJ I/12 I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
623 NIK : 3172066604470002 unspecified MG
AMLODIPIN 10 MG
RAFASYA AL KENZO ARTIN, AN (L) JL PGS II RT 6/5 J18.9 - Pneumonia, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-047832 BPJS : 0002230993888 MG
SALBUTAMOL 2 MG
ERISMA L.A.SIMARMATA, NY (P) JL. BCS RT 06/05 PEGANGSAAN DUA J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
625 NIK : 3172066512650007
No. RM : 05-000990 BPJS : 0000998906422
SUNOKO NUGROHO SAMIADJI, TN (L) JL. KLP KOPYOR RT 003/009 B33.0 - Epidemic myalgia AMLODIPIN 10 MG
I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
No. RM : 01-029286 BPJS : 0001741314778
ATIH BT AYAT, NY (P) JL PEGANGSAAN DUA RT 03/04 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-046717 BPJS : 0000378220105
2019-09-09 13:37 Hal. 160 dari 1322

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LUKMAN NG, TN (L) JL.BELLYRA II BLOK M\2 RT 06\08 I10 - Essential (primary) hypertension ANTASIDA DOEN
PGS2 AMLODIPIN 10 MG
DEDEN NUGROHO, TN (L) JL MUNDU DALAM TIMUR NO 02 BLOK K30 - Dyspepsia RANITIDIN 150 MG
K GG II NO 02 RT 05/13 DOMPERIDON TAB 10 MG
629 ANTASIDA DOEN
No. RM : 01-041679 NIK : 18070312018200002
NURIS DIKA CAHYANI, NY (P) TUGU PERJUANGAN TANAH MERAH K30 - Dyspepsia RANITIDIN 150 MG
07/08 DOMPERIDON TAB 10 MG
630 ANTASIDA DOEN
No. RM : 01-001700 NIK : -
ARETA FELICIA CALLISTA, BY (P) TUGU PERJUANGAN RT 007/08 TANAH A09 - Diarrhoea and gastroenteritis of ZINC 20 MG
MERAH presumed infectious origin KOTRIMOKSAZOL DOEN SUSPENSI
631 (SULFAMETOKSAZOL 200 MG +
No. RM : 01-066201 NIK : 3172036303180010 TRIMETOPRIM 40 MG)
Tgl Diagnosis : 25 February 2019 10:46 PM BPJS : 0002376797556 GARAM ORALIT KOMBINASI
SULIATI, NN (P) JL. PGS II K30 - Dyspepsia ANTASIDA DOEN

DEKSAMETASON 0,5 MG
MUHAMMAD FAJRIANTO ALBANI (L) JL KOMPI UDIN RT 06/05 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
AMOKSISILIN 500 MG
ZINC 20 MG
2019-09-09 13:37 Hal. 161 dari 1322

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ANANG JUARI WIBOWO, TN (L) JL ULTRA VIOLET BLK A4 NO.32 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
003/010
634
No. RM : 01-011928 NIK : 3172060412851001
MUHAMAD AGUNG SANTOSO (L) KP. RAWA INDAH J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
No. RM : 01-088542 BPJS : 0002332857071 MG
ACHMAD ABI LUDVI RAMADHAN, an (L) JL PULAU REMPANG II NO 8 RT J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
006/009 PARASETAMOL TAB 500 MG
No. RM : 01-009224 NIK : 3172061009080001
TUTIK SANTI ANDRIANA, NY (P) JL. RAWA SENGON RT 001/022 K04.0 - Pulpitis NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
637 NIK : 3574046009720003
No. RM : 01-042827 BPJS : 0001224372745
DAWA ADITHIA, an (L) H.OYAR 02/02 L50.0 - Allergic urticaria KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 22-Mar-2004 ( 15 Thn 5 Bln 18 Hr ) DEKSAMETASON 0,5 MG
638 NIK : 3172062203040005
JENNIFER ADRIANI REMETWA, NN (P) MESS SUMMARECON KELAPA M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
GADING DEKSAMETASON 0,5 MG
639
No. RM : 01-071583 NIK : 3172036301990007
SUYONO, TN (L) PEGANGSAAN DUA 05/02 N39.3 - Stress incontinence ASAM MEFENAMAT KAPS 500
640 NIK : 3172062601740003 MG
2019-09-09 13:37 Hal. 162 dari 1322

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BERLIAN NATHANIA SIMBOLON, BY (P) JL SEJAHTERA PULO GEBANG A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin KOTRIMOKSAZOL DOEN SUSPENSI
FAUZI FADILA (L) KP.WARUNG JENGKOL 02/13 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
642 NIK : 3172060803071002 ASAM ASKORBAT (VITAMIN C) 50 MG
No. RM : 01-037064 BPJS : 0000377376478
LAOREN ENGGARJATI, NN (P) JL. INSP KALI SUNTER K30 - Dyspepsia RANITIDIN 150 MG
ANTASIDA DOEN
No. RM : 01-022665 BPJS : 0001742331295
DEMARIA GAVRIEL SINAMBELA, AN (L) JL PUSKESMAS NO.19 006/006 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
644 NIK : 3172031403160008 MG
MULYANI (P) H.OYAR 01/02 N77.1 - Vaginitis, vulvitis and vulvovaginitis ASAM MEFENAMAT KAPS 500
in infectious and parasitic diseases classified DEKSAMETASON 0,5 MG
Tgl Lahir : 02-Mar-1979 ( 40 Thn 6 Bln 7 Hr ) elsewhere
645 NIK : 3172064203790002
No. RM : 01-028334 BPJS : 0000377220947
VALDA THABINA (P) JL PENYENGAT 1 NO 36 K30 - Dyspepsia RANITIDIN 150 MG
ANY MARLINA, NN (P) P.BESAR 02/11 Z48.9 - Surgical follow-up care, unspecified GENTAMISIN SALEP KULIT
LEPAS HECTING
647 NIK : - TOILET MATA / WOUND TOILET
No. RM : 01-044054 BPJS : 0000564840729
2019-09-09 13:37 Hal. 163 dari 1322

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CHINTYA DEWI SARTIKA, NY (P) JL SUMMANGUNG II BLK V NO.3 O20.8 - Other haemorrhage in early
pregnancy
648 NIK : 3172066701900001
No. RM : 01-088747 BPJS : 0002332916954
dr. Bambang Nugroho Marojahan

DRG. DINI INDRAWATI, NY (P) JL BAMBU DURI XI NO 8 RT 12 / 6 Z00.0 - General medical examination

1 NIK : 3175074605690003
No. RM : 01-016748 BPJS : 0000041679786
PARTINI (P) PEGANGSAAN DUA 02/04 E78.5 - Hyperlipidaemia, unspecified PIROKSIKAM 10 MG
DEKSAMETASON 0,5 MG
2 NIK : -
No. RM : 01-072886 BPJS : 0002332713161
LENNY FRANSICA L, NY (P) JL PAL BATU IV NO 35 RT 010 RW 004 H05.2 - Exophthalmic conditions RUJUKAN (0113R074) RS KHUSUS MATA
RUJUKAN SMEC
(MAT) MATA - (65) Mata - (0)
3 NIK : 3174015709600008 RUJUKAN Telah Diberikan :
No. RM : 01-086552 BPJS : 0001337504804 Faskes : (0113R074) RS
Tgl Diagnosis : 20 February 2019 12:39 PM KHUSUS MATA SMEC
Alamat : PEMUDA NO.36
Telp : 021-4714848
Kelas : C
Cabang : JAKARTA TIMUR
Jumlah Rujukan : 23
Kapasitas : 0
Jadwal : Kamis : 08:00 - 16:00,
08:00 - 16:00;08:00 - 12:00, 12:00
- 16:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 164 dari 1322

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LIE HOA DERMAWAN (P) JL PEGANGSAAN INDAH BARAT IV K21.0 - Gastro-oesophageal reflux disease
BLOK H NO 11A with oesophagitis
4
No. RM : 01-008461 NIK : 3172065406640001
MITA YANI (P) RAWA SENGON BLOK H J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified AMBROKSOL TAB 30 MG
No. RM : 01-088074 BPJS : 0002332842129
MEISA RAHMA (P) JL RAWA SENGON BLOK H NO 38 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
No. RM : 01-088075 BPJS : 0002332842142
INA GUNAWAN (P) JANUR ASRI 1 BLK. QJ 11 NO. 2 RT. H28.2 - Cataract in other diseases classified RUJUKAN (0116R025) Rumah Sakit Firdaus
008/012 KGT elsewhere (MAT) MATA - (65) Mata - (0)
7 Telah Diberikan :
No. RM : 01-002610 NIK : 3172064506590002 Faskes : (0116R025) Rumah
Tgl Diagnosis : 20 February 2019 1:03 PM BPJS : 0001312812336 Sakit Firdaus
Alamat : JL. SIAK J5/14
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SERIANA GIRSANG (P) JL PUTIH SALJU RT 16/10 E78.5 - Hyperlipidaemia, unspecified DOKTER UMUM
M10.9 - Gout, unspecified SIMVASTATIN 10 MG
8 NIK : 3172064804610003 ALOPURINOL 300 MG
No. RM : 01-057290 BPJS : 0000046161933
2019-09-09 13:37 Hal. 165 dari 1322

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JUMINTEN, NY (P) PGS II RT 5/2 E11.0 - Non-insulin-dependent diabetes RETRIBUSI LAYANAN SIAGA 24 JAM
mellitus with coma RANITIDIN 150 MG
Tgl Lahir : 11-Nov-1979 ( 39 Thn 9 Bln 29 Hr ) I10 - Essential (primary) hypertension
No. RM : 01-019469 BPJS : 0001328729455 Z03.0 - Observation for suspected PARASETAMOL TAB 500 MG
Tgl Diagnosis : 20 February 2019 1:29 PM tuberculosis
ISOSORBID DINITRAT 5 MG
TRI SUTRISNO (L) JL PERUM PURI INTAN KAV 76 014/007 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-021741 BPJS : 0001602767204 OKSITETRASIKLIN 1% SM
HJ.ASTUTY AMRULLAH M. (P) JL ALUR LAUT BLK GG NO 1 I71.1 - Thoracic aortic aneurysm, ruptured RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
(JAN) JANTUNG DAN
11 NIK : 3172035808540004 PEMBULUH
Telah DARAH
Diberikan : - (89)
No. RM : 01-080185 BPJS : 0001836362147 JANTUNG DAN PEMBULUH
Faskes : (0905R003) RS
Tgl Diagnosis : 20 February 2019 1:47 PM DARAH - (0) JAKARTA
PELABUHAN
Alamat : JL. KRAMAT JAYA NO.1
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Kamis : 14:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
SUMARNI, NY (P) PASAR INPRES RT 6/6 O34.2 - Maternal care due to uterine scar RUJUKAN (0116R025) Rumah Sakit Firdaus
from previous surgery DOKTER UMUM (OBG) OBGYN - (19) obgyn - (0)
No. RM : 01-048891 BPJS : 0000547424897 Faskes : (0116R025) Rumah
Tgl Diagnosis : 20 February 2019 2:50 PM Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
2019-09-09 13:37 Hal. 166 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
PURNAMA HS PANGGABEAN (L) PERUM DKI BLOK Q6 /18 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
ROFI QOWI (L) JL. SKPR RT 04/010 W22.9 - STRIKING AGAINST OR STRUCK AMOKSISILIN 500 MG
BY OTHER OBJECTS, UNSPECIFIED ASAM MEFENAMAT KAPS 500
Tgl Lahir : 31-Dec-1993 ( 25 Thn 8 Bln 9 Hr ) PLACE
14 NIK : 3172043112931002 INJEKSI (UGD)
No. RM : 01-059984 BPJS : 0001125495235
dr. Catarine
SRI SUBEKTI, NY (P) JL REBANA H 6 RT 003 RW 007 Z48.9 - Surgical follow-up care, unspecified LEPAS HECTING

1 NIK : 3172064711690006
No. RM : 01-045233 BPJS : 0000039838961
YUNI ANITA (P) JL. RAWA SENGON BLOK B. 38 Z48.9 - Surgical follow-up care, unspecified VITAMIN B KOMPLEKS
LEPAS HECTING
No. RM : 01-086070 BPJS : 0001676901789
MATYASIN (L) PEGANGSAAN 2 RT 03/01 J06.9 - Acute upper respiratory infection, GLIBENKLAMIDA 5 MG
unspecified METFORMIN TAB 500 MG
3 NIK : 3172061010640005 AMLODIPIN 5 MG
MG
SETIRIZIN 10MG
2019-09-09 13:37 Hal. 167 dari 1322

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MICHELLA AGNES IRENE SIMANJUNTAK, AN KELAPA HIJAU 3 D4 NO 2 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN SUSPENSI
4 NIK : 3142066307131002 unspecified (SULFAMETOKSAZOL 200 MG +
MG
DEKSAMETASON 0,5 MG
IDLAN MUFID, AN (L) JL KP RAWA INDAH RT 2/3 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN SUSPENSI
5 NIK : - unspecified (SULFAMETOKSAZOL 200 MG +
Tgl Diagnosis : 02 February 2019 4:49 PM DOMPERIDON SUSP 5 MG/5 ML
MG
DEKSAMETASON 0,5 MG
MARYANI, NY (P) KP RAWA INDAH RT 002/03 PGSN II J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
AGUS RIYANTO, TN (L) KP MANGGA RT 3 RW 2 Z48.9 - Surgical follow-up care, unspecified AMOKSISILIN 500 MG
METRONIDAZOL 500 MG
Tgl Diagnosis : 02 February 2019 5:02 PM PERAWATAN LUKA RINGAN (UGD)
MUHAMMAD FATAH AL JABBAR, AN (L) JL RAWA INDAH B01.9 - Varicella without complication PARASETAMOL SYR 120 MG/5 ML
ASIKLOVIR KRIM 5%
8 NIK : 3172060203180002 ASIKLOVIR 200 MG
2019-09-09 13:37 Hal. 168 dari 1322

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IIS NUR FARIDA, NY (P) JL PGS II RT 4/1 N61 - Inflammatory disorders of breast AMOKSISILIN 500 MG
No. RM : 01-058342 BPJS : 0001774013444
YOHANA YENY ANDRIYANI, NY (P) JL PERJUANGAN RT 04/07 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
10 NIK : 3175065211757001 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-043827 BPJS : 0002049041553 MG
AMLODIPIN 5 MG
SRI WAHYUNI, NY (P) PULO NAGKA BARAT II RT 007/016 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
11 NIK : 3175024104740012 MG
Tgl Diagnosis : 02 February 2019 5:21 PM MULTIVITAMIN DEWASA
DRA JULIANTY LINTONG, NY (P) JANUR KUNING TIMUR VII WN 2/1 RT I10 - Essential (primary) hypertension AMLODIPIN 10 MG
006 RW 016 L08.9 - Local infection of skin and HIDROKLORTIAZID 25 MG
12 subcutaneous tissue, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-086419 NIK : 3172066407400004 GENTAMISIN SALEP KULIT
KASMINAH, NY (P) JL KEPU III NMO 103 RT 06/01 R42 - Dizziness and giddiness RANITIDIN 150 MG
13 NIK : - MCG
MG
RASMI SITORUS, NY (P) RAWA SENGON BLOK F 14 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
ART006/022 KGB unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-063516 NIK : 3175064807760001 MG
2019-09-09 13:37 Hal. 169 dari 1322

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TALITA SAKHI RAMADHANI. S (P) JL SENTOSA 4 NO 9 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
CHRIST AGATA SEMBIRING (L) JL RAWA SENGON BLOK D RT 04/022 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
LIGAN PATRICIA BR SEMBIRING (P) JL RAWA SENGON BLOK D RT 004/022 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-018015 BPJS : 0001298044225 MG
ISMAIL, TN (L) JL PSR IMPRES NO.53 006/06 Z48.9 - Surgical follow-up care, unspecified GENTAMISIN SALEP KULIT

18 NIK : 3172060508931001
No. RM : 01-035266 BPJS : 0002100023324
JOKO ARIANTO, TN (L) CAKUNG BARAT 03/09 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
DAVI ARDIANSYAH, AN (L) GG SEPAT SUKAPURA RT 03 RW 09 J06.9 - Acute upper respiratory infection, PARASETAMOL DROP 60 MG/0,6 ML
unspecified KOTRIMOKSAZOL DOEN SUSPENSI
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 170 dari 1322

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IMAM SUKARMAN, TN (L) KARANG KLASEM RT 007 RW 003 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
PURBALINGGA J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
21 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
MCG
FARIS AL HABSYI, AN (L) JL. RAWA INDAH J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-079259 BPJS : 0002274442615 MG
LILIS NAWATI, NY (P) RAWA INDAH 006/003 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
RIZKI AMELIA, NY (P) PEGANGSAAN DUA B35.4 - Tinea corporis MIKONAZOL KRIM 2 %

24 NIK : 3172064301960002
No. RM : 04-001901 BPJS : 0002097055078
ZULFIGAR WALI (L) KP RAWA INDAH RT 007 RW 003 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-086427 BPJS : 0000378096625 MG
AQILA AINUN SALSABILLAH, AN (P) JL RAYA RW SENGON NO 32 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-038508 BPJS : 0002082033955 MG
MUHAMMAD IQBAL, TN (L) APT GADING NIAS TOWER MIRAL I10 - Essential (primary) hypertension AMLODIPIN 10 MG
21RS J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 171 dari 1322

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AHMAD ARYANTO, an (L) PGS II RT 3 RW 5 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-086429 BPJS : 0002142133806 MG
ROHAYAH, NY (P) JL INSPEKSI KALI SUNTER NO.30 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
007/004 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
29 unspecified AMBROKSOL TAB 30 MG
C MASNAH ZAHRI BA, NY (P) PELEPAH INDAH RAYA BLK LB24 M79.1 - Myalgia RETRIBUSI LAYANAN SIAGA 24 JAM
NO.12A 009/018 R51 - Headache NATRIUM DIKLOFENAK 50 MG
30 MULTIVITAMIN DEWASA
No. RM : 01-048218 NIK : 3172066006450001
ROSALIA AGUSTIN, AN (P) JL PEGANGSAAN DUA RT 06/02 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 04-000170 BPJS : 0002196954303 MG
DIANA DWI KUSUMA NINGRUM, NY (P) WARUNG JENGKOL RT 1/13 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-003290 BPJS : 0001197012699 MG
ZIEZA GENDIS ARETA (P) WARUNG JENGKOL RT 1/13 L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 02-Dec-2012 ( 6 Thn 9 Bln 7 Hr ) DEKSAMETASON 0,5 MG
33 NIK : -
RINJANI SAGITA PUTRI AMBARIA, AN (P) JL PERINTIS KEMERRDEKAAN RT R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
11/04 NO 71 KLORFENIRAMIN MALEAT (CTM) TAB 4
34 MG
Tgl Diagnosis : 02 February 2019 8:17 PM BPJS : 0002299301548 RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 172 dari 1322

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ADZRIL RAFIF ALFAREZI (L) P.KEMERDEKAAN 11/04 NO.71 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-055963 BPJS : 0002299299748 MG
TARISAH (P) RAWA SENGON RT 06/22 TG UTARA J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
unspecified ANTASIDA DOEN
M. NASRULLOH, AN (L) JL RAWA SENGON BLOK F RT 006/022 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-001106 BPJS : 0001602768082
MARIYAM, NY (P) JL H OYAR RT 03/02 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
ANTASIDA DOEN
SRI AMBARWATI, NY (P) JL.KANTIL RT 001/003 BERMIS KLP R05 - Cough RETRIBUSI LAYANAN SIAGA 24 JAM
GADING KOTRIMOKSAZOL DOEN I (DEWASA)
No. RM : 01-041026 NIK : - TRIMETOPRIM 80 MG)
MG
DEKSAMETASON 0,5 MG
CATALEYA AZAHRA SALMIN, AN (P) JL KANTIL NO 12 RT 001-003 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 173 dari 1322

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HJ .AIDA (P) JL PERINTIS KEMERDEKAAN RT J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
011/04 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-063411 NIK : 3172066807780002 MG
Sahid Mahmud (L) JL PERINTIS RT001/04 KGB J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-056573 BPJS : 0001225754763 MG
MAYSAROH, NY (P) JL PERJUANGAN NO 26 RT 002/007 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MULTIVITAMIN DEWASA
SUGIONO, TN (L) KAMP RAWA INDAH I10 - Essential (primary) hypertension AMLODIPIN 10 MG
MCG
DISTYA AYRA ZHARIFA (P) TANAH MERAH 008/007 NO. 1 A09 - Diarrhoea and gastroenteritis of sukapura
presumed infectious origin igd
45 NIK : - rujukan
No. RM : 01-066209 BPJS : 0002437562924
2019-09-09 13:37 Hal. 174 dari 1322

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MARIO GUNTORO (L) KP RAWA INDAH 2/3 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-028146 BPJS : 0001791642508 MG
MULTIVITAMIN DEWASA
A. ASNADI (L) JL. PGS2 RT.002 RW.002 NO.38 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
No. RM : 01-086437 BPJS : 0001478363218 MG TAB
AGUS ISMAIL, TN (L) JL H.OYAR RT 002/002 A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
presumed infectious origin ANTASIDA DOEN
No. RM : 01-015529 BPJS : 0001146630396 MG TAB
TRIMETOPRIM 80 MG)
BJORN DERIAN INDRADJAJA (L) APT KALIA JL PERINTIS J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
KEMERDEKAAN TWR 03/17 KLORFENIRAMIN MALEAT (CTM) TAB 4
49 MG
No. RM : 01-080383 NIK : 3175022109980003 MULTIVITAMIN DEWASA
SATIRAH, NY (P) BCS 04/05 R05 - Cough AMOKSISILIN 500 MG

RANITIDIN 150 MG
INHALASI (UGD)
AGUS RAMADHAN (L) KELAPA ,M OLEK VII RT 014/19 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
51 NIK : 3172060908790001 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-028676 BPJS : 0002332830172 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
2019-09-09 13:37 Hal. 175 dari 1322

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MG
DEKSAMETASON 0,5 MG
ALVARO EZRA DARMAWAN (L) JL TEGUH III NO.106 006/001 L08.9 - Local infection of skin and GENTAMISIN SALEP KULIT
subcutaneous tissue, unspecified AMOKSISILIN 500 MG
No. RM : 01-015585 BPJS : 0002039794108 MG
AVIGAIL FARZANA METTADEVI (P) JL TEGUH III NO 106 RT 06/01 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
53 NIK : - MG
KHOIRUL ANNAM, AN (L) PGS II 003/005 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
54 NIK : 3403091504100002 MG
ROHMAN, TN (L) JL SUMAGUNG III H92.0 - Otalgia RETRIBUSI LAYANAN SIAGA 24 JAM
L23.9 - Allergic contact dermatitis, KLORAMFENIKOL TT 3%
55 NIK : 3302130605900001 unspecified cause KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-035807 BPJS : 0002271067896 MG
Tgl Diagnosis : 02 February 2019 10:02 PM BETAMETASON KRIM 0,5MG/G
ALVARO IVANDER SINURAT, BY (L) JL GADING SENGON V RT 05 RW 22 J06.9 - Acute upper respiratory infection, PARASETAMOL DROP 60 MG/0,6 ML
No. RM : 01-082614 BPJS : 0002612208194 MG
CASNOTO, TN (L) TNH MERAH 006/007 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-009559 BPJS : 0002202510093 MG
2019-09-09 13:37 Hal. 176 dari 1322

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MILLAH, NY (P) TANAH MERAH RT 7 J02.9 - Acute pharyngitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
M79.1 - Myalgia MG
58 NIK : 3326135012730001
No. RM : 01-003263 BPJS : 0002202510543 NATRIUM DIKLOFENAK 50 MG
MCG
NGATMINI (P) TANAH RENDAH RT 06/02 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J06.9 - Acute upper respiratory infection, HIDROKLORTIAZID 25 MG
APIF KAMAL SEI, TN (L) KP WR JENGKOL RT 5/13 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
No. RM : 01-013045 BPJS : 0000210641084 MG
MCG
JASMINE AGNIYA KAMAL (P) KP.WARUNG JENGKOL 05/13 J03.9 - Acute tonsillitis, unspecified AMOKSISILIN 500 MG
J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
No. RM : 01-009468 BPJS : 0000210641387 MG
JUMIYATI, NY (P) KP RAWA INDAH RT 005/003 PGS II I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
L08.9 - Local infection of skin and GENTAMISIN SALEP KULIT
62 NIK : 3172065108670001 subcutaneous tissue, unspecified AMLODIPIN 5 MG
MCG
SUSIYATI, NY (P) P.NANGAKA BARAT II 10/16 NO.32 M54.5 - Low back pain RETRIBUSI LAYANAN SIAGA 24 JAM
NATRIUM DIKLOFENAK 50 MG
No. RM : 01-031365 BPJS : 0002247690295 MCG
RANITIDIN 150 MG
2019-09-09 13:37 Hal. 177 dari 1322

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ACHMAD AGUS, TN (L) JL PULAU REMPANG III NO 15 RT 007 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
RW 009 DEKSAMETASON 0,5 MG
64 ASAM ASKORBAT (VITAMIN C) 50 MG
AHMAD NUR YUSUF, AN (L) KOMP DEP PERDAGANGAN RT 5/6 J00 - Acute nasopharyngitis [common cold] ANTASIDA DOEN
65 NIK : 3172061204081001 MG
SUKARI, TN (L) KP RAWA INDAH 003/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
KIRANTI RAMADITA FATRICIA P, NN (P) JL. PGS II 001/004 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-057849 BPJS : 0000377465725 MG
ELITA YANTI, NY (P) JL. KESADARAN 001/004 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
PEGANGSAAN DUA PARASETAMOL TAB 500 MG
68 ANTASIDA DOEN
MUHAMAD SAPUTRA, AN (L) JL PERINTIS KEMERDEKAAN J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 178 dari 1322

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SUNENTI, NY (P) RAWA INDAH 01/03 L08.9 - Local infection of skin and AMOKSISILIN 500 MG
subcutaneous tissue, unspecified METRONIDAZOL 500 MG
DARREL SHAKEEL AL RESCHA, AN (L) JL LESTARI VIII RT 02/10 NO 10-11 R50.9 - Fever, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
IDA, NY (P) KONM HII RT 003/005 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
MULTIVITAMIN DEWASA
AUDINA FEBRILIA (P) KOMP.PERUM PT.HII B/24 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-046510 BPJS : 0001225380385 MG
ABDULHAIR, AN (L) KAMP SUKAPURA J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
ANGELIA P R KOKALI (P) JL LESTARI VIII RT 02/10 K30 - Dyspepsia ANTASIDA DOEN
OMEPRAZOL KAPS 20 MG
2019-09-09 13:37 Hal. 179 dari 1322

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NUR AZIZAH RAHMAWATI (P) JL H OYAR RT 04/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-015978 BPJS : 0001607827094
M.JAMINTER SIMANJUNTAK (L) JL.PERINTIS KEMERDEKAAN 011/04 I10 - Essential (primary) hypertension koja
KGB R06.0 - Dyspnoea igd
77 rujukan
No. RM : 01-003855 NIK : 3172061003
IGNATIO YUNANTA, TN (L) JL PEGANGSAAN DUA RW 004 W19.9 - UNSPECIFIED FALL, AMOKSISILIN 500 MG
UNSPECIFIED PLACE ASAM MEFENAMAT KAPS 500
78 NIK : 3172062306010003 HECTING BESAR, TENDON, PASANG
No. RM : 01-086451 BPJS : 0000998906848 SPALK KECIL (UGD)
Tgl Diagnosis : 03 February 2019 7:16 AM PERAWATAN LUKA RINGAN (UGD)
ANDI BAGUS PRASETYO, TN (L) JL KOPYOR RAYA BLK BA II NO.1 H92.1 - Otorrhoea AMOKSISILIN 500 MG
SHINTA SEPTIANTY SUNARYO, NN (P) JL PUSKESMAS NO 27 KGT K30 - Dyspepsia PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified ANTASIDA DOEN
80 NIK : 3175035309980007 RANITIDIN 150 MG
SERI YANAH, NY (P) PGS II RT 06/02 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
unspecified AMBROKSOL TAB 30 MG
81 NIK : 3201205201880003 RANITIDIN 150 MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 180 dari 1322

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ALIKA PUTRI, AN (P) PGS II RT 06/02 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
MARIANUS LEO, AN (P) JL KESATRIAAN RT 04/05 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
No. RM : 01-021157 BPJS : 0002496594543 MG
BENEDIKTUS DEGHO, TN (L) JL KESATRIAAN RT 04/05 J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN I (DEWASA)
unspecified (SULFAMETOKSAZOL 400 MG +
84 NIK : 31720408720018
DEKSAMETASON 0,5 MG
MG
HANIAH, NY (P) JL.PERINTIS KEMERDEKAAN 11/04 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
85 NIK : 3172064103700004 unspecified AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
ADILA JUNIA AZKADINA RIZKY, AN (P) JL.GADING SENGON 06/022 KGB J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 181 dari 1322

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ARZUN SETYAWAN (L) JL. RAWA SENGON BLK G J06.9 - Acute upper respiratory infection, AMOKSISILIN KAPS 250 MG
VITAMIN B KOMPLEKS
ENDAH WAHYUNINGSIH (P) JLN PGS DUA 003/004 M54.5 - Low back pain NATRIUM DIKLOFENAK 50 MG
88 NIK : 3172066010820006 MCG
ARI YANGGA, AN (L) JL PEGANGSAAN DUA RT 03/04 R10.3 - Pain localized to other parts of lower ASAM MEFENAMAT KAPS 500
abdomen HIOSINA BUTILBROMIDA 10mg
89 NIK : 3172062806970001
No. RM : 04-001152 BPJS : 0000377816073
AIRIN SUHARDINI, NY (P) RT003/03 PEGANGSAAN DU J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
90 NIK : 3172025701830012 MG
TAN KUI SENG, TN (L) VILLA MENARA KLG AI 006/021 PGS II B02.9 - Zoster without complication ASIKLOVIR 400 MG
No. RM : 01-005705 BPJS : 0001335783925 MG
Tgl Diagnosis : 08 February 2019 6:34 PM ASIKLOVIR KRIM 5%
ENDAH MULYANINGSIH, AN (P) RW INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
WITNO HALMAHERA (L) JL. PGS II 006/002 I10 - Essential (primary) hypertension KAPTOPRIL 12,5 MG
L08.9 - Local infection of skin and GENTAMISIN SALEP KULIT
93 NIK : - subcutaneous tissue, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-059818 BPJS : 0001740738339 R50.9 - Fever, unspecified DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 182 dari 1322

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SITI HARTATI (P) HARAPAN II RT 2/02 W22.0 - STRIKING AGAINST OR STRUCK RETRIBUSI LAYANAN SIAGA 24 JAM
BY OTHER OBJECTS, HOME AMOKSISILIN 500 MG
No. RM : 01-007629 BPJS : 0001225645209 EKSTIRPASI KUKU, CLAFUS (UGD)
Tgl Diagnosis : 08 February 2019 7:35 PM HECTING KECIL (1-5 JAHITAN)
INJEKSI (UGD)
DINI AMI NARTI BY (P) KP RAWA INDAH RT 005 RW 003 NO 61 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin AMBROKSOL TAB 30 MG
Tgl Lahir : 25-Jul-2018 ( 1 Thn 1 Bln 15 Hr ) R05 - Cough
Tgl Diagnosis : 08 February 2019 7:38 PM KOTRIMOKSAZOL DOEN SUSPENSI
TRIMETOPRIM 40 MG)
HERTI HARTATI (P) JL KP RAWA INDAH RT 005/003 A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
presumed infectious origin AMBROKSOL TAB 30 MG
Tgl Lahir : 03-Feb-1988 ( 31 Thn 7 Bln 6 Hr ) J06.9 - Acute upper respiratory infection,
No. RM : 01-051206 BPJS : 0002136184244 unspecified MG TAB
MG
FANNESYAH INDRA SYACHRINI, AN (P) P.GALANG RT009/03 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
DELISA KAMELIA AZZAHRA AN (P) RW INDAH RT 1/3 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 183 dari 1322

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YUNIANA SARIHANDAYANI, NY (P) PERMATA BIRU 1 BLOK H3 NO 12A A01.0 - Typhoid fever OMEPRAZOL KAPS 20 MG
K30 - Dyspepsia PARASETAMOL TAB 500 MG
GILANG BAGASKARA, TN (L) GADING BUKIT INDAH Q/34 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
100 NIK : 3173071608980001
MG TAB
VITAMIN B KOMPLEKS
VIVI NURAENI, NN (P) PULO NANGKA BARAT II RT 1/16 NO K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
35 PIRIDOKSIN (VITAMIN B6) 10 MG
101
No. RM : 01-004415 NIK : 3175024607950002
MARNI, NY (L) JL TARIAN RAYA TMR BLK BIV NO.1 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
LAELA, NY (P) JL PENYENGAN III/7 RT 05/03 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-069414 BPJS : 0001132318844 MG
SYAHRIL ANWAR, TN (L) JL. BCS J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-086950 BPJS : 0001225771301 MG
Tgl Diagnosis : 08 February 2019 8:51 PM VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 184 dari 1322

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SITI SARAH, NY (P) JL BCS K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
No. RM : 01-086951 BPJS : 0001323595067 OMEPRAZOL KAPS 20 MG
WINDY OKTAVIANI EDLIN (P) JL. PERINTIS KEMERDEKAAN J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
ANTASIDA DOEN
VITAMIN B KOMPLEKS
SARMIDI (L) KP RAWA INDAH RT.001/003 PGS 2 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-075142 BPJS : 0000341622898 MG
DENI ARYANSYAH (L) JL. KP RAWA INDAH 001/003 R05 - Cough RETRIBUSI LAYANAN SIAGA 24 JAM
AMBROKSOL TAB 30 MG
No. RM : 01-055568 BPJS : 0002135244249 MG
DANA MIHARJA, TN (L) JL RAWAV INDAH 004 /003 PGS II I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
109 NIK : 3175061912780010 unspecified AMOKSISILIN 500 MG
MG
MEY FATIMAH, NY (P) JL PUSKESMAS NO 27 B RT 02/06 I10 - Essential (primary) hypertension ANTASIDA DOEN
K30 - Dyspepsia OMEPRAZOL KAPS 20 MG
110 NIK : 3671044105530002 L23.9 - Allergic contact dermatitis, SETIRIZIN 10MG
No. RM : 01-040276 BPJS : 0002511590657 unspecified cause BETAMETASON 0,1%,KRIM
2019-09-09 13:37 Hal. 185 dari 1322

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DJIMS KURNIA, TN (L) JL KLPA PUAN TMR I BLK NB2/25 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
001/012 presumed infectious origin AMBROKSOL TAB 30 MG
Tgl Lahir : 09-Jan-1957 ( 62 Thn 8 Bln 0 Hr ) J06.9 - Acute upper respiratory infection,
No. RM : 01-013614 NIK : 3172060901570003 unspecified MG
Tgl Diagnosis : 08 February 2019 9:26 PM BPJS : 0001476553779 KOTRIMOKSAZOL DOEN I (DEWASA)
TRIMETOPRIM 80 MG)
MG TAB
BURHANUDIN, TN (L) JL PEGANGSAAN DUA RT 05/02 R05 - Cough AMBROKSOL TAB 30 MG
112 NIK : 3172061412710003 MG
RASDI, TN (L) RAWA INDAH RT 03/03 L50.9 - Urticaria, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
SETIRIZIN 10MG
R O I H, TN (L) JL RW INDAH J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-086956 BPJS : 0002074968674 MG
SUJADI, TN (L) KALIMAHA KULON RT 01/04 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
No. RM : 01-008791 BPJS : 0001136887918 MCG
2019-09-09 13:37 Hal. 186 dari 1322

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WINDA NOVIANI, NN (P) KP TANAH MERAHRT 03/08 NO 30D J40 - Bronchitis, not specified as acute or AMOKSISILIN 500 MG
chronic PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
INHALASI (UGD)
HANDIKA TUBAGUS ARDIARNO (L) PGS II RT 01/04 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
117 NIK : 3172060805030001
AMBROKSOL TAB 30 MG
FEREN TYAS MUNANDAR (P) RAWA INDAH 005/003 H10.9 - Conjunctivitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
118 NIK : 3172064811991001 MG
Tgl Diagnosis : 08 February 2019 10:07 PM KLORAMFENIKOL 1 % SM
JULIA SUSANTI HALIM, NY (P) JL IMPORT 1 D 2 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG

mellitus without complications METFORMIN TAB 500 MG
Tgl Lahir : 18-Mar-1951 ( 68 Thn 5 Bln 22 Hr ) I10 - Essential (primary) hypertension
119 NIK : 3172060106490001 GLIBENKLAMIDA 5 MG
IBRAHIM DEMA BOZZA RINI (L) JL MARAMBA NO 1A RT 05/05 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MG
2019-09-09 13:37 Hal. 187 dari 1322

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SUGITO PURWONEGORO, TN (L) JL KELAPA SAWIT II BLOK I I NO 8 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
DEKSAMETASON 0,5 MG
JANUAR MIFTAHUDIN, AN (L) JL KELAPA SAWIT II BLOK II NO 08 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
RIFQI OKTAVIANDO, AN (L) GRANDE KLP GADING RT 07/25 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-011569 BPJS : 0001386087658 MG
FAEYZA DWI NUGRAHA (L) PERUM INKOPOL BLOK E /10 RT 01/04 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
AHMAD RIVAI, TN (L) JL RAWA TENGAH RT 06/05 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-031469 BPJS : 0001229450837 MG
2019-09-09 13:37 Hal. 188 dari 1322

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AMBAR RESTIKA SURYANDARU, NY (P) JL P TEMIANG III NO 33 RT 10/03 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
Tgl Diagnosis : 08 February 2019 10:44 PM OMEPRAZOL KAPS 20 MG
DJESI SRI AMBARWATI (P) JL BCS J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
127 NIK : 3328075012020001 MG
KAREN ZEFANYA INGKAN, NN (P) JL DEWI SHINTA BLOK KH NO 11 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
VITAMIN B KOMPLEKS
ROSELINE, NY (P) KLP KOPYOR RT 002/009 J06.9 - Acute upper respiratory infection, ANTASIDA DOEN
No. RM : 01-012420 BPJS : 0000041195867 MG
BUDI FIRMANSYAH, TN (L) KOMP BEA CUKAI JL. TOBA BLK. D7 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
NO. 22 RT. 010/007 SUKAPURA R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
130 ANTASIDA DOEN
No. RM : 01-012717 NIK : 3172041203800017 PIRIDOKSIN (VITAMIN B6) 10 MG
LULIS TIWIYANI, NY (P) JL REOG BLOK M NO 28 RT 013/007 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-002766 BPJS : 0001225698592 MG
2019-09-09 13:37 Hal. 189 dari 1322

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ALDI DESANDY, TN (L) JL REOG BLOK M NO 28 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
SUPARTI, NY (P) LORONG L NO 21 RT 012/08 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
R51 - Headache NATRIUM DIKLOFENAK 50 MG
MCG
TIAMIN (VITAMIN B1) 50 MG
AHMAD PRABU RAMADAN (L) JL.SUKAMULIA IV NO.77 HARAPAN J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MULIA KEMAYORAN unspecified PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
QINARA AULIA PUTRI, AN (P) JL. WARUNG JENGKOL 005/013 NO.38 R05 - Cough AMBROKSOL TAB 30 MG
R11 - Nausea and vomiting DOMPERIDON TAB 10 MG
135 NIK : - VITAMIN B KOMPLEKS
IMAN SANTOSO, TN (L) PEGANGSAAN DUA 05/13 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
Tgl Diagnosis : 08 February 2019 11:29 PM ASAM ASETILSALISILAT 80 mg
(ASETOSAL)
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 190 dari 1322

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NIENUK INDRIASARI, NY (P) KOMPLEK HI B 28 KGT J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
APIF KAMAL SEI, TN (L) KP WR JENGKOL RT 5/13 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN I (DEWASA)
MG
DEKSAMETASON 0,5 MG
AMLODIPIN 10 MG
YASMIN, NN (P) JL SIMPONI MAS 6 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-086961 BPJS : 0002064632692 MG
NATAN (L) JL PEGANGSAAN DUA RT 06/03 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-036663 BPJS : 0000378580173 MG
NENI NURYANA, NN (P) JL. TNH MERAH 002/002 R51 - Headache PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 191 dari 1322

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TASYA DARAJATUN, AN (P) KOMPLEK BEACUKAI R5 NO 10 RT R05 - Cough AMBROKSOL TAB 30 MG
142 MG
Tgl Diagnosis : 09 February 2019 12:10 AM BPJS : 0001198658709 KOTRIMOKSAZOL DOEN I (DEWASA)
TRIMETOPRIM 80 MG)
TINI YANTI DJAFAR, NY (P) APT GADING MEDITERANIA I10 - Essential (primary) hypertension AMLODIPIN 10 MG
RESIDENCES UNIT CA/10B/NQ RT NATRIUM DIKLOFENAK 50 MG
143 002/018 SIANOKOBALAMIN (VITAMIN B12) 50
No. RM : 01-015852 MCG
Tgl Diagnosis : 09 February 2019 12:22 AM NIK : 3172065702710003 TIAMIN (VITAMIN B1) 50 MG
INDAH RATNA DEWI, NY (P) JL. SUKAPURA 006/010 NO.39 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-023809 BPJS : 0001293824553 MCG
Tgl Diagnosis : 09 February 2019 12:28 AM TIAMIN (VITAMIN B1) 50 MG
JOKO SUTOPO (L) PGS II RT 03/04 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
R05 - Cough AMLODIPIN 10 MG
MCG
MG
RASYID RACHMAT PAMBUDI, AN (L) PEGANGSAAN DUA 03/04 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Diagnosis : 09 February 2019 12:47 AM VITAMIN B KOMPLEKS
YULIANA NUR AZIZAH, NN (P) JL PGS DUA RT 003/04 K30 - Dyspepsia PARASETAMOL TAB 500 MG
147 NIK : 3172065110971002 VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 192 dari 1322

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SAPUTRA DAFFA NARENDRA (L) JL TNH MERAH N47 - Redundant prepuce, phimosis and RETRIBUSI LAYANAN SIAGA 24 JAM
paraphimosis RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-086967 BPJS : 0002354934993
FRANS NATAL SAYOU, TN (L) RAWA INDAH 05/03 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
149 NIK : 3172062212030001 MG
VITAMIN B KOMPLEKS
LIATUS SOLEHAH (P) JL TEKUN NO 30 RT 2/3 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
150 NIK : 3172064405011002 unspecified PARASETAMOL TAB 500 MG
MG
DEKSAMETASON 0,5 MG
SAKRO, TN (L) JLN BCS . GG L BLOK C NO 101RT I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
08/05 J06.9 - Acute upper respiratory infection, AMLODIPIN 10 MG
151 unspecified PARASETAMOL TAB 500 MG
MG
DEKSAMETASON 0,5 MG
RUHAELA, NY (P) JL. WARUNG JENGKOL RT 05/013 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
IBRAHIM ARAZID, AN (L) INSPEKSI KALI SUNTER RT 08/13 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
2019-09-09 13:37 Hal. 193 dari 1322

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DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
IR MASAGUS FERRY ARIFIN, TN (L) PRT WGP TOWER B LT3 /14 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
154 NIK : 3172060111620004 MCG
BUDIATI ZEGA (P) JL RW SENGON BLK C NO.52 B O36.4 - Maternal care for intrauterine death firdaus
igd
155 NIK : 1204321508890001 rujukan
No. RM : 01-086943 BPJS : 0000262136024
DENI REPTASARI, NY (P) JL TIPAR CAKUNG GG SALON Z34.0 - Supervision of normal first AMOKSISILIN 500 MG
pregnancy PARASETAMOL TAB 500 MG
ASAM FOLAT 0,25 MG
RETINOL (VITAMIN A) KAPS LUNAK
100.000 UI
YUYUN YUNINGSIH (P) TELUK GONG 011/10 M54.5 - Low back pain SETIRIZIN 10MG
R05 - Cough AMBROKSOL TAB 30 MG
SIENNY UTAMA, NY (P) PNTU BESAR SEL IV NO.18 002/006 R05 - Cough AMBROKSOL TAB 30 MG
ANTASIDA DOEN
2019-09-09 13:37 Hal. 194 dari 1322

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CHANDRA NEWS, TN (L) JL PEGANGSAAN DUA RT 03/04 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 19-Apr-1993 ( 26 Thn 4 Bln 21 Hr ) K12.1 - Other forms of stomatitis
No. RM : 01-005617 BPJS : 0000998911405 SETIRIZIN 10MG
KLORAMFENIKOL 1 % SM
JUMIYATI, NY (P) KP RAWA INDAH RT 005/003 PGS II I10 - Essential (primary) hypertension AMLODIPIN 10 MG
M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK 50 MG
No. RM : 01-000791 BPJS : 0001225885779 MCG
MARIA JACINTA SANI, NY (P) GGL BLOK B III /44 RT 10/12 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-036286 BPJS : 0001371782935 MCG
SUHARTI, NY (P) JL GADING MEDITERANIA 1 BLOK BE I10 - Essential (primary) hypertension KAPTOPRIL 25 MG
NO 15 KGB R05 - Cough AMBROKSOL TAB 30 MG
No. RM : 01-068087 NIK : 3401035805690002 MCG
Tgl Diagnosis : 11 February 2019 5:23 PM BPJS : 0002179851884 TIAMIN (VITAMIN B1) 50 MG
THERESIA WILYANINGSIH,NY (P) JL. TAMPAK SIRING INDAH NO. 103 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
005/007 mellitus without complications SIMVASTATIN 10 MG
No. RM : 01-066803 NIK : 3172065504560006 MCG
ILHAM PUTRA ARYANTO (L) JL. KP PULO GADUNG J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 195 dari 1322

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VITAMIN B KOMPLEKS
SYAKINA AURORA GISEL (P) GADING MEDITERANIA J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
SITI MA'MUNAH, NY (P) TANAH MERAH 09/07 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Diagnosis : 11 February 2019 7:40 PM SETIRIZIN 10MG
VITAMIN B KOMPLEKS
NGADINO, TN (L) PERJUANGAN GG NIAGA RT 6/7 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
YAN HARNY SIWALETTE (P) P PENYENGAT IV NO 33 RT 3/3 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
ANOM SETIARA, TN (L) P PENYENGAT IV NO 33 RT 3/3 L50.9 - Urticaria, unspecified SETIRIZIN 10MG
No. RM : 01-019937 BPJS : 0002096718467
2019-09-09 13:37 Hal. 196 dari 1322

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HETI HERAWATI, NY (P) PGS II RT 02/01 A06.0 - Acute amoebic dysentery KOMBINASI KAOLIN 550 MG, PEKTIN 20
MG TAB
Tgl Lahir : 23-Nov-1979 ( 39 Thn 9 Bln 17 Hr ) ANTASIDA DOEN
170 NIK : 317206631190008
MCG
DESTIA CHANDRA (L) PGS II RT 2/1 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 03-Apr-2005 ( 14 Thn 5 Bln 6 Hr ) R11 - Nausea and vomiting
171 NIK : 3172060304050003 MG
ARJUNA MUZAMIL HASBALLAH, AN (L) PERUMNAS KLENDER MAWAR J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MERAH III GG 8 NO 18 unspecified GENTAMISIN SALEP KULIT
172 AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-021053 NIK : - AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
SETIRIZIN 10MG
SITI AMINAH (P) JL. PEGANGSAAN 2 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
N39.0 - Urinary tract infection, site not NATRIUM DIKLOFENAK 50 MG
173 NIK : 3172064804550002 specified KOTRIMOKSAZOL DOEN I (DEWASA)
WARIYAH, NY (P) MOLEK I B4 NO 15 M13.9 - Arthritis, unspecified SIMVASTATIN 10 MG
No. RM : 01-022619 BPJS : 0002464946177 MCG
ZAHWA RIFA HUMAIRA (P) KAPLING TIPAR TIMUR RT013/04 NO R05 - Cough AMBROKSOL TAB 30 MG
175 MG
Tgl Diagnosis : 12 February 2019 4:55 PM BPJS : 0001314831025 VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 197 dari 1322

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ADE SUTRIAWAN (L) JL TIPAR TIMUR RT 013/004 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-028433 BPJS : 0001602767902 MG
VITAMIN B KOMPLEKS
DEDY SARI MUDA TAMPUBOLON, TN (L) KGB K02.3 - Arrested dental caries AMOKSISILIN 500 MG
K05.0 - Acute gingivitis PARASETAMOL TAB 500 MG
No. RM : 01-054673 BPJS : 0001438539491
KEISYA ANDHYRA YUSRIZAL, AN (P) JL SIAK J5 / 12 M79.1 - Myalgia NATRIUM DIKLOFENAK 50 MG
178 NIK : 3172046010060011 MCG
DESI SAFITRI ARDILA, NN (P) JL INPEKSI KALI SUNTER RT 04/07 K30 - Dyspepsia PARASETAMOL TAB 500 MG
R51 - Headache ANTASIDA DOEN
179 NIK : 320814471200002 RANITIDIN 150 MG
VERONICA MARIA K (P) JL JOGET KH/6 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK 50 MG
M54.5 - Low back pain AMLODIPIN 10 MG
No. RM : 01-059474 BPJS : 0002199500818 MCG
AINUN NAJBAH (P) JL. BELIRA III BLK M NO.22 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
ANTASIDA DOEN
181 NIK : 3172066509740001 RANITIDIN 150 MG
MUHAMMAD HAIKAL AZAMI (L) PEGANGSAAN DUA 02/02 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
182 NIK : 3172061305040006 MG TAB
Tgl Diagnosis : 12 February 2019 5:39 PM HIOSINA BUTILBROMIDA 10mg
2019-09-09 13:37 Hal. 198 dari 1322

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METRONIDAZOL 500 MG
SURJANI TJAHYANA HADI, NY (P) JL PUSPA GADING AI NO 48 I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4
J00 - Acute nasopharyngitis [common cold] MG
183 NIK : 3172064905570002 J02.9 - Acute pharyngitis, unspecified
HARI NURIL ANHAR (L) JL PGS II 006/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-024131 BPJS : 0002095453822 MG
AMINI (P) PGS II 006/002 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
No. RM : 01-024130 BPJS : 0002282411171 MG
AMLODIPIN 10 MG
MUHAMAD ISA FAHRUR ROZI, TN (L) KP PULO GADUNG GG Q NO 31 W19.9 - UNSPECIFIED FALL, AMOKSISILIN 500 MG
No. RM : 01-064656 BPJS : 0001376821956
ASNI KONGA WANDAL (P) JL KELAPA SAWIT II RW 17 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
187 NIK : 5311046707970002 RANITIDIN 150 MG
2019-09-09 13:37 Hal. 199 dari 1322

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TIORISTA IDA MALAU, NY (P) JL HIJAU DAUN D VIII/8 RT 10/10 J06.9 - Acute upper respiratory infection, ANTASIDA DOEN
Tgl Lahir : 04-Jun-1954 ( 65 Thn 3 Bln 5 Hr ) K30 - Dyspepsia
RANITIDIN 150 MG
MARIAM, NY (P) JL PERINTIS KEMERDEKAAN RT J06.9 - Acute upper respiratory infection, SALBUTAMOL 2 MG
011/004 unspecified DEKSAMETASON 0,5 MG
No. RM : 01-016521 NIK : 3175024308510002 MG
Tgl Diagnosis : 12 February 2019 6:09 PM BPJS : 0001224504066 NATRIUM DIKLOFENAK 50 MG
VITAMIN B KOMPLEKS
AMBROKSOL TAB 30 MG
MARIANI PADANGALAM, NY (P) JL GADING MAS BARAT VI DVIII /4 R05 - Cough AMBROKSOL TAB 30 MG
190 NIK : 3172066803570003 MG
SUYONO, TN (L) PEGANGSAAN DUA 05/02 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
I84.5 - External haemorrhoids without ANTIHEMOROID DOEN
191 NIK : 3172062601740003 complication RANITIDIN 150 MG
RD SRI YUNISAPTA MULIAWATI, NY (P) JL PULAU REMPANG III NO 20 RT J45.9 - Asthma, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
07/09 L23.9 - Allergic contact dermatitis, KLORFENIRAMIN MALEAT (CTM) TAB 4
192 unspecified cause MG
Tgl Diagnosis : 12 February 2019 6:32 PM BPJS : 0001170147846 SALBUTAMOL 2 MG
MIKONAZOL KRIM 2 %
2019-09-09 13:37 Hal. 200 dari 1322

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MUHAMMAD RAFA ALFATIH (L) JL. PGS II J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-087292 BPJS : 0002358539526 MG
VITAMIN B KOMPLEKS
DEBORAH NAINGGOLAN, NY (P) JL.JANUR KUNING IX WO 02/07 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
007/016 KGT unspecified NATRIUM DIKLOFENAK 50 MG
Tgl Lahir : 12-Feb-1962 ( 57 Thn 6 Bln 28 Hr ) M79.1 - Myalgia
DEKSAMETASON 0,5 MG
YAFI AUFA ALHANAN, AN (L) JL. SUKAPURA JAYA 004/010 A91 - Dengue haemorrhagic fever firdaus
igd
195 NIK : 3172042907170005 rujukan
No. RM : 01-056006 BPJS : 0002270695904
ROSLINDA NAINGGOLAN, NY (P) JL JANUR KUNING IX WO 2/7 RT J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
SIMVASTATIN 10 MG
DAIDA MERY SITOMPUL, NY (P) JANUR KUNING IX WO 2/7 RT 007/016 E11.9 - Non-insulin-dependent diabetes NATRIUM DIKLOFENAK 50 MG
mellitus without complications GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 30-Apr-1942 ( 77 Thn 4 Bln 9 Hr ) J06.9 - Acute upper respiratory infection,
No. RM : 01-017900 BPJS : 0001225558102 unspecified
VITAMIN B KOMPLEKS
HERMAN KRISTANTO, TN (L) JL. GRANDE RESIDENCE BLOK 9 CL I10 - Essential (primary) hypertension AMLODIPIN 10 MG
K02.3 - Arrested dental caries ANTASIDA DOEN
198 NIK : 3371021103850002 K30 - Dyspepsia KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-047951 BPJS : 0002168284768 MG
2019-09-09 13:37 Hal. 201 dari 1322

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FARIDA WAHYU, NY (P) JL GADING RAYA BLOK D 8/26 RT I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
08/10 J02.9 - Acute pharyngitis, unspecified NATRIUM DIKLOFENAK 50 MG
199 M13.9 - Arthritis, unspecified DEKSAMETASON 0,5 MG
MCG
KASWAN KASMIARJO,TN (L) JL. TANAH MERAHA RT 06/07 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
200 NIK : 3302120508650001 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK 50 MG
KURDI, TN (L) JANUR ASRI BLOK QJ 09 NO 24 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
R42 - Dizziness and giddiness RANITIDIN 150 MG
No. RM : 01-021841 BPJS : 0000443912591 MCG
PRAYITNO, TN (L) JL RAWA SENGON BLOK E RT 05/022 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
SUDARSONO, TN (L) PEGANGSAN DUA 02/02 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK 50 MG
M13.9 - Arthritis, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
203 NIK : 3502032408840001 MCG
RASIDA AULIA TSARI, AN (P) JL TERAMPIL I NO.26 005/002 KOMP R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
TNI AL KGB DOMPERIDON TAB 10 MG
No. RM : 01-009106 NIK : 3172064507061004 MCG
2019-09-09 13:37 Hal. 202 dari 1322

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DEVANNE BELGIANA AFSARI, NN (P) JL SUMMAGUNG III BLK N II NO.6 I84.5 - External haemorrhoids without HIOSINA BUTILBROMIDA 10mg
complication KOMBINASI BESI (II) SULFAT 200 MG,
205 NIK : 3273264502940001 ASAM FOLAT 0,25 MG
No. RM : 01-087294 BPJS : 0001784989269 ANTIHEMOROID DOEN
IQBAL DWI SYAHPUTRA, TN (L) JL RAYA PEGANGSAAN DUA RT 06/02 A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
presumed infectious origin DOMPERIDON TAB 10 MG
No. RM : 01-047867 BPJS : 0000378933355 MG TAB
WISNU PRATAMA YUDHA BAHARI, AN (L) TELUK RATAI I RT 02/10 L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 07-Aug-2015 ( 4 Thn 1 Bln 2 Hr ) DEKSAMETASON 0,5 MG
207 NIK : 3172060708151003
EKI JESSICA WINARKO, NN (P) PEGANGSAAN II RT 002/006 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
ANDRI PERMANA, TN (L) JL KEBANTENAN II/49 RT 003/002 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
209 NIK : 3172042510800011 RANITIDIN 150 MG
RABIZA ASHALINA GUNAWAN, AN (P) JL PERJUANGAN II R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
210 NIK : 3172031511170000 MG
2019-09-09 13:37 Hal. 203 dari 1322

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ALMAIRA ZULFA FARIHA (P) JL H OYAR RT 03/02 R11 - Nausea and vomiting RETRIBUSI LAYANAN SIAGA 24 JAM
211 NIK : 3172065111131001 HIOSINA BUTILBROMIDA 10mg
No. RM : 01-016813 BPJS : 0001313648335 GARAM ORALIT KOMBINASI
NASUKAT, TN (L) jl raya pegangsaan dua rt 06/02 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
212 NIK : 3172063012690001 KALSIUM LAKTAT (KALK) 500 MG
No. RM : 01-039865 BPJS : 0000378861862
SAZKIA PUTRI AMALIA, NN (P) RT 03/02 PEGANGSAAN DUA J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 05-000336 BPJS : 0001225379215 MG
VITAMIN B KOMPLEKS
NIKEN WAHYUNI, NY (P) JL PIANO BLK O NO.11 004/009 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
214 NIK : 3172064203760008 MCG
Tgl Diagnosis : 12 February 2019 8:52 PM HIDROKLORTIAZID 25 MG
JUBAEDAH, NY (P) JL KP RAWA INDAH NO 75 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK 50 MG
W19.9 - UNSPECIFIED FALL, AMLODIPIN 10 MG
215 NIK : 3172064207690001 UNSPECIFIED PLACE HIDROKLORTIAZID 25 MG
DJOKO NURJONO (L) KP RAWA INDAH NO 75 RT 06/03 W19.9 - UNSPECIFIED FALL, AMOKSISILIN 500 MG
No. RM : 01-018284 BPJS : 0000378122826 MCG
2019-09-09 13:37 Hal. 204 dari 1322

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LUTHFI RAFA ALFATIH, AN (L) JL.KESADARAN 05/01 NO.27 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
ALIF SHARKAN RAMADHAN, BY (L) PGS 2 RT 4/1 R05 - Cough INHALASI (UGD)
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
SAMIATI ,NY (P) JL. RAWA INDAH RT 04/03 E78.0 - Pure hypercholesterolaemia NATRIUM DIKLOFENAK 50 MG
I10 - Essential (primary) hypertension SIANOKOBALAMIN (VITAMIN B12) 50
219 NIK : 3172066612750005 MCG
Tgl Diagnosis : 12 February 2019 9:19 PM SIMVASTATIN 10 MG
FADIA WARDAH AFIAH, NN (P) JL JANUR INDAH III LA 12/10 K30 - Dyspepsia ANTASIDA DOEN
R11 - Nausea and vomiting RANITIDIN 150 MG
DAFFA AL FARIZI,AN (L) RAWA INDAH RT 006/003 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 205 dari 1322

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ANISSA ALYA, NN (P) JL. H OYAR RT 004/002 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
DEKSAMETASON 0,5 MG
ERIKA APRILIA, NN (P) JL. GD NIAS BLK NI I NO.9 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
223 NIK : 3215244704950002 RANITIDIN 150 MG
VITAMIN B KOMPLEKS
KONNY KONTU, TN (L) CAKUNG BARAT RT02/10 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK 50 MG
K02.3 - Arrested dental caries ANTASIDA DOEN
224 NIK : 3175061212730017 K30 - Dyspepsia RANITIDIN 150 MG
MASUDAH, NY (P) JL. INSPEKSI KALI SUNTER RT 02 RW I10 - Essential (primary) hypertension ANTASIDA DOEN
04 KGB K30 - Dyspepsia RANITIDIN 150 MG
225 AMLODIPIN 10 MG
SOLIKHIN, TN (L) KGB RT 2/4 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 27-Aug-1972 ( 47 Thn 0 Bln 13 Hr ) L23.9 - Allergic contact dermatitis,
No. RM : 01-024456 BPJS : 0001225573762 unspecified cause MG
LINTANG AULIA RUDIANTO, AN (P) JL TANGGUH V NO 65 RT 09/02 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
J03.9 - Acute tonsillitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 206 dari 1322

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NOK HELEN, NY (P) KGT RT 04/06 L23.9 - Allergic contact dermatitis, ASAM MEFENAMAT KAPS 500
unspecified cause HIOSINA BUTILBROMIDA 10mg
Tgl Lahir : 29-Dec-1970 ( 48 Thn 8 Bln 11 Hr ) N94.6 - Dysmenorrhoea, unspecified
MG
AHMAD NUR YUSUF, AN (L) KOMP DEP PERDAGANGAN RT 5/6 L08.9 - Local infection of skin and AMOKSISILIN 500 MG
subcutaneous tissue, unspecified ASAM MEFENAMAT KAPS 500
EKA NOVIA SYAHFITRI (P) JL PEGANGSAAN DUA RT 04/02 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-053827 BPJS : 0000998908266 MG
M RIDHO MAULANA, TN (L) PGS II RT 3/4 K12.1 - Other forms of stomatitis DEKSAMETASON 0,5 MG
No. RM : 01-031588 BPJS : 0000377204534
PUTRI RIZKY AGATHA, NN (P) KAMP PULO GADUNG RT 006/005 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-005535 BPJS : 0001226144439 MG
WINDA NOVIANI, NN (P) KP TANAH MERAHRT 03/08 NO 30D J45.9 - Asthma, unspecified ANTASIDA DOEN
RANITIDIN 150 MG
233 NIK : 3172036802001001 SALBUTAMOL 2 MG
MG
INHALASI (UGD)
2019-09-09 13:37 Hal. 207 dari 1322

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CHAYRA NUR JANNAH (P) JL. PERINTIS KEMERDEKAAN RT J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-044804 NIK : 3172065910160007 MG
VITAMIN B KOMPLEKS
FATMAWATI, NY (P) JL PULO NANGKA BRT II H10.9 - Conjunctivitis, unspecified SETIRIZIN 10MG
DEKSAMETASON 0,5 MG
NAMIH,NY (P) PEGANGSAAN DUA RT 002/004 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
PUTRA SETIAWAN, AN (L) SUKAPURA JAYA RT 05/10 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-006792 BPJS : 0001740738172 MG
VITAMIN B KOMPLEKS
FAJAR SETIAWAN, TN (L) SUKAPURA 05/10 K30 - Dyspepsia PARASETAMOL TAB 500 MG
238 NIK : 3172041902981001 RANITIDIN 150 MG
DINDA ALFIANA, NN (P) JL. PERINTIS KEMERDEKAAN RT 03 J00 - Acute nasopharyngitis [common cold] RETRIBUSI LAYANAN SIAGA 24 JAM
RW 06 KGT J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 208 dari 1322

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SARAH NAJWA (P) JL. PERINTIS KEMERDEKAAN RT L04.0 - Acute lymphadenitis of face, head AMOKSISILIN 500 MG
003/06 NO 69 and neck ASAM MEFENAMAT KAPS 500
240 PREDNISON 5 MG
No. RM : 01-051414 NIK : 3172065109040005 ASAM ASKORBAT (VITAMIN C) 50 MG
SUKINEM, NY (P) JL.HARAPAN III NO.8 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
No. RM : 01-016643 BPJS : 0000205534449 MG
TRI WIYONO, TN (L) JL BANGUN CIPTA SARANA RT 05/05 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
SIMVASTATIN 10 MG
YEYEN YULIAWATI, NY (P) KOMP PLN BLOK E NO 90 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-056217 BPJS : 0001340045673 MG
KAYVA RAHIZA NANDOLA, AN (P) JL.IMPORT A/30 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-054139 BPJS : 0001773844593 MG
RANITIDIN 150 MG
2019-09-09 13:37 Hal. 209 dari 1322

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RISTA ELISABET, NY (P) PEGANGSAAN DUA RT 03/05 R07.4 - Chest pain, unspecified ISOSORBID DINITRAT 5 MG
R51 - Headache ASAM ASETILSALISILAT 80 mg
245 NIK : 3172065505690002 (ASETOSAL)
EKG
HANDOYO, TN (L) JL RAWA INDAH RT 07/03 R51 - Headache NATRIUM DIKLOFENAK 50 MG
246 NIK : 3172061310860004 MCG
ZAINAL MUARIF, TN (L) JL P REMPANG III NO 27 RT 7/9 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
AGUS SUMANTRI, TN (L) JL. KP BABAKAN L50.2 - Urticaria due to cold and heat SETIRIZIN 10MG
DEKSAMETASON 0,5 MG
248 NIK : 3201170406750001 BETAMETASON 0,1%,KRIM
SRI PUJIARSIH, NY (P) RW INDAH NO 60 RT 6/3 M79.1 - Myalgia NATRIUM DIKLOFENAK 50 MG
R51 - Headache SIANOKOBALAMIN (VITAMIN B12) 50
249 NIK : 3172065209610003 MCG
YANI INDRIAWATI, NN (P) JL TIPAR CAKUNG RT 001/001 K02.3 - Arrested dental caries KOTRIMOKSAZOL DOEN I (DEWASA)
N89.9 - Noninflammatory disorder of vagina, (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 03-Mar-1998 ( 21 Thn 6 Bln 6 Hr ) TRIMETOPRIM 80 MG)
250 NIK : 3301204303980004 unspecified
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 210 dari 1322

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TRISWANTO, TN (L) JL. PGS II 004/002 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
MANDAN S KUMING, TN (L) JL P TEMIANG RT 13/3 R50.9 - Fever, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
SYAKIRA TITANIA PUTRI JATMIKO (P) JL KGT I 005/008 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
SYAKILA ARUM OKTAVIA, BY (P) JL. SWADAYA NO. 24 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-080254 BPJS : 0002497871777 MG
ARSAKHA ZIKRI ALVARO, AN (L) GG PERINTIS2 NO 94E J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-017049 BPJS : 0002240797241 MG
VITAMIN B KOMPLEKS
AIJAZ PARSA EL GRABIAN, AN (L) RAWA INDAH J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 211 dari 1322

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ANDI SUPRIANDI (L) PEGANGSAAN DUA 06/02 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-024384 BPJS : 0001225753626 MG
SUGIYANTO, TN (L) JL. KOMP WALIKOTA BLK Y III NO.20 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
ANNISA ZAHRA, an (P) KOMP PELINDO BLOK G III NO 11 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-039661 BPJS : 0002423337849 MG
VITAMIN B KOMPLEKS
HADIJA AZHARIANTI, NN (P) JL RAWA INDAH RT 06/03 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
J06.9 - Acute upper respiratory infection, DEKSAMETASON 0,5 MG
260 NIK : 3172066702010001 unspecified
No. RM : 01-047009 BPJS : 0000377210981
ELNIWATI, NY (P) KOMP BEA CUKAI BLK H 5/25 008/007 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
261 NIK : 3172044610670005 ASAM ASETILSALISILAT 80 mg
No. RM : 01-012997 BPJS : 0001156987642 (ASETOSAL)
MCG
WAN YENTRI, TN (L) KOMP BEA CUKAI 08/07 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
2019-09-09 13:37 Hal. 212 dari 1322

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NUR LELAH AINI, NY (P) JL PEGANGSAAN DUA RT 06/03 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
SUDARMINTO (L) BCS GG.Q NO.61 03/05 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
264 NIK : 3172061401690001 MCG
MUHAMMAD SAID ROMADHON (L) JL PEGANGSAAN DUA RT 04/13 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
TRIYONO, TN (L) DUSUN PELEMGEDE W22.6 - STRIKING AGAINST OR STRUCK RETRIBUSI LAYANAN SIAGA 24 JAM
BY OTHER OBJECTS, INDUSTRIAL AND AMOKSISILIN 500 MG
Tgl Lahir : 01-Dec-1984 ( 34 Thn 9 Bln 8 Hr ) CONSTRUCTION AREA
No. RM : 01-087603 BPJS : 0000586057443 HECTING KECIL (1-5 JAHITAN)
ABRAHAM REYNAND PRASTI, AN (L) JL. INSP KALI SUNTER RT 009/013 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
SYIN LUDJENG, TN (L) RAWA INDAH 02/03 L50.9 - Urticaria, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
268 NIK : 3172061812510002 MG
BEDAK SALISIL 2 %
2019-09-09 13:37 Hal. 213 dari 1322

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WARYADI, TN (L) JL. PERINTIS KEMERDEKAAN GG I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
PUSKESMAS RT 09 RW 02 J06.9 - Acute upper respiratory infection, AMLODIPIN 10 MG
269 unspecified HIDROKLORTIAZID 25 MG
MG
RANITIDIN 150 MG
CEP RIDWAN MAULANA (L) JL,\.SUTRA UNGU J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
270 NIK : NULL KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-087606 BPJS : 0001910946565 MG
AMIN MUCHROMIN, TN (L) PEGANGSAAN DUA 02/01 K29.7 - Gastritis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
ROLIYAH DEWI, NY (P) JL. GADING INDAH UTARA V BLK NH 8 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
NO.25 024/012 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
272 unspecified MG
IMAN SANTOSO, TN (L) PEGANGSAAN DUA 05/13 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
MG
QINARA AULIA PUTRI, AN (P) JL. WARUNG JENGKOL 005/013 NO.38 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
274 NIK : - unspecified PARASETAMOL TAB 500 MG
MG
2019-09-09 13:37 Hal. 214 dari 1322

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DEKSAMETASON 0,5 MG
JUMINTEN, NY (P) PGS II RT 5/2 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
275 NIK : 3172065111790006 AMLODIPIN 10 MG
No. RM : 01-019469 BPJS : 0001328729455 R05 - Cough AMBROKSOL TAB 30 MG
MG
SUYONO, TN (L) PEGANGSAAN DUA 05/02 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
276 NIK : 3172062601740003 MG
ANTASIDA DOEN
DESY ASMARANTI (P) JL SWASEMBADA BARAT 24 RT 09/011 J02.9 - Acute pharyngitis, unspecified KOTRIMOKSAZOL DOEN SUSPENSI
277 NIK : -
MG
VITAMIN B KOMPLEKS
OBH SIRUP 100 ML
HASAN, TN (L) PEGANGSAAN DUA RT 02/01 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
No. RM : 01-021928 BPJS : 0000998909785 MCG
SUHADAH, NY (P) PEGANGSAAN DUA RT 02/01 L23.9 - Allergic contact dermatitis, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified cause MG
279 NIK : 3172064605670004
2019-09-09 13:37 Hal. 215 dari 1322

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IR DJANUAR LUKMAN, TN (L) PETOJO SELATAN II NO 16 RT 003/005 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-004699 BPJS : 0001260170537 MG
VITAMIN B KOMPLEKS
MARISA NOFIANTI, NY (P) JL. PGS II 002/002 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK TAB 25 MG
PREDNISON 5 MG
No. RM : 01-035278 BPJS : 0001225613204 MCG
EDI BOGOWONTO, TN (L) ASRAMA PEMADAM KEBAKARAN RT J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
ASMAROH BT ASMAT, NY (P) RAWA INDAH RT 6/3 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
unspecified RANITIDIN 150 MG
Tgl Lahir : 05-Dec-1950 ( 68 Thn 9 Bln 4 Hr ) K30 - Dyspepsia
MG
SUWITO SUSILO, TN (L) JL.SENEN RAYA NO.48A 08/01 F41.9 - Anxiety disorder, unspecified DEKSAMETASON 0,5 MG
284 NIK : 3171042901690002 unspecified SIANOKOBALAMIN (VITAMIN B12) 50
No. RM : 01-001259 BPJS : 0001310313982 K30 - Dyspepsia MCG
Tgl Diagnosis : 15 February 2019 6:41 PM OMEPRAZOL KAPS 20 MG
SYAKINA AURORA GISEL (P) GADING MEDITERANIA J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
285 NIK : 32090151041200002 MG
2019-09-09 13:37 Hal. 216 dari 1322

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KOTRIMOKSAZOL DOEN SUSPENSI
TRIMETOPRIM 40 MG)
KASRA KOSASIH (L) GADING MEDITERNIA MESST J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
286 NIK : 3209011006870004 MG
TUTI ROAENAH, NY (P) GADING MEDITERANIA J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
287 NIK : 3209015406890004 MG
AMOKSISILIN 500 MG
MARSIDAH (P) JL PGS II RT 006/002 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
I84.5 - External haemorrhoids without HIDROKLORTIAZID 25 MG
288 NIK : 3172064910680002 complication ANTIHEMOROID DOEN
No. RM : 01-018712 BPJS : 0000377711177 FITOMENADION (VITAMIN K1) 10 MG
BUDIANTO SH, TN (L) THE ROYAL RESIDENCE JL BIGNONIA J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
II BLOK B 6/27 RT 04/04 unspecified PARASETAMOL TAB 500 MG
TRIMETOPRIM 80 MG)
RIDHO MAULANA (L) PGS II RT 3/4 J45.9 - Asthma, unspecified SALBUTAMOL 2 MG
290 NIK : 3172060508101006 MG
2019-09-09 13:37 Hal. 217 dari 1322

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INHALASI (UGD)
PARAMITHA WIDJAJA (P) KLP PUYUH IV KB30-31 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-078355 BPJS : 0002275406908
REZINA ELVANIA (P) O TEMIANG I / 36 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
ELISTYOWATI, NY (P) JL KGT RT 001/006 N39.0 - Urinary tract infection, site not KOTRIMOKSAZOL DOEN I (DEWASA)
specified (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 30-Nov-1980 ( 38 Thn 9 Bln 9 Hr ) TRIMETOPRIM 80 MG)
293 NIK : 3327137011800002
Tgl Diagnosis : 15 February 2019 7:55 PM HIOSINA BUTILBROMIDA 10mg
NOVA ABDU RACHMAN FAUZI, NY (L) JL. BCS RT 02/05 NO 98 J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-014937 BPJS : 0001607827318 MG
TRIMETOPRIM 80 MG)
MIRA PURBAYASARI, NY (P) JL RAYA GADING PERMAIU BLOK B 1 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
NO 3 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
295 MG
No. RM : 01-062055 NIK : 3671085707810008
2019-09-09 13:37 Hal. 218 dari 1322

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DIAN AYU PURNAMA SARI, NN (P) JL BOULEVARD ARAY BLK WE II NO.4L K05.0 - Acute gingivitis PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified AMOKSISILIN 500 MG
No. RM : 01-087612 BPJS : 0002332900449
ALESHA IZZATUNNISA AN (P) JL PUSKESMAS 003/006 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 02-002141 BPJS : 0002332844313 MG
VITAMIN B KOMPLEKS
TJHIN PO SIAT, NY (P) JL. JANUR ASRI III QK 6 NO. 18 004/012 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin HIOSINA BUTILBROMIDA 10mg
No. RM : 01-065620 BPJS : 0002143459743 MG TAB
Tgl Diagnosis : 15 February 2019 8:25 PM GARAM ORALIT KOMBINASI
TRIMETOPRIM 80 MG)
DJELTY TITI KENI (P) JL GADING KIRANA BLOK E 10/40 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
MAIDI (L) JL H OYAR K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
RAFFA PRATAMA (L) JL PGS II J06.9 - Acute upper respiratory infection,
unspecified
301 NIK : -
No. RM : 01-087620 BPJS : 0000377835524
2019-09-09 13:37 Hal. 219 dari 1322

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ERAWATI, NY (P) TAPAK SIRING ELOK NO.16 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
302 NIK : 3209194608940005 RANITIDIN 150 MG
SITI FATIMAH (P) RW INDAH RT 6/3 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
RUSIMIN, TN (L) JL GADING VII NO 2 RT 05/05 B02.9 - Zoster without complication RETRIBUSI LAYANAN SIAGA 24 JAM
304 NIK : 3172061310790006 MG
Tgl Diagnosis : 15 February 2019 9:03 PM ASIKLOVIR 400 MG
ASIKLOVIR KRIM 5%
TRIPUTRI OKTAVIANI TASMAH, AN (P) KALI SUNTER 03/04 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-051766 BPJS : 0001225573942 MG
IRFAN, AN (L) JL RAWA SENGON BLOK F NO 8 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
306 NIK : - unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
DEKSAMETASON 0,5 MG
AHMAD EFENDI, TN (L) JL RW SENGON I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
J06.9 - Acute upper respiratory infection, RANITIDIN 150 MG
AMLODIPIN 10 MG
2019-09-09 13:37 Hal. 220 dari 1322

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ERLANGGA SYAHPUTRA, AN (L) KP RAWA INDAH PGS2 RT07/03 R05 - Cough AMBROKSOL TAB 30 MG
308 NIK : - MG
SUTARMI (P) PGS II RT 002/001 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-007911 BPJS : 0000378157983 MG
LIA ANITA, NY (P) RAWA SENGON RT 06/22 I10 - Essential (primary) hypertension AMBROKSOL TAB 30 MG
310 NIK : 31720663019510003 unspecified AMLODIPIN 10 MG
SYAQILA AYUNDIA (P) KL RAWA SENGON RT 006/022 KGB J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-002873 BPJS : 0001612412651 MG
VITAMIN B KOMPLEKS
SIFA CHAIRIYAH (P) KL KGT RT 03/06 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
RANITIDIN 150 MG
DEOVALDI IKHWAN TAMIMI (L) KOMP PT HII RT 03/05 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
313 NIK : 3172062404060002 MG
Tgl Diagnosis : 15 February 2019 10:16 PM BEDAK SALISIL 2 %
2019-09-09 13:37 Hal. 221 dari 1322

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R.M IKA HERDINOVITA, NY (P) JL TELUK ARATAI II NO.32 004/010 R51 - Headache PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
REPNO, TN (L) INSP KALI SUNTER RT 007/013 L50.9 - Urticaria, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-018708 BPJS : 0001225611505 MG
VITAMIN B KOMPLEKS
QYLAW SYAHARA (P) JL KAYU JATI V 003/005 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
316 NIK : 3175026809101008 MG
DONI FAHRIZAL SUMANTRI, TN (L) JL RW SENGON BLK D NO.20 W22.2 - STRIKING AGAINST OR STRUCK AMOKSISILIN 500 MG
BY OTHER OBJECTS, SCHOOL, OTHER METRONIDAZOL 500 MG
Tgl Lahir : 25-Oct-2000 ( 18 Thn 10 Bln 15 Hr ) INSTITUTION AND PUBLIC
No. RM : 01-087629 BPJS : 0001200536111 ADMIMISTRATION AREA
PERAWATAN LUKA RINGAN (UGD)
Tgl Diagnosis : 15 February 2019 10:34 PM INJEKSI (UGD)
DOLY ARIAWAN, TN (L) JL HARPA VI BLK EEI NO.1 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
No. RM : 01-082485 BPJS : 0001882603337 MCG
CHAYRA NUR JANNAH (P) JL. PERINTIS KEMERDEKAAN RT J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
011/004 unspecified KOTRIMOKSAZOL DOEN SUSPENSI
MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 222 dari 1322

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SRI LESTARI, NY (P) RAWA INDAH RT.003/03 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
320 NIK : 330110551910011 MG
EL SHAFF MUZZAMMIL MOSLEM (L) JL.GADING III NO.1 03/08 KGB J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-061483 BPJS : 0001467273508 MG
SUGENG HARTONO, TN (L) JL GADING III NO 1 K30 - Dyspepsia ANTASIDA DOEN

RANITIDIN 150 MG
No. RM : 01-035594 BPJS : 0001467273475
JOHN RUDOLF BACHTIAR HULU, AN (L) RGTC BLOK ANGSANA NO 419 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
METTA RACHMA, NY (P) KOMP PT HII BLOK C/4 RT 03/05 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 223 dari 1322

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JESSLYN CHRISTIE, AN (P) BANGUN CIPTA SARANA 03/05 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
No. RM : 01-007082 BPJS : 0001225218598 MG
SANIM IMRAN, TN (L) JL RW INDAH I84.5 - External haemorrhoids without PARASETAMOL TAB 500 MG
complication ANTASIDA DOEN
326 NIK : 3172060904850006 ANTIHEMOROID DOEN
HANIFATUZAHRO, NN (P) JL. RAWA INDAH NO. 84 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-081965 BPJS : 0000377418284 MG
TATANG SUHANA, TN (L) PASAR ULAR J00 - Acute nasopharyngitis [common cold] RETRIBUSI LAYANAN SIAGA 24 JAM
VITAMIN B KOMPLEKS
IMANUEL WILLY HARYANTO, TN (L) PONDOK BAMBU L23.9 - Allergic contact dermatitis, RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified cause GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 11-May-1990 ( 29 Thn 3 Bln 29 Hr ) R05 - Cough
No. RM : 01-007873 BPJS : 0002260339402 MG
HANDOYO, TN (L) JL RAWA INDAH RT 07/03 E78.0 - Pure hypercholesterolaemia ALOPURINOL 100 MG
No. RM : 01-014148 BPJS : 0001631444927 MCG
2019-09-09 13:37 Hal. 224 dari 1322

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SANTI NURCAHYANI, NY (P) JL H OYAR RT 004/002 Z38.0 - Singleton, born in hospital AMOKSISILIN 500 MG
KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
100.000 UI
SANTI NURCAHYANI, NY (P) JL H OYAR RT 004/002 Z38.0 - Singleton, born in hospital

332 NIK : 3201125811920004
No. RM : 01-015780 BPJS : 0001737320466
NURHAYATI, AN (P) KALI SUNTER 05/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-040222 BPJS : 0001384903247 MG
TRI WIYONO, TN (L) JL BANGUN CIPTA SARANA RT 05/05 I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
MG
SIMVASTATIN 10 MG
SARIYEM, NY (P) JL BANGUN CIPTA SARANA RT 05/05 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
Tgl Lahir : 16-Jul-1971 ( 48 Thn 1 Bln 24 Hr ) K30 - Dyspepsia
DEKSAMETASON 0,5 MG
RANITIDIN 150 MG
2019-09-09 13:37 Hal. 225 dari 1322

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AMSAR, TN (L) JL PULO NANGKA BARAT II NO 154 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
336 NIK : 3171060106850004
MG TAB
VITAMIN B KOMPLEKS
SRIKANDI NURUL FATIMAH, AN (L) JL. BANGUN CIPTA SARANA J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
SIDIK SILA PRAWOTO, TN (L) JL KOSAMBI II RT 2/8 H10.9 - Conjunctivitis, unspecified PARASETAMOL TAB 500 MG
338 NIK : 3172022212900008 MG
Tgl Diagnosis : 16 February 2019 6:46 AM KLORAMFENIKOL 1 % SM
SINTA YANUARTI DEWI, NY (P) JL.MAHONI BLOK GG.IV/6 O42.9 - Premature rupture of membranes,
unspecified
339 NIK : 3172035301890005
No. RM : 01-063465 BPJS : 0001622412202
MUHAMAD JENAL, TN (L) KOMP BEA CUKAI JL LOMBOK NO 13 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
Tgl Diagnosis : 16 February 2019 7:26 AM DOMPERIDON TAB 10 MG
DRG. DINI INDRAWATI, NY (P) JL BAMBU DURI XI NO 8 RT 12 / 6 N39.0 - Urinary tract infection, site not
specified
341 NIK : 3175074605690003
No. RM : 01-016748 BPJS : 0000041679786
2019-09-09 13:37 Hal. 226 dari 1322

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SONYA DEVI MAHARANI, NY (P) APT GADING NIAS TW DAHLIA LT 8 O80.9 - Single spontaneous delivery,
unspecified
342 NIK : 3172065109011002
No. RM : 01-071669 BPJS : 0002518266519
SYAHRIR AWAN, TN (L) KOMP BEA CUKAI BLOK I /5 RT 08/07 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-015201 BPJS : 0001312706226 MG
AMSAR, TN (L) JL PULO NANGKA BARAT II NO 154 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
MCG
DEWI WULANSARI, NN (P) PULO NANGKA BARAT II 02/16 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
SRI RUNINGSIH BT MASHUDI, NY (P) P NANGKA BARAT II 002/016 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MG
DEKSAMETASON 0,5 MG
KHAULAH AZ-ZAHRA, NN (P) JL P BESAR 2 RT 8/11 R11 - Nausea and vomiting PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified DOMPERIDON TAB 10 MG
2019-09-09 13:37 Hal. 227 dari 1322

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ARDIANI SAFITRI, NY (P) KGT RT 03/04 K30 - Dyspepsia ANTASIDA DOEN
M79.1 - Myalgia RANITIDIN 150 MG
DARRA ERUM HERDIANI (P) KGT RT 03/04 J00 - Acute nasopharyngitis [common cold] PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-050340 BPJS : 0002332830216 MG
VITAMIN B KOMPLEKS
SUPRIHATI ,NY (P) JL KESADARAN RT 01/04 E11.9 - Non-insulin-dependent diabetes NATRIUM DIKLOFENAK TAB 25 MG
mellitus without complications SIANOKOBALAMIN (VITAMIN B12) 50
350 NIK : 3172064701641001 MCG
No. RM : 01-010963 BPJS : 0001224315358 M54.5 - Low back pain AMLODIPIN 10 MG
Tgl Diagnosis : 18 February 2019 5:08 PM GLIBENKLAMIDA 5 MG
METFORMIN TAB 500 MG
WIBISONO SUGIH HARTA, TN (L) JL. BANGKA NO. 1/ KOMPYOR BARAT I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
IV C12/23 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
351 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-000880 NIK : 33725050803540003 unspecified DEKSAMETASON 0,5 MG
MG
AMLODIPIN 10 MG
HERTI JUNIAR, NY (P) JL PLUMPANG B 003/009 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-015527 BPJS : 0000378382533 MG
HERA APRILIA P, NN (P) JL ISSPEKSI KALI SUNTER RT 008/013 B35.4 - Tinea corporis RETRIBUSI LAYANAN SIAGA 24 JAM
R50.9 - Fever, unspecified MIKONAZOL KRIM 2 %
No. RM : 01-035341 BPJS : 0001225563039
2019-09-09 13:37 Hal. 228 dari 1322

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HARDIANAH, NY (P) JL KLP KOPYOR TMR III BG I/8 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
MG
OBH SIRUP 100 ML
SRI MAIZURNI, NY (P) JL. PULO NANGKA BRT II H10.9 - Conjunctivitis, unspecified PARASETAMOL TAB 500 MG
355 NIK : 317524805760012 MG
No. RM : 01-087880 BPJS : 0001853666526 PREDNISON 5 MG
JIYAN, TN (L) JL. H. OYAR 001/002 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
DEKSAMETASON 0,5 MG
HARIYAH, NY (P) JL.PELANGI UNGU VII BLK C III S J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
NO.11 unspecified AMBROKSOL TAB 30 MG
No. RM : 01-015635 NIK : 3306135703770006 MG
Tgl Diagnosis : 18 February 2019 5:41 PM BPJS : 0002507286598 ASAM ASKORBAT (VITAMIN C) 50 MG
NABILLAH FATIHAH ARIYANTO, NN (P) PGS II RT 4/1 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
SUDARSONO, TN (L) PEGANGSAN DUA 02/02 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
359 NIK : 3502032408840001 RANITIDIN 150 MG
2019-09-09 13:37 Hal. 229 dari 1322

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HERLINA PRATIWI, NY (P) RAWA SENGON RT 01/22 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
360 NIK : 3376026405890002 RANITIDIN 150 MG
AYLA ZAHRA SALSABILA, AN (P) RAWA SENGON RT 01/22 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-019082 BPJS : 0002082034574 MG
KASWAN KASMIARJO,TN (L) JL. TANAH MERAHA RT 06/07 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK TAB 25 MG
M13.9 - Arthritis, unspecified RANITIDIN 150 MG
362 NIK : 3302120508650001 AMLODIPIN 10 MG
ANGGUN AVERA ANINDITA, AN (P) JL TEKUN NO 33 RT 02/03 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-013417 BPJS : 0001825441209 MG
NAYLA DWI AFIFAH HANY, NN (P) jl. perintis RT 03 RW 06 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 02-001203 BPJS : 0001225130848 MG
THORRY KASIDA, TN (L) KALI SUNTER 02/04 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
unspecified NATRIUM DIKLOFENAK TAB 25 MG
2019-09-09 13:37 Hal. 230 dari 1322

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NANDA PRASASTI, AN (P) KALI SUNTER 02/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-019014 BPJS : 0001476040678
DRG. DINI INDRAWATI, NY (P) JL BAMBU DURI XI NO 8 RT 12 / 6 R95 - Sudden infant death syndrome AMBROKSOL TAB 30 MG
OBH SIRUP 100 ML
No. RM : 01-016748 BPJS : 0000041679786
HENDRO SUBROTO,TN (L) PERUM PTI KHUSUS J2/10 RT 05/10 R05 - Cough RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-008794 BPJS : 0001744985981 MG
TRIMETOPRIM 80 MG)
ATIQAH RANASARI FAUZIYYAH, NN (P) PGS 2 RT 003/005 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
Tgl Lahir : 01-Feb-2000 ( 19 Thn 7 Bln 8 Hr ) J45.9 - Asthma, unspecified
No. RM : 05-000062 BPJS : 0000376849574 MG
SALBUTAMOL 2 MG
AZZAHRA PUTRI SURYAMAN (P) JL PUSKESMAS NO.18 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
IRAWATY KON, NY (P) APT GADING NIAS RESIDENCE D/2 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
DK RT 02/03 OGS II J06.9 - Acute upper respiratory infection, AMLODIPIN 10 MG
371 unspecified PARASETAMOL TAB 500 MG
No. RM : 01-001475 NIK : 3172065304640001 GLISERIL GUAIAKOLAT (GG) 100 MG
MG
2019-09-09 13:37 Hal. 231 dari 1322

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DEKSAMETASON 0,5 MG
MCG
PARJIYEM, NY (P) PGS II RT 04/02 NO 111 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-033262 BPJS : 0001317761796 MCG
IMMANUEL ARISTYA SULAIMAN, TN (L) JL. APRT GD MEDIETRANIA R51 - Headache NATRIUM DIKLOFENAK TAB 25 MG
RESIEDENCES TWR A UNIT CA 17AA SIANOKOBALAMIN (VITAMIN B12) 50
373 MCG
No. RM : 01-087885 NIK : 3310240903800005 TIAMIN (VITAMIN B1) 50 MG
AHMAD JULKIPLI, TN (L) JL LINGKUNGAN III J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-087886 BPJS : 0001376979186 MG
SITI SURIETI, NY (P) RW SENGON BLK E J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
375 NIK : 3328115401860007 MG
Tgl Diagnosis : 18 February 2019 7:46 PM DOMPERIDON TAB 10 MG
DEKSAMETASON 0,5 MG
ANNA THERESIA WAHYU LUXWINARTI, NY JL. KLPA NIAS BLK PBB II NO.8 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
376 NIK : 3578134709670001 MCG
2019-09-09 13:37 Hal. 232 dari 1322

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RIDWAN, TN (L) PGS II RT 2/1 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
AL GIFARY ARABY, AN (L) PEGANGSAAN DUA 02/01 R51 - Headache PARASETAMOL TAB 500 MG
No. RM : 01-046705 BPJS : 0000377920517
WAHYUDI HARSONO, TN (L) JL. PGS II J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
EMAH, NY (P) JL RAWA SENGOM RT 12/14 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-018574 BPJS : 0001603218879 MCG
ISMAIL, TN (L) PEGANGSAAN DUA 03/04 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
381 NIK : 3172060703830002 AMLODIPIN 10 MG
RIZKA AMALLIA RANTI, NN (P) JL PGS II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 233 dari 1322

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ABDUL KARIM, TN (L) JL BANGUN CIPTA SARANA RT H66.9 - Otitis media, unspecified AMOKSISILIN 500 MG
003/005 PARASETAMOL TAB 500 MG
383 PREDNISON 5 MG
No. RM : 01-017514 NIK : 3175022610930013
SARYANTO, TN (L) RAWA INDAH RT 04/03 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-059738 BPJS : 0001425239302 MG
YULIATIN, NY (P) JL PERINTIS RT 11/4 N94.6 - Dysmenorrhoea, unspecified NATRIUM DIKLOFENAK TAB 25 MG
R50.9 - Fever, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
385 NIK : 3172065907870006 MCG
No. RM : 01-063139 BPJS : 0001296400533
RUDIN, TN (L) JL. KLP NIAS VIII PB 16 NO 5 A09 - Diarrhoea and gastroenteritis of AMLODIPIN 10 MG
presumed infectious origin METRONIDAZOL 500 MG
No. RM : 01-056939 BPJS : 0002104114138 MG TAB
SUSI ELVIANA SAGALA, NY (L) KP.MUARA BAHARI 10/12 J06.9 - Acute upper respiratory infection, AMLODIPIN 10 MG
Tgl Lahir : 09-Jan-1983 ( 36 Thn 8 Bln 0 Hr ) L08.9 - Local infection of skin and
No. RM : 01-000030 BPJS : 0001875468958 subcutaneous tissue, unspecified
METRONIDAZOL 500 MG
RANITIDIN 150 MG
MG
PERAWATAN LUKA RINGAN (UGD)
2019-09-09 13:37 Hal. 234 dari 1322

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HANDOKO ALWI, TN (L) INSPEKSI KALI SUNTER RT 8/13 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
SRI WULAN (P) PGS DUA RT3/5 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
L23.9 - Allergic contact dermatitis, AMLODIPIN 10 MG
389 NIK : 3172066206540002 unspecified cause BETAMETASON 0,1%,KRIM
DEKSAMETASON 0,5 MG
RINI SETTIYAWATI, NY (L) RAWA SENGON RT 003-022 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
390 NIK : 3172064912810009 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-072088 BPJS : 0000378273835 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
MG
DEKSAMETASON 0,5 MG
PUTRI ASYILLAPURNIAJI, NN (P) JL. PGS DUA J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 05-002853 BPJS : 0001225154259 MG
YUSAK KANA, TN (L) JL KOMPI UDIN RT 6/5 L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
392 NIK : 3172062306691001
No. RM : 01-074020 BPJS : 0002332873618 BEDAK SALISIL 2 %
ANJANI, TN (L) JL PULAU TEMIANG III NO 9 R10.3 - Pain localized to other parts of lower RETRIBUSI LAYANAN SIAGA 24 JAM
abdomen PARASETAMOL TAB 500 MG
No. RM : 01-070550 BPJS : 0002232381058 KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Diagnosis : 18 February 2019 9:37 PM (SULFAMETOKSAZOL 400 MG +
TRIMETOPRIM 80 MG)
2019-09-09 13:37 Hal. 235 dari 1322

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NADIFA SYAHIRA AULIANNISA, an (P) JL BCS GG L/54 RT 004/005 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-008522 BPJS : 0001772309867 MG
NINA KARLINA, NY (P) JL BANGUN CIPTA SARANA GG L /54 M54.5 - Low back pain AMBROKSOL TAB 30 MG
RT 04/05 R05 - Cough KLORFENIRAMIN MALEAT (CTM) TAB 4
395 MG
No. RM : 01-013850 NIK : 3172065608840002 NATRIUM DIKLOFENAK TAB 25 MG
Tgl Diagnosis : 18 February 2019 9:44 PM BPJS : 0001225880739 SIANOKOBALAMIN (VITAMIN B12) 50
MCG
MUHAMMAD FARRAS FIKRI, AN (L) KGT RT02/04 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-014465 BPJS : 0001224184454 MG
HINDUN, NY (P) PGS DUA RT 1/13 I10 - Essential (primary) hypertension
R07.4 - Chest pain, unspecified
397 NIK : 3172064603650003
No. RM : 05-001202 BPJS : 0001673984531
MU'AMALAH, NN (P) JL BANGUN CIPTA SARANA GG L RT K30 - Dyspepsia RANITIDIN 150 MG
04/05 R51 - Headache RETRIBUSI LAYANAN SIAGA 24 JAM
ESRA ARI ANDAPATI, TN (L) JL. KAYU MAS UTARA NO 81 RT 02 RW L23.9 - Allergic contact dermatitis, BETAMETASON 0,1%,KRIM
03 unspecified cause KLORFENIRAMIN MALEAT (CTM) TAB 4
399 MG
2019-09-09 13:37 Hal. 236 dari 1322

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INA KASINAH, NY (P) JL. KY MAS UTARA RT 02 RW 03 NO 81 K05.0 - Acute gingivitis RETRIBUSI LAYANAN SIAGA 24 JAM
L50.9 - Urticaria, unspecified ASAM MEFENAMAT KAPS 500
No. RM : 06-000153 BPJS : 0002264674342 MG
BEDAK SALISIL 2 %
YANTO, TN (L) JL. GADING KIRANA BLK G 10 NO.52 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-087903 BPJS : 0002277462881 MG
SITI AISAH, AN (P) JL PGS II J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-087905 BPJS : 0000998907197 MG
MUHAMMAD ALFIAN TASHAQIF, AN (L) RAWA INDAH RT 6/10 N39.0 - Urinary tract infection, site not RETRIBUSI LAYANAN SIAGA 24 JAM
specified KOTRIMOKSAZOL DOEN SUSPENSI
AISYAH NURAINI,AN (P) KP RAWA INDAH RT 003/003 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-009057 BPJS : 0001672405558 MG
NUR AHYANA, NY (P) JL BANGUN CIPTA SARANA J40 - Bronchitis, not specified as acute or GLISERIL GUAIAKOLAT (GG) 100 MG
chronic KLORFENIRAMIN MALEAT (CTM) TAB 4
405 NIK : 317206590390005 MG
TRIMETOPRIM 80 MG)
2019-09-09 13:37 Hal. 237 dari 1322

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SARAH NAJWA (P) JL. PERINTIS KEMERDEKAAN RT L04.0 - Acute lymphadenitis of face, head GLISERIL GUAIAKOLAT (GG) 100 MG
003/06 NO 69 and neck PREDNISON 5 MG
No. RM : 01-051414 NIK : 3172065109040005
ANGGUN MUTAMMIMAH, AN (P) PGS II J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MG
DEKSAMETASON 0,5 MG
SALSABILATUL MA,WA, NN (P) JL. PERINTIS KEMERDEKAAN J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
NUR HIDAYAH, NY (P) PGS II 003/005 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
ALISHA RAMADHANI, AN (P) KP. PULO GADUNG J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 238 dari 1322

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SITI JULEKHA BT TARMO, NY (P) JL PERINTIS KEMERDEKAAN RT 05/04 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
411 NIK : 3172064112850006 OBH SIRUP 100 ML
No. RM : 01-034975 BPJS : 0002332863178
TARMUDI, TN (L) KGT RT 4/6 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-050882 BPJS : 0000378133582 MG
WAN YENTRI, TN (L) KOMP BEA CUKAI 08/07 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
MG
DEKSAMETASON 0,5 MG
AMLODIPIN 10 MG
ELNIWATI, NY (P) KOMP BEA CUKAI BLK H 5/25 008/007 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
MCG
GERTRUIDA NELWAN, NY (L) JL H KAMANG NO 34 RT 007/010 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
MCG
MG TAB
2019-09-09 13:37 Hal. 239 dari 1322

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DODO SUKADAH, TN (L) JL RAYA PEGANGSAAN DUA RT 06/*02 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
416 NIK : 3172062102670002 RANITIDIN 150 MG
JENNIETO SETIAWATI, NY (P) JL TAMAN PEGANGSAAN INDAH BLOK R53 - Malaise and fatigue RETRIBUSI LAYANAN SIAGA 24 JAM
E / 12A RT 1/19 PARASETAMOL TAB 500 MG
No. RM : 01-011648 NIK : 3172066911630001 MCG
VERA, NN (P) TAMAN PEGANGSAAN INDAH BLOK K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
E12A RT 01/019 ANTASIDA DOEN
KHALIFAH NURUL JANNAH,AN (P) RW INDAH RT 02/03 A09 - Diarrhoea and gastroenteritis of ZINC 20 MG
ALICHA PUTRI NURFATWA (P) JL.PERINTIS RT 01/04 N0 32 KLP J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
GADING TIMUR unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-074806 NIK : 3172065011111003 MG
Tgl Diagnosis : 19 February 2019 1:05 AM BPJS : 0001773719447 DEKSAMETASON 0,5 MG
DANIS MAYZA, AN (L) JL SKPR JAYA RT 006/010 R05 - Cough KOTRIMOKSAZOL DOEN SUSPENSI
421 NIK : 3172041005151004
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 240 dari 1322

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VIRGINIA ANGEL THOMAS, AN (P) JL. RAWA SENGON BLOK E NO 27 A09 - Diarrhoea and gastroenteritis of
presumed infectious origin
422 NIK : 3172067010101004
No. RM : 01-087854 BPJS : 0001906671914
RADITYA PUTRA, TN (L) JL. KELAPA MOLEK 6 BLOK Z1 NO. 2 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
No. RM : 01-085436 BPJS : 0002332804162
APRILIA ANJATRI, NY (P) JL PULAU PENYENGAT II NO 7 7/3 Z38.0 - Singleton, born in hospital

424 NIK : 3404026504880001
No. RM : 01-022573 BPJS : 0002095925859
APRILIA ANJATRI, NY (P) JL PULAU PENYENGAT II NO 7 7/3 Z38.0 - Singleton, born in hospital AMOKSISILIN 500 MG
ASAM FOLAT 0,25 MG
100.000 UI
KOMARUDIN (L) KELAPA GADING TIMUR RT 003/004 Z48.9 - Surgical follow-up care, unspecified AMOKSISILIN 500 MG
426 NIK : - PERAWATAN LUKA RINGAN (UGD)
No. RM : 02-005365 BPJS : 0002332806399
RANI ALIDA SIMBOLON , NN (P) JL KAYU MAS TIMUR RT 0/03 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 241 dari 1322

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IKA LAURA WINARKO, an (P) JL RAYA PEGANGSAAN DUA RT 06/02 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
KONGO BERUTU, TN (L) JL. INPRES 2 NO. 27 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
429 NIK : 3671130712930004 MG
RIJADI KURNIAWAN, TN (L) JL. PERINTIS I NO 40 C I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
430 NIK : 3172061601690001 AMLODIPIN 10 MG
No. RM : 01-088285 BPJS : 0001442242394
FARHAIS MUMTAZ, NN (L) JL H OYAR RT 02/02 A09 - Diarrhoea and gastroenteritis of ANTASIDA DOEN
presumed infectious origin RANITIDIN 150 MG
Tgl Lahir : 17-Feb-1997 ( 22 Thn 6 Bln 23 Hr ) K30 - Dyspepsia
INJEKSI (UGD)
LUSTI FERTA SARI, NY (P) JL. KEBUN KELAPA, LAMPUNG Z48.9 - Surgical follow-up care, unspecified

432 NIK : 1809075212890009
No. RM : 01-087973 BPJS : 0002198312357
KAILA ALSHIFA DWI AINI, AN (P) PGS2 RT002/04 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-049081 BPJS : 0001180165083 MG
2019-09-09 13:37 Hal. 242 dari 1322

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AZZAHRA ALIYAH PUTRI, AN (P) JL PULAU REMPANG II NO.22 007/009 R11 - Nausea and vomiting DOMPERIDON TAB 10 MG
434 NIK : 3172065305121002
No. RM : 01-016616 BPJS : 0001962945707
MUHAMMAD FATAH AL JABBAR, AN (L) JL RAWA INDAH J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
SYIN LUDJENG, TN (L) RAWA INDAH 02/03 M54.5 - Low back pain NATRIUM DIKLOFENAK TAB 25 MG
436 NIK : 3172061812510002
No. RM : 01-059513 BPJS : 0001225695969
AHMAD HUMAIDI ARBANI, AN (L) JL H OYAR RT 3/2 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
437 NIK : 3172062409170001 MG
ALIKA JULIA SYAFINA, AN (P) H.OYAR 03/02 J02.9 - Acute pharyngitis, unspecified KOTRIMOKSAZOL DOEN SUSPENSI
438 NIK : 3172064906151003
MG
DEKSAMETASON 0,5 MG
MALIKA ZAHIRA MAHMUDATUZ ZAHRA, AN JL PERINTIS KEMERDEKAAN NO 69 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-056206 BPJS : 0001843561293 MG
2019-09-09 13:37 Hal. 243 dari 1322

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MAHJOBA HASINA WARDAK, NN (P) GRAND EMERALD LT 11 UJ J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-058635 BPJS : 0002212690061 MG
ADITA FEBRIANI, NN (P) JL. BANGUN CIPTA SARANA J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-088288 BPJS : 0001225827562 MG
ROY LATIPYO ROKADJI, TN (L) JL TEGUH VII NO.74 008/001 N20.9 - Urinary calculus, unspecified KOTRIMOKSAZOL DOEN I (DEWASA)
442 NIK : 3172062944760001
No. RM : 01-031843 BPJS : 0001335429573 NATRIUM DIKLOFENAK TAB 25 MG
DITA YULIYANTI, NN (P) JL.HARPA II 02/01 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
ZULIYANTO (L) KOMP UKA BLOK BB /33 RT 11/08 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
ASHYLA NAFISA, AN (P) PEGANGSAAN DUA RT 01/02 A09 - Diarrhoea and gastroenteritis of ZINC 20 MG
presumed infectious origin GARAM ORALIT KOMBINASI
445 NIK : 3172064806141002 KOTRIMOKSAZOL DOEN SUSPENSI
ANDIKA YUDA PRATAMA, TN (L) JL PRIHATIN NO 10 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-035747 BPJS : 0001224287908 MG
2019-09-09 13:37 Hal. 244 dari 1322

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NATASYA RIZKY ALAM, AN (P) PGS II RT 003/002 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
J03.9 - Acute tonsillitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
SUTISNA WIJAYA (L) JL. PESEKON LOJI RT 002/017 L23.9 - Allergic contact dermatitis, BETAMETASON 0,1%,KRIM
unspecified cause PARASETAMOL TAB 500 MG
No. RM : 01-013240 BPJS : 0001609225874 MG
NIKO PETER AYAL, AN (L) JL RAWA SENGON BLOK D N 61 RT J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
449 MG
No. RM : 01-010951 NIK : 3174061011091006
AISYAH AYU DIAH INARA (P) JL PEJUANG III 003/004 KGT J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-027239 BPJS : 0002139423849 MG
TARMINAH (L) JL. PEJUANG 3 RT 03 RW 04 KGT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
451 NIK : 3327064508850009 RANITIDIN 150 MG
No. RM : 02-000603 BPJS : 0001628534046
LILIK SUDARIYAH, NY (P) RUSUN DAKOTA 13B 13/11 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
No. RM : 01-026679 BPJS : 0002097242954
2019-09-09 13:37 Hal. 245 dari 1322

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VIO ARZIKI PRASETIO, AN (L) JL PULAU REMPANG IV NO.25 007/009 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-027695 BPJS : 0002332925008 MG
RAIYAH, NY (P) JANUR HIJAU 12 BLK TP II NO.24 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
No. RM : 01-023043 BPJS : 0001461227231 J45.9 - Asthma, unspecified MG
AMLODIPIN 10 MG
WISNU REGA KENCANA, AN (L) JL.PERINTIS KEMERDEKAAN 004/005 R05 - Cough RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-018080 BPJS : 0001476002182 MG
SRI HASTUTI, NY (P) KP RAWA TERATAI RT 04/01 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
MULYAWATI SE, NY (P) JL.MAWAR LUAR BLOK L/27 09/12 L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
LAGOA MG
Tgl Lahir : 06-Nov-1965 ( 53 Thn 10 Bln 3 Hr ) PREDNISON 5 MG
457
No. RM : 01-049529 NIK : 3174044611650004
MUHAMMAD HAFIDZ MAULANA, AN (L) RW INDAH RT 004/03 PGSN II J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
unspecified BEDAK SALISIL 2 %
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 246 dari 1322

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SRI MULASIH, NY (P) PERINTIS KEMERDEKAAN RT 5/4 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Diagnosis : 22 February 2019 6:47 PM KAPTOPRIL 25 MG
TATA CARNATA, TN (L) DUSUN CARIANG RT 014/005 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-005559 BPJS : 0001326466236 MG
BUDI ATMOKO (L) JL TMN PGS INDAH RT 5/02 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
No. RM : 01-062892 BPJS : 0000437563934
MITA NOVIANTI TRIAS PRATIWI, NN (P) JL PERJUANGAN RAYA 022/007 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
PREDNISON 5 MG
IBNU AFFAN F, TN (L) RAWA INDAH RT 05/03 Z04.2 - Examination and observation
following work accident
463 NIK : 31720627020200004
No. RM : 01-061056 BPJS : 0000378514168
DADAN RAMDAN, TN (L) PGS II RT 6/2 R05 - Cough PARASETAMOL TAB 500 MG
464 NIK : 3172061305710003
No. RM : 01-058498 BPJS : 0001134421942
2019-09-09 13:37 Hal. 247 dari 1322

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GITA M MASAEL,NY (P) JLN RW SENGON RT 03/022 J40 - Bronchitis, not specified as acute or AMOKSISILIN 500 MG
chronic GLISERIL GUAIAKOLAT (GG) 100 MG
465 NIK : 3172034204930003 PREDNISON 5 MG
No. RM : 01-008758 BPJS : 0001288441001
SAMIATI ,NY (P) JL. RAWA INDAH RT 04/03 I10 - Essential (primary) hypertension SIMVASTATIN 10 MG
466 NIK : 3172066612750005 AMLODIPIN 10 MG
No. RM : 01-040551 BPJS : 0002098687904
ASMAWIYAH, NY (P) RAWA INDAH I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-088294 BPJS : 0001802691933 MG
RAIHAN MAULANA MALIK (L) RAWA INDAH RT04/03 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-015880 BPJS : 0002332745425 MG
WAHYUDI (L) RAWA INDAH 04/03 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-057463 BPJS : 0001802692719 MG
HAJJAH KANA, NY (P) JL PERJUANGAN NO 2 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK TAB 25 MG
AMLODIPIN 10 MG
No. RM : 01-087713 BPJS : 0000046160583
RISYA RIZKYA AULIANANDA, NN (P) PGS2 RT04/04 W19.9 - UNSPECIFIED FALL, ASAM MEFENAMAT KAPS 500
UNSPECIFIED PLACE PREDNISON 5 MG
471 NIK : 3172067101980001
No. RM : 01-010209 BPJS : 0001225399915
2019-09-09 13:37 Hal. 248 dari 1322

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SUDARNO, TN (L) JL GADING VI NO 1 004/055 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
DEKSAMETASON 0,5 MG
AYANIH BT H MUGENI (P) JL. PGS II 002/002 L23.9 - Allergic contact dermatitis, GENTAMISIN SALEP KULIT
unspecified cause BETAMETASON 0,1%,KRIM
No. RM : 01-056938 BPJS : 0001478364434 MG
VIKRY NURHADIANSYAH (L) KP PULO GADUNGRT 04/05 N39.0 - Urinary tract infection, site not ASAM MEFENAMAT KAPS 500
specified HIOSINA BUTILBROMIDA 10mg
AL ZHAFRAN PUTRA RACHMAN, AN (L) JL KGT I 003/006 R05 - Cough KOTRIMOKSAZOL DOEN SUSPENSI
475 NIK : 3172061805170001
MG
DEKSAMETASON 0,5 MG
INHALASI (UGD)
TINIK (P) PGS II RT 2/4 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
No. RM : 01-026600 BPJS : 0001157306883
NGATERAN, tn (L) JL DAHLIA I/5 RT 005/003 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
KAPTOPRIL 12,5 MG
2019-09-09 13:37 Hal. 249 dari 1322

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SUYATI, NY (P) P TEmIANG 3/17 RT13/03 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
L50.9 - Urticaria, unspecified AMLODIPIN 10 MG
478 NIK : 3172067112560008 SIMVASTATIN 10 MG
MG
ACHMAD ZAELANI, TN (L) JL RAWA SENGON RT 01/022 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
No. RM : 01-059872 BPJS : 0001603220229
KASINI, NY (P) JL TAMPAK SIRING RAYA NO 14 J02.9 - Acute pharyngitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-004968 BPJS : 0000530018471
SULINDA, NN (P) JL. GG PERINTSI I NO.38 004/002 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
481 NIK : 3172065008961001
No. RM : 01-035468 BPJS : 0002097264701
R YANTI BT SUMIHLAT, NY (P) JL RAWA SENGON RAYA BLOK D NO J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
53 unspecified OBH SIRUP 100 ML
No. RM : 01-079511 NIK : 3203194201860010 MG
BADRU BIN KAMAL, TN (L) IMPERIAL GADING A.1/7 SUKAPURA J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 250 dari 1322

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AHMAD FIKRI, AN (L) KP RAWA INDAH RT 007/003 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
484 NIK : 3172062206060005 MG
MUHAMMAD RAIHAN DIVANDA, AN (L) JL TERAMPIL I NO 26 RT 05/002 L23.9 - Allergic contact dermatitis, KLORFENIRAMIN MALEAT (CTM) TAB 4
485 NIK : 3172061706050002
ADIBA NUR HIJRIYAH, AN (P) KGT RT 003/004 J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN SUSPENSI
486 NIK : 3172064110160001
MG
DEKSAMETASON 0,5 MG
G. AGUNG KRISTIAWAN, TN (L) JL GAMBYONG BLOK U NO 29 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-088300 BPJS : 0001391275675 MG
DEDY KURNIAWAN, TN (L) JL HARAPAN III NO 3 RT 003/001 N20.9 - Urinary calculus, unspecified ASAM MEFENAMAT KAPS 500
488 NIK : 3172060205710001 RANITIDIN 150 MG
No. RM : 01-030270 BPJS : 0001295182078
ATHAYA SHOFWATUNIISA, AN (P) KP PULO GADUNG RT 02/05 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-011626 BPJS : 0001225808561 MG
RANITIDIN 150 MG
2019-09-09 13:37 Hal. 251 dari 1322

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DEDE KURNIAWATI, NN (P) JL. PGS II J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-088302 BPJS : 0001031633853 MG
AZARINE SALSABILA, AN (P) JL P BANGKA NO 10 RT 14/03 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-035960 BPJS : 0001223477008 MG
ARIS AL FATHIR, an (L) JL RAWA INDAH RT 001/003 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-027183 BPJS : 0001296729404 MG
YUSTINUS MAURE (L) JL RAWA SENGON BLOK B RT 02/022 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 09-Sep-1980 ( 39 Thn 0 Bln 0 Hr ) GARAM ORALIT KOMBINASI
493 NIK : 3172030909800008
No. RM : 01-014004 BPJS : 0001313102924
KEZIA RACHAEL MAURE, AN (P) RAWASENGON 02/22 L23.9 - Allergic contact dermatitis, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 27-Oct-2009 ( 9 Thn 10 Bln 13 Hr ) R05 - Cough
DEKSAMETASON 0,5 MG
SUSANTO SUMARTONO, TN (L) PELEPAH INDAH 2 RT 09/18 R05 - Cough DEKSAMETASON 0,5 MG
No. RM : 01-011024 BPJS : 0001373377847 MG
RINI SAVITRY, NN (P) JL KELAPA GADING TIMUR RT 03/06 K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
496 NIK : 317206602940004
No. RM : 01-011151 BPJS : 0001225599502
2019-09-09 13:37 Hal. 252 dari 1322

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TINI YANTI DJAFAR, NY (P) APT GADING MEDITERANIA I10 - Essential (primary) hypertension AMLODIPIN 10 MG
RESIDENCES UNIT CA/10B/NQ RT
497 002/018
No. RM : 01-015852
Tgl Diagnosis : 22 February 2019 10:10 PM NIK : 3172065702710003
JOSIC TRINDI AGI, TN (L) JL BCS PGS II RT 04/05 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
498 NIK : 317206050701002
No. RM : 01-023154 BPJS : 00003774432943
MELVIANA MEUTHIA SANTI (P) JL P.KEMERDEKAAN 011/004 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-015115 BPJS : 0001817742791 MG
AGUS IRAWAN, TN (L) JL TARIAN RAYA TIMUR BKL WI NO.21 K30 - Dyspepsia PARASETAMOL TAB 500 MG
005/009 ANTASIDA DOEN
TARYATI, NY (P) TANAH MERAH 01/07 R51 - Headache PARASETAMOL TAB 500 MG
501 NIK : 3329036805880005
No. RM : 01-018550 BPJS : 0002641614219
PRAYITNO, TN (L) PGS2 RT06/02 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
502 NIK : 3316123112490064 MG
HASNAH ARIFIN, NY (L) JL SUNTER 1 PULO GADUNG RT 10/01 E79.0 - Hyperuricaemia without signs of RETRIBUSI LAYANAN SIAGA 24 JAM
inflammatory arthritis and tophaceous ALOPURINOL 100 MG
Tgl Lahir : 24-Apr-1953 ( 66 Thn 4 Bln 16 Hr ) disease
No. RM : 02-004391 BPJS : 0001818898301 R05 - Cough
MG
2019-09-09 13:37 Hal. 253 dari 1322

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EDI SUPRAPTO (L) JL. INSP KALI SUNTER K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
504 NIK : 3172062403031001 RANITIDIN 150 MG
No. RM : 01-088308 BPJS : 0001482262929
TRIYONO (L) JL. PGS II J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-088309 BPJS : 0002097247983 MG
DELVANO TRAY ALVAHRYZY, AN (L) PGSN 2 RT 06/02 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-034323 BPJS : 0002097248005 MG
TATI MULYANI (P) PGS DUA RT 5/5 A09 - Diarrhoea and gastroenteritis of RANITIDIN 150 MG
presumed infectious origin HIOSINA BUTILBROMIDA 10mg
No. RM : 05-000531 BPJS : 0000376802875 MG TAB
AQILAH NUR AZZAHRA, AN (P) JL. TANAH MERAH RT 05/07 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-013831 BPJS : 0002136864464 MG
JOLANDA VS ROBOT (P) JLN GADING SENGON RT 01/22 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
509 NIK : 3172065010680006 RANITIDIN 150 MG
No. RM : 01-002637 BPJS : 0001439486504
2019-09-09 13:37 Hal. 254 dari 1322

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GABRIEL HAN WILLIAM, BY (L) APT GADING NIAS C/8/JJ R50.9 - Fever, unspecified PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
No. RM : 01-079380 BPJS : 0002378721003 MG
ABRAHAM REYNAND PRASTI, AN (L) JL. INSP KALI SUNTER RT 009/013 J06.9 - Acute upper respiratory infection, INHALASI (UGD)
unspecified KLORAMFENIKOL 1 % SM
No. RM : 01-075898 BPJS : 0002480041067 KOTRIMOKSAZOL DOEN SUSPENSI
Tgl Diagnosis : 23 February 2019 1:28 AM (SULFAMETOKSAZOL 200 MG +
TRIMETOPRIM 40 MG)
MG
DEKSAMETASON 0,5 MG
ARBI SATRIA KUSUMANEGARA, AN (L) KUNING MAS D.4/5 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
NIKEISHA FARRAS RAFIFAH, AN (P) KESADARAN RT 05/01 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-014173 BPJS : 0002425064782 MG
ZAHIRA AMBAR WARJITO (P) JL. SENTOSAN II RT 09/010 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 255 dari 1322

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M KHALID FATAHILLAH (L) KOMP BEA CUKAI JL. TOBA BLK. D7 J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN SUSPENSI
NO. 22 RT. 010/007 SUKAPURA unspecified (SULFAMETOKSAZOL 200 MG +
Tgl Lahir : 30-Sep-2013 ( 5 Thn 11 Bln 9 Hr ) TRIMETOPRIM 40 MG)
515
No. RM : 01-018335 NIK : 3172041203800010 PARASETAMOL SYR 120 MG/5 ML
Tgl Diagnosis : 23 February 2019 5:56 AM BPJS : 0001814355731 GLISERIL GUAIAKOLAT (GG) 100 MG
MG
DEKSAMETASON 0,5 MG
NIKMATULAH, TN (L) PGS II 002/003 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
516 NIK : 3304100110790001 PREDNISON 5 MG
No. RM : 01-015785 BPJS : 0001297575876
HENDRA SETIAWAN TJHIN, TN (L) JL GADING MANSION ELOK RG 9/30 A09 - Diarrhoea and gastroenteritis of AMLODIPIN 10 MG
RT 04/24 presumed infectious origin KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 30-Apr-1956 ( 63 Thn 4 Bln 9 Hr ) I10 - Essential (primary) hypertension
517 MG TAB
No. RM : 01-010237 NIK : 3172063004560003 GARAM ORALIT KOMBINASI
Tgl Diagnosis : 23 February 2019 6:43 AM BPJS : 0001324640924 METRONIDAZOL 500 MG
ZAHWA RIFA HUMAIRA (P) KAPLING TIPAR TIMUR RT013/04 NO R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
518 MG
Tgl Diagnosis : 23 February 2019 7:56 AM BPJS : 0001314831025 ZINC 20 MG
SRI RAHAYU, AN (P) JL PERINTIS KEMERDEKAAN 011/004 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
PREDNISON 5 MG
HARYONO, TN (L) KLP GADING PELEPAH ASRI BLK. QC E11.9 - Non-insulin-dependent diabetes PARASETAMOL TAB 500 MG
2/7 mellitus without complications GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 16-Jul-1942 ( 77 Thn 1 Bln 24 Hr ) I10 - Essential (primary) hypertension
No. RM : 01-001137 NIK : 3172061607420002 J06.9 - Acute upper respiratory infection, MG
Tgl Diagnosis : 24 February 2019 8:19 AM BPJS : 0001439952287 unspecified METFORMIN TAB 500 MG
GLIBENKLAMIDA 5 MG
AMLODIPIN 10 MG
2019-09-09 13:37 Hal. 256 dari 1322

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ACHMAD FATHIR ALBANTANI, AN (L) JL PERINTIS KEMERDEKAAN RT 11/4 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
AYU FITRIANI, AN (P) JL. RAWA SENGON 008/022 R11 - Nausea and vomiting ANTASIDA DOEN
No. RM : 01-068398 BPJS : 0002490935815 MG TAB
ADAM GIFARY, AN (L) JN PERJUIANGAN RT 04/07 TUGU J03.9 - Acute tonsillitis, unspecified AMOKSISILIN 500 MG
SELATAN J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
MALIK FIRDAUS SYARIF, AN (L) JL. H. OYAR 002/002 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 257 dari 1322

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ROSINTA DAME MARPAUNG, NY (P) KUNING MUDA D.2/30 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-015602 BPJS : 0002453249531 MG
ARGESIA SIFANA TAKBIRAMEZZA, AN (P) P.NANGKA 05/16 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-017243 BPJS : 0001856895794 MG
NUR AISAH OKTAVIANI, AN (P) RT. 04/05 NO.119 PEGANGSAAN DUA J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
No. RM : 05-000242 BPJS : 0001452878886 MG
MARIAM, NY (P) JL PERINTIS KEMERDEKAAN RT J06.9 - Acute upper respiratory infection, BETAMETASON 0,1%,KRIM
011/004 unspecified NATRIUM DIKLOFENAK TAB 25 MG
Tgl Lahir : 03-Aug-1951 ( 68 Thn 1 Bln 6 Hr ) J45.9 - Asthma, unspecified
No. RM : 01-016521 NIK : 3175024308510002 L23.9 - Allergic contact dermatitis, KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Diagnosis : 24 February 2019 9:07 AM BPJS : 0001224504066 unspecified cause MG
DEKSAMETASON 0,5 MG
SALBUTAMOL 2 MG
RD SRI YUNISAPTA MULIAWATI, NY (P) JL PULAU REMPANG III NO 20 RT J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
07/09 unspecified KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Diagnosis : 24 February 2019 9:18 AM BPJS : 0001170147846 GLISERIL GUAIAKOLAT (GG) 100 MG
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 258 dari 1322

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RAHMAD HANDAYA DS, TN (L) JL BANYO II NO 13-14 A16.2 - Tuberculosis of lung, without
mention of bacteriological or histological
Tgl Lahir : 18-Nov-1986 ( 32 Thn 9 Bln 22 Hr ) confirmation
530 NIK : 3172061811860004
No. RM : 03-001022 BPJS : 0002739794242
ALBERTH ANUGRAH HARAZAKHI P, AN (L) JL. TANAH MERAH NO 21 B01.9 - Varicella without complication PARASETAMOL TAB 500 MG
ASIKLOVIR KRIM 5%
531 NIK : 317202050110005 ASIKLOVIR 400 MG
MUHAMMAD ALI, TN (L) KP WARNG JENGKOL RT 03/013 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified AMLODIPIN 10 MG
Tgl Lahir : 12-Jan-1966 ( 53 Thn 7 Bln 28 Hr ) R07.4 - Chest pain, unspecified
MUHAMMDAD DHAFA (L) RAWA BADAK J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
No. RM : 01-023205 BPJS : 0001205008119 MG
ENDRIYANTO, TN (L) KAMPUNG MANGGA NO 44 RT 03/03 R50.9 - Fever, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
TUGU SELATAN KOJA DOMPERIDON TAB 10 MG
534 KOMBINASI KAOLIN 550 MG, PEKTIN 20
No. RM : 01-066834 NIK : 3172032508790002 MG TAB
ARSYLA LATISHA ZILFA, AN (P) JL. PGS 2 A01.2 - Paratyphoid fever B

535 NIK : 3172064401170002
No. RM : 01-087746 BPJS : 0002213748257
2019-09-09 13:37 Hal. 259 dari 1322

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WIRSYATUNNISA MANALU, AN (P) JL SMU 83 NO 32 RT 03/047 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified BORAK GLYSEROL 5% LARUTAN
PREDNISON 5 MG
WIRDA POHAN, NY (P) KMP SUKAPURA JL SMU 83 NO 38 RT J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 14-Jun-1986 ( 33 Thn 2 Bln 26 Hr ) L23.9 - Allergic contact dermatitis,
No. RM : 01-006442 NIK : 3172045406860004 unspecified cause MG
KOMARUDIN (L) KELAPA GADING TIMUR RT 003/004 Z48.9 - Surgical follow-up care, unspecified GENTAMISIN SALEP KULIT
LEPAS HECTING
No. RM : 02-005365 BPJS : 0002332806399
RAHMA NURJANNAH (P) JL REMAJA 2 SUMUR BATU A09 - Diarrhoea and gastroenteritis of NATRIUM DIKLOFENAK TAB 25 MG
539 NIK : 3674034906970009 MG TAB
No. RM : 01-048064 BPJS : 0001168090233 METRONIDAZOL 500 MG
Tgl Diagnosis : 24 February 2019 11:08 AM HIOSINA BUTILBROMIDA 10mg
NINIK DEWI ANGGRAINI, NY (P) JL PELEPAH INDAH II LB 21/5 RT 09/19 R42 - Dizziness and giddiness PARASETAMOL TAB 500 MG

540 NIK : 3172064704520001
No. RM : 01-011951 BPJS : 0001820637966
WARYA BIN DAKIM, TN (L) JL RAWA SENGON BLOK G RT 07/022 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 260 dari 1322

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NARYA SUNARYA, TN (L) JL PUTIH MELATI C 4 30 R05 - Cough AMOKSISILIN 500 MG

No. RM : 01-079220 BPJS : 0000402565959 MG
FARIZ RAYNAR NARENDRA (L) JL. TEGUH RT 07 /01 B36.0 - Pityriasis versicolor PARASETAMOL SYR 120 MG/5 ML
J06.9 - Acute upper respiratory infection, MIKONAZOL KRIM 2 %
543 NIK : - unspecified BORAK GLYSEROL 5% LARUTAN
No. RM : 06-000672 BPJS : 0002229274618 K12.1 - Other forms of stomatitis GLISERIL GUAIAKOLAT (GG) 100 MG
MG
DEKSAMETASON 0,5 MG
SYAMSUL ARIFIN (L) RUKO GADING BUKIT INDAH/32 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
No. RM : 01-047954 BPJS : 0001785438977
ARI YANGGA, AN (L) JL PEGANGSAAN DUA RT 03/04 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
SAI'IN (L) jl. PEGANGSAAN L23.9 - Allergic contact dermatitis, HIDROKORTISON KRIM 2,5 %
unspecified cause LORATADIN 10 MG
546 NIK : NULL DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 261 dari 1322

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UMI BAROKAH, NY (P) JL PGS II L23.9 - Allergic contact dermatitis, HIDROKORTISON KRIM 2,5 %
unspecified cause LORATADIN 10 MG
AHMAD SAFA RUDI (L) JL. PEGANGSAAN DUA L23.9 - Allergic contact dermatitis, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 09-Jan-2013 ( 6 Thn 8 Bln 0 Hr ) R05 - Cough
548 NIK : NULL BEDAK SALISIL 2 %
MG
DEKSAMETASON 0,5 MG
FAUZAN AZMI HANIF, AN (L) KMP. RAWA INDAH J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
PREDNISON 5 MG
RAHMAT, TN (L) JL. INSPEKSI KALI SUNTER 004/004 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
R50.9 - Fever, unspecified AMLODIPIN 10 MG
YUNINARTI KELANA SH, NY (P) HYBRIDA XI RA.30/7 I10 - Essential (primary) hypertension KOTRIMOKSAZOL DOEN I (DEWASA)
J06.9 - Acute upper respiratory infection, (SULFAMETOKSAZOL 400 MG +
551 NIK : 3172065006640001 unspecified
MG
RANITIDIN 150 MG
SRI SULASTRI (P) JL.MUSIK RAYA E/17 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
552 NIK : 3172066908560001 MG
2019-09-09 13:37 Hal. 262 dari 1322

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SULIASTUTI, NY (P) JL KESATRUAAN RT 4/5 J00 - Acute nasopharyngitis [common cold] RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-014860 BPJS : 0002332105154 MG
MARIANUS LEO, AN (P) JL KESATRIAAN RT 04/05 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
BENEDIKTUS DEGHO, TN (L) JL KESATRIAAN RT 04/05 M54.5 - Low back pain AMOKSISILIN 500 MG
No. RM : 01-018569 BPJS : 0002332105143 MG
ARDIANTO PRAYOGO (L) JL JANUR KUNING 11 BLK WQ II NO.1 Z48.9 - Surgical follow-up care, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
No. RM : 01-022375 BPJS : 0002356552765 PERAWATAN LUKA RINGAN (UGD)
STEPHANUS JANUARDI RIDWAN, TN (L) TMN PEGS DUA BLOK O/17 A09 - Diarrhoea and gastroenteritis of METRONIDAZOL 500 MG
Tgl Lahir : 17-Jan-1952 ( 67 Thn 7 Bln 23 Hr ) J06.9 - Acute upper respiratory infection,
557 NIK : 3172061701520001 MG TAB
No. RM : 01-015224 BPJS : 0001335948423 unspecified GARAM ORALIT KOMBINASI
MG
MARIA R SRI UNI, NY (P) TMN PGS INDAH BLOK O /187 RT 6/19 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 263 dari 1322

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MUSALI (L) JL H. OYAR 003/002 H92.0 - Otalgia RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
MASITOH, NY (P) H.0YAR RT 003/002 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
M13.9 - Arthritis, unspecified ANTASIDA DOEN
560 NIK : 3172064808680009 RANITIDIN 150 MG
MCG
BEN SABAM PANJAITAN, AN (L) JL PERJUANGAN RAYA NO 01 RT L22 - Diaper [napkin] dermatitis BETAMETASON 0,1%,KRIM
08/07 RETRIBUSI LAYANAN SIAGA 24 JAM
561
No. RM : 01-066571 NIK : 3275060503180002
ABDILLAH PRATAMA , AN (L) JL.PEGANGSAAN DUA 04/02 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
AL BADY PUTRA ASYARI (L) KP RAWA INDAH 003/003 PGSII J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
MG
DEKSAMETASON 0,5 MG
SARONAH, NY (P) JL. RAWA SENGON BLOK C K02.3 - Arrested dental caries AMOKSISILIN 500 MG
L23.9 - Allergic contact dermatitis, ASAM MEFENAMAT KAPS 500
564 NIK : 3172026207780010 unspecified cause PREDNISON 5 MG
2019-09-09 13:37 Hal. 264 dari 1322

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AMELIA KARTIKA,NN (P) RAWA SENGON BLK C J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-085793 BPJS : 0001602768598 MG
KOSONG (P) JL PERINTIS KEMERDEKAAN R00.0 - Tachycardia, unspecified koja
igd
566 NIK : - rujukan
No. RM : 01-042453 BPJS : 0001225566404
NAUFAL RIDHO ISMAIL, AN (L) JL PGS II RT 04/05 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
RAFAEL GADING PRATAMA SIAGIAN, AN (L) PEGANGSAAN DUAN 02/01 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
568 NIK : 3172062112091001 MG
TRISNAWATI, NY (P) JL PGS II RT 005/001 NO 16 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
ANY MARLINA, NN (P) P.BESAR 02/11 Z48.9 - Surgical follow-up care, unspecified PERAWATAN LUKA RINGAN (UGD)
570 NIK : -
No. RM : 01-044054 BPJS : 0000564840729
2019-09-09 13:37 Hal. 265 dari 1322

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FITRA SAHARA, NN (P) RAWASENGON 08/22 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
No. RM : 01-076038 BPJS : 0001224284894
JULIA SALIM, NY (P) JL KELAPA NIAS XI PE 5/18 H10.9 - Conjunctivitis, unspecified PARASETAMOL TAB 500 MG
R51 - Headache KLORAMFENIKOL 1 % SM
No. RM : 01-056208 BPJS : 0002303040879
SELFIA NOVITA SARI, NY (P) KPRAWA INDAH RT 02/03 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
JENNIE FILIA CLARA HULU (P) JL INSPEKSI POL PP RT 02/07 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
JOHN RUDOLF BACHTIAR HULU, AN (L) RGTC BLOK ANGSANA NO 419 J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN SUSPENSI
575 NIK : 3175061305151002
MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 266 dari 1322

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ABDUL MUSYAYAB, TN (L) KP PULO GADUNG GG Q NO.31 Z00.8 - Other general examinations SIANOKOBALAMIN (VITAMIN B12) 50
002/005 MCG
Tgl Lahir : 30-Dec-1947 ( 71 Thn 8 Bln 10 Hr ) TIAMIN (VITAMIN B1) 50 MG
576
PUJIANTO, TN (L) SUKAPURA Z00.8 - Other general examinations

577 NIK : 3327062108670001
No. RM : 01-085696 BPJS : 0000619800467
SYIFA AZKIA, AN (P) KP SUKAPURA 004/002 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
MUHAMMAD ALI (L) JL RAWA BINANGUN VI RT 009/008 A01.0 - Typhoid fever PARASETAMOL TAB 500 MG
Tgl Diagnosis : 25 February 2019 9:35 AM TRIMETOPRIM 80 MG)
RANITIDIN 150 MG
DJURIAH, NY (P) PEGANGSAAN DUA RT 02/04 Z48.9 - Surgical follow-up care, unspecified

580 NIK : 3172066412490001
No. RM : 01-012493 BPJS : 0002332713205
PUTRI ROSKAMAWAR RUSTAM (P) KELAPA GADING Z48.9 - Surgical follow-up care, unspecified AMOKSISILIN 500 MG
581 NIK : 3172035806430002 PERAWATAN LUKA RINGAN (UGD)
No. RM : 01-005968 BPJS : 0001326652694
2019-09-09 13:37 Hal. 267 dari 1322

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IHSAN NURROHMAN (L) RAWA INDAH RT 06/02 R56.0 - Febrile convulsions DIAZEPAM LAR REKTAL 10 MG/2,5 ML
PARASETAMOL SUPP 240 MG
582 NIK : 3172062804170001
No. RM : 01-045162 BPJS : 0002246094235
TOMMY RAJ SANJAYA, TN (L) APT. GADING NIAS RESIDANCE Z00.0 - General medical examination RETRIBUSI LAYANAN SIAGA 24 JAM
D/08/NV
583
No. RM : 01-088606 NIK : 3172062509981001
JOHAN WONGSO, TN (L) jl kelapa cengkir raya blk cli-i K30 - Dyspepsia ANTASIDA DOEN
RANITIDIN 150 MG
No. RM : 01-088663 BPJS : 0001593474186 INJEKSI (UGD)
IRAWATI (P) JL. PEGANGSAAN DUA NO.45 A01.0 - Typhoid fever RETRIBUSI LAYANAN SIAGA 24 JAM
RANITIDIN 150 MG
JOPI E SEMBUNG (L) RAWA SENGON R07.4 - Chest pain, unspecified

586 NIK : 3172031801650005
No. RM : 03-001458 BPJS : 0001476514563
ARDIANTO PRAYOGO (L) JL JANUR KUNING 11 BLK WQ II NO.1 Z48.9 - Surgical follow-up care, unspecified LEPAS HECTING

587 NIK : 3515183005920002
No. RM : 01-022375 BPJS : 0002356552765
dr. Ika Reny Retnowati
2019-09-09 13:37 Hal. 268 dari 1322

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SALAMAH, NY (P) JL. PULO NANGKA BARAT II O80.9 - Single spontaneous delivery, ASAM MEFENAMAT KAPS 500
Tgl Lahir : 07-Aug-1990 ( 29 Thn 1 Bln 2 Hr ) O80.9 - Single spontaneous delivery,
1 NIK : 3175024708900001 RETINOL (VITAMIN A) KAPS LUNAK
No. RM : 01-080094 BPJS : 0001139577309 unspecified 200.000 UI
ASAM FOLAT 0,25 MG
AGUN LUKMAN (L) JL. RAWA SENGON BLOK A RT 01 RW A90 - Dengue fever [classical dengue]
022
2
No. RM : 06-000396 NIK : 3208143005930001
ERIC JONATHAN SOETANTO (L) AGUNG PERKASA RAYA BLOK J 8 / 15 E05.9 - Thyrotoxicosis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG (0116R029) Rumah Sakit
B J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4 Hermina
(INT) Podomoro
PENYAKIT DALAM - (3)
3 MG Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 01-008700 NIK : 3172020805870002 DEKSAMETASON 0,5 MG Faskes : (0116R029) Rumah
Tgl Diagnosis : 04 February 2019 3:25 PM BPJS : 0001302157923 RUJUKAN Sakit Hermina Podomoro
Alamat : JL. DANAU AGUNG 2
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Kamis : 08:00 - 12:00,
15:00 - 17:00;18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
JOKO INDARTO, TN (L) JL.TEGUH VIII B.29/1 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
K29.6 - Other gastritis GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-046524 BPJS : 0001441957555 MG
2019-09-09 13:37 Hal. 269 dari 1322

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GUNASTHI (P) JANUR ELOK VIII QI 4/10 KGT D17.9 - Benign lipomatous neoplasm, RUJUKAN (0116R029) Rumah Sakit
unspecified Hermina Podomoro
(BED) BEDAH - (16) Bedah - (0)
Tgl Lahir : 17-May-1979 ( 40 Thn 3 Bln 23 Hr ) N60.2 - Fibroadenosis of breast
5 NIK : - Telah Diberikan :
Tgl Diagnosis : 06 February 2019 8:26 AM Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 08:00 - 12:00,
12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
GUNAWAN DJAJA (L) jl klp lilin 2 ng4/8 H25.8 - Other senile cataract RUJUKAN (0113R034) MEDIROS
(MAT) MATA - (65) Mata - (0)
No. RM : 01-070171 BPJS : 0002332728641 Faskes : (0113R034) MEDIROS
Tgl Diagnosis : 06 February 2019 8:36 AM Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
SRI TUTI HENDRASWATI, NY (P) JL KELAPA HIBRIDA VII RA 21/5 K29.1 - Other acute gastritis SIANOKOBALAMIN (VITAMIN B12) 50
MCG
Tgl Lahir : 25-Oct-1960 ( 58 Thn 10 Bln 15 Hr ) ANTASIDA DOEN
7 NIK : 3172066510600001
2019-09-09 13:37 Hal. 270 dari 1322

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MINA HALIM (P) JL GAMBYONG T NO 7 H25.8 - Other senile cataract PARASETAMOL TAB 500 MG (0114R030) RS PERTAMINA
J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG JAYA
(MAT) MATA - (65) Mata - (0)
8 NIK : 3172066410590002 AMLODIPIN 5 MG Telah Diberikan : Anamnesis (S) :
No. RM : 01-046178 BPJS : 0001795129301 - MATA KANAN/KIRI BURAM
RUJUKAN
Tgl Diagnosis : 06 February 2019 9:27 AM 1BLN
- BATUK KERING 2HARI
- KEPALA PUSING
- RIW HT ADA TDK MNM OBAT
LAGI,DM TDK ADA
Pemeriksaan (O) : faring tidak
hiperemis, kedua lensa mata
keruh
- AKRAL HANGAT
A : GANGUAN RASA NYAMAN
P : - KOLABORASI DENGAN
DOKTER
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK DIET
RENDAH GARAM
- ANJURKAN OS UNTUK
ISTIRAHAT YANG CUKUP
- ANJURKAN OS UNTUK
KONTROL ULANG TEKANAN
DARAH
A : GANGGUAN POLA NAPAS
P : KOLABORASI DENGAN
DOKTER
- ANJURKAN OS UNTUK
BANYAK MINUM AIR PUTIH
- ANJURKAN OS UNTUK
MENGHINDARI
MAKANAN/MINUMAN YANG
MERANGSANG BATUK
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
PERTAMINA JAYA
Alamat : JL. AHMAD YANI NO. 2
BY PASS
Telp : 0214211913
2019-09-09 13:37 Hal. 271 dari 1322

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Kelas : C
Cabang : JAKARTA PUSAT
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SRI AGUSTINA RUMAPEA S KOM MT (P) APARTEMEN GADING MEDITERANIA A09 - Diarrhoea and gastroenteritis of SIANOKOBALAMIN (VITAMIN B12) 50
CC 8 AC presumed infectious origin MCG
Tgl Lahir : 17-Aug-1978 ( 41 Thn 0 Bln 23 Hr ) BETAMETASON KRIM 0,5MG/G
9
No. RM : 01-085599 NIK : 1271145708780010 KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Diagnosis : 06 February 2019 9:52 AM BPJS : 0002216172565 MG TAB
KEYZA DWI PUTRI (P) JL. MASJID ALJIHAD RT 06 RW 04 KGT R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
10 NIK : - MCG
No. RM : 02-000610 BPJS : 0001225699176
JANTIPANUS SIMATUPANG, TN (L) TANAH MERAH JL KLP HIJAU NO 89A I64 - Stroke, not specified as haemorrhage RUJUKAN (0116R025) Rumah Sakit Firdaus
or infarction RUJUKAN (SAR) SARAF - (76) Saraf - (0)
11 NIK : 3175020904600012 Telah Diberikan : Anamnesis (S) :
No. RM : 01-080423 BPJS : 0001266133959 - PERPANJANG RUJUKAN POLI
Tgl Diagnosis : 06 February 2019 11:55 AM SYARAF DGN DX STROKE NOT
SPECIFIED HEMORAGIC
INFARCTION UNTUK KONTROL
Pemeriksaan (O) :
- AKRAL HANGAT
A;-
P ; KOLABORASI DGN DOKTER

Faskes : (0116R025) Rumah
Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
2019-09-09 13:37 Hal. 272 dari 1322

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Kapasitas : 0
Jadwal : Kamis : 16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
SURYADI (L) JL.BAHARI GG II/31 G51.0 - Bell's palsy RUJUKAN (0116R025) Rumah Sakit Firdaus
(SAR) SARAF - (76) Saraf - (0)
12 NIK : 3172041007840028 Telah Diberikan : namnesis (S) :
No. RM : 01-086682 BPJS : 0001653541896 - nyeri tengkuk belakang,wajah
Tgl Diagnosis : 06 February 2019 12:03 PM sebelah kanan 1 minggu yang
lalu. riwayat bells palsy
-
-
Pemeriksaan (O) : wajah miring
ke sebelah kanan
- P : KALBORASI DENGAN
DOKTER
-ANJURKAN TEKNIK
RELAKSASI
-A : GANGGUAN RASA NYAMAN
BERHUBUNGAN DENGAN
PUSING
-ANJURKAN OS UNTUK
BEDREST
-ANJURKAN OS UNTUK
-
-

Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
2019-09-09 13:37 Hal. 273 dari 1322

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Jadwal : Rabu : 17:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
IDA SAIDAH, NY (P) GG. PERINTIS RT 01 RW 04 M13.9 - Arthritis, unspecified RUJUKAN (0113R034) MEDIROS
RUJUKAN (SAR) SARAF - (76) Saraf - (0)
13 NIK : - Telah Diberikan : Anamnesis (S) :
No. RM : 02-000683 BPJS : 0001226370453 - baca hasil lab
Tgl Diagnosis : 06 February 2019 12:15 PM - pegel-pegel
- nyeri di lengan kanan 1 bulan
yang lalu
Pemeriksaan (O) : phalen sign +,
tinel sign +
- P : KALBORASI DENGAN
DOKTER
-ANJURKAN TEKNIK
RELAKSASI
BERHUBUNGAN DENGAN
PUSING
-ANJURKAN OS UNTUK
BEDREST
-ANJURKAN OS UNTUK
-
-
Faskes : (0113R034) MEDIROS
Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Sabtu : 09:00 - 13:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 274 dari 1322

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Alasan TACC :
EPI YUSTINI, NY (P) KP. RAWA INDAH NO. 112 006/003 PGS I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
II J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-063863 NIK : 3172066011680007 MG
DODI LUKMAN (L) SAWAH BESAR TAMAN SARI 1B J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
15 NIK : 3201151612940004
No. RM : 01-071359 BPJS : 0001653368804
MUHAMMAD NURUL (L) ASRAMA PEMADAN KEBAKARAN J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
SEMPER BLOK H NO 46 T 02/017 GLISERIL GUAIAKOLAT (GG) 100 MG
16 LORATADIN 10 MG
SATRIA PUTRA PRATAMA, AN (L) RAWA INDAH RT 06/03 C92.8 - ACUTE MYELOID LEUKAEMIA RUJUKAN (0116R025) Rumah Sakit Firdaus
WITH MULTILINEAGE DYSPLASIA (ANA) ANAK - (26) Anak - (0)
No. RM : 01-030749 BPJS : 0001225849037 - os perpanjang rujukan ke RSUD
Tgl Diagnosis : 06 February 2019 12:58 PM Tarakan poli anak DIAGNOSA
LEUKEMIA
-
-
Pemeriksaan (O) :
- osmdianjurkan kolaborasi
dengan dokter
-
-

Sakit Firdaus
KOMP.BEA CUKAI
2019-09-09 13:37 Hal. 275 dari 1322

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Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 07:00 - 10:30,
16:30 - 19:00;18:00 - 20:30
TACC : Tanpa TACC

Alasan TACC :
RAKHA IBNU SABIL, AN (L) PGSN 2 RT 04/02 H. OYAR J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-007607 BPJS : 0001223506181 MG
AMOKSISILIN 500 MG
INDRIYANI (P) APT GADING NIAS RESIDENCE U L B17.8 - Other specified acute viral hepatitis
R09 LU RT 02/03
19
No. RM : 01-021510 NIK : 3172034101880017
ROMENAH, NY (P) PERJUANGAN RT. 02/04 KGT H25.8 - Other senile cataract LORATADIN 10 MG (0903R012) RS KARTIKA
L20.8 - Other atopic dermatitis BETAMETASON KRIM 0,5MG/G PULOMAS
(MAT) MATA - (65) Mata - (0)
20 NIK : 3172064202610002 M79.1 - Myalgia NATRIUM DIKLOFENAK 50 MG Telah Diberikan : Anamnesis (S) :
No. RM : 01-000750 BPJS : 0000378113578 - os perpanjang rujukan ke RS
Tgl Diagnosis : 06 February 2019 2:22 PM MCG kartika pulomas poli mata
RUJUKAN diagnosa katarak
- gatal gatal dibadan 1 minggu
yang lalu, badan pegal linu
-
Pemeriksaan (O) : skuama
eritema, di seluruh badan, kedua
lensa mata keruh. nyeri tekan di
badan rom terbatas
-
- os dianbjurkan kolaborasi
dengan dokter
-
KARTIKA PULOMAS
2019-09-09 13:37 Hal. 276 dari 1322

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Alamat : JL.PULOMAS TIMUR
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 10:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
ERNA INDRAJANI (P) JL GADING ELOK TIMUR BO 2/23 RT I10 - Essential (primary) hypertension RUJUKAN
10/09 087782370896 I25.9 - Chronic ischaemic heart disease,
21 unspecified
No. RM : 01-002981 NIK : 3172066105480001 I64 - Stroke, not specified as haemorrhage
Tgl Diagnosis : 06 February 2019 2:29 PM BPJS : 0001433439729 or infarction
DR.MATTEUS TEDJASAPUTRA, TN (L) GADING ELOK TIUMR VI I10 - Essential (primary) hypertension RUJUKAN
I25.0 - Atherosclerotic cardiovascular
22 NIK : 3172061602460001 disease, so described
No. RM : 01-002983 BPJS : 0001336153419
THOMAS HIUGONY, TN (L) KELAPA MOL;EK VII E11.9 - Non-insulin-dependent diabetes RUJUKAN
mellitus without complications
Tgl Lahir : 06-Jun-1956 ( 63 Thn 3 Bln 3 Hr ) E78.0 - Pure hypercholesterolaemia
23 NIK : 3172060606560005
No. RM : 01-036357 BPJS : 0001287629199 I10 - Essential (primary) hypertension
Tgl Diagnosis : 06 February 2019 2:37 PM I25.9 - Chronic ischaemic heart disease,
unspecified
HILDA LISIAWATI, NY (P) JL KASUARI VII NO.21 E11.7 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
mellitus with multiple complications RUJUKAN PULOMAS
(INT) PENYAKIT DALAM - (3)
24 NIK : 3216095602380001 RUJUKAN Penyakit
Telah Dalam :-Anamnesis
Diberikan (0) (S) :
No. RM : 01-086680 BPJS : 0001821851807 -kaki luka sdh di beih di bersih
Tgl Diagnosis : 06 February 2019 2:44 PM kan di ugd ganguan rasa nyaman
ugd
-saran dr ugd pasien di rujuk
- suspek ulkus dm
Pemeriksaan (O) :
-akral hangat
-a ganguan rasa nyaman
-p kolaborasi dg dokter
2019-09-09 13:37 Hal. 277 dari 1322

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KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
TJHIE SUNIARTI (P) JL. PAGUYUH KC 34 M13.9 - Arthritis, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
NATRIUM DIKLOFENAK 50 MG (ORT) ORTHOPEDI - (93)
25 NIK : 3172065202590002 SIANOKOBALAMIN (VITAMIN B12) 50 Orthopedi
Telah - (0) :
Diberikan
No. RM : 01-058253 BPJS : 0001384054299 MCG Faskes : (0116R025) Rumah
Tgl Diagnosis : 06 February 2019 2:57 PM DIAZEPAM 2 MG Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
SURJA MULYADI SETIADI (L) JL JANUR KUNING VI BLOK WK RT L03.9 - Cellulitis, unspecified BETAMETASON KRIM 0,5MG/G
004/017 OMEPRAZOL KAPS 20 MG
AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 278 dari 1322

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M M TAMBUNAN (P) JLTARIAN RAYA TIMUR 02/09 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
mellitus without complications PULOMAS
27 NIK : 3172065906480002 Penyakit Dalam :-Anamnesis
Telah Diberikan (0) (S) :
No. RM : 01-004066 BPJS : 0000046014028 - perpanjang rujukan poli dalam
Tgl Diagnosis : 07 February 2019 1:37 PM dx dm tipe 2 sudah
menggunakan insulin ke rs
-
-
Pemeriksaan (O) :
-
-
-
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00
TACC : Tanpa TACC

Alasan TACC :
SURYANINGSIH (P) JL P GALANG NO 56 RT 9/3 E11.9 - Non-insulin-dependent diabetes PARASETAMOL TAB 500 MG
mellitus without complications SIANOKOBALAMIN (VITAMIN B12) 50
Tgl Lahir : 08-Oct-1969 ( 49 Thn 11 Bln 1 Hr ) M79.1 - Myalgia
28 NIK : 3172064810690002 MCG
No. RM : 01-020710 BPJS : 0001223498981
ZAKIRA ALUNA AZAHRA, AN (P) SAMBONG RT 07/01 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
29 NIK : - MG
No. RM : 01-008319 BPJS : 0001216086669 KOTRIMOKSAZOL DOEN SUSPENSI
TRIMETOPRIM 40 MG)
2019-09-09 13:37 Hal. 279 dari 1322

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ALIFIA NUR ADZANI, AN (P) KOMPLEK KODAM JAYA BLOK 0/1 RT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
30 MG
Tgl Diagnosis : 07 February 2019 1:54 PM BPJS : 0002198783619 AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
M TAUFIK, TN (L) KOMPLEK KODAM JAYA BLOK 0/1 RT J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
JULIAN RISKI, AN (L) JL. RAWA SENGON R50.9 - Fever, unspecified AMBROKSOL TAB 30 MG
32 NIK : 3376041507090002 MG
MCG
NOFIANTI (P) PGS II 04/01 E11.9 - Non-insulin-dependent diabetes DIAZEPAM 2 MG
SRI JANTI SUHARKO, NY (P) TAMAN PEGANGSAAN INDAH BLOK E N19 - Unspecified renal failure RUJUKAN (0903R012) RS KARTIKA
15 PULOMAS
34 Penyakit Dalam :-Anamnesis
No. RM : 01-075475 NIK : 31720643086000005 - pwerpanjang rujukan poli
Tgl Diagnosis : 08 February 2019 1:41 PM BPJS : 0001387765326 hemodialisa 3x seminggu dengan
diagnosa gagal ginjal akut
Pemeriksaan (O) :
- akral hangat
DOKTER
- ANJURKAN OS UNTUK MI
2019-09-09 13:37 Hal. 280 dari 1322

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NUM OBAT TERATUR
- ANJURKAN OS UNTUK DIET
RENDAH GARAM
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK
DARAH
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
HASAN BASRI, TN (L) SENTOSA 3 RT 7/10 L20.8 - Other atopic dermatitis BETAMETASON 0,1%,KRIM
SETIRIZIN 10MG
35 NIK : 3172061006660004
No. RM : 01-014872 BPJS : 0000378294096
INDRIATI ISKANDAR, NY (P) GADING GRIYA LESTARI H.2/15 M13.9 - Arthritis, unspecified RUJUKAN (0116R029) Rumah Sakit
Hermina Podomoro - (93)
(ORT) ORTHOPEDI
36 NIK : 3674036512380002 Orthopedi - (0) : Anamnesis (S) :
Telah Diberikan
No. RM : 01-022406 BPJS : 0001258803461 - konsul hasil rontgen
Tgl Diagnosis : 08 February 2019 1:55 PM - jatuh 2 minggu yang lalu dari
gereja tumpuan lengan kiri
-
Pemeriksaan (O) : kesan foto ro :
oa artic humeri sinistra
-
-
-
2019-09-09 13:37 Hal. 281 dari 1322

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a. gangguan rasa nyaman
p. konsul dokter
Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Sabtu : 11:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
YASMI ANDOKOWATI, NY (P) JL GADING III / 4 RT 3/5 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
37 NIK : 3172065607500001 Penyakit
Diberikan (0) (S) :
No. RM : 01-011748 BPJS : 0000195535091 - perpanjang rujukan poli dalam
Tgl Diagnosis : 08 February 2019 2:01 PM ke rs kartika pulomas dengan
diagnosa DM
-
-
Pemeriksaan (O) :
-
-
-
A : Resti infeksi berhubungan
dengan kadar glukosa tinggi
P : Mengurangi porsi
makan,terutama nasi
- Olahraga teratur
- Kontrol rutin
- Minum obat teratur
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
2019-09-09 13:37 Hal. 282 dari 1322

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Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
ADHWA RIZKA FACHRIYA, AN (P) JL TIPAR CAKUNG RT 02/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
K29.6 - Other gastritis AMBROKSOL TAB 30 MG
No. RM : 01-054676 BPJS : 0001301976033 MG
SUGENG RIYADI, TN (L) GG PERINTIS I 001/004 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
39 NIK : 3172062609760005 MCG
KAREN ZEFANYA INGKAN, NN (P) JL DEWI SHINTA BLOK KH NO 11 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
K29.6 - Other gastritis AMBROKSOL TAB 30 MG
No. RM : 01-086727 BPJS : 0001820878132 MG
AMOKSISILIN 500 MG
ESTHER NOOR CAHYANI, NY (P) JL RAYA GADING PERMAI BLOK DE I84.5 - External haemorrhoids without RUJUKAN (0116R029) Rumah Sakit
NO 12A complication Hermina
(BED) Podomoro
BEDAH - (16) Bedah - (0)
41 Telah Diberikan : Anamnesis (S) :
No. RM : 01-016815 NIK : 0000093895334 -ada riwayat hemoroid 3 bulan
Tgl Diagnosis : 08 February 2019 2:34 PM BPJS : 0000093895334 yang lalu
-
-
Pemeriksaan (O) : benjolan di
anus 1 buah sebesar kacang hijau
namun tak bisa dimasukkan
-akral hangat
2019-09-09 13:37 Hal. 283 dari 1322

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BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
BANYU DEWANGGA (L) RAWA SENGON BLK E 005/022 R50.9 - Fever, unspecified

42 NIK : 3172060110101010
No. RM : 01-022849 BPJS : 0001672405637
TJENDRA EFFENDI, TN (L) JLN PELEPAH ELOK 9 QF 2 NO 16 E11.9 - Non-insulin-dependent diabetes DIAZEPAM 2 MG
Tgl Lahir : 27-Jan-1968 ( 51 Thn 7 Bln 13 Hr ) M79.1 - Myalgia
MUHAMMAD HARIRI, TN (L) P. GADUNG WR JENGKOL H61.2 - Impacted cerumen PARASETAMOL TAB 500 MG
FENOL GLISEROL TT 10%
44 NIK : -
No. RM : 01-086917 BPJS : 0002332918708
GRACE NATALIN TJIETRA (P) JL. APRT GD NIAS TWR D BLK X LG J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
45 NIK : 3171034512131005 MG
MCG
2019-09-09 13:37 Hal. 284 dari 1322

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LINDA KRISTIANTI (P) GANG SPOOR IV DALAM NO. 25 J02.9 - Acute pharyngitis, unspecified AMBROKSOL TAB 30 MG
009/005 GUNUNG SAHARI KLORFENIRAMIN MALEAT (CTM) TAB 4
46 MG
LIM TJEK THIAN (L) ROYAL GADING MANSION RG.9/6 K25.9 - Gastric ulcer, unspecified as acute RUJUKAN (0903R012) RS KARTIKA
or chronic, without haemorrhage or PULOMAS
Tgl Lahir : 18-Nov-1950 ( 68 Thn 9 Bln 22 Hr ) perforation
47 NIK : 3172061811500003 Penyakit
Diberikan (0) (S) :
No. RM : 01-012606 BPJS : 0001795251699 -pasien habis di rawat nginap di
Tgl Diagnosis : 08 February 2019 3:14 PM royal progress
-hari ini minta rujukan tuk kontrol
- diagnosa ulkus gaster
Pemeriksaan (O) :
-akral hangat
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
KERIAHENTA TARIGAN (L) JANUR ASRI RT 1/12 NO 1 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
48 NIK : 3172061505860004 SETIRIZIN 10MG
2019-09-09 13:37 Hal. 285 dari 1322

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APRILIA LANJAR SITI SURYANI (P) JL PASAR INPRES RT 006/006 NO 60 Z34.9 - Supervision of normal pregnancy, PARASETAMOL TAB 500 MG
Tgl Lahir : 01-Jun-1989 ( 30 Thn 3 Bln 8 Hr ) Z34.9 - Supervision of normal pregnancy,
No. RM : 02-004176 BPJS : 0001617935106 unspecified 200.000 UI
Z39.0 - Care and examination immediately
after delivery
MCG
KEZIA RACHAEL MAURE, AN (P) RAWASENGON 02/22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-021614 BPJS : 0001313108403 MG
ACAH TARSAH (P) JL. PUSKESMAS NO.74B 006/006 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-049714 BPJS : 0002478251103 MG
DEDEH RUSMIYATI (P) JL. PGS II RT 05/01 H52.4 - Presbyopia GLISERIL GUAIAKOLAT (GG) 100 MG (0113R034) MEDIROS
I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4 (MAT) MATA - (65) Mata - (0)
52 NIK : 32020963087250001 J02.9 - Acute pharyngitis, unspecified MG Telah Diberikan : Anamnesis (S) :
No. RM : 01-031758 BPJS : 0001296853255 AMOKSISILIN 500 MG - BATUK KERING 1 MGG,PILEK
Tgl Diagnosis : 13 February 2019 9:47 AM RUJUKAN ADA
- MATA KANAN BERAIR,MATA
KIRI BURAM
- HT,DM TDK ADA
Pemeriksaan (O) : faring
hiperemis
- AKRAL HANGAT
A : GANGGUAN POLA NAPAS
DOKTER
- ANJURKAN OS UNTUK
BANYAK MINUM AIR PUTIH
- ANJURKAN OS UNTUK
MENGHINDARI
MAKANAN/MINUMAN YANG
MERANGSANG BATUK
2019-09-09 13:37 Hal. 286 dari 1322

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- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
P : - KOLABORASI DENGAN
DOKTER
- ANJURKAN OS UNTUK
ADIET RENDAH GARAM
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK
DARAH
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Kamis : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
MAHARDIKA ZAIN ARIESKY (L) JL SWASEMBADA TIMUR XI NO 02 RT D69.3 - Idiopathic thrombocytopenic purpura RUJUKAN (0905R003) RS PELABUHAN
12/10I 089656688804 JAKARTA
(ANA) ANAK - (26) Anak - (0)
No. RM : 01-025665 NIK : 31720222203121002 - perpanjang rujukan poli anak dx
Tgl Diagnosis : 13 February 2019 9:54 AM BPJS : 0001262563266 indiopatic thrombocytopenic
purpura
-
-
Pemeriksaan (O) :
-
-
-
PELABUHAN JAKARTA
2019-09-09 13:37 Hal. 287 dari 1322

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Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Sabtu : 08:00 - 14:00,
14:00 - 16:00;16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
ROHMAT (L) INPEKSI KALI SUNTER 11/04 A06.0 - Acute amoebic dysentery KOMBINASI KAOLIN 550 MG, PEKTIN 20
MG TAB
Tgl Lahir : 01-Jan-1994 ( 25 Thn 8 Bln 8 Hr ) GARAM ORALIT KOMBINASI
54 NIK : 3212040101940007
Tgl Diagnosis : 13 February 2019 10:09 AM KOTRIMOKSAZOL DOEN I (DEWASA)
TRIMETOPRIM 80 MG)
MCG
DR IKA RENY RETNOWATI (P) KLP GADING PELEPAH ELOK HF 7 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
OBH SIRUP 100 ML
DEKSAMETASON 0,5 MG
DINA PURNAMASARI (P) JL INFEKSI KALI SUNTER N20.0 - Calculus of kidney RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
(URO) UROLOGI - (88) Urologi -
56 NIK : 3172064708000001 (0)
Telah Diberikan : Anamnesis (S) :
No. RM : 01-081120 BPJS : 0000377987051 - kalau BAK nyeri dan perih sejak
Tgl Diagnosis : 13 February 2019 10:54 AM 2 hari
- riwayat batu ginja disebeah kiri,
hasi ft rntegn
-
Pemeriksaan (O) :
- A : GANGUAN RASA NYAMAN
NYERI
P : KOLABORASI DENGAAN
DOKTER
- KAJI TINGKAT SKALA
2019-09-09 13:37 Hal. 288 dari 1322

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NYERI PASIEN
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
KURANGI AKTIFITAS BERLEBIH
- ANJURKAN OS UNTUK
PELABUHAN JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 11:00 - 14:00,
16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
CHRISTIN NATALIA CHANDRA, NY (P) JL.PELEPAH INDAH II LA.22/8 010/RW J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
57 MG
Tgl Diagnosis : 13 February 2019 1:41 PM BPJS : 0002141813169 DOKTER UMUM
JIE TJE SEN, TN (L) WGP MENARA C 15/12 RT 10/20 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-057598 BPJS : 0001423711113 MG
SULASTIKA LINDUNG (P) PULOMAS BARAT II RT 7/16 K29.6 - Other gastritis PARASETAMOL TAB 500 MG
ANTASIDA DOEN
59 NIK : 3175024309730012 DIAZEPAM 5 MG
2019-09-09 13:37 Hal. 289 dari 1322

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IDHA YANTI (P) JL PGS II RT 06/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-059325 BPJS : 0001225850084 MG
NOURAH ZAHROTUL MILLA (P) BCS RT 4/5 NO 73 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-015295 BPJS : 0001225850242 MG
Tgl Diagnosis : 13 February 2019 2:14 PM AMOKSISILIN KAPS 250 MG
LENI PITRIYANI (P) JL PEGANGSAAN DUA R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-087377 BPJS : 0001460193322 MG
NUR ALUTFIATI, NY (P) KP RAWA INDAH RT 6/3 N94.6 - Dysmenorrhoea, unspecified PARASETAMOL TAB 500 MG (0116R025) Rumah Sakit Firdaus
O75.7 - Vaginal delivery following previous SIANOKOBALAMIN (VITAMIN B12) 50 (OBG) OBGYN - (19) obgyn - (0)
63 NIK : 3172065509960001 caesarean section MCG Telah Diberikan : Anamnesis (S) :
No. RM : 01-031587 BPJS : 0000379193927 RUJUKAN - RIW DEMAM , PUSING, NYERI
Tgl Diagnosis : 13 February 2019 3:14 PM PERUT 3 hari
- LEMAS, SEDANG
MENSTRUASI HARI KE 3 ,
DARAH KELUAR BANYAK,
LUKA BEKAS SECAR TERASA
NYERI
- MUAL ADA
Pemeriksaan (O) :
- AKRAL HANGAT
A : GANGGUAN RASA NYAMAN

P:
-KOLABORASI DENGAN
DOKTER
-JANGAN BERDIRI SECARA
TIBA-TIBA
-BATASI KONSUMSI KAFEIN,
MINUMAN KERAS DAN
ROKOK
-BANYAK MINUM
2019-09-09 13:37 Hal. 290 dari 1322

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- MAKAN SECARA TERATUR
- SEGERA DUDUK ATAU
BERBARING KETIKA MERASA
AKAN PINGSAN ATAU
KEHILANGAN KESEIMBANGAN
Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Kamis : 08:00 - 13:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
KHARISMA AGUSTIN, AN (P) JL PEGANGSAAN DUA RT 03/047 A01.4 - Paratyphoid fever, unspecified PARASETAMOL SYR 120 MG/5 ML
FERRO SULFAT SIR. 15 MG/5 ML
MG
TIRZA AMELIA LONGKUTOY, NY (P) JL. MELODI MAS RAYA A-8/1 RT Z03.0 - Observation for suspected GLISERIL GUAIAKOLAT (GG) 100 MG
013/007 tuberculosis DEKSAMETASON 0,5 MG
No. RM : 01-016589 NIK : 3172065611700003 DIAZEPAM 5 MG
AMOKSISILIN 500 MG
KADISUN (P) JL INSPEKSI KALI SUNTER RT 08/13 K29.6 - Other gastritis PARASETAMOL TAB 500 MG
M79.1 - Myalgia SIANOKOBALAMIN (VITAMIN B12) 50
66 NIK : 3172064509830005 MCG
Tgl Diagnosis : 14 February 2019 8:56 AM DIAZEPAM 5 MG
2019-09-09 13:37 Hal. 291 dari 1322

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OLIVIA THOMAS RESSA (P) TMN PGS INDAH RT 7/19 J00 - Acute nasopharyngitis [common cold] DEKSAMETASON 0,5 MG
No. RM : 01-040974 BPJS : 0002059318056 MG
Tgl Diagnosis : 14 February 2019 9:21 AM DIAZEPAM 5 MG
RAISA MAULIANA PUTRI (P) JL TEGUH II NO 128 RT 005/001 J02.9 - Acute pharyngitis, unspecified PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
MCG
UNDI LUSIANA (P) RAWASENGON 02/22 K29.6 - Other gastritis PARASETAMOL TAB 500 MG
ANTASIDA DOEN
69 NIK : 3329104105910004 RANITIDIN 150 MG
DOKTER UMUM
MAKIYANI (P) KELAPA GADING TIMUR RT 003/004 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
MUGIHARMI (P) JL RAWA SENGON RT 02/022 O75.7 - Vaginal delivery following previous RUJUKAN (0905R003) RS PELABUHAN
caesarean section JAKARTA
(OBG) OBGYN - (19) obgyn - (0)
Tgl Lahir : 11-Mar-1981 ( 38 Thn 5 Bln 29 Hr ) Z35.8 - Supervision of other high-risk
No. RM : 01-076031 BPJS : 0001225833074 pregnancies - riwayat saesar
Tgl Diagnosis : 14 February 2019 10:52 AM - G2P1A0 usia kehamian 38
minggu dengan diagnosa riwayat
SC dan usia diatas 35 tahun
-
Pemeriksaan (O) :
-
-
-
a.-
2019-09-09 13:37 Hal. 292 dari 1322

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p. konsul dokter
PELABUHAN JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Selasa : 10:00 - 14:00,
14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
MURNIATI MAR'ATUSH SHOLIKHAH (P) JL PGS II J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
O21.0 - Mild hyperemesis gravidarum OBH SIRUP 100 ML
72 NIK : - AMOKSISILIN 500 MG
TITA ROSITA (P) KP TANAH MERAH JL MANDIRI 002/009 H70.0 - Acute mastoiditis PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
No. RM : 01-004436 BPJS : 0000378345958 MCG
SRI MUKARTI, NY (P) KOMPI UDIN RT 6/5 J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
L20.8 - Other atopic dermatitis MG
Tgl Lahir : 21-Mar-1980 ( 39 Thn 5 Bln 19 Hr ) DEKSAMETASON 0,5 MG
74 NIK : -
Tgl Diagnosis : 14 February 2019 11:52 AM BEDAK SALISIL 2 %
DECCA ADELYA (P) PEGANGSAAN DUA 05/05 H52.1 - Myopia DOKTER UMUM (0116R025) Rumah Sakit Firdaus
RUJUKAN (MAT) MATA - (65) Mata - (0)
No. RM : 01-037068 BPJS : 0001225639034 - perpanjang rujukan poli mata
Tgl Diagnosis : 14 February 2019 2:36 PM dengan diagnosa miopia
-
-
Pemeriksaan (O) :
-
2019-09-09 13:37 Hal. 293 dari 1322

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-
-
a. gangguan rasa nyaman
p. kontrol rutin
minum obat teratur
Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Sabtu : 09:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
LIE TJUNG PO (L) KOMP BPP BEACUKAI JL TELUK LADA M79.1 - Myalgia PARASETAMOL TAB 500 MG
RT 05/08 SIANOKOBALAMIN (VITAMIN B12) 50
76 MCG
No. RM : 01-036860 NIK : 3175021506700016
NAUFAL AL SYAFIQ, AN (L) JL SUKAPURA JAYA RT 06/10 R50.9 - Fever, unspecified PARASETAMOL SYR 120 MG/5 ML
77 NIK : 3172040911111001 MG
Tgl Diagnosis : 14 February 2019 2:50 PM DOMPERIDON SUSP 5 MG/5 ML
RETRIBUSI KLINIK UMUM
VIVI AISYAH RUWAIDAH, NN (P) JL. PUSKESMAS NO 82 M79.1 - Myalgia PARASETAMOL TAB 500 MG
78 NIK : - MCG
No. RM : 01-087794 BPJS : 0002332876184
2019-09-09 13:37 Hal. 294 dari 1322

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ITA SURYANI, NY (P) JL KELAPA SAWIT VIII BE / 05 M79.73 - FIBROMYALGIA, FOREARM RUJUKAN (0113R034) MEDIROS
No. RM : 01-041234 BPJS : 0001195834206 - KONTROL BADAN SERING
Tgl Diagnosis : 18 February 2019 10:37 AM KEBAS 1 bulan yang lalu, OBAT
HABIS BLM MEMBAIK
-
Pemeriksaan (O) : nyeri tekan di
badan + rom terbatas
- AKRAL HANGAT
NYERI
DOKTER
NYERI PASIEN
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
SAYI, NY (P) GG PERINTIS II/42 I10 - Essential (primary) hypertension FUROSEMID 40 MG (0905R003) RS PELABUHAN
N20.2 - Calculus of kidney with calculus of RUJUKAN JAKARTA
80 NIK : 3172065210690002 ureter KAPTOPRIL 25 MG (0)
Telah Diberikan :
Tgl Diagnosis : 18 February 2019 11:20 AM PELABUHAN JAKARTA
2019-09-09 13:37 Hal. 295 dari 1322

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SIANOKOBALAMIN (VITAMIN B12) 50 Telp : 021-4403026
MCG Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Selasa : 14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
ADELIA SYAIRILLA AZAHRA (P) JL TEGUH 7/86 R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
81 NIK : 3172066708131001 MG
MCG
FARIZ PRATAMA (L) JL RAWA SENGON 09/022 R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
82 MG
MCG
OKTAFIAN ANGGARA FRILI, AN (L) PGS II J00 - Acute nasopharyngitis [common cold] PARASETAMOL SYR 120 MG/5 ML
83 NIK : - MG
MCG
ETY AMIATI (P) PEGANGSAAN DAU NO.106 03/03 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-033070 BPJS : 0001847128858 MG
2019-09-09 13:37 Hal. 296 dari 1322

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AUDY QOUDRUN NADA, AN (P) JL BCS 002/006 L20.8 - Other atopic dermatitis PARASETAMOL TAB 500 MG
85 NIK : 3209065312070001 MG
IWAN HERYAWAN.TN (L) KP SUKAPURA 006/010 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-011383 BPJS : 0001132131936 MG
AMLODIPIN 10 MG
EMELIE DOMINIQUE ANGIE (P) JL KELAPA PUAN TIMUR II NB II NO 09 I25.9 - Chronic ischaemic heart disease, RUJUKAN (0116R029) Rumah Sakit
unspecified Hermina
(JAN) Podomoro
JANTUNG DAN
87 NIK : 31730462080510002 PEMBULUH
Telah DARAH
Diberikan - (89) (S) :
: Anamnesis
- PERPANJANG RUJUKAN POLI
Tgl Diagnosis : 18 February 2019 2:56 PM DARAH - (0)
JANTUNG DX VENTRICULER
SEPTAL DEFECT AS CURRENT
COMPLICATION
-
-
Pemeriksaan (O) :
-
-
-

BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 297 dari 1322

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FAHRI SAPUTRA (L) JL P TEMIANG III NO 7 RT 013/003 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-021085 BPJS : 0001263147568 MG
MUHAMMAD FAISAL SAPUTRA, AN (L) JL.P. TEMIANG III NO.7 013/003 R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
89 NIK : 3172060506121003 MG
MCG
MUHAMAD TAUFIQ HIDAYAT (L) JL RAWA SENGON J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-087873 BPJS : 0001603145158 MG
MCG
MUHAMMDAD DHAFA (L) RAWA BADAK D50.8 - Other iron deficiency anaemias FERRO SULFAT SIR. 15 MG/5 ML
91 NIK : 3172030112121012
No. RM : 01-023205 BPJS : 0001205008119
DURIAH (P) JL RW SNEGON RT 5/22 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
M54.5 - Low back pain SIANOKOBALAMIN (VITAMIN B12) 50
92 NIK : - MCG
No. RM : 01-063965 BPJS : 0000377435057 DIAZEPAM 5 MG
BIANCA SARI KURNIAWAN (P) JL.LEAPA GADING NIS 8 PA 23/16 M35.0 - Sicca syndrome [Sjogren] RUJUKAN (0903R012) RS KARTIKA
PULOMAS
93 NIK : 3172065104870002 Penyakit
Diberikan (0) (S) :
No. RM : 01-001313 BPJS : 0001795694027 - PERPANJANG RUJUKAN POLI
Tgl Diagnosis : 19 February 2019 10:43 AM PENYAKIT DALAM DGN DX
2019-09-09 13:37 Hal. 298 dari 1322

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SICCA SYNDROME
-
-
Pemeriksaan (O) :
- AKRAL HANGAT
NYERI
DOKTER
NYERI PASIEN
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
SUKARDI,TN (L) JL TELUK RATAI I NO 69 RT 001/010 I25.9 - Chronic ischaemic heart disease, RUJUKAN (0905R004) RS ISLAM JKT
unspecified SUKAPURA
(JAN) JANTUNG DAN
94 NIK : 3172061202600001 PEMBULUH
Telah DARAH
Diberikan : - (89)
Faskes : (0905R004) RS ISLAM
Tgl Diagnosis : 19 February 2019 11:01 AM DARAH
JKT - (0)
SUKAPURA
Alamat : JL. TIPAR CAKUNG NO.
5
Telp : 021-4400778
Kelas : C
2019-09-09 13:37 Hal. 299 dari 1322

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Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
PARTINI SADIIN, NY (P) JL MATRAMAN SALEMBA V/10 H52.1 - Myopia RUJUKAN (0116R027) Rumah Sakit
H52.2 - Astigmatism Mulyasari
(MAT) MATA - (65) Mata - (0)
Tgl Diagnosis : 19 February 2019 11:05 AM Sakit Mulyasari
Alamat : Jl. Raya Plumpang
Semper No.19
Telp : 021-43931111
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
FARIZ PRATAMA (L) JL RAWA SENGON 09/022 R50.9 - Fever, unspecified
081905510957
96
No. RM : 01-059309 NIK : 3208244310920006
FAHRI SAPUTRA (L) JL P TEMIANG III NO 7 RT 013/003 D50.9 - Iron deficiency anaemia, unspecified FERRO SULFAT SIR. 15 MG/5 ML
R50.9 - Fever, unspecified
97 NIK : 3172062205090002
No. RM : 01-021085 BPJS : 0001263147568
LINAWATY, NY (P) JL SITER BLOK E/10 RT 004/007 K80.8 - Other cholelithiasis RUJUKAN (0903R012) RS KARTIKA
L20.8 - Other atopic dermatitis LORATADIN 10 MG PULOMAS
98 NIK : 3172067103660008 BETAMETASON 0,1%,KRIM Penyakit
Diberikan (0) (S) :
No. RM : 01-020740 BPJS : 0001460780673 - GATAL DI KAKI BERPINDAH2 ,
Tgl Diagnosis : 19 February 2019 11:47 AM - RIW BATU EMPEDU 1 TAHUN
YG LALAU
2019-09-09 13:37 Hal. 300 dari 1322

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-
Pemeriksaan (O) : skuama
eritema di kaki kiri 1 buah
- AKRAL HANGAT
A : GANGGUAN INTEGRITAS
KULIT
DOKTER
-ANJURKAN OS UNTUK
TIDAK MENGARUK PADA
BAGIAN GATAL
- ANJURKAN OS UNTUK
MENJAGA KEBERSIHAN KULIT
- ANJURKAN OS UNTUK
MENGHINDARI PENYEBaAAB
ALERGI
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00
TACC : Tanpa TACC

Alasan TACC :
ROHAENI, NY (P) RW SENGON BLOK B RT 2/22 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-018089 BPJS : 0002332726569 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 301 dari 1322

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MEILIA WIDIANTI (P) JLN SUMAGUNG 2 BLOK I 5 /7 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-087721 BPJS : 0002332907998
SITI NURHASANAH (P) JL. INSPEKSI KALI SUNTER A01.4 - Paratyphoid fever, unspecified PARASETAMOL TAB 500 MG
J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
MCG
AHMAD FIHRY ALFARUQ, AN (L) KOMP IMPERIAL GADING R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
MANUNGGAL 2 S1 NO 16 GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-070039 NIK : 3171061709121002 MG
Tgl Diagnosis : 19 February 2019 2:14 PM BPJS : 0001630247387 DOMPERIDON TAB 10 MG
BAMBANG DJUMANTRI (L) JL TERATAI NO 26 RT 07/03 B35.9 - Dermatophytosis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
B76.0 - Ancylostomiasis MG
Tgl Lahir : 27-Oct-1965 ( 53 Thn 10 Bln 13 Hr ) MIKONAZOL KRIM 2 %
103 NIK : 3173042709650010
No. RM : 01-020742 BPJS : 0001900687915 ALBENDAZOL 400 MG
RATNAWATI, NY (P) JL. PULAU BATU NO 34 RT 001/003 J02.9 - Acute pharyngitis, unspecified RETRIBUSI KLINIK UMUM
S99.9 - Unspecified injury of ankle and foot PARASETAMOL TAB 500 MG
MG
ISMAIL BIN USUP (L) KP RAWA INDAH RT 01/03 I25.9 - Chronic ischaemic heart disease, RUJUKAN (0116R025) Rumah Sakit Firdaus
unspecified (INT) PENYAKIT DALAM - (3)
105 NIK : 3172061205590001 Penyakit Dalam :-Anamnesis
No. RM : 01-011340 BPJS : 0000379161729 - perpanjang rujukan poli penyakit
Tgl Diagnosis : 21 February 2019 8:49 AM dalam dgn dx chf
-
-
Pemeriksaan (O) :
- akral hangat
2019-09-09 13:37 Hal. 302 dari 1322

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A : - Gangguan rasa Nyaman
nyeri
P : - Mengurangi berat badan
-Mengendalikan tekanan
darah, diabetes dan kolesterol
- Kontrol ulang bila keluhan
berlanjut
- Istirahat yang cukup

Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Sabtu : 08:00 - 13:30
TACC : Tanpa TACC

Alasan TACC :
DAISY KRISTYANTO (P) JL REOG BLK L NO.13 013/007 L20.9 - Atopic dermatitis, unspecified RUJUKAN (0114R030) RS PERTAMINA
RUJUKAN JAYA
(KLT) KULIT KELAMIN - (110)
106 NIK : 3172064609800008 KULITDiberikan
Telah KELAMIN: -Anamnesis
(0) (S) :
No. RM : 01-036541 BPJS : 0001259881053 - perpanjang rujukan ke poli kulit
Tgl Diagnosis : 21 February 2019 8:51 AM dengan dx dermatitis atropik
-
-
Pemeriksaan (O) :
- A : GANGGUAN INTEGRITAS
KULIT
P : -Bersihkan kulit
- Hindari kontak dengan
penyebabnya,
-mandi air hangat
-Konsul dokter
-
-
2019-09-09 13:37 Hal. 303 dari 1322

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PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 09:00 - 10:00,
14:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
ALZHIDANE BHILAL QHEANO, AN (L) JL, PERINTIS KEMERDEKAAN R50.9 - Fever, unspecified PARASETAMOL SYR 120 MG/5 ML
No. RM : 01-088142 BPJS : 0002095315233 MG
MCG
ADE SATIM AHMAD SANI, TN (L) PS TRADISIONAL UJUNG HYBRIDA A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 11-May-1965 ( 54 Thn 3 Bln 29 Hr ) I10 - Essential (primary) hypertension GARAM ORALIT KOMBINASI
108 NIK : 3205161105650003
AMLODIPIN 10 MG
EDI RIZWAR (L) KP PULO GADUNG NO 62 RT 05/05 L40.8 - Other psoriasis RUJUKAN (0116R025) Rumah Sakit Firdaus
PGS II RUJUKAN (KLT) KULIT KELAMIN - (110)
109 KULIT KELAMIN: -Anamnesis
No. RM : 01-005286 NIK : 3202242312900003 - perpanjang rujukan poli kulit yg
Tgl Diagnosis : 21 February 2019 9:54 AM BPJS : 0001900275568 lama dengan diagnosa psoriasis
-
-
Pemeriksaan (O) :
- -A : GANGGUAN RASA
NYAMAN BERHUBUNGAN
DENGAN NYERI
-P : KOLABORASI DENGAN
DOKTER
2019-09-09 13:37 Hal. 304 dari 1322

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-ANJURKAN OS UNTUK
BEDREST
- ANJURKAN TEKNIK
RELAKSASI
- ANJURKAN OS UNTUK

Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 09:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
LINDAWATI (P) JL. BOULEVARD TIMUR BLK CA NO.11 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-026449 BPJS : 0001970695967 MG
Tgl Diagnosis : 21 February 2019 10:05 AM OMEPRAZOL KAPS 20 MG
VICTOR ARIE ANTONI LENZUN, TN (L) JL.WESEL A/16 B58.9 - Toxoplasmosis, unspecified RUJUKAN (0116R029) Rumah Sakit
Hermina Podomoro
(BSY) BEDAH SARAF - (92)
111 NIK : 3172060906760002 BEDAH
Telah Diberikan :- Anamnesis
SARAF (0) (S) :
No. RM : 01-017428 BPJS : 0001606460501 - MEMPERPANJANG RUJUKAN
Tgl Diagnosis : 21 February 2019 10:09 AM KE RS BEDAH SYARAF DGN
TOXOFLASMOSIS
Pemeriksaan (O) :
- AKRAL HANGAT
A-GANGGUAN RASA NYAMAN
P-KOLABORASI DGN DOKTER
2019-09-09 13:37 Hal. 305 dari 1322

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BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
DURIAH (P) JL RW SNEGON RT 5/22 D50.8 - Other iron deficiency anaemias PARASETAMOL TAB 500 MG
M10.9 - Gout, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
112 NIK : - Z03.0 - Observation for suspected KOMBINASI BESI (II) SULFAT 200 MG,
No. RM : 01-063965 BPJS : 0000377435057 tuberculosis ASAM FOLAT 0,25 MG
ALOPURINOL 100 MG
SARTINI (P) INPEKSI KALI SUNTER RT 8/4 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
ROSELYN TAMPUBOLON, NY (P) JL. PERJUANGAN NO.108 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
ANTASIDA DOEN
No. RM : 01-016014 BPJS : 0001853589655 MCG
ABDUL HADI, TN (L) KP.WARUNG JENGKOL 05/13 J45.9 - Asthma, unspecified AMLODIPIN 10 MG

115 NIK : 3172061612630005
No. RM : 01-030805 BPJS : 0000042783873
NURDIN ZAELANI (L) PEGANGSAAN I R51 - Headache PARASETAMOL TAB 500 MG
116 NIK : 3206250907930002 MCG
2019-09-09 13:37 Hal. 306 dari 1322

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SUHARTINI, NY (P) KELAPA GADING TIMUR ER 06/04 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
HENY SUNDARI (P) KP PULO GADUNG RT 002/005 K25.9 - Gastric ulcer, unspecified as acute DIAZEPAM 5 MG (0116R025) Rumah Sakit Firdaus
or chronic, without haemorrhage or PARASETAMOL TAB 500 MG (INT) PENYAKIT DALAM - (3)
Tgl Lahir : 05-Aug-1981 ( 38 Thn 1 Bln 4 Hr ) perforation
118 NIK : 3172064508810004 ANTASIDA DOEN Penyakit
Diberikan (0) (S) :
No. RM : 01-003389 BPJS : 0001225764606 - nyeri pingang sudah 3
Tgl Diagnosis : 21 February 2019 10:53 AM RUJUKAN bulan,sesak nafas
- riwayat ulkus gaster
RUJUKAN
-
Pemeriksaan (O) :
-
NYAMAN BERHUBUNGAN
DENGAN NYERI
DOKTER
-ANJURKAN OS UNTUK
BEDREST
- ANJURKAN TEKNIK
RELAKSASI
- ANJURKAN OS UNTUK
-
Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
16:00 - 18:00;17:00 - 20:30
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 307 dari 1322

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Alasan TACC :
AMSAR, TN (L) JL PULO NANGKA BARAT II NO 154 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-026853 BPJS : 0001268954605 MG
ANTASIDA DOEN
MURITNO, TN (L) KP PULO GADUNG RT 06/05 D50.8 - Other iron deficiency anaemias PARASETAMOL TAB 500 MG (0905R004) RS ISLAM JKT
I25.9 - Chronic ischaemic heart disease, ASAM ASKORBAT (VITAMIN C) 50 MG SUKAPURA
(JAN) JANTUNG DAN
120 NIK : 3172061805610001 unspecified KOMBINASI BESI (II) SULFAT 200 MG, PEMBULUH
Telah DiberikanDARAH - (89) (S) :
: Anamnesis
No. RM : 01-055253 BPJS : 0001226095211 R50.9 - Fever, unspecified ASAM FOLAT 0,25 MG JANTUNG
- pusing DAN PEMBULUH
Tgl Diagnosis : 21 February 2019 11:10 AM ANTASIDA DOEN -DARAH - (0)belakang
sakit leher
- sesak mual
- lemas
- klien tampak pucat,demam 1
minggu yang lalu
Pemeriksaan (O) : ekg ves
-
-
-
P:
-KOLABORASI DENGAN
DOKTER
-JANGAN BERDIRI SECARA
TIBA-TIBA
-BATASI KONSUMSI KAFEIN,
MINUMAN KERAS DAN
ROKOK
-BANYAK MINUM
- MAKAN SECARA TERATUR
- SEGERA DUDUK ATAU
BERBARING KETIKA MERASA
AKAN PINGSAN ATAU
KEHILANGAN KESEIMBANGAN
2019-09-09 13:37 Hal. 308 dari 1322

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JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
FERDIAN MARANATHA MARULITUA BOULEVARD TIMUR RAYA V KAV 7 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
121 NIK : - MG
MCG
YULIONO, TN (L) JL GADING VII NO 1 RT 05/05 KGB I10 - Essential (primary) hypertension RUJUKAN (0113R034) MEDIROS
I64 - Stroke, not specified as haemorrhage ALOPURINOL 100 MG (SAR) SARAF - (76) Saraf - (0)
122 NIK : 3172062607710002 or infarction PIROKSIKAM 10 MG Telah Diberikan :
No. RM : 01-003516 BPJS : 0001223475682 M10.9 - Gout, unspecified Faskes : (0113R034) MEDIROS
Tgl Diagnosis : 21 February 2019 11:23 AM MCG Alamat : JALAN PERINTIS
AMLODIPIN 10 MG KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
GRANT CHRISTIO M TJAHJONO (L) JL KELAPA PUAN TIMUR VI NB 6/24 RT M13.9 - Arthritis, unspecified RUJUKAN (0113R034) MEDIROS
06/12 RUJUKAN (SAR) SARAF - (76) Saraf - (0)
123 Telah Diberikan :
No. RM : 01-065518 NIK : 3172060711900003 Faskes : (0113R034) MEDIROS
Tgl Diagnosis : 21 February 2019 11:27 AM BPJS : 0001608525009 Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
2019-09-09 13:37 Hal. 309 dari 1322

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Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
SUYANTO (L) PLAZA PASIFIK A III/71 E11.9 - Non-insulin-dependent diabetes GLISERIL GUAIAKOLAT (GG) 100 MG
mellitus without complications KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 24-Apr-1971 ( 48 Thn 4 Bln 16 Hr ) J02.9 - Acute pharyngitis, unspecified
124 NIK : 3374072404710004 MG
Tgl Diagnosis : 21 February 2019 11:45 AM METFORMIN TAB 500 MG
AMOKSISILIN 500 MG
REKSA MAULANA AWALUDIN (L) PGS II RT 06/02 J02.8 - Acute pharyngitis due to other PARASETAMOL TAB 500 MG
specified organisms GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-029102 BPJS : 0002332886872 MG
RATNA (P) JANUR ELOK III BLOK QC 6 NO 12 M13.9 - Arthritis, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
M79.1 - Myalgia MCG
Tgl Lahir : 29-Jul-1964 ( 55 Thn 1 Bln 11 Hr ) PARASETAMOL TAB 500 MG
126 NIK : 3211036907640002
ITA SURYANI, NY (P) JL KELAPA SAWIT VIII BE / 05 N20.2 - Calculus of kidney with calculus of DOKTER UMUM
ureter
127 NIK : 3302056007760002
No. RM : 01-041234 BPJS : 0001195834206
ROHMAYATI, NY (P) JL PEGANGSAAN DUA RT 04/02 O14.9 - Pre-eclampsia, unspecified PARASETAMOL TAB 500 MG RSUD Koja
O80.9 - Single spontaneous delivery, AMOKSISILIN 500 MG UGD PONED
128 NIK : 3172065201870001 unspecified RETINOL (VITAMIN A) KAPS LUNAK S : pusing, O : keadaan umum
No. RM : 04-000989 BPJS : 0001225683011 200.000 UI baik, kesadaran compos mentis td
Tgl Diagnosis : 21 February 2019 1:59 PM KOMBINASI BESI (II) SULFAT 200 MG, 122/82 mmhg, nadi 80 x/menit, rr
ASAM FOLAT 0,25 MG 20x/menit, s 36,4 derajat celsius,
ASAM ASKORBAT (VITAMIN C) 50 MG CA+/+ perdarahan 30 cc dengan
2019-09-09 13:37 Hal. 310 dari 1322

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NIFEDIPIN KAPS 10 MG terpasang urine dc 200 cc tfu 3
jari dibawh pusat, kontraksi uterus
baik, A: P3A0 post partum 18 jam
riwayat PEB, anemia, HPP, P :
kolaborasi dengan bidan untuk
perawatan
ibu dan bayi. persiapan rujukan ke
RS.
RETNO SETIA WARDIYANTI, NY (P) JL. P NANGKA BRT II 006/016 O80.9 - Single spontaneous delivery, PARASETAMOL TAB 500 MG
Tgl Diagnosis : 21 February 2019 4:04 PM RETINOL (VITAMIN A) KAPS LUNAK
200.000 UI
YOSAFAT BAGAS ADI SANTOSO (L) JL PERJUANGAN RAYA GG BUNTU NO J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
2 RT 021/007 DEKSAMETASON 0,5 MG
No. RM : 01-015834 NIK : 3175020106020010 MG
SAMUEL KRISTANTO LIE, TN (L) JL. TMN MODERN BLK CVI NO.27 E11.3 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
013/006 mellitus with ophthalmic complications (MAT) MATA - (65) Mata - (0)
No. RM : 01-021062 NIK : 3175062104650016 - PANDANGAN MATA KABUR 1
Tgl Diagnosis : 22 February 2019 10:12 AM BPJS : 0001456343864 bulan yang lalu
- RIW DM, RUTIN MINUM OBAT
-
Pemeriksaan (O) :
- AKRAL HANGTA
A : GANGGUAN SENSORI
PENGLIHATAN
P:
-HINDARI MENGGOSOK MATA
-HINDARI AKTIFITAS FISIK
YANG BERAT
-GUNAKAN KACA MATA UNTUK
MELINDUNGI MATA DARI DEBU
DAN ANGIN
-KONSUMSI MAKANAN TINGGI
VIT C
2019-09-09 13:37 Hal. 311 dari 1322

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Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Sabtu : 09:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SUHENDRA (L) KOMP UKA BLOK R/82 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-035571 BPJS : 0001643914012 MG
FAISAL EFENDI (L) RAWA INDAH 03/03 R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
DEKSAMETASON 0,5 MG
133 NIK : - TIAMIN (VITAMIN B1) 50 MG
RYAN SURYA SUHANDI (L) JL BARONG N0 10 RT 006/07 KGT A06.9 - Amoebiasis, unspecified RUJUKAN (0903R012) RS KARTIKA
PULOMAS
134 NIK : 3172060206920002 Penyakit
Diberikan (0) (S) :
No. RM : 01-075409 BPJS : 0002293078656 - RIW DIARE, SUDAH BEROBAT
Tgl Diagnosis : 22 February 2019 12:01 PM DI IGD, ALERGI OBAT DARI
IGD, SUDAH DI KONSULKAN KE
DOKTER
- SAAT INI DIARE MASIH ADA 3-
4x/hari tidak ada lendir dan tidak
ada darah,MUAL ADA
- saat dilihat riwayat konsultasi di
dokter ugd, pasien mengaku di
berikan obat mual dan antibiotik
namun alergi. obatnya ternyata :
2019-09-09 13:37 Hal. 312 dari 1322

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domperidon dan ciprofloxacin
Pemeriksaan (O) :
- AKRAL HANGAT
NYERI
P : - KAJI TINGKAT SKALA
NYERI
-MINUM OBAT SESUAI
ANJURAN
-KOLABORASI DENGAN
DOKTER
-ISTIRAHAT YANG CUKUP
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Jumat : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
NITA INDRIYANI SR, NY (P) KOMP AL III JL GADING VII BLOK D NO J00 - Acute nasopharyngitis [common cold] TIAMIN (VITAMIN B1) 50 MG
71 K29.6 - Other gastritis PARASETAMOL TAB 500 MG
No. RM : 01-029346 NIK : 3172025103770018 DIAZEPAM 5 MG
WIWIT WIDYAWATI (P) jl. bhayangkara 86 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0113R034) MEDIROS
mellitus without complications (SAR) SARAF - (76) Saraf - (0)
Tgl Lahir : 17-Oct-1942 ( 76 Thn 10 Bln 23 Hr ) I10 - Essential (primary) hypertension
No. RM : 01-088091 BPJS : 0001421169952 M13.9 - Arthritis, unspecified -sakit di pinggang dan sdh di
Tgl Diagnosis : 22 February 2019 12:13 PM rontangen
-kaki kesemutan
-ada riwayat hipertensi
Pemeriksaan (O) : [2019-02-22
12:12:50]
2019-09-09 13:37 Hal. 313 dari 1322

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spodyloarthrosis th - l - s dengan
scoliosis lumbalis
-akral hangat
-A : GANGUAN RASA NYAMAN
NYERI
DOKTER
NYERI PASIEN
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK

KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Sabtu : 09:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
HOLLIE MARLEN LAM, NY (P) JANUR KUNING VIII WM 1/8 RT 6/16 A09 - Diarrhoea and gastroenteritis of ANTASIDA DOEN
Tgl Lahir : 05-Mar-1950 ( 69 Thn 6 Bln 4 Hr ) K29.6 - Other gastritis
137 NIK : 3172064503500001 OMEPRAZOL KAPS 20 MG
2019-09-09 13:37 Hal. 314 dari 1322

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ADZKA HAYZA ALFATHAN RIZKY, AN (L) GADING VII D/71 R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
DEKSAMETASON 0,5 MG
WAGIYAH (P) PSG II RT 06/02 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-022165 BPJS : 0001225628199 MG
ENDANG SRI WAHYUNI (P) KALI SUNTER 07/04 K29.6 - Other gastritis PARASETAMOL TAB 500 MG
ANTASIDA DOEN
RUTHY AZARJA, NY (P) JL KACANG POLONG III NO 14 RT E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG (0114R030) RS PERTAMINA
010/007 mellitus without complications GLIBENKLAMIDA 5 MG JAYA
(ORT) ORTHOPEDI - (93)
Tgl Lahir : 11-Jul-1954 ( 65 Thn 1 Bln 29 Hr ) M13.9 - Arthritis, unspecified
141 AMLODIPIN 10 MG Orthopedi - (0) : Anamnesis (S) :
Telah Diberikan
No. RM : 01-012008 NIK : 3173015107540003 - PERPANJANG RUJUKAN POLI
RUJUKAN
Tgl Diagnosis : 22 February 2019 12:38 PM BPJS : 0001457403568 ORTHOPEDI DGN DX
ARTHRITIS
- NYERRI KAKI
-
Pemeriksaan (O) :
- AKRAL HANGAT
BERHUBUNGAN DENGAN
NYERI
DOKTER
-ANJURKAN OS UNTUK
BEDREST
- ANJURKAN TEKNIK
RELAKSASI
- ANJURKAN OS UNTUK
2019-09-09 13:37 Hal. 315 dari 1322

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PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
HERMAN SUSANTO, TN (L) PENYENGAT II N0 51 J33.9 - Nasal polyp, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
(THT) THT-KL - (66) THT-KL - (0)
No. RM : 01-015916 BPJS : 0001421497809 - KLIEN perpanjang RUJUKAN
Tgl Diagnosis : 22 February 2019 12:43 PM KE RS KOJA POLI THT
- KLIEN SDH DI RUJUK KE RS
PERTAMINA TP DOKTER TDK
ADA LAGI JAM 10PAGI
Pemeriksaan (O) :
- AKRAL HANGAT
A-GANGGUAN RASA NYAMAN
P-KOLABORASI DGN DOKTER

Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Sabtu : 08:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 316 dari 1322

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DEWI YUNINGSIH (P) JL HIJAU DAUN BLOK B 8 NO 8 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
ANTASIDA DOEN
MARIA A MEO, NN (P) WELUJARA E05.9 - Thyrotoxicosis, unspecified ANTASIDA DOEN (0116R028) Rumah Sakit Puri
K29.6 - Other gastritis RANITIDIN 150 MG Medika
144 NIK : - PARASETAMOL TAB 500 MG Telah Diberikan : [2019-02-22
No. RM : 01-087833 BPJS : 0000863025816 12:53:49]
Tgl Diagnosis : 22 February 2019 12:54 PM RUJUKAN asam urat 4,7, t3 3.91 t4 >24 tshs
<0.0025
Sakit Puri Medika
Alamat : Jalan Sungai Bambu
Raya No. 46
Telp : 021-43903355
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Sabtu : 09:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
ISNIWATI, NY (P) JL. KAYU MAS UTARA RS Kartika Pulomas
Kandungan
145 NIK : - S : perut mules O: keadaan umum
No. RM : 01-082220 BPJS : 0002340112871 baik, kesadaran compos mentis td
Tgl Diagnosis : 22 February 2019 1:37 PM 115/73 mmHg nadi 82x/menit rr
22x/menit, S 36.8 derajat selsius
tfu 36 cm djj 144x/menit VT v/v
tak
portio tebal pembukaan 2 cm
prsentasi kepala hodge I A
G1POA0 usia kehamilan 39
minggu inpartu kala I fase laten
suspek bayi besar P: kolaborasi
dengan bidan untuk perawatan
ibu dan bayi, saran dirujuk untuk
2019-09-09 13:37 Hal. 317 dari 1322

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usg
WAHYUNI, NY (P) TANAH MERAH 04/08 RAWA BADAK O80.9 - Single spontaneous delivery, PARASETAMOL TAB 500 MG
SELATAN unspecified AMOKSISILIN 500 MG
146 RETINOL (VITAMIN A) KAPS LUNAK
No. RM : 01-048416 NIK : 3171085302880005 200.000 UI
Tgl Diagnosis : 22 February 2019 1:49 PM BPJS : 0002095423885 KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
FARIDA EVA (P) JL.KELAPA MOLEK II C4/29 H40.8 - Other glaucoma ANTASIDA DOEN (0116R025) Rumah Sakit Firdaus
K29.6 - Other gastritis OMEPRAZOL KAPS 20 MG (MAT) MATA - (65) Mata - (0)
147 NIK : 3172065703620003 PARASETAMOL TAB 500 MG Telah Diberikan : Anamnesis (S) :
No. RM : 01-003719 BPJS : 0001223506247 - nyeri lambung sejak 1 minggu
Tgl Diagnosis : 25 February 2019 9:13 AM MCG - kaki bengkak
RUJUKAN - os perpanjang rujuksn ke RS
firdaus poli mata dengan
diagnosa glaukoma
Pemeriksaan (O) :
- A : GANGUAN RASA NYAMAN
NYERI
DOKTER
NYERI PASIEN
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK

Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
2019-09-09 13:37 Hal. 318 dari 1322

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Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
ENIK NURYANI (P) JL INSPESKI KALI SUNTER 008/013 J02.9 - Acute pharyngitis, unspecified RETRIBUSI KLINIK UMUM
AMOKSISILIN 500 MG
LENI HARTONO, NY (P) JL KELAPA NIAS PA 17 NO 20 T26.9 - Corrosion of eye and adnexa, part RUJUKAN (0114R030) RS PERTAMINA
unspecified RUJUKAN JAYA
(MAT) MATA - (65) Mata - (0)
149 NIK : - Telah Diberikan : Anamnesis (S) :
No. RM : 01-008507 BPJS : 0002355573341 - mata berair, merah, gatal
Tgl Diagnosis : 25 February 2019 10:03 AM - 1 minggu yang lalu
-
Pemeriksaan (O) : ods merah,
oedem
-
NYAMAN BERHUBUNGAN
DENGAN NYERI
DOKTER
-ANJURKAN OS UNTUK
BEDREST
- ANJURKAN TEKNIK
RELAKSASI
- ANJURKAN OS UNTUK
PERTAMINA JAYA
BY PASS
Telp : 0214211913
2019-09-09 13:37 Hal. 319 dari 1322

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Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 09:00 - 10:00
TACC : Tanpa TACC

Alasan TACC :
HERRA ROSANAWATI, NY (P) JL GADING GRIYA LESTARI RT 006/009 E05.9 - Thyrotoxicosis, unspecified RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
No. RM : 01-078780 BPJS : 0001441344047 - post op struma di rsud koja
Tgl Diagnosis : 25 February 2019 10:06 AM -
-
Pemeriksaan (O) : luka jahitan
baik
-
-
-
a.gangguan rasa nyaman
p. kontrol ulang
minum obat teratur
JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 09:00 - 11:00,
13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 320 dari 1322

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RISMA RAHAYU, NY (P) PEGANGSAAN DUA RT 04/05 O80.8 - Other single spontaneous delivery PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
No. RM : 01-012295 BPJS : 0001045562714 200.000 UI
ASAM FOLAT 0,25 MG
MUHAMMAD HABIEBIE ALBAR (L) JL. PEGANGSAAN DUA R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
152 NIK : 3172060502141002 MG
MCG
TILLY INDRAWATI WANAGIRI (P) JL. GADING KIRANA BARAT V RT N81.4 - Uterovaginal prolapse, unspecified RUJUKAN (0114R030) RS PERTAMINA
014/008 RUJUKAN JAYA
153 RUJUKAN Telah Diberikan : Anamnesis (S) :
No. RM : 01-019646 NIK : 3172064904490003 - PERPANJANG RUJUKAN POLI
Tgl Diagnosis : 25 February 2019 1:43 PM BPJS : 0001799738897 OBSGYN UNTUK KONTROL
DGN DX POST DP TVH
- NYERI PERUT HILANG
TIMBUL
-
Pemeriksaan (O) :
- AKRAL HANGAT

NYERI
DOKTER
NYERI PASIEN
- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK
2019-09-09 13:37 Hal. 321 dari 1322

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PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 11:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
ENGEL TRIANA SARI, NY (P) KL KOMPLEK BEA CUKAI RT 02/07 J45.9 - Asthma, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
SUKAPURA RUJUKAN (PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Time
Alasan TACC : >= 7 Hari
INGGRID LORENCIA (P) P. PENYENGAT 3 NO 06 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-088511 BPJS : 0002332754638 MG
RUJUKAN
DOKTER UMUM
2019-09-09 13:37 Hal. 322 dari 1322

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SITI AMNAH.NY (P) PERUM VILLA GADING INDAH BLOK C M13.9 - Arthritis, unspecified PARASETAMOL TAB 500 MG
156 MCG
Tgl Diagnosis : 25 February 2019 2:16 PM BPJS : 0001641187214 DIAZEPAM 5 MG
KWOK LIN DJIN, NY (P) GADING ELOK TMR 1 BLK I/15 RT. I25.9 - Chronic ischaemic heart disease, RUJUKAN (0114R054) RS HERMINA
015/009 unspecified SIANOKOBALAMIN (VITAMIN B12) 50 KEMAYORAN
(JAN) JANTUNG DAN
Tgl Lahir : 09-May-1958 ( 61 Thn 4 Bln 0 Hr ) M79.1 - Myalgia
157 MCG PEMBULUH
Telah DARAH
Diberikan : - (89)
No. RM : 01-000325 NIK : 3172064905580001 PARASETAMOL TAB 500 MG JANTUNG DAN PEMBULUH
Tgl Diagnosis : 25 February 2019 2:17 PM BPJS : 0001380930996 RUJUKAN DARAH - (0)
HERMINA KEMAYORAN
RUJUKAN Alamat : JALAN SELANGIT BLOK
B10 KAV 4
Telp : 021-22602525
Kelas : B
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
14:00 - 16:00;19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
FARHAIS MUMTAZ, NN (L) JL H OYAR RT 02/02 K29.6 - Other gastritis ANTASIDA DOEN (0116R025) Rumah Sakit Firdaus
PARASETAMOL TAB 500 MG (INT) PENYAKIT DALAM - (3)
158 NIK : 3172060501090685 OMEPRAZOL KAPS 20 MG Penyakit Dalam :- (0)
Telah Diberikan
Tgl Diagnosis : 25 February 2019 2:30 PM MCG Sakit Firdaus
RUJUKAN Alamat : JL. SIAK J5/14
RUJUKAN KOMP.BEA CUKAI
Telp : 021-4407322
RUJUKAN
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00,
13:30 - 16:30;16:00 - 18:00, 18:00
- 20:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 323 dari 1322

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WONG AY LIAN, NY (P) TPI BLOK G 1 /2 RT 1/2 PGS 2 N20.2 - Calculus of kidney with calculus of RUJUKAN (0905R003) RS PELABUHAN
ureter JAKARTA
Tgl Lahir : 15-Jul-1951 ( 68 Thn 1 Bln 25 Hr ) N39.0 - Urinary tract infection, site not
159 NIK : 3172065507510002 (0)
Telah Diberikan :
No. RM : 01-002258 BPJS : 0001379321065 specified Faskes : (0905R003) RS
Tgl Diagnosis : 25 February 2019 3:52 PM PELABUHAN JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Selasa : 14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
LISA BUDIARTI (P) RAWA SENGON RT 01 RW 22 O80.8 - Other single spontaneous delivery PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
No. RM : 01-041263 BPJS : 0001287397978 200.000 UI
ASAM FOLAT 0,25 MG
LIU HUI NJI, NY (P) JL GILIMANUK BLOK T 1A RT 3/8 K29.6 - Other gastritis RUJUKAN (0114R030) RS PERTAMINA
ANTASIDA DOEN JAYA
161 NIK : 3172045210610007 PARASETAMOL TAB 500 MG Penyakit
Diberikan (0) (S) :
No. RM : 01-038257 BPJS : 0001813289589 - SERING SESAK NAFAS,
Tgl Diagnosis : 26 February 2019 2:05 PM DIAZEPAM 5 MG TEKUK LEHER MENJALAR KE
PUNDAK SERING NYERI
- TENGGOROKAN TERASA
PANAS
- NYERI PERUT 1 bulan yang lalu
Pemeriksaan (O) : nyeri tekan
epigastrium
- AKRAL HANGAT
NYERI
DOKTER
NYERI PASIEN
2019-09-09 13:37 Hal. 324 dari 1322

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- ANJURKAN OS UNTUK
MINUM OBAT TERATUR
- ANJURKAN OS UNTUK
- ANJURKAN OS UNTUK
PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
NUR HAMZAH (L) JL TELUK BAYUR BLOK G NO7 001/008 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
RAYMOND CHRISTIAN IMMANUEL, AN (L) KLP PUAN TIMUR III NC III /8 J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
163 NIK : - MG
MCG
AMOKSISILIN 500 MG
FITA RAHAYU, NY (P) JKL. PELEPAH RAYA BLK E G44.2 - Tension-type headache ASAM MEFENAMAT KAPS 500
ANTASIDA DOEN
No. RM : 01-082670 BPJS : 0002143523193 DOKTER UMUM
2019-09-09 13:37 Hal. 325 dari 1322

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JUSLAN DJASMeINI (P) APT PALADIAN PARK TWR G LT9 NO6 M54.56 - Low back pain, lumbar region RUJUKAN (0116R029) Rumah Sakit
ASAM MEFENAMAT KAPS 500 Hermina Podomoro
165 NIK : 317202430260002 OMEPRAZOL KAPS 20 MG Telah Diberikan :
RUJUKAN
Tgl Diagnosis : 26 February 2019 2:54 PM Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Kamis : 15:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
MARTIN KOMALA (L) JL KEMURNIAN RT 003/005 J45.0 - Predominantly allergic asthma RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
(PAR) PARU - (94) PARU - (0)
No. RM : 01-018724 BPJS : 0001283041348 Faskes : (0905R004) RS ISLAM
Tgl Diagnosis : 26 February 2019 3:01 PM JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 08:00 - 17:00,
08:00 - 12:00;11:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
RENI SAPUTRI, NY (P) KP BEND BATIK RT 7/4 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
L23.9 - Allergic contact dermatitis, OBH SIRUP 100 ML
167 NIK : 3172034801940002 unspecified cause KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-068293 BPJS : 0000046027899 MG
2019-09-09 13:37 Hal. 326 dari 1322

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dr. Lidia Christina

GO IWAN GUNADI (L) JL KLP PUAN TIMUR VNB 6/41 F20.8 - Other schizophrenia DIAZEPAM 2 MG
F32.1 - Moderate depressive episode AMITRIPTILIN 25 MG
1 NIK : - OMEPRAZOL KAPS 20 MG
No. RM : 01-062596 BPJS : 0002205996254
HARYONO, TN (L) KLP GADING PELEPAH ASRI BLK. QC E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
2/7 mellitus without complications METFORMIN TAB 500 MG
2 GLIBENKLAMIDA 5 MG
No. RM : 01-001137 NIK : 3172061607420002 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
MG
SITI WAHYUNI, NY (P) JANUR INDAH III LA 11 NO. 4 KGB I10 - Essential (primary) hypertension AMLODIPIN 10 MG
R51 - Headache VITAMIN B KOMPLEKS
SUKARMANTO, TN (L) JL WESEL BLK A13 PGS II RT 06/10 R05 - Cough ANTASIDA DOEN
VITAMIN B KOMPLEKS
ELLEN RACHELLA TJIA, NY (P) JL KELAPA PUAN RAYA FU 1/18 RT E78.4 - Other hyperlipidaemia SIMVASTATIN 10 MG
09/13 M10.2 - Drug-induced gout ALOPURINOL 100 MG
5 M79.1 - Myalgia VITAMIN B KOMPLEKS
I WAYAN MERTAYASA, TN (L) JL PULO LAKI E 10 NO 09 KOMP H40.8 - Other glaucoma RUJUKAN (0113R074) RS KHUSUS MATA
KODAMAR SMEC
(MAT) MATA - (65) Mata - (0)
6 Telah Diberikan :
No. RM : 01-024516 NIK : 3674060406460002 Faskes : (0113R074) RS
Tgl Diagnosis : 01 February 2019 9:05 AM BPJS : 0000047555267 KHUSUS MATA SMEC
Telp : 021-4714848
2019-09-09 13:37 Hal. 327 dari 1322

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Kelas : C
Jumlah Rujukan : 21
Kapasitas : 0
Jadwal : Jumat : 08:00 - 16:00,
08:00 - 16:00;08:00 - 12:00, 12:00
- 16:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

Alasan TACC :
SUPARNO, TN (L) KOMP BEA CUKAI K 5/12 RT 01/17 E11.9 - Non-insulin-dependent diabetes RUJUKAN
SUKA PURA mellitus without complications
7
No. RM : 01-002830 NIK : 3172040210550003
SRIWATI LUKMAN, NY (P) JL. KELAPA NIAS I BLOK PB-2 I10 - Essential (primary) hypertension AMBROKSOL TAB 30 MG
Z03.0 - Observation for suspected KLORFENIRAMIN MALEAT (CTM) TAB 4
8 NIK : 3172064909470001 tuberculosis MG
SIENY TANJUNG, NY (P) VILLA GADING INDAH C.12 D21.9 - Other benign neoplasm of RUJUKAN (0116R025) Rumah Sakit Firdaus
connective and other soft tissue, unspecified (BED) BEDAH - (16) Bedah - (0)
Tgl Diagnosis : 01 February 2019 9:22 AM Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Jumat : 06:00 - 07:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 328 dari 1322

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SOBARI (L) JL PULAU PENYENGAT II NO 42 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
L30.9 - Dermatitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
10 NIK : 3172063101470004 R05 - Cough MG
KRISPINA HARNIWATI, NY (P) TEGUH II NO. 112 RT. 05/01 F20.8 - Other schizophrenia RISPERIDONE 2MG
HALOPERIDOL 5 MG
11 NIK : 3172067004750006 TRIHEKSIFENIDIL 2 MG
No. RM : 01-001818 BPJS : 0001849948301
RELLUS SIMANGUNSONG ,TN (L) RAWA SNGON 07/22 R63.4 - Abnormal weight loss RUJUKAN (0116R025) Rumah Sakit Firdaus
12 NIK : 3172062006490001 Penyakit
Telah Dalam :- (0)
Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
16:00 - 18:00;17:00 - 20:30
TACC : Tanpa TACC

Alasan TACC :
MARNO (L) RAWA SENGON R N40 - Hyperplasia of prostate RUJUKAN (0116R025) Rumah Sakit Firdaus
R33 - Retention of urine (URO) UROLOGI - (88) Urologi -
13 NIK : 3172031109570005 (0)
Telah Diberikan :
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
2019-09-09 13:37 Hal. 329 dari 1322

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Kapasitas : 0
Jadwal : Jumat : 16:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
WONG PO LAN (P) JL LAYAN NO 17 N18.9 - Chronic renal failure, unspecified RUJUKAN (0116R021) Royal Progress
(HDL) HEMODIALISA
14 NIK : 3174014607620006 Telah Diberikan : riwaYAT ckd ON
No. RM : 01-046065 BPJS : 0001260277288 hd 3X/ MINGGU
Tgl Diagnosis : 01 February 2019 10:05 AM Faskes : (0116R021) Royal
Progress
Alamat : DANAU SUNTER
UTARA
Telp : 021-6400261
Kelas : B
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal :
TACC : Tanpa TACC

Alasan TACC :
RATU ROCHANI, TN (P) JL SUTRA UNGU C 3/28 RT 13/10 I11.9 - Hypertensive heart disease without RUJUKAN
(congestive) heart failure
15 NIK : 3172066001570004
No. RM : 01-031561 BPJS : 0000041873894
YUSMANAH, NY (P) JL FLAMBOYAN A NO 1 RT 08/08 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0905R004) RS ISLAM JKT
mellitus without complications SUKAPURA
Tgl Lahir : 15-Mar-1951 ( 68 Thn 5 Bln 25 Hr ) I15.8 - Other secondary hypertension
16 NIK : 3172065503510001 Penyakit
Telah Dalam :- (0)
Diberikan
Tgl Diagnosis : 01 February 2019 10:24 AM JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
2019-09-09 13:37 Hal. 330 dari 1322

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Jadwal : Jumat : 07:00 - 09:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
LILIEK ROEKIYATI (P) KOMP BEACUKAI BLOK S 5/22 RT A15.1 - Tuberculosis of lung, confirmed by RUJUKAN (0116R025) Rumah Sakit Firdaus
07/.07 culture only (PAR) PARU - (94) PARU - (0)
Tgl Lahir : 22-Jun-1942 ( 77 Thn 2 Bln 18 Hr ) E11.9 - Non-insulin-dependent diabetes
No. RM : 01-033887 NIK : 3172042206470002 mellitus without complications Faskes : (0116R025) Rumah
Tgl Diagnosis : 01 February 2019 10:51 AM BPJS : 0001259659822 Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 09:00 - 12:00,
10:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
SATIJAN EDY RIYANTO,TN (L) KOMP PERDAGANGAN RT. 005/006 I50.0 - Congestive heart failure RUJUKAN (0905R001) RS KOJA
KGT RUJUKAN (JAN) JANTUNG DAN
18 PEMBULUH
Telah DARAH
Diberikan : - (89)
No. RM : 01-007974 NIK : 3172060404680002 JANTUNG DAN PEMBULUH
Faskes : (0905R001) RS KOJA
Tgl Diagnosis : 01 February 2019 11:14 AM BPJS : 0001153466831 DARAH: -JALAN
Alamat (8) Pelayanan Darah
DELI NO.4,
RT.11/RW.7, K
Telp : 021-43938478
Kelas : B
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Jumat : 08:00 - 14:30,
08:00 - 14:30;08:00 - 14:30, 08:00
- 14:30
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 331 dari 1322

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IR SULISTIONO MSC, TN (L) PULAU RAYA E.9/10 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
Tgl Lahir : 25-Nov-1945 ( 73 Thn 9 Bln 15 Hr ) N39.9 - Disorder of urinary system,
19 NIK : 3172062511450002 AMLODIPIN 5 MG
VITAMIN B KOMPLEKS
HENDI RUDI HARYONO K, TN (L) KLP NIAS VII BLOK PA 18 NO 10 I50.0 - Congestive heart failure RUJUKAN (0116R029) Rumah Sakit
RUJUKAN Hermina Podomoro
(JAN) JANTUNG DAN
20 NIK : 3172022607490003 PEMBULUH DARAH
Telah Diberikan : - (89)
No. RM : 01-055933 BPJS : 0001791534159 JANTUNG
Faskes DAN PEMBULUH
: (0116R029) Rumah
Tgl Diagnosis : 01 February 2019 2:36 PM DARAH - (0) Podomoro
Sakit Hermina
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Sabtu : 16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
RUDY SUMARTONO DRS., MA, MM (L) RAYA KELAPA CENGKIR FH 2/3 RT E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
1/11 mellitus without complications (INT) PENYAKIT DALAM - (3)
Tgl Lahir : 24-May-1954 ( 65 Thn 3 Bln 16 Hr ) K30 - Dyspepsia
21 Penyakit Dalam :- (0)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 332 dari 1322

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BARYANTI (P) SENTOSA RAYA NO 14 RT 8/10 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
mellitus without complications JAYA
22 NIK : - Penyakit Dalam :- (0)
Telah Diberikan
Tgl Diagnosis : 06 February 2019 8:42 AM PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
PASKAH GUMILAR (L) PGS DUA RT 14/07 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 05-000127 BPJS : 0000040271859 MG
KASMUAD (L) KMP SUKAPURA JAYA RT 07/10 I63.2 - Cerebral infarction due to unspecified RUJUKAN (0905R004) RS ISLAM JKT
occlusion or stenosis of precerebral arteries SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 15:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 333 dari 1322

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AMRIN NURDIN, TN (L) JL TELUK GILI MANUK V NO 6 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN
without complications
25 NIK : 1471013012480001
No. RM : 01-012930 BPJS : 0001265601609
UNTUNG SUDARSONO (L) KELAPA HYBRIDA VII RA.21/5 K30 - Dyspepsia OMEPRAZOL KAPS 20 MG
DEDEH KURNIASIH (P) IMPERIAL GADING KOMP WALIKOTA I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
SUKAPURA PIROKSIKAM 10 MG
27 VITAMIN B KOMPLEKS
No. RM : 01-074157 NIK : - KALSIUM LAKTAT (KALK) 500 MG
AMLODIPIN 10 MG
NAISA ESTERIA GULTOM, NY (P) JL PRIHATIN NO 71 Z03.0 - Observation for suspected GLISERIL GUAIAKOLAT (GG) 100 MG
tuberculosis KLORFENIRAMIN MALEAT (CTM) TAB 4
28 NIK : 3172065810490003 MG
B. SOEROSO, TN (L) PENYENGAT RAYA NO 6 RT 2/3 I11.9 - Hypertensive heart disease without HIDROKLORTIAZID 25 MG
(congestive) heart failure AMLODIPIN 10 MG
No. RM : 01-008337 BPJS : 0000045887938 MG
SUWANDY ANWAR (L) JL GADING KIRANA G 1/216 RT 09/08 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
M10.2 - Drug-induced gout ALOPURINOL 100 MG
No. RM : 01-055503 BPJS : 0001725484037
TAN (CHAN) FIE TJUNG, TN (L) KLP MOLEK V Z II / 17 RT 9/19 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
VITAMIN B KOMPLEKS
31 NIK : 3172060506550001
No. RM : 01-020657 BPJS : 0001452284098
2019-09-09 13:37 Hal. 334 dari 1322

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SUPARMAN (L) KP. BARU D21.9 - Other benign neoplasm of RUJUKAN (0905R004) RS ISLAM JKT
connective and other soft tissue, unspecified SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 09:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
ANNA CHEN, NY (P) PGS INDAH BRT 2 B BLK O/32 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
33 NIK : 3172066412590007 MG
TUHFATUL MUHTAZIRRIDHONI, TN (L) BLOK JATI CININI Z03.0 - Observation for suspected
tuberculosis
34 NIK : 3212011402970004
No. RM : 01-081501 BPJS : 0000465996982
35
No. RM : 01-075196 NIK : 3172040611770015
HADI HALIM (L) JL. TARIAN RAYA BARAT D. 28 H52.4 - Presbyopia RUJUKAN (0114R030) RS PERTAMINA
I10 - Essential (primary) hypertension AMLODIPIN 10 MG JAYA
(MAT) MATA - (65) Mata - (0)
36 NIK : - VITAMIN B KOMPLEKS Telah Diberikan :
BY PASS
2019-09-09 13:37 Hal. 335 dari 1322

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Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Rabu : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
JEFFRI AGUS (L) JL.KELAPA NIAS IX PA.24/15 K59.0 - Constipation OMEPRAZOL KAPS 20 MG
37 NIK : 3172063011570001
No. RM : 01-071775 BPJS : 0001457152852
TERESA IRMA SINARO (P) APT WISMA GADING PER,AI 16/12 KLP H25.8 - Other senile cataract RUJUKAN (0113R074) RS KHUSUS MATA
GADING RUJUKAN SMEC
(MAT) MATA - (65) Mata - (0)
No. RM : 01-076138 NIK : - Faskes : (0113R074) RS
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 37
Kapasitas : 0
Jadwal : Rabu : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 15:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

SOEMARYO (L) P P-ENYENGAT II /12 RT 6/3 N40 - Hyperplasia of prostate RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
39 NIK : 3172061507470004 (0)
Telah Diberikan :
Telp : 021-4403026
Kelas : C
2019-09-09 13:37 Hal. 336 dari 1322

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Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SUWARNI (P) JL. PERINTIS 2 NO 12 I11.9 - Hypertensive heart disease without RUJUKAN (0114R030) RS PERTAMINA
(congestive) heart failure JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
WIBISONO SUGIH HARTA, TN (L) JL. BANGKA NO. 1/ KOMPYOR BARAT H52.4 - Presbyopia VITAMIN B KOMPLEKS (0114R030) RS PERTAMINA
IV C12/23 M79.1 - Myalgia ASAM ASKORBAT (VITAMIN C) 50 MG JAYA
(MAT) MATA - (65) Mata - (0)
41 PARASETAMOL TAB 500 MG Telah Diberikan :
RUJUKAN
Tgl Diagnosis : 06 February 2019 9:47 AM BPJS : 0001468935325 PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Rabu : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 337 dari 1322

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KISWORAHATI, IR (P) JL GADING PUTIH RAYA UTARA BLOK I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
BJ NO 4 JAYA
(JAN) JANTUNG DAN
42 PEMBULUH DARAH
No. RM : 01-018940 NIK : 3172061001 JANTUNG
Faskes DAN PEMBULUH
: (0114R030) RS
Tgl Diagnosis : 06 February 2019 9:51 AM BPJS : 0000046160234 DARAH
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
YAP ENG LAN (P) JL.ALANDA II N0 21 RT 013/08 SUNTER I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
JAYA JAKUT K29.7 - Gastritis, unspecified GENTAMISIN SALEP KULIT
43 L30.9 - Dermatitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-076788 NIK : 3172060603510001 MG
Tgl Diagnosis : 06 February 2019 9:54 AM BPJS : 0001336632592 RANITIDIN 150 MG
HJ NURSIAH KANANG, NY (P) JL.GAMBIR ANOM F-6/13 I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
AMLODIPIN 5 MG
No. RM : 01-009474 BPJS : 0002035549888
SAHALA L.TOBING, TN (L) APT WGP TOWERC 19/10 C85.9 - Non-Hodgkin's lymphoma, RUJUKAN (0903R012) RS KARTIKA
unspecified type PULOMAS
45 NIK : 3172061707570007 Penyakit Dalam :- (0)
Telah Diberikan
Tgl Diagnosis : 06 February 2019 10:04 AM KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00, 14:
2019-09-09 13:37 Hal. 338 dari 1322

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00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
ENDANG SUKARNA (L) JL. KELAP KOPYOR BARAT VII BLOK C G57.8 - Other mononeuropathies of lower RUJUKAN (0114R030) RS PERTAMINA
K I NO. 15 limb JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
MAHMUD ARSYAD, TN (L) JL TIPAR CAKUNG RT 09/02 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
I64 - Stroke, not specified as haemorrhage KLORFENIRAMIN MALEAT (CTM) TAB 4
47 NIK : 3172042311530006 or infarction MG
No. RM : 01-010256 BPJS : 0000046104636 R05 - Cough HIDROKLORTIAZID 25 MG
DAVID LAY (L) JANUR HIJAU XI TQ 2/1 RT 003/015 J18.0 - Bronchopneumonia, unspecified RUJUKAN (0114R030) RS PERTAMINA
JAYA
(PAR) PARU - (94) PARU - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
2019-09-09 13:37 Hal. 339 dari 1322

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Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
EFFENDI DJAPRI (L) JL TIPAR CAKUNG 006/001 N40 - Hyperplasia of prostate RUJUKAN (0116R025) Rumah Sakit Firdaus
49 NIK : 3172042910510004 (0)
Telah Diberikan :
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 16:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
CHRISTINA SHINTA (P) GADING NIRWANA V /8 RT 8/23 KGB E78.4 - Other hyperlipidaemia
I10 - Essential (primary) hypertension
50 NIK : - M13.9 - Arthritis, unspecified
No. RM : 01-069566 BPJS : 0001854554793
CHRISTINA SHINTA (P) GADING NIRWANA V /8 RT 8/23 KGB E78.4 - Other hyperlipidaemia RUJUKAN (0116R029) Rumah Sakit
I10 - Essential (primary) hypertension Hermina Podomoro
(JAN) JANTUNG DAN
51 NIK : - M13.9 - Arthritis, unspecified PEMBULUH DARAH
Faskes DAN PEMBULUH
: (0116R029) Rumah
Tgl Diagnosis : 06 February 2019 10:46 AM DARAH - (0) Podomoro
Sakit Hermina
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Rabu : 16:00 - 18:00
2019-09-09 13:37 Hal. 340 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
CABU, TN (L) JANUR INDAH 1 NO 01 RT 01-018 I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
K29.7 - Gastritis, unspecified AMLODIPIN 10 MG
52 NIK : 3208241212560002 M13.9 - Arthritis, unspecified RANITIDIN 150 MG
MG
TJITRA SIDHA RAMA KRSHNA RASSAD + (L) APT. GADING NIAS ROWER DAHLIA A09 - Diarrhoea and gastroenteritis of RUJUKAN (0116R025) Rumah Sakit Firdaus
2KK presumed infectious origin (INT) PENYAKIT DALAM - (3)
Tgl Lahir : 26-Mar-1941 ( 78 Thn 5 Bln 14 Hr ) K92.1 - Melaena
53 Penyakit
Telah Dalam :- (0)
Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
NAISA ESTERIA GULTOM, NY (P) JL PRIHATIN NO 71 Z03.0 - Observation for suspected
tuberculosis
54 NIK : 3172065810490003
No. RM : 01-003705 BPJS : 0000046005939
2019-09-09 13:37 Hal. 341 dari 1322

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TEDJO SUWITO (L) KLP PUYUH III BLOK KH NO 43 M13.9 - Arthritis, unspecified VITAMIN B KOMPLEKS
55 NIK : 3172060805450001 RANITIDIN 150 MG
No. RM : 01-015749 BPJS : 00014387851079
HIOE AY SIAN, NY (P) JL EKSPOR I BLOK C 1/19 N81.4 - Uterovaginal prolapse, unspecified RUJUKAN (0116R029) Rumah Sakit
Hermina
(OBG) Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 08:00 - 13:00,
17:00 - 20:00;19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
SYAMSIAH BT RAZAK (P) JL PANCONG RT .3/002 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications VITAMIN B KOMPLEKS
Tgl Lahir : 10-Dec-1956 ( 62 Thn 8 Bln 30 Hr ) K29.7 - Gastritis, unspecified
No. RM : 01-000182 BPJS : 0001822035148 L29.8 - Other pruritus MG
IDA HALIM (P) JL KLPA PUAN TMR I NE 2/35 008/012 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
PGS II mellitus without complications (PAR) PARU - (94) PARU - (0)
Tgl Lahir : 01-Oct-1954 ( 64 Thn 11 Bln 8 Hr ) I10 - Essential (primary) hypertension
No. RM : 01-007143 NIK : 3172064110540001 J18.0 - Bronchopneumonia, unspecified Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
2019-09-09 13:37 Hal. 342 dari 1322

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Jadwal : Rabu : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
NATSIR SIMBOLON, TN (L) SUKAPURABLK. J.3 / 7 RT. 04/06 E11.9 - Non-insulin-dependent diabetes GLIBENKLAMIDA 5 MG
No. RM : 01-000628 BPJS : 0000046114108
NGENAWATI PURBA (P) JL. RAYA PASAR INPRES NO.43A E11.9 - Non-insulin-dependent diabetes AMLODIPIN 5 MG
mellitus without complications ASAM ASETILSALISILAT 80 mg
Tgl Lahir : 08-Mar-1952 ( 67 Thn 6 Bln 1 Hr ) E78.4 - Other hyperlipidaemia
60 NIK : 3172064803520002 (ASETOSAL)
No. RM : 01-009930 BPJS : 0001794368529 I10 - Essential (primary) hypertension SIMVASTATIN 20 MG
Tgl Diagnosis : 06 February 2019 2:36 PM ALOPURINOL 100 MG
KWEE KAY GIE ALIAS PERRY, TN (L) JL HARPA III RT 9/7 I11.9 - Hypertensive heart disease without RUJUKAN (0116R021) Royal Progress
(congestive) heart failure (JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0116R021) Royal
Tgl Diagnosis : 06 February 2019 2:43 PM DARAH
Progress- (0)
UTARA
Telp : 021-6400261
Kelas : B
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00,
09:30 - 18:00
TACC : Tanpa TACC

Alasan TACC :
YUKE INGGAWATI JOSO (P) KELAPA NIAS VII PC 14/2 RT 9/17 E78.4 - Other hyperlipidaemia RUJUKAN (0116R025) Rumah Sakit Firdaus
62 NIK : 3172065510520003 Penyakit
Telah Dalam :- (0)
Diberikan
Alamat : JL. SIAK J5/14 KOMP.
2019-09-09 13:37 Hal. 343 dari 1322

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BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
P IRWAN SANTOSO MURGANI (L) JL SIMPONI MAS III B 7/19 RT 10/08 J45.9 - Asthma, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
RUJUKAN (PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Rabu : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Age
Alasan TACC : >= 55 Tahun
TEDI YONO, TN (L) JANUR INDAH IX NO.5 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
64 NIK : 1971042407540002 MG
HJ RENI SUTRIANTI (P) JL KLP KOPYOR BRT V CJ 2/20 E11.9 - Non-insulin-dependent diabetes ANTASIDA DOEN
mellitus without complications KAPTOPRIL 12,5 MG
Tgl Lahir : 16-Jun-1955 ( 64 Thn 2 Bln 24 Hr ) I10 - Essential (primary) hypertension
No. RM : 01-015220 BPJS : 0001301191424 I21.9 - Acute myocardial infarction, ASAM ASETILSALISILAT 80 mg
Tgl Diagnosis : 07 February 2019 8:35 AM unspecified (ASETOSAL)
2019-09-09 13:37 Hal. 344 dari 1322

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NABA MARSUDI, TN (L) JL SENTOSA II NO.12 0011/010 Z03.0 - Observation for suspected VITAMIN B KOMPLEKS
No. RM : 01-042700 BPJS : 0001314541282
INDRIATI ISKANDAR, NY (P) GADING GRIYA LESTARI H.2/15 I10 - Essential (primary) hypertension RUJUKAN
AMLODIPIN 5 MG
No. RM : 01-022406 BPJS : 0001258803461 HIDROKLORTIAZID 25 MG
DEDI TEGUH SAPUTRO, TN (L) JL RAWA SENGON RT 005/022 A15.0 - Tuberculosis of lung, confirmed by
68 NIK : 3301222712910005
No. RM : 01-059637 BPJS : 0001015652755
ANISSA RAHMALYA, NN (P) JL MUNDARI RT 05/02 NO 8 Z03.0 - Observation for suspected
tuberculosis
69 NIK : 31720254601000008
No. RM : 01-016806 BPJS : 0001887042532
Tgl Lahir : 06-Nov-1977 ( 41 Thn 10 Bln 3 Hr ) Z11.1 - Special screening examination for
70
No. RM : 01-075196 NIK : 3172040611770015 respiratory tuberculosis
RADITYA PUTRA, TN (L) JL. KELAPA MOLEK 6 BLOK Z1 NO. 2 A15.0 - Tuberculosis of lung, confirmed by
71 NIK : 3172062604950001
No. RM : 01-085436 BPJS : 0002332804162
DARWIN NAPITUPULU (L) JL. CIPTA SARARANA NO 44 N40 - Hyperplasia of prostate RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
72 NIK : - (0)
Telah Diberikan :
2019-09-09 13:37 Hal. 345 dari 1322

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Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
SUGANTO DINOTO, TN (L) KELAPA HYBRIDA VIII RA.22/4 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
VITAMIN B KOMPLEKS
73 NIK : 3172062609570004 AMLODIPIN 10 MG
A MUHAJIRI S.AG, TN (L) JL RAWA INDAH B36.8 - Other specified superficial mycoses RUJUKAN (0116R025) Rumah Sakit Firdaus
H61.2 - Impacted cerumen (THT) THT-KL - (66) THT-KL - (0)
74 NIK : 317206150450002 H92.0 - Otalgia Telah Diberikan :
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 13:00 - 16:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
HJ RENI SUTRIANTI (P) JL KLP KOPYOR BRT V CJ 2/20 E11.9 - Non-insulin-dependent diabetes ANTASIDA DOEN
mellitus without complications KAPTOPRIL 12,5 MG
No. RM : 01-015220 BPJS : 0001301191424 I21.9 - Acute myocardial infarction, ASAM ASETILSALISILAT 80 mg
Tgl Diagnosis : 07 February 2019 9:31 AM unspecified (ASETOSAL)
2019-09-09 13:37 Hal. 346 dari 1322

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SITI FATONAH, NY (P) PLAMBANG RT 002/016 A09.9 - GASTROENTERITIS AND COLITIS PARASETAMOL TAB 500 MG
OF UNSPECIFIED ORIGIN KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 31-Dec-1958 ( 60 Thn 8 Bln 9 Hr ) I10 - Essential (primary) hypertension
76 NIK : 3309027112589210 MG TAB
No. RM : 01-008715 BPJS : 0001456275543 METFORMIN TAB 500 MG
ANTASIDA DOEN
LIE ALI CHANDRA (L) PELEPAH KUNING II WX II NO. 7 RT. I10 - Essential (primary) hypertension AMBROKSOL TAB 30 MG (0905R004) RS ISLAM JKT
02/16 M54.57 - Low back pain, lumbosacral region KLORFENIRAMIN MALEAT (CTM) TAB 4 SUKAPURA
77 R05 - Cough MG Orthopedi - (0) :
Telah Diberikan
No. RM : 01-001364 NIK : 3172060210500004 PARASETAMOL TAB 500 MG Faskes : (0905R004) RS ISLAM
Tgl Diagnosis : 07 February 2019 9:47 AM BPJS : 0001390682755 AMLODIPIN 5 MG JKT SUKAPURA
RUJUKAN Alamat : JL. TIPAR CAKUNG NO.
RUJUKAN 5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
B. SOEROSO, TN (L) PENYENGAT RAYA NO 6 RT 2/3 H11.0 - Pterygium RUJUKAN (0113R074) RS KHUSUS MATA
I10 - Essential (primary) hypertension RUJUKAN SMEC
(MAT) MATA - (65) Mata - (0)
Tgl Diagnosis : 07 February 2019 9:59 AM KHUSUS MATA SMEC
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 44
Kapasitas : 0
Jadwal : Kamis : 08:00 - 16:00,
08:00 - 16:00;08:00 - 12:00, 12:00
- 16:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 347 dari 1322

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Alasan TACC :
TIMU AL GUNAWAN (L) JL PELEPAH INDAH BLK LB KANTOR J18.8 - Other pneumonia, organism RUJUKAN (0114R030) RS PERTAMINA
RW 18 unspecified JAYA
(PAR) PARU - (94) PARU - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
NABA MARSUDI, TN (L) JL SENTOSA II NO.12 0011/010 Z03.0 - Observation for suspected
tuberculosis
80 NIK : 3172061010480004
No. RM : 01-042700 BPJS : 0001314541282
WINDA SUSANTI, NY (P) KEMURNIAN 1 NO. 44 RT. 008/001 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
GLODOK TAMAN SARI HIDROKLORTIAZID 25 MG
81
No. RM : 01-001771 NIK : 3173034904530002
INGGIH PRATAMI (P) KELAPA CENGKIR 7 BLOK FN NO 7 J44.0 - Chronic obstructive pulmonary RUJUKAN (0905R004) RS ISLAM JKT
disease with acute lower respiratory SUKAPURA
(PAR) PARU - (94) PARU - (0)
Tgl Lahir : 16-Oct-1949 ( 69 Thn 10 Bln 24 Hr ) infection
5
2019-09-09 13:37 Hal. 348 dari 1322

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Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 08:00 - 17:00,
08:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
DARDO BUDIARJO, TN (L) APT CITY HOME HAWAIAN BAY LT 9 I67.9 - Cerebrovascular disease, unspecified RUJUKAN (0114R030) RS PERTAMINA
NO 28A RT 6/19 JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
JANNY BUDIANA, NY (P) APT CITY HOME HAWAIAN BAY LT 9 J45.0 - Predominantly allergic asthma RUJUKAN (0114R030) RS PERTAMINA
NO 28A RT 6/19 J45.9 - Asthma, unspecified RUJUKAN JAYA
(PAR) PARU - (94) PARU - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00
2019-09-09 13:37 Hal. 349 dari 1322

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TACC : Tanpa TACC
Alasan TACC :
TEDI YONO, TN (L) JANUR INDAH IX NO.5 A01.1 - Paratyphoid fever A VITAMIN B KOMPLEKS
85 NIK : 1971042407540002 MG
HARRI YUSUF WIDJAYA (L) JL SUMANGGUNG II BLOK J 5/3 A RT I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
08/02 R51 - Headache HIDROKLORTIAZID 25 MG
86 AMLODIPIN 10 MG
No. RM : 01-040819 NIK : 3172062710451001 VITAMIN B KOMPLEKS
ABU BAKAR HARAHAP, TN (L) KOMP WALIKOTA JL. CAMAR III BLOK I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
D 2/9 AMLODIPIN 10 MG
87 HIDROKLORTIAZID 25 MG
No. RM : 01-086774 NIK : 3172040106570001
FRANSISKA KURNIAWAN LIONG, NY (P) PULO MAS VIII RT 0012/11 KY PUTIH I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
JKTM J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
No. RM : 01-068625 NIK : 3175024311520002 MG
AMLODIPIN 10 MG
MARIA E SUWARTINI (P) JL TELUK RATA IV BLK F NO.6 006/010 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
No. RM : 01-017558 BPJS : 00000045940645 M54.5 - Low back pain KLORFENIRAMIN MALEAT (CTM) TAB 4
2019-09-09 13:37 Hal. 350 dari 1322

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NYATIMAH SATRIAWAN (P) JL KLP MOLEK VII RT 14/19 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
mellitus without complications (INT) PENYAKIT DALAM - (3)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 09:00 - 13:00,
13:30 - 16:30
TACC : Tanpa TACC

Alasan TACC :
PARADJIT SINGH (L) GADING GRIYA LESTARI BLK B2 NO.28 H25.8 - Other senile cataract RUJUKAN (0905R004) RS ISLAM JKT
C010/012 H52.4 - Presbyopia SUKAPURA
(MAT) MATA - (65) Mata - (0)
No. RM : 01-049681 NIK : - Faskes : (0905R004) RS ISLAM
Tgl Diagnosis : 07 February 2019 11:01 AM BPJS : 0002055698065 JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
WINARNI UDIYATSO, NY (P) JL DISCO Q1 E11.9 - Non-insulin-dependent diabetes VITAMIN B KOMPLEKS
mellitus without complications KALSIUM LAKTAT (KALK) 500 MG
92 NIK : - METFORMIN TAB 500 MG
No. RM : 01-051461 BPJS : 0001390191489
2019-09-09 13:37 Hal. 351 dari 1322

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LIES SULISTYANA (P) JL. KELAPA PUYUH IV KC/16 E78.4 - Other hyperlipidaemia KAPTOPRIL 25 MG
I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
NY. NURLATIFAH (P) JL. BANGUN CIPTA SARANA NO. 1 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 5 MG
RT.005 RW.006 mellitus without complications ALOPURINOL 100 MG
Tgl Lahir : 14-Jul-1953 ( 66 Thn 1 Bln 26 Hr ) E78.4 - Other hyperlipidaemia
94 SIMVASTATIN 20 MG
No. RM : 01-083996 NIK : 3172065407530001 I10 - Essential (primary) hypertension METFORMIN TAB 500 MG
Tgl Diagnosis : 07 February 2019 11:23 AM BPJS : 0000037094556 M10.9 - Gout, unspecified VITAMIN B KOMPLEKS
SANTY AULIA (P) GADING INDAH UTARA III NH 4/17 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
mellitus without complications RUJUKAN (INT) PENYAKIT DALAM - (3)
95 NIK : 3172065607460001 Penyakit
Telah Dalam :- (0)
Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 09:00 - 13:00,
13:30 - 16:30
TACC : Tanpa TACC

Alasan TACC :
DRA.TRIPOSA L.KASNADI (P) KLP PUAN TIMUR IIINB2/12A L13.8 - Other specified bullous disorders RUJUKAN (0114R030) RS PERTAMINA
M13.9 - Arthritis, unspecified JAYA
96 NIK : - KULIT KELAMIN: - (0)
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
2019-09-09 13:37 Hal. 352 dari 1322

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Jadwal : Kamis : 09:00 - 10:00,
14:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
DARMAWAN CHAIRUL (L) JANUR INDAH IX LB 9/1 RT 6/8 M54.56 - Low back pain, lumbar region RUJUKAN (0116R025) Rumah Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Kamis : 16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
MUTIARA CHAIRUL, NY (P) JANUR INDAH IX LB 9/1 I10 - Essential (primary) hypertension RUJUKAN (0116R025) Rumah Sakit Firdaus
I69.3 - Sequelae of cerebral infarction AMLODIPIN 10 MG (SAR) SARAF - (76) Saraf - (0)
98 NIK : 3172066901580004 PARASETAMOL TAB 500 MG Telah Diberikan :
VITAMIN B KOMPLEKS
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Kamis : 16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 353 dari 1322

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TEDJO SUWITO (L) KLP PUYUH III BLOK KH NO 43 M47.12 - Other spondylosis with RUJUKAN (0903R012) RS KARTIKA
myelopathy, cervical region PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
MARHMAH (P) JL HARAPAN II NO.6 001/001 M54.5 - Low back pain PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
GINNA HERAWATI (P) KLP MOLEK III C2/21 RT 6/002 I11.9 - Hypertensive heart disease without RUJUKAN (0903R017) RS OMNI MEDICAL
(congestive) heart failure AMBROKSOL TAB 30 MG CENTER
(JAN) JANTUNG DAN
Tgl Lahir : 03-Mar-1955 ( 64 Thn 6 Bln 6 Hr ) J45.9 - Asthma, unspecified
101 NIK : 3172064303550001 DEKSAMETASON 0,5 MG PEMBULUH
Telah DARAH
Diberikan : - (89)
Faskes : (0903R017) RS OMNI
Tgl Diagnosis : 07 February 2019 1:46 PM MG DARAH - (0)
MEDICAL CENTER
Alamat : JL PULO MAS BARAT
VI NO 20
Telp : 021-29779999
Kelas : B
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Kamis : 08:00 - 12:00,
09:00 - 11:30;14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 354 dari 1322

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RACHMANIWATI (P) SUMAGUNG III N 2/1 G91.9 - Hydrocephalus, unspecified RUJUKAN (0113R034) MEDIROS
Tgl Diagnosis : 07 February 2019 2:01 PM Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
DRS. JOHANES ARI SUSANTO, TN (L) JL KINTAMANI I NO 48 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
Tgl Lahir : 10-May-1947 ( 72 Thn 3 Bln 30 Hr ) I10 - Essential (primary) hypertension
No. RM : 01-049169 BPJS : 0002262495846
LIANAWATI, NY (P) JL KINTAMANI I/48 L30.9 - Dermatitis, unspecified GENTAMISIN SALEP KULIT
104 NIK : 3172064711550006 MG
SETIAWAN KUMALA (L) PLUIT KARANG SARI BLOK E 7 S NO L85.3 - Xerosis cutis RUJUKAN (0114R030) RS PERTAMINA
24 RT 10/08 JAYA
105 KULIT KELAMIN: - (0)
Telah Diberikan
Tgl Diagnosis : 07 February 2019 2:17 PM BPJS : 0001380472762 PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Kamis : 09:00 - 10:00,
2019-09-09 13:37 Hal. 355 dari 1322

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14:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
ANDRIANI WIDODO (P) JL KLP LILIN X BLOK NI 8 NO 21 C34.9 - Malignant neoplasm of bronchus or RUJUKAN (0116R025) Rumah Sakit Firdaus
lung, unspecified RUJUKAN (PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
SOSILAWATI WIGUNA,NY (P) PLUIT KARANG SARI BLOK E7.5 NO 24 I11.9 - Hypertensive heart disease without RUJUKAN (0114R030) RS PERTAMINA
107 NIK : 3172015505390002 Penyakit
Telah Dalam :- (0)
Diberikan
Tgl Diagnosis : 07 February 2019 2:23 PM PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 356 dari 1322

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SURIAHWATI NURWANDI, ny (P) GADING ELOK UTARA II BLK GF I/II E11.9 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
011/012 mellitus without complications PULOMAS
Telah Diberikan
Tgl Diagnosis : 07 February 2019 2:26 PM BPJS : 0001827717906 KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00
TACC : Tanpa TACC

Alasan TACC :
SALBIAH,NY (P) JL RAWA SENGON BLOK C NO 59 RT H40.9 - Glaucoma, unspecified RUJUKAN (0905R004) RS ISLAM JKT
03/022 SUKAPURA
(MAT) MATA - (65) Mata - (0)
No. RM : 01-020973 NIK : 3172036004570003 Faskes : (0905R004) RS ISLAM
Tgl Diagnosis : 07 February 2019 2:28 PM BPJS : 0001224828819 JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
CECILE GEONADI (P) JL TASKA P25 M13.9 - Arthritis, unspecified RUJUKAN (0116R028) Rumah Sakit Puri
Medika
110 NIK : 3172066905490002 Orthopedi - (0) :
Telah Diberikan
Tgl Diagnosis : 07 February 2019 2:56 PM Sakit Puri Medika
2019-09-09 13:37 Hal. 357 dari 1322

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Raya No. 46
Telp : 021-43903355
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 07:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
LENNY GUNAWAN, NY (P) JL. KELAPA NIAS RT 007/017 F20.9 - Schizophrenia, unspecified HALOPERIDOL 5 MG
RISPERIDONE 2MG
No. RM : 01-022298 BPJS : 0002046197013 KLORPROMAZIN TAB SAL 100 MG
MCG
LYLYAWATI GUNAWAN, NY (P) JL KELAPA NIAS VIII PB-16/7 RT 07/17 F20.8 - Other schizophrenia RISPERIDONE 2MG
F20.9 - Schizophrenia, unspecified TRIHEKSIFENIDIL 2 MG
112 NIK : 3172066708510002 I10 - Essential (primary) hypertension KLORPROMAZIN TAB SAL 100 MG
AMLODIPIN 10 MG
DENNY PRIBADI, TN (L) JL. KLP MOLEK 7 L 1 NO 16 F20.8 - Other schizophrenia HALOPERIDOL 5 MG
RISPERIDONE 2MG
MCG
MCG
FENIRIA KARTIKA, NN (P) JL BEKASI TIMUR RT 9/9 F20.8 - Other schizophrenia RISPERIDONE 2MG
TRIHEKSIFENIDIL 2 MG
114 NIK : 3175034902800005 KLORPROMAZIN TAB SAL 100 MG
No. RM : 01-051506 BPJS : 0002137389884 TRIFLUPERAZINE 5MG
MCG
2019-09-09 13:37 Hal. 358 dari 1322

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BENNY KURNIAWAN HOLY (L) JALAN RAYA PELABUHAN NO 1 07 F20.0 - Paranoid schizophrenia HALOPERIDOL 5 MG
115 NIK : 3172031804750006 RISPERIDONE 2MG
No. RM : 01-000399 BPJS : 0001387286651 AMITRIPTILIN 25 MG
Tgl Diagnosis : 08 February 2019 2:16 PM KLORPROMAZIN TAB SAL 100 MG
LINDAWATI GUNAWAN, NY (P) JL KLPA HIBRIDA V BLK RB 11/2 M54.5 - Low back pain RUJUKAN (0114R030) RS PERTAMINA
018/015 JAYA
116 Orthopedi - (0) :
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
WONG SIN JOEN, NY (P) GADING PUTIH IV SC 1/10 RT 007/002 E78.2 - Mixed hyperlipidaemia AMLODIPIN 5 MG
I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
117 NIK : 31720661044900036 J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-010543 BPJS : 0001225881933 MG
Tgl Diagnosis : 11 February 2019 8:39 AM SIMVASTATIN 10 MG
VITAMIN B KOMPLEKS
INAN BIN PAUN (L) RAWA INDAH 06/03 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
R05 - Cough VITAMIN B KOMPLEKS
GREGORIUS HANDY (L) JL KLP LILIN II RT 16/12 I11.9 - Hypertensive heart disease without RUJUKAN (0903R012) RS KARTIKA
(congestive) heart failure PULOMAS
Telah Diberikan
2019-09-09 13:37 Hal. 359 dari 1322

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BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
STELLA MARIA WANGKA, NY (P) P SIAU E 18 NO 14 RT 15/ 03 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
RADITYA PUTRA, TN (L) JL. KELAPA MOLEK 6 BLOK Z1 NO. 2 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
sputum microscopy with or without culture VITAMIN B KOMPLEKS
121 NIK : 3172062604950001
No. RM : 01-085436 BPJS : 0002332804162
HELLY BACHTIAR (P) PERUM GREEN GARDEN C20/16 I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
M79.1 - Myalgia KAPTOPRIL 12,5 MG
122 NIK : 3172045403580003 RANITIDIN 150 MG
M YUSUF FANANY (L) KOMP WALIKOTA BI / 14 RT 3/6 E11.9 - Non-insulin-dependent diabetes
Tgl Lahir : 25-Feb-1951 ( 68 Thn 6 Bln 15 Hr ) I11.9 - Hypertensive heart disease without
123 NIK : 3172042502510001
No. RM : 01-016438 BPJS : 0000046096176 (congestive) heart failure
IRWANI WALIMAN, NY (P) JANUR INDAH 10 BLOK LB 10 NO 11 G62.8 - Other specified polyneuropathies RUJUKAN (0903R012) RS KARTIKA
K12.1 - Other forms of stomatitis RUJUKAN PULOMAS
124 NIK : 317206640251002 N39.0 - Urinary tract infection, site not Penyakit
Telah Dalam :- (0)
Diberikan
2019-09-09 13:37 Hal. 360 dari 1322

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BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
HUGO SITOMPUL (L) PERUM WAYANG PRATAMA BLK. E I11.9 - Hypertensive heart disease without RUJUKAN (0114R030) RS PERTAMINA
5/17 RT. 008/008 MUSTIKA JAYA (congestive) heart failure JAYA
(JAN) JANTUNG DAN
125 PEMBULUH
Telah DARAH
Diberikan : - (89)
Tgl Diagnosis : 11 February 2019 9:18 AM BPJS : 0000046007065 DARAH - (0) JAYA
PERTAMINA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
TIODORAN SINAGA (P) PERUM WAYANGB PRATAMA BLK. E E05.8 - Other thyrotoxicosis RUJUKAN (0114R030) RS PERTAMINA
5/17 RT. 008/008 MUSTIKA JAYA JAYA
126 Penyakit
Telah Dalam :- (0)
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
2019-09-09 13:37 Hal. 361 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
IRWANI WALIMAN, NY (P) JANUR INDAH 10 BLOK LB 10 NO 11 G62.8 - Other specified polyneuropathies RUJUKAN (0903R012) RS KARTIKA
K12.1 - Other forms of stomatitis RUJUKAN PULOMAS
127 NIK : 317206640251002 N39.0 - Urinary tract infection, site not Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
SIN SIOE HWA, NY (P) GADING KIRANA V BLOK C 7 12A E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
Tgl Lahir : 04-Feb-1944 ( 75 Thn 7 Bln 5 Hr ) E78.2 - Mixed hyperlipidaemia
Tgl Diagnosis : 11 February 2019 9:29 AM RUJUKAN
ENGKOS KOSASIH (L) JL.CEKATAN III NO.52 01/02 A15.3 - Tuberculosis of lung, confirmed by RUJUKAN (0114R030) RS PERTAMINA
unspecified means RUJUKAN JAYA
(JAN) JANTUNG DAN
Tgl Lahir : 08-May-1942 ( 77 Thn 4 Bln 1 Hr ) I25.9 - Chronic ischaemic heart disease,
No. RM : 01-001425 BPJS : 0000045888276 unspecified JANTUNG DAN PEMBULUH
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
2019-09-09 13:37 Hal. 362 dari 1322

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Jadwal : Senin : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
TARMIJO TOHA (L) JL HARAPA III BB 5 RT 09/07 H25.8 - Other senile cataract RUJUKAN (0116R025) Rumah Sakit Firdaus
H40.0 - Glaucoma suspect (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
KUSNADI (L) KOMP WALIKLOTA G.2/10 13/06 E11.9 - Non-insulin-dependent diabetes PARASETAMOL TAB 500 MG
131 NIK : 3172043112530017 MG
No. RM : 01-009325 BPJS : 0000039981227 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
NAISA ESTERIA GULTOM, NY (P) JL PRIHATIN NO 71 E78.2 - Mixed hyperlipidaemia KOTRIMOKSAZOL DOEN I (DEWASA)
I10 - Essential (primary) hypertension (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 18-Jan-1948 ( 71 Thn 7 Bln 22 Hr ) TRIMETOPRIM 80 MG)
132 NIK : 3172065810490003 Z03.0 - Observation for suspected
tuberculosis
AMLODIPIN 10 MG
SIMVASTATIN 10 MG
KOESMINI (P) JL TANGGUH III NO 12 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 18-Apr-1946 ( 73 Thn 4 Bln 22 Hr ) M13.9 - Arthritis, unspecified GARAM ORALIT KOMBINASI
133 NIK : 3172065804460001
2019-09-09 13:37 Hal. 363 dari 1322

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VITAMIN B KOMPLEKS
NURBAYA SITORUS (-) RAWA SENGON 007/022 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 29-Mar-1955 ( 64 Thn 5 Bln 11 Hr ) GARAM ORALIT KOMBINASI
134 NIK : 3172066903550001
MOHAMMAD SALIM, TN (L) JL PEGANGSAAN DUA A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
No. RM : 01-085155 BPJS : 0001382101896 M10.2 - Drug-induced gout AMLODIPIN 5 MG
TUTY LIANTY WONGSO (P) JL. PERMATA BIRU 1 BLOK A 6 NO 2A J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
K29.7 - Gastritis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
136 NIK : 3171046207420001 MG
VITAMIN B KOMPLEKS
JALOSTER SITIJAK (L) JL.KEPODANG C-3/20 RT 006/006 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG (0116R025) Rumah Sakit Firdaus
mellitus without complications GLIBENKLAMIDA 5 MG (INT) PENYAKIT DALAM - (3)
137 NIK : 3172041002 VITAMIN B KOMPLEKS Penyakit Dalam :- (0)
Telah Diberikan
RUJUKAN
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00,
13:30 - 16:30;16:00 - 18:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 364 dari 1322

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Alasan TACC :
GITO SAKIDI, TN (L) RAWA INDAH RT. 002/003 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
138 NIK : 3172060102570003 MG
FANDY SULAIMAN SIAUW, TN (L) JL MAPULUS BLOK C NO 9 RT 004/006 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
mellitus without complications PARASETAMOL TAB 500 MG PULOMAS
139 NIK : 3172042608550003 DIAZEPAM 2 MG Penyakit Dalam :- (0)
Telah Diberikan
VITAMIN B KOMPLEKS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
HJ NURSIAH KANANG, NY (P) JL.GAMBIR ANOM F-6/13 H25.8 - Other senile cataract RUJUKAN (0116R025) Rumah Sakit Firdaus
H52.4 - Presbyopia GLISERIL GUAIAKOLAT (GG) 100 MG (MAT) MATA - (65) Mata - (0)
140 NIK : 3172054707520001 I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4 Telah Diberikan :
No. RM : 01-009474 BPJS : 0002035549888 MG Faskes : (0116R025) Rumah
J00 - Acute nasopharyngitis [common cold]
Tgl Diagnosis : 11 February 2019 10:26 AM AMLODIPIN 5 MG Sakit Firdaus
K29.7 - Gastritis, unspecified
RANITIDIN 150 MG Alamat : JL. SIAK J5/14
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
2019-09-09 13:37 Hal. 365 dari 1322

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Jadwal : Senin : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
KORNELIA PANGGABEAN, NY (P) KOMP PERUM PT HIII B/7 I10 - Essential (primary) hypertension AMLODIPIN 5 MG (0113R034) MEDIROS
M79.2 - Neuralgia and neuritis, unspecified VITAMIN B KOMPLEKS (SAR) SARAF - (76) Saraf - (0)
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
WATI SETIAWAN, NY (P) JANUR HIJAU XI TR 1/10 RT 003/015 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
VITAMIN B KOMPLEKS
No. RM : 01-025621 BPJS : 0001319834529 MG
MESTIKA GR SITOMPUL (P) JL. GADING RESIDEN PELANGI RAYA E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R029) Rumah Sakit
BLK. A11 NO. 59 mellitus without complications Hermina Podomoro
Telah Diberikan
No. RM : 01-040001 NIK : - Faskes : (0116R029) Rumah
Tgl Diagnosis : 11 February 2019 10:40 AM BPJS : 0000042524638 Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 14
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00, 09:
2019-09-09 13:37 Hal. 366 dari 1322

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00 - 11:00;16:00 - 18:00, 18:00 -
20:00
TACC : Tanpa TACC

Alasan TACC :
PAIMAN (L) INSPEKSI KALI SUNTER H25.9 - Senile cataract, unspecified RUJUKAN (0114R030) RS PERTAMINA
JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
LIM NJOEK JIN (P) jl kopyor raya wi /17 rt 016-019 H25.8 - Other senile cataract RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
(MAT) MATA - (65) Mata - (0)
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 08:00 - 16:00,
08:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 367 dari 1322

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INDAH TANUDJAJA, NY (P) APT GADING NAS RESIDENCES E66.9 - Obesity, unspecified PARASETAMOL TAB 500 MG (0114R030) RS PERTAMINA
I11.9 - Hypertensive heart disease without VITAMIN B KOMPLEKS JAYA
146 NIK : 3175065302530006 (congestive) heart failure AMLODIPIN 10 MG Penyakit Dalam :- (0)
Telah Diberikan
No. RM : 01-013739 BPJS : 0001268625284 M13.9 - Arthritis, unspecified Faskes : (0114R030) RS
RANITIDIN 150 MG
Tgl Diagnosis : 11 February 2019 11:03 AM RUJUKAN PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 14
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
KIU HELIANA (P) JL. KELAPA KOPYOR Q1 NO. 21 M13.86 - Other specified arthritis, lower leg RUJUKAN (0114R030) RS PERTAMINA
016/019 S92.3 - Fracture of metatarsal bone JAYA
147 Orthopedi
Telah - (0) :
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
RISOEN (L) P PENYENGAT II NO 8 RT 6/3 A90 - Dengue fever [classical dengue] PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
148 NIK : 3172061507440004 RANITIDIN 150 MG
No. RM : 01-011057 BPJS : 0000045889514
2019-09-09 13:37 Hal. 368 dari 1322

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WIYONO (L) JL.P.TEMIANG II N0 18 M13.9 - Arthritis, unspecified DEKSAMETASON 0,5 MG
VITAMIN B KOMPLEKS
BONG SIAT MUI, NY (P) KLP CENGKIR BRT. IX FP 1/19 1/3 KGT E78.4 - Other hyperlipidaemia SIMVASTATIN 10 MG
I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
150 NIK : 3172066403560002 AMLODIPIN 5 MG
No. RM : 01-047878 BPJS : 0002231284566
MOONA JYOTSNA RAVINDRA, NY (P) JL WALANG TIMUR III 009/012 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
151 NIK : 3171035305500003 tuberculosis MG
RUJUKAN
RUJUKAN
RAVINDRA KUMAR MOONA, TN (L) JL WALANG TIMUR 3 RT 09/12 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
152 NIK : 3172031701450003 MG
HERTA PARAMITA GITAMURTI, NN (P) JL ANGKLUNG RT 001/007 F20.0 - Paranoid schizophrenia HALOPERIDOL 5 MG
BUDI WIBISONO (L) JL NUSA INDAH A/29 008/008 KGT I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
154 NIK : 3172062009370002 MG
2019-09-09 13:37 Hal. 369 dari 1322

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JULIANA, NY (P) JL NUSA INDAH A/29 008/008 KGT I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
155 NIK : 31720654610490001 MG
AMLODIPIN 5 MG
RUTH, SH (P) TAMAN PEGANGSAAN INDAH R./7 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
M79.1 - Myalgia VITAMIN B KOMPLEKS
No. RM : 01-009903 BPJS : 0001319964895
HARMAN (L) JL. JANUR ASRI 3 Q K 7 NO 5 A90 - Dengue fever [classical dengue]

157 NIK : 3171021501560001
No. RM : 01-087161 BPJS : 0001725502026
TJIE KIAN TJONG (L) JL GADING KIRANA BARAT I C2 / 12 E78.2 - Mixed hyperlipidaemia VITAMIN B KOMPLEKS

158 NIK : -
No. RM : 01-067435 BPJS : 0002308671595
TARCISIUS HARJANTO (L) JL JANUR KUNING VII RT 006/016 H35.3 - Degeneration of macula and RUJUKAN (0114R030) RS PERTAMINA
posterior pole JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 370 dari 1322

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TAUFAN SURYATHYO, TN (L) JL KLP CENGKIR BRT II FJ 2/19 E78.4 - Other hyperlipidaemia AMLODIPIN 10 MG
No. RM : 01-045192 BPJS : 0002081330807
161
No. RM : 01-075196 NIK : 3172040611770015
LIM JONG MENG, NY (L) JL. MUSIK RAYA BLOK E/11 Z03.0 - Observation for suspected
tuberculosis
162 NIK : -
No. RM : 01-087131 BPJS : 0001453883793
ASMAWATY, NY (P) RAWA INDAH 06/03 Z03.0 - Observation for suspected
tuberculosis
163 NIK : 3172066308880001
No. RM : 01-053680 BPJS : 0001225780389
MOONA JYOTSNA RAVINDRA, NY (P) JL WALANG TIMUR III 009/012 Z03.0 - Observation for suspected
tuberculosis
164 NIK : 3171035305500003
No. RM : 01-021066 BPJS : 0001325482626
LIA YULIARSIH (P) PUSKESMAS KEC KLP GADING J02.9 - Acute pharyngitis, unspecified BORAK GLYSEROL 5% LARUTAN
K12.2 - Cellulitis and abscess of mouth ASAM MEFENAMAT KAPS 500
BROMHEKSIN HCL SOL 2MG/ML 50 ML
2019-09-09 13:37 Hal. 371 dari 1322

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INDRIATI ISKANDAR, NY (P) GADING GRIYA LESTARI H.2/15 M13.9 - Arthritis, unspecified RUJUKAN (0116R034) Rumah Sakit Umum
Pekerja
166 NIK : 3674036512380002 Orthopedi - (0) :
Telah Diberikan
Tgl Diagnosis : 11 February 2019 3:01 PM Sakit Umum Pekerja
Alamat : JL. RAYA CAKUNG
CILINCING
Telp : 021-29484848
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 11:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
M ERAWATI L TOBING, NY (P) JL PULAU TEMIANG III NO 3 RT A15.0 - Tuberculosis of lung, confirmed by AMBROKSOL TAB 30 MG
013/003 sputum microscopy with or without culture KLORFENIRAMIN MALEAT (CTM) TAB 4
167 MG
No. RM : 01-029978 NIK : 3172064303500001 OAT KAT. II (FASE LANJUTAN)
Tgl Diagnosis : 12 February 2019 9:10 AM BPJS : 0000039735112 VITAMIN B KOMPLEKS
AMLODIPIN 10 MG
SIDIK WAHYUDIONO, TN (L) SUNTER RT08/03 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
168 NIK : 1801132803860002
No. RM : 01-014468 BPJS : 0001132131892
ARPAN SAPTU (L) FLAMBOYAN NO 8 BERMIS RT 6/3 I25.1 - Atherosclerotic heart disease
M10.2 - Drug-induced gout
169 NIK : 3172062202420001
No. RM : 01-003093 BPJS : 0000046002881
SITI MARDINAH, NY (P) JL PULAU BENGKALIS NO 18 RT 10/03 I50.0 - Congestive heart failure RUJUKAN (0114R030) RS PERTAMINA
JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
Tgl Diagnosis : 12 February 2019 9:35 AM DARAH - (0) JAYA
PERTAMINA
2019-09-09 13:37 Hal. 372 dari 1322

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BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
JONI LINGGAWATI S, NY (P) JL NUSANTARA 7 BLOK E NO 7 RT I10 - Essential (primary) hypertension AMLODIPIN 10 MG
08/017 VITAMIN B KOMPLEKS
171 KALSIUM LAKTAT (KALK) 500 MG
IRWAN YENATAN HERYSUSANTO (L) JL. GRIYA PRATAMA 4 BLOK 3 NO20 E11.9 - Non-insulin-dependent diabetes KALSIUM LAKTAT (KALK) 500 MG (0903R012) RS KARTIKA
mellitus without complications METFORMIN TAB 500 MG PULOMAS
Tgl Lahir : 23-Oct-1958 ( 60 Thn 10 Bln 17 Hr ) I11.9 - Hypertensive heart disease without
172 NIK : - VITAMIN B KOMPLEKS Penyakit Dalam :- (0)
Telah Diberikan
RUJUKAN Faskes : (0903R012) RS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
LIEM YOE SANG (P) JL. GRUYA PRATAMA 4 BLOK 3 NO 20 E11.9 - Non-insulin-dependent diabetes GLIBENKLAMIDA 5 MG
mellitus without complications PARASETAMOL TAB 500 MG
No. RM : 01-087209 BPJS : 0001388912308
2019-09-09 13:37 Hal. 373 dari 1322

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WIWIEK (P) APT WISMA GADING PERMAI TOWER F20.0 - Paranoid schizophrenia RISPERIDONE 2MG
A BLOK 18 NO 17 RT 03/20 TRIHEKSIFENIDIL 2 MG
No. RM : 01-000328 NIK : 3172055311790003 MCG
SUDJANI (L) PADEMANGAN IV GG 24 NO 37 RT 3/01 I21.9 - Acute myocardial infarction,

unspecified
175 NIK : 3172051609480001
No. RM : 01-000469 BPJS : 0001318741457
LIANNY IRAWATI (P) JL. KLP CENGKIR BARAT 8 BLOK F O 1 E78.2 - Mixed hyperlipidaemia HIDROKLORTIAZID 25 MG (0903R012) RS KARTIKA
NO 11 I11.9 - Hypertensive heart disease without SIMVASTATIN 10 MG PULOMAS
176 (congestive) heart failure ALOPURINOL 100 MG Penyakit Dalam :- (0)
Telah Diberikan
No. RM : 01-087219 NIK : - M10.2 - Drug-induced gout Faskes : (0903R012) RS
Tgl Diagnosis : 12 February 2019 10:08 AM BPJS : 0001386293229 R60.0 - Localized oedema KARTIKA PULOMAS
RANITIDIN 150 MG
RUJUKAN
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
RONNY NGADITEJA (L) MITRA GADING VILLA BLOK C 2 H61.2 - Impacted cerumen FENOL GLISEROL TT 10%

177 NIK : -
No. RM : 01-087227 BPJS : 0002332764371
YAP ENG LAN (P) JL.ALANDA II N0 21 RT 013/08 SUNTER L30.9 - Dermatitis, unspecified GENTAMISIN SALEP KULIT
JAYA JAKUT KLORFENIRAMIN MALEAT (CTM) TAB 4
178 MG
2019-09-09 13:37 Hal. 374 dari 1322

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lie shi mie (P) JL GAMMYONG NO 33 KGT E11.9 - Non-insulin-dependent diabetes GLIBENKLAMIDA 5 MG
179 NIK : - KALSIUM LAKTAT (KALK) 500 MG
No. RM : 01-068968 BPJS : 0001863827054
RENY MANORA SINAGA, NY (P) JL PRIHATIN NO 44 RT 7/2 H81.3 - Other peripheral vertigo
180 NIK : 3172065908480001
No. RM : 01-040783 BPJS : 0000046162337
RUTH, SH (P) TAMAN PEGANGSAAN INDAH R./7 M10.2 - Drug-induced gout ALOPURINOL 100 MG
VITAMIN B KOMPLEKS
No. RM : 01-009903 BPJS : 0001319964895
TJIE KIAN TJONG (L) JL GADING KIRANA BARAT I C2 / 12 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
Tgl Lahir : 17-Aug-1957 ( 62 Thn 0 Bln 23 Hr ) E78.5 - Hyperlipidaemia, unspecified
182 NIK : - SIMVASTATIN 20 MG
No. RM : 01-067435 BPJS : 0002308671595
SIN SIOE HWA, NY (P) GADING KIRANA V BLOK C 7 12A E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
Tgl Lahir : 04-Feb-1944 ( 75 Thn 7 Bln 5 Hr ) E78.5 - Hyperlipidaemia, unspecified
Telah Diberikan
No. RM : 01-043484 BPJS : 0001293340353 N39.0 - Urinary tract infection, site not Faskes : (0114R030) RS
Tgl Diagnosis : 12 February 2019 11:14 AM specified PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 375 dari 1322

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DASUKI (L) JL.P TEMIANG I NO.41 11/03 I25.0 - Atherosclerotic cardiovascular RUJUKAN (0114R030) RS PERTAMINA
disease, so described JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
LILY MARNIATY,WONG NY (P) JL KLP NIAS VI BLOK PA RT 005/014 E78.5 - Hyperlipidaemia, unspecified KAPTOPRIL 25 MG (0114R030) RS PERTAMINA
I10 - Essential (primary) hypertension SIMVASTATIN 20 MG JAYA
185 NIK : 3172065910490001 M47.87 - Other spondylosis, lumbosacral RUJUKAN Telah Diberikan :
No. RM : 01-012286 BPJS : 0001475606362 region Faskes : (0114R030) RS
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
ACHYAR SAHARI, TN (L) GG SERINDO I/15 RT 3/04 A01.0 - Typhoid fever SIPROFLOKSASIN 500 MG
Tgl Diagnosis : 12 February 2019 11:29 AM SALBUTAMOL 2 MG
2019-09-09 13:37 Hal. 376 dari 1322

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ATIBAE ZAMILI, NY (P) JL JEND SUDIRMAN H25.8 - Other senile cataract (0116R025) Rumah Sakit Firdaus
H26.4 - After-cataract (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
BONG SUGIANTINI (P) JL SUNTER PRATAMA BLOK D2 RT R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
20/08 VITAMIN B KOMPLEKS
No. RM : 01-005307 NIK : 3172024505490003
ABEDNEGO RAGIL SAKSOMO (L) JL KLPA KOPYOR BRT III CH 2/15 E11.9 - Non-insulin-dependent diabetes SIMVASTATIN 10 MG
003/012 mellitus without complications GLIBENKLAMIDA 5 MG
Tgl Lahir : 13-Jul-1953 ( 66 Thn 1 Bln 27 Hr ) E78.5 - Hyperlipidaemia, unspecified
189 METFORMIN TAB 500 MG
MG
LIANNY IRAWATI (P) JL. KLP CENGKIR BARAT 8 BLOK F O 1 E78.2 - Mixed hyperlipidaemia HIDROKLORTIAZID 25 MG (0903R012) RS KARTIKA
NO 11 I11.9 - Hypertensive heart disease without SIMVASTATIN 10 MG PULOMAS
190 (congestive) heart failure ALOPURINOL 100 MG Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 01-087219 NIK : - M10.2 - Drug-induced gout Faskes : (0903R012) RS
Tgl Diagnosis : 12 February 2019 12:09 PM BPJS : 0001386293229 R60.0 - Localized oedema KARTIKA PULOMAS
RANITIDIN 150 MG
RUJUKAN
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
2019-09-09 13:37 Hal. 377 dari 1322

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Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
YULIANA SOESANTO (P) KELAPA CENGKIR BARAT VI FM I /14 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 10 MG (0903R012) RS KARTIKA
H25.8 - Other senile cataract RUJUKAN PULOMAS
(MAT) MATA - (65) Mata - (0)
Tgl Diagnosis : 12 February 2019 12:16 PM KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
NURLENNY MUIN (P) JL PELEPAH INDAH raya lb 22 no 9 E78.4 - Other hyperlipidaemia ALOPURINOL 100 MG (0116R025) Rumah Sakit Firdaus
M10.2 - Drug-induced gout SIMVASTATIN 10 MG (ORT) ORTHOPEDI - (93)
192 NIK : 7371134503580003 M13.9 - Arthritis, unspecified VITAMIN B KOMPLEKS Orthopedi - (0) :
Telah Diberikan
Tgl Diagnosis : 13 February 2019 11:03 AM ANTASIDA DOEN Sakit Firdaus
RUJUKAN
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 378 dari 1322

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ONG HERWINDO KURNIAWAN, TN (L) J; PELEPAH HIJAU III TM 2/3 RT H25.9 - Senile cataract, unspecified RUJUKAN (0113R074) RS KHUSUS MATA
009/001 H52.4 - Presbyopia SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 60
Kapasitas : 0
Jadwal : Rabu : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 15:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

KASIM ETENG, NY (L) KLP PUYUH VI KJ NO KLP GADING N18.9 - Chronic renal failure, unspecified RUJUKAN (0116R021) Royal Progress
TIMUR R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG (HDL) HEMODIALISA
194 Telah Diberikan : riwayat CKD on
No. RM : 01-076916 NIK : - HD pro Hemodialisa 3x/ minggu.
Tgl Diagnosis : 13 February 2019 11:13 AM BPJS : 0001821254218 Faskes : (0116R021) Royal
Progress
UTARA
Telp : 021-6400261
Kelas : B
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal :
TACC : Tanpa TACC

Alasan TACC :
SURYA NINGSIH (P) SENTOSA BARAT NO 07 RT 08/10 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
195 NIK : 3171036707590002 MG
2019-09-09 13:37 Hal. 379 dari 1322

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CHONG LAN HWA (P) JL. A SUCIPTO GR ELLEN C9 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
No. RM : 01-085393 BPJS : 0002044916122
LAUW (LIOE) TJIOE HIONG (P) GADING ELOK BARAT MI CB.1/7 I10 - Essential (primary) hypertension KAPTOPRIL 25 MG
VITAMIN B KOMPLEKS
197 NIK : - HIDROKLORTIAZID 25 MG
No. RM : 01-073035 BPJS : 0002332800123
FRANKY SOETANTO (L) JL AGUNG PERKASA RAYA BLOK J J45.9 - Asthma, unspecified RUJUKAN
8/15 B RT 08/14
198
No. RM : 01-024237 NIK : 3172022505580003
TJAN PAK TJENG, TN (L) KPM SAWITRAYA KN /11RT 001/019 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
KGT mellitus without complications JAYA
199 Penyakit
Telah Dalam :- (0)
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
TINCE RANGKUTI, NY (P) PPI BLOK BB 30 NO 4 I10 - Essential (primary) hypertension DOKTER UMUM
AMLODIPIN 10 MG
No. RM : 01-026063 BPJS : 0002746334057
2019-09-09 13:37 Hal. 380 dari 1322

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ERWANTO SIMATUPANG (L) JL. DENAI GG RUKUN NO. 18 A15.1 - Tuberculosis of lung, confirmed by AMBROKSOL TAB 30 MG
culture only KLORFENIRAMIN MALEAT (CTM) TAB 4
201 NIK : - MG
IR BUDI SANTOSO (L) KELAPA PUAN TIMUR III NE 4/49 RT H35.9 - Retinal disorder, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
10/12 (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Kamis : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
DJIMRONAH M PRAJITNO (P) JL GADING VI NO 7 RT 4/05 H25.9 - Senile cataract, unspecified AMLODIPIN 10 MG (0114R030) RS PERTAMINA
I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS JAYA
(MAT) MATA - (65) Mata - (0)
203 NIK : 3172064708440001 R51 - Headache PARASETAMOL TAB 500 MG Telah Diberikan :
RUJUKAN
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 381 dari 1322

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TJIOE SOEY KIM (P) JL KLPA MOLEK VII BLOK MII NO 12A Z01.7 - Laboratory examination

204 NIK : 3171015704500002
No. RM : 01-006763 BPJS : 0001208524127
NGENAWATI PURBA (P) JL. RAYA PASAR INPRES NO.43A E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
205 NIK : 3172064803520002 AMLODIPIN 10 MG
Tgl Diagnosis : 14 February 2019 8:41 AM KALSIUM LAKTAT (KALK) 500 MG
AMLODIPIN 10 MG
TARMIJO TOHA (L) JL HARAPA III BB 5 RT 09/07 I48 - Atrial fibrillation and flutter RUJUKAN (0114R030) RS PERTAMINA
JAYA
(JAN) JANTUNG DAN
206 NIK : 3172060307480001 PEMBULUH
Telah DARAH
Diberikan : - (89)
PERTAMINA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
SRI RAHAYU (P) SUKAPURA RT. 05/03 NO. 129 I11.9 - Hypertensive heart disease without AMBROKSOL TAB 30 MG
CILINCING (congestive) heart failure DEKSAMETASON 0,5 MG
Tgl Lahir : 04-Apr-1954 ( 65 Thn 5 Bln 5 Hr ) J45.9 - Asthma, unspecified
207 SALBUTAMOL 2 MG
AMLODIPIN 10 MG
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 382 dari 1322

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NURAINI (P) JL GADANG NO.36G 010/002 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
Tgl Lahir : 30-Dec-1947 ( 71 Thn 8 Bln 10 Hr ) I11.9 - Hypertensive heart disease without
Telah Diberikan
No. RM : 01-004572 BPJS : 0000046060108 (congestive) heart failure Faskes : (0114R030) RS
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
ENDANG SETIAWTI (P) MENARA CONDOMINIUM KLP GADING C53.9 - Malignant neoplasm of cervix uteri, RUJUKAN (0116R029) Rumah Sakit
F 503 unspecified Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 08:00 - 10:00,
10:00 - 12:00;19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
HARJANTO KOSASIH, TN (L) KELAPA NIAS V PC 10/11 RT 10/17 I10 - Essential (primary) hypertension AMBROKSOL SYR 15MG/5ML 60 ML
210 NIK : 3172061408500001 AMLODIPIN 10 MG
No. RM : 01-003184 BPJS : 0001269306009 LORATADIN 10 MG
2019-09-09 13:37 Hal. 383 dari 1322

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AMIRUL MU'MININ, TN (L) GANG AHMAD RT 15/03 I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4
L29.8 - Other pruritus MG
Tgl Lahir : 01-Oct-1953 ( 65 Thn 11 Bln 8 Hr ) AMLODIPIN 10 MG
211 NIK : 3175080110530004
DRA HJ IPUNG SUPARMI (P) JL MERAH DELIMA A5/20 RT005/010 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG (0113R074) RS KHUSUS MATA
KGT mellitus without complications AMLODIPIN 10 MG SMEC
(MAT) MATA - (65) Mata - (0)
Tgl Lahir : 10-Nov-1952 ( 66 Thn 9 Bln 30 Hr ) H25.9 - Senile cataract, unspecified
212 VITAMIN B KOMPLEKS Telah Diberikan :
No. RM : 01-068508 NIK : 3172065011520003 I10 - Essential (primary) hypertension Faskes : (0113R074) RS
RUJUKAN
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 42
Kapasitas : 0
Jadwal : Kamis : 08:00 - 16:00,
08:00 - 16:00;08:00 - 12:00, 12:00
- 16:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

Alasan TACC :
TAN BIAUW LIE, NY (L) GADING ELOK TIMUR VI BO 2/5 H81.4 - Vertigo of central origin AMLODIPIN 10 MG (0116R025) Rumah Sakit Firdaus
VITAMIN B KOMPLEKS (SAR) SARAF - (76) Saraf - (0)
213 NIK : 3172065111540001 SIMVASTATIN 10 MG Telah Diberikan :
RUJUKAN
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 384 dari 1322

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UNGGU SENDUK, NY (P) PESING KONENG RT 8/8 I10 - Essential (primary) hypertension AMLODIPIN 10 MG (0116R025) Rumah Sakit Firdaus
L85.9 - Epidermal thickening, unspecified VITAMIN B KOMPLEKS (KLT) KULIT KELAMIN - (110)
214 NIK : 3173054906481001 RUJUKAN KULIT KELAMIN: - (0)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 09:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
PONEWATY RUSLI (P) JL.MANDOLIN KAV.25 M54.5 - Low back pain RUJUKAN (0903R012) RS KARTIKA
M79.20 - Neuralgia and neuritis, unspecified, PULOMAS
215 NIK : 3172066705540001 multiple sites Telah Diberikan :
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
TERESIAWATI KASLIM, NY (P) JL KARYA JL SUKAOURA A3/6 KOMP H25.9 - Senile cataract, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
WALIKOTAKOMP PONDOK PELANGI H52.4 - Presbyopia (MAT) MATA - (65) Mata - (0)
216 BLOK Telah Diberikan :
No. RM : 01-020807 Faskes : (0116R025) Rumah
Tgl Diagnosis : 14 February 2019 10:08 AM NIK : 6171015911560001 Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
2019-09-09 13:37 Hal. 385 dari 1322

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Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
NENI RATNASIH, NY (P) RAWA INDAHR RT 006/003 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
217 NIK : 3172064903580005 L30.9 - Dermatitis, unspecified MG
TJIO TJOEI TJIN (P) GADING MEDITERANIA CB/9 K56.5 - Intestinal adhesions [bands] with RUJUKAN (0903R012) RS KARTIKA
obstruction PULOMAS
218 NIK : 3171045401350001 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00
TACC : Tanpa TACC

Alasan TACC :
LILIANA TASIM (P) PERMATA BIRU 1 H3 NO 8 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
AMBROKSOL SYR 15MG/5ML 60 ML
No. RM : 01-003453 BPJS : 0001427294338 MG
2019-09-09 13:37 Hal. 386 dari 1322

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TUMIRIN (L) JL JATI 5C RT006/006 NO 7 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
220 NIK : 3172022111274002
No. RM : 02-003801 BPJS : 0001744217752
KWOK TUNG TJEN (P) GADING INDAH VIII NF.5/19 J00 - Acute nasopharyngitis [common cold] VITAMIN B KOMPLEKS
PEGANGSAAN DUA PARASETAMOL TAB 500 MG
LASMARIANG MEISA TAMPUBOLON (P) JL IMPORT1 BLOK E/23 D03.9 - Melanoma in situ, unspecified VITAMIN B KOMPLEKS
222 NIK : 3172064105550003 L85.9 - Epidermal thickening, unspecified
No. RM : 01-023746 BPJS : 0000041609485
BAMBANG SUSILO IRIANTO (L) JL LENSO BLOK C/9 I10 - Essential (primary) hypertension OMEPRAZOL KAPS 20 MG
K29.7 - Gastritis, unspecified RANITIDIN 150 MG
No. RM : 05-002490 BPJS : 0001826007895
DJURIAH, NY (P) PEGANGSAAN DUA RT 02/04 J00 - Acute nasopharyngitis [common cold] AMLODIPIN 10 MG
No. RM : 01-012493 BPJS : 0002332713205 MG
ARISTA RISMA MELATI (P) GG PEJUANG RT 003/04 KGT Z00.8 - Other general examinations

225 NIK : 3175066006960009
No. RM : 01-076435 BPJS : 0000370212298
MANLY MEGAHRIA LAIJ, NY (P) GADING KIRANA TUIMUR V A7/7 KGB E78.2 - Mixed hyperlipidaemia SIMVASTATIN 10 MG
226 NIK : 3271016911430001 M10.2 - Drug-induced gout ALOPURINOL 100 MG
2019-09-09 13:37 Hal. 387 dari 1322

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SJAFRIDIANA, NY (P) JL.IMPORT II D/13 M43.02 - Spondylolysis, cervical region RUJUKAN (0116R029) Rumah Sakit
Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
Jadwal : Kamis : 15:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
ERWANTO SIMATUPANG (L) JL. DENAI GG RUKUN NO. 18 A15.0 - Tuberculosis of lung, confirmed by PARASETAMOL TAB 500 MG (0116R025) Rumah Sakit Firdaus
sputum microscopy with or without culture RUJUKAN (PAR) PARU - (94) PARU - (0)
228 NIK : - RUJUKAN Telah Diberikan :
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Kamis : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
lie shi mie (P) JL GAMMYONG NO 33 KGT E78.4 - Other hyperlipidaemia ALOPURINOL 100 MG
M10.2 - Drug-induced gout SIMVASTATIN 10 MG
No. RM : 01-068968 BPJS : 0001863827054
2019-09-09 13:37 Hal. 388 dari 1322

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SANTY SIMODIREDJO, NY (P) JL JANUR KUNING III WH /1 E11.9 - Non-insulin-dependent diabetes VITAMIN B KOMPLEKS
Tgl Lahir : 16-Sep-1937 ( 81 Thn 11 Bln 24 Hr ) E78.2 - Mixed hyperlipidaemia
No. RM : 01-000354 BPJS : 0001801704486 I10 - Essential (primary) hypertension METFORMIN TAB 500 MG
Tgl Diagnosis : 14 February 2019 11:33 AM GLIBENKLAMIDA 5 MG
ANDRYANINGSIH SANTOSA, NY (P) JL GADING AYU 1 RA 2B NO 15 K29.7 - Gastritis, unspecified RANITIDIN 150 MG
VITAMIN B KOMPLEKS
231 NIK : 3172066005510002
No. RM : 01-066034 BPJS : 0002355125545
RONIMA AMANTJIK,NY (P) JL TABAH II NO 2 RT006/002 I11.9 - Hypertensive heart disease without GLISERIL GUAIAKOLAT (GG) 100 MG
(congestive) heart failure KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 04-Dec-1952 ( 66 Thn 9 Bln 5 Hr ) J00 - Acute nasopharyngitis [common cold]
232 NIK : 3172064412520007 MG
NAOMI YANTI KAMTO, NY (P) JL.SISTER E/12 04/07 J00 - Acute nasopharyngitis [common cold] ANTASIDA DOEN
M54.5 - Low back pain GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-003317 BPJS : 0001299335804 MG
Tgl Diagnosis : 14 February 2019 11:59 AM NATRIUM DIKLOFENAK TAB 25 MG
DJONSON LIUSVIA (L) JL.SISTER E/12 04/07 I25.9 - Chronic ischaemic heart disease, RUJUKAN (0114R030) RS PERTAMINA
unspecified JAYA
(JAN) JANTUNG DAN
234 NIK : 3172062808430001 PEMBULUH
Telah DARAH
Diberikan : - (89)
Tgl Diagnosis : 14 February 2019 12:02 PM DARAH - (0) JAYA
PERTAMINA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 389 dari 1322

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SRI KASMIATI (P) GADING III NO 10 RT 3/05 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications SIMVASTATIN 10 MG
No. RM : 01-006042 BPJS : 0000165562863
LIM LIE TJOE, NY (P) APT GADING NIAS RESIDENCE D/16 I15.9 - Secondary hypertension, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
MP RT. 02/03 PGS II (INT) PENYAKIT DALAM - (3)
236 Penyakit
Telah Dalam :- (0)
Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Kamis : 09:00 - 13:00,
13:30 - 16:30
TACC : Tanpa TACC

Alasan TACC :
LELY PURNAMASARI WDIJAYA, NY (P) GD ELOK TIMUR BK II / 19 C18.9 - Malignant neoplasm of colon, RUJUKAN (0903R012) RS KARTIKA
unspecified PULOMAS
Tgl Lahir : 24-Jun-1940 ( 79 Thn 2 Bln 16 Hr ) K56.7 - Ileus, unspecified
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 390 dari 1322

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JULITA DEWI ADHI SURYA (P) JL PERMATA BIRU I I3 NO 1 F20.8 - Other schizophrenia HALOPERIDOL 5 MG
RISPERIDONE 2MG
MCG
SURYANI SETIAWAN (P) JL KLP CENGKIR BRT I FH 1/21 M13.9 - Arthritis, unspecified RANITIDIN 150 MG
PIROKSIKAM 10 MG
MCG
TJHIN NAM KIN (L) JL JANUR ASRI I BLK QJ II NO.2 J06.9 - Acute upper respiratory infection, SALBUTAMOL 2 MG
008/012 unspecified OBH SIRUP 100 ML
Tgl Lahir : 22-Jan-1950 ( 69 Thn 7 Bln 18 Hr ) J45.9 - Asthma, unspecified
No. RM : 01-014612 NIK : 3172062201500003 MG
TJHOEI HE (L) JL GADING INDAH RT 11/12 S42.9 - Fracture of shoulder girdle, part RUJUKAN (0116R029) Rumah Sakit
unspecified Hermina
(ORT) Podomoro - (93)
ORTHOPEDI
241 NIK : - Orthopedi
Telah - (0) :
Diberikan
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Kamis : 16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
WONG KHA JOENG, TN (L) JL KELAPA MOLEK NO 02 C4 H25.9 - Senile cataract, unspecified GENTAMISIN SALEP KULIT (0113R034) MEDIROS
T00.9 - Multiple superficial injuries, AMOKSISILIN 500 MG (MAT) MATA - (65) Mata - (0)
242 NIK : 3171020103480001 unspecified METRONIDAZOL 500 MG Telah Diberikan :
2019-09-09 13:37 Hal. 391 dari 1322

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KLORFENIRAMIN MALEAT (CTM) TAB 4 KEMERDEKAAN KAV
MG Telp : 021-4721336
RUJUKAN Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
HJ.TJAHYA CHAERANI MUIN, NY (P) PEGANGSAAN INDAH BARATIII H./28 R42 - Dizziness and giddiness RANITIDIN 150 MG
243 NIK : 3172066503530001
No. RM : 01-049533 BPJS : 0001422561014
YAP GIOK SWAN, NY (P) KELAPA HYBRIDA RAYA PD.14/10 J00 - Acute nasopharyngitis [common cold] VITAMIN B KOMPLEKS
L30.9 - Dermatitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-015243 BPJS : 0001379890383 MG
Tgl Diagnosis : 14 February 2019 2:18 PM SALEP 2-4, KOMBINASI: ASAM
SALISILAT 2 % + BELERANG ENDAP 4 %
IRWAN YENATAN HERYSUSANTO (L) JL. GRIYA PRATAMA 4 BLOK 3 NO20 H25.8 - Other senile cataract RUJUKAN (0903R012) RS KARTIKA
I10 - Essential (primary) hypertension AMLODIPIN 10 MG PULOMAS
(MAT) MATA - (65) Mata - (0)
245 NIK : - VITAMIN B KOMPLEKS Telah Diberikan :
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 10:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 392 dari 1322

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SJARIFINA (P) JL JANUR ELOK III BLOK QE 6 NO 6 RT E11.9 - Non-insulin-dependent diabetes PARASETAMOL TAB 500 MG
Tgl Lahir : 04-Mar-1946 ( 73 Thn 6 Bln 5 Hr ) M10.2 - Drug-induced gout
No. RM : 01-007475 NIK : 3172024403460001 ALOPURINOL 100 MG
GLIBENKLAMIDA 5 MG
LISDA SUTANTO, NY (P) JL JANUR KUNING BLK WS I NO.19 I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
NURHAJATI, NY (P) JL SENTOSAN II NO 15 RT 009/ 010 I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
VITAMIN B KOMPLEKS
248 NIK : 1272030000
No. RM : 01-086030 BPJS : 0000046012285
BONAR FREDERICK POERBA (L) BONGO III H 14 RT 3/08 I11.9 - Hypertensive heart disease without
Tgl Lahir : 26-Jun-1936 ( 83 Thn 2 Bln 14 Hr ) I25.1 - Atherosclerotic heart disease
249 NIK : 3172062606360001
No. RM : 01-000703 BPJS : 0000046156432
MUJI ASTUTY (P) BONGO III H 14 RT 3/08 E11.9 - Non-insulin-dependent diabetes
Tgl Lahir : 21-Oct-1946 ( 72 Thn 10 Bln 19 Hr ) I25.1 - Atherosclerotic heart disease
250 NIK : 3172061002
No. RM : 01-000707 BPJS : 0000046156443
2019-09-09 13:37 Hal. 393 dari 1322

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YENNY WATY JAHYA (P) TPI GG.II/4 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
mellitus without complications HIDROKLORTIAZID 25 MG (INT) PENYAKIT DALAM - (3)
251 NIK : 3172064103420001 VITAMIN B KOMPLEKS Penyakit Dalam :- (0)
Telah Diberikan
No. RM : 01-019330 BPJS : 0001224304064 N17.9 - Acute renal failure, unspecified Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
16:00 - 18:00;17:00 - 20:30
TACC : Tanpa TACC

Alasan TACC :
LEVINA TEHUPURING (P) JL DAHLIA RAYA NO 09 RT 07/03 L30.9 - Dermatitis, unspecified DEKSAMETASON 0,5 MG
252 NIK : 3171055003501001 MG
Tgl Diagnosis : 15 February 2019 9:21 AM GENTAMISIN SALEP KULIT
SUSANTY, NY (P) KLP PUAN 3 BLOK ND 3 NO 1 E10.9 - Insulin-dependent diabetes mellitus NATRIUM DIKLOFENAK TAB 25 MG
without complications RANITIDIN 150 MG
Tgl Lahir : 01-Sep-1945 ( 74 Thn 0 Bln 8 Hr ) M54.5 - Low back pain
253 NIK : 3326164109450002 RUJUKAN
No. RM : 01-048429 BPJS : 0002265323308
TAN SWAN LIEN/LYNDAWATI, NY (P) KLP PUAN TMR 3 ND3/1 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN
without complications
254 NIK : 3173046304670001
No. RM : 01-050640 BPJS : 0002261847216
PRAWOTO (L) JL. INSPEKSI KALI SUNTER NO. 14 I10 - Essential (primary) hypertension AMLODIPIN 10 MG (0114R030) RS PERTAMINA
KEL. KELAPA GADING BARAT KEC. I64 - Stroke, not specified as haemorrhage HIDROKLORTIAZID 25 MG JAYA
255 KELAPA GADING or infarction VITAMIN B KOMPLEKS Telah Diberikan :
No. RM : 01-082202 Faskes : (0114R030) RS
RUJUKAN
Tgl Diagnosis : 15 February 2019 10:12 AM NIK : - PERTAMINA JAYA
2019-09-09 13:37 Hal. 394 dari 1322

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BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
ALEX P SIHOMBING, TN (L) TANAH MERAH 01/07 H40.9 - Glaucoma, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
(MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
HOO TJUIJ ENG (P) JL. EBONI 4 B;LOK AC NO. 30 GRANC I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
ORCHARD M79.1 - Myalgia VITAMIN B KOMPLEKS
No. RM : 01-087243 NIK : - KAPTOPRIL 12,5 MG
ENING SUMARNI (CALON HAJI) (P) JL TEGUH II RT 006/001 H93.1 - Tinnitus NATRIUM DIKLOFENAK TAB 25 MG (0114R030) RS PERTAMINA
M79.1 - Myalgia RUJUKAN JAYA
258 NIK : 3172066801510002 ANTASIDA DOEN Telah Diberikan :
BY PASS
Telp : 0214211913
Kelas : C
2019-09-09 13:37 Hal. 395 dari 1322

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Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
SU TANTO NG, TN (L) KP RAWA INDAH RT 006/003 H25.9 - Senile cataract, unspecified RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
(MAT) MATA - (65) Mata - (0)
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
TAN MERCY LIESCYA (P) JL SUMAGUNG II J 5/6 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
260 NIK : 3172066607560001 RANITIDIN 150 MG
No. RM : 01-047801 BPJS : 0001298458078
DJOENG SUN THIAM (L) JL SUMANGGUNG II 8/2 M79.1 - Myalgia VITAMIN B KOMPLEKS

261 NIK : 3172060206560002
No. RM : 01-039678 BPJS : 0001144048904
RACHMAN EFFENDI, TN (L) JL ANCOL SELATAN RT 9/07 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R029) Rumah Sakit
mellitus without complications METFORMIN TAB 500 MG Hermina Podomoro
(MAT) MATA - (65) Mata - (0)
Tgl Lahir : 30-Jun-1945 ( 74 Thn 2 Bln 9 Hr ) E78.4 - Other hyperlipidaemia
262 NIK : 3172023006450001 GLIBENKLAMIDA 5 MG Telah Diberikan :
No. RM : 01-003754 BPJS : 0002043315617 H25.8 - Other senile cataract Faskes : (0116R029) Rumah
SIMVASTATIN 10 MG
Tgl Diagnosis : 15 February 2019 10:55 AM I10 - Essential (primary) hypertension Sakit Hermina Podomoro
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 396 dari 1322

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AMLODIPIN 10 MG Alamat : JL. DANAU AGUNG 2
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Jumat : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
SRI SUDJATI N.T (P) JL PRIHATIN NO 37 RT 07/02 S20.3 - Other superficial injuries of front wall RUJUKAN (0114R030) RS PERTAMINA
of thorax JAYA
263 NIK : 3172065901490001 Orthopedi
Telah - (0) :
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
J. CHR CHRISTIANNO EMANUELLE, AN (L) JL MELODI MAS RAYA BLOK A8 NO 1 A18.0 - Tuberculosis of bones and joints RUJUKAN (0116R025) Rumah Sakit Firdaus
(PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 09:00 - 12:00,
2019-09-09 13:37 Hal. 397 dari 1322

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10:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
SUHAYNI HERMANTO (P) JL DANAU INDAH XV BLOK B6 NO 08 I11.9 - Hypertensive heart disease without RUJUKAN (0903R012) RS KARTIKA
RT 10/13 (congestive) heart failure PULOMAS
Tgl Lahir : 01-Jan-1940 ( 79 Thn 8 Bln 8 Hr ) M13.9 - Arthritis, unspecified
265 Penyakit
Telah Dalam :- (0)
Diberikan
Tgl Diagnosis : 15 February 2019 11:30 AM BPJS : 0001445750908 KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
ERWANI, NY (P) P REMPANG II NO 5 RT 6/9 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
L30.9 - Dermatitis, unspecified GENTAMISIN SALEP KULIT
No. RM : 01-018034 BPJS : 0000045889108 MG
AMLODIPIN 10 MG
JOHANNES DHARMAWAN (L) VILLA GADING INDAH A4 NO 1 E78.2 - Mixed hyperlipidaemia AMLODIPIN 10 MG
02145850167 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
267 J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-006921 NIK : 3172021607440001 MG
M10.2 - Drug-induced gout
Tgl Diagnosis : 15 February 2019 11:50 AM BPJS : 0001337147043 SIMVASTATIN 10 MG
ALOPURINOL 100 MG
2019-09-09 13:37 Hal. 398 dari 1322

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RINI, NY (P) VILLA GADING INDAH A4 NO 1 G50.1 - Atypical facial pain RUJUKAN (0114R030) RS PERTAMINA
JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Jumat : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
NAOMI YANTI KAMTO, NY (P) JL.SISTER E/12 04/07 M54.56 - Low back pain, lumbar region RUJUKAN (0114R030) RS PERTAMINA
JAYA
269 NIK : 3172066802490003 Orthopedi - (0) :
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Jumat : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SRI IRIYANI (P) JL EKSPORT I BLOK H / 16 E78.2 - Mixed hyperlipidaemia SIMVASTATIN 20 MG
M10.2 - Drug-induced gout VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 399 dari 1322

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ERNA KURNIATI LUKMAN, NY (P) JL. GADING KIRANA TIMUR II B. 8 NO. C50.9 - Malignant neoplasm of breast, RUJUKAN (0116R029) Rumah Sakit
38 unspecified Hermina Podomoro
Tgl Diagnosis : 15 February 2019 12:10 PM BPJS : 0001883909621 Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 08:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
ENNY, NY (P) KP.WARUNG JENGKOL 01/13 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK TAB 25 MG
VITAMIN B KOMPLEKS
No. RM : 01-009938 BPJS : 0001339863344
SRIWATI LUKMAN, NY (P) JL. KELAPA NIAS I BLOK PB-2 E78.2 - Mixed hyperlipidaemia SIMVASTATIN 10 MG
VITAMIN B KOMPLEKS
273 NIK : 3172064909470001
No. RM : 01-012232 BPJS : 0001452336164
LEONNY TRISNADI, NY (P) JLDEWI SINTA BLOK O /9 KGT J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
274 NIK : 3172065901520001 MG
TINAWATI HADI, NY (P) PEGANGSAAN INDAH BARAT L2 RT I25.9 - Chronic ischaemic heart disease, RUJUKAN (0116R029) Rumah Sakit
6/16 unspecified Hermina
(JAN) Podomoro
JANTUNG DAN
275 PEMBULUH
Telah DARAH
Diberikan : - (89)
Tgl Diagnosis : 15 February 2019 1:57 PM BPJS : 0001319925532 DARAH
Sakit - (0) Podomoro
Hermina
BLOK E3 NO 2
2019-09-09 13:37 Hal. 400 dari 1322

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Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Jumat : 17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
RUSFANDI HUSEIN (L) JL JANUR HIJAU XI TR 1/12A RT 003/15 S30.8 - Other superficial injuries of ASAM ASKORBAT (VITAMIN C) 50 MG
abdomen, lower back and pelvis DEKSAMETASON 0,5 MG
MICHAEL WAHYUDI LUZAR, TN (L) KLP NIAS VIPC 14/2 RT 09/017 PGSN II I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
VITAMIN B KOMPLEKS
277 NIK : 3172060512480002
No. RM : 01-072068 BPJS : 0001821983141
HARMAINI (P) JL.PULAU PENYENGAT IV NO.33 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
VITAMIN B KOMPLEKS
278 NIK : 3172065504470002
No. RM : 01-006920 BPJS : 0000045889683
NAURA HAZNA AINI (P) JL KGT I 002/006 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. ANAK (FASE LANJUTAN)
279 NIK : 3172064110131002
No. RM : 02-002895 BPJS : 0002099782517
SUTANDI WIJAYA, TN (L) JL. RAYA KLP NIAS BLK. PB 1/2 PGS II E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R029) Rumah Sakit
mellitus without complications Hermina
(INT) Podomoro
Tgl Lahir : 03-Mar-1948 ( 71 Thn 6 Bln 6 Hr ) I25.1 - Atherosclerotic heart disease
280 NIK : 31720603490001 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
2019-09-09 13:37 Hal. 401 dari 1322

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Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Jumat : 08:00 - 12:00,
09:00 - 11:00;15:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
FITRIA (P) PGS2 RT005/03 F20.0 - Paranoid schizophrenia RISPERIDONE 2MG
HALOPERIDOL 5 MG
MCG
HENRI, TN (L) TAMAN PEGANGSAAN INDAH BLOK G F20.0 - Paranoid schizophrenia RISPERIDONE 2MG
1 NO.2 R05 - Cough TRIHEKSIFENIDIL 2 MG
282 HALOPERIDOL 5 MG
No. RM : 01-001238 NIK : 3172062610780001 AMITRIPTILIN 25 MG
KLORPROMAZIN TAB SAL 100 MG
OBH SIRUP 100 ML
RIRI DAMAN HURI (L) JL RW SENGON RT 8/22 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. II (FASE LANJUTAN)
sputum microscopy with or without culture METFORMIN TAB 500 MG
Tgl Lahir : 03-May-1976 ( 43 Thn 4 Bln 6 Hr ) E11.9 - Non-insulin-dependent diabetes
No. RM : 01-072366 BPJS : 0001313699894 mellitus without complications
VITAMIN B KOMPLEKS
M. MARSONGKO MF, TN (L) jl rawa sengon rt 005/022 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
sputum microscopy with or without culture AMLODIPIN 10 MG
No. RM : 01-076005 BPJS : 0000158268835
APRILIA KUSUMA AYU, NN (P) JL.PUSKESMAS NO.22C 02/06 KGT A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
285 NIK : 3312254204010002
No. RM : 01-073788 BPJS : 0002332883845
2019-09-09 13:37 Hal. 402 dari 1322

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STEVEN RAJA GOMGOM HAMONANGAN (L) JL PASAR SENEN DALAM VI RT A15.0 - Tuberculosis of lung, confirmed by OAT KAT. ANAK (FASE LANJUTAN)
014/004 sputum microscopy with or without culture VITAMIN B KOMPLEKS
No. RM : 01-006252 NIK : 3171040710111003
ADE BELA KOMARA, TN (L) JL PEGANGSAAN DUA RT 04/01 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. II (FASE AWAL)
No. RM : 04-000867 BPJS : 0001741635933
DRA JULIANTY LINTONG (P) janur kuning 8 wn 2/1 I10 - Essential (primary) hypertension AMLODIPIN 5 MG (0114R030) RS PERTAMINA
L30.9 - Dermatitis, unspecified VITAMIN B KOMPLEKS JAYA
288 NIK : - RUJUKAN KULIT KELAMIN: - (0)
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00
TACC : Tanpa TACC

Alasan TACC :
SITI WAHYUNI, NY (P) JANUR INDAH III LA 11 NO. 4 KGB Z00.8 - Other general examinations

289 NIK : 3271024608440001
No. RM : 01-001060 BPJS : 0001285510397
NANI SRI WAHYUNI, NY (P) PULAU BANGKA I N0 1 RT 008/09 H25.8 - Other senile cataract RUJUKAN (0113R074) RS KHUSUS MATA
I10 - Essential (primary) hypertension SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
2019-09-09 13:37 Hal. 403 dari 1322

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Kelas : C
Jumlah Rujukan : 33
Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
SUTATMI (P) TEGUH IV NO.33 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
291 NIK : 3172066008530004 AMLODIPIN 10 MG
TAN KIA MOI, NY (P) APT GADING NIAS RESIDEN F/8 FL H10.9 - Conjunctivitis, unspecified RUJUKAN (0113R074) RS KHUSUS MATA
H52.4 - Presbyopia SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 35
Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
KHOE NJOEN HOA, NY (P) JL SUMAGUNG III S1/18 RT 012/019 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN
without complications RUJUKAN
293 NIK : 3172065904470003
No. RM : 01-015038 BPJS : 0001384825138
2019-09-09 13:37 Hal. 404 dari 1322

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MASNIAR, NY (P) TMN PGS INDAH BLOK D/2 RT 1/19 Z03.0 - Observation for suspected GLISERIL GUAIAKOLAT (GG) 100 MG
294 NIK : 3172065712490004 MG
SANIMIN, TN (L) JL PERINTIS KEMERDEKAAN I10 - Essential (primary) hypertension RETRIBUSI KLINIK LANSIA
J45.9 - Asthma, unspecified HIDROKLORTIAZID 25 MG
295 NIK : 3526111312560001 AMLODIPIN 10 MG
HUSEIN DJAUHARI, BA (L) JL KOMPI UDIN RT 1/1 I50.0 - Congestive heart failure RUJUKAN (0116R027) Rumah Sakit
Mulyasari
(JAN) JANTUNG DAN
296 NIK : - PEMBULUH
Telah DiberikanDARAH
: - (89)
Faskes DAN PEMBULUH
: (0116R027) Rumah
Tgl Diagnosis : 18 February 2019 9:16 AM DARAH - (0)
Sakit Mulyasari
Semper No.19
Telp : 021-43931111
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
MEILARD SAMAD POIRE (L) JL SWASEMBADA BARAT 1/9 RT 18/9 E11.9 - Non-insulin-dependent diabetes GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 29-Jan-1951 ( 68 Thn 7 Bln 11 Hr ) J00 - Acute nasopharyngitis [common cold]
297 NIK : 6171012901510003 MG
No. RM : 01-060751 BPJS : 0000026112846 K02.1 - Caries of dentine ASAM MEFENAMAT KAPS 500
GLIBENKLAMIDA 5 MG
SIMVASTATIN 10 MG
ABDUL MUKTI (L) JL. BELLYRA IV N-21 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J00 - Acute nasopharyngitis [common cold] ANTASIDA DOEN
298 NIK : - K29.7 - Gastritis, unspecified OMEPRAZOL KAPS 20 MG
2019-09-09 13:37 Hal. 405 dari 1322

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MG
FR WIWIEK ISTIATI (P) APT WGP BLOK A NO 10 14 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
299 NIK : 3471125702590001 Penyakit
Telah Dalam :- (0)
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
MARGO WALUYO (L) JL NUSA INDAH RT 8/8 M13.9 - Arthritis, unspecified VITAMIN B KOMPLEKS
300 NIK : 3172060709480001
No. RM : 01-022802 BPJS : 0001276897983
RETNO PURWENI (P) JL NUSA INDAH RT 8/8 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK TAB 25 MG
RANITIDIN 150 MG
No. RM : 01-022803 BPJS : 0001276898411
AMELIA PARUNTU (P) PANIKIINDAHLINGKUNGANX1/1PANIKI K21.9 - Gastro-oesophageal reflux disease OMEPRAZOL KAPS 20 MG
BAWAH without oesophagitis DOMPERIDON TAB 10 MG
Tgl Lahir : 17-Sep-1946 ( 72 Thn 11 Bln 23 Hr ) R50.9 - Fever, unspecified
2019-09-09 13:37 Hal. 406 dari 1322

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NGADIMAN THENARA, TN (L) JANUR KUNING VIII WM I8 RT 6/16 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
303 NIK : 3172060908490004 MG
STEPHANUS JANUARDI RIDWAN, TN (L) TMN PEGS DUA BLOK O/17 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-015224 BPJS : 0001335948423 MG
KAMSIYATI (P) P PENYENGFAT 1 NO 48 RT 8/13 H25.8 - Other senile cataract RUJUKAN (0114R030) RS PERTAMINA
H40.8 - Other glaucoma JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
L.AGUNG JUNAIDI (L) JL JANUR ASRI II BLK QJ 13 NO.1 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
009/012 GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-049689 NIK : - MG
FATUKAH (P) TABAH RAYA I G1 NO 03 RT 01/09 I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
M13.9 - Arthritis, unspecified AMLODIPIN 10 MG
307 NIK : 3201045210450001 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
2019-09-09 13:37 Hal. 407 dari 1322

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FAUZIA DRA. MS (P) JL. PLAMBOYAN BLOK A1/6 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK TAB 25 MG
M13.9 - Arthritis, unspecified ANTASIDA DOEN
No. RM : 01-087799 BPJS : 0000041900488
ENNY MEILANI, NH (P) JL. WESEL BLOK A 13 I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
AMLODIPIN 10 MG
309 NIK : 3172064905520003
No. RM : 01-087203 BPJS : 0001673622472
NEINY N HORMAN (P) JANUR INDAH I LA.2/10 L30.9 - Dermatitis, unspecified RANITIDIN 150 MG
RETRIBUSI KLINIK LANSIA
VITAMIN B KOMPLEKS
HENDRA GUNAWAN,TN (L) JL. MANGGA GG II BLOK A/4 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
VITAMIN B KOMPLEKS
311 NIK : 3172030212490007
No. RM : 01-087791 BPJS : 0001621530562
LIANA LIAUW (P) JL JANUR HIJAU VIII TC 1 NO 9 C34.9 - Malignant neoplasm of bronchus or RUJUKAN (0113R034) MEDIROS
lung, unspecified (PAR) PARU - (94) PARU - (0)
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 08:00 - 10:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 408 dari 1322

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SURYATIE (P) SIMPONI MAS II BLOK B 3 NO 11 E78.4 - Other hyperlipidaemia NATRIUM DIKLOFENAK TAB 25 MG
I10 - Essential (primary) hypertension ANTASIDA DOEN
313 NIK : 3172066211550001 M13.9 - Arthritis, unspecified AMLODIPIN 10 MG
MG
R. OOM SUKMAWIDJAJA (L) JL PULAU REMPANG III NO.9 L30.9 - Dermatitis, unspecified VITAMIN B KOMPLEKS
314 NIK : 3172063006420002 MG
No. RM : 01-083349 BPJS : 0000046013185
HJ. R. AAN HASANAH (P) JL PULAU REMPANG III NO.9 007/009 L29.8 - Other pruritus RUJUKAN (0114R030) RS PERTAMINA
L30.9 - Dermatitis, unspecified JAYA
Telah KELAMIN: - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00
TACC : Tanpa TACC

Alasan TACC :
NURYADI, TN (L) JL KLP MOLEK VII R1 NO 20 I10 - Essential (primary) hypertension RANITIDIN 150 MG
K29.7 - Gastritis, unspecified VITAMIN B KOMPLEKS
316 NIK : 3171041302500002 M10.2 - Drug-induced gout AMLODIPIN 10 MG
No. RM : 01-028662 BPJS : 0001439451461 ALOPURINOL 100 MG
MICHAEL WAHYUDI LUZAR, TN (L) KLP NIAS VIPC 14/2 RT 09/017 PGSN II E78.2 - Mixed hyperlipidaemia HIDROKLORTIAZID 25 MG
I10 - Essential (primary) hypertension SIMVASTATIN 10 MG
317 NIK : 3172060512480002 M10.2 - Drug-induced gout VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 409 dari 1322

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SOETIANTO, TN (L) KLP PUAN TIMUR II NC 2 NO 11 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK TAB 25 MG
08128054579 M54.5 - Low back pain ANTASIDA DOEN
No. RM : 01-018953 NIK : 3172062212530006
JOHANNES RICART SITORUS (L) RT 002/006 PGSN DUA F20.0 - Paranoid schizophrenia HALOPERIDOL 5 MG
No. RM : 01-054331 BPJS : 0002269284164 AMITRIPTILIN 25 MG
MCG
TJIOE SOEY KIM (P) JL KLPA MOLEK VII BLOK MII NO 12A H04.9 - Disorder of lacrimal system, RUJUKAN (0113R034) MEDIROS
unspecified (MAT) MATA - (65) Mata - (0)
Tgl Lahir : 17-Apr-1950 ( 69 Thn 4 Bln 23 Hr ) H25.8 - Other senile cataract
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
NURYADI, TN (L) JL KLP MOLEK VII R1 NO 20 I10 - Essential (primary) hypertension RANITIDIN 150 MG
K29.7 - Gastritis, unspecified VITAMIN B KOMPLEKS
321 NIK : 3171041302500002 M10.2 - Drug-induced gout AMLODIPIN 10 MG
SITI AISYAH, NY (P) JL.TIPAR CAKUNG 09/02 SUKAPURA I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
322 NIK : 372047112570049 MG
SALBUTAMOL 2 MG
2019-09-09 13:37 Hal. 410 dari 1322

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BETSY ANGKASA, NY (P) JL GADING INDAH UTARA IV N39.8 - Other specified disorders of urinary RANITIDIN 150 MG
system PIRIDOKSIN (VITAMIN B6) 10 MG
HUSIN, TN (L) PERUM BUMI ASIH PERMAI JL. E78.0 - Pure hypercholesterolaemia RUJUKAN (0114R030) RS PERTAMINA
MANGGA B7/11 RT. 01/10 CIKARANG I11.9 - Hypertensive heart disease without JAYA
(JAN) JANTUNG DAN
324 KOTA (congestive) heart failure PEMBULUH
Telah DARAH
Diberikan : - (89)
No. RM : 01-001548 J44.9 - Chronic obstructive pulmonary JANTUNG DAN PEMBULUH
Tgl Diagnosis : 18 February 2019 1:47 PM NIK : 1371010206420006 disease, unspecified DARAH - (0) JAYA
PERTAMINA
M13.9 - Arthritis, unspecified Alamat : JL. AHMAD YANI NO. 2
M54.5 - Low back pain BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
HOO TJUIJ ENG (P) JL. EBONI 4 B;LOK AC NO. 30 GRANC E78.4 - Other hyperlipidaemia SIMVASTATIN 10 MG
ORCHARD M10.2 - Drug-induced gout ALOPURINOL 100 MG
No. RM : 01-087243 NIK : -
SOPHIA SOPAMENA, NY (P) JL.BONGO I/F.23 I11.9 - Hypertensive heart disease without RUJUKAN
326 NIK : 3172065606480002
No. RM : 01-032509 BPJS : 0001259721865
ERWANI, NY (P) P REMPANG II NO 5 RT 6/9 E78.4 - Other hyperlipidaemia SIMVASTATIN 10 MG
I10 - Essential (primary) hypertension ALOPURINOL 100 MG
327 NIK : 3172064109490001 M10.2 - Drug-induced gout GENTAMISIN SALEP KULIT
2019-09-09 13:37 Hal. 411 dari 1322

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DJARI SUNARYO, TN (L) JL GADING RAYA I NO 1 RT 001/005 J44.1 - Chronic obstructive pulmonary RUJUKAN (0116R025) Rumah Sakit Firdaus
disease with acute exacerbation, unspecified (PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
STEFANUS FERDINAND.L (L) TANJUNG KATUNG J 21 RT 011/007 F03 - Unspecified dementia RUJUKAN (0114R030) RS PERTAMINA
JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
JESAJA JULIA (L) PELEPAH HIJAU III BLOK TM II NO 6 A15.1 - Tuberculosis of lung, confirmed by RUJUKAN (0114R030) RS PERTAMINA
culture only JAYA
(PAR) PARU - (94) PARU - (0)
2019-09-09 13:37 Hal. 412 dari 1322

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BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
M. F. WIDAJANTI S. (P) JL KLP KOPYOR BRT IIICH2/20 KGT H25.8 - Other senile cataract RUJUKAN (0114R030) RS PERTAMINA
JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SUTRIMO HS (L) JL. KOM BEA CUKAI BLK K7 NO.18 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
332 MG
UTAMININGSIH (P) JL. KOM BEA CUKAI BLK K7 NO.18 M13.9 - Arthritis, unspecified KALSIUM LAKTAT (KALK) 500 MG
005/007 RANITIDIN 150 MG
2019-09-09 13:37 Hal. 413 dari 1322

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ERWIN JONATHAN (L) JL GUNUNG SAHARI I NO.44 B 018/004 M79.26 - Neuralgia and neuritis, unspecified, RUJUKAN (0903R012) RS KARTIKA
lower leg PULOMAS
Telah Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
YUSAK ADRIAN ALFONZ RAHARJA, TN (L) JL KELAPA NIAS VI PB-13/12 Z03.0 - Observation for suspected
tuberculosis
335 NIK : 3172021407870008
No. RM : 01-087658 BPJS : 0001633697267
SUMARTO (L) APT MOI LT 1 NO 15 Z03.0 - Observation for suspected
tuberculosis
336 NIK : 312042705621001
No. RM : 03-001336 BPJS : 0001786620093
SUKITO DJAMARI, TN (L) JL.GAMBANG P25 KELAPA GADING Z03.0 - Observation for suspected
BCS tuberculosis
337
No. RM : 01-003233 NIK : 3173041605620002
MASNIAR, NY (P) TMN PGS INDAH BLOK D/2 RT 1/19 Z03.0 - Observation for suspected
tuberculosis
338 NIK : 3172065712490004
No. RM : 01-023201 BPJS : 0001838056061
2019-09-09 13:37 Hal. 414 dari 1322

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YAYAT ISMAWAN (L) KP. RAWA INDAH Z03.0 - Observation for suspected
tuberculosis
339 NIK : 3172041212941006
No. RM : 01-085642 BPJS : 0001645491341
SEK KHENG (P) JL. TOMANG TANAH TINGGI 11/28 N04.8 - Nephrotic syndrome, other (0903R012) RS KARTIKA
PULOMAS
340 NIK : - Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 252 BPJS : 0001821550252 Faskes : (0903R012) RS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
RUDIYANTO LOEIS (L) JL.GADING RIVIERA II PF-26/9 I25.1 - Atherosclerotic heart disease RUJUKAN (0905R004) RS ISLAM JKT
J44.1 - Chronic obstructive pulmonary SUKAPURA
(PAR) PARU - (94) PARU - (0)
341 NIK : 3172062503410001 disease with acute exacerbation, unspecified Telah Diberikan :
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 07:30 - 09:00,
08:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 415 dari 1322

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endang winarti (P) JL KEMPUL BLOK O RRT 4/9 H40.9 - Glaucoma, unspecified RUJUKAN (0113R034) MEDIROS
(MAT) MATA - (65) Mata - (0)
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
LIE SHAN MIE, NY (P) JANUR KUNING VI WK 1/20 H25.9 - Senile cataract, unspecified RUJUKAN (0113R074) RS KHUSUS MATA
H52.4 - Presbyopia SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 46
Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
MUHAMAD TOHA, TN (L) KP RAWA INDAH RT 007/003 PGS II I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
344 NIK : 3172061705460001 MG
Tgl Diagnosis : 25 February 2019 9:10 AM HIDROKLORTIAZID 25 MG
2019-09-09 13:37 Hal. 416 dari 1322

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HENDRA HARTANTO (L) APRT WGP TOWER C LT 20NO.10 D23.4 - Other benign neoplasm of skin of RUJUKAN (0116R029) Rumah Sakit
011/020 scalp and neck RUJUKAN Hermina Podomoro
Tgl Lahir : 23-May-1949 ( 70 Thn 3 Bln 17 Hr ) R59.1 - Generalized enlarged lymph nodes
Telah Diberikan
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
09:00 - 11:00;16:00 - 18:00, 20:00
- 22:00
TACC : Tanpa TACC

Alasan TACC :
J.C ROMPAS, TN (L) JL PASAR INPRES NO 54 RT 006/006 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK TAB 25 MG
M54.5 - Low back pain RANITIDIN 150 MG
346 NIK : 3276102310460001 AMLODIPIN 10 MG
No. RM : 01-016902 BPJS : 0001225569892
RATNA DJUWITA (P) PELEPAH INDAH 1 BLK. LA. 7/19 L30.9 - Dermatitis, unspecified KAPTOPRIL 25 MG
347 NIK : 3515185207490004 MCG
Tgl Diagnosis : 25 February 2019 9:26 AM ALOPURINOL 100 MG
TJAWIR TARIGAN, TN (L) PULAU SIAUW E18 NO 9 RT 015/003 I10 - Essential (primary) hypertension RUJUKAN (0905R004) RS ISLAM JKT
N43.3 - Hydrocele, unspecified AMLODIPIN 10 MG SUKAPURA
348 NIK : 3172061808440004 SIANOKOBALAMIN (VITAMIN B12) 50 (0)
Telah Diberikan :
No. RM : 01-006279 BPJS : 0000046019935 MCG Faskes : (0905R004) RS ISLAM
Tgl Diagnosis : 25 February 2019 9:39 AM RUJUKAN JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
2019-09-09 13:37 Hal. 417 dari 1322

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Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 08:00 - 14:00,
15:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
ABDUL MUSYAYAB, TN (L) KP PULO GADUNG GG Q NO.31 K29.7 - Gastritis, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
002/005 MCG
Tgl Lahir : 30-Dec-1947 ( 71 Thn 8 Bln 10 Hr ) RETRIBUSI KLINIK LANSIA
349
No. RM : 01-009547 NIK : 3172063012470002
SONDANG TA HARAHAP, SH. MM (P) TARIAN RAYA BRT C-VIII/4 RT 3/11 H04.9 - Disorder of lacrimal system, RUJUKAN (0113R074) RS KHUSUS MATA
unspecified RUJUKAN SMEC
(MAT) MATA - (65) Mata - (0)
Tgl Lahir : 09-Dec-1952 ( 66 Thn 9 Bln 0 Hr ) H25.9 - Senile cataract, unspecified
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 50
Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
CECILIA JULIANTI TJAHJONO (P) JL. KOMP BEA CUKAI, JL SUNDA H25.9 - Senile cataract, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
KELAPA BLOK O V NO 9 (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
2019-09-09 13:37 Hal. 418 dari 1322

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Kapasitas : 0
Jadwal : Senin : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
CIOE LEH CU, NY (P) KELAPAMPUAN TIMUR III NP 4/30 RT I11.9 - Hypertensive heart disease without RUJUKAN
10/12 (congestive) heart failure
352
No. RM : 01-009757 NIK : 3172066709450002
ETTY MARYATI (P) JANUR ASRI 3 QJ 14 NO 5 I11.9 - Hypertensive heart disease without RUJUKAN (0905R004) RS ISLAM JKT
(congestive) heart failure SUKAPURA
(JAN) JANTUNG DAN
Tgl Lahir : 27-Oct-1956 ( 62 Thn 10 Bln 13 Hr ) I25.1 - Atherosclerotic heart disease
353 NIK : 3172066710560003 PEMBULUH
: - (89)
Faskes DAN PEMBULUH
: (0905R004) RS ISLAM
JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
ASNAWATY, NY (P) JL PULO PENYENGAT II NO 24 RT I10 - Essential (primary) hypertension RANITIDIN 150 MG (0114R030) RS PERTAMINA
006/003 K29.7 - Gastritis, unspecified PIRIDOKSIN (VITAMIN B6) 10 MG JAYA
354 L30.9 - Dermatitis, unspecified RUJUKAN KULIT KELAMIN: - (0)
Telah Diberikan
AMLODIPIN 10 MG
RUJUKAN
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00
2019-09-09 13:37 Hal. 419 dari 1322

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TACC : Time
ELYDIA NURKASIH, NY (P) KEALPA PUAN TIMUR I NC.2/22 E11.4 - Non-insulin-dependent diabetes RUJUKAN (0905R004) RS ISLAM JKT
mellitus with neurological complications SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Senin : 07:30 - 13:30,
15:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
TJHIN KUI DJUNG, NY (P) JL KELAPA NIAS 11 PE 4 NO 7 C50.9 - Malignant neoplasm of breast, RUJUKAN (0116R025) Rumah Sakit Firdaus
unspecified RUJUKAN (BED) BEDAH - (16) Bedah - (0)
Tgl Lahir : 22-Jun-1952 ( 67 Thn 2 Bln 18 Hr ) D05.9 - Carcinoma in situ of breast,
No. RM : 01-023967 BPJS : 00001792815006 unspecified Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 06:00 - 07:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 420 dari 1322

P : 021-45853300 F : 021-45853301
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PANTUN SILITONGA (L) RAWA SENBGON RT. 006/022 BLK. F N40 - Hyperplasia of prostate RUJUKAN (0116R025) Rumah Sakit Firdaus
NO. 51 (URO) UROLOGI - (88) Urologi -
357 (0)
Telah Diberikan :
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 16:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
SRI SURIANI (P) APT PALADIAN PARK TWR F 502 RT I10 - Essential (primary) hypertension SIANOKOBALAMIN (VITAMIN B12) 50
04/020 M13.9 - Arthritis, unspecified MCG
Tgl Lahir : 06-Aug-1936 ( 83 Thn 1 Bln 3 Hr ) HIDROKLORTIAZID 25 MG
358
No. RM : 01-013761 NIK : 3173064608360002
EVELINE STIABUDI (P) PULOMAS UTARA III E / 12 RT 2/14 R51 - Headache PARASETAMOL TAB 500 MG
359 NIK : 3175026909480003 MCG
No. RM : 01-007998 BPJS : 0001792519593
TIMOTIUS CHANDRA, TN (L) JL. KLP GADING ELOK NARAT I CC 2 M54.57 - Low back pain, lumbosacral region RUJUKAN (0114R030) RS PERTAMINA
NO 12 A JAYA
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00, 13:
2019-09-09 13:37 Hal. 421 dari 1322

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00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
TJEN LOEI KHENG, NY (P) KLP HIBRIDA XI RA 30/2 RT. 010/015 H52.4 - Presbyopia RUJUKAN (0116R025) Rumah Sakit Firdaus
PGS II I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG (MAT) MATA - (65) Mata - (0)
361 R05 - Cough KLORFENIRAMIN MALEAT (CTM) TAB 4 Telah Diberikan :
No. RM : 01-000902 NIK : 3172065010520002 MG Faskes : (0116R025) Rumah
Tgl Diagnosis : 25 February 2019 11:28 AM BPJS : 0001225823117 ASAM ASKORBAT (VITAMIN C) 50 MG Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
HANNY A RUNTU, TN (L) TAMAN PEGANGSAAN INDAH F/21 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
K29.7 - Gastritis, unspecified RANITIDIN 150 MG
H M SANUSI TASLIM, TN (L) JL GADING MAS TMR II BLK F-IV/29 RT I11.9 - Hypertensive heart disease without RUJUKAN (0116R021) Royal Progress
012/010 (congestive) heart failure (JAN) JANTUNG DAN
Tgl Lahir : 09-Sep-1940 ( 79 Thn 0 Bln 0 Hr ) I25.1 - Atherosclerotic heart disease
363 PEMBULUH DARAH
No. RM : 01-027705 NIK : 3172060909400005 JANTUNG
Faskes DAN PEMBULUH
: (0116R021) Royal
Progress- (0)
UTARA
Telp : 021-6400261
Kelas : B
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00, 09:
2019-09-09 13:37 Hal. 422 dari 1322

P : 021-45853300 F : 021-45853301
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30 - 17:00
TACC : Tanpa TACC

Alasan TACC :
JEFFRI AGUS (L) JL.KELAPA NIAS IX PA.24/15 C76.2 - Malignant neoplasm of abdomen RUJUKAN (0114R054) RS HERMINA
K92.0 - Haematemesis KEMAYORAN
(BED) BEDAH - (18) Bedah
364 NIK : 3172063011570001 R19.0 - Intra-abdominal and pelvic swelling, Digestif
Telah - (0)
Diberikan :
No. RM : 01-071775 BPJS : 0001457152852 mass and lump Faskes : (0114R054) RS
Tgl Diagnosis : 25 February 2019 11:39 AM HERMINA KEMAYORAN
Alamat : JALAN SELANGIT BLOK
B10 KAV 4
Telp : 021-22602525
Kelas : B
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
TJHIA BUN KWANG, TN (L) JL KELAPA MOLEK V Z 2/15 RT 09/19 E11.9 - Non-insulin-dependent diabetes SIANOKOBALAMIN (VITAMIN B12) 50
mellitus without complications MCG
Tgl Lahir : 05-May-1947 ( 72 Thn 4 Bln 4 Hr ) I10 - Essential (primary) hypertension AMLODIPIN 10 MG
365 NIK : 3172060505470002
No. RM : 01-008481 BPJS : 0001788362447 METFORMIN TAB 500 MG
SUTASMI, NY (P) JL.KUNING MAS D-4/5 RT 018/10 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN (0116R025) Rumah Sakit Firdaus
without complications (INT) PENYAKIT DALAM - (3)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00, 13:
2019-09-09 13:37 Hal. 423 dari 1322

P : 021-45853300 F : 021-45853301
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30 - 16:30;16:00 - 18:00, 18:00 -
20:00
TACC : Tanpa TACC

Alasan TACC :
SANTI GUNAWAN, NY (P) VILLA GADING INDAH BLOK O 17 L50.8 - Other urticaria DEKSAMETASON 0,5 MG
KODAMAR BEDAK SALISIL 2 %
367 RETRIBUSI KLINIK LANSIA
TRI WIJOKONGKO (L) JL PULAU BENGKALIS NO.16 010/03 I10 - Essential (primary) hypertension SIANOKOBALAMIN (VITAMIN B12) 50
KGB R05 - Cough MCG
Tgl Lahir : 19-Jan-1939 ( 80 Thn 7 Bln 21 Hr ) AMLODIPIN 10 MG
368
OBH SIRUP 100 ML
BAMBANG HARIJANTO GUNAWAN, TN (L) JL KELAPA NIAS XIII PD 12/7 RT E10.9 - Insulin-dependent diabetes mellitus RUJUKAN
004/018 without complications
369
No. RM : 01-006455 NIK : 3172060410550002
HANDOKO FARIADY, TN (L) GADING MAS TIMUR BLK. B4/34 I25.1 - Atherosclerotic heart disease RANITIDIN 150 MG
K29.7 - Gastritis, unspecified RUJUKAN
370 NIK : 3172060601490001
No. RM : 01-000636 BPJS : 0001312781826
HERAWATI NURDJAJA, NY (P) KLP PUYUH V KB 7 RT 4/9 H40.1 - Primary open-angle glaucoma RUJUKAN (0113R074) RS KHUSUS MATA
SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 79
2019-09-09 13:37 Hal. 424 dari 1322

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Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
VERNNY TRISNADI, NY (P) JL GAMBANG BLK P 34 006/007 E78.4 - Other hyperlipidaemia RUJUKAN (0114R030) RS PERTAMINA
S00.9 - Superficial injury of head, part SIMVASTATIN 20 MG JAYA
372 NIK : 3172066206580004 unspecified SIANOKOBALAMIN (VITAMIN B12) 50 Telah Diberikan :
No. RM : 01-033169 BPJS : 0001722761098 MCG Faskes : (0114R030) RS
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
KAIMANA P M L LAPIAN (L) JL. TERATAI NO 04 I10 - Essential (primary) hypertension GENTAMISIN SALEP KULIT
L30.9 - Dermatitis, unspecified BETAMETASON 0,1%,KRIM
373 NIK : - KALSIUM LAKTAT (KALK) 500 MG
No. RM : 01-088514 BPJS : 0002332834378
SITI AMINAH (P) JL. PEGANGSAAN 2 I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
ANTASIDA DOEN
374 NIK : 3172064804550002
No. RM : 01-087275 BPJS : 0002135142731
ASRORY B MUSTAJAB.TN (L) JL. WARUNG JENGKOL 003/013 M13.9 - Arthritis, unspecified ANTASIDA DOEN
ALOPURINOL 100 MG
No. RM : 01-048913 BPJS : 0001128881171 PIROKSIKAM 10 MG
2019-09-09 13:37 Hal. 425 dari 1322

P : 021-45853300 F : 021-45853301
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NURJATI, NY (P) GADING INDAH UTR 4 NH7/12 023/012 I64 - Stroke, not specified as haemorrhage RUJUKAN (0903R012) RS KARTIKA
PGS II or infarction PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SRI MURTI (P) JL ALMUHABAB RT 09/09 R05 - Cough PARASETAMOL TAB 500 MG
No. RM : 01-073883 BPJS : 0001139382999 MG
SANTI YULIANA SARI (P) GADING GRIYA LESTARI G.1/45 L30.9 - Dermatitis, unspecified BETAMETASON 0,1%,KRIM
LORATADIN 10 MG
No. RM : 01-028145 BPJS : 0001318022594
LAKSMI DEWI TEDJAGIRI (P) JL. CENGKIR TMR I ED 2 NO 9 N20.2 - Calculus of kidney with calculus of RUJUKAN (0116R025) Rumah Sakit Firdaus
ureter (URO) UROLOGI - (88) Urologi -
379 NIK : 3172066608590002 (0)
Telah Diberikan :
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 16:00 - 21:00
2019-09-09 13:37 Hal. 426 dari 1322

P : 021-45853300 F : 021-45853301
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TACC : Tanpa TACC

Alasan TACC :
MUHAMMAD YUSRIZAL (L) JL TANGGUH RT005/02 A15.4 - Tuberculosis of intrathoracic lymph RUJUKAN (0114R030) RS PERTAMINA
nodes, confirmed bacteriologically and JAYA
(PAR) PARU - (94) PARU - (0)
Tgl Lahir : 16-Jun-1977 ( 42 Thn 2 Bln 24 Hr ) histologically
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SRI REJEKI (P) INPEKSI KALI SUNTER RT005/004 I11.9 - Hypertensive heart disease without RUJUKAN (0114R030) RS PERTAMINA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 427 dari 1322

P : 021-45853300 F : 021-45853301
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HO SIM KHIAN, TN (L) JL BOULEVARD RAYA BLK QJ I NO.7 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-014030 BPJS : 0001454210054 MG
DEKSAMETASON 0,5 MG
CHINDY FITRIA NINGRUM (P) JL PRIHATIN NO 10 RT 7/02 S32.20 - Fracture of coccyx, closed RUJUKAN (0114R030) RS PERTAMINA
JAYA
383 NIK : 3172066007991002 Orthopedi - (0) :
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
HASANUDIN, TN (L) KGT RT 2/4 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
VITAMIN B KOMPLEKS
384 NIK : 3172062805700003 AMLODIPIN 5 MG
No. RM : 01-065064 BPJS : 0001136848184
JIHAN DIWA SABRINA (P) GG PERINTIS I 001/004 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
385 NIK : 3171034309040008 MG
ANTASIDA DOEN
2019-09-09 13:37 Hal. 428 dari 1322

P : 021-45853300 F : 021-45853301
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ITOH MASITOH, AN (P) JL INSPEKSI KALI SUNTER RT 09/013 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
NO 412 GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-013796 NIK : 3172064401040003 MG
NUNUNG BINTI CAYA, NY (P) INSFEKSI KALI SUNTER RT. 09/13 NO. E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
412 KGB mellitus without complications GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 01-Aug-1969 ( 50 Thn 1 Bln 8 Hr ) J00 - Acute nasopharyngitis [common cold]
No. RM : 01-001029 NIK : 3172064808690003 MG
KEZIA WOWOR, NN (P) JL S.MAHAKAM II 011/001 J30.4 - Allergic rhinitis, unspecified PARASETAMOL TAB 500 MG
388 NIK : 3172044308900005 MG
LUGIYEM (P) JL H OYAR RT 04/02 I10 - Essential (primary) hypertension AMLODIPIN 5 MG

No. RM : 01-020747 BPJS : 0002140748943 MG
VITAMIN B KOMPLEKS
GERTRUIDA NELWAN, NY (L) JL H KAMANG NO 34 RT 007/010 E78.2 - Mixed hyperlipidaemia SIMVASTATIN 20 MG
I10 - Essential (primary) hypertension ALOPURINOL 100 MG
390 NIK : 3174064804650002 M10.2 - Drug-induced gout VITAMIN B KOMPLEKS
No. RM : 01-003065 BPJS : 0002519401353
ANGELINA SRININGSIH (P) PANDA LESTARI I/1 RT 2/9 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
391 NIK : 3172045508930002 MG
2019-09-09 13:37 Hal. 429 dari 1322

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MUHAMMAD SYAHRONI, TN (L) JL GADINGV V NO 10 RT 004/005 Z48.9 - Surgical follow-up care, unspecified RUJUKAN (0903R012) RS KARTIKA
PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Selasa : 18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
ADWAN (L) DUSUN BANTASARI 004/001 E78.4 - Other hyperlipidaemia NATRIUM DIKLOFENAK TAB 25 MG
L30.9 - Dermatitis, unspecified SIMVASTATIN 10 MG
393 NIK : 3304031704830002 LORATADIN 10 MG
DARMAN (L) GG. L NO. 22 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
VITAMIN B KOMPLEKS
394 NIK : -
No. RM : 01-088479 BPJS : 0001293831055
SANTY IRAWATI TJANDRA, NY (P) JL. PELEPAH INDAH II LA 22 NO. 08 M79.1 - Myalgia DOKTER UMUM
R05 - Cough PARASETAMOL TAB 500 MG
MG
SUTRIYAH, NY (P) JL. JANUR HIJAU 3 BLOK TH2 NO. 1 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
396 NIK : 3308185101790004
No. RM : 01-086316 BPJS : 0002244174164
2019-09-09 13:37 Hal. 430 dari 1322

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ARIS FIRDAUS (L) JL PULAU PENYENAGT I NO 46 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
ANTASIDA DOEN
397 NIK : 3172062205800004
No. RM : 01-026368 BPJS : 0001789008232
SADAM DINO SUTRISNO, AN (L) JL. ASRAMA PEMADAM A90 - Dengue fever [classical dengue] PARASETAMOL TAB 500 MG
No. RM : 01-085740 BPJS : 0000204915442 MG
NAOMI MIKHAILA NGURU DIOE (P) JL TERATAI BNO 06/ R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
399 NIK : - ASAM ASKORBAT (VITAMIN C) 50 MG
No. RM : 01-054543 BPJS : 0001767030862
J. SUSANTO WARDOYO (L) KOMP NO.4 RT 004/006 G40.9 - Epilepsy, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG (0113R034) MEDIROS
J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4 (SAR) SARAF - (76) Saraf - (0)
400 NIK : 3172061509650007 MG Telah Diberikan :
No. RM : 01-003790 BPJS : 0001225786689 VITAMIN B KOMPLEKS Faskes : (0113R034) MEDIROS
Tgl Diagnosis : 27 February 2019 8:51 AM RUJUKAN Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
Iis Aisah (P) P.KEMERDEKAAN RT 004/011 KGB R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
401 NIK : - tuberculosis MG
No. RM : 01-065339 BPJS : 0001658930152
2019-09-09 13:37 Hal. 431 dari 1322

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QYLAW SYAHARA (P) JL KAYU JATI V 003/005 J45.9 - Asthma, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
402 NIK : 3175026809101008 MG
No. RM : 01-044251 BPJS : 0001200453366 SALBUTAMOL 2 MG
VITAMIN B KOMPLEKS
MICHAL LUKAS (P) JL JANUR KUNING 6 BLOK WL 2 NO 16 M79.1 - Myalgia RANITIDIN 150 MG
RT 4/16 VITAMIN B KOMPLEKS
403 NATRIUM DIKLOFENAK TAB 25 MG
No. RM : 01-014671 NIK : 31720670089640003
AISAH (P) JL PERINTIS KEMERDEKAAN K59.0 - Constipation

K59.8 - Other specified functional intestinal
404 NIK : 3172064407680001 disorders
No. RM : 01-025844 BPJS : 0001224515957
AHID PADILAH, TN (L) JL TEMBONGRAJA J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
No. RM : 01-088711 BPJS : 0002097506349 MG
DOKTER UMUM
AMOKSISILIN 500 MG
HASTUTI ANGGRAINI, NY (P) JL. PERINTISA KEMERDEKAAN R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
406 NIK : -
No. RM : 01-088712 BPJS : 0001467836526
SUHADI, TN (L) JL PERINTIS KEMERDEKAAN RT 05/04 I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
M79.1 - Myalgia KALSIUM LAKTAT (KALK) 500 MG
407 NIK : 3172061001094952 AMLODIPIN 10 MG
No. RM : 01-010772 BPJS : 0001226389983
2019-09-09 13:37 Hal. 432 dari 1322

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NASIFAH PUTRI N (P) TANAH MERAH RT 02/14 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
408 NIK : 312036111111001 MG
No. RM : 01-027308 BPJS : 0001287948936 DOKTER UMUM
YOSEPH GATOT (L) APT GADING NIAS RESIDENCE P 10 H40.9 - Glaucoma, unspecified NATRIUM DIKLOFENAK TAB 25 MG
PC RT 2/03 M54.5 - Low back pain ANTASIDA DOEN
409 Q85.1 - Tuberous sclerosis
No. RM : 01-002164 NIK : 3172062410810002
F.A ANTONY YUSWANTO (L) JL JANUR INDAH XIV LB 19/12 RT 08/18 B00.9 - Herpesviral infection, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 04-Oct-1960 ( 58 Thn 11 Bln 5 Hr ) ASIKLOVIR 400 MG
410 NIK : 3275110410600001
No. RM : 01-012622 BPJS : 0000038769873 ASIKLOVIR KRIM 5%
WANG CHING (P) JL KAYU MANIS RT 08/12 H93.9 - Disorder of ear, unspecified KLORAMFENIKOL TT 3%
No. RM : 01-014394 BPJS : 0001301630894 MG
TINCE RANGKUTI, NY (P) PPI BLOK BB 30 NO 4 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
No. RM : 01-026063 BPJS : 0002746334057 MG
AMLODIPIN 10 MG
ADZRA NUR DZAKIRA (P) SUKIA MULYA VI RT 8/01 L30.9 - Dermatitis, unspecified DOKTER UMUM
413 NIK : - MG
ENDAH MULYANINGSIH, AN (P) RW INDAH RT 03/03 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
414 NIK : 3203105810090004 MG
TRIMETOPRIM 80 MG)
2019-09-09 13:37 Hal. 433 dari 1322

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BROMHEKSIN HCL SOL 2MG/ML 50 ML
SULIATI, NN (P) JL. PGS II D64.9 - Anaemia, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
KOMBINASI BESI (II) SULFAT 200 MG, (INT) PENYAKIT DALAM - (3)
415 NIK : 3172064308010001 ASAM FOLAT 0,25 MG Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 01-084521 BPJS : 0000377997401 ANTASIDA DOEN Faskes : (0116R025) Rumah
Tgl Diagnosis : 27 February 2019 1:39 PM RUJUKAN Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
18:00 - 20:00;18:00 - 21:00
TACC : Time
Alasan TACC : >= 3 - 7 Hari
ANGGELA, (P) JL JANUR ASRI IV QJ 17/11 E78.0 - Pure hypercholesterolaemia TRIFLUPERAZINE 5MG
F20.0 - Paranoid schizophrenia DIAZEPAM 5 MG
416 NIK : 3172066906650004 AMITRIPTILIN 25 MG
No. RM : 01-034284 BPJS : 0002215724477 ISOSORBID DINITRAT 5 MG
SARANA ENDANG KUSWANDI, TN (P) RW SENGON RT 12/14 K30 - Dyspepsia DOMPERIDON TAB 10 MG
No. RM : 01-039457 BPJS : 0001603218881
YUSMAWATI (P) KP SUKPURA GG SALON 009/003 M79.77 - FIBROMYALGIA, ANKLE AND DEKSAMETASON 0,5 MG
FOOT ASAM MEFENAMAT KAPS 500
418 NIK : 3172044501660008
No. RM : 01-020323 BPJS : 0001313660801
2019-09-09 13:37 Hal. 434 dari 1322

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YANI HARYANI, NY (P) JL. HIBRIDA NO 6 RA 17 NO 7 KLP K30 - Dyspepsia OMEPRAZOL KAPS 20 MG
GADING DOMPERIDON TAB 10 MG
419 AMLODIPIN 10 MG
No. RM : 01-088741 NIK : 3207185206720006
ANISA SABIRIN AULIA (P) KONDOMINIUM LT.2 J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
420 NIK : 3172014503131012 MG
VLORA AULIA SYAKIA (P) RAWA SENGON 07/22 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG

421 NIK : 3172015908061001
No. RM : 01-045252 BPJS : 0001286126616
dr. Lilianawati
IRA KURNIAWATI, NY (P) PERUM WALI KOTA. JL SUTRA UNGU O82.9 - Delivery by caesarean section, RUJUKAN (0114R030) RS PERTAMINA
BLOK D 6 NO 31 unspecified JAYA
1 Telah Diberikan :
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Jumat : 11:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
MUAROHMAH, NY (P) DK. SITATAH A O20.9 - Haemorrhage in early pregnancy, RUJUKAN (0905R004) RS ISLAM JKT
unspecified SUKAPURA
2019-09-09 13:37 Hal. 435 dari 1322

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5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
09:00 - 12:00;13:00 - 20:00, 14:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
UNTARI, NY (P) RAWA SENGON RT 03/22 O99.0 - Anaemia complicating pregnancy, RUJUKAN (0905R003) RS PELABUHAN
childbirth and the puerperium KOMBINASI BESI (II) SULFAT 200 MG, JAKARTA
3 NIK : 3172066207820004 ASAM FOLAT 0,25 MG Telah Diberikan :
No. RM : 01-000289 BPJS : 0001225599557 KALSIUM LAKTAT (KALK) 500 MG Faskes : (0905R003) RS
Tgl Diagnosis : 04 February 2019 9:24 AM SIANOKOBALAMIN (VITAMIN B12) 50 PELABUHAN JAKARTA
MCG Alamat : JL. KRAMAT JAYA NO.1
ASAM ASKORBAT (VITAMIN C) 50 MG Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00,
14:30 - 19:00;16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
SULIKAH (P) RAWA SENGON BLOK F NO.21 06/022 O48 - Prolonged pregnancy RUJUKAN (0116R025) Rumah Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
2019-09-09 13:37 Hal. 436 dari 1322

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Jadwal : Senin : 12:00 - 17:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
ROS KURNIAWATI, NY (P) TANAH RENDAH 06/02 PGI Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
unspecified TIAMIN (VITAMIN B1) 50 MG
IFLAHAH ZUHRIYATEN, NY (P) JL INPEKSI KALI SUNTER RT 4 R 4 NO N91.2 - Amenorrhoea, unspecified RUJUKAN (0905R004) RS ISLAM JKT
14 SUKAPURA
6 Telah Diberikan :
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
09:00 - 12:00;13:00 - 20:00, 14:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
FELISHA SHEZA RIYADI MECCA (P) KOMPLEK BEA CUKAI BLOK C.7/26 L20.9 - Atopic dermatitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
010/007 SUKAPURA MG
Tgl Lahir : 01-Feb-2018 ( 1 Thn 7 Bln 8 Hr ) DEKSAMETASON 0,5 MG
7
No. RM : 01-064249 NIK : 3172044102180004 HIDROKORTISON KRIM 2,5 %
AZKA GIBRAN SETYAWAN (L) GOTONG ROTONG NO 11 RT 9/7 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-006874 BPJS : 0002097449943 MCG
2019-09-09 13:37 Hal. 437 dari 1322

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MG
AMBROKSOL TAB 30 MG
JACINDA QUEENCY SHIEERA HUTAGAOL, JL TABAH I J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 26-May-2015 ( 4 Thn 3 Bln 14 Hr ) AMBROKSOL TAB 30 MG
9 NIK : 3525156605150001
No. RM : 01-040194 BPJS : 0002075442118
MUHAMMAD SHADID PRASETYO, AN (L) PGS II 006/002 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-049792 BPJS : 0002476971538 MCG
MG
AMBROKSOL TAB 30 MG
DEKSAMETASON 0,5 MG
JULIA SORABA (P) PGS II RT 03/04 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
No. RM : 01-014443 BPJS : 0001607832538 MG
MCG
DR. LILIANAWATI (P) JL KELAPA HIBRIDA II BLK RB 5/6 E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 20 MG
017/015 ASAM FOLAT 1 MG
12
No. RM : 01-013099 NIK : 3172064511600005
ERNI NOFIANTI, NY (P) PEGANGSAAN DUA 01/04 P05.9 - Slow fetal growth, unspecified KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
Tgl Lahir : 26-Nov-1984 ( 34 Thn 9 Bln 14 Hr ) SIANOKOBALAMIN (VITAMIN B12) 50
13 NIK : 3172066611840002
No. RM : 01-073787 BPJS : 0001225747157 MCG
2019-09-09 13:37 Hal. 438 dari 1322

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RUSTI AGUSTINA, NY (P) RAWA SENGON 01/22 O32.9 - Maternal care for malpresentation of RUJUKAN (0116R025) Rumah Sakit Firdaus
fetus, unspecified (OBG) OBGYN - (19) obgyn - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
EVIANAH, NY (P) RAWA INDAH RT 03/03 PGS II O43.9 - Placental disorder, unspecified RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 08:00 - 12:00,
08:00 - 12:00;13:00 - 20:00, 14:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
NENG ANASIH (P) JL PERINTIS NO 34 RT011/004 KGB O20.9 - Haemorrhage in early pregnancy, RUJUKAN (0116R025) Rumah Sakit Firdaus
unspecified (OBG) OBGYN - (19) obgyn - (0)
2019-09-09 13:37 Hal. 439 dari 1322

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KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
SITI WARSIH, NY (P) KGT RT 01 RW 04 Z34.0 - Supervision of normal first ASAM FOLAT 1 MG
pregnancy TIAMIN (VITAMIN B1) 50 MG
LINAH, NY (P) JL RAWA BADAK 11-008 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
SARIPAH,NY (P) KP PULO GADUNG RT 04/05 N30.9 - Cystitis, unspecified RUJUKAN (0114R030) RS PERTAMINA
Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG, JAYA
19 NIK : 3172067105810004 unspecified ASAM FOLAT 0,25 MG Telah Diberikan :
No. RM : 01-000364 BPJS : 0002032563104 KALSIUM LAKTAT (KALK) 500 MG Faskes : (0114R030) RS
Tgl Diagnosis : 06 February 2019 12:49 PM SIANOKOBALAMIN (VITAMIN B12) 50 PERTAMINA JAYA
MCG Alamat : JL. AHMAD YANI NO. 2
AMOKSISILIN 500 MG BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 11:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 440 dari 1322

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DEWI EFRIYANI (P) TANAH MERAH RT 008/007 O82.9 - Delivery by caesarean section, KOMBINASI BESI (II) SULFAT 200 MG, (0116R025) Rumah Sakit Firdaus
unspecified ASAM FOLAT 0,25 MG (OBG) OBGYN - (19) obgyn - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
FITRI, NY (P) APRT GD NIAS RESIDENCES UNIT KD O14.9 - Pre-eclampsia, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
RUJUKAN (OBG) OBGYN - (19) obgyn - (0)
21 NIK : 3175026206850003 RETRIBUSI KLINIK KIA Telah Diberikan : Anamnesis (S) :
No. RM : 01-086672 BPJS : 0002332855809 - kontrol hamil - kel : bengkak -
Tgl Diagnosis : 06 February 2019 3:32 PM ASAM FOLAT 0,25 MG Pemeriksaan (O) : - ku : baik - tfu
KALSIUM LAKTAT (KALK) 500 MG : 32 cm - djj : 145 x/mnt - prot urin
SIANOKOBALAMIN (VITAMIN B12) 50 : +1 A : G1P0A0 hamil 35-36
MCG minggu dengan preeklampsia
ASAM ASKORBAT (VITAMIN C) 50 MG JTHIU P: - Menjelaskan tentang
hasil pemeriksaan - Menjelaskan
tentang persiapan persalinan -
Menjelaskan tentang tanda
persalinan - Menjelaskan tentang
rencana KB - Menjelaskan
tentang proses persalinan -
konsul dokter - Pemberian tablet
tambah darah dan vitamin -
Kunjungan ulang 2 minggu atau
kembali segera jika ada keluhan
Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
2019-09-09 13:37 Hal. 441 dari 1322

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Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Kamis : 08:00 - 13:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
SYEFIRA PRAMAISHELA, NY (P) JL PULAU SAMBU III NO 8 KGB Z36.9 - Antenatal screening, unspecified RUJUKAN (0114R030) RS PERTAMINA
ASAM FOLAT 1 MG JAYA
22 NIK : 3172064804960002 SIANOKOBALAMIN (VITAMIN B12) 50 Telah Diberikan :
No. RM : 01-058211 BPJS : 0001225563581 MCG Faskes : (0114R030) RS
Tgl Diagnosis : 07 February 2019 10:34 AM KALSIUM LAKTAT (KALK) 500 MG PERTAMINA JAYA
KOMBINASI BESI (II) SULFAT 200 MG, Alamat : JL. AHMAD YANI NO. 2
ASAM FOLAT 0,25 MG BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
NOVIA DEWI SUCININGATI, NN (P) JL H OYAR NO 120 H52.0 - Hypermetropia RUJUKAN (0116R025) Rumah Sakit Firdaus
O99.8 - Other specified diseases and (MAT) MATA - (65) Mata - (0)
23 NIK : 3171036911940001 conditions complicating pregnancy, childbirth Telah Diberikan :
No. RM : 01-082336 BPJS : 0000371933943 and the puerperium Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 442 dari 1322

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TUNIPAH (P) JL PERINTIS KEMERDEKAAN GG O99.0 - Anaemia complicating pregnancy, RUJUKAN (0903R012) RS KARTIKA
PERINTIS 1 RT 001/004 childbirth and the puerperium PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 07:00 - 16:00,
12:00 - 14:00;18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
WIWIK SUSILOWATI, NY (P) JL PEGANGSAAN DUA RT 03/04 O25 - Malnutrition in pregnancy KOMBINASI BESI (II) SULFAT 200 MG,
ASAM FOLAT 0,25 MG
Tgl Lahir : 01-Jan-1990 ( 29 Thn 8 Bln 8 Hr ) KALSIUM LAKTAT (KALK) 500 MG
25 NIK : 3578074101900001
MARLINAH, NY (P) JL. DAHLIA RAYA NO.10 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
No. RM : 01-086891 BPJS : 0002066779978 MCG
DORISAN SUMANTO SIMBOLON, NY (P) RAWA SENGON RT 005/022 K30 - Dyspepsia ANTASIDA DOEN
Z34.9 - Supervision of normal pregnancy,
27 NIK : 3175055507810003 unspecified
No. RM : 01-008215 BPJS : 0002043843603
FITRI KURNIA SARI, NY (P) JL TEGUH 3 NO. 44 KOMP TNI AL O82.9 - Delivery by caesarean section, KOMBINASI BESI (II) SULFAT 200 MG, (0116R029) Rumah Sakit
(OBG) Podomoro
No. RM : 01-084632 BPJS : 0000148338371 SIANOKOBALAMIN (VITAMIN B12) 50 Faskes : (0116R029) Rumah
2019-09-09 13:37 Hal. 443 dari 1322

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BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Jumat : 08:00 - 13:00,
08:00 - 10:00;18:00 - 20:00, 18:00
- 20:00
TACC : Tanpa TACC

Alasan TACC :
DEDEH AGUSTINA, NY (P) DUREN SAWIT O25 - Malnutrition in pregnancy KOMBINASI BESI (II) SULFAT 200 MG, (0116R029) Rumah Sakit
O82.9 - Delivery by caesarean section, ASAM FOLAT 0,25 MG Hermina Podomoro
29 NIK : 3209345108890001 unspecified Telah Diberikan :
RETRIBUSI KLINIK KIA Alamat : JL. DANAU AGUNG 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Jumat : 08:00 - 13:00,
08:00 - 10:00;18:00 - 20:00, 18:00
- 20:00
TACC : Tanpa TACC

Alasan TACC :
AYU EKATNITI, NY (P) BOULEVARD HIJAU I 5 NO 9 BEKASI K30 - Dyspepsia ANTASIDA DOEN
UTARA Z34.0 - Supervision of normal first
30 pregnancy
No. RM : 01-058820 NIK : 6213026705910001
WIGIARTI, NY (P) JL KEPU 001/001 J02.9 - Acute pharyngitis, unspecified KOMBINASI BESI (II) SULFAT 200 MG,
Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 0,25 MG
Tgl Lahir : 15-Feb-1992 ( 27 Thn 6 Bln 25 Hr ) KALSIUM LAKTAT (KALK) 500 MG
31 NIK : 3304015502920001 unspecified
2019-09-09 13:37 Hal. 444 dari 1322

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AMOKSISILIN 500 MG
IRA. S (P) APT GADING NIAS TOWER CHRISANT O20.0 - Threatened abortion RUJUKAN (0116R029) Rumah Sakit
11 HB Hermina
(OBG) Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 08:00 - 11:00,
08:00 - 10:00;10:00 - 12:00, 17:00
- 19:00;18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
IKA EVA WAHYUNI, NY (P) JL.BCS 01/05 PGS DUA O48 - Prolonged pregnancy RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
09:00 - 12:00;13:00 - 20:00, 14:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 445 dari 1322

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Alasan TACC :
YULIANA SUKMAWATI , NY (P) JL PERINTIS KEMERDEKAAN RT 11/04 O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG, (0116R029) Rumah Sakit
childbirth and the puerperium ASAM FOLAT 0,25 MG Hermina
(OBG) Podomoro
Tgl Diagnosis : 11 February 2019 11:27 AM MCG Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 08:00 - 11:00,
08:00 - 10:00;10:00 - 12:00, 17:00
- 19:00;18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
NUR FITRIA, NY (P) PGS DUA RT 5/5 O99.0 - Anaemia complicating pregnancy,
35 NIK : 3172065403940007
No. RM : 05-002407 BPJS : 0000377711357
SUMIYATI, NY (P) JL PEGANGSAAN DUA RT 04/04 O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Lahir : 11-Nov-1981 ( 37 Thn 9 Bln 29 Hr ) KALSIUM LAKTAT (KALK) 500 MG
36 NIK : 3172065111810007
RIMA AL FIANI, NY (P) PGSN DUA RT 002/004 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
37 NIK : - PIRIDOKSIN (VITAMIN B6) 10 MG
2019-09-09 13:37 Hal. 446 dari 1322

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SUSANTI, NY (P) JL INFEKSI X SUNTER O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG, (0905R003) RS PELABUHAN
childbirth and the puerperium ASAM FOLAT 0,25 MG JAKARTA
No. RM : 01-081478 BPJS : 0000378174699 SIANOKOBALAMIN (VITAMIN B12) 50 Faskes : (0905R003) RS
Tgl Diagnosis : 11 February 2019 2:15 PM MCG PELABUHAN JAKARTA
RUJUKAN Alamat : JL. KRAMAT JAYA NO.1
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00,
14:30 - 19:00;16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
KRISTIN, NY (P) KP RAWA INDAH RT 005/003 O32.1 - Maternal care for breech RUJUKAN (0116R025) Rumah Sakit Firdaus
presentation (OBG) OBGYN - (19) obgyn - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 12:00 - 17:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
SILVIA ANGGRAINI, NY (P) KP RAWA INDAH RT 4/3 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG (0116R025) Rumah Sakit Firdaus
unspecified TIAMIN (VITAMIN B1) 50 MG (OBG) OBGYN - (19) obgyn - (0)
40 NIK : 3172065508951001 PIRIDOKSIN (VITAMIN B6) 10 MG Telah Diberikan :
KOMP.BEA CUKAI
2019-09-09 13:37 Hal. 447 dari 1322

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Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 12:00 - 17:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
SONYA DEVI MAHARANI, NY (P) APT GADING NIAS TW DAHLIA LT 8 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
Z34.0 - Supervision of normal first PARASETAMOL TAB 500 MG
41 NIK : 3172065109011002 pregnancy AMBROKSOL TAB 30 MG
MCG
NURHAYATI, NY (P) JL RW SENGON RT 6/22 L02.9 - Cutaneous abscess, furuncle and AMOKSISILIN 500 MG
carbuncle, unspecified GENTAMISIN SALEP KULIT
MCG
MG
NOVI ANDRIYANI, NY (P) JL BOULEVARD A2 NO 9 O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
43 NIK : 3301125011920008
No. RM : 01-076319 BPJS : 0000518074391
FITRI, NY (P) APRT GD NIAS RESIDENCES UNIT KD O14.9 - Pre-eclampsia, unspecified NIFEDIPIN KAPS 10 MG

44 NIK : 3175026206850003
No. RM : 01-086672 BPJS : 0002332855809
2019-09-09 13:37 Hal. 448 dari 1322

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SUNARSIH, NY (P) JL SUKAPURA I P05.1 - Small for gestational age KALSIUM LAKTAT (KALK) 500 MG (0116R025) Rumah Sakit Firdaus
KOMBINASI BESI (II) SULFAT 200 MG, (OBG) OBGYN - (19) obgyn - (0)
Tgl Diagnosis : 13 February 2019 9:29 AM MCG Sakit Firdaus
ASAM FOLAT 1 MG Alamat : JL. SIAK J5/14
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
EDA DIANA, NY (P) JL TABAH RAYA NO 6 RT 001 RW 009 J06.9 - Acute upper respiratory infection, RETRIBUSI KLINIK KIA
unspecified ASAM FOLAT 1 MG
ASAM FOLAT 0,25 MG
AMBROKSOL TAB 30 MG
MG
NOVIA DEWI SUCININGATI, NN (P) JL H OYAR NO 120 H52.0 - Hypermetropia KALSIUM LAKTAT (KALK) 500 MG (0116R025) Rumah Sakit Firdaus
O99.8 - Other specified diseases and SIANOKOBALAMIN (VITAMIN B12) 50 (OBG) OBGYN - (19) obgyn - (0)
47 NIK : 3171036911940001 conditions complicating pregnancy, childbirth MCG Telah Diberikan :
No. RM : 01-082336 BPJS : 0000371933943 and the puerperium KOMBINASI BESI (II) SULFAT 200 MG, Faskes : (0116R025) Rumah
Tgl Diagnosis : 13 February 2019 10:30 AM ASAM FOLAT 0,25 MG Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
2019-09-09 13:37 Hal. 449 dari 1322

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Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
HERLINAH,NY (P) PEGANGSAAN DUA RT 01/04 O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG, (0905R004) RS ISLAM JKT
childbirth and the puerperium ASAM FOLAT 0,25 MG SUKAPURA
Tgl Lahir : 16-Apr-1984 ( 35 Thn 4 Bln 24 Hr ) Z36.9 - Antenatal screening, unspecified RUJUKAN
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 08:00 - 12:00,
08:00 - 12:00;13:00 - 20:00, 14:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
RENI PURWANINGSIH (P) KP PEDONGKELAN RT 02/15 KAYU Z34.0 - Supervision of normal first RUJUKAN (0903R012) RS KARTIKA
PUTIH pregnancy PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Rabu : 07:00 - 16:00,
09:00 - 11:00;12:00 - 14:00, 18:00
- 20:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 450 dari 1322

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Alasan TACC :
mulyana (P) PEAGANGSAAN DUA 01/04 N88.1 - Old laceration of cervix uteri NISTATIN TAB VAGINAL 100.000 UI/TAB
Z30.5 - Surveillance of (intrauterine) LINCOMYCIN 500 MG
50 NIK : 3172066811880006 contraceptive device ASAM ASKORBAT (VITAMIN C) 50 MG
No. RM : 01-053777 BPJS : 0000377904789
MUTIA DWI NOVITA SARI, NY (P) PEGANGSAAN DUA 04/01 Z34.9 - Supervision of normal pregnancy,
unspecified
51 NIK : 3175064211921003
No. RM : 01-023431 BPJS : 0002068715676
SRI HARYATI, NY (P) KP PULO GADUNG Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Lahir : 06-Jun-1989 ( 30 Thn 3 Bln 3 Hr ) Z34.9 - Supervision of normal pregnancy, KALSIUM LAKTAT (KALK) 500 MG
52 NIK : 3327064606890006
No. RM : 01-087568 BPJS : 0002332897086 unspecified SIANOKOBALAMIN (VITAMIN B12) 50
SUSILAWATI, NY (P) GADING GRIYA LESTARI BLOK Y.6/13 O25 - Malnutrition in pregnancy RUJUKAN (0116R029) Rumah Sakit
Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Jumat : 08:00 - 13:00,
08:00 - 10:00;18:00 - 20:00, 18:00
- 20:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 451 dari 1322

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DESI ISMAWATI, NY (P) KP. PULO GADUNG NO.42 RT.006 O99.0 - Anaemia complicating pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
RW.005 childbirth and the puerperium ASAM FOLAT 0,25 MG
54
DORIFINA ADERADE KALANGIB (P) JL. GADING SENGON V J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
Z39.2 - Routine postpartum follow-up KLORFENIRAMIN MALEAT (CTM) TAB 4
55 NIK : 7172066912932001 MG
MCG
RADITHYA ARDHANI RAFIF (L) JL.BENTENGAN ,SUNTER JAYA A49.9 - Bacterial infection, unspecified RUJUKAN (0116R029) Rumah Sakit
Hermina
(ANA) Podomoro
ANAK - (26) Anak - (0)
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Sabtu : 08:00 - 12:00,
13:00 - 15:00;16:01 - 18:00, 18:00
- 21:00
TACC : Tanpa TACC

Alasan TACC :
DEVI EVIANTI, NY (P) JL. RAWA INDAH 003/003 Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 1 MG
57 NIK : 3172067112860002 ASAM FOLAT 0,25 MG
MCG
2019-09-09 13:37 Hal. 452 dari 1322

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LILIS NURLITA, NY (P) JL BOULEVARD RAYA BLK WE II Z34.0 - Supervision of normal first ASAM FOLAT 1 MG
NO.2A pregnancy KOMBINASI BESI (II) SULFAT 200 MG,
MCG
MENDAWATI SEBAYANG (P) JL RAYA PERJUANGAN GG O10.9 - Unspecified pre-existing (0905R004) RS ISLAM JKT
DEMOKARASI RT 19/07 hypertension complicating pregnancy, SUKAPURA
Tgl Lahir : 19-Jul-1984 ( 35 Thn 1 Bln 21 Hr ) childbirth and the puerperium
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
09:00 - 12:00;13:00 - 20:00, 14:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
FEBRINA ADINTA PUTRI BR TARIGAN, BY (P) JL. PERJUANGAN RAYA GG. P59.9 - Neonatal jaundice, unspecified (0905R004) RS ISLAM JKT
DEMOKRASI NO. 38 SUKAPURA
(ANA) ANAK - (26) Anak - (0)
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 08:00 - 10:00,
09:00 - 13:00;10:00 - 12:00, 13:00
- 16:00;15:00 - 17:00
2019-09-09 13:37 Hal. 453 dari 1322

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TACC : Tanpa TACC
Alasan TACC :
LIA KHALIDAZIA NY (P) JL. JANUR KUNING 8 BLOK WN2 NO.11 I49.9 - Cardiac arrhythmia, unspecified RUJUKAN (0905R004) RS ISLAM JKT
O99.0 - Anaemia complicating pregnancy, SUKAPURA
61 NIK : 3328115608940007 childbirth and the puerperium Telah Diberikan :
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
09:00 - 12:00;13:00 - 20:00, 14:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
SITI HARIYANTI, NY (P) jl pejuang 4 no. 49 Z34.0 - Supervision of normal first
pregnancy
62 NIK : 3172064107950001
No. RM : 02-005225 BPJS : 0000378121713
FERA CAHYANI HAREFA (P) JL MAYHEN NO 2 CAWANG O25 - Malnutrition in pregnancy KOMBINASI BESI (II) SULFAT 200 MG,
O82.9 - Delivery by caesarean section, ASAM FOLAT 0,25 MG
Tgl Lahir : 19-Sep-1987 ( 31 Thn 11 Bln 21 Hr ) ASAM FOLAT 1 MG
63 NIK : 1204165909870001 unspecified
MCG
2019-09-09 13:37 Hal. 454 dari 1322

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SITTI LUTFIYAH, NY (P) JL MERAH DELIMA B 2/33 RT 4/10 O32.1 - Maternal care for breech KOMBINASI BESI (II) SULFAT 200 MG, (0114R030) RS PERTAMINA
presentation ASAM FOLAT 0,25 MG JAYA
Tgl Lahir : 23-Feb-1983 ( 36 Thn 6 Bln 17 Hr ) O82.9 - Delivery by caesarean section, ASAM FOLAT 1 MG
No. RM : 01-035099 BPJS : 0001621463545 unspecified KALSIUM LAKTAT (KALK) 500 MG Faskes : (0114R030) RS
Tgl Diagnosis : 20 February 2019 9:00 AM SIANOKOBALAMIN (VITAMIN B12) 50 PERTAMINA JAYA
MCG Alamat : JL. AHMAD YANI NO. 2
RUJUKAN BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 11:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
CARYATI, NY (P) TANAH MERAH UJUNG RT 02/06 O99.0 - Anaemia complicating pregnancy,
65 NIK : 3172035212830006
No. RM : 01-008403 BPJS : 0001451223988
ATIKA WULANDARI, NY (P) JL RAWA INDAH RT 07/03 Z34.0 - Supervision of normal first ASAM FOLAT 1 MG (0116R025) Rumah Sakit Firdaus
pregnancy KOMBINASI BESI (II) SULFAT 200 MG, (OBG) OBGYN - (19) obgyn - (0)
No. RM : 01-013842 BPJS : 0001225404933 KALSIUM LAKTAT (KALK) 500 MG Faskes : (0116R025) Rumah
Tgl Diagnosis : 20 February 2019 9:44 AM SIANOKOBALAMIN (VITAMIN B12) 50 Sakit Firdaus
MCG Alamat : JL. SIAK J5/14
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 455 dari 1322

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SITI ZULAEHA, NY (P) JL H OYAR RT 01/02 NO 017 O82.0 - Delivery by elective caesarean (0116R025) Rumah Sakit Firdaus
section (OBG) OBGYN - (19) obgyn - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 13:00 - 18:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
FITRIYAWATI, NY (P) JL PGS II RT 04/01 O26.9 - Pregnancy-related condition, KOMBINASI BESI (II) SULFAT 200 MG, (0116R029) Rumah Sakit
(OBG) Podomoro
Tgl Lahir : 19-May-1985 ( 34 Thn 3 Bln 21 Hr ) O99.0 - Anaemia complicating pregnancy, ASAM FOLAT 1 MG
No. RM : 01-035757 BPJS : 0001225578969 childbirth and the puerperium KALSIUM LAKTAT (KALK) 500 MG Faskes : (0116R029) Rumah
Tgl Diagnosis : 20 February 2019 11:09 AM SIANOKOBALAMIN (VITAMIN B12) 50 Sakit Hermina Podomoro
MCG Alamat : JL. DANAU AGUNG 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 08:00 - 13:00,
08:00 - 10:00;17:00 - 20:00, 19:00
- 21:00
TACC : Tanpa TACC

Alasan TACC :
DEWI TRI HANDAYANI, NY (P) JL. HARAPAN II NO. 9 B16.9 - Acute hepatitis B without delta-agent KOMBINASI BESI (II) SULFAT 200 MG,
and without hepatic coma ASAM FOLAT 0,25 MG
Tgl Lahir : 10-Feb-1982 ( 37 Thn 6 Bln 30 Hr ) O99.0 - Anaemia complicating pregnancy, ASAM FOLAT 1 MG
69 NIK : 317206500282002
No. RM : 01-087432 BPJS : 0002332694496 childbirth and the puerperium KALSIUM LAKTAT (KALK) 500 MG
2019-09-09 13:37 Hal. 456 dari 1322

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MCG
ROSIANA, NY (P) JL. MADU RATNA J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
Z34.9 - Supervision of normal pregnancy, PARASETAMOL TAB 500 MG
No. RM : 01-033037 BPJS : 0001743874457 MG
ASAM FOLAT 0,25 MG
MCG
QURRATU AINI (P) JL. PRIHATIN NO 59 RT 06 RW 02 Z34.9 - Supervision of normal pregnancy, KOMBINASI BESI (II) SULFAT 200 MG,
Tgl Lahir : 12-Feb-1990 ( 29 Thn 6 Bln 28 Hr ) ASAM FOLAT 1 MG
71 NIK : 3203045202900010
MCG
YULIANA PRASETIAWATI, NY (P) KP SUKAPURA RT 009/01 CILINCING M79.1 - Myalgia PARASETAMOL TAB 500 MG (0905R003) RS PELABUHAN
JAKUT Z34.9 - Supervision of normal pregnancy, RUJUKAN JAKARTA
72 unspecified Telah Diberikan :
Tgl Diagnosis : 20 February 2019 12:36 PM BPJS : 0001445030741 PELABUHAN JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
10:00 - 14:00;14:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 457 dari 1322

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SAFITRI NOVARITA, NY (P) JL PEGANGSAAN DUA NO 18 Z34.0 - Supervision of normal first
RT003/004 pregnancy
73
No. RM : 01-083543 NIK : 1471116409910001
IRAWATI (P) JL. INSPEKSI KALI SUNTER O82.9 - Delivery by caesarean section, RUJUKAN (0116R029) Rumah Sakit
unspecified AMBROKSOL TAB 30 MG Hermina
(OBG) Podomoro
74 NIK : 3172064908870004 KLORFENIRAMIN MALEAT (CTM) TAB 4 Telah Diberikan :
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 08:00 - 13:00,
08:00 - 10:00;17:00 - 20:00, 19:00
- 21:00
TACC : Tanpa TACC

Alasan TACC :
OKY PINUNI, NY (P) JL INFEKSI KALI SUNTER NO 22 RT J00 - Acute nasopharyngitis [common cold] ASAM FOLAT 1 MG (0905R004) RS ISLAM JKT
06/2 Z34.0 - Supervision of normal first KALSIUM LAKTAT (KALK) 500 MG SUKAPURA
75 pregnancy PIRIDOKSIN (VITAMIN B6) 10 MG Telah Diberikan :
Tgl Diagnosis : 21 February 2019 10:01 AM BPJS : 0001635161927 MCG JKT SUKAPURA
KLORFENIRAMIN MALEAT (CTM) TAB 4 Alamat : JL. TIPAR CAKUNG NO.
MG 5
AMBROKSOL TAB 30 MG Telp : 021-4400778
RUJUKAN Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 08:00 - 12:00,
08:00 - 12:00;13:00 - 20:00, 14:00
- 17:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 458 dari 1322

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Alasan TACC :
NUR AYU ADISTY WULANDARI, NY (P) JL GADING II RTR 002/006 KGB J00 - Acute nasopharyngitis [common cold] KOMBINASI BESI (II) SULFAT 200 MG, (0116R029) Rumah Sakit
Z34.0 - Supervision of normal first ASAM FOLAT 0,25 MG Hermina
(OBG) Podomoro
76 NIK : 3172066608960003 pregnancy Telah Diberikan :
Tgl Diagnosis : 21 February 2019 10:16 AM MCG Sakit Hermina Podomoro
KLORFENIRAMIN MALEAT (CTM) TAB 4 Alamat : JL. DANAU AGUNG 2
MG BLOK E3 NO 2
RUJUKAN Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 08:00 - 10:00,
10:00 - 12:00;19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
MUHIFAH, NY (P) PGS II RW 001 J00 - Acute nasopharyngitis [common cold] KOMBINASI BESI (II) SULFAT 200 MG,
Z34.9 - Supervision of normal pregnancy, ASAM FOLAT 0,25 MG
77 NIK : 3172066706930002 unspecified
AMBROKSOL TAB 30 MG
YUSMINA YULIANA ATAUPAH (P) JL HARPA III CC 21 RT 007/009 O32.1 - Maternal care for breech RUJUKAN (0116R029) Rumah Sakit
presentation Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
2019-09-09 13:37 Hal. 459 dari 1322

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Jadwal : Kamis : 08:00 - 10:00,
10:00 - 12:00;19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
AGUSTINA WULANDARI, NN (P) JL. PEGANGSAAN DUA NO.49 O32.1 - Maternal care for breech RUJUKAN (0116R025) Rumah Sakit Firdaus
presentation KOMBINASI BESI (II) SULFAT 200 MG, (OBG) OBGYN - (19) obgyn - (0)
Tgl Lahir : 20-Aug-1994 ( 25 Thn 0 Bln 20 Hr ) O99.0 - Anaemia complicating pregnancy,
No. RM : 01-087938 BPJS : 0001226371566 childbirth and the puerperium KALSIUM LAKTAT (KALK) 500 MG Faskes : (0116R025) Rumah
Tgl Diagnosis : 21 February 2019 11:46 AM SIANOKOBALAMIN (VITAMIN B12) 50 Sakit Firdaus
MCG Alamat : JL. SIAK J5/14
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 08:00 - 13:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
WIYANA NURHANDAYANI (P) JL KECAK BLOK B NO 14 O82.9 - Delivery by caesarean section, PARASETAMOL TAB 500 MG
80 NIK : 3172066801890004 ASAM FOLAT 0,25 MG
Tgl Diagnosis : 21 February 2019 3:08 PM KALSIUM LAKTAT (KALK) 500 MG
MCG
SOPIAH (P) PGS RT006/005 O82.9 - Delivery by caesarean section, RUJUKAN (0116R025) Rumah Sakit Firdaus
unspecified (OBG) OBGYN - (19) obgyn - (0)
No. RM : 01-080758 BPJS : 0002099674844 - PANDANGAN MATA KABUR 1
Tgl Diagnosis : 22 February 2019 10:16 AM bulan yang lalu
- RIW DM, RUTIN MINUM OBAT
-
Pemeriksaan (O) :
- AKRAL HANGTA
A : GANGGUAN SENSORI
2019-09-09 13:37 Hal. 460 dari 1322

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PENGLIHATAN
P:
-HINDARI MENGGOSOK MATA
-HINDARI AKTIFITAS FISIK
YANG BERAT
-GUNAKAN KACA MATA UNTUK
MELINDUNGI MATA DARI DEBU
DAN ANGIN
-KONSUMSI MAKANAN TINGGI
VIT C

Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 13:00 - 17:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
MARIA YUNITA MBUKA, NY (P) KOJANGABA RT 012/005 O82.2 - Delivery by caesarean hysterectomy (0116R025) Rumah Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Jumat : 13:00 - 17:00,
19:00 - 21:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 461 dari 1322

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Alasan TACC :
IDA JUBAEDAH (P) JL. BENDUNGAN MELAYU NO.25 K O14.9 - Pre-eclampsia, unspecified RETRIBUSI KLINIK KIA (0905R003) RS PELABUHAN
005/001 RUJUKAN JAKARTA
Tgl Diagnosis : 26 February 2019 9:41 AM BPJS : 0000376829842 PELABUHAN JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Selasa : 10:00 - 14:00,
14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SAWATI (P) JL. PEGANGSAN DUA Z35.8 - Supervision of other high-risk KOMBINASI BESI (II) SULFAT 200 MG, (0116R025) Rumah Sakit Firdaus
pregnancies ASAM FOLAT 0,25 MG (OBG) OBGYN - (19) obgyn - (0)
Tgl Lahir : 12-Sep-1982 ( 36 Thn 11 Bln 28 Hr ) KALSIUM LAKTAT (KALK) 500 MG
RETRIBUSI KLINIK UMUM Alamat : JL. SIAK J5/14
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Selasa : 08:00 - 12:00,
19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 462 dari 1322

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ELIS SUCIYATI, NY (P) APT GADING NIAS TOWER ALAMANDA O13 - Gestational [pregnancy-induced] RUJUKAN (0905R004) RS ISLAM JKT
NO 02 AK hypertension without significant proteinuria SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 08:00 - 12:00,
08:00 - 12:00;13:00 - 20:00, 14:00
- 17:00
TACC : Tanpa TACC

Alasan TACC :
AULIA AZIZAH, NY (P) JL.BOJANA TIRTA E/2 O30.9 - Multiple gestation, unspecified RUJUKAN (0116R029) Rumah Sakit
Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 08:00 - 13:00,
08:00 - 10:00;17:00 - 20:00, 19:00
- 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 463 dari 1322

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RIA AGUSTIN, NY (P) GG. PERJUANG 6 N30.9 - Cystitis, unspecified RUJUKAN (0903R012) RS KARTIKA
O28.9 - Abnormal finding on antenatal RUJUKAN PULOMAS
87 NIK : 3327084308980142 screening of mother, unspecified Penyakit Dalam :- (0)
Telah Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
FERA CAHYANI HAREFA (P) JL MAYHEN NO 2 CAWANG O25 - Malnutrition in pregnancy RETRIBUSI KLINIK KIA
O82.9 - Delivery by caesarean section,
88 NIK : 1204165909870001 unspecified
No. RM : 01-083727 BPJS : 0001738196019
YULI KURNIATI, NY (P) JL. P.PENYENGAT 2 NO 5 RT 07 RW 05 O82.9 - Delivery by caesarean section, ASAM FOLAT 1 MG
89 NIK : - PIRIDOKSIN (VITAMIN B6) 10 MG
MAHFIROH, NY (P) JL GADING KIRANA BLOK G 2 NO 49 O99.0 - Anaemia complicating pregnancy, ASAM FOLAT 1 MG
childbirth and the puerperium TIAMIN (VITAMIN B1) 50 MG
Tgl Lahir : 02-Sep-1985 ( 34 Thn 0 Bln 7 Hr ) Z34.9 - Supervision of normal pregnancy,
dr. Naomi Eveline
2019-09-09 13:37 Hal. 464 dari 1322

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GRACIA BEVERLY SIMANGUNSONG (P) JL TANAH MERAH, RAWA SENGON J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
RT004/022 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 01-Oct-2015 ( 3 Thn 11 Bln 8 Hr ) R11 - Nausea and vomiting
1 MG
ANTASIDA DOEN
LINDA ANITA SENGKEY (P) RGTC BLOK ANGSANA NO.301 A15.2 - Tuberculosis of lung, confirmed
histologically
2 NIK : 3275036810760014
No. RM : 01-025107 BPJS : 0001140235007
ETY ROHAYATI, NY (P) APT EVIAN GARDEN 7C FRENCH K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
WALK M79.1 - Myalgia SIANOKOBALAMIN (VITAMIN B12) 50
3 M79.22 - Neuralgia and neuritis, unspecified, MCG
No. RM : 01-074765 NIK : 3205304808720001 upper arm RANITIDIN 150 MG
IBUPROFEN 200 MG
SUKARMIATI, NY (P) JL PULO REMPANG III NO 22 I10 - Essential (primary) hypertension ASAM ASKORBAT (VITAMIN C) 50 MG
J00 - Acute nasopharyngitis [common cold] AMLODIPIN 5 MG
SAVIRA, NN (P) JL. PUSPA GADING BLOK A-1 NO. 38 K30 - Dyspepsia ANTASIDA DOEN
R51 - Headache RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-045919 BPJS : 0001432594541
ALI MASKHI (L) JL PELEPAH ELOK 1 BLOK GN NO J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
28/29 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
6 MG
Tgl Diagnosis : 02 February 2019 8:59 AM BPJS : 0001647208754 KOTRIMOKSAZOL DOEN I (DEWASA)
TRIMETOPRIM 80 MG)
2019-09-09 13:37 Hal. 465 dari 1322

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SITI ZAENAB (P) JL RAWA INDAH G51.0 - Bell's palsy PARASETAMOL TAB 500 MG
R51 - Headache
7 NIK : 3172064307010003
No. RM : 01-086379 BPJS : 0000378470902
HUFAF MUFTI ALI YUSUP (L) RAWA INDAH 02/03 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
8 NIK : 3172061907960003 MG
ABOCATH NO24
MARYAM (P) PULO NANGKA BARAT II RT 1/16 NO K30 - Dyspepsia RANITIDIN 150 MG
35 M79.1 - Myalgia NATRIUM DIKLOFENAK 50 MG
9 R42 - Dizziness and giddiness SIANOKOBALAMIN (VITAMIN B12) 50
No. RM : 01-004411 NIK : 3175024101790019 MCG
Tgl Diagnosis : 02 February 2019 9:12 AM BPJS : 0001263120208 RETRIBUSI LAYANAN SIAGA 24 JAM
HANNY A RUNTU, TN (L) TAMAN PEGANGSAAN INDAH F/21 H02.9 - Disorder of eyelid, unspecified AMLODIPIN 10 MG
I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
SUTRI (P) GADING UTAMA BLOK C NO 62 I84.5 - External haemorrhoids without PARASETAMOL TAB 500 MG
complication GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 21-Aug-1989 ( 30 Thn 0 Bln 19 Hr ) J06.9 - Acute upper respiratory infection,
No. RM : 01-051496 BPJS : 0001736800053 unspecified MG
K30 - Dyspepsia
DEKSAMETASON 0,5 MG
ANTIHEMOROID DOEN
JOSEPH MARVEL CAHYADI (L) JL. GOLEK NO. 16 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-086399 BPJS : 0002332816839 MG
2019-09-09 13:37 Hal. 466 dari 1322

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CIOE LEH CU, NY (P) KELAPAMPUAN TIMUR III NP 4/30 RT E79.9 - Disorder of purine and pyrimidine DEKSAMETASON 0,5 MG
10/12 metabolism, unspecified RANITIDIN 150 MG
Tgl Lahir : 27-Sep-1945 ( 73 Thn 11 Bln 13 Hr ) I10 - Essential (primary) hypertension
13 ALOPURINOL 300 MG
No. RM : 01-009757 NIK : 3172066709450002 J06.9 - Acute upper respiratory infection, ASAM MEFENAMAT KAPS 500
Tgl Diagnosis : 02 February 2019 9:34 AM BPJS : 0001444804165 unspecified
K30 - Dyspepsia
MG
OBH SIRUP 100 ML
HIZKIA CHANDRA HERMAN (L) KELAP CENGKIR RAYA TO I/4 I84.5 - External haemorrhoids without FITOMENADION (VITAMIN K1) 10 MG
complication ANTIHEMOROID DOEN
Tgl Lahir : 11-Jul-1958 ( 61 Thn 1 Bln 29 Hr ) J06.9 - Acute upper respiratory infection,
14 NIK : 3172061107580004 RANITIDIN 150 MG
OBH SIRUP 100 ML
K30 - Dyspepsia
HANA ROSA SIMANJUNTAK, NY (P) KELAPA MOLEK 1 BLOK B4 NO. 15 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
15 NIK : 6171035610890002
No. RM : 01-086400 BPJS : 000051059902
HIZKIA CHANDRA HERMAN (L) KELAP CENGKIR RAYA TO I/4 I84.5 - External haemorrhoids without FITOMENADION (VITAMIN K1) 10 MG
16 NIK : 3172061107580004 RANITIDIN 150 MG
OBH SIRUP 100 ML
K30 - Dyspepsia
MUHASAN, TN (L) JL RAYA EPEGANGSAAN DUA RT S51.9 - Open wound of forearm, part AMOKSISILIN 500 MG
05/02 unspecified PARASETAMOL TAB 500 MG
17 TOILET MATA / WOUND TOILET
SIPA SABINA PUTRI, NN (P) KP RAWA INDAH RT 3/03 H10.9 - Conjunctivitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
R60.0 - Localized oedema AMOKSISILIN 500 MG
Tgl Diagnosis : 02 February 2019 10:06 AM KLORAMFENIKOL 1 % SM
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IMAM SUYANTO, TN (L) JL KEPU RT 01/01 PGS II I10 - Essential (primary) hypertension AMLODIPIN 5 MG
ATNAN YUDI SAPUTRA (L) JL. SENTOSA 1 RT 09 RW 010 KGB J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
RATIH LALITAVISTARA BASUKI, NY (P) JL GAMBANG BLOK N NO 18 BCS H70.0 - Acute mastoiditis KOTRIMOKSAZOL DOEN I (DEWASA)
J06.9 - Acute upper respiratory infection, (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 11-Feb-1983 ( 36 Thn 6 Bln 29 Hr ) TRIMETOPRIM 80 MG)
21 NIK : 3276055102830018 unspecified
MG
MUHAMMAD RAIHAN RAMADHAN, TN (L) JL. HARPA V BLOK EE/20 S01.5 - Open wound of lip and oral cavity AMOKSISILIN 500 MG
22 NIK : - TOILET MATA / WOUND TOILET
SYEFIRA PRAMAISHELA, NY (P) JL PULAU SAMBU III NO 8 KGB J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-058211 BPJS : 0001225563581 MG
ZHAFIRA IZZATY A (P) JL. PULAU SAMBU III NO. 8 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 05-Oct-2015 ( 3 Thn 11 Bln 4 Hr ) L08.9 - Local infection of skin and
No. RM : 01-086403 BPJS : 0002510680509 subcutaneous tissue, unspecified
2019-09-09 13:37 Hal. 468 dari 1322

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ANNISA HUMAIRRA (P) PGS II 003/002 B26.9 - Mumps without complication PARASETAMOL TAB 500 MG
R11 - Nausea and vomiting DEKSAMETASON 0,5 MG
No. RM : 01-005543 BPJS : 0001676014391 MCG
ANTASIDA DOEN
BIMO PUTERA YAJID, TN (L) JL KOMP WALIKOTA SRI GUNTING A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
BLOK D 1 NO 45 presumed infectious origin ANTASIDA DOEN
Tgl Lahir : 22-Dec-2003 ( 15 Thn 8 Bln 18 Hr ) J06.9 - Acute upper respiratory infection,
No. RM : 01-070617 NIK : 3172012212030003 unspecified
MG TAB
ROHAYATI, NY (P) RAWA SENGON RT 05/012 A15.2 - Tuberculosis of lung, confirmed
histologically
27 NIK : 3277016704720017
No. RM : 01-058943 BPJS : 0000514033751
BANYU DEWANGGA (L) RAWA SENGON BLK E 005/022 K12.2 - Cellulitis and abscess of mouth BORAK GLYSEROL 5% LARUTAN
DEKSAMETASON 0,5 MG
No. RM : 01-022849 BPJS : 0001672405637
SOFIA SEKAR ANINDIA (P) JL RAWA SENGON BLOK E RT 005/022 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 06-Aug-2015 ( 4 Thn 1 Bln 3 Hr ) R04.0 - Epistaxis
No. RM : 01-000515 BPJS : 0001868884233 MG
FITOMENADION (VITAMIN K1) 10 MG
OLIVER WINTER TANAMAS (L) JANUR ASRI I BLOK QJ XI /2 J06.9 - Acute upper respiratory infection, AMOKSISILIN SYR KERING 125 MG/5ML
MG
2019-09-09 13:37 Hal. 469 dari 1322

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KAI AMDEUS TANAMAS (L) JL JANUR ASRI I BLOK QJ XI/2 RT J06.9 - Acute upper respiratory infection, AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 01-020793 NIK : 3172060911111019 MG
INDRA TJAHJA (L) JL KELAPA MOLEK VII BLOK N 1/22 RT J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
32 MG
ENDAR WININGSIH (P) JL GG PERJUANGAN IV RT 004/004 NO I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4
52 L03.9 - Cellulitis, unspecified MG
33 L23.9 - Allergic contact dermatitis,
No. RM : 01-014897 NIK : 3172065404690004 unspecified cause AMOKSISILIN 500 MG
Tgl Diagnosis : 02 February 2019 11:32 AM BPJS : 0001224437387 BETAMETASON KRIM 0,5MG/G
KLORAMFENIKOL TT 3%
DAMRONI LIWON (L) KELAPA GADING TIMUR RT 001/004 K30 - Dyspepsia PARASETAMOL TAB 500 MG
MARINGAN GULTOM, TN (L) JEMBATAN BARU NO.29 009/04 KGB J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
M79.1 - Myalgia MG
Tgl Lahir : 17-Jul-1950 ( 69 Thn 1 Bln 23 Hr ) AMOKSISILIN 500 MG
35 NIK : 3172061003
Tgl Diagnosis : 02 February 2019 11:39 AM NATRIUM DIKLOFENAK 50 MG
MCG
RENO SAPUTRA (L) GG. TARUNA NO. 46 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-086406 BPJS : 0002484158916
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ENGELBERTUS BAYU (L) JL. TALEMPONG BLK K 31 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
unspecified KOTRIMOKSAZOL DOEN I (DEWASA)
MG
ANITA (P) JL INSPEKSI KALI SUNTER RT009-004 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
KGB unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
38 MG
No. RM : 01-082645 NIK : - PARASETAMOL TAB 500 MG
Tgl Diagnosis : 02 February 2019 11:54 AM BPJS : 0000378108358 AMOKSISILIN 500 MG
VERDI MALDINI (L) KAMPUNG PULO GADUNG RT 02/05 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
PGS II KG unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
39 MG
Tgl Diagnosis : 02 February 2019 11:55 AM BPJS : 0001843965191 ASAM ASKORBAT (VITAMIN C) 50 MG
GILANG KASELA (L) RW SENGON RT 06/22 A09 - Diarrhoea and gastroenteritis of PARASETAMOL TAB 500 MG
presumed infectious origin ANTASIDA DOEN
Tgl Lahir : 14-Jan-2007 ( 12 Thn 7 Bln 26 Hr ) R11 - Nausea and vomiting
40 NIK : 3174071401071001
No. RM : 01-053295 BPJS : 0001673957395
AS SYIFAH FAUZIAH, AN (P) RW SENGON RT 007/022 KGB L23.9 - Allergic contact dermatitis, RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified cause KLORFENIRAMIN MALEAT (CTM) TAB 4
41 NIK : 3208202905170002 MG
SOEYADI, TN (L) PULAU BENGKALIS NO.4 RT 010/003 E79.9 - Disorder of purine and pyrimidine NATRIUM DIKLOFENAK 50 MG
metabolism, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
42 NIK : 3172060503460003 MCG
DAFFUN PERASTIO, AN (L) JL. PEJUANG 1 NO. 24 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Diagnosis : 02 February 2019 1:22 PM PARASETAMOL SYR 120 MG/5 ML
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ANTON BIEANTORO MULIE (L) JLN PERMATA BIRU 2 BLOK K 2 NO 1 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 11-Apr-1957 ( 62 Thn 4 Bln 29 Hr ) PARASETAMOL TAB 500 MG
44 NIK : 3172061104570001
TRIMETOPRIM 80 MG)
DINA APRILLIYANA LATIF, NY (P) JL. KELAPA KOPYOR TIMUR 1 BA 1/5 L23.9 - Allergic contact dermatitis, KLORFENIRAMIN MALEAT (CTM) TAB 4
45 NIK : 3172064104730005
No. RM : 01-086410 BPJS : 0001644191291 HIDROKORTISON KRIM 2,5 %
AGUN LUKMAN (L) JL. RAWA SENGON BLOK A RT 01 RW A91 - Dengue haemorrhagic fever RANITIDIN 150 MG
46 MCG
SUWANDY ANWAR (L) JL GADING KIRANA G 1/216 RT 09/08 E79.9 - Disorder of purine and pyrimidine GLISERIL GUAIAKOLAT (GG) 100 MG
metabolism, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 26-Nov-1951 ( 67 Thn 9 Bln 14 Hr ) J06.9 - Acute upper respiratory infection,
47 NIK : 3172062611510001 MG
No. RM : 01-055503 BPJS : 0001725484037 unspecified DEKSAMETASON 0,5 MG
M13.9 - Arthritis, unspecified
SLAMET RIYANTI, NY (P) RAWA INDAH RT003/003 L23.9 - Allergic contact dermatitis, PARASETAMOL TAB 500 MG
unspecified cause GENTAMISIN SALEP KULIT
48 NIK : 3315025503950006 HIDROKORTISON KRIM 2,5 %
No. RM : 01-003873 BPJS : 0002049918939
MEISYA KANZA SAPUTRI (P) JL RAWA INDAH RT 03/03 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
49 NIK : 3315024505120002 MG
MOBIN (L) RAWA INDAH NO. 38 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
I84.2 - Internal haemorrhoids without FITOMENADION (VITAMIN K1) 10 MG
50 NIK : - complication AMLODIPIN 10 MG
No. RM : 01-086412 BPJS : 0000574888792 ANTIHEMOROID DOEN
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MOH SAFRI JEFFRI (L) APARTEMEN WGP TW A 11 19 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
51 NIK : - MG
Tgl Diagnosis : 02 February 2019 2:14 PM HIDROKORTISON KRIM 2,5 %
ABOCATH NO24
DIAH ANGGRAENI, NY (P) JL CAMAR IV BLOK D 2 RT 011/006 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
DANI HILMAN FELANI , TN (L) JL BOULEVARD RAYA BLK WB NO.16 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-037847 BPJS : 0002139941957 MCG
Tgl Diagnosis : 02 February 2019 2:30 PM ABOCATH NO24
SUTARNI, NY (P) PAPANGGO I JLON KELAPA N0.23 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
RT11/02 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 16-Oct-1984 ( 34 Thn 10 Bln 24 Hr ) K30 - Dyspepsia
54 MG
RANITIDIN 150 MG
SITI BARKAH (P) KP PULO GADUNG GG Q NO.31 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 11-Apr-1960 ( 59 Thn 4 Bln 29 Hr ) M54.5 - Low back pain
No. RM : 01-011402 NIK : 3172065104600001 NATRIUM DIKLOFENAK 50 MG
MCG
ABDUL MUSYAYAB, TN (L) KP PULO GADUNG GG Q NO.31 J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
002/005 MG
Tgl Lahir : 30-Dec-1947 ( 71 Thn 8 Bln 10 Hr ) FUROSEMID 40 MG
56
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M ALVIN ABIZAR RAMADHAN (L) JL KOMPI UDIN NO 86 A L50.9 - Urticaria, unspecified DEKSAMETASON 0,5 MG
57 NIK : - MG
KARSONO (L) TEBET RT 008/012 MANGGARAI E79.9 - Disorder of purine and pyrimidine RETRIBUSI LAYANAN SIAGA 24 JAM
JAKSEL metabolism, unspecified ASAM MEFENAMAT KAPS 500
Tgl Lahir : 10-Nov-1962 ( 56 Thn 9 Bln 30 Hr ) M13.9 - Arthritis, unspecified
HASBUN UMAM MUZAKI (L) TANAH MERAH RT 04/10 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
ABYAN PRANAJA WIJAYA (L) JL PELEPAH ELOK BLK QE NO.8/15 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-015407 BPJS : 0001319196701 MG
GENDI (L) GADING KIRANA BLOK D3 NO. 27 J06.9 - Acute upper respiratory infection, INJEKSI (UGD)
unspecified PEMBERIAN OKSIGEN O2 SAMPAI
Tgl Lahir : 20-Nov-1966 ( 52 Thn 9 Bln 20 Hr ) K30 - Dyspepsia
61 NIK : - DENGAN 1 JAM (UGD)
No. RM : 01-086415 BPJS : 0000465381808 RINGER LAKTAT
Tgl Diagnosis : 02 February 2019 3:02 PM RANITIDIN INJ
SPUIT 3 CC
BLOOD SET
ABOCATH NO22
KRISTHIE ROBERTH HATTU (P) T MERAH RT 2/7 S07.8 - Crushing injury of other parts of RETRIBUSI LAYANAN SIAGA 24 JAM
head AMOKSISILIN 500 MG
Tgl Lahir : 07-Dec-1970 ( 48 Thn 9 Bln 2 Hr ) S67.8 - Crushing injury of other and
No. RM : 01-016777 BPJS : 0001295560181 unspecified parts of wrist and hand
2019-09-09 13:37 Hal. 474 dari 1322

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TEDI YONO, TN (L) JANUR INDAH IX NO.5 J06.9 - Acute upper respiratory infection, ASAM MEFENAMAT KAPS 500
No. RM : 01-002557 BPJS : 0002231006646 MG
MCG
SUPARLIN SIBARANI, TN (L) JL SUNGAI KAMPAR 10 TERUSAN NO A15.2 - Tuberculosis of lung, confirmed
22 histologically
64
No. RM : 01-075196 NIK : 3172040611770015
WIDYAWATI AYUDIA INARA, AN (P) INS KALI SUNTER RT 9/13 H10.9 - Conjunctivitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
65 NIK : 3172046109131002 unspecified DEKSAMETASON 0,5 MG
PAULUS BUDIMAN BUDIARTO.L, TN (L) KELAPA NIAS 006/14 L08.9 - Local infection of skin and GENTAMISIN SALEP KULIT
subcutaneous tissue, unspecified HIDROKORTISON KRIM 2,5 %
66 NIK : 3172060902800001
No. RM : 01-004552 BPJS : 0001475606946
GILANG RAMADHANI, AN (L) KOMPIUDIN RT 06/05 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
67 NIK : 3172062707121003 MG
SRI NUGROHO RINI, NY (P) JL TASKA BLOK P- NO 24 RT 005/010 K30 - Dyspepsia RANITIDIN 150 MG
R42 - Dizziness and giddiness ANTASIDA DOEN
No. RM : 01-003964 BPJS : 0001299864914
2019-09-09 13:37 Hal. 475 dari 1322

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VICKY FERDIANSYAH, AN (L) JL. ENIM NO. 19B J06.9 - Acute upper respiratory infection, DEKSAMETASON 0,5 MG
No. RM : 01-085016 BPJS : 0001743396546
SRI ROHMINAH, NN (P) JL PEGANGSAAN DUA 006/002 J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 20-Jan-1993 ( 26 Thn 7 Bln 20 Hr ) PARASETAMOL TAB 500 MG
70 NIK : 3172066001930004
HIDROKORTISON KRIM 2,5 %
DWI OKTAVIANI TASMAH, NN (P) JL INSPEKSI KALI SUNTER RT 003/004 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
71 NIK : 3172066110990001 MG
SUBAWI, TN (L) KAYMAS TENGAH 1RT10/04 I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
RANITIDIN 150 MG
72 NIK : 3175021604720011
No. RM : 01-010216 BPJS : 0001377758531
NURAINI PUTERI KURNIAWAN, AN (L) RRUKAN GADING KIRANAN J.10/23 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
73 NIK : 3173086403111007 MG
SALIMAH, NY (P) INF X SUNTER RT 5/4 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-037991 BPJS : 0000378981707 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 476 dari 1322

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YENNY SURYANA, NY (P) SUNTER HIJAU I BLOK B4 NO. 15 K30 - Dyspepsia RANITIDIN 150 MG
No. RM : 01-063935 BPJS : 0001643863318 MCG
SISWOYO, TN (L) KELAPA GADING TIMUR 03/04 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
76 NIK : 3328071610820002 MCG
FAUZAN DWI ANDHIKA, AN (L) PGS II JL H OYAR RT 4/4 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
SAMIJAH, NY (P) KP. PULO GADUNG K30 - Dyspepsia RANITIDIN 150 MG
ANTASIDA DOEN
No. RM : 01-082130 BPJS : 0002143767611
PURWATININGSIH, NY (P) JL PGS II 006/002 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 05-Feb-1968 ( 51 Thn 7 Bln 4 Hr ) M79.2 - Neuralgia and neuritis, unspecified
79 NIK : 3172064502680003 MG
DEKSAMETASON 0,5 MG
SUHADI, TN (L) JL PGS II 006/002 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
unspecified NATRIUM DIKLOFENAK 50 MG
No. RM : 01-039822 BPJS : 0000039642052
ARNOLD CHRISTOPHER KUNTORO, AN (L) JL WARAKAS III RT 009/003 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
81 NIK : 3172022203081002 MG
2019-09-09 13:37 Hal. 477 dari 1322

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ARTHUR ALEXANDER KUNTORO, AN (L) JL WARAKAS III RT 009/003 J06.9 - Acute upper respiratory infection, DOMPERIDON SUSP 5 MG/5 ML
AGUS PRASETYO, TN (L) JL. TERATAI PUTIH 1 GG 15 RT 06/04 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
AHMAD FIHRY ALFARUQ, AN (L) KOMP IMPERIAL GADING J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
MANUNGGAL 2 S1 NO 16 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
84 MG
ALYSSA FANIE MUZDALIFAH, AN (P) KOMP IMPERIAL GADING PELINDO II J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
BLOK E1/16 009/008 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-076737 NIK : 3172046911131012 MG
ALFAN BAHARUDDIN ISKANDAR, TN (L) PERUM IMPERIAL GADING PELINDO II J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
BLOK E1 NO 16 RT 09/08 unspecified DEKSAMETASON 0,5 MG
No. RM : 01-016745 NIK : 3171061801790002 ASAM MEFENAMAT KAPS 500
NASYWA PUTRI ZAHRA, NN (P) JL PUTIH MELATI BLOK C3 NO 9 R11 - Nausea and vomiting RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-007302 BPJS : 0001440869422
2019-09-09 13:37 Hal. 478 dari 1322

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FAKHRI MUHAMMAD SYAMIL (L) JL.GADING IV NO.5 003/005 B01.9 - Varicella without complication ASIKLOVIR 400 MG
No. RM : 01-002044 BPJS : 0001224131218 MG
ENDANG S. MAIMUNAH, NY (P) TNH MERAH 001/007 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-012990 BPJS : 0002053298283 MG
ANTASIDA DOEN
NOVA FEBRIYANTI SEMBIRING. ST , NN (P) JL ISMAIL LK VI LIMAU MUNGKUR K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
BINJAI RANITIDIN 150 MG
90 ANTASIDA DOEN
DEMAS NANDO MAKARAWUNG, AN (L) JL. INSPESKI KALI SUNTER J00 - Acute nasopharyngitis [common cold] RETRIBUSI LAYANAN SIAGA 24 JAM
R11 - Nausea and vomiting DOMPERIDON SUSP 5 MG/5 ML
DEKSAMETASON 0,5 MG
NADYA NATHALIA SULU, NN (P) APT WGP TOWER C LT12 NO.29 K30 - Dyspepsia RANITIDIN 150 MG
K59.0 - Constipation NATRIUM DIKLOFENAK 50 MG
92 NIK : 0950015711010022
No. RM : 01-040089 BPJS : 0001579449194
NURFAJRI GUSNIAWAN, TN (L) WARUNG JENGKOL 002/013 L02.9 - Cutaneous abscess, furuncle and RETRIBUSI LAYANAN SIAGA 24 JAM
carbuncle, unspecified AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 479 dari 1322

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EMAH,NY (P) JL. RAWA SENGON RT 001/022 H10.9 - Conjunctivitis, unspecified AMLODIPIN 10 MG
I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
94 NIK : 31720352075500004 K30 - Dyspepsia PARASETAMOL TAB 500 MG
No. RM : 01-019829 BPJS : 0001229071419 L08.9 - Local infection of skin and GENTAMISIN SALEP KULIT
Tgl Diagnosis : 03 February 2019 7:51 PM subcutaneous tissue, unspecified RANITIDIN 150 MG
KHUMEDI KHAMBALI, TN (L) WARUNG PIRING S61.0 - Open wound of finger(s) without AMOKSISILIN 500 MG
damage to nail PARASETAMOL TAB 500 MG
SHARFARAZ YUSUF,AN (L) RAWA INDAH 04/03 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
96 NIK : 3172061607170003 MG
TRIMETOPRIM 40 MG)
SHEILA POLIMAN, NN (P) JL APRT PALADIAN PART TWR G K30 - Dyspepsia ANTASIDA DOEN
NO.1509 R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-086479 NIK : 3172066609010009 MG
ANDRIAN POLIMAN PHO, TN (L) APT PALADIANPARK TWR G /1509 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
98 NIK : 3172062504620001 MG
Tgl Diagnosis : 03 February 2019 8:09 PM KOTRIMOKSAZOL DOEN I (DEWASA)
TRIMETOPRIM 80 MG)
2019-09-09 13:37 Hal. 480 dari 1322

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YULIONO, TN (L) JL GADING VII NO 1 RT 05/05 KGB I10 - Essential (primary) hypertension AMLODIPIN 10 MG
99 NIK : 3172062607710002
No. RM : 01-003516 BPJS : 0001223475682
HANUM AZALIA, AN (P) JL GADING VII NO 01 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
100 NIK : 317265502070001 MG
IZQIAN MALIKI ALKAHFI HELDI, BY (L) JL.PGS II KP RAWA INDAH RT 07/03 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 14-Jun-2018 ( 1 Thn 2 Bln 26 Hr ) R11 - Nausea and vomiting
101 NIK : 3172062911170019 MG
SAADAH, NY (P) KP RWA INDAH J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
102 NIK : 3172064901750002 MG
KUSNIAWATI, NY (P) KP PULO GADUNG RT 02/05 L02.9 - Cutaneous abscess, furuncle and RETRIBUSI LAYANAN SIAGA 24 JAM
KUSUMAH DEWI, NN (P) JL RAWA SENGON RT 12/14 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
104 NIK : 3211035311080002 MG
2019-09-09 13:37 Hal. 481 dari 1322

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EMI BUDIYANTI, NY (P) PEGANGSAAN DUA 06/05 K30 - Dyspepsia RANITIDIN 150 MG
105 NIK : 3172064908920004
No. RM : 01-041917 BPJS : 0000378237993
FENITA KASYANTI, AN (P) JL. KEPU RT 01/01 B26.9 - Mumps without complication GLISERIL GUAIAKOLAT (GG) 100 MG
106 NIK : - unspecified TIAMIN (VITAMIN B1) 50 MG
DEKSAMETASON 0,5 MG
KARNIAH, NY (P) JL GOTONG ROYONG II RT 12/07 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
TUGU SE;LATAN KOJJA unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 26-Jul-1973 ( 46 Thn 1 Bln 14 Hr ) M79.1 - Myalgia
107 MG
Tgl Diagnosis : 03 February 2019 8:56 PM BPJS : 0001285024937 ASAM MEFENAMAT KAPS 500
AMOKSISILIN 500 MG
SANJAYA PRATAMA PUTRA, AN (L) KP RAWA INDAH RT 06/03 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
108 NIK : 3172060212100050 MG
MOHAMAD TOIF TN (L) GS II RT 5/5 M79.1 - Myalgia

109 NIK : 3172062108690001
No. RM : 01-042341 BPJS : 0001225993241
2019-09-09 13:37 Hal. 482 dari 1322

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NUR APIYAH, NY (P) JL GADING RAYA II RT 01/05 NO 4 J30.4 - Allergic rhinitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-021845 BPJS : 0001224304031 MCG
AHMAD FARRAS FAUZAN, AN (L) JLN. GADING RAYA 11 RT 01/05 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 06-Mar-2006 ( 13 Thn 6 Bln 3 Hr ) J45.9 - Asthma, unspecified
111 NIK : 3172060603060002 MG
INHALASI (UGD)
JOHANNES, TN (L) KLP MOLEK VI S2/15 RT 010/19 J06.9 - Acute upper respiratory infection, NATRIUM DIKLOFENAK 50 MG
unspecified ASAM MEFENAMAT KAPS 500
No. RM : 01-007530 BPJS : 0001745534395 MCG
AMOKSISILIN 500 MG
BILLY JANUAR ARDI, TN (L) KOMP BEA CUKAI R7/11 RT 007/007 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MG
CLARISSA AMDJAH, AN (P) JL. GADING ARCADIA BLK R NO.6 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
114 NIK : 3173064510090004 MG
2019-09-09 13:37 Hal. 483 dari 1322

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RICKY, NN (P) JL. GADING ARCADIA BLK L NO.6 K30 - Dyspepsia ANTASIDA DOEN
No. RM : 01-086486 BPJS : 0002070895274 MCG
RICHARDO SEBASTIAN, TN (L) JL KIELAPA SAWIT V AA 18 M79.1 - Myalgia RETRIBUSI LAYANAN SIAGA 24 JAM
Z00.0 - General medical examination ASAM MEFENAMAT KAPS 500
116 NIK : 3172062309900003 NATRIUM DIKLOFENAK 50 MG
No. RM : 01-017343 BPJS : 0001791148206
MELISSA HAZEL, NN (P) KELAPA SAWIT V AA//18 Z00.0 - General medical examination

117 NIK : 3172064807890003
No. RM : 01-004493 BPJS : 0001791147644
ERI TANUWIDJAJA, NY (P) KEALAP SAWIT V AA/18 Z00.0 - General medical examination

118 NIK : 3172066106620002
No. RM : 01-004494 BPJS : 0001791147093
RADEN MUHAMMAD FAUZAN, AN (L) JL KELAPA GADING TIMUR RT 03/04 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
119 NIK : 3172060907141002 MG
RADEN SYIFA QYARA, AN (P) KGT RT 03/04 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 28-Aug-2016 ( 3 Thn 0 Bln 12 Hr ) J06.9 - Acute upper respiratory infection,
2019-09-09 13:37 Hal. 484 dari 1322

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NANI SRI WAHYUNI, NY (P) PULAU BANGKA I N0 1 RT 008/09 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 5 MG
121 NIK : 3172065106490001
No. RM : 01-026236 BPJS : 0000046019553
INDAH FITRIANA WANDA, NY (P) KOMP PT HII NO 83 RT 6/06 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
unspecified SETIRIZIN 10MG
Tgl Lahir : 09-Mar-1995 ( 24 Thn 6 Bln 0 Hr ) O00.0 - Abdominal pregnancy
IDA ROSIDA, NY (P) KOMP PT HII NO 83 RT 06 RW 06 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
KELAPA GADING TIMUR AMLODIPIN 10 MG
No. RM : 01-048065 NIK : 317206511173001
MAHARDHIKA EKO SAPUTRO, AN (L) JL PEGANGSAAN DUA RT 01/04 J06.9 - Acute upper respiratory infection, ANTASIDA DOEN
No. RM : 04-000529 BPJS : 0001794369273 MG
MUSALIMTA PINEM, TN (L) JL H ROMLI RT 003/005 H66.9 - Otitis media, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
125 NIK : 317203160776010 J30.4 - Allergic rhinitis, unspecified
No. RM : 01-011275 BPJS : 0001824848379 KLORAMFENIKOL TT 3%
SELVI HANDAYANI, NY (P) JLN BANGUN CIPTA SARANA M79.2 - Neuralgia and neuritis, unspecified DEKSAMETASON 0,5 MG
GG.MASJID ARRAHMAN RT.01/06 SIANOKOBALAMIN (VITAMIN B12) 50
126 MCG
No. RM : 01-071045 NIK : 3308015902850001
MUTIARA DIVA ARYANTI, AN (P) TANAH MERAH UJUNG RT 02/06 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 485 dari 1322

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ABDUL SUPRIYATNA, TN (L) TANAH MERAT RT 02/06 NO 46 R60.0 - Localized oedema RETRIBUSI LAYANAN SIAGA 24 JAM
AMOKSISILIN 500 MG
WILLIAM OTNIEL SIMANGUNSONG, AN (L) JL RAWA SENGON BLOK D NO 39 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
129 NIK : 3175061212121001 MG
MARIUN WIRIATMADJA, TN (L) JL. PGS II L08.9 - Local infection of skin and AMOKSISILIN 500 MG
subcutaneous tissue, unspecified METRONIDAZOL 500 MG
Tgl Lahir : 15-Nov-1947 ( 71 Thn 9 Bln 25 Hr ) T14.91 - Injury, unspecified, open
JIHAN SABRINARAHMANI, AN (P) JL. BCS 005/006 NO.2B KGT J45.9 - Asthma, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
131 NIK : 3172065412019003 MG
INHALASI (UGD)
NY JUSNI ZULWIS , NY (P) KLP MOLEK V SA 1 NO 7 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 08-Sep-1945 ( 74 Thn 0 Bln 1 Hr ) ANTASIDA DOEN
132 NIK : 3172064809450003
AL GIFARY ARABY, AN (L) PEGANGSAAN DUA 02/01 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
133 NIK : 3172062308070003 MG
2019-09-09 13:37 Hal. 486 dari 1322

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RIDWAN, TN (L) PGS II RT 2/1 I10 - Essential (primary) hypertension SIANOKOBALAMIN (VITAMIN B12) 50
J06.9 - Acute upper respiratory infection, MCG
Tgl Lahir : 15-Jun-1968 ( 51 Thn 2 Bln 25 Hr ) RETRIBUSI LAYANAN SIAGA 24 JAM
134 NIK : 3172061506680004 unspecified
MG
TRIMETOPRIM 80 MG)
AMLODIPIN 5 MG
RIYANTO, TN (L) GG.PUSKESMAS NO.76 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-016638 BPJS : 0000378073438 MG
NADIRA AULIA PUTRI, an (P) JL. MEPU RT 04/01 PEGANGSAAN DUA J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
136 NIK : 3172064111170006 MG
PUPUT FITRIANA, NN (P) JL INF X SUNTER RT 10/0 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
MIDA SILALAHI, NY (P) RW SENGON BLK D M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
INJEKSI (UGD)
No. RM : 01-086491 BPJS : 0001379764934
2019-09-09 13:37 Hal. 487 dari 1322

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DEDI ISKANDAR, TN (L) JL PGS II RT 6/5 M79.1 - Myalgia NATRIUM DIKLOFENAK 50 MG
139 NIK : 3172061009870009 AMLODIPIN 5 MG
No. RM : 01-058747 BPJS : 0002098804206
FAJAR AGUSTIAN (L) JL. H OYAR RT N39.0 - Urinary tract infection, site not RETRIBUSI LAYANAN SIAGA 24 JAM
140 NIK : 3207191308930003
No. RM : 01-040767 BPJS : 0000438477658
IWIS DANINGSIH (P) RAWASENGON 03/22 O00.0 - Abdominal pregnancy

141 NIK : 3172036608840004
No. RM : 01-066487 BPJS : 0001195749628
PIETER JOHNSON LAWA, AN (L) KP.MUARA BAHARI 10/12 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
142 NIK : 3172021206111010 MG
SYIFA AZALIA PUTRI, AN (P) JL SUNGAI KAMPAR X 020/01 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
143 NIK : - MG
SALAMAH, NY (P) JL. PULO NANGKA BARAT II I84.5 - External haemorrhoids without
complication
Tgl Lahir : 07-Aug-1990 ( 29 Thn 1 Bln 2 Hr ) O00.0 - Abdominal pregnancy
144 NIK : 3175024708900001
No. RM : 01-080094 BPJS : 0001139577309
DIANA OKTAVIA, NY (P) PULO JAHE RT 007/005 O00.0 - Abdominal pregnancy

145 NIK : 3172065710940002
No. RM : 01-012582 BPJS : 0001657453026
2019-09-09 13:37 Hal. 488 dari 1322

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JENNE PUTRI PRISILIA (P) APT GADING DAHLIA 22 PGSN II O00.0 - Abdominal pregnancy

146 NIK : 6472054801960003
No. RM : 01-071774 BPJS : 0001723584576
NURUL KHOIRUNNISA (P) KAPLING TIPAR TIMUR BLOK G NO.13 G44.0 - Cluster headache syndrome PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
147 NIK : 3172044802030001
No. RM : 01-086677 BPJS : 0001377793517
DIANA OKTAVIA, NY (P) PULO JAHE RT 007/005 O00.0 - Abdominal pregnancy PARASETAMOL TAB 500 MG
Z39.0 - Care and examination immediately AMOKSISILIN 500 MG
148 NIK : 3172065710940002 after delivery KOMBINASI BESI (II) SULFAT 200 MG,
200.000 UI
DIDIT WURYANTO (L) JL. PEJUANG 3 RT. 003/004 KGT Z00.0 - General medical examination

149 NIK : 3306121309900002
No. RM : 01-040022 BPJS : 0001658438335
HERMAWAN DHARSONO (L) KELAPA HYBRIDA IX RA.25/8 Z00.0 - General medical examination

150 NIK : 3172062505550001
No. RM : 01-074288 BPJS : 0001337034677
EKA SAFITRI (P) KARANGDUWET I 014/006 Z00.0 - General medical examination

151 NIK : 3172025903931001
No. RM : 01-062368 BPJS : 0001645488685
2019-09-09 13:37 Hal. 489 dari 1322

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UNTUNG SUDARSONO (L) KELAPA HYBRIDA VII RA.21/5 Z00.0 - General medical examination

152 NIK : 3172061002
No. RM : 01-065248 BPJS : 0000038264905
MINI BIN ROMIN, NY (P) KP RAWA INDAH Z00.0 - General medical examination

153 NIK : 3172065204780006
No. RM : 01-081594 BPJS : 0001293033249
JULIA HALOMOAN (P) JL GADING AYU I BLOK RA 20/12 A RT Z00.0 - General medical examination
V11/15
154
No. RM : 01-003415 NIK : 3276064807610002
M. SUPRIYADI, TN (L) GG. L NO. 105 JL. BANGUN CIPTA Z00.0 - General medical examination
SARANA
155
No. RM : 01-086782 NIK : -
ANDRYANSAH (L) JL GADING III NO 11 Z00.0 - General medical examination

156 NIK : 3322181910840002
No. RM : 01-086784 BPJS : 0001634496219
RICHI OKTAVIA, NY (P) KP WARUNG JENGKOL NO 53 Z00.0 - General medical examination

157 NIK : 1603075710880001
No. RM : 01-086330 BPJS : 0002511292915
FIRMANSYAH, TN (L) JL PK WRG JENGKOL Z00.0 - General medical examination

158 NIK : 3172061909790002
No. RM : 01-086786 BPJS : 0000998907568
2019-09-09 13:37 Hal. 490 dari 1322

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TIMU AL GUNAWAN (L) JL PELEPAH INDAH BLK LB KANTOR S50.9 - Superficial injury of forearm, TOILET MATA / WOUND TOILET
RW 18 unspecified
Tgl Lahir : 10-Dec-1963 ( 55 Thn 8 Bln 30 Hr ) S61.1 - Open wound of finger(s) with
159
No. RM : 02-002751 NIK : 3208051012630003 damage to nail
FAUZIAH OKTAVIANI (P) JL AMPERA IV /22 RT 005/009 Z00.0 - General medical examination

160 NIK : 3172055310940004
No. RM : 01-016487 BPJS : 0001645494895
RIFKI ANFARI (L) ASRAMA DPK NO. 123 Z00.0 - General medical examination

161 NIK : -
No. RM : 01-084482 BPJS : 0000041765826
LAELI MIFTAKHUL JANNAH, NY (P) BALING BALING NO. 16 RT. 003/01 R07.4 - Chest pain, unspecified NATRIUM DIKLOFENAK 50 MG
RAWA BADAK SELATAN KOJA ASAM MEFENAMAT KAPS 500
162
No. RM : 01-001729 NIK : 3172031003
MARIA YUNITA MBUKA, NY (P) KOJANGABA RT 012/005 O00.0 - Abdominal pregnancy

163 NIK : 5308186003910001
No. RM : 01-072869 BPJS : 0000860083784
MARIA YUNITA MBUKA, NY (P) KOJANGABA RT 012/005 O00.0 - Abdominal pregnancy

164 NIK : 5308186003910001
No. RM : 01-072869 BPJS : 0000860083784
SUCIADI, TN (L) JL. PEGANGSAAN DUA NO. 69 Z00.0 - General medical examination

165 NIK : 3172063110820010
No. RM : 05-001020 BPJS : 0001223482869
2019-09-09 13:37 Hal. 491 dari 1322

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FIRMANSYAH (L) H OYAR RT 4/2 Z00.0 - General medical examination

166 NIK : 3172062705960003
No. RM : 01-044662 BPJS : 0001326482368
LENDY SUBHANA WIDJAJA (L) JL JANUR KUNING I WG 2/8 RT 07/15 Z00.0 - General medical examination
KGT 085719303006
167
No. RM : 01-005973 NIK : 3172061001092157
BERLYANA AUREL WIDJAJA, AN (P) JL JANUR KUN9ING I1 WG 2/8 RT 07/15 Z00.0 - General medical examination
168 NIK : 3172066212081001
No. RM : 01-005976 BPJS : 0001225683674
TITIN PRIHATIN, NY (P) KP PULO GADUNG Z00.0 - General medical examination

169 NIK : 3172065209850002
No. RM : 01-086796 BPJS : 0001446934059
HAFIDZ ZAKY MUBAROK (L) KP.PULOGADUNG 02/05 J45.9 - Asthma, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-050887 BPJS : 0002202090456 MG
SALBUTAMOL 2 MG
HARYONO, TN (L) KLP GADING PELEPAH ASRI BLK. QC E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
171 AMLODIPIN 10 MG
No. RM : 01-001137 NIK : 3172061607420002 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Diagnosis : 10 February 2019 8:25 AM BPJS : 0001439952287 unspecified
MG
AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 492 dari 1322

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FAZA FAUZIYAWATI, NY (P) JL PEGANGSAAN DUA RT 06/02 O91.2 - Nonpurulent mastitis associated with AMOKSISILIN 500 MG
childbirth PARASETAMOL TAB 500 MG
SHALOMITHA GRACIA PRATAMA, AN (P) JL. PERJUANGAN NO.108 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN SUSPENSI
173 NIK : 3172020402151017
No. RM : 01-060121 BPJS : 0002306502797 ZINC 20 MG
LIU FAN DJU (P) JL. GRIYA PRATAMA IV BLOK IV/ 9 I10 - Essential (primary) hypertension GENTAMISIN SALEP KULIT
L08.9 - Local infection of skin and RETRIBUSI LAYANAN SIAGA 24 JAM
174 NIK : - subcutaneous tissue, unspecified AMLODIPIN 10 MG
MASNIAR, NY (P) TMN PGS INDAH BLOK D/2 RT 1/19 E11.9 - Non-insulin-dependent diabetes RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-023201 BPJS : 0001838056061 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Diagnosis : 10 February 2019 9:22 AM unspecified
MG
DEKSAMETASON 0,5 MG
JUSTIN ERICHO (L) JL. PEGANGSAAN DUA NO 23 J45.9 - Asthma, unspecified INHALASI (UGD)
INJEKSI (UGD)
176 NIK : 3172062709700007 NACL 0,9% 500 ML
No. RM : 01-087043 BPJS : 0001775030951
LISNAWATI, NY (P) GG PEJUANGH IV RT 4/4 K30 - Dyspepsia RANITIDIN 150 MG
R42 - Dizziness and giddiness ASAM MEFENAMAT KAPS 500
No. RM : 01-040960 BPJS : 0002246773522 MCG
2019-09-09 13:37 Hal. 493 dari 1322

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RASITO B SAKIB (L) GG PEJUANG IV RT 04/04 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
178 NIK : 317205062830002 MG
sabrina nurul shafa (P) JL. HJ OYAR 004/004 NO. 13 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
PEGANGSAAN DUA unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
179 MG
Tgl Diagnosis : 10 February 2019 10:07 AM BPJS : 0002327082974 AMOKSISILIN SYR KERING 125 MG/5ML
SYAFIRARAIHANAH (P) RT 004/004 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
180 NIK : 3172065809111001 MG
YULI AGUSTIANINGSIH (P) H.OYAR 04/04 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
181 NIK : 3175067007870021 MG
RAHMAD HANDAYA DS, TN (L) JL BANYO II NO 13-14 A15.2 - Tuberculosis of lung, confirmed
histologically
182 NIK : 3172061811860004
No. RM : 03-001022 BPJS : 0002739794242
NIGAR KAYLA TSANI (P) cekatan 1 no 11 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
183 NIK : 3172064903101001 MG
2019-09-09 13:37 Hal. 494 dari 1322

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GHIFARI SASMADYA MUHAMMAD (L) JL. CEKATAN 1 NO. 11 KODAMAR J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
184 NIK : - MG
SUGIHARTO KARIM, TN (L) SUMANGGUNG II C/2 I10 - Essential (primary) hypertension SALBUTAMOL 2 MG
J45.9 - Asthma, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-003530 BPJS : 0001386901282 MG
AMLODIPIN 10 MG
RIZKY NAZAR DARMAWAN, AN (L) PGS II RT 3/4 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
186 NIK : 3172061101170017 MG
AMANDA KALISA ALIVIA, AN (P) JL. BAKTI ABRI NO.3 003/004 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
187 NIK : 3172065004160004 MG
MUHAMMAD RAYYAN BAIHAQI, AN (L) JL. BHAKTI ABRI NO. 2 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
188 NIK : 3172060110101005 MG
ALFIATU TAHZANI AHLA (P) JL BCS GG L RT 04/05 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
189 NIK : 3172066410170001 MG
2019-09-09 13:37 Hal. 495 dari 1322

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SHIFA SILVANA, NY (P) JL. RAWA SENGON BLOK B NO. 115 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 12-Nov-1997 ( 21 Thn 9 Bln 28 Hr ) M79.1 - Myalgia
190 NIK : 3175065211970010 MG
DELINA WIDITYA (P) JL PGS II 003/002 NO.76 J06.9 - Acute upper respiratory infection, ANTASIDA DOEN
Tgl Lahir : 23-Apr-2000 ( 19 Thn 4 Bln 17 Hr ) K30 - Dyspepsia
191 NIK : -
No. RM : 01-015801 BPJS : 0000378854155
MARWAH NY (P) jl. PEGANGSAAN DUA no.52 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
192 NIK : 3172064505670003 MG
AMOKSISILIN 500 MG
HASAN (L) JL PEGANGSAAN DUA RT 03/04 L29.9 - Pruritus, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
193 NIK : 3172061509660002 MG
Tgl Diagnosis : 10 February 2019 11:21 AM KOMBINASI KAOLIN 550 MG, PEKTIN 20
MG TAB
LILIK WAHYUDI (L) RAWA SENGON 05/22 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-014560 BPJS : 0001740747622 MCG
ALDI GUNTUR SAPUTRA, AN (L) JL. H OYAR RT 01/02 L02.9 - Cutaneous abscess, furuncle and AMOKSISILIN 500 MG
No. RM : 01-075362 BPJS : 0002507286633
2019-09-09 13:37 Hal. 496 dari 1322

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CAMELIA ULFA, NY (P) JL.WARAKAS VI GG.16 T14.0 - Superficial injury of unspecified body TOILET MATA / WOUND TOILET
region AMOKSISILIN 500 MG
No. RM : 01-087061 BPJS : 0002331556514
GINI SRIJATI, NY (P) PONDOK PEKAYON INDAH RT 005/018 J06.9 - Acute upper respiratory infection, KOTRIMOKSAZOL DOEN I (DEWASA)
197 NIK : 3275046305620011
SYLVIA SULISTIO (P) JL JANUR ASRI VI QK RT 13/22 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 14-Sep-1976 ( 42 Thn 11 Bln 26 Hr ) AMOKSISILIN 500 MG
198 NIK : 3172065409760002
NADA FAJRIAN SALSABILA, AN (P) JL PUSKESMAS 005/006 KGT J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
199 NIK : 3172066710031001 MG
NURFITRIYANI (P) JL PUSKESMAS NO 68 RT 005/006 J06.9 - Acute upper respiratory infection, ANTASIDA DOEN
No. RM : 02-003885 BPJS : 0001224056237 MG
TYAS RAMAHDANI (P) JL PGS II NO.15 004/003 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
MEISYA ANDINA (P) JL PEGANGSAAN DUA RT 01/04 I88.1 - Chronic lymphadenitis, except AMOKSISILIN 500 MG
mesenteric PARASETAMOL TAB 500 MG
Tgl Lahir : 06-Sep-2004 ( 15 Thn 0 Bln 3 Hr ) K05.0 - Acute gingivitis
No. RM : 04-000921 BPJS : 0001770512185
2019-09-09 13:37 Hal. 497 dari 1322

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YULI MAYASARI (P) JL INSPEKSI KALI SUNTER RT 07/04 O00.0 - Abdominal pregnancy
O48 - Prolonged pregnancy
203 NIK : 3172064507910005
No. RM : 01-022352 BPJS : 0000378514631
SUCIPTO ADI RESTU, TN (L) JL. BOULEVARD TIMUR NO. 40 J06.9 - Acute upper respiratory infection, NATRIUM DIKLOFENAK 50 MG
Tgl Lahir : 02-Jan-1997 ( 22 Thn 8 Bln 7 Hr ) M79.1 - Myalgia
MILA (P) PGS II RT 4/5 R51 - Headache PARASETAMOL TAB 500 MG
No. RM : 01-019952 BPJS : 0001225767227 MCG
ALDY RAMADHANI, BY (L) TANAH MERAH RT 01/07 J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
unspecified
206 NIK : 3175060406180002
No. RM : 01-074807 BPJS : 0002464616889
TATI MUNAWAROH (P) JL KGT RT 03/04 R53 - Malaise and fatigue SIANOKOBALAMIN (VITAMIN B12) 50
MCG
Tgl Lahir : 19-May-1983 ( 36 Thn 3 Bln 21 Hr ) PARASETAMOL TAB 500 MG
207 NIK : 3208275905830005
No. RM : 01-025374 BPJS : 0001225567192
SARAH SITAH RAHMANIA (P) PGS II RT 03/07 A09 - Diarrhoea and gastroenteritis of ZINC 20 MG
presumed infectious origin ANTASIDA DOEN SUSPENSI
Tgl Lahir : 08-Oct-2015 ( 3 Thn 11 Bln 1 Hr ) J06.9 - Acute upper respiratory infection,
R11 - Nausea and vomiting
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 498 dari 1322

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RIDWAN HANDOKO (L) JL. P NANGKA BARAT II J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-044212 BPJS : 0001630103793 MG
DEKSAMETASON 0,5 MG
SENDY TAMA SAPUTRA (P) PGS II J06.9 - Acute upper respiratory infection, ANTASIDA DOEN SUSPENSI
No. RM : 01-082814 BPJS : 0001818100642 MG
ANNISA ADIBA (P) JL RW SENGON BLPOK D RT 7/22 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
211 NIK : - MG
MUHAMMAD GHAILAN FAIZ, AN (L) TPI D/2RT 01/19 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
212 NIK : 3172061203091001 MG
SYANNE (P) JL. MUSTIKA 2 NO. 21 J30.4 - Allergic rhinitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
213 NIK : 31710359160001
KHANSA RALINE MIKAILA (P) JL.GAMBIR ANOM F-6/13 RT 002/006 R50.9 - Fever, unspecified ANTASIDA DOEN SUSPENSI
2019-09-09 13:37 Hal. 499 dari 1322

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DZAKY DANO HILMY (L) SUKAPURA J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
215 NIK : 1271100412930003 MG
AHMAD DZULKARNAIN, TN (L) GADING ICON TOWER LT 15 NO.19 K05.0 - Acute gingivitis ASAM MEFENAMAT KAPS 500
R60.0 - Localized oedema AMOKSISILIN 500 MG
PUTRI FATIMAH HIDAYAH (P) JL. INSPEKSI KALI SUNTER RT 04 RW R11 - Nausea and vomiting PARASETAMOL TAB 500 MG
04 KGB R50.9 - Fever, unspecified AMOKSISILIN 500 MG
GRACE.I.P.SIMATUPANG (P) KOMP PERUMAHAN PT HII B/6 JL. B76.9 - Hookworm disease, unspecified ALBENDAZOL 400 MG
PERINTIS KEMERDEKAAN KLORFENIRAMIN MALEAT (CTM) TAB 4
218 MG
No. RM : 01-087070 NIK : 3172065911720003
DEWI YULIANI, NN (P) JL PGS II 004/001 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
219 NIK : 3172065807950004 MG
JEFANYA FITRI ROWENA, NN (P) APT WGP B 27-06 RT 8/20 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
220 NIK : 3172065503930007 MG
2019-09-09 13:37 Hal. 500 dari 1322

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TIMOTIUS CHANDRA, TN (L) JL. KLP GADING ELOK NARAT I CC 2 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
NO 12 A L29.9 - Pruritus, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
221 MG
SAHRIN MANALU, TN (L) JL. SMA 83 N0 32 T 003/004 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-014745 BPJS : 0001270673706 MG
MCG
KABIRAN ,TN (L) RAWA SENGON RT 03/22 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
223 NIK : 31720302087430001 MCG
SALBIAH,NY (P) JL RAWA SENGON BLOK C NO 59 RT J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
03/022 unspecified MG
Tgl Lahir : 20-Apr-1957 ( 62 Thn 4 Bln 20 Hr ) M79.1 - Myalgia NATRIUM DIKLOFENAK 50 MG
224
ESTER LITA (P) GADING VI NO 4 RT 4/5 H66.9 - Otitis media, unspecified PARASETAMOL TAB 500 MG
AMOKSISILIN 500 MG
225 NIK : 3172064509960004
No. RM : 01-009384 BPJS : 0001224789287
ROSIANA INDAH PRATIWI (P) RAWA SENGON R11 - Nausea and vomiting RETRIBUSI LAYANAN SIAGA 24 JAM
ANTASIDA DOEN
2019-09-09 13:37 Hal. 501 dari 1322

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SUNANTO HADINATA, TN (L) TMN PGS INDAH RT 003-019 BLOK M E11.9 - Non-insulin-dependent diabetes RETRIBUSI LAYANAN SIAGA 24 JAM
NO 8 mellitus without complications PARASETAMOL TAB 500 MG
No. RM : 01-039131 NIK : 3171012801610001 GLIBENKLAMIDA 5 MG
AMLODIPIN 5 MG
FEREN TYAS MUNANDAR (P) RAWA INDAH 005/003 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
WARIYAH, NY (P) MOLEK I B4 NO 15 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 10 MG
I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
NURAENI, NY (P) KP RAWA INDAH RT 003/003 K30 - Dyspepsia GLISERIL GUAIAKOLAT (GG) 100 MG
230 NIK : 3172065001910001 MG
AMOKSISILIN 500 MG
MASNIAR, NY (P) TMN PGS INDAH BLOK D/2 RT 1/19 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 17-Dec-1949 ( 69 Thn 8 Bln 23 Hr ) E11.9 - Non-insulin-dependent diabetes RANITIDIN 150 MG
231 NIK : 3172065712490004
No. RM : 01-023201 BPJS : 0001838056061 mellitus without complications ANTASIDA DOEN
Tgl Diagnosis : 11 February 2019 5:46 PM FENOL GLISEROL TT 10%
K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
SERI YANAH, NY (P) PGS II RT 06/02 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 12-Jan-1988 ( 31 Thn 7 Bln 28 Hr ) K30 - Dyspepsia
No. RM : 01-036482 BPJS : 0001886633111 MG
RANITIDIN 150 MG
AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 502 dari 1322

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LILI, NY (L) PGS II RT 06/02 R50.9 - Fever, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
DEWI EVITA AYU, NY (P) KP RAWA INDAH RT 006/003 PGS II O06.4 - Unspecified abortion, incomplete,
without complication
234 NIK : 3172045601911001
No. RM : 01-000765 BPJS : 0001740738194
DONI DERMAWAN (L) DUSUN PUTO DUA RT 004 RW 002 R50.9 - Fever, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-087185 BPJS : 0001057707562 MCG
YUNI ASTARI (P) PGS II RT 6/2 H10.9 - Conjunctivitis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
K30 - Dyspepsia RANITIDIN 150 MG
ELAH, NY (P) KP GANG PEJUANG 4 B02.9 - Zoster without complication RETRIBUSI LAYANAN SIAGA 24 JAM
ASIKLOVIR 400 MG
ASIKLOVIR KRIM 5%
SIKIN, TN (L) GRAND ORCHARD CLOVER 5 BLOK M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK 50 MG
BF 03 ASAM MEFENAMAT KAPS 500
No. RM : 01-069030 NIK : 3302111008800003
2019-09-09 13:37 Hal. 503 dari 1322

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NOVIANTI EKA PRAMONO (P) JL INPEKSI KALI SUNTER NO 2 A90 - Dengue fever [classical dengue]

239 NIK : 3172066411141008
No. RM : 01-086872 BPJS : 0001740750017
FAIZ KENZIE HAMIZAN (L) JL TABAH RAYA RT 1/9 NO 21 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-016189 BPJS : 0001774869118 MG
SAYUNI, NY (P) RAWA SENGON RT 03/05 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-055687 BPJS : 0000378198426 MG
AMOKSISILIN 500 MG
HILDA FEBRIYANI (P) PULO NANGKA BARAT II RT 002/016 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-019127 BPJS : 0001853761408 MG
AZALEA KHALILUNA DZAHIN, AN (P) JL KEPU RT 04/1 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 05-Mar-2017 ( 2 Thn 6 Bln 4 Hr ) R11 - Nausea and vomiting
No. RM : 01-038505 BPJS : 0002232695485 MG
MCG
ILHAM ABUBAKAR, TN (L) JL RAWA SENGON BLOK B RT 02/022 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
244 NIK : 3174021506650008 SALBUTAMOL 2 MG
2019-09-09 13:37 Hal. 504 dari 1322

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SUMIYATI, NY (P) JL H OYAR RT 04/02 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
RANITIDIN 150 MG
M ALIF ABYMOEL ATTAR, AN (L) JL INFEKSI KALI SUNTER RT 02/04 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
246 NIK : 3202033009080001 MG
ABDULATIF, TN (L) JL PGS 2 RT 006/005 J30.4 - Allergic rhinitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
L23.9 - Allergic contact dermatitis, MG
Tgl Lahir : 13-Nov-1985 ( 33 Thn 9 Bln 27 Hr ) DEKSAMETASON 0,5 MG
247 NIK : 3328081611870002 unspecified cause
FASHIHATUL FITRIYANI, NY (P) PGS II RT RT 6/5 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-059800 BPJS : 0000625706548 MG
RANITIDIN 150 MG
ROFIFAH ZAHIRAH, AN (P) JL GADING SENGON RT 06/022 KGB J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 13-Aug-2016 ( 3 Thn 0 Bln 27 Hr ) R11 - Nausea and vomiting
249 NIK : 0002098500309 MG
ALLELUIA VICTORIA ALJONAK. S (P) VILLA PERMATA GADING BLOK L10 K30 - Dyspepsia OMEPRAZOL KAPS 20 MG
RANITIDIN 150 MG
No. RM : 01-076530 BPJS : 0001970334887
2019-09-09 13:37 Hal. 505 dari 1322

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ALFIN MUTTAQIN, AN (L) JL. KELAPA MOLEK IV U2 NO.2 006/019 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
251 NIK : 3172060501131002 MG
NIDA HASANAH (P) JL KELAPA MOLEK IV U2 NO 2 RT J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
252 MG
NINGSIH, NY (P) JL.PERJUANGAN TUGU SELATAN RT N39.0 - Urinary tract infection, site not SIPROFLOKSASIN 500 MG
008;007 specified PARASETAMOL TAB 500 MG
253 FITOMENADION (VITAMIN K1) 10 MG
ANDINA SYIFA FAUZIAH (L) JL. PULAU PENYENGAT RAYA 002/003 L23.9 - Allergic contact dermatitis, KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 16-Nov-1999 ( 19 Thn 9 Bln 24 Hr ) L70.9 - Acne, unspecified DEKSAMETASON 0,5 MG
254 NIK : 3172065611990001
RINA TRIANA DEWI (P) PEGANGSAAN DUA KM 20 NO 11 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
NUR SETIYADI, TN (L) JL PELEPAH INDAH RAY LB 24 NO 02 M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
No. RM : 01-027002 BPJS : 0000531031432 MCG
2019-09-09 13:37 Hal. 506 dari 1322

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SUPRIYADI, TN (L) RAWA INDAH RT 03/02 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-012431 BPJS : 0001840154951 MG
MCG
FANNIYATUL FARUNI (P) JL. BCS GG L 005/005 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
258 NIK : 3172064901030002 MG
RANITIDIN 150 MG
AARON HAHOLONGAN PANGGABEAN (L) JL PRIHATIN NO.44 006/002 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
IVANA MELINA SARAGI (P) JL.PRIHATIN NO.44 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
LUKMAN NG, TN (L) JL.BELLYRA II BLOK M\2 RT 06\08 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
PGS2 K30 - Dyspepsia ANTASIDA DOEN
No. RM : 01-066521 NIK : 3172060710570001
DIAN ALFIAH, SE, NY (P) KELPA PUYUH V KG/5 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
262 NIK : 3171055012790006 MG
2019-09-09 13:37 Hal. 507 dari 1322

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JUMI ROHANI, NY (P) KP.PULO GADUNG 04/05 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
YUSUF NUR FAJRI, AN (L) KALI SUNTER 09/04 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
264 NIK : - MG
MCG
RENALD RAMADHANI (L) PEGANGSAAN DUA 04/04 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 14-Sep-2007 ( 11 Thn 11 Bln 26 Hr ) PARASETAMOL TAB 500 MG
265 NIK : 3172061409071002
RUNIAH, NY (P) RW SENGON RT 5/22 O00.0 - Abdominal pregnancy AMOKSISILIN 500 MG

No. RM : 01-065775 BPJS : 0002332920576 200.000 UI
PARASETAMOL SUPP 240 MG
MCG
ASAM FOLAT 0,25 MG
NEVA RAZITA NANDOLA (P) JL IMPORT BLOK A / 30 RT 06/10 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 508 dari 1322

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JUDIKA RAHMAYAR MARPAUNG, NY (P) JL RAWA SENGON RT 002/022 B35.6 - Tinea cruris RETRIBUSI LAYANAN SIAGA 24 JAM
I10 - Essential (primary) hypertension AMLODIPIN 10 MG
268 NIK : 3172024204730011 K30 - Dyspepsia PARASETAMOL TAB 500 MG
No. RM : 01-015251 BPJS : 0001141753173 L50.9 - Urticaria, unspecified RANITIDIN 150 MG
MG
MIKONAZOL KRIM 2 %
KETOKONAZOL 200 MG
ERLANGGA HARDIANSYAH, AN (L) JL GADING VI NO 01 RT 04/05 KGB J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 21-Apr-2011 ( 8 Thn 4 Bln 19 Hr ) L50.9 - Urticaria, unspecified
269 NIK : - MG
IR MASAGUS FERRY ARIFIN, TN (L) PRT WGP TOWER B LT3 /14 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-001787 BPJS : 0001336794287
ZAKIYAH, NY (P) PEGANGSAAN DUA RT 04/04 I10 - Essential (primary) hypertension RANITIDIN 150 MG
271 NIK : 3172066702800004 AMLODIPIN 10 MG
No. RM : 01-046999 BPJS : 0000379188573
NIZAM RASYID ASSAIDI, AN (L) PEGANGSAAN DUA 04/04 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 10-Sep-2015 ( 3 Thn 11 Bln 30 Hr ) J45.9 - Asthma, unspecified
272 NIK : 3172061009151002 MG
INHALASI (UGD)
MAYANI, NY (P) KP RAWA INDAH RT. 004/003 PGS II J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 509 dari 1322

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ABIZAR HIZAM MALDINI (L) JL PGS II RT 004/002 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
274 NIK : - MG
JANICE MADALA WELT LAROSA, AN (P) JL MERAH DELIMA BLOK D3 NO 14 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
275 NIK : 3175046005160010 MG
HIDAYAT KOSASIH (L) JL SENTOSA II J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
276 NIK : 3172061308700002 FITOMENADION (VITAMIN K1) 10 MG
No. RM : 01-086593 BPJS : 0001793854449
RUNIAH, NY (P) RW SENGON RT 5/22 O80.9 - Single spontaneous delivery, AMOKSISILIN 500 MG
Tgl Lahir : 08-Sep-1987 ( 32 Thn 0 Bln 1 Hr ) Z39.2 - Routine postpartum follow-up
200.000 UI
MCG
SANTI NURCAHYANI, NY (P) JL H OYAR RT 004/002 O00.0 - Abdominal pregnancy

278 NIK : 3201125811920004
No. RM : 01-015780 BPJS : 0001737320466
NURHAYATI (P) KP PULO GADUNG RT 02/05 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 20-Oct-1993 ( 25 Thn 10 Bln 20 Hr ) R50.9 - Fever, unspecified
2019-09-09 13:37 Hal. 510 dari 1322

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ARIF TARMIZI (L) RT 03/01 PEGANGSAAN DUA J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
280 NIK : 3172061811971001 MG
FU CEN LIE, NY (P) JL GADING INDAH UTARA 4 NH NO 20 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
RT 23/17 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
281 unspecified MG
AMLODIPIN 5 MG
SOLEKAH, NY (P) ASARAMA PEMADAM RT 04/17 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
SEMPER BARAT unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
282 MG
DEKSAMETASON 0,5 MG
DEDEN SAPUTRA, TN (L) ASRAMA PEMADAM J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
SYAHRIL DWI CAHYA, AN (L) ASRAMA PEMADAM SEMPER J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
284 NIK : - MG
ALFIAN SAPUTRA, AN (L) ASRAMA PEMADAM RT 004/017 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
285 NIK : - MG
2019-09-09 13:37 Hal. 511 dari 1322

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MUHAMAD SOLIKIN, TN (L) JL RAWA SENGON BLOK B K30 - Dyspepsia RANITIDIN 150 MG
ANTASIDA DOEN
286 NIK : 3172062403830009 BISAKODIL TAB SALUT 5MG
ELLIOTT NATHANIEL CHRISTIAN JL. PAJAJARAN BLOK Q NO. 2 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
SUKAPURA DEKSAMETASON 0,5 MG
No. RM : 01-069921 NIK : -
SRI SUPADMI, NY (P) JL CAKUNG PERTUKANGAN I10 - Essential (primary) hypertension RANITIDIN 150 MG
K30 - Dyspepsia KAPTOPRIL 25 MG
No. RM : 01-015995 BPJS : 0001743590992
DEBBY KEMALA INTAN, NY (P) JL IMPORT BLOK A /30 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
J06.9 - Acute upper respiratory infection, ASAM ASKORBAT (VITAMIN C) 50 MG
AMLODIPIN 10 MG
KAYVA RAHIZA NANDOLA, AN (P) JL.IMPORT A/30 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-054139 BPJS : 0001773844593 MG
SITI SHOLEHA, NY (P) 005/007 PERJUANGAN I K30 - Dyspepsia SIPROFLOKSASIN 500 MG

N39.0 - Urinary tract infection, site not PARASETAMOL TAB 500 MG
291 NIK : 3172036309951001 specified RANITIDIN 150 MG
No. RM : 01-001941 BPJS : 0001324179674
TALITA PUTRI HUMAIROH, AN (P) JL. RAWA INDAH 004/003 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 512 dari 1322

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MG
SALBUTAMOL 2 MG
EHA BT HALIMI, NY (P) PGS2 RT06/02 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
CINDY TALIA DESVIERRA, AN (P) RAWA INDAH RT. 003/003 PGS II J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 22-Dec-2013 ( 5 Thn 8 Bln 18 Hr ) L50.9 - Urticaria, unspecified
No. RM : 01-001958 BPJS : 0001770523751 MG
DEKSAMETASON 0,5 MG
MITA NOVIANTI TRIAS PRATIWI, NN (P) JL PERJUANGAN RAYA 022/007 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
295 NIK : 3173056011980005 MG
ANDI KUSUMA, TN (L) JL JANUR ELOK VII BLK QG II NO.10 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
003/011 unspecified DEKSAMETASON 0,5 MG
SHEFIA RESTA, AN (P) JL KP PULO GADUNG J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
297 NIK : 3172065407121002 MG
2019-09-09 13:37 Hal. 513 dari 1322

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SUGIYAT, TN (L) JL SENTOSA II NO 16 RT 009/010 I84.5 - External haemorrhoids without ANTIHEMOROID DOEN
complication ASAM MEFENAMAT KAPS 500
298 NIK : 3172061909670001
No. RM : 01-009356 BPJS : 0001128867096
RAHMAT AZAN ISYA (L) KELAPA AGDING KUSUMA BLOK GK J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
NO 5 unspecified PARASETAMOL TAB 500 MG
No. RM : 01-017823 NIK : -
M. NASRULLOH, AN (L) JL RAWA SENGON BLOK F RT 006/022 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
300 NIK : 3328021901040005 MG
AMOKSISILIN 500 MG
INJEKSI (UGD)
EVI AGUS TISNA, NN (P) KP KAUNGGADING K30 - Dyspepsia PARASETAMOL TAB 500 MG
No. RM : 01-085219 BPJS : 0000380130028 MCG
M CAHYA AL FAJHRI, AN (L) YPGS II RT 6/2 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
302 NIK : 3172062001131002 MG
ENI WAHYUNI, NY (P) YPGS II RT 6/2 K30 - Dyspepsia RANITIDIN 150 MG
O36.9 - Maternal care for fetal problem, ASAM MEFENAMAT KAPS 500
No. RM : 01-033117 BPJS : 0001743180581 R51 - Headache PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 514 dari 1322

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EUIS SITI HODIDJAH (P) JLN BCS RT 02 RW 05 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
MOCH. BAGUS MIFTAHUSSURUR (L) P.GADUNG RT 03 RW 17 H10.9 - Conjunctivitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
305 NIK : 3329142702120001 AMOKSISILIN KAPS 250 MG
SELI RAHMAH DANI, AN (P) JL BENDUNGAN MELAYU RT 11/01 R11 - Nausea and vomiting RETRIBUSI LAYANAN SIAGA 24 JAM
306 NIK : 3173064911041001 RANITIDIN 150 MG
JENNY NOVITA M.ARITONANG, NY (P) JL TIPARB SELATAN 3 E79.9 - Disorder of purine and pyrimidine RETRIBUSI LAYANAN SIAGA 24 JAM
metabolism, unspecified DEKSAMETASON 0,5 MG
Tgl Lahir : 02-Nov-1973 ( 45 Thn 10 Bln 7 Hr ) M13.9 - Arthritis, unspecified
307 NIK : 3172044211730006 TIAMIN (VITAMIN B1) 50 MG
RENY MANORA SINAGA, NY (P) JL PRIHATIN NO 44 RT 7/2 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
K30 - Dyspepsia NATRIUM DIKLOFENAK TAB 25 MG
308 NIK : 3172065908480001 M79.1 - Myalgia SIANOKOBALAMIN (VITAMIN B12) 50
No. RM : 01-040783 BPJS : 0000046162337 MCG
R51 - Headache
AMLODIPIN 5 MG
TUMIAR MARIANI, NN (P) JL KOMP WALIKOTA JL CAMAR III I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
BLOK C 2/6 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
309 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
No. RM : 01-082806 NIK : 3172045303850002 MG
2019-09-09 13:37 Hal. 515 dari 1322

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MIRNA SARI, NY (P) JL CEKATAN III NO 47 I10 - Essential (primary) hypertension RANITIDIN 150 MG
310 NIK : 3172066505760002 unspecified ASAM MEFENAMAT KAPS 500
No. RM : 01-031475 BPJS : 0001224110968
AMSON CHAN, TN (L) PGS II RT 4/5 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
311 NIK : 3172061001760003 MG
ANI (P) JL KP RAWA INDAH RT 005/003 K30 - Dyspepsia PARASETAMOL TAB 500 MG
R51 - Headache RANITIDIN 150 MG
No. RM : 01-009723 BPJS : 0000378819516 MCG
M EDIYANTO, TN (L) JL MERPATI VII NO 205 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
313 NIK : 3274032805990008 MG
ARYANI, NY (P) PGS II RT 1/03 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-007644 BPJS : 0001676014424
EFVI DWI NURVIANTI, NY (P) JL RAYA PGS II RT 06/02 J06.9 - Acute upper respiratory infection, DEKSAMETASON 0,5 MG
315 NIK : 3316126409870001
No. RM : 01-065525 BPJS : 0001652883851
NURHASANAH, NY (P) JL. PERINTIS KEMERDEKAAN RT 01 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
RW 04 KGT unspecified MG
316
2019-09-09 13:37 Hal. 516 dari 1322

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MUHAMAD NGIRFAN (L) JL. PERINTIS KEMERDEKAAN RT 01 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
RW 04 KGT unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-087702 NIK : 3172060305740003 MG
Tgl Diagnosis : 16 February 2019 8:57 PM BPJS : 0002104336539 ANTASIDA DOEN
MOCH SJAFEI SASS, TN (L) JL HARPA II AA NO 16 I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4
L29.9 - Pruritus, unspecified MG
Tgl Lahir : 27-Apr-1945 ( 74 Thn 4 Bln 13 Hr ) ASAM MEFENAMAT KAPS 500
318 NIK : 3172062704450002 M13.9 - Arthritis, unspecified
MCG
AFIFAH NURFIANI, AN (P) JL. PERINTIS KEMERDEKAAN 001/004 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
319 NIK : 3172064506080001 MG
SLAMET SUPRIYADI, TN (L) JL KEPU 004/001 NO 59 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
320 NIK : 3325110104820009 MG
SUYATI, NY (P) P TEmIANG 3/17 RT13/03 I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
321 NIK : 3172067112560008 M13.9 - Arthritis, unspecified AMLODIPIN 10 MG
HIDAYATULLAH, TN (L) JL TIPAR CAKUNG RT 02/03 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 11-Jun-1971 ( 48 Thn 2 Bln 29 Hr ) K30 - Dyspepsia PARASETAMOL TAB 500 MG
322 NIK : 3172041106710013
AZMYA RAISHA ADIBA, AN (P) SUKAPURA JAYA RT003/010 NO70 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 517 dari 1322

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DEKSAMETASON 0,5 MG
HAYATIN NUFUS, NY (P) GD KIRANA BARAT IX 6.6 41/42 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 13-Jul-1984 ( 35 Thn 1 Bln 27 Hr ) R17 - Unspecified jaundice
No. RM : 01-016795 BPJS : 0001811125192 MCG
MUHAMMAD ABDURRAHMAN HAFIDZ (L) GG PEJUANG RT 3/4 S81.9 - Open wound of lower leg, part AMOKSISILIN KAPS 250 MG
No. RM : 01-080933 BPJS : 0001427482923
SOFIA ANDRIYANI, AN (P) JL RAWA SENGON BLOK C NO 52 L02.9 - Cutaneous abscess, furuncle and AMOKSISILIN 500 MG
carbuncle, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
326 NIK : 3172066101041002 MG
BAYU PERMANA, AN (L) JL RAWA SENGON BLOK C NO 52 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
327 NIK : 3172060704091001 MG
HENDRA (L) JL PISANGAN BARU RT 003/011 J06.9 - Acute upper respiratory infection, KAPTOPRIL 12,5 MG
MCG
ANJALI SALMA AULIA, AN (P) DADING MAS TIMUR RT 14/12 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 29-Nov-2013 ( 5 Thn 9 Bln 11 Hr ) L08.9 - Local infection of skin and
329 NIK : 3175066911131006 MG
No. RM : 01-002420 BPJS : 0001446325997 subcutaneous tissue, unspecified PARASETAMOL TAB 500 MG
2019-09-09 13:37 Hal. 518 dari 1322

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SYAKILLA NAYYA, AN (P) RAWA INDAH 06/03 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
330 NIK : 3172065508081001 MG
ZALTAN IBRAHIM MUFFITZ, AN (L) KMP RAWA INDAH RT 06/03 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 01-Sep-2005 ( 14 Thn 0 Bln 8 Hr ) R11 - Nausea and vomiting
No. RM : 01-038470 BPJS : 0001224065485 MG
ALFIN MUTTAQIN, AN (L) JL. KELAPA MOLEK IV U2 NO.2 006/019 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
332 NIK : 3172060501131002 MG
SARIAH DEWI SETIYAWATI, NY (P) KGB RT02/22 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
K30 - Dyspepsia AMLODIPIN 10 MG
333 NIK : 3328106303670001 M13.9 - Arthritis, unspecified HIDROKLORTIAZID 25 MG
No. RM : 01-010684 BPJS : 0000079380573 R42 - Dizziness and giddiness ASAM MEFENAMAT KAPS 500
DUROTUL BAHIYAH, NN (P) RGTC BLOK JATISARI J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-087708 BPJS : 0001086399674 MG
AMOKSISILIN 500 MG
MUSTOPA, TN (L) CAKUNG BARAT RT007/001 S91.3 - Open wound of other parts of foot AMOKSISILIN 500 MG
335 NIK : 3175060907790019 INSISI SILANG
No. RM : 01-082387 BPJS : 0001215437049 TOILET MATA / WOUND TOILET
2019-09-09 13:37 Hal. 519 dari 1322

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TOMMY JULIENS ARFESTO (L) JL. TELUK RATAI 5/9 B01.9 - Varicella without complication PARASETAMOL TAB 500 MG
336 NIK : 3172060307940001 MG
No. RM : 06-002107 BPJS : 0001447129438 ASIKLOVIR 400 MG
PUSPITA SARAGI, NY (P) JL RAWA SENGON RT 03/22 L08.9 - Local infection of skin and AMOKSISILIN 500 MG
subcutaneous tissue, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-011961 BPJS : 0001224147262 MG
DAUD RAJA WITAK, AN (L) RW SENGON RT 3/22 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
338 NIK : 3175021401121002 MG
SYARANI, AN (P) JL. RAWA SENGON RT 01/022 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 21-Jun-2007 ( 12 Thn 2 Bln 19 Hr ) L50.9 - Urticaria, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
339 NIK : 3171036106071005
ACHMAD ZAELANI, TN (L) JL RAWA SENGON RT 01/022 A09 - Diarrhoea and gastroenteritis of GLISERIL GUAIAKOLAT (GG) 100 MG
340 NIK : 3171030504730016 MG
No. RM : 01-059872 BPJS : 0001603220229 unspecified KOMBINASI KAOLIN 550 MG, PEKTIN 20
TRIMETOPRIM 80 MG)
ARSAKHA ZIKRI ALVARO, AN (L) GG PERINTIS2 NO 94E R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
341 NIK : 3172063007160001
No. RM : 01-017049 BPJS : 0002240797241
2019-09-09 13:37 Hal. 520 dari 1322

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TUSLIM, TN (L) TANAH MERAH RT 06/07 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-020444 BPJS : 0001795172578 MG
MCG
AHMAD FIKRI, AN (L) KP RAWA INDAH RT 007/003 K05.0 - Acute gingivitis PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
343 NIK : 3172062206060005
No. RM : 01-078572 BPJS : 0002332915402
PUTRI RIZKY AGATHA, NN (P) KAMP PULO GADUNG RT 006/005 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
344 NIK : 3172067001960001 MG
ALDIANSYAH, AN (L) JL CIPTA BANGUN SARANA RT 03/11 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
345 NIK : 3211090111120002
No. RM : 01-034502 BPJS : 0002201820388
ASKERI, NY (P) JL PGS II 005/002 N39.0 - Urinary tract infection, site not SIPROFLOKSASIN 500 MG
346 NIK : 3172065401750002
No. RM : 01-055123 BPJS : 0000378149848
NUR IKSAN AL FATAH, AN (L) JL CILINCING LAMA RT 009/004 R50.9 - Fever, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
MG
ANTASIDA DOEN
2019-09-09 13:37 Hal. 521 dari 1322

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MUHAMAD SAPUTRA, AN (L) JL PERINTIS KEMERDEKAAN J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
348 NIK : 3172060508040002 MG
EDDI SUSWANTO, TN (L) JL. PERINTIS KEMERDEKAAN I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
AMLODIPIN 5 MG
HENI WAHYUNI (P) KELAPA GADING TIMUR RT 0104 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
350 NIK : 3172066211820004 MG
DEBORA DWI RUJIANTI, NY (P) TNH MERAH JL PERJUANGAN KOJA I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
351 NIK : 3302105207770007 R51 - Headache AMLODIPIN 10 MG
No. RM : 01-005923 BPJS : 0001830336974
MURIAWATI AOLIA, NN (P) JL KALISALAK J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
352 NIK : 3302056603000003
No. RM : 01-087711 BPJS : 0000524532194
DARREL SHAKEEL AL RESCHA, AN (L) JL LESTARI VIII RT 02/10 NO 10-11 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-067442 BPJS : 0002443128895
FATIMAH, NY (P) KP SUKAPURA RT 4/10 K30 - Dyspepsia PARASETAMOL TAB 500 MG
R42 - Dizziness and giddiness RANITIDIN 150 MG
354 NIK : 317204441186000
No. RM : 01-027718 BPJS : 0001790246722
2019-09-09 13:37 Hal. 522 dari 1322

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TAN MEILIANI, NY (P) GG LANGGAR 010/006 I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
N89.4 - Leukoplakia of vagina PIROKSIKAM 10 MG
355 NIK : 3671036005770011 S97.8 - Crushing injury of other parts of AMLODIPIN 5 MG
No. RM : 01-023337 BPJS : 0001737006197 ankle and foot KLORFENIRAMIN MALEAT (CTM) TAB 4
NISTATIN TAB VAGINAL 100.000 UI/TAB
HAJJAH KANA, NY (P) JL PERJUANGAN NO 2 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
M79.1 - Myalgia ASAM MEFENAMAT KAPS 500
ALF ELIJAH BELOVED SIGARLAKI, AN (L) RGTC BLOK ANGSANA NO.307 J06.9 - Acute upper respiratory infection, DEKSAMETASON 0,5 MG
CAKUNG BARAT unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
357 MG
MUHAMMAD REYHAN, AN (L) PULO NANGJA BARAT II NO 154 RT J06.9 - Acute upper respiratory infection, PARASETAMOL SYR 120 MG/5 ML
DEKSAMETASON 0,5 MG
ULPAH, NY (P) JL PGS II RT 002/006 K30 - Dyspepsia INJEKSI (UGD)
RANITIDIN 150 MG
No. RM : 01-002291 BPJS : 0000379334834 PEMBERIAN OKSIGEN O2 SAMPAI
Tgl Diagnosis : 17 February 2019 2:37 AM DENGAN 1 JAM (UGD)
DELVINO (L) PGSN 2 RT 06/02 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-005298 BPJS : 0000379335262 MG
2019-09-09 13:37 Hal. 523 dari 1322

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NURUL RAHMASARI (P) JL JOHAR BARU UTARA V RT 017/003 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
361 NIK : 3171086212990001 MG
FANDY TRI ADHITAMA, AN (L) RT 5/5 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
362 NIK : 3172062702170002 MG
DWI PUTRI AFRIYANI, NY (P) BCS 05/05 J06.0 - Acute laryngopharyngitis DEKSAMETASON 0,5 MG
363 NIK : 3172066304930003
No. RM : 01-033865 BPJS : 0000378262438
NIDIA SARASWATI, NY (P) PEGANGSAA DUA RT 02/04 L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
R50.9 - Fever, unspecified MG
364 NIK : 3172064104960004
No. RM : 01-007468 BPJS : 0000378471295
HELMUTH OKTAFIVE SIWI (L) APT GADING NIAS RESIDENCES J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
L/25/LN RT 004 RW 027 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
365 MG
No. RM : 01-086351 NIK : 7102060510720003 KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Diagnosis : 19 February 2019 4:47 PM BPJS : 0002625050902 (SULFAMETOKSAZOL 400 MG +
TRIMETOPRIM 80 MG)
MCG
FERYADI WINATA, TN (L) JL CERMAI RAYA BLOK D 4 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
366 NIK : 3274032503760009 MG
2019-09-09 13:37 Hal. 524 dari 1322

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TEDI YONO, TN (L) JANUR INDAH IX NO.5 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 24-Jul-1954 ( 65 Thn 1 Bln 16 Hr ) K12.2 - Cellulitis and abscess of mouth
367 NIK : 1971042407540002 MG
MARLON RIONNY ALBERT.J, TN (L) JL. KELAPA PUYUH V BLOK KB/16 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
004/019 K30 - Dyspepsia RANITIDIN 150 MG
ANTASIDA DOEN
MCG
WARDAH MUTMAINAH KAMILA, AN (P) H.OYAR 04/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
MARISA NOFIANTI, NY (P) JL. PGS II 002/002 M89.47 - Other hypertrophic RETRIBUSI LAYANAN SIAGA 24 JAM
osteoarthropathy, ankle and foot NATRIUM DIKLOFENAK TAB 25 MG
ARDIANTO, TN (L) TANAH MERAH J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-075687 BPJS : 0001834423626 MG
LUSTI FERTA SARI, NY (P) JL. KEBUN KELAPA, LAMPUNG Z48.9 - Surgical follow-up care, unspecified TOILET MATA / WOUND TOILET
AMOKSISILIN 500 MG
No. RM : 01-087973 BPJS : 0002198312357
2019-09-09 13:37 Hal. 525 dari 1322

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SIDIK SILA PRAWOTO, TN (L) JL KOSAMBI II RT 2/8 H00.0 - Hordeolum and other deep AMOKSISILIN 500 MG
inflammation of eyelid KLORAMFENIKOL 1 % SM
DEKSAMETASON 0,5 MG
BAGUS DWI PRAYOGO, TN (L) JL H OYAR RT 002/004 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
MG
PARTINI (P) PEGANGSAAN DUA 02/04 R51 - Headache RETRIBUSI LAYANAN SIAGA 24 JAM
375 NIK : -
No. RM : 01-072886 BPJS : 0002332713161
ARIZLA BERLIANA (P) TELUK RATAI II NO 28 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-017551 BPJS : 0002260583065 MG
RAJINO, TN (L) JLN BCS Gg.Q NO 31 KEL PGS 2 G56.0 - Carpal tunnel syndrome PIROKSIKAM 10 MG
DEKSAMETASON 0,5 MG
No. RM : 01-075143 BPJS : 0001791052694 MCG
WIDIGDHO, TN (L) JL P TEMIANG V RT 15/3 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
AMOKSISILIN 500 MG
2019-09-09 13:37 Hal. 526 dari 1322

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CATTLEYA MUKHBITA BASHARI, AN (P) KELAPA NIAS IV PC 9/9 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
379 NIK : 3172065505160003 MG
TRIMETOPRIM 40 MG)
MADELEINE RUBINA BASHORI, AN (P) KELAPA NIAS IV PC 9/9 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
380 NIK : 3172065310170004 MG
TRIMETOPRIM 40 MG)
YOELAANNY PINDRIANA (P) JL PUSPA GADING IV B 1 NO 4 E11.9 - Non-insulin-dependent diabetes GLISERIL GUAIAKOLAT (GG) 100 MG
381 NIK : 3172065112500001 MG
No. RM : 01-046561 BPJS : 0001479612701 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Diagnosis : 20 February 2019 4:37 PM unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
NUR OKTAVIANI, NN (P) JL SENTOSA I NO.19 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
382 NIK : 317206641980002 MG
EGI TRIWIBOWO, TN (L) KP PULO GADUNG RT 01/05 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 23-Aug-2002 ( 17 Thn 0 Bln 17 Hr ) K30 - Dyspepsia
YATI ,NY (P) JL. RAWA SENGON BLOK B RT. 002 / I10 - Essential (primary) hypertension ASAM MEFENAMAT KAPS 500
022 M13.9 - Arthritis, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
384 MCG
2019-09-09 13:37 Hal. 527 dari 1322

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LINDA DWIJAYA, NY (P) RAWA SENGON BLOK B RT 02/22 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 05-Apr-1987 ( 32 Thn 5 Bln 4 Hr ) R53 - Malaise and fatigue
385 NIK : 3172034504870015 MG
MCG
HADI MULYONO, TN (L) JL INSPEKSI KALI SUNYER RT 009/013 R51 - Headache PARASETAMOL TAB 500 MG
386 NIK : 3172041412841001 MCG
No. RM : 01-008497 BPJS : 0001224588903
KABIRAN ,TN (L) RAWA SENGON RT 03/22 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-022151 BPJS : 0001293829525 MCG
SALBIAH,NY (P) JL RAWA SENGON BLOK C NO 59 RT I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
03/022 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
388 unspecified MG
No. RM : 01-020973 NIK : 3172036004570003 M13.9 - Arthritis, unspecified ASAM MEFENAMAT KAPS 500
KAPTOPRIL 12,5 MG
MAULANA CAHYO MAGHRIBI, AN (L) JL PERJUANGAN RT 06/07 TANAH R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
MERAH RETRIBUSI LAYANAN SIAGA 24 JAM
389
No. RM : 01-007253 NIK : 3321071611110001
MUZDALIFAH, NY (P) JL.PERJUANGAN II 006/007 E78.5 - Hyperlipidaemia, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
K30 - Dyspepsia ASAM MEFENAMAT KAPS 500
390 NIK : 3321135606840007 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
No. RM : 01-001242 BPJS : 0001387494843 R51 - Headache SIMVASTATIN 20 MG
2019-09-09 13:37 Hal. 528 dari 1322

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HARYANTO WIJAYA, TN (L) JL.PELEPAH INDAH II LB.23/6 H01.9 - Inflammation of eyelid, unspecified AMOKSISILIN 500 MG
391 NIK : 3172062604650001 MG
QINARA AULIA PUTRI, AN (P) JL. WARUNG JENGKOL 005/013 NO.38 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-049448 BPJS : 0002136787064 MG
TRIMETOPRIM 80 MG)
MUHAMAD ABQORI RUNACO ARSENIO, AN JL. PELEPAH KUNING I BLK WE I K12.2 - Cellulitis and abscess of mouth BORAK GLYSEROL 5% LARUTAN
NO.10 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
ZAYDAN ULHAK, AN (L) KP SUKAPURA R50.9 - Fever, unspecified ASAM ASKORBAT (VITAMIN C) 50 MG

394 NIK : 3172040511141009
No. RM : 01-088104 BPJS : 0001650289206
ROSIANA MARLINA (P) JL TIPAR CAKUNG KP SUKAPURA RT K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
02/03 CILINCING JAKARTA UTARA R50.9 - Fever, unspecified ANTASIDA DOEN
No. RM : 01-073489 NIK : 3172047011020009
CHINTIA EKA SUSANTI, NN (P) KNTR IMIGRASI JL BOULEVARD BRT K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
396 NIK : 6471034903960007 RANITIDIN 150 MG
No. RM : 01-088106 BPJS : 0001307419198
2019-09-09 13:37 Hal. 529 dari 1322

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PRUNGGU, TN (L) JL PEGANGSAAN DUA NO 22 RT 004 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
RW 001 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
MG
BERLIAN NATHANIA SIMBOLON, BY (P) JL SEJAHTERA PULO GEBANG A09 - Diarrhoea and gastroenteritis of ZINC 20 MG
Tgl Lahir : 25-Oct-2018 ( 0 Thn 10 Bln 15 Hr ) R50.9 - Fever, unspecified
SRIPUJI ASTUTI (P) JL. PULO GADUNG A09 - Diarrhoea and gastroenteritis of RANITIDIN 150 MG
399 NIK : 3317035408980001 MG TAB
SLAMET SRIYONO, TN (L) JL INSFEKSI KALI SUNTER RT 04/05 K30 - Dyspepsia RANITIDIN 150 MG
M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
ROHATA, TN (L) JL BCS GG Q RT 05/05 NO 142 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 28-Mar-1979 ( 40 Thn 5 Bln 12 Hr ) K30 - Dyspepsia
401 NIK : 3172062803790005 MG
KURNIA, NY (P) JL P GADUNG RT 5/5 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
402 NIK : 3172065406790002 MG
2019-09-09 13:37 Hal. 530 dari 1322

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EMUS, TN (L) JL. BOULEVARD BRT RAYA BLK LC 7 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
NO.48 unspecified PARASETAMOL TAB 500 MG
Tgl Lahir : 01-Jun-1988 ( 31 Thn 3 Bln 8 Hr ) R50.9 - Fever, unspecified
PUTRI KHOIRUN NISA, NN (P) JL EKSPORT C 5/1 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-065589 BPJS : 0002140044131 MG
ANTASIDA DOEN
DEKSAMETASON 0,5 MG
SILVINA PERMATASARI, AN (P) KP RAWA INDAH RT 004/03 PGSN II J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-068066 BPJS : 0002355394555 MG
DEKSAMETASON 0,5 MG
KOISAH, ny (P) KP TNH MERAH J06.9 - Acute upper respiratory infection, DEKSAMETASON 0,5 MG
Tgl Lahir : 03-Sep-1981 ( 38 Thn 0 Bln 6 Hr ) L50.9 - Urticaria, unspecified
406 NIK : 3175024309810010 MG
DEVI HAYATUNNISA, NN (P) JL BANGUN CIPTA SARANA 002/005 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-023826 BPJS : 0001225695666 MG
Tgl Diagnosis : 20 February 2019 8:13 PM ANTIHEMOROID DOEN
LIPHTON KARDONO, TN (L) GADING RESIDENCE JL.PELANGI I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
JINGGA II D.2.S/12 BEDAK SALISIL 2 %
No. RM : 01-014791 NIK : 3172062506750008
2019-09-09 13:37 Hal. 531 dari 1322

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USWATUN HASANAH, NY (P) KOMP PLN BLK E NO.98 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-088115 BPJS : 0001225770221 MG
AMOKSISILIN 500 MG
SITI NURSIYANTUN, NY (P) JL. TNH MERAH J06.9 - Acute upper respiratory infection, RANITIDIN 150 MG
FITRI DIAH NOFITA, NY (P) JL RAYA PGS II RT 006/002 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 17-Mar-1994 ( 25 Thn 5 Bln 23 Hr ) O00.0 - Abdominal pregnancy
REINHARD, TN (L) JL SERAMPANG XII BLOK T NO 27 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 08-Apr-2003 ( 16 Thn 5 Bln 1 Hr ) L50.9 - Urticaria, unspecified
412 NIK : 3172020804031001 MG
ASMAWAN SYAFULLAH, TN (L) KP.PULO GADUNG 03/05 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
413 NIK : 3172062808870001 MG
MIMIE SUSILAWATI SUPIAH, NY (P) GADING ELOK TIMUR V BO.1/5 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 24-Dec-1960 ( 58 Thn 8 Bln 16 Hr ) PARASETAMOL TAB 500 MG
414 NIK : 3172066412600003
No. RM : 01-011689 BPJS : 0001317765453 KAPTOPRIL 12,5 MG
2019-09-09 13:37 Hal. 532 dari 1322

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FARDANA UBAY DILLAH (L) JL PGS II RT 001/003 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
JENNY NOVITA M.ARITONANG, NY (P) JL TIPARB SELATAN 3 E79.9 - Disorder of purine and pyrimidine RETRIBUSI LAYANAN SIAGA 24 JAM
metabolism, unspecified ALOPURINOL 100 MG
416 NIK : 3172044211730006 PIROKSIKAM 10 MG
MICHELLA AGNES IRENE SIMANJUNTAK, AN KELAPA HIJAU 3 D4 NO 2 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
ABIDAH, NY (P) KP RAWA INDAH RT 05/03 O00.0 - Abdominal pregnancy RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-027117 BPJS : 0001613328884
ODIH, TN (L) JL PEJUANG IV I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
AMLODIPIN 10 MG
AL ZHAFRAN PUTRA RACHMAN, AN (L) JL KGT I 003/006 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
420 NIK : 3172061805170001 MG
2019-09-09 13:37 Hal. 533 dari 1322

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IRVAN ARIEF RACHMAN, TN (L) KGT RT 3/06 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 19-Feb-1988 ( 31 Thn 6 Bln 21 Hr ) M79.1 - Myalgia
SRI REZEKI, NY (P) KELAPA MOLEK IV NO.2 006/019 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
422 NIK : 3327067008840005 MCG
MG
AMOKSISILIN 500 MG
RIMA LESMANA, NY (P) JL GIRO 1 BLOK R /03 RT 01/10 PGS II J01.9 - Acute sinusitis, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-056335 BPJS : 0001225397621 MG
RANITIDIN 150 MG
FATHI HILMI HUSAIN, AN (L) PGS II NO 60 RT 05/02 B86 - Scabies KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 01-Jan-2015 ( 4 Thn 8 Bln 8 Hr ) ASAM ASKORBAT (VITAMIN C) 50 MG
424 NIK : 3172060101151001
No. RM : 01-000231 BPJS : 0001672405536
BIMO PUTERA YAJID, TN (L) JL KOMP WALIKOTA SRI GUNTING J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
BLOK D 1 NO 45 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
425 MG
ANTASIDA DOEN
ADELIA KHOTRUN NADA (P) PEGANGSAAN DUA RT 04/02 B26.9 - Mumps without complication DEKSAMETASON 0,5 MG
426 NIK : 3172067101071001 MCG
2019-09-09 13:37 Hal. 534 dari 1322

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MUHAMMAD RASYID (L) JL GADING MAS BARAT BLK DVIII J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
NO.18 006/005 unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
427 MG
MARIA GORETTY AIRA ERNESTA, AN (P) KOMP PLN B 24 RT 05/014 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-039847 BPJS : 0001225635118 MG
DEKSAMETASON 0,5 MG
TRIMETOPRIM 40 MG)
DWI HERTIYASTUTI, NY (P) JL TARIAN RAYA TMR BLK B IV NO.14 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
429 NIK : 3172064405580003 unspecified ASAM ASKORBAT (VITAMIN C) 50 MG
MAHIRA HASNA AQILATUNNISA (P) JL INSPEKSI KALI SUNTER RT 07 J06.0 - Acute laryngopharyngitis RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
ARSHIYA HARSA SAPUTRI (P) JL TIPAR CAKUNG RT 07/04 R11 - Nausea and vomiting PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified DEKSAMETASON 0,5 MG
BAMBANG IRAWAN, TN (L) JL INSPEKSI KALI SUNTER M79.1 - Myalgia PARASETAMOL TAB 500 MG
R51 - Headache SIANOKOBALAMIN (VITAMIN B12) 50
432 NIK : 3172061611930001 MCG
2019-09-09 13:37 Hal. 535 dari 1322

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KHUZAIFA (P) JL H OYAR RT 02/02 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
NAFI ZAMZAMI, AN (L) JL PERNTIS II RT 1/04 NO 90 L23.9 - Allergic contact dermatitis, RETRIBUSI LAYANAN SIAGA 24 JAM
unspecified cause PARASETAMOL TAB 500 MG
No. RM : 01-031138 BPJS : 0002052636658 MG
YUNITA ANGGRAINI, NY (P) PERINTIS II RT 1/4 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
ARIBARAN KARINA, TN (L) RAWA SENGON RT 02/22 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
436 NIK : 32750913018300014 MG
YEYEN YULIAWATI, NY (P) KOMP PLN BLOK E NO 90 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-056217 BPJS : 0001340045673 MG
AMOKSISILIN 500 MG
SALBUTAMOL 2 MG
DENNY RAYANO, TN (L) KOMP PLN E/90 KGT J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-074251 BPJS : 0001339911371 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 536 dari 1322

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ANDIKA RACHMAT SAPUTRA, TN (L) KP. RAWA INDAH 6/3 PGS II J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 10-Sep-2005 ( 13 Thn 11 Bln 30 Hr ) R11 - Nausea and vomiting
No. RM : 01-076088 BPJS : 0000378121803 MG
AMOKSISILIN 500 MG
ANTASIDA DOEN
KEVIN YONATHAN, TN (L) JL KRAMA BARU I NO 20 E78.5 - Hyperlipidaemia, unspecified NATRIUM DIKLOFENAK TAB 25 MG
E79.9 - Disorder of purine and pyrimidine ASAM MEFENAMAT KAPS 500
440 NIK : 3171041910930002 metabolism, unspecified SIMVASTATIN 10 MG
No. RM : 01-042653 BPJS : 0000072004331 M79.1 - Myalgia ALOPURINOL 300 MG
NURHAYATI, NY (P) RW INDAH RT 6/3 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 29-May-1972 ( 47 Thn 3 Bln 11 Hr ) M79.1 - Myalgia
No. RM : 01-011433 BPJS : 0000378121072 MG
LUKI HERDIAN JUNIZAR,TN (L) PERUM PT.HII B/28 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
442 NIK : 3172061106870003 MG
ERWIN KURNIAWAN, TNB (L) PERMATA BIRU RT 9/2 J06.8 - Other acute upper respiratory GLISERIL GUAIAKOLAT (GG) 100 MG
infections of multiple sites DEKSAMETASON 0,5 MG
No. RM : 01-055766 BPJS : 0001225767126 MCG
MG
M TAUFIK, TN (L) KOMPLEK KODAM JAYA BLOK 0/1 RT J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
444 MG
2019-09-09 13:37 Hal. 537 dari 1322

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SRI ROHYATI, NY (P) PULO NANGKA RT 01/16 I10 - Essential (primary) hypertension RANITIDIN 150 MG
K30 - Dyspepsia AMLODIPIN 10 MG
ANGELINE JESSIKA LUMINTANG, NY (P) RGTC BLK MAHONI NO.310003/010 L08.9 - Local infection of skin and RETRIBUSI LAYANAN SIAGA 24 JAM
subcutaneous tissue, unspecified ASAM MEFENAMAT KAPS 500
Tgl Diagnosis : 20 February 2019 11:13 PM INCISI ABSES
UNTUNG ADJI MULYONO TAN, TN (L) JL PERMATA BIRU H 2/7 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
R51 - Headache PARASETAMOL TAB 500 MG
447 NIK : 3172061407640003 RANITIDIN 150 MG
HASNAH ARIFIN, NY (L) JL SUNTER 1 PULO GADUNG RT 10/01 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
448 NIK : 3171036404530004 unspecified NATRIUM DIKLOFENAK TAB 25 MG
No. RM : 02-004391 BPJS : 0001818898301 M13.9 - Arthritis, unspecified AMOKSISILIN 500 MG
RANITIDIN 150 MG
AMLODIPIN 10 MG
SATRIA FHARIZ SETIAWAN (L) JL PEGANGSAAN DUA RT 02/01 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 06-Nov-2010 ( 8 Thn 10 Bln 3 Hr ) R11 - Nausea and vomiting
449 NIK : 3172060611101004 MG
DEKSAMETASON 0,5 MG
RIYANTO, TN (L) RAWASENGON 08/22 S01.9 - Open wound of head, part ASAM MEFENAMAT KAPS 500
Tgl Diagnosis : 21 February 2019 12:58 AM SPALK KECIL (POLIKLINIK / BP)
2019-09-09 13:37 Hal. 538 dari 1322

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EMERALD ALIEF, TN (L) JL. BCS S01.9 - Open wound of head, part
unspecified
451 NIK : 3172061010881001
No. RM : 01-088108 BPJS : 0002100793397
JONLY KUSSOY, TN (L) TANAH MERAH RT 03/07 E11.9 - Non-insulin-dependent diabetes GLISERIL GUAIAKOLAT (GG) 100 MG
452 NIK : 3275120712590005 MG
No. RM : 01-024188 BPJS : 0001381366236 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Diagnosis : 21 February 2019 3:38 AM unspecified AMLODIPIN 10 MG
GLIBENKLAMIDA 5 MG
DIAH SUSIANA, NY (P) TANAH MERAH RT 003/007 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
No. RM : 01-024182 BPJS : 0001381367171
PAINTEN, NY (P) JL.SENTOSA II N0 13 RT 09/10 KGB J06.9 - Acute upper respiratory infection,
unspecified
454 NIK : -
No. RM : 01-071935 BPJS : 0000045999606
SARIYEM, NY (P) JL BANGUN CIPTA SARANA RT 05/05 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-025602 BPJS : 0001226009744 R53 - Malaise and fatigue MCG
Tgl Diagnosis : 21 February 2019 5:53 AM KOTRIMOKSAZOL DOEN I (DEWASA)
TRIMETOPRIM 80 MG)
TRI WIYONO, TN (L) JL BANGUN CIPTA SARANA RT 05/05 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 03-Feb-1967 ( 52 Thn 7 Bln 6 Hr ) K30 - Dyspepsia RANITIDIN 150 MG
456 NIK : 3172060302670001
Tgl Diagnosis : 21 February 2019 5:56 AM (SULFAMETOKSAZOL 400 MG +
TRIMETOPRIM 80 MG)
2019-09-09 13:37 Hal. 539 dari 1322

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NURMANSYAH, TN (L) PERUM TAMAN NURI BLOK NC/8-16 K30 - Dyspepsia RANITIDIN 150 MG
RT010/08 OMEPRAZOL KAPS 20 MG
457
No. RM : 01-006592 NIK : 3603121407660007
RETNO SETIA WARDIYANTI, NY (P) JL. P NANGKA BRT II 006/016 O00.0 - Abdominal pregnancy

458 NIK : 3376026810870002
No. RM : 01-053285 BPJS : 0001335924865
IRFAN ARACHMAN, TN (L) JL TANGGUH I NO.1 Z00.0 - General medical examination

459 NIK : 3172063006910001
No. RM : 01-088555 BPJS : 0001637166284
TRI BOEDOMO (L) JANUR ASRI II QL 5 NO 5 RT 1/12 Z00.0 - General medical examination RETRIBUSI LAYANAN SIAGA 24 JAM

460 NIK : 3172061806520002
No. RM : 01-003119 BPJS : 0001813024686
SITI ROHANI, NY (P) JL RAYA PEGANGSAAN DUA RT 05/02 J00 - Acute nasopharyngitis [common cold] RETRIBUSI LAYANAN SIAGA 24 JAM
M79.1 - Myalgia SIANOKOBALAMIN (VITAMIN B12) 50
461 NIK : 3172064409910003 MCG
MG
DJURIAH, NY (P) PEGANGSAAN DUA RT 02/04 E11.9 - Non-insulin-dependent diabetes METRONIDAZOL 500 MG
mellitus without complications TOILET MATA / WOUND TOILET
462 NIK : 3172066412490001
No. RM : 01-012493 BPJS : 0002332713205 S61.0 - Open wound of finger(s) without
Tgl Diagnosis : 27 February 2019 4:31 PM damage to nail
2019-09-09 13:37 Hal. 540 dari 1322

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VICTOR RUDOLF JUNIOR MONTOLALU (L) APRT GD MEDITERANIA RES TWR B I64 - Stroke, not specified as haemorrhage
UNIT CB 06 BEG or infarction
463
No. RM : 01-088745 NIK : 7106090806720001
WARYADI, TN (L) JL. PERINTIS KEMERDEKAAN GG I10 - Essential (primary) hypertension AMLODIPIN 10 MG
PUSKESMAS RT 09 RW 02 M13.9 - Arthritis, unspecified RANITIDIN 150 MG
BAMBANG PRASETYO, TN (L) JL. PERJUANGAN GG MERAH JAMBU J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
ANANDA AYU RAHMAWATI, AN (P) JL . PERJUANGAN 005/007 NO.24 GG J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
MERAH JAMBU unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-050147 NIK : 3172025402080002 MG
SUYATNO, TN (L) LORONG L NO 21 RT 12/08 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-030369 BPJS : 0001645232973 MCG
SALBUTAMOL 2 MG
FAIDAH NAILAH, AN (P) PEGANGSAAN DUA 05/02 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
2019-09-09 13:37 Hal. 541 dari 1322

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SUYITNO , TN (L) PGS2 RT005/02 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 06-Apr-1980 ( 39 Thn 5 Bln 3 Hr ) L23.9 - Allergic contact dermatitis,
No. RM : 01-025723 BPJS : 0001154379925 unspecified cause MG
SUROTO, TN (L) JL BOULEVARD TIMUR RT 1/16 E11.9 - Non-insulin-dependent diabetes RANITIDIN 150 MG
mellitus without complications PARASETAMOL TAB 500 MG
No. RM : 01-015893 BPJS : 0001795838229 K30 - Dyspepsia MCG
Tgl Diagnosis : 27 February 2019 5:11 PM METFORMIN TAB 500 MG
AMLODIPIN 10 MG
RINDI ANTIKA, NY (P) PEGANGSAAN DUA 03/02 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 07-Sep-1989 ( 30 Thn 0 Bln 2 Hr ) K30 - Dyspepsia
MARLINA ARITONANG, NY (P) TANAH MERAH NO 22 RT 21/07 NO 22 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 04-Oct-1985 ( 33 Thn 11 Bln 5 Hr ) K12.2 - Cellulitis and abscess of mouth
No. RM : 01-000740 BPJS : 0001635762025 MG
IKO PRASETYA PUTRA, AN (L) KELPA LILIN IV NG.8/1 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-042838 BPJS : 0002438087668 MG
MURNIATI, NY (P) JL KELAPA LILIN 4 NG 8 NO 1 A16.2 - Tuberculosis of lung, without GLISERIL GUAIAKOLAT (GG) 100 MG
mention of bacteriological or histological RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 09-Apr-1988 ( 31 Thn 5 Bln 0 Hr ) confirmation
474 NIK : 3302214904880002
No. RM : 01-047253 BPJS : 0001447683401
2019-09-09 13:37 Hal. 542 dari 1322

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YETI BINTI TIMIN, NY (P) PGS II RT 003/004 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
475 NIK : 3172065202740003 unspecified BORAK GLYSEROL 5% LARUTAN
HANIFAH, NY (P) JL PEGANGSAAN DUA RT 02/04 M13.9 - Arthritis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
RANITIDIN 150 MG
GRACIO LIAM OHOIWOTUN, AN (L) KGT RT001/008 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
477 NIK : 3172060607160001 MG
NOVINTA DELIMA, NY (P) JL MARAMBAK BLOK P NO 4 J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
M79.1 - Myalgia MG
Tgl Lahir : 15-Nov-1985 ( 33 Thn 9 Bln 25 Hr ) ASAM MEFENAMAT KAPS 500
478 NIK : 3172065511850001
SADRIYAH PRATIWI (P) JL JANUR INDAH 3 LA 12 NO 11 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-082575 BPJS : 0000082729642 MG
LAILIL RAMADHANI KURNIAWATI, NN (P) APT GAIDNG NIAS TW EMERALD P I84.2 - Internal haemorrhoids without RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-086004 BPJS : 0001178167961
2019-09-09 13:37 Hal. 543 dari 1322

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BUDIANTO SH, TN (L) THE ROYAL RESIDENCE JL BIGNONIA E70.2 - Disorders of tyrosine metabolism OBH SIRUP 100 ML
II BLOK B 6/27 RT 04/04 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
481 unspecified MG
No. RM : 01-051688 NIK : 3171011507760001 KOTRIMOKSAZOL DOEN I (DEWASA)
Tgl Diagnosis : 27 February 2019 6:03 PM BPJS : 0001900729811 (SULFAMETOKSAZOL 400 MG +
TRIMETOPRIM 80 MG)
MCG
DAFFA RAIHANSYAH, AN (L) RAWA INDAH 05/03 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
482 NIK : 3172061212060001 MG
SISWANTO, TN (L) PGS II 006/002 NO.42 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
483 NIK : 3328181109680001 MG
AMLODIPIN 10 MG
CLARINDA EKA CHANDRA, NN (P) KELAPA KOPYOR BARAT VI CK.2/10 Z00.0 - General medical examination

484 NIK : 3172066506910002
No. RM : 01-035043 BPJS : 0001790634126
TRIANA NOVIANTI, NY (P) JL TEKUN NO 33 RT 03/02 A09 - Diarrhoea and gastroenteritis of GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 08-Nov-1984 ( 34 Thn 10 Bln 1 Hr ) J06.9 - Acute upper respiratory infection,
485 NIK : 3172064811840002 MG
No. RM : 01-025974 BPJS : 0001452707864 unspecified KOMBINASI KAOLIN 550 MG, PEKTIN 20
K30 - Dyspepsia MG TAB
RANITIDIN 150 MG
2019-09-09 13:37 Hal. 544 dari 1322

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CHAIRUL DJOHAN, TN (L) JL BENDUNGAN UTARA BLK 40 NO.5 E79.9 - Disorder of purine and pyrimidine GLISERIL GUAIAKOLAT (GG) 100 MG
001/015 metabolism, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 08-Nov-1958 ( 60 Thn 10 Bln 1 Hr ) I25.0 - Atherosclerotic cardiovascular
486 MG
No. RM : 01-017732 NIK : 3172010811580002 disease, so described DEKSAMETASON 0,5 MG
BPJS : 0001450891282 J06.9 - Acute upper respiratory infection,
unspecified
R94.4 - Abnormal results of kidney function
studies
ENI, NY (P) RW INDAH RT 03/03 B02.9 - Zoster without complication PARASETAMOL TAB 500 MG
ASIKLOVIR 400 MG
ZULFIKAR.S, AN (L) TEGUH IV N0 25 RT 006/001 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
SITI FATIMAH, NY (P) JL TEGUH IV NO.25 006/001 L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
489 NIK : 3172065106790002
MUHAMAD SAIPI, TN (L) JL TEGUH IV NO 25 RT 06/001 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-052464 BPJS : 0001449625241 MG
MCG
RAKA JULIAN RAMADHAN (L) JL PEGANGSAAN DUA RT 06/02 A09 - Diarrhoea and gastroenteritis of RETRIBUSI LAYANAN SIAGA 24 JAM
presumed infectious origin GLISERIL GUAIAKOLAT (GG) 100 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 545 dari 1322

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TRIMETOPRIM 80 MG)
ZINC 20 MG
BIBIN SARBINI, TN (L) JL PT INDO PORA PT KAI S41.1 - Open wound of upper arm AMOKSISILIN 500 MG
492 NIK : 3273061305730003 HECTING BESAR, TENDON, PASANG
No. RM : 01-088755 BPJS : 0001140876674 SPALK KECIL (POLIKLINIK / BP)
RAKA SAMUDRA (L) PGS II RT 03/04 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 09-Sep-2010 ( 9 Thn 0 Bln 0 Hr ) PARASETAMOL TAB 500 MG
493 NIK : 3172060909101001
MAHARGONO SE MBA (L) TEBET UTARA III NO. 17 RT.008 S72.9 - Fracture of femur, part unspecified
RW.002
494
No. RM : 01-084359 NIK : 31740209700002
MUHAMMAD REYHAN FADIL (L) JL PULAU TEMIANG III NO 09 RT 13/03 L50.9 - Urticaria, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
495 NIK : 3172061006050006
TARMANI, TN (L) JL KGT I 004/004 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
RANITIDIN 150 MG
No. RM : 02-001240 BPJS : 0001606544561
MAULANA CAHYO MAGHRIBI, AN (L) JL PERJUANGAN RT 06/07 TANAH R50.9 - Fever, unspecified
MERAH
497
No. RM : 01-007253 NIK : 3321071611110001
2019-09-09 13:37 Hal. 546 dari 1322

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ADILA JUNIA AZKADINA RIZKY, AN (P) JL.GADING SENGON 06/022 KGB J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-001411 BPJS : 0001226380241 MG
RELA NOFRI SYAPNADA, NY (P) JL.GADING SENGON 06/022 KGB J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
499 NIK : 3172035407860012 MG
BAGUS KURNIA, TN (L) JL. KEPU NO. 33 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-060758 BPJS : 0000037689456 MG
RANITIDIN 150 MG
MUSTAIMAH (P) KP PULO GADUNG RT 02/05 L23.9 - Allergic contact dermatitis, KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 11-Oct-1981 ( 37 Thn 10 Bln 29 Hr ) DEKSAMETASON 0,5 MG
501 NIK : 3172065110810007
No. RM : 01-074764 BPJS : 0001225596194
TALITHA ARZETY, AN (P) H OYAR RT 4/4 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
ACHMAD ROZAK SIREGAR, TN (L) JL PEJUANG IV RT 04/04 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
503 NIK : 3172061409891001 MG
2019-09-09 13:37 Hal. 547 dari 1322

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ARYATI, NY (P) JL PERINTIS KEMERDEKAAN 011/004 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
KGB RETRIBUSI LAYANAN SIAGA 24 JAM
504
No. RM : 01-007741 NIK : 3175064703731001
MULUS MULYONO, TN (L) JL. ARTHA GADING BLOK A 7 B NO 17 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-034650 BPJS : 0002049477276 MG
AMOKSISILIN 500 MG
IRWANSYAH HAZNIEL (L) APT GADING NIAS TOWER ALAMANDA J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
A 12 BR unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
DEKSAMETASON 0,5 MG
WINDAH DESSY F, AN (P) JL PGS DUA J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
DISWATI, NY (P) APT MEDITERANIA TOWER B 17AK M13.9 - Arthritis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
TUWIATI, NY (P) TIPAR AKUNG RT 04/04 H10.9 - Conjunctivitis, unspecified PARASETAMOL TAB 500 MG
O00.0 - Abdominal pregnancy KLORAMFENIKOL 1 % SM
509 NIK : 3305214805960002 R50.9 - Fever, unspecified ASAM ASKORBAT (VITAMIN C) 50 MG
2019-09-09 13:37 Hal. 548 dari 1322

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MELI PRATIWI (P) TNH MERAH 006/007 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
510 NIK : 3175066703000016
RANGGA SAFRONI HUSNI (L) ASRAMA PEMADAM KLAPA GADING J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-018634 BPJS : 0000163128071 MG
MCG
OKTA RAMADHAN, AN (L) JL PUSKESMAS RT 02/006 NO 27 KGT J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-002536 BPJS : 0001839291052 MG
ARANTO JUNIOR SIREGAR (L) JL RAWA SENGON BLOK E RT 05/022 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
Tgl Lahir : 13-Aug-2018 ( 1 Thn 0 Bln 27 Hr ) R11 - Nausea and vomiting
513 NIK : - MG
AL FAJRI NUGROHO TARIGAN (L) JL. P KEMERDEKAAN RT 003/013 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
Tgl Lahir : 24-Oct-2014 ( 4 Thn 10 Bln 16 Hr ) L08.9 - Local infection of skin and
No. RM : 01-021499 BPJS : 0001740738699 subcutaneous tissue, unspecified MG
TRIMETOPRIM 40 MG)
2019-09-09 13:37 Hal. 549 dari 1322

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WARNA, TN (L) JL BANGUN CIPTA SARANA NO 1029 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
RT 06/05 unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-062772 NIK : 3172052802870008 MG
BONIFASIUS SEGA, TN (L) JL HARFA RAYA BLK FF NO.17 RT 12/5 I10 - Essential (primary) hypertension RETRIBUSI LAYANAN SIAGA 24 JAM
516 NIK : 5307010506750001 unspecified ASAM MEFENAMAT KAPS 500
ALZHIDANE BHILAL QHEANO, AN (L) JL, PERINTIS KEMERDEKAAN R11 - Nausea and vomiting INFUS RL, NACL, DEXT 5% (UGD)
ANTASIDA DOEN
Tgl Diagnosis : 27 February 2019 10:27 PM INFUS RL, NACL, DEXT 5% (UGD)
SARNO, TN (L) VILLA GADING INDAH RT 07/10 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
518 NIK : 3301170306730001 MG
ZAYN NABIAN IBRAHIM, AN (L) PEGANGSAAN DUA 6/2 NO 123 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEDEN NUGROHO, TN (L) JL MUNDU DALAM TIMUR NO 02 BLOK J06.9 - Acute upper respiratory infection, SALBUTAMOL 2 MG
K GG II NO 02 RT 05/13 unspecified DEKSAMETASON 0,5 MG
Tgl Lahir : 12-Jan-1982 ( 37 Thn 7 Bln 28 Hr ) R06.0 - Dyspnoea
No. RM : 01-041679 NIK : 18070312018200002
EVELYN VICTORIA GANI, AN (P) JL.BALAI RAKYAT II NO.42 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 550 dari 1322

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DIONESIA TEGAR TIARA DANA (P) RAWA SENGON 4/22 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-007513 BPJS : 0001613336679 MG
KARTIKA, NN (P) PEGANGSAAN DUA RT 005/02 K30 - Dyspepsia RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-022427 BPJS : 0000378909066 MCG
DEDE INDRAWAN (L) JL WARAKAS 4 GANG. 1 NO 58 RT I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
02/06
524
No. RM : 04-000222 NIK : 3172022211930003
MOCH RAMLY CHAIRUL ARIFIN, TN (L) JL WESEL BLOK A 14 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
525 NIK : 3172061301540003 AMLODIPIN 10 MG
ADY SUHARYADI BUN, TN (L) GADING ELOK TIMUR 2 BLOK BK 2/6 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 30-Nov-1958 ( 60 Thn 9 Bln 9 Hr ) K30 - Dyspepsia RANITIDIN 150 MG
526 NIK : 3172063011580001
GUSTI NANDA NUR ROHMAN, AN (L) JL GADING VI NO.6 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
CLAUDENSIANI (P) jlnpelepah indah 2 lb 23 no 8 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
528 NIK : 3276086510940001 MG
2019-09-09 13:37 Hal. 551 dari 1322

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ISMONO, TN (L) GADING VI NO.6 J06.9 - Acute upper respiratory infection, DEKSAMETASON 0,5 MG
No. RM : 01-034770 BPJS : 0001223475895 MG
SRIYATI, NY (P) KMP SUKAPURA JAYA RT 05/10 T14.9 - Injury, unspecified KLORAMFENIKOL 1 % SM
SUKPAURA AMOKSISILIN 500 MG
No. RM : 01-061058 NIK : 3172044911731001
SITI HADIJAH, NY (P) JL. RW INDAH RT 06/03 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
dr. Novy Erliana

MULYADI, TN (L) JL JANUR KUNING XII WQ I/17 RT H25.9 - Senile cataract, unspecified RUJUKAN (0113R034) MEDIROS
010/016 (MAT) MATA - (65) Mata - (0)
1 Telah Diberikan :
Tgl Diagnosis : 01 February 2019 10:12 AM BPJS : 0001260705519 Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
SRI BUDISETIATI, NY (P) ELANG A.3 NO.10 SUKAPURA I10 - Essential (primary) hypertension AMLODIPIN 10 MG
M13.9 - Arthritis, unspecified PIROKSIKAM 10 MG
No. RM : 01-004100 BPJS : 00000041851045 MCG
2019-09-09 13:37 Hal. 552 dari 1322

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BUDI RAHARDJO, TN (L) JL GAMBYONG T NO 5 K44.9 - Diaphragmatic hernia without RUJUKAN (0116R029) Rumah Sakit
obstruction or gangrene Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
SARDJONO, TN (L) JL PULAU BENGKALIS NO 12 RT 10/03 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SUHARTATI, NY (P) JL PULAU BENGKALIS NO 12 RT 10/03 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
5 NIK : 3172065402540002 MCG
No. RM : 01-009629 BPJS : 0000046015042
2019-09-09 13:37 Hal. 553 dari 1322

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OEI SIAN JONG, TN (L) SUNTER INDAH RT 12/12 R05 - Cough AMOKSISILIN 500 MG
No. RM : 01-052630 BPJS : 0002283906148 MG
S HANDOJO SOEKAMTO (L) JL TARIAN RAYA BARAT BLK DF NO.12 H26.4 - After-cataract AMLODIPIN 5 MG (0905R004) RS ISLAM JKT
006/008 I10 - Essential (primary) hypertension RUJUKAN SUKAPURA
(MAT) MATA - (65) Mata - (0)
7 Telah Diberikan :
Tgl Diagnosis : 04 February 2019 9:03 AM BPJS : 0001817809345 JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
ADELIS AZWAR (L) JL ORANYE BLOK A 5/13 RT 7/10 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
No. RM : 01-003738 BPJS : 0000046155699 MCG
SURYANINGRUM (P) JL PULAU BENGKALIS NO 16 RT I11.9 - Hypertensive heart disease without RUJUKAN (0114R030) RS PERTAMINA
10/003 (congestive) heart failure JAYA
(JAN) JANTUNG DAN
9 PEMBULUH DARAH
No. RM : 01-004923 NIK : 3172065008450002 JANTUNG
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 10:30 - 12:30
2019-09-09 13:37 Hal. 554 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
MUHAMAD TOHA, TN (L) KP RAWA INDAH RT 007/003 PGS II I10 - Essential (primary) hypertension AMLODIPIN 10 MG

10 NIK : 3172061705460001
No. RM : 01-004375 BPJS : 0001225412537
IR.H.ISKANDAR, MM (L) GADING VII D/73 K05.0 - Acute gingivitis

11 NIK : 3172060908470002
No. RM : 01-040811 BPJS : 0000046007739
MOCHAMMAD SUMARLI IKROM (L) JL INPEKSI KLI SUNTER RT 008 RW I10 - Essential (primary) hypertension RUJUKAN (0905R003) RS PELABUHAN
013 I84.5 - External haemorrhoids without AMLODIPIN 10 MG JAKARTA
12 complication Telah Diberikan :
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 08:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
ALE WIDJAJA (L) KELAPA LILIN X NI 9/16 RT 30/12 H26.4 - After-cataract AMLODIPIN 10 MG (0116R029) Rumah Sakit
I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK 50 MG Hermina Podomoro
(MAT) MATA - (65) Mata - (0)
13 NIK : 3172060608460001 M54.5 - Low back pain SIANOKOBALAMIN (VITAMIN B12) 50 Telah Diberikan :
No. RM : 01-003087 BPJS : 0001260500275 MCG Faskes : (0116R029) Rumah
Tgl Diagnosis : 04 February 2019 9:38 AM KLORAMFENIKOL 1 % SM Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
2019-09-09 13:37 Hal. 555 dari 1322

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Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 08:00 - 12:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
HERAWATI NURDJAJA, NY (P) KLP PUYUH V KB 7 RT 4/9 I10 - Essential (primary) hypertension RUJUKAN
RUJUKAN
14 NIK : 3172066409540006
No. RM : 01-008182 BPJS : 0001837349673
RACHMAN EFFENDI, TN (L) JL ANCOL SELATAN RT 9/07 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
MARINI NUR ZASKIA ALI (P) JL H ISMAIL JATINEGARA A15.3 - Tuberculosis of lung, confirmed by GLISERIL GUAIAKOLAT (GG) 100 MG
unspecified means PARASETAMOL TAB 500 MG
No. RM : 01-080670 BPJS : 0001933792288 MG
Tgl Diagnosis : 04 February 2019 9:51 AM OAT KAT. ANAK (FASE LANJUTAN)
KHOE NJOEN HOA, NY (P) JL SUMAGUNG III S1/18 RT 012/019 M79.88 - Other specified soft tissue NATRIUM DIKLOFENAK 50 MG
disorders, other site SIANOKOBALAMIN (VITAMIN B12) 50
17 NIK : 3172065904470003 MCG
No. RM : 01-015038 BPJS : 0001384825138
DJONY ROY, TN (L) KELAPA HIBRIDA I RA -4/1 RT 1/15 D03.9 - Melanoma in situ, unspecified RUJUKAN

18 NIK : 3172062903500001
No. RM : 01-002129 BPJS : 0001788292168
2019-09-09 13:37 Hal. 556 dari 1322

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PONEWATY RUSLI (P) JL.MANDOLIN KAV.25 M54.5 - Low back pain NATRIUM DIKLOFENAK 50 MG
19 NIK : 3172066705540001 MCG
No. RM : 01-061379 BPJS : 0002308862384
ANIEK YOEILANY (P) SENTOSA II NO. 19 RT. 09/10 KLP I11.9 - Hypertensive heart disease without ASAM MEFENAMAT KAPS 500
GADING BARAT (congestive) heart failure SIANOKOBALAMIN (VITAMIN B12) 50
20 MCG
No. RM : 01-000889 NIK : 3172066707550004
DRS.HENDRIK A.TH.KANDOU (L) rt 01/017 pegangsaan dua R25.1 - Tremor, unspecified RUJUKAN
R27.8 - Other and unspecified lack of
21 NIK : - coordination
No. RM : 05-000347 BPJS : 0001317384358
MARTHA HARTANTI, NY (P) JANUR KUNING III WH.1/23 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
No. RM : 01-022280 BPJS : 0001450998876
PADMA, TN (L) BLOK AMPERA RT 005/009 N39.0 - Urinary tract infection, site not
specified
23 NIK : 3210132904530021
No. RM : 01-075106 BPJS : 0002611331166
SRI NINGRUM, NY (P) KP TANAH MERAH ATAS RT 06/08 I10 - Essential (primary) hypertension AMLODIPIN 5 MG (0905R003) RS PELABUHAN
RAWA BADAK SELATAN KOJA M13.9 - Arthritis, unspecified PARASETAMOL TAB 500 MG JAKARTA
24 Orthopedi
Telah - (0) :
Diberikan
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Senin : 18:00 - 20:00
2019-09-09 13:37 Hal. 557 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
INDAH ANISA, NN (P) INF X SUNTER RT 4/4 Z03.0 - Observation for suspected GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-028916 BPJS : 0001225559237 MG
HERTI JULIATI SIREGAR,NY (P) PERJUANGAN RAYA NO 1 RT 08/07 Z03.0 - Observation for suspected GLISERIL GUAIAKOLAT (GG) 100 MG
tuberculosis SIANOKOBALAMIN (VITAMIN B12) 50
26 NIK : 3172064107870003 MCG
LIANDA MIKA KARTIKA FEBRIYANTI, AN (P) JL PERINTIS KEMERDEKAAN RT Z03.0 - Observation for suspected KLORFENIRAMIN MALEAT (CTM) TAB 4
001/005 tuberculosis MG
Tgl Lahir : 25-Feb-2008 ( 11 Thn 6 Bln 15 Hr ) SIANOKOBALAMIN (VITAMIN B12) 50
27
No. RM : 01-002713 NIK : 3172066502081001 MCG
BPJS : 0001225672121 TIAMIN (VITAMIN B1) 50 MG
TRIMETOPRIM 80 MG)
KHOE HIN VIE NY (P) JL KELAPA HIBRIDA X RA 29/3 J45.9 - Asthma, unspecified OBH SIRUP 100 ML
R05 - Cough SIANOKOBALAMIN (VITAMIN B12) 50
28 NIK : 3172044302580002 MCG
HIMAWAN SIDARTA, TN (L) JLM KLP HIJAU 4 BLOK E 4 NO 8 RT I10 - Essential (primary) hypertension AMLODIPIN 5 MG
1/17 SIANOKOBALAMIN (VITAMIN B12) 50
29 MCG
2019-09-09 13:37 Hal. 558 dari 1322

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IE TJIN WAN, NY (P) JLM KLP HIJAU 4 BLOK E 4 NO 8 RT M54.5 - Low back pain NATRIUM DIKLOFENAK 50 MG
1/17 SIANOKOBALAMIN (VITAMIN B12) 50
30 MCG
No. RM : 01-019349 NIK : 3204094902550002
DIANA KARTIKA SARI (P) JL BANDAR II NO 24A J40 - Bronchitis, not specified as acute or AMOKSISILIN 500 MG
chronic GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-086254 BPJS : 0001850334085 MG
MCG
SUKARMIATI, NY (P) JL PULO REMPANG III NO 22 E11.9 - Non-insulin-dependent diabetes (0114R030) RS PERTAMINA
32 NIK : 31720665055200003 Penyakit
Telah Dalam :- (0)
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 18
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
IR H MUMUNG MARTHASASMITA (L) JL KUNING LANGSAT C V/19 RT E11.9 - Non-insulin-dependent diabetes FENOL GLISEROL TT 10%
019/010 mellitus without complications
33
No. RM : 01-007514 NIK : 3172062009500002
2019-09-09 13:37 Hal. 559 dari 1322

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SITI WAHYUNI, NY (P) JANUR INDAH III LA 11 NO. 4 KGB E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 10 MG
No. RM : 01-001060 BPJS : 0001285510397
DAMRONI LIWON (L) KELAPA GADING TIMUR RT 001/004 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
K29.7 - Gastritis, unspecified ANTASIDA DOEN
OEY GUAT TEK (L) HARPA V DD-9 J45.9 - Asthma, unspecified AMLODIPIN 5 MG
OBH SIRUP 100 ML
No. RM : 01-011789 BPJS : 0001390617639
TAMTO (L) KELAPA GADING TIMUR M51.2 - Other specified intervertebral disc (0114R030) RS PERTAMINA
displacement JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
DRS RUSTAM, TN (L) JL SUNTER II/24 RT 008/014 L03.9 - Cellulitis, unspecified (0116R025) Rumah Sakit Firdaus
38 NIK : 3172031802370001 Penyakit
Telah Dalam :- (0)
Diberikan
KOMP.BEA CUKAI
2019-09-09 13:37 Hal. 560 dari 1322

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Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 09:00 - 13:00,
13:30 - 16:30;16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
DRA JULIANTY LINTONG (P) janur kuning 8 wn 2/1 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
39 NIK : - KLORAMFENIKOL 1 % SM
No. RM : 01-086531 BPJS : 0002332694597
HENNY A MANUMPIL, NY (P) BANYO I BLOK A/9 RT 8/8 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
No. RM : 01-008111 BPJS : 0000045943468 MG
RUDDY LOLOWANG, TN (L) JL. JEND A YANI NO. 11 H61.2 - Impacted cerumen AMOKSISILIN 500 MG
L97 - Ulcer of lower limb, not elsewhere GENTAMISIN SALEP KULIT
41 NIK : 6471041406570002 classified FENOL GLISEROL TT 10%
No. RM : 01-086537 BPJS : 0001296317057
DRS. ANTON HALIM, TN (L) KELAPA NIAS XII PB.8/02 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
mellitus without complications ALOPURINOL 100 MG
No. RM : 01-010760 BPJS : 0001335283211 M10.9 - Gout, unspecified GLIBENKLAMIDA 5 MG
MCG
JOICKE PARERA, NY (P) JL KUNING TUA BLOK C 7/3 RT 023/010 I10 - Essential (primary) hypertension RUJUKAN (0116R025) Rumah Sakit Firdaus
J31.0 - Chronic rhinitis AMLODIPIN 5 MG (THT) THT-KL - (66) THT-KL - (0)
2019-09-09 13:37 Hal. 561 dari 1322

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BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 08:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
MISCHLIE ARIANCYE (L) KOMP TPI PENGGILINGAN B.219 L30.9 - Dermatitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 03-Jan-1996 ( 23 Thn 8 Bln 6 Hr ) DEKSAMETASON 0,5 MG
44 NIK : 3171084301961001
DENY DATUN SOLANG (L) KOMP TPI TAMAN PULO INDAH B 219 L72.9 - Follicular cyst of skin and AMOKSISILIN 500 MG
subcutaneous tissue, unspecified DEKSAMETASON 0,5 MG
45 NIK : 3275041812650012
No. RM : 01-039388 BPJS : 0002252651556
DRA HJ SUMARSIDAH (P) JL TELUK LADA A2 /10 KOMP BPP N39.9 - Disorder of urinary system, RUJUKAN (0116R025) Rumah Sakit Firdaus
unspecified (URO) UROLOGI - (88) Urologi -
46 NIK : 3172046911510001 (0)
Telah Diberikan :
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 16:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 562 dari 1322

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BIMO ARIONANTO (L) INSPEKSI KALI SUNTER R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG

47 NIK : -
No. RM : 01-086505 BPJS : 0001223516226
IMAM NUGROHO PURWANDI, TN (L) KOMP WALIKOTA JL KELATIK BLOK J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
A2/18 unspecified PARASETAMOL TAB 500 MG
48
No. RM : 01-027740 NIK : 3172042104760017
UMAR, TN (L) KELAPA GADING TIMUR 02/04 K30 - Dyspepsia PARASETAMOL TAB 500 MG
ANTASIDA DOEN
No. RM : 01-059116 BPJS : 0001138117724
ANCELA ARIANE KURNIAWATI, NY (P) GADING ELOK TIMUR I BJ.2/22 F20.8 - Other schizophrenia HALOPERIDOL 5 MG
M ADRIAN (L) JL DANAU INDAH BLK AII NO.8 005/013 F20.8 - Other schizophrenia RUJUKAN

51 NIK : 2171060505959005
No. RM : 01-012566 BPJS : 0001170584605
YUKE INGGAWATI JOSO (P) KELAPA NIAS VII PC 14/2 RT 9/17 E78.0 - Pure hypercholesterolaemia

52 NIK : 3172065510520003
No. RM : 01-002331 BPJS : 0001821983973
MICHAEL WAHYUDI LUZAR, TN (L) KLP NIAS VIPC 14/2 RT 09/017 PGSN II I20.9 - Angina pectoris, unspecified RUJUKAN (0114R030) RS PERTAMINA
JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
Tgl Diagnosis : 04 February 2019 2:45 PM DARAH - (0) JAYA
PERTAMINA
2019-09-09 13:37 Hal. 563 dari 1322

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BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
HERAWATI GUMULYA, NY (P) KELAPA NIAS X PD 4/11 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
54 NIK : 3172066011470003
No. RM : 01-008933 BPJS : 0001457763647
HENDRIK SURJADJAJA, TN (L) KELAPA NIAS X PD 4/11 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
Tgl Lahir : 28-May-1947 ( 72 Thn 3 Bln 12 Hr ) E78.0 - Pure hypercholesterolaemia
55 NIK : 3172062805470001
No. RM : 01-008931 BPJS : 0001457752397 I10 - Essential (primary) hypertension
URSULA YOLANDA HARTANTO, NY (P) JL. JANUR KUNING 6/BLOK WL2/24 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications TIAMIN (VITAMIN B1) 50 MG
Tgl Lahir : 06-Aug-1957 ( 62 Thn 1 Bln 3 Hr ) E78.0 - Pure hypercholesterolaemia
No. RM : 01-050639 BPJS : 0001259180976 I10 - Essential (primary) hypertension MCG
RUSLAN, TN (L) JANUR KUNING XII WQ 1/10 RT H26.4 - After-cataract RUJUKAN (0114R030) RS PERTAMINA
010/016 RUJUKAN JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
2019-09-09 13:37 Hal. 564 dari 1322

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TACC : Tanpa TACC
Alasan TACC :
NITA NANDA NINGRUM, NN (P) JL PULO NANGKA BARAT J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-080704 BPJS : 0001770265056 MG
AMOKSISILIN 500 MG
SUYA SS (P) APT WGP C5 03 BOULEVRAD RAYA J45.9 - Asthma, unspecified RUJUKAN (0116R029) Rumah Sakit
CN I RUJUKAN Hermina
(PAR) Podomoro
PARU - (94) PARU - (0)
59 RUJUKAN Telah Diberikan :
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Senin : 16:00 - 18:00
TACC : Age
Alasan TACC : >= 12 Tahun s/d <
55 Tahun
IDA SAIDAH, NY (P) GG. PERINTIS RT 01 RW 04 G56.0 - Carpal tunnel syndrome DEKSAMETASON 0,5 MG
60 NIK : -
No. RM : 02-000683 BPJS : 0001226370453
SUMARNI (P) PGS II RT 03/04 R51 - Headache ASAM MEFENAMAT KAPS 500
ANTASIDA DOEN
61 NIK : -
No. RM : 01-051115 BPJS : 0001326175942
2019-09-09 13:37 Hal. 565 dari 1322

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RICHARDO SEBASTIAN, TN (L) JL KIELAPA SAWIT V AA 18 E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 10 MG
M10.9 - Gout, unspecified ALOPURINOL 100 MG
62 NIK : 3172062309900003
No. RM : 01-017343 BPJS : 0001791148206
JOYCE KATHERINE QUEEN HUTAGAOL (P) JL TABAH I UJUNG J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
63 NIK : 3525154203100003 MG
SURANTO, TN (P) PEGANGSAAN RT 06/02 R05 - Cough AMOKSISILIN 500 MG
64 NIK : 3312102801730001 AMLODIPIN 5 MG
No. RM : 01-065871 BPJS : 0000566595933
MUHAMMAD FAKHRI RAZZAQ (L) JL PERJUANGAN RT 02/04 Z00.0 - General medical examination

65 NIK : 31720626110001
No. RM : 01-000586 BPJS : 0001225558293
JUSNIAR SIALLAGAN (L) PUSKESMAS KEC.KELAPA GADING M79.89 - Other specified soft tissue PARASETAMOL TAB 500 MG
disorders, site unspecified
66 NIK : 3172020501700013
No. RM : 01-020956 BPJS : 0000041700701
RUDDY PANDJAJA SUGITO (L) JL HARPA RAYA BLOK FF NO 15 I21.9 - Acute myocardial infarction, RUJUKAN (0116R029) Rumah Sakit
unspecified Hermina Podomoro
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0116R029) Rumah
Tgl Diagnosis : 08 February 2019 8:19 AM DARAH - (0) Podomoro
Sakit Hermina
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 5
2019-09-09 13:37 Hal. 566 dari 1322

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Kapasitas : 0
Jadwal : Jumat : 17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
LAUW POEIN NIO, NY (P) JL HARPA RAYA BLOK FF NO 15 I24.9 - Acute ischaemic heart disease, RUJUKAN (0116R029) Rumah Sakit
unspecified Hermina
(JAN) Podomoro
JANTUNG DAN
68 NIK : 31720647054500002 PEMBULUH
Telah DARAH
Diberikan : - (89)
Hermina
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Jumat : 17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
PONITI, NY (P) JL GADING VII NO 6 05/05 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
mellitus without complications RUJUKAN JAYA
69 NIK : 3172066011490001 RUJUKAN Penyakit
Telah Dalam :- (0)
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Jumat : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 567 dari 1322

P : 021-45853300 F : 021-45853301
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GEK SIA, TN (L) PERUM GADING ACARDIA BLOK A/42 N18.9 - Chronic renal failure, unspecified RUJUKAN

70 NIK : 2104012004390001
No. RM : 01-086893 BPJS : 0002379074444
ISMAN PHANOTO, TN (L) JLN KELAPA PUAN TIMUR 1 NB M65.3 - Trigger finger RUJUKAN (0113R034) MEDIROS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
HARYANTO GUNADI, TN (L) JANUR HIJAU II TQ 2 NO 12 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN
without complications PIROKSIKAM 10 MG
72 NIK : 3172061005530003
No. RM : 01-004518 BPJS : 0001316542869
H. A. M DALOM MONANG (L) BEA CUKAI M.7 NO.2 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
73 NIK : 3172041709410004
No. RM : 01-000891 BPJS : 0001808472205
MARIA E SUWARTINI (P) JL TELUK RATA IV BLK F NO.6 006/010 E78.5 - Hyperlipidaemia, unspecified RUJUKAN (0114R030) RS PERTAMINA
I10 - Essential (primary) hypertension KAPTOPRIL 25 MG JAYA
74 NIK : 3172064707390001 M41.9 - Scoliosis, unspecified METFORMIN TAB 500 MG Orthopedi
Telah - (0) :
Diberikan
SIMVASTATIN 10 MG
BY PASS
2019-09-09 13:37 Hal. 568 dari 1322

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Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
LIDIA AGUSTIEN MANOPO (P) JL PONDOK GADING UTAMA A15.3 - Tuberculosis of lung, confirmed by RUJUKAN (0116R025) Rumah Sakit Firdaus
unspecified means (PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Jumat : 09:00 - 12:00,
10:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
TUHFATUL MUHTAZIRRIDHONI, TN (L) BLOK JATI CININI A15.3 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
unspecified means VITAMIN B KOMPLEKS
76 NIK : 3212011402970004
No. RM : 01-081501 BPJS : 0000465996982
LUCY SOFIANA WINOWATAN, NY (P) GADING ELOK TIMUR 7 PP2 22 A15.3 - Tuberculosis of lung, confirmed by OAT KAT. II (FASE LANJUTAN)
77 NIK : -
No. RM : 01-076178 BPJS : 0002052904983
2019-09-09 13:37 Hal. 569 dari 1322

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JAP TIAM SENG, TN (L) SUNTER ALAMANDA 1 BLOK A2 NO 26 A15.3 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
78 NIK : 31703031902550001
No. RM : 01-020214 BPJS : 0002334240786
ANISSA RAHMALYA, NN (P) JL MUNDARI RT 05/02 NO 8 A15.3 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
79 NIK : 31720254601000008
No. RM : 01-016806 BPJS : 0001887042532
PRIJONO R SUTADJO, TN (L) JL GIRO 3/10 E11.9 - Non-insulin-dependent diabetes FENOL GLISEROL TT 10%
Tgl Lahir : 20-Jul-1947 ( 72 Thn 1 Bln 20 Hr ) H61.2 - Impacted cerumen
80 NIK : 3172062007470002
No. RM : 01-006411 BPJS : 0001833944343
NY ERMIYATI PRIJONO (P) JL GIRO T/20 E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 20 MG
M10.9 - Gout, unspecified ALOPURINOL 100 MG
81 NIK : 3172067010530001
No. RM : 01-006414 BPJS : 0001833944703
HARRI YUSUF WIDJAYA (L) JL SUMANGGUNG II BLOK J 5/3 A RT E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 10 MG (0116R025) Rumah Sakit Firdaus
08/02 L03.9 - Cellulitis, unspecified RUJUKAN (INT) PENYAKIT DALAM - (3)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
16:00 - 18:00;17:00 - 20:30
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 570 dari 1322

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KARTINI, NY (P) P TEMIANG 1 NO 16 N20.9 - Urinary calculus, unspecified RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
83 NIK : 3172064202490003 (0)
Telah Diberikan :
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Jumat : 11:00 - 14:00,
16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
NURHAYATI (P) WARUNG JENGKOL A15.3 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
unspecified means PARASETAMOL TAB 500 MG
No. RM : 01-083924 BPJS : 0001958678379
JOHNNY PRANSISCO, TN (L) GADING NIAS RESIDENT N18.5 - CHRONIC KIDNEY DISEASE, RUJUKAN (0905R004) RS ISLAM JKT
STAGE 5 SUKAPURA
(HDL) HEMODIALISA
85 NIK : 3471141901580001 Telah Diberikan : CKD STAGE V
No. RM : 01-012819 BPJS : 0001291358079 HEMODIALISA RUTIN 2X/
Tgl Diagnosis : 08 February 2019 1:06 PM MINGGU
ASAM FOLAT 2X1, CaCo3 3x1
JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal :
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 571 dari 1322

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SUGIARTO SUSANTIO (L) JL JATI NEGARA BRT RAYA NO 171 RT H26.4 - After-cataract RUJUKAN (0114R030) RS PERTAMINA
5/03 JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SUWANDY ANWAR (L) JL GADING KIRANA G 1/216 RT 09/08 I10 - Essential (primary) hypertension RETRIBUSI KLINIK LANSIA
M10.9 - Gout, unspecified AMLODIPIN 5 MG
SUMARNI, NY (P) JL.PUSKESMAS 02/06 D06.9 - Carcinoma in situ of cervix, RUJUKAN (0114R030) RS PERTAMINA
unspecified JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 572 dari 1322

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RAMDANI (L) GADING MAS BARAT V B.8/2 I10 - Essential (primary) hypertension ANTIHEMOROID DOEN
I84.5 - External haemorrhoids without KAPTOPRIL 25 MG
89 NIK : 3172061308440001 complication GENTAMISIN SALEP KULIT
HANDIYANTO WIBOWO TN (L) GADING NIRWANA VI PF 9-7 RT 007/23 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
J00 - Acute nasopharyngitis [common cold] VITAMIN B KOMPLEKS
LILY SUSILOWATI (P) JL TARIAN RAYA BRT RT 009/007 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-019978 BPJS : 0001826830934 MG
MARIA EILEEN GANI (P) GADING AYU I RA 2/22 I10 - Essential (primary) hypertension RANITIDIN 150 MG (0903R012) RS KARTIKA
I11.9 - Hypertensive heart disease without RUJUKAN PULOMAS
92 NIK : 3172065708491001 (congestive) heart failure NATRIUM DIKLOFENAK 50 MG Penyakit Dalam :- (0)
Telah Diberikan
No. RM : 01-004169 BPJS : 0001224415607 K21.9 - Gastro-oesophageal reflux disease Faskes : (0903R012) RS
VITAMIN B KOMPLEKS
Tgl Diagnosis : 12 February 2019 8:49 AM without oesophagitis KARTIKA PULOMAS
AMLODIPIN 10 MG
M54.5 - Low back pain Alamat : JL.PULOMAS TIMUR
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 573 dari 1322

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NURLENNY MUIN (P) JL PELEPAH INDAH raya lb 22 no 9 H10.9 - Conjunctivitis, unspecified KLORAMFENIKOL 1 % SM
SAWARNO, TN (L) JLP BENGKALIS NO 128 RT 10/03 I25.0 - Atherosclerotic cardiovascular RUJUKAN (0114R030) RS PERTAMINA
(JAN) JANTUNG DAN
94 NIK : 3172060710430004 PEMBULUH
Telah DARAH
Diberikan : - (89)
PERTAMINA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
ELISNAWATI TEORIMAN (P) APT GADING NIAS RESIDNCE F22 / FP M13.9 - Arthritis, unspecified RUJUKAN (0114R030) RS PERTAMINA
RT 02/03 PGS II JAYA
Telah Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Selasa : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 574 dari 1322

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SRI SUTOMI ASRI (P) JL. TRAMPIL 1 NO. 33 RT. 004/022 KGB H25.8 - Other senile cataract AMLODIPIN 10 MG (0114R030) RS PERTAMINA
I10 - Essential (primary) hypertension RUJUKAN JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Selasa : 09:00 - 10:00
TACC : Tanpa TACC

Alasan TACC :
ANTONIUS DERMAWAN P.BBA, TN (L) KELAPA PUAN TIMUR VII NC 7/08 RTM H91.1 - Presbycusis RUJUKAN (0116R025) Rumah Sakit Firdaus
007/012 (THT) THT-KL - (66) THT-KL - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 13:00 - 16:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
KESUMA TASLIM, TN (L) JL PERMATA BIRU I H 3/8 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R029) Rumah Sakit
mellitus without complications Hermina
(JAN) Podomoro
JANTUNG DAN
Tgl Lahir : 09-Feb-1947 ( 72 Thn 7 Bln 0 Hr ) I11.0 - Hypertensive heart disease with
98 NIK : 3172060902470002 PEMBULUH
Telah DARAH
Diberikan : - (89)
No. RM : 01-074539 BPJS : 0001785536289 (congestive) heart failure JANTUNG DAN PEMBULUH
Hermina
BLOK E3 NO 2
2019-09-09 13:37 Hal. 575 dari 1322

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Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Selasa : 19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
HARMAN (L) JL. JANUR ASRI 3 Q K 7 NO 5 R50.9 - Fever, unspecified VITAMIN B KOMPLEKS

99 NIK : 3171021501560001
No. RM : 01-087161 BPJS : 0001725502026
SUWARDO SUHARTONO, TN (L) JL PGS INDAH RT 7/16 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
No. RM : 01-045835 BPJS : 0002104300001 MG
HOO TJUIJ ENG (P) JL. EBONI 4 B;LOK AC NO. 30 GRANC H25.8 - Other senile cataract KAPTOPRIL 25 MG (0116R025) Rumah Sakit Firdaus
ORCHARD I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Selasa : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 576 dari 1322

P : 021-45853300 F : 021-45853301
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LILIEK ROEKIYATI (P) KOMP BEACUKAI BLOK S 5/22 RT E10.9 - Insulin-dependent diabetes mellitus RUJUKAN (0116R025) Rumah Sakit Firdaus
07/.07 without complications (INT) PENYAKIT DALAM - (3)
Tgl Lahir : 22-Jun-1942 ( 77 Thn 2 Bln 18 Hr ) I11.9 - Hypertensive heart disease without
Telah Diberikan
No. RM : 01-033887 NIK : 3172042206470002 (congestive) heart failure Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 09:00 - 13:00,
16:00 - 18:00;18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
HERMAN, TN (L) KLP NIAS V PC 11 I10 - Essential (primary) hypertension RUJUKAN (0116R029) Rumah Sakit
I25.0 - Atherosclerotic cardiovascular Hermina
(URO) Podomoro
UROLOGI - (88) Urologi -
103 NIK : 3172060211500001 disease, so described (0)
Telah Diberikan :
No. RM : 01-039787 BPJS : 0001383700083 N40 - Hyperplasia of prostate Faskes : (0116R029) Rumah
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Selasa : 17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
JOE TJOENG BOEN (L) JL.RUSA PESERTA LESTARI III F.4/16 G20 - Parkinson's disease RUJUKAN (0116R025) Rumah Sakit Firdaus
KOMP.BEA CUKAI
2019-09-09 13:37 Hal. 577 dari 1322

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Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Selasa : 16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
ALBERT SULTANTO (L) GADING INDAH VI BLOH NF 4 /5 PGSN I25.0 - Atherosclerotic cardiovascular RUJUKAN (0116R025) Rumah Sakit Firdaus
II disease, so described (INT) PENYAKIT DALAM - (3)
Tgl Lahir : 20-Jan-1956 ( 63 Thn 7 Bln 20 Hr ) I64 - Stroke, not specified as haemorrhage
105 Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 01-060171 NIK : 3172062001560001 or infarction Faskes : (0116R025) Rumah
BPJS : 0002056675915 R60.0 - Localized oedema
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Selasa : 09:00 - 13:00,
16:00 - 18:00;18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
ANTON SUGIARTO, TN (L) JL GAMBYONG BLK U NO.25 009/007 I25.0 - Atherosclerotic cardiovascular
disease, so described
106 NIK : 3172060804470001
No. RM : 01-029270 BPJS : 0001226135013
Sudaryastuty, NY (P) RT 09/07 PEGANGSAAN DUA E78.5 - Hyperlipidaemia, unspecified
M10.9 - Gout, unspecified
107 NIK : - N21.9 - Calculus of lower urinary tract,
2019-09-09 13:37 Hal. 578 dari 1322

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IR H MUMUNG MARTHASASMITA (L) JL KUNING LANGSAT C V/19 RT H61.2 - Impacted cerumen RUJUKAN (0116R025) Rumah Sakit Firdaus
019/010 H93.1 - Tinnitus (THT) THT-KL - (66) THT-KL - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 13:00 - 16:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
MEGAWATI, NY (P) KELAPA HYBRISA 6 BLOK RB 13 N0.2 M13.9 - Arthritis, unspecified RUJUKAN (0114R030) RS PERTAMINA
RT006/15 JAYA
109 Orthopedi
Telah - (0) :
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Selasa : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SURIAH KOMALADI, TN (L) JL GADING NIAS BARAT IV B8 NO 16 I25.1 - Atherosclerotic heart disease RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0905R004) RS ISLAM
JKT SUKAPURA
2019-09-09 13:37 Hal. 579 dari 1322

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5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
FURAWATY TEDJA, NY (P) APT WGP MENARA BLT 12/7 I10 - Essential (primary) hypertension RUJUKAN
K30 - Dyspepsia RUJUKAN
111 NIK : 3172065803410001
No. RM : 01-082366 BPJS : 0002103752035
INGGRID SETIO TAN (P) JL KLP SAWIT VII RT 004/017 D47.3 - Essential (haemorrhagic) RUJUKAN
thrombocythaemia
112 NIK : 3171054309500001
No. RM : 01-033825 BPJS : 0001450153787
JUNUS MARDJUADI ( + ), TN (L) JL KH WAHID HASYIM 11 RT 9/9 Z95.1 - Presence of aortocoronary bypass RUJUKAN (0116R029) Rumah Sakit
graft RUJUKAN Hermina Podomoro
(JAN) JANTUNG DAN
113 NIK : - PEMBULUH DARAH
Faskes DAN PEMBULUH
: (0116R029) Rumah
Tgl Diagnosis : 12 February 2019 2:18 PM DARAH - (0) Podomoro
Sakit Hermina
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 14
Kapasitas : 0
Jadwal : Selasa : 19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 580 dari 1322

P : 021-45853300 F : 021-45853301
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MANLY MEGAHRIA LAIJ, NY (P) GADING KIRANA TUIMUR V A7/7 KGB K30 - Dyspepsia ANTASIDA DOEN
KAPTOPRIL 12,5 MG
114 NIK : 3271016911430001
No. RM : 01-061868 BPJS : 0001260730866
SJARIFINA (P) JL JANUR ELOK III BLOK QE 6 NO 6 RT I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
12/06 R51 - Headache
115
No. RM : 01-007475 NIK : 3172024403460001
ELS SUTARDI (P) VILLA PERMATA GADING A2/41 PGSN I11.0 - Hypertensive heart disease with RUJUKAN (0116R021) Royal Progress
II (congestive) heart failure (JAN) JANTUNG DAN
Tgl Lahir : 09-Feb-1939 ( 80 Thn 7 Bln 0 Hr ) I50.0 - Congestive heart failure
116 PEMBULUH DARAH
No. RM : 01-076760 NIK : - JANTUNG
Faskes DAN PEMBULUH
: (0116R021) Royal
Progress- (0)
UTARA
Telp : 021-6400261
Kelas : B
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
09:30 - 18:00
TACC : Tanpa TACC

Alasan TACC :
LIANAWATI, NY (P) JL KINTAMANI I/48 M54.5 - Low back pain SIANOKOBALAMIN (VITAMIN B12) 50
MCG
Tgl Lahir : 07-Nov-1955 ( 63 Thn 10 Bln 2 Hr ) AMLODIPIN 10 MG
117 NIK : 3172064711550006
No. RM : 01-049140 BPJS : 0002262496206
NURMAULINA BR SIMATUPANG (P) JL RAYA PGS II RT 005/002 M13.9 - Arthritis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
R05 - Cough MG
Tgl Lahir : 04-Jul-1958 ( 61 Thn 2 Bln 5 Hr ) GLISERIL GUAIAKOLAT (GG) 100 MG
118 NIK : 3172064407580002
MCG
2019-09-09 13:37 Hal. 581 dari 1322

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TJOEK SOEGIARTO,SE,MM.AK (L) PULAU SANBU BRAYA O 15 M13.9 - Arthritis, unspecified PIROKSIKAM 10 MG
No. RM : 01-015752 BPJS : 0000046019957
LIE LAN SIOE (P) GADING INDAH UTARA III NHIV NO.9 R11 - Nausea and vomiting PARASETAMOL TAB 500 MG
120 NIK : 1871075108480002
No. RM : 01-003035 BPJS : 0001335629529
RUSFANDI HUSEIN (L) JL JANUR HIJAU XI TR 1/12A RT 003/15 W57.8 - BITTEN OR STUNG BY GENTAMISIN SALEP KULIT
NONVENOMOUS INSECT AND OTHER PARASETAMOL TAB 500 MG
Tgl Lahir : 18-Feb-1945 ( 74 Thn 6 Bln 22 Hr ) NONVENOMOUS ARTHROPODS, OTHER
121 NIK : 3172061802450002
No. RM : 01-008101 BPJS : 000145540579 SPECIFIED AREA
PURWATI KURNIA (P) JL PERJUANGAN RT 013/007 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
122 NIK : 3172024402440008 BORAK GLYSEROL 5% LARUTAN
LUKITO HENDRA GUNAWAN, TN (L) JL BOULEVARD RAYA BLOK J 4/4 RT I25.9 - Chronic ischaemic heart disease, RUJUKAN (0905R004) RS ISLAM JKT
09/02 unspecified SUKAPURA
(JAN) JANTUNG DAN
123 PEMBULUH
: - (89)
No. RM : 01-037601 NIK : 3172062209510002 JANTUNG
Faskes DAN PEMBULUH
: (0905R004) RS ISLAM
Tgl Diagnosis : 13 February 2019 2:40 PM BPJS : 0001436253851 DARAH - (0)
JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 582 dari 1322

P : 021-45853300 F : 021-45853301
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IRENE LAMONDA, NY (P) TMN PEGANGSAAN INDAH BLOK G 2/3 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
mellitus without complications (INT) PENYAKIT DALAM - (3)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
INDRA WINOTO (L) PERMATA HARAPAN BARU BLOK B I25.0 - Atherosclerotic cardiovascular RUJUKAN (0116R029) Rumah Sakit
2/12 disease, so described Hermina
(JAN) Podomoro
JANTUNG DAN
125 PEMBULUH
Telah DARAH
Diberikan : - (89)
Hermina
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
WIYONO (L) JL.P.TEMIANG II N0 18 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
126 NIK : 3172061806460004 MCG
No. RM : 01-038688 BPJS : 0000046021318
2019-09-09 13:37 Hal. 583 dari 1322

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SUWANTINI, NY (P) KOMP BEA CUKAI JL SRIWIJAYA BLOK I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
K5/12 R51 - Headache SIMVASTATIN 10 MG
127 AMLODIPIN 10 MG
MARYAM (P) PULO NANGKA BARAT II RT 1/16 NO H40.0 - Glaucoma suspect RUJUKAN (0113R034) MEDIROS
35 H81.3 - Other peripheral vertigo ALOPURINOL 100 MG (MAT) MATA - (65) Mata - (0)
Tgl Diagnosis : 15 February 2019 12:05 PM BPJS : 0001263120208 Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
TRIAJI ADISAPUTRO, TN (L) APT. FRENCH WALK TOWER PG/ 29B J45.9 - Asthma, unspecified AMOKSISILIN 500 MG
011/019 GLISERIL GUAIAKOLAT (GG) 100 MG
129 PREDNISON 5 MG
ROMENAH, NY (P) PERJUANGAN RT. 02/04 KGT H26.4 - After-cataract RUJUKAN (0113R034) MEDIROS
I10 - Essential (primary) hypertension KAPTOPRIL 12,5 MG (MAT) MATA - (65) Mata - (0)
130 NIK : 3172064202610002 SIANOKOBALAMIN (VITAMIN B12) 50 Telah Diberikan :
No. RM : 01-000750 BPJS : 0000378113578 MCG Faskes : (0113R034) MEDIROS
Tgl Diagnosis : 15 February 2019 12:24 PM PARASETAMOL TAB 500 MG Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 09:30 - 13:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 584 dari 1322

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Alasan TACC :
LARISSA BELVA CAHYADI, AN (L) JL. GOLEK NO. 16 M54.5 - Low back pain NATRIUM DIKLOFENAK TAB 25 MG

131 NIK : -
No. RM : 01-087577 BPJS : 0001225426623
SRI PRIYANTI, NY (P) KMP RAWA INDAH RT 07/03 M54.5 - Low back pain NATRIUM DIKLOFENAK TAB 25 MG
132 NIK : 3172065107740007 MCG
No. RM : 01-051321 BPJS : 0000378391375
LYDIA FREDIANTO, NY (P) KLP HIBRIDA IX RA 24/9 RT 09/15 H26.4 - After-cataract RUJUKAN (0116R025) Rumah Sakit Firdaus
RUJUKAN (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Jumat : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
LUKMAN FREDIANTO, TN (L) JL KELAPA HIBRIDA IX RA 24/9 RT I64 - Stroke, not specified as haemorrhage ANTASIDA DOEN
09/15 or infarction RUJUKAN
134
No. RM : 01-002471 NIK : 3172061612570004
2019-09-09 13:37 Hal. 585 dari 1322

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ALBERT AGUSTA (L) JL. SUMAMAGUNG I BLK AIV NO.12A R05 - Cough AMBROKSOL TAB 30 MG
VITAMIN B KOMPLEKS
135 NIK : 3172060608870001
No. RM : 01-022042 BPJS : 0001435915269
ITA SURYANI, NY (P) JL KELAPA SAWIT VIII BE / 05 M79.7 - FIBROMYALGIA ASAM MEFENAMAT KAPS 500
DEKSAMETASON 0,5 MG
Tgl Diagnosis : 15 February 2019 1:49 PM KALSIUM LAKTAT (KALK) 500 MG
UNA FALENTINA (P) P. KEMERDEKAAN RT. 005/010 PULO N39.0 - Urinary tract infection, site not RUJUKAN (0905R004) RS ISLAM JKT
GADUNG specified RUJUKAN SUKAPURA
Tgl Lahir : 08-Dec-1972 ( 46 Thn 9 Bln 1 Hr ) N39.9 - Disorder of urinary system,
137 (0)
Telah Diberikan :
No. RM : 01-002432 NIK : 3301064812720001 unspecified Faskes : (0905R004) RS ISLAM
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 08:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
MUNARTI (P) JL.SWADAYA 05/02 K30 - Dyspepsia PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
M AGUNG SOEKOTJO, TN (L) RW SARI SELTAN 2 NO 5 M79.7 - FIBROMYALGIA ASAM MEFENAMAT KAPS 500
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 586 dari 1322

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JUMANTO (L) PGSN 2 RT 04/01 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
140 NIK : 3172060412860002 MG
GALUH ARETA TRUSTHA (-) JL TASKA P 24 RT 05/10 PGS II J06.0 - Acute laryngopharyngitis ASAM MEFENAMAT KAPS 500
141 NIK : 33741064030200002 MG
FEREN TYAS MUNANDAR (P) RAWA INDAH 005/003 R50.9 - Fever, unspecified ZINC 20 MG
MULTIVITAMIN DEWASA
142 NIK : 3172064811991001
No. RM : 01-007700 BPJS : 0001225885847
MASROFAH (P) RT004/03 RW INDAH H81.1 - Benign paroxysmal vertigo ASAM MEFENAMAT KAPS 500
143 NIK : 3172064710770007 (ASETOSAL)
JESSICA HANANTA (P) JL. KLAP NIAS V BLK PC X NO.4 R05 - Cough PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified RANITIDIN 150 MG
No. RM : 01-055489 BPJS : 0001462429844 MG
DEKSAMETASON 0,5 MG
M SARKUM, TN (L) JL. PRIHATIN SMA NO. 72 F20.8 - Other schizophrenia HALOPERIDOL 5 MG
145 NIK : - RISPERIDONE 2MG
MCG
2019-09-09 13:37 Hal. 587 dari 1322

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LIEM LANDY BUDIONO, NY (P) TELUK HONG 11/10 PEJAGALAN H81.3 - Other peripheral vertigo

146 NIK : 3578095504590003
No. RM : 01-072233 BPJS : 0002330820933
WARTIYATI, NY (P) KP. P.GADUNG GG N /8 RT 03/05 E78.5 - Hyperlipidaemia, unspecified PIROKSIKAM 10 MG
SIMVASTATIN 10 MG
No. RM : 01-009802 BPJS : 0001461994525
JOHNNY EDWARD MANENGKEI (L) GADING VII NO 58 RT 7/05 J44.9 - Chronic obstructive pulmonary RUJUKAN (0905R004) RS ISLAM JKT
disease, unspecified SUKAPURA
(PAR) PARU - (94) PARU - (0)
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 08:00 - 17:00,
08:00 - 12:00;11:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SRI WATININGSIH (P) JL DEMUNG 1 BLOK Z 12 RTR 003/009 I11.9 - Hypertensive heart disease without RUJUKAN (0903R012) RS KARTIKA
149 NIK : 3172066111420001 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
2019-09-09 13:37 Hal. 588 dari 1322

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Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
BANUARA GULTOM (L) KP SUKAPURA RT. 005/010 J44.9 - Chronic obstructive pulmonary RUJUKAN (0116R025) Rumah Sakit Firdaus
SUKAPURA disease, unspecified (PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
KARMILA MIMY PANGESTU, NY (P) KELAPA KOPYOR BRT IV CI 2/20 RT H33.0 - Retinal detachment with retinal RUJUKAN (0116R025) Rumah Sakit Firdaus
4/12 break (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 589 dari 1322

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DRA.RUTH INGAWATI.T, NY (P) JL.HYBRIDA I RB.2/3 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
H.M. HARRIS EFFENDY (L) JL DAHLIA I NO 12 RT 005/003 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
153 NIK : 3172011303490003 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
SAID, TN (L) PULAO TEMIANG 1 NO. 16 RT. 011/003 J02.9 - Acute pharyngitis, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
KGB R05 - Cough KLORFENIRAMIN MALEAT (CTM) TAB 4
154 MG
Tgl Diagnosis : 19 February 2019 9:00 AM BPJS : 0000046014546 SIANOKOBALAMIN (VITAMIN B12) 50
MCG
SUGANTO DINOTO, TN (L) KELAPA HYBRIDA VIII RA.22/4 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
155 NIK : 3172062609570004 MCG
2019-09-09 13:37 Hal. 590 dari 1322

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TAN TIAN SIEN, TN (L) JL SUNTER MAS S I K74.6 - Other and unspecified cirrhosis of RUJUKAN (0116R025) Rumah Sakit Firdaus
liver GLISERIL GUAIAKOLAT (GG) 100 MG (INT) PENYAKIT DALAM - (3)
Tgl Lahir : 16-Oct-1956 ( 62 Thn 10 Bln 24 Hr ) R05 - Cough
156 NIK : 3172021610560008 KLORFENIRAMIN MALEAT (CTM) TAB 4 Penyakit Dalam :- (0)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 09:00 - 13:00,
16:00 - 18:00;18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
KUNDARSIH (L) JL.INPEKSI KALI SUNTER RT 004/04 KL H35.3 - Degeneration of macula and RUJUKAN (0113R074) RS KHUSUS MATA
GADING BARAT N0 46 posterior pole AMLODIPIN 10 MG SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 41
Kapasitas : 0
Jadwal : Selasa : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 16:00
- 20:00
TACC : Tanpa TACC

Alasan TACC :
HENDRY KURNIAWAN (L) KELAPA NIAS VIII PA 23/16 RT 5/14 H57.8 - Other specified disorders of eye and RUJUKAN (0903R012) RS KARTIKA
adnexa PULOMAS
(MAT) MATA - (65) Mata - (0)
2019-09-09 13:37 Hal. 591 dari 1322

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BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
GAZI (L) JL TMN GADING INDAH BLK E NO.26 I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
001/014 Z95.5 - Presence of coronary angioplasty JAYA
(JAN) JANTUNG DAN
159 implant and graft PEMBULUH DARAH
No. RM : 01-042690 NIK : 3172061705490001 JANTUNG
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
PARDOMUAN HARAHAP, TN (L) TAMAN PGS INDAH K-1 RT 02/19 I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
JAYA
(JAN) JANTUNG DAN
160 NIK : 3172061401580003 PEMBULUH
Telah DARAH
Diberikan : - (89)
PERTAMINA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
10:00 - 11:00
2019-09-09 13:37 Hal. 592 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
HOTJE INDALAO (L) JL GRIYA PRTAMA V BLOK III/1 005/020 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
PGS II mellitus without complications PULOMAS
161 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
IRWAN WALUYA, TN (L) JL SIMPONI MAS 1 BLOK B1/11 A09 - Diarrhoea and gastroenteritis of AMLODIPIN 10 MG
presumed infectious origin SIMVASTATIN 10 MG
Tgl Diagnosis : 19 February 2019 9:58 AM MG TAB
ZINC 20 MG
LINA SJOFJAN, NY (P) JANUR HIJAU XII TP 2/19 S90.9 - Superficial injury of ankle and foot, SIANOKOBALAMIN (VITAMIN B12) 50
unspecified MCG
163 NIK : 3172065506520001
No. RM : 01-013086 BPJS : 0001446956245
2019-09-09 13:37 Hal. 593 dari 1322

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LESMISERE SIMANJUNTAK, NY (P) PERJUANGAN RAYA NO 43 RT 4/7 I25.1 - Atherosclerotic heart disease RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
(JAN) JANTUNG DAN
164 NIK : 3175026010510001 PEMBULUH
: - (89)
Faskes DAN PEMBULUH
: (0905R004) RS ISLAM
JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Selasa : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
NANI SRI WAHYUNI, NY (P) PULAU BANGKA I N0 1 RT 008/09 E78.5 - Hyperlipidaemia, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
I10 - Essential (primary) hypertension MCG
Tgl Lahir : 11-Jun-1949 ( 70 Thn 2 Bln 29 Hr ) AMLODIPIN 10 MG
165 NIK : 3172065106490001
WIRO SUSILO LU (L) JL.GADING ASRI V PD-4/1.A I73.9 - Peripheral vascular disease, RUJUKAN (0903R012) RS KARTIKA
unspecified PULOMAS
166 NIK : 1671001702430003 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 594 dari 1322

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SUWITO HADI SAPUTRA,TN (L) SENTOSA RAYA NO 8 RT 8/10 I63.9 - Cerebral infarction, unspecified ANTIHEMOROID DOEN (0114R030) RS PERTAMINA
I84.2 - Internal haemorrhoids without RUJUKAN JAYA
167 NIK : 3174050304550002 complication Telah Diberikan :
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
HANAFI TJIOMAS (L) KOKON PERMATA GADING F 33 M13.9 - Arthritis, unspecified PIROKSIKAM 10 MG
168 NIK : - MCG
SIMVASTATIN 10 MG
TAN MERCY LIESCYA (P) JL SUMAGUNG II J 5/6 M13.9 - Arthritis, unspecified PIROKSIKAM 10 MG
169 NIK : 3172066607560001 MCG
No. RM : 01-047801 BPJS : 0001298458078
MARGO WALUYO (L) JL NUSA INDAH RT 8/8 I10 - Essential (primary) hypertension
M77.37 - Calcaneal spur, ankle and foot
170 NIK : 3172060709480001
No. RM : 01-022802 BPJS : 0001276897983
SUHARTY ACHMAD (P) KP.PULO GADUNG NO.109 06/05 E78.5 - Hyperlipidaemia, unspecified SIANOKOBALAMIN (VITAMIN B12) 50
M10.9 - Gout, unspecified MCG
Tgl Lahir : 12-Dec-1958 ( 60 Thn 8 Bln 28 Hr ) SIMVASTATIN 10 MG
171 NIK : 3172065212580001
2019-09-09 13:37 Hal. 595 dari 1322

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ANTASIDA DOEN
SITI FATONAH, NY (P) PLAMBANG RT 002/016 E78.5 - Hyperlipidaemia, unspecified RUJUKAN (0905R003) RS PELABUHAN
M10.9 - Gout, unspecified SIMVASTATIN 10 MG JAKARTA
172 NIK : 3309027112589210 Z09.0 - Follow-up examination after surgery ALOPURINOL 100 MG Orthopedi
Telah - (0) :
Diberikan
No. RM : 01-008715 BPJS : 0001456275543 for other conditions Faskes : (0905R003) RS
Tgl Diagnosis : 19 February 2019 11:26 AM SIANOKOBALAMIN (VITAMIN B12) 50 PELABUHAN JAKARTA
MCG Alamat : JL. KRAMAT JAYA NO.1
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Selasa : 11:00 - 13:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
LAMARIS HUTAEAN (P) INSFEKSI KLI SUNTER RT 02/04 KLP M81.5 - Idiopathic osteoporosis RUJUKAN (0116R028) Rumah Sakit Puri
GADING Medika
173 Penyakit
Telah Dalam :- (0)
Diberikan
Tgl Diagnosis : 19 February 2019 11:32 AM BPJS : 0001224221905 Sakit Puri Medika
Raya No. 46
Telp : 021-43903355
Kelas : C
Jumlah Rujukan : 19
Kapasitas : 0
Jadwal : Selasa : 08:00 - 16:00,
16:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 596 dari 1322

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IRMA (L) JL SITER BLOK E/10 RT 004/007 H81.1 - Benign paroxysmal vertigo RUJUKAN (0903R012) RS KARTIKA
PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Selasa : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
TJO MOEI MOIJ (P) JL GADING ELOK UTR II FD 11/11 E11.9 - Non-insulin-dependent diabetes RUJUKAN
mellitus without complications RETRIBUSI KLINIK LANSIA
175 NIK : 3172065703480002
No. RM : 01-065478 BPJS : 0001728854616 I50.0 - Congestive heart failure
SURYATIE (P) SIMPONI MAS II BLOK B 3 NO 11 M77.3 - Calcaneal spur SIMVASTATIN 10 MG
No. RM : 01-019501 BPJS : 0001482845422
DADI, TN (L) JL KINTAMANI NO 107 I10 - Essential (primary) hypertension KAPTOPRIL 12,5 MG
177 NIK : 3175032109580005 MIKONAZOL KRIM 2 %
No. RM : 01-012390 BPJS : 0001639151234 RETRIBUSI KLINIK LANSIA
SITI WAHYUNI, NY (P) JANUR INDAH III LA 11 NO. 4 KGB E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 10 MG
No. RM : 01-001060 BPJS : 0001285510397 MCG
2019-09-09 13:37 Hal. 597 dari 1322

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TRI WIJOKONGKO (L) JL PULAU BENGKALIS NO.16 010/03 R05 - Cough AMBROKSOL TAB 30 MG
KGB KLORFENIRAMIN MALEAT (CTM) TAB 4
179 MG
No. RM : 01-004911 NIK : 3172061901390002
SEK KHENG (P) JL. TOMANG TANAH TINGGI 11/28 M13.9 - Arthritis, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
N39.8 - Other specified disorders of urinary (INT) PENYAKIT DALAM - (3)
180 NIK : - system Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 252 BPJS : 0001821550252 Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Selasa : 09:00 - 13:00,
16:00 - 18:00;18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
WARSINI, NY (P) JL PULAU GALANG NO.39 009/003 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG (0114R030) RS PERTAMINA
I11.0 - Hypertensive heart disease with SIANOKOBALAMIN (VITAMIN B12) 50 JAYA
(JAN) JANTUNG DAN
181 NIK : 3172064111460001 (congestive) heart failure MCG PEMBULUH DARAH
No. RM : 01-029464 BPJS : 0000045931961 RUJUKAN JANTUNG
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 598 dari 1322

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SYAFRUDDIN TADUH (L) NUSA INDAH G 21 RT 9/8 E11.9 - Non-insulin-dependent diabetes RUJUKAN
mellitus without complications RUJUKAN
182 NIK : 3172062404500004
No. RM : 01-002338 BPJS : 0001306630462
LISTIANA MALIAN (P) NUSA INDAH G 21 RT 9/8 H61.2 - Impacted cerumen RUJUKAN (0905R004) RS ISLAM JKT
H93.1 - Tinnitus SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 08:00 - 10:00,
16:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
SUMARTO (L) APT MOI LT 1 NO 15 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
184 NIK : 312042705621001 MCG
No. RM : 03-001336 BPJS : 0001786620093
NURBIANTI (P) GADING RAYA IIRT01/05 N18.5 - CHRONIC KIDNEY DISEASE, AMLODIPIN 10 MG (0903R012) RS KARTIKA
STAGE 5 RUJUKAN PULOMAS
(HDL) HEMODIALISA
185 NIK : 3172065601510002 RUJUKAN Telah Diberikan : pasien rutin
No. RM : 01-010713 BPJS : 0000045889086 hemodialisa, CKD stage 5
Tgl Diagnosis : 19 February 2019 2:04 PM Faskes : (0903R012) RS
KARTIKA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 0
2019-09-09 13:37 Hal. 599 dari 1322

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Kapasitas : 0
Jadwal :
TACC : Tanpa TACC

Alasan TACC :
MICHAEL WAHYUDI LUZAR, TN (L) KLP NIAS VIPC 14/2 RT 09/017 PGSN II M41.9 - Scoliosis, unspecified

186 NIK : 3172060512480002
No. RM : 01-072068 BPJS : 0001821983141
DIRAN SUKARNO, TN (L) JL. KLP GADING TIMUR NO 52 RT R05 - Cough PARASETAMOL TAB 500 MG
003/006 R50.9 - Fever, unspecified GLISERIL GUAIAKOLAT (GG) 100 MG
187
No. RM : 01-023100 NIK : 3172060902620005
LIE LANG HWA, NY (P) JL SUNTER INDAH II BLOK KB 2 / 8 RT L20.9 - Atopic dermatitis, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
04/02 (KLT) KULIT KELAMIN - (110)
188 KULITDiberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
HIKMAH LUBIS (P) KOMP BEA CUKAI K7/17 H06.0 - Disorders of lacrimal system in NATRIUM DIKLOFENAK TAB 25 MG (0905R004) RS ISLAM JKT
diseases classified elsewhere RUJUKAN SUKAPURA
(MAT) MATA - (65) Mata - (0)
Tgl Lahir : 18-Jan-1957 ( 62 Thn 7 Bln 22 Hr ) H25.8 - Other senile cataract
No. RM : 01-044410 BPJS : 0000046070032 M54.5 - Low back pain Faskes : (0905R004) RS ISLAM
5
2019-09-09 13:37 Hal. 600 dari 1322

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Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
15:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
KOSASIH TENGGARA (L) KLP HIBRIDA V RB. XI NO, 7 H40.9 - Glaucoma, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
(MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
HANDAJANI TIRTAWIDJAJA (P) JL JANUR ASRI VII QK 14 NO 2 I25.9 - Chronic ischaemic heart disease, RUJUKAN (0114R030) RS PERTAMINA
unspecified JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 601 dari 1322

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Alasan TACC :
YUSAK ADRIAN ALFONZ RAHARJA, TN (L) JL KELAPA NIAS VI PB-13/12 A15.0 - Tuberculosis of lung, confirmed by KOTRIMOKSAZOL DOEN I (DEWASA)
sputum microscopy with or without culture (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 14-Jul-1987 ( 32 Thn 1 Bln 26 Hr ) Z03.0 - Observation for suspected TRIMETOPRIM 80 MG)
192 NIK : 3172021407870008
No. RM : 01-087658 BPJS : 0001633697267 tuberculosis GLISERIL GUAIAKOLAT (GG) 100 MG
PRISKILA THEOPHILUS, NY (P) KELAPA HYBRIDA V RB XI/7 H25.8 - Other senile cataract RUJUKAN (0116R025) Rumah Sakit Firdaus
(MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SUHARNI (P) PELAPH INDAH RAYA LC.2 NO.5 I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
AMLODIPIN 10 MG JAYA
(JAN) JANTUNG DAN
194 NIK : 3519085812530002 ANTASIDA DOEN PEMBULUH DARAH
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
2019-09-09 13:37 Hal. 602 dari 1322

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Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
DODOK MULYANI, NY (P) JANUR ELOK VI QJ 12 NO 9 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
No. RM : 01-003100 BPJS : 0001256800252
SITI DALEHA (P) JL PADEMANGAN RT 4/7 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
mellitus without complications AMLODIPIN 10 MG (MAT) MATA - (65) Mata - (0)
Tgl Lahir : 06-Aug-1947 ( 72 Thn 1 Bln 3 Hr ) H40.9 - Glaucoma, unspecified
196 NIK : 3172054608470001 GLIBENKLAMIDA 5 MG Telah Diberikan :
No. RM : 01-063238 BPJS : 0001723675577 I10 - Essential (primary) hypertension Faskes : (0116R025) Rumah
SIMVASTATIN 10 MG
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SITI ZAETUN (P) JL. TEGUH II NO. 111 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
197 NIK : - MG
OSLAN GUNARSIH, TN (L) JL KLP CENGKIR BARAT XII FS 1/06 RT I25.1 - Atherosclerotic heart disease RUJUKAN (0116R027) Rumah Sakit
04/13 Mulyasari
(JAN) JANTUNG DAN
198 PEMBULUH
Telah DARAH
Diberikan : - (89)
Sakit - (0)
Mulyasari
Semper No.19
2019-09-09 13:37 Hal. 603 dari 1322

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Telp : 021-43931111
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
YUSAK ADRIAN ALFONZ RAHARJA, TN (L) JL KELAPA NIAS VI PB-13/12 A15.0 - Tuberculosis of lung, confirmed by (0116R025) Rumah Sakit Firdaus
sputum microscopy with or without culture (PAR) PARU - (94) PARU - (0)
Tgl Lahir : 14-Jul-1987 ( 32 Thn 1 Bln 26 Hr ) Z03.0 - Observation for suspected
No. RM : 01-087658 BPJS : 0001633697267 tuberculosis Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
ROSMAWARTY (P) APT GADING RESORT RES CITY L84 - Corns and callosities AMOKSISILIN 500 MG
HOUSER BLK E2 /23 SIANOKOBALAMIN (VITAMIN B12) 50
200 MCG
No. RM : 01-038278 NIK : - PARASETAMOL TAB 500 MG
JIMMY WIJAYA, SE (L) JL JANUR ELOK RAYA PE 1/8 H26.4 - After-cataract RUJUKAN (0114R030) RS PERTAMINA
JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
2019-09-09 13:37 Hal. 604 dari 1322

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Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SRI LESTARI RAHAYU ,NY (P) KLP PUAN TIMUR II NG 2/10 PGSN II C80.9 - MALIGNANT NEOPLASM, RUJUKAN (0114R030) RS PERTAMINA
UNSPECIFIED JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 14:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
HJ NURSIAH KANANG, NY (P) JL.GAMBIR ANOM F-6/13 K30 - Dyspepsia ANTASIDA DOEN
No. RM : 01-009474 BPJS : 0002035549888 MCG
I G K WIJASA DRS (L) KOMPLEK WALIKOTA JL HIJAU DAUN H26.4 - After-cataract RUJUKAN (0113R074) RS KHUSUS MATA
D7/32 SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 35
Kapasitas : 0
2019-09-09 13:37 Hal. 605 dari 1322

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Jadwal : Rabu : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 15:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

MARLINI (P) JL ORANYE BLOK A 5/13 RT 7/10 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
205 NIK : 3172066104430001
No. RM : 01-003741 BPJS : 0000046155701
ADELIS AZWAR (L) JL ORANYE BLOK A 5/13 RT 7/10 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
MASTURI (L) BCS RAYA B1 RT 4/06 R05 - Cough AMOKSISILIN 500 MG
No. RM : 01-003772 BPJS : 0001224259132 MG
MCG
YUDI HERMANSYAH WIDHIT (L) HIBRIDA 11 RA.30 NO.2 R05 - Cough AMOKSISILIN 500 MG
No. RM : 01-001143 BPJS : 0001225823051 MCG
DRS SERVRYANUS SARNO (L) KLP CENGKIR RAYA BLK. WF 2/1 RT. I10 - Essential (primary) hypertension
006/015
209
No. RM : 01-001812 NIK : 3173070404420003
2019-09-09 13:37 Hal. 606 dari 1322

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DRA. H PAULINA PAKAN (P) KLP CENGKIR RAYA BLK. WF 2/1 KGT I10 - Essential (primary) hypertension

210 NIK : 3172061001
No. RM : 01-001814 BPJS : 0000045660161
SUDRADJAT TIRTA, TN (L) PULO GEBANG PERMAI A 12/15 H25.8 - Other senile cataract RUJUKAN (0116R025) Rumah Sakit Firdaus
(MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
PUDJIANTO PURNAMASIDI (L) JANUR KUNING III WI 2/8 RT. 009/015 I25.1 - Atherosclerotic heart disease RUJUKAN
RUJUKAN
212 NIK : 3172061412440002
No. RM : 01-000696 BPJS : 0001259883663
SOETIANTO, TN (L) KLP PUAN TIMUR II NC 2 NO 11 M41.9 - Scoliosis, unspecified
08128054579 M47.8 - Other spondylosis
213
No. RM : 01-018953 NIK : 3172062212530006
FRANSISKA KURNIAWAN LIONG, NY (P) PULO MAS VIII RT 0012/11 KY PUTIH I10 - Essential (primary) hypertension AMLODIPIN 10 MG
JKTM R05 - Cough AMBROKSOL TAB 30 MG
RETRIBUSI KLINIK LANSIA
2019-09-09 13:37 Hal. 607 dari 1322

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SANTY SIMODIREDJO, NY (P) JL JANUR KUNING III WH /1 B00.8 - Other forms of herpesviral infection ASIKLOVIR KRIM 5%
No. RM : 01-000354 BPJS : 0001801704486
FAUZIA DRA. MS (P) JL. PLAMBOYAN BLOK A1/6 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK TAB 25 MG
216 NIK : - MCG
No. RM : 01-087799 BPJS : 0000041900488
PAULUS MINTARDJO, TN (L) GADING ARCADIA BLOK O 3 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
Tgl Lahir : 21-Nov-1947 ( 71 Thn 9 Bln 19 Hr ) R05 - Cough
217 NIK : 3271052111470001 AMOKSISILIN 500 MG Penyakit Dalam :- (0)
Telah Diberikan
Tgl Diagnosis : 20 February 2019 11:30 AM KLORFENIRAMIN MALEAT (CTM) TAB 4 PERTAMINA JAYA
MG Alamat : JL. AHMAD YANI NO. 2
PARASETAMOL TAB 500 MG BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
ROSITA RONIA MURNI, NY (P) JL KOMPLEK WALIKOTA E3 / 21 RT E78.5 - Hyperlipidaemia, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
09/06 H93.1 - Tinnitus SIMVASTATIN 10 MG (THT) THT-KL - (66) THT-KL - (0)
RUJUKAN
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
2019-09-09 13:37 Hal. 608 dari 1322

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Jadwal : Rabu : 08:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
TJHIN NAM KIN (L) JL JANUR ASRI I BLK QJ II NO.2 J40 - Bronchitis, not specified as acute or KOTRIMOKSAZOL DOEN I (DEWASA)
008/012 chronic (SULFAMETOKSAZOL 400 MG +
219
No. RM : 01-014612 NIK : 3172062201500003 SALBUTAMOL 2 MG
Tgl Diagnosis : 20 February 2019 11:40 AM BPJS : 0001312812156 AMLODIPIN 10 MG
SANDHY CAHYADI (L) APT GREN LAKE SUNTER TOWER 2 K35.8 - ACUTE APPENDICITIS, OTHER RUJUKAN
JL. DANAU SUNTER AND UNSPECIFIED
220
No. RM : 01-088073 NIK : 1771021009890014
LING SIOE TJOENG (P) APT GADING MEDITERANIA RESIDEN G40.9 - Epilepsy, unspecified AMLODIPIN 10 MG
UBIT CB/23 B/EG FRT 6/18 I10 - Essential (primary) hypertension KARBAMAZEPIN 200 MG
221
No. RM : 01-000426 NIK : 3173025510550006
ARIEF KOESTIADI KURNIAWAN, TN (L) JL PELEPAH RAYA TL 1/25 RT 010/001 I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 609 dari 1322

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KRISTINA GUNAWAN, NY (P) RT 010/01 KLP GADING TIMUR I11.9 - Hypertensive heart disease without RUJUKAN (0114R030) RS PERTAMINA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
TJOENG LIEN NJOEK, NY (P) JL GADING NAIS BARAT VI BLK D8/3 J33.9 - Nasal polyp, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
004/011 (THT) THT-KL - (66) THT-KL - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 13:00 - 16:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
DAVID LAY (L) JANUR HIJAU XI TQ 2/1 RT 003/015 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN (0903R012) RS KARTIKA
without complications PULOMAS
Telah Diberikan
2019-09-09 13:37 Hal. 610 dari 1322

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BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00
TACC : Tanpa TACC

Alasan TACC :
HERMAN EFENDI, TN (L) JL GAMBVYONG RT 009/007 I50.0 - Congestive heart failure RUJUKAN (0114R030) RS PERTAMINA
R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG JAYA
(JAN) JANTUNG DAN
226 NIK : 3172060706520002 RUJUKAN PEMBULUH DARAH
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
IRIANTI SRI SETYANINGSIH (P) JL PERINTIS KEMERDEKAAN 011/004 I10 - Essential (primary) hypertension PIROKSIKAM 10 MG
227 NIK : 3172066211570002 MCG
MUHAMMAD SALEH, TN (L) KOMP WALIKOTA BLOK A2/16 01/06 H40.9 - Glaucoma, unspecified AMLODIPIN 10 MG (0116R025) Rumah Sakit Firdaus
SUKAPURA I10 - Essential (primary) hypertension RUJUKAN (MAT) MATA - (65) Mata - (0)
2019-09-09 13:37 Hal. 611 dari 1322

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BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
HENDRA GUNAWAN,TN (L) JL. MANGGA GG II BLOK A/4 I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG
229 NIK : 3172030212490007
No. RM : 01-087791 BPJS : 0001621530562
KARTONO HUSAIN, TN (L) KLP NIAS VII PA 21/12 A RT 006/014 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN (0114R030) RS PERTAMINA
without complications JAYA
Tgl Lahir : 01-Jan-1952 ( 67 Thn 8 Bln 8 Hr ) I11.0 - Hypertensive heart disease with
230 NIK : 3172060101520001 Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 01-004910 BPJS : 0001450832815 (congestive) heart failure Faskes : (0114R030) RS
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
MASRIKI, NY (P) GASDING VI NO 8 RT 4/5 E11.9 - Non-insulin-dependent diabetes GLISERIL GUAIAKOLAT (GG) 100 MG
231 NIK : 3172065902500001 MG
Tgl Diagnosis : 21 February 2019 9:18 AM METFORMIN TAB 500 MG
MCG
2019-09-09 13:37 Hal. 612 dari 1322

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PRISKILA THEOPHILUS, NY (P) KELAPA HYBRIDA V RB XI/7 M10.9 - Gout, unspecified ALOPURINOL 100 MG
232 NIK : 3172064301530001 MCG
No. RM : 01-044963 BPJS : 0001223550562
JOE SIOE MOY (P) JANUR ELOK 5 QB / 11 M54.5 - Low back pain AMOKSISILIN 500 MG
No. RM : 01-000451 BPJS : 0001259957081
DASUKI (L) JL.P TEMIANG I NO.41 11/03 L23.9 - Allergic contact dermatitis, RUJUKAN (0114R030) RS PERTAMINA
unspecified cause JAYA
Tgl Lahir : 10-Oct-1940 ( 78 Thn 10 Bln 30 Hr ) L27.1 - Localized skin eruption due to drugs
234 NIK : 317206101040001 KULIT KELAMIN: - (0)
Telah Diberikan
No. RM : 01-001336 BPJS : 0000046004321 and medicaments Faskes : (0114R030) RS
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Kamis : 09:00 - 10:00,
14:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
RAMLAN SLAMET (L) ULTRA VIOLET B 4 NO 8 RT 2/10 M54.5 - Low back pain RUJUKAN (0903R012) RS KARTIKA
PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
2019-09-09 13:37 Hal. 613 dari 1322

P : 021-45853300 F : 021-45853301
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Jadwal : Kamis : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
HJ. RETNANINGSIH (P) JL. ULTRA VIOLET B4 NO. 8 Z00.0 - General medical examination

236 NIK : -
No. RM : 01-088150 BPJS : 0001225381858
HERMAN BUDIMAN (L) JL.MANDOR I NO.71.A D21.9 - Other benign neoplasm of RUJUKAN (0116R025) Rumah Sakit Firdaus
connective and other soft tissue, unspecified (THT) THT-KL - (66) THT-KL - (0)
Tgl Lahir : 14-Aug-1953 ( 66 Thn 0 Bln 26 Hr ) J30.4 - Allergic rhinitis, unspecified
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 13:00 - 16:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
SUNIARSIH, NY (P) JL SENTOSA I NNO 10 RT 9/10 L20.9 - Atopic dermatitis, unspecified RUJUKAN (0114R030) RS PERTAMINA
JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
2019-09-09 13:37 Hal. 614 dari 1322

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Jadwal : Kamis : 09:00 - 10:00,
14:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
SRI SURIANI (P) APT PALADIAN PARK TWR F 502 RT E10.9 - Insulin-dependent diabetes mellitus KAPTOPRIL 25 MG
04/020 without complications
239
No. RM : 01-013761 NIK : 3173064608360002
RENY MANORA SINAGA, NY (P) JL PRIHATIN NO 44 RT 7/2 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 10 MG (0114R030) RS PERTAMINA
M10.9 - Gout, unspecified SIMVASTATIN 10 MG JAYA
240 NIK : 3172065908480001 M51.9 - Intervertebral disc disorder, ALOPURINOL 100 MG Telah Diberikan :
No. RM : 01-040783 BPJS : 0000046162337 unspecified Faskes : (0114R030) RS
RUJUKAN
Tgl Diagnosis : 21 February 2019 10:16 AM ANTASIDA DOEN PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
LIE WITTY LESMANA (P) KELAPA PUAN TIMUR I N0.2/26 RT E10.9 - Insulin-dependent diabetes mellitus RUJUKAN
008/012 without complications RUJUKAN
241
No. RM : 01-033377 NIK : 3172065502550002
TIRTA SUBAKTI, tn (L) SITER BLOK F 2 RT 4/7 I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
JAYA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA
2019-09-09 13:37 Hal. 615 dari 1322

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BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
YAP ENG LAN (P) JL.ALANDA II N0 21 RT 013/08 SUNTER E05.8 - Other thyrotoxicosis RUJUKAN (0903R012) RS KARTIKA
JAYA JAKUT I10 - Essential (primary) hypertension AMLODIPIN 10 MG PULOMAS
243 L30.9 - Dermatitis, unspecified GENTAMISIN SALEP KULIT Penyakit
Telah Dalam :- (0)
Diberikan
ANTASIDA DOEN
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00
TACC : Tanpa TACC

Alasan TACC :
ABDUL RACHIM B, DJAFAR (L) JL. SENTOSA2 NO 15 RT 09 RW 010 I64 - Stroke, not specified as haemorrhage RUJUKAN (0114R030) RS PERTAMINA
KGB or infarction SIANOKOBALAMIN (VITAMIN B12) 50 JAYA
Tgl Lahir : 15-May-1945 ( 74 Thn 3 Bln 25 Hr ) R47.0 - Dysphasia and aphasia
244 MCG Telah Diberikan :
No. RM : 06-001120 NIK : 3172061505450002 TIAMIN (VITAMIN B1) 50 MG Faskes : (0114R030) RS
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
2019-09-09 13:37 Hal. 616 dari 1322

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Jadwal : Kamis : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
SIWALETTE JACOB MATHEUS (L) JL. P.PENYENGAT IV NO.33 J30.4 - Allergic rhinitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
M54.5 - Low back pain MG
Tgl Lahir : 19-Oct-1940 ( 78 Thn 10 Bln 21 Hr ) NATRIUM DIKLOFENAK TAB 25 MG
245 NIK : 3172061910400001
AMLODIPIN 10 MG
IR. NURMAN RUBINO M.SC, TN (L) JL.IMPOR BLOK A KOMP BBDB RT E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
00/010 mellitus without complications AMBROKSOL TAB 30 MG
No. RM : 01-002733 NIK : 3172060211420001 MCG
Tgl Diagnosis : 21 February 2019 10:58 AM BPJS : 0001430478437 METFORMIN TAB 500 MG
MCG
ONG TJOE ENG (P) JL. SUNTER HIJAU X BLOK K2/12 A H91.1 - Presbycusis RUJUKAN (0114R030) RS PERTAMINA
SIANOKOBALAMIN (VITAMIN B12) 50 JAYA
247 NIK : - MCG Telah Diberikan :
No. RM : 01-088164 BPJS : 0001425161406 RUJUKAN Faskes : (0114R030) RS
Tgl Diagnosis : 21 February 2019 11:04 AM RUJUKAN PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 617 dari 1322

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NINA WIDYANINGSIH (P) P SAMBU RAYA NO 15 RT 4/09 H25.8 - Other senile cataract RUJUKAN (0114R030) RS PERTAMINA
I10 - Essential (primary) hypertension AMLODIPIN 10 MG JAYA
(MAT) MATA - (65) Mata - (0)
248 NIK : 317206590353004 KAPTOPRIL 25 MG Telah Diberikan :
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
HERAWATI (P) KEBON KOSONG 3 RT. 010/001 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 10 MG
N39.0 - Urinary tract infection, site not KAPTOPRIL 12,5 MG
249 NIK : 3171035106570002 specified SIMVASTATIN 10 MG
MCG
PUDJIANTO PURNAMASIDI (L) JANUR KUNING III WI 2/8 RT. 009/015 I10 - Essential (primary) hypertension AMOKSISILIN 500 MG
No. RM : 01-000696 BPJS : 0001259883663 MG
MCG
LANI PRATIWI (P) RGTC JANUR KUNING I10 - Essential (primary) hypertension KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 01-Apr-1948 ( 71 Thn 5 Bln 8 Hr ) AMLODIPIN 10 MG
251 NIK : 0951064104480173
JEANNE WOROTIKAN (P) RGTC BLOK CENDANA NO. 219 A09 - Diarrhoea and gastroenteritis of RUJUKAN
presumed infectious origin
Tgl Lahir : 09-Sep-1934 ( 85 Thn 0 Bln 0 Hr ) F03 - Unspecified dementia
252 NIK : -
No. RM : 01-088174 BPJS : 0002252770187 J18.0 - Bronchopneumonia, unspecified
2019-09-09 13:37 Hal. 618 dari 1322

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BERTHES TERISNO (L) JL JANUR INDAH III LA 12/6 RT 002/018 H25.8 - Other senile cataract RUJUKAN (0114R030) RS PERTAMINA
H26.4 - After-cataract ANTASIDA DOEN JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
LIEM IWAN YUWANA, TN (L) APT FRENCH WALK TOWER PG / 29 B R05 - Cough AMBROKSOL TAB 30 MG
RT 11/19 PARASETAMOL TAB 500 MG
No. RM : 01-021435 NIK : 3172061602540003 MG
TJOEK SOEGIARTO,SE,MM.AK (L) PULAU SANBU BRAYA O 15 H52.2 - Astigmatism RUJUKAN (0114R030) RS PERTAMINA
H52.4 - Presbyopia JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 619 dari 1322

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RINI EKA ASTUTI (P) KELAPA GADING TIMUR 01/04 M54.27 - Cervicalgia, lumbosacral region NATRIUM DIKLOFENAK TAB 25 MG (0903R012) RS KARTIKA
SIANOKOBALAMIN (VITAMIN B12) 50 PULOMAS
256 NIK : 3172066206550002 MCG Telah Diberikan :
No. RM : 01-023883 BPJS : 0001383179365 RUJUKAN Faskes : (0903R012) RS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Kamis : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
DRS. JOHANES ARI SUSANTO, TN (L) JL KINTAMANI I NO 48 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
No. RM : 01-049169 BPJS : 0002262495846 MCG
LIANAWATI, NY (P) JL KINTAMANI I/48 I10 - Essential (primary) hypertension SIANOKOBALAMIN (VITAMIN B12) 50
MCG
Tgl Lahir : 07-Nov-1955 ( 63 Thn 10 Bln 2 Hr ) AMLODIPIN 10 MG
258 NIK : 3172064711550006
No. RM : 01-049140 BPJS : 0002262496206
SUNNY PUJISATIA (P) GD ELOK TIMUR VII BQ I/5 009/009 N81.9 - Female genital prolapse, unspecified RUJUKAN (0903R012) RS KARTIKA
RETRIBUSI KLINIK LANSIA PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Kamis : 07:00 - 16:00,
2019-09-09 13:37 Hal. 620 dari 1322

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12:00 - 14:00;18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
SANTI GUNAWAN, NY (P) VILLA GADING INDAH BLOK O 17 L20.9 - Atopic dermatitis, unspecified BEDAK SALISIL 2 %
KODAMAR KLORFENIRAMIN MALEAT (CTM) TAB 4
260 MG
No. RM : 01-027411 NIK : 3172064809560005
MARTHA HARTANTI, NY (P) JANUR KUNING III WH.1/23 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
mellitus without complications SIMVASTATIN 10 MG JAYA
Tgl Lahir : 15-Jul-1950 ( 69 Thn 1 Bln 25 Hr ) S52.9 - Fracture of forearm, part unspecified METFORMIN TAB 500 MG
261 NIK : 3172065507500002 Orthopedi - (0) :
Telah Diberikan
GLIBENKLAMIDA 5 MG
Tgl Diagnosis : 21 February 2019 12:20 PM RUJUKAN PERTAMINA JAYA
RUJUKAN
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Kamis : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
LIAUW MAN FA (P) PELEPAH HIJAU IV TN 1/1 E78.5 - Hyperlipidaemia, unspecified RUJUKAN (0114R030) RS PERTAMINA
H25.8 - Other senile cataract JAYA
(MAT) MATA - (65) Mata - (0)
262 NIK : - I10 - Essential (primary) hypertension Telah Diberikan :
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 13
Kapasitas : 0
2019-09-09 13:37 Hal. 621 dari 1322

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Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
PAINTEN, NY (P) JL.SENTOSA II N0 13 RT 09/10 KGB R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-071935 BPJS : 0000045999606 MG
MCG
EFFENDY UTAMA (L) GADING RIVER VEUW MANHATAN C18.7 - Malignant neoplasm of sigmoid RUJUKAN (0116R029) Rumah Sakit
B07/06 colon Hermina
(BED) Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 10:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
DR. LIWINA TASMAN (P) JL KLP CENGKIR TMR I EA I /12 I10 - Essential (primary) hypertension

265 NIK : 3172065603490004
No. RM : 01-004817 BPJS : 0000039030715
MUHAMMAD NANDIKA PUTRA (L) JK INFEKSI KALI SUNTER RT 08/04 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG

266 NIK : 3172062004131001
No. RM : 01-009508 BPJS : 0001793219692
2019-09-09 13:37 Hal. 622 dari 1322

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KHOUW HUI LING (P) JL MEMBERAMO 1NO 8 C80.9 - MALIGNANT NEOPLASM, RUJUKAN (0116R025) Rumah Sakit Firdaus
UNSPECIFIED (INT) PENYAKIT DALAM - (3)
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Kamis : 09:00 - 13:00,
13:30 - 16:30;18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
BOEN HON KWIE (L) KELAPA HYBRIDA VII RA.21/11 I64 - Stroke, not specified as haemorrhage RUJUKAN (0114R030) RS PERTAMINA
or infarction RUJUKAN JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
HIOE SIM JAN, NY (P) APT NIAS CRUISSANT 12/HL K30 - Dyspepsia AMLODIPIN 10 MG
269 NIK : 3172014507590002 RANITIDIN 150 MG
2019-09-09 13:37 Hal. 623 dari 1322

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FARIDHA (P) GADING GRIA LESTARI F1/11 K30 - Dyspepsia RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
Telah Diberikan
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 14
Kapasitas : 0
Jadwal : Kamis : 06:30 - 08:30,
16:00 - 18:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
LUCY (P) PELEPAH ASRI I QJ 2/14 RT 11/12 J00 - Acute nasopharyngitis [common cold] SIPROFLOKSASIN 500 MG
AMLODIPIN 10 MG
DUWARI (L) JL. PULAU PENYENGAT IV NO. 5 H61.2 - Impacted cerumen RUJUKAN (0114R030) RS PERTAMINA
RUJUKAN JAYA
RUJUKAN
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 10:00 - 11:00
TACC : Time
Alasan TACC : >= 3 - 7 Hari
2019-09-09 13:37 Hal. 624 dari 1322

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KOSASIH TENGGARA (L) KLP HIBRIDA V RB. XI NO, 7 E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 20 MG

273 NIK : -
No. RM : 01-040008 BPJS : 0001223550549
DJUMIYAH, NY (P) GADING RAYA I NO.3 001/005 B00.8 - Other forms of herpesviral infection PARASETAMOL TAB 500 MG
ASIKLOVIR KRIM 5%
Tgl Diagnosis : 22 February 2019 8:28 AM KAPTOPRIL 25 MG
TJHIN KUI DJUNG, NY (P) JL KELAPA NIAS 11 PE 4 NO 7 H35.9 - Retinal disorder, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
(MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
DELMIANA EMMY NAINGGOLAN, NY (P) JL GADING RAYA A 6/3 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 10 MG
SIMVASTATIN 10 MG
276 NIK : 3172065106540001
No. RM : 01-037589 BPJS : 0000046080437
PUSPA HIANTY GOENAWAN (P) JANUR HIJAU 12 TQ -1/8 RT004/015 L30.9 - Dermatitis, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
Tgl Lahir : 02-Mar-1948 ( 71 Thn 6 Bln 7 Hr ) HIDROKORTISON KRIM 2,5 %
277 NIK : 3172064203480001
No. RM : 01-002910 BPJS : 0001805956503
2019-09-09 13:37 Hal. 625 dari 1322

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THERESIA JULIA ISTUTI (P) JL.SENTOSA IV B.19/13 H10.3 - Acute conjunctivitis, unspecified KLORAMFENIKOL 1 % SM

278 NIK : 3172065011540003
No. RM : 01-048113 BPJS : 0002206481141
TAN (CHAN) FIE TJUNG, TN (L) KLP MOLEK V Z II / 17 RT 9/19 I10 - Essential (primary) hypertension AMLODIPIN 10 MG

279 NIK : 3172060506550001
No. RM : 01-020657 BPJS : 0001452284098
KASOEM (L) JL. SENTOSA 4 NO. 13 RT. 07/10 I10 - Essential (primary) hypertension RUJUKAN

280 NIK : 3172062508530002
No. RM : 01-001402 BPJS : 0001295502028
ANITA SUTANTI HENDRATA (P) TANAH ABANG GH 1/2 JAKARTA M51.9 - Intervertebral disc disorder, RUJUKAN (0114R030) RS PERTAMINA
PUSAT unspecified JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Jumat : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
JUWISAMSUDIN KURNIAWAN (L) JL JANUR ASRI V QK 11 K27.9 - Peptic ulcer, unspecified as acute or RUJUKAN (0116R025) Rumah Sakit Firdaus
chronic, without haemorrhage or perforation (INT) PENYAKIT DALAM - (3)
282 NIK : 3172061306560003 Penyakit
Telah Dalam :- (0)
Diberikan
KOMP.BEA CUKAI
2019-09-09 13:37 Hal. 626 dari 1322

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Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
16:00 - 18:00;17:00 - 20:30, 18:00
- 20:00
TACC : Tanpa TACC

Alasan TACC :
YUSAK ADRIAN ALFONZ RAHARJA, TN (L) JL KELAPA NIAS VI PB-13/12 Z03.0 - Observation for suspected KOTRIMOKSAZOL DOEN I (DEWASA)
tuberculosis (SULFAMETOKSAZOL 400 MG +
283 NIK : 3172021407870008
TJHIE SUNIARTI (P) JL. PAGUYUH KC 34 R05 - Cough KLORFENIRAMIN MALEAT (CTM) TAB 4
Z03.0 - Observation for suspected MG
Tgl Lahir : 12-Feb-1959 ( 60 Thn 6 Bln 28 Hr ) GLISERIL GUAIAKOLAT (GG) 100 MG
284 NIK : 3172065202590002 tuberculosis
No. RM : 01-058253 BPJS : 0001384054299
TASLIMIN, TN (L) KOMP BEA CUKAI F.5/11 09/07 R05 - Cough KLORFENIRAMIN MALEAT (CTM) TAB 4
MG
285 NIK : 3172040804500003
No. RM : 01-010091 BPJS : 0000046148624
PUTRI ROSKAMAWAR RUSTAM (P) KELAPA GADING R05 - Cough TOILET MATA / WOUND TOILET
KLORAMFENIKOL SALEP KULIT
2019-09-09 13:37 Hal. 627 dari 1322

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ESTHER SETIADI (P) JL PAKARENA BLOK S NO 9 RT 7/1 H25.8 - Other senile cataract AMOKSISILIN 500 MG (0116R029) Rumah Sakit
I10 - Essential (primary) hypertension GLISERIL GUAIAKOLAT (GG) 100 MG Hermina Podomoro
(MAT) MATA - (65) Mata - (0)
287 NIK : 3172065601550003 R05 - Cough KLORFENIRAMIN MALEAT (CTM) TAB 4 Telah Diberikan :
Tgl Diagnosis : 22 February 2019 9:37 AM RUJUKAN Sakit Hermina Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
SUMINTO (L) JL PADEANGAN RT 09/08 H81.3 - Other peripheral vertigo TIAMIN (VITAMIN B1) 50 MG
288 NIK : 3175061605520002
No. RM : 01-039586 BPJS : 0001317791722
MARION DALINA, NY (P) JL KALIBARU BARAT IV RT 01/06 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0905R003) RS PELABUHAN
mellitus without complications JAKARTA
(JAN) JANTUNG DAN
289 NIK : 3172045608500003 PEMBULUH
Telah DARAH
Diberikan : - (89)
No. RM : 01-016819 BPJS : 0001224649034 I51.7 - Cardiomegaly JANTUNG DAN PEMBULUH
Tgl Diagnosis : 22 February 2019 9:48 AM DARAH - (0) JAKARTA
PELABUHAN
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Jumat : 14:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 628 dari 1322

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JANTO MARDISO, TN (L) JL. RAYA KKLP GADING PERMAI BLKO J40 - Bronchitis, not specified as acute or KOTRIMOKSAZOL DOEN I (DEWASA)
AB NO 3 chronic (SULFAMETOKSAZOL 400 MG +
Tgl Lahir : 04-Feb-1967 ( 52 Thn 7 Bln 5 Hr ) TRIMETOPRIM 80 MG)
290
Tgl Diagnosis : 22 February 2019 9:52 AM BPJS : 0002142190383 TIAMIN (VITAMIN B1) 50 MG
PANCA AGUNG WIDODO (L) JL.NURI A.2/5 Z03.0 - Observation for suspected PARASETAMOL TAB 500 MG
291 NIK : 3172030802820010 MG
AINUN MARDIYAH (P) TNH MERAH 010/07 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. ANAK (FASE LANJUTAN)
292 NIK : 3172025311131005
No. RM : 01-004783 BPJS : 0001286542855
MUHAMAD IBNU FIRDAUS (L) TANAH MERAH RT 10/07 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
sputum microscopy with or without culture TIAMIN (VITAMIN B1) 50 MG
No. RM : 01-012640 BPJS : 0001223812168
NURHAYATI (P) WARUNG JENGKOL A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
No. RM : 01-083924 BPJS : 0001958678379 RETRIBUSI KLINIK PARU
HEDYWATI WIDJAJA MUDITA (P) JL KLPA SAWIT IV BLOK GG NO.12 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG (0116R029) Rumah Sakit
007/017 KGT mellitus without complications HIDROKORTISON KRIM 2,5 % Hermina
(MAT) Podomoro
MATA - (65) Mata - (0)
Tgl Lahir : 15-May-1947 ( 72 Thn 3 Bln 25 Hr ) H25.8 - Other senile cataract
295 KAPTOPRIL 25 MG Telah Diberikan :
No. RM : 01-006144 NIK : 3171015505470004 I10 - Essential (primary) hypertension Faskes : (0116R029) Rumah
RUJUKAN
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 4
2019-09-09 13:37 Hal. 629 dari 1322

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Kapasitas : 0
Jadwal : Jumat : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
DRS RUSTAM, TN (L) JL SUNTER II/24 RT 008/014 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
mellitus without complications RUJUKAN (KLT) KULIT KELAMIN - (110)
Tgl Lahir : 18-Feb-1937 ( 82 Thn 6 Bln 22 Hr ) L30.9 - Dermatitis, unspecified
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 12:00 - 16:00
TACC : Age
KHURIYAH (L) JL PEDAENGAN RT 9/8 I25.1 - Atherosclerotic heart disease RUJUKAN (0905R004) RS ISLAM JKT
I50.0 - Congestive heart failure SUKAPURA
(JAN) JANTUNG DAN
297 NIK : - PEMBULUH
Telah DARAH
Diberikan : - (89)
JKT - (0)
SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 630 dari 1322

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SUSANTO ARIFIN (L) SUNTER HIJAU VIII J4/12 H25.8 - Other senile cataract RUJUKAN (0116R029) Rumah Sakit
Hermina Podomoro
(MAT) MATA - (65) Mata - (0)
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Jumat : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
LILIEK UMIATI, NY (P) PULAU PENYENGAT IV N0 N25 RT E78.5 - Hyperlipidaemia, unspecified METFORMIN TAB 500 MG
003/003 I10 - Essential (primary) hypertension SIMVASTATIN 10 MG
299 AMLODIPIN 10 MG
No. RM : 01-036161 NIK : 3172064603520001
ZUL AMRAN USMAN (L) GADING V NO 4 RT 4/5 I25.1 - Atherosclerotic heart disease RUJUKAN (0114R030) RS PERTAMINA
RUJUKAN JAYA
(JAN) JANTUNG DAN
300 NIK : 3172061510450002 TIAMIN (VITAMIN B1) 50 MG PEMBULUH
Telah DARAH
Diberikan : - (89)
PERTAMINA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 631 dari 1322

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TRI WIJOKONGKO (L) JL PULAU BENGKALIS NO.16 010/03 I10 - Essential (primary) hypertension TIAMIN (VITAMIN B1) 50 MG
KGB R05 - Cough PIRIDOKSIN (VITAMIN B6) 10 MG
MG
ELYDIA NURKASIH, NY (P) KEALPA PUAN TIMUR I NC.2/22 E10.9 - Insulin-dependent diabetes mellitus RUJUKAN (0905R004) RS ISLAM JKT
without complications GLISERIL GUAIAKOLAT (GG) 100 MG SUKAPURA
Tgl Lahir : 05-Aug-1950 ( 69 Thn 1 Bln 4 Hr ) I11.0 - Hypertensive heart disease with
302 NIK : 3172064508500001 PARASETAMOL TAB 500 MG Penyakit Dalam :- (0)
Telah Diberikan
AMLODIPIN 10 MG Faskes : (0905R004) RS ISLAM
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 07:00 - 09:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
NATSIR SIMBOLON, TN (L) SUKAPURABLK. J.3 / 7 RT. 04/06 E11.9 - Non-insulin-dependent diabetes PARASETAMOL TAB 500 MG
CANG KENG TIANG (P) APT GADING NIAS TW ALAMANDA 10 M54.5 - Low back pain GLISERIL GUAIAKOLAT (GG) 100 MG
HM R05 - Cough NATRIUM DIKLOFENAK TAB 25 MG
No. RM : 01-049885 NIK : 1404046909560001 MG
2019-09-09 13:37 Hal. 632 dari 1322

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IKSAN TADIUSM, TN (L) JL SUMMANGUNG II KF 3 I10 - Essential (primary) hypertension RUJUKAN
RUJUKAN
305 NIK : 3172060202490001
No. RM : 01-011263 BPJS : 0001458486898
DJOSNITAWATI, NY (P) JL. APRT GADING SQUARE M41.06 - Infantile idiopathic scoliosis, RUJUKAN (0116R029) Rumah Sakit
MANHATEN NO.206 lumbar region Hermina
(BED) Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 08:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
TAN BENG HOCK (L) KELAPA KOPYOR V CI/NO 16 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0903R012) RS KARTIKA
Tgl Lahir : 27-Nov-1952 ( 66 Thn 9 Bln 13 Hr ) L03.9 - Cellulitis, unspecified
307 NIK : 3172062711520004 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Jumat : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 633 dari 1322

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L.BUDIARTI (P) JL KOMP WALIKOTA JL MURAI 1 BLOK K29.7 - Gastritis, unspecified ANTASIDA DOEN
G 3 NO21 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-088256 NIK : 3172044908520001 MG
SIMVASTATIN 10 MG
LIEM HOA GIOK (P) HIBRIDA 9 RA 24 NO 5 M13.95 - Arthritis, unspecified, pelvic and RUJUKAN (0113R034) MEDIROS
thigh RUJUKAN (SAR) SARAF - (76) Saraf - (0)
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Jumat : 09:00 - 13:00,
12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
SUHERMAN HAMDANI, TN (L) PONDOK GADING UTAMA BLK L/2 H52.4 - Presbyopia RUJUKAN (0116R029) Rumah Sakit
006/016 Hermina Podomoro
(MAT) MATA - (65) Mata - (0)
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Jumat : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 634 dari 1322

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NENNI (P) JL. ANGKLUNG C -24 H25.8 - Other senile cataract SIPROFLOKSASIN 500 MG (0113R034) MEDIROS
N39.0 - Urinary tract infection, site not RUJUKAN (MAT) MATA - (65) Mata - (0)
311 NIK : - specified RUJUKAN Telah Diberikan :
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Jumat : 09:30 - 13:00
TACC : Time
sugiyono (L) vila gading indah l/8 H25.8 - Other senile cataract RUJUKAN (0114R030) RS PERTAMINA
JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Jumat : 09:00 - 10:00
TACC : Tanpa TACC

Alasan TACC :
ALBERT GUNAWAN SISWAJA, TN (L) GADING MAS BRT V B8/01 RT 02/011 H40.9 - Glaucoma, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
PGSN II I10 - Essential (primary) hypertension KAPTOPRIL 25 MG (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
2019-09-09 13:37 Hal. 635 dari 1322

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Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Jumat : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
BERIMAN S (L) INFEKSI KALI SUNTER RT010/004 R05 - Cough GLISERIL GUAIAKOLAT (GG) 100 MG
FITOMENADION (VITAMIN K1) 10 MG
314 NIK : 3172060708500004
No. RM : 01-002525 BPJS : 0001602767147
RUSFANDI HUSEIN (L) JL JANUR HIJAU XI TR 1/12A RT 003/15 W57.8 - BITTEN OR STUNG BY DEKSAMETASON 0,5 MG
NONVENOMOUS INSECT AND OTHER PARASETAMOL TAB 500 MG
Tgl Lahir : 18-Feb-1945 ( 74 Thn 6 Bln 22 Hr ) NONVENOMOUS ARTHROPODS, OTHER
315 NIK : 3172061802450002
No. RM : 01-008101 BPJS : 000145540579 SPECIFIED AREA
UTIN SILOWATI (P) JANUR ASRI III OL 7 N0 6 M13.9 - Arthritis, unspecified RUJUKAN (0114R030) RS PERTAMINA
S72.9 - Fracture of femur, part unspecified JAYA
Telah - (0) :
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Jumat : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
THERESIA MARIA GERARD (P) KWINI RT009/01 SENEN JAKPUS I84.0 - Internal thrombosed haemorrhoids ANTIHEMOROID DOEN (0114R030) RS PERTAMINA
M54.5 - Low back pain GENTAMISIN SALEP KULIT JAYA
317 NIK : - RUJUKAN Orthopedi - (0) :
Telah Diberikan
RUJUKAN
2019-09-09 13:37 Hal. 636 dari 1322

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RUJUKAN Alamat : JL. AHMAD YANI NO. 2
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Jumat : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
LAY LIE TJENG, NY (P) APT GD.NIAS RESIDENCE CRUISSANT J40 - Bronchitis, not specified as acute or RUJUKAN (0114R030) RS PERTAMINA
4.6 chronic RUJUKAN JAYA
(PAR) PARU - (94) PARU - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
CANG KENG TIANG (P) APT GADING NIAS TW ALAMANDA 10 M41.9 - Scoliosis, unspecified RUJUKAN (0113R034) MEDIROS
HM M47.87 - Other spondylosis, lumbosacral GLISERIL GUAIAKOLAT (GG) 100 MG (SAR) SARAF - (76) Saraf - (0)
319 region NATRIUM DIKLOFENAK TAB 25 MG Telah Diberikan :
Tgl Diagnosis : 26 February 2019 2:17 PM BPJS : 0002378125372 Alamat : JALAN PERINTIS
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 09:00 - 13:00,
2019-09-09 13:37 Hal. 637 dari 1322

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12:30 - 15:00
TACC : Tanpa TACC

Alasan TACC :
HANA SUHARTANTO (P) JL RAYA JANUR ELOK PD 3/10 02/18 N18.5 - CHRONIC KIDNEY DISEASE, RUJUKAN (0903R012) RS KARTIKA
PGS II STAGE 5 RUJUKAN PULOMAS
320 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
10:00 - 12:00;11:00 - 14:00, 14:00
- 17:00;16:30 - 19:30
TACC : Tanpa TACC

Alasan TACC :
HENDI RUDI HARYONO K, TN (L) KLP NIAS VII BLOK PA 18 NO 10 H26.4 - After-cataract RUJUKAN (0113R074) RS KHUSUS MATA
SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 76
Kapasitas : 0
Jadwal : Selasa : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 16:00
- 20:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 638 dari 1322

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LENNY KRISLIANA DRA. (P) PELEPAH RAYA TS I /18 KLP GADING H40.9 - Glaucoma, unspecified AMLODIPIN 10 MG (0903R012) RS KARTIKA
TIMUR RUJUKAN PULOMAS
(MAT) MATA - (65) Mata - (0)
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
HARTOYO (L) JL LORONMG I/IV RT001/005 E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 10 MG
VITAMIN B KOMPLEKS
323 NIK : 3172032705520001
No. RM : 01-028612 BPJS : 0001258195634
MIKO ELIAS, TN (L) PELEPAH RAYA TM.1/24 H25.8 - Other senile cataract SIANOKOBALAMIN (VITAMIN B12) 50
R05 - Cough MCG
Tgl Lahir : 08-Apr-1953 ( 66 Thn 5 Bln 1 Hr ) GLISERIL GUAIAKOLAT (GG) 100 MG
324 NIK : 3172060804530003
LISTAFORIN LAY BUN TJOE, NY (P) KELAPA CENGKIR ARAT IX FQ 2/9 RT H25.9 - Senile cataract, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
1/13 (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
2019-09-09 13:37 Hal. 639 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
ISKANDAR (L) JL. GADING ELOK TMR 5BO1/19 K40.9 - Unilateral or unspecified inguinal RUJUKAN (0903R012) RS KARTIKA
hernia, without obstruction or gangrene PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
ENDANG PENI PRATIWI (P) JL. GADING ELOK TMR 5 BO1/19 D17.9 - Benign lipomatous neoplasm, RUJUKAN (0903R012) RS KARTIKA
unspecified RUJUKAN PULOMAS
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 18:00 - 20:00
TACC : Age
2019-09-09 13:37 Hal. 640 dari 1322

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SURMI, NY (P) HARAPAN III NO. 3 RT. 003/001 KGB J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-001564 BPJS : 0000046018787
SINARTA WIDJAYA (L) JL. JANUR KUNING 6WK 1/20 H25.9 - Senile cataract, unspecified VITAMIN B KOMPLEKS (0113R074) RS KHUSUS MATA
AMLODIPIN 10 MG SMEC
(MAT) MATA - (65) Mata - (0)
329 NIK : - RUJUKAN Telah Diberikan :
Tgl Diagnosis : 27 February 2019 9:08 AM MG KHUSUS MATA SMEC
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 35
Kapasitas : 0
Jadwal : Rabu : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 15:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

GOUW GIOK LAN (P) JL MUSIK RAYA BLOK L/4 RT 006/008 E11.8 - Non-insulin-dependent diabetes RUJUKAN (0905R004) RS ISLAM JKT
mellitus with unspecified complications SUKAPURA
Tgl Lahir : 24-May-1953 ( 66 Thn 3 Bln 16 Hr ) E78.9 - Disorder of lipoprotein metabolism,
Telah Diberikan
No. RM : 01-006199 BPJS : 0001431378123 unspecified Faskes : (0905R004) RS ISLAM
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 07:00 - 09:00,
08:00 - 11:00;14:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 641 dari 1322

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WAGINI (P) JL MUSIK RAYA NO.23 001/003 M19.90 - Arthrosis, unspecified, multiple RUJUKAN (0116R025) Rumah Sakit Firdaus
sites (ORT) ORTHOPEDI - (93)
331 NIK : 3521125406490001 Orthopedi - (0) :
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
IDA YUNANINGSIH (P) JL.GADING MAS TIMUR III I/16 12/10 H40.9 - Glaucoma, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
I10 - Essential (primary) hypertension (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
R.SUPRAPTI, NY (P) JL.TEGUH I NO.143 I11.0 - Hypertensive heart disease with RUJUKAN (0114R030) RS PERTAMINA
(congestive) heart failure VITAMIN B KOMPLEKS JAYA
(JAN) JANTUNG DAN
333 NIK : 3172065506441001 PARASETAMOL TAB 500 MG PEMBULUH DARAH
Faskes DAN PEMBULUH
: (0114R030) RS
RUJUKAN
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
2019-09-09 13:37 Hal. 642 dari 1322

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Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
DAUDI RACHMAT MTH (L) JL. HIBRIDA 1 RB 2/3 I49.9 - Cardiac arrhythmia, unspecified RUJUKAN

334 NIK : 3273130405460002
No. RM : 01-037075 BPJS : 0001818045303
NILAWATI (P) PGS2 RT06/10 C50.9 - Malignant neoplasm of breast, RUJUKAN
unspecified AMLODIPIN 10 MG
335 NIK : 3172064510480001
No. RM : 01-010188 BPJS : 0001430479135
MEILARD SAMAD POIRE (L) JL SWASEMBADA BARAT 1/9 RT 18/9 E11.9 - Non-insulin-dependent diabetes GLIBENKLAMIDA 5 MG
Tgl Lahir : 29-Jan-1951 ( 68 Thn 7 Bln 11 Hr ) E78.5 - Hyperlipidaemia, unspecified
No. RM : 01-060751 BPJS : 0000026112846 MG
AMIRUL MU'MININ, TN (L) GANG AHMAD RT 15/03 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
VITAMIN B KOMPLEKS
337 NIK : 3175080110530004
No. RM : 01-005196 BPJS : 0001311490822
HOT TSIU YING (P) JL GADING MASTIMUR,PEGANGSAAN I11.9 - Hypertensive heart disease without GLISERIL GUAIAKOLAT (GG) 100 MG
(congestive) heart failure ANTASIDA DOEN
No. RM : 01-073959 BPJS : 0001226057501
2019-09-09 13:37 Hal. 643 dari 1322

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ANDRIAN THEO KARMAN, TN (L) J; KLP MOLEK 1 BLOK B 4/16 H25.9 - Senile cataract, unspecified (0113R074) RS KHUSUS MATA
SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 41
Kapasitas : 0
Jadwal : Rabu : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 15:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

ESLY SINAGA, NY (P) SUKAPURA 01/10 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
No. RM : 01-040987 BPJS : 0001290356504
HJ.TJAHYA CHAERANI MUIN, NY (P) PEGANGSAAN INDAH BARATIII H./28 K29.5 - Chronic gastritis, unspecified OMEPRAZOL KAPS 20 MG
ANTASIDA DOEN
No. RM : 01-049533 BPJS : 0001422561014
WIJAYA RAIS LAY (L) GADING NIRWANA BLOK PF 2/9 RT H25.8 - Other senile cataract GLISERIL GUAIAKOLAT (GG) 100 MG
08/23 J06.9 - Acute upper respiratory infection, ASAM ASKORBAT (VITAMIN C) 50 MG
342 unspecified
No. RM : 01-016684 NIK : 3172060610500001
YUNIWATI, NY (P) JL. GADING KIRANA I BLK A. 12/9 E11.9 - Non-insulin-dependent diabetes KLORFENIRAMIN MALEAT (CTM) TAB 4
mellitus without complications MG
Tgl Lahir : 05-Jan-1956 ( 63 Thn 8 Bln 4 Hr ) L28.0 - Lichen simplex chronicus HIDROKORTISON KRIM 2,5 %
343 NIK : 3172034501560003
No. RM : 01-088716 BPJS : 0002332792517
2019-09-09 13:37 Hal. 644 dari 1322

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NURYADI, TN (L) JL KLP MOLEK VII R1 NO 20 E79.0 - Hyperuricaemia without signs of ANTASIDA DOEN
inflammatory arthritis and tophaceous OMEPRAZOL KAPS 20 MG
Tgl Lahir : 13-Feb-1950 ( 69 Thn 6 Bln 27 Hr ) disease
No. RM : 01-028662 BPJS : 0001439451461 I11.9 - Hypertensive heart disease without
AMLODIPIN 10 MG
RUTHY AZARJA, NY (P) JL KACANG POLONG III NO 14 RT E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
No. RM : 01-012008 NIK : 3173015107540003 SIMVASTATIN 10 MG
ABDUL LATIF, TN (L) JL JANUR ASRI II BLK QK 4 NO 11 I50.0 - Congestive heart failure
J90 - Pleural effusion, not elsewhere
346 NIK : - classified
No. RM : 01-088719 BPJS : 0001431682716
MARGARETHA SERUNIWATI (P) KOMP BEA CUKAI BLOK I 7/6 RT 4/7 H40.9 - Glaucoma, unspecified AMLODIPIN 10 MG
347 NIK : 3172045110510001 MG
No. RM : 01-041697 BPJS : 0001603113399
RUDY KARTAWINATA (L) TAMAN HOLIS INDAH RT 002/14 ( APT I11.9 - Hypertensive heart disease without AMLODIPIN 10 MG
GADING NIAS LT 2 BLOK E/2SB (congestive) heart failure DEKSAMETASON 0,5 MG
Tgl Lahir : 29-Jan-1947 ( 72 Thn 7 Bln 11 Hr ) M13.17 - Monoarthritis, not elsewhere
No. RM : 01-015961 NIK : 3273151901470001 classified, ankle and foot
SETYOE, TN (L) JL. GADING KIRANA I BLK A 12/9 K30 - Dyspepsia VITAMIN B KOMPLEKS
N40 - Hyperplasia of prostate PARASETAMOL TAB 500 MG
No. RM : 01-088717 BPJS : 0002332792506
DRS RUSTAM, TN (L) JL SUNTER II/24 RT 008/014 N18.1 - CHRONIC KIDNEY DISEASE, RUJUKAN (0116R025) Rumah Sakit Firdaus
STAGE 1 VITAMIN B KOMPLEKS (INT) PENYAKIT DALAM - (3)
350 NIK : 3172031802370001 Penyakit
Telah Dalam :- (0)
Diberikan
2019-09-09 13:37 Hal. 645 dari 1322

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KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
18:00 - 21:00;18:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
LO INGE, NY (P) KELAPA CENGKIR BARAT I NO.14 H25.8 - Other senile cataract RUJUKAN
M79.7 - FIBROMYALGIA VITAMIN B KOMPLEKS
SHANTY INDRIANTI (P) APT. GADING NIAS ALAMANDA DU/17 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
352 NIK : 3172045511460001
No. RM : 01-013866 BPJS : 0001273980115
AZIZAH (P) TEGUH III NO, 46-47 RT. 006/01 KGB I25.0 - Atherosclerotic cardiovascular RUJUKAN (0114R030) RS PERTAMINA
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0114R030) RS
PERTAMINA- (0) JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 14
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 646 dari 1322

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THONG SENG IE (L) J KLPA CENGKIR TIMUR III BLK EJ II H81.1 - Benign paroxysmal vertigo GLISERIL GUAIAKOLAT (GG) 100 MG (0116R025) Rumah Sakit Firdaus
NO.17 I25.0 - Atherosclerotic cardiovascular RUJUKAN (SAR) SARAF - (76) Saraf - (0)
354 disease, so described Telah Diberikan :
No. RM : 01-036101 NIK : 3171041510560003 J06.9 - Acute upper respiratory infection, Faskes : (0116R025) Rumah
Tgl Diagnosis : 27 February 2019 2:44 PM BPJS : 0001723430013 unspecified Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 17:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
dr. Prayudi Andriyana
KENDY SUSANTO, TN (L) JL. VILLA GADING INDAH C 12 B20.3 - HIV disease resulting in other viral DUVIRAL (ZDV+3TC)
infections NEVIRAPINE (NVP)200mg
1 NIK : 3172061304810007
No. RM : 01-032343 BPJS : 0001870313455
LINA KHOLINA, NY (P) PEGANGSAAN DUA 002/001 B20.1 - HIV disease resulting in other RUJUKAN (0905R001) RS KOJA
bacterial infections (HIV) HIV-ODHA
No. RM : 01-004358 BPJS : 0001827834399 Faskes : (0905R001) RS KOJA
Tgl Diagnosis : 04 February 2019 8:41 AM Alamat : JALAN DELI NO.4,
RT.11/RW.7, K
Telp : 021-43938478
Kelas : B
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal :
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 647 dari 1322

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ADITYA KOESBUDI (L) KOMPLEK WALIKOTA SUKAPURA JL G50.1 - Atypical facial pain NATRIUM DIKLOFENAK 50 MG
ELANG BLOK A3 NO 10 AMLODIPIN 5 MG
3
No. RM : 01-007147 NIK : 3172041004820003
LAILATUL MUFAROCHA (P) JL. TARIAN TIMUR J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
AMOKSISILIN 500 MG
No. RM : 01-086495 BPJS : 0001478220603 MG
Tgl Diagnosis : 04 February 2019 8:53 AM MULTIVITAMIN DEWASA
MUSTARI, TN (L) JL PUSKESMAS GG SASANA KRIDA H26.9 - Cataract, unspecified RUJUKAN (0113R074) RS KHUSUS MATA
RT 05/06 I10 - Essential (primary) hypertension AMLODIPIN 5 MG SMEC
(MAT) MATA - (65) Mata - (0)
5 Telah Diberikan :
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 38
Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
DONY SUSANTO (L) JL TALEMPONG BLK J NO.15 004/007 J00 - Acute nasopharyngitis [common cold] AMOKSISILIN 500 MG
SETIRIZIN 10MG
SUBROTO, TN (L) ASRAMA POLRI RT 01/07 A01.0 - Typhoid fever PARASETAMOL TAB 500 MG
No. RM : 01-007950 BPJS : 0001093360252
2019-09-09 13:37 Hal. 648 dari 1322

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WIYATNO, TN (L) KOMPLEK LANUD ISKANDAR H11.0 - Pterygium RUJUKAN (0114R030) RS PERTAMINA
JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SUTIARNI (P) JL PERINTIS KEMERDEKAAN NO 35 N94.6 - Dysmenorrhoea, unspecified ASAM MEFENAMAT KAPS 500

9 NIK : -
No. RM : 01-086498 BPJS : 0001797372101
DHIA SYARA FANA, AN (P) JL H OYAR RT 02/02 NO 38 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
10 NIK : 3172066702111101
No. RM : 01-037736 BPJS : 0001225679679
ERNI SULISTYOWATI (P) JL P NANGKA BARAT II RT 02/016 NO R50.9 - Fever, unspecified PIRIDOKSIN (VITAMIN B6) 10 MG
49 OMEPRAZOL KAPS 20 MG
11 ANTASIDA DOEN
No. RM : 01-053754 NIK : 3175026510760004
THERESIA DWI ASTUTIK (P) JL PALMERIAM II 016/008 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 649 dari 1322

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DONI AFIDIN, TN (L) PGS II RT 01/? H65.0 - Acute serous otitis media KLORAMFENIKOL TT 3%
J00 - Acute nasopharyngitis [common cold] ASAM MEFENAMAT KAPS 500
No. RM : 01-067799 BPJS : 0001651522375 MG
Tgl Diagnosis : 04 February 2019 9:29 AM OMEPRAZOL KAPS 20 MG
SUPRIYANTO (L) CILINCING RT 001/010 JAKARTA L08.0 - Pyoderma GENTAMISIN SALEP KULIT
UTARA AMOKSISILIN 500 MG
No. RM : 01-076297 NIK : -
YUNI YANTI (P) KP WR JENGKLOL RT 4/13 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
15 NIK : 3172064101880005 MG
LINDA ANITA SENGKEY (P) RGTC BLOK ANGSANA NO.301 A15.3 - Tuberculosis of lung, confirmed by RUJUKAN (0116R025) Rumah Sakit Firdaus
unspecified means (PAR) PARU - (94) PARU - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
SOLIKIN (L) JL PULAU BATU NO 37 H25.8 - Other senile cataract

17 NIK : 3571011207740009
No. RM : 01-080440 BPJS : 0002437107761
2019-09-09 13:37 Hal. 650 dari 1322

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KORI MAULANA, NY (P) JL TNH MERAH 003/007 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
LIEM LIAN ING (P) KELAPA HIBRIDA V BLOK RB 10/6 H81.4 - Vertigo of central origin RUJUKAN (0116R025) Rumah Sakit Firdaus
I63.4 - Cerebral infarction due to embolism RUJUKAN (SAR) SARAF - (76) Saraf - (0)
19 NIK : 32750341025640020 of cerebral arteries Telah Diberikan :
No. RM : 01-007354 BPJS : 0001256054679 I63.9 - Cerebral infarction, unspecified Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 17:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
GERTRUIDA NELWAN, NY (L) JL H KAMANG NO 34 RT 007/010 I15.9 - Secondary hypertension, unspecified KAPTOPRIL 25 MG
No. RM : 01-003065 BPJS : 0002519401353
LIEM LIAN ING (P) KELAPA HIBRIDA V BLOK RB 10/6 H81.4 - Vertigo of central origin RUJUKAN (0116R025) Rumah Sakit Firdaus
I63.4 - Cerebral infarction due to embolism RUJUKAN (SAR) SARAF - (76) Saraf - (0)
21 NIK : 32750341025640020 of cerebral arteries Telah Diberikan :
No. RM : 01-007354 BPJS : 0001256054679 I63.9 - Cerebral infarction, unspecified Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 17:00 - 21:00
2019-09-09 13:37 Hal. 651 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
LIEM MARTHA DEVI (P) HIBRIDA V RB10 NO 6 G40.9 - Epilepsy, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 17:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
AZRIL RAFISQY ARFADHIA, AN (L) JL. RAWA SENGON BLOM E/22 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 04-Dec-2017 ( 1 Thn 9 Bln 5 Hr ) KLORFENIRAMIN MALEAT (CTM) TAB 4
23 NIK : -
No. RM : 01-076100 BPJS : 0002355491981 MG
ATHARIQ RAZANAL BAYAN BANGKIT JL TARI LILIN H26 RT 010 RW 008 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 06-Aug-2017 ( 2 Thn 1 Bln 3 Hr ) GLISERIL GUAIAKOLAT (GG) 100 MG
24 NIK : 3172060710131001
No. RM : 01-054101 BPJS : 0002273258485
GUSJONO LILIGANDA PRIATNA (L) GD GRIYA LESTARI B5/14 S92.90 - Fracture of foot, unspecified,
closed
25 NIK : 3172040511620002
No. RM : 01-015227 BPJS : 0001798514864
2019-09-09 13:37 Hal. 652 dari 1322

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E SRI KURNIATI (P) JL. TEGUH II RT 05/01 H60.2 - Malignant otitis externa RUJUKAN (0905R003) RS PELABUHAN
RUJUKAN JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 13:00 - 16:00,
16:00 - 18:00
TACC : Tanpa TACC

Alasan TACC :
WILLIE GANDAPRIATNA (L) JL GADING GRIYA LESTARI B5 NO 14 S62.20 - Fracture of first metacarpal bone , RUJUKAN
closed
27 NIK : -
No. RM : 01-072043 BPJS : 0001798517338
TUYEM (P) JANUR ASRI 3 QL 66/22 G44.8 - Other specified headache ASAM MEFENAMAT KAPS 500
syndromes SIANOKOBALAMIN (VITAMIN B12) 50
Tgl Lahir : 28-Nov-1974 ( 44 Thn 9 Bln 12 Hr ) K02.9 - Dental caries, unspecified
28 NIK : - MCG
FAJAR AGUSTIAN (L) JL. H OYAR RT N39.0 - Urinary tract infection, site not ASAM MEFENAMAT KAPS 500
specified MULTIVITAMIN DEWASA
29 NIK : 3207191308930003
No. RM : 01-040767 BPJS : 0000438477658
MAWI BIN MARTA, TN (L) RW INDAH G44.2 - Tension-type headache ASAM MEFENAMAT KAPS 500
M79.1 - Myalgia PIRIDOKSIN (VITAMIN B6) 10 MG
30 NIK : 3172061802800002
No. RM : 01-074306 BPJS : 0001224449627
2019-09-09 13:37 Hal. 653 dari 1322

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HONANTO (L) GD GRIYA LESTARI BLOK D1 NO 55 H65.0 - Acute serous otitis media KLORAMFENIKOL TT 3%
AMOKSISILIN 500 MG
No. RM : 01-058452 BPJS : 0001469878536
TAUFIQUR ROHMAN TAUFAN (L) KP PULO GADUNG NO 17 RT 02/05 H65.2 - Chronic serous otitis media ASAM MEFENAMAT KAPS 500

32 NIK : -
No. RM : 01-042784 BPJS : 0000041817633
RISMAWATI (P) JL. BANGUN CIPTA SARAN NO. 135 J00 - Acute nasopharyngitis [common cold] AMOKSISILIN 500 MG
GG. L PARASETAMOL TAB 500 MG
33 ANTASIDA DOEN
No. RM : 01-085976 NIK : -
ASYIFA LUTFIANA PRATAMA (P) T MERAH ATAS RT 8/11 H52.1 - Myopia (0905R004) RS ISLAM JKT
SUKAPURA
(MAT) MATA - (65) Mata - (0)
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Senin : 16:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
JOHANES SOENARDY (L) ANCOL SELATAN N0.21 01/01 B20.3 - HIV disease resulting in other viral RETRIBUSI KLINIK FELASE / IMS
infections TENOVOFIR (TDF)
35 NIK : 3172051301450001 LAMIVUDINE (3TC) 150MG
No. RM : 01-003863 BPJS : 0001294119854 NEVIRAPINE (NVP)200mg
2019-09-09 13:37 Hal. 654 dari 1322

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ANITA HENDAYANI (P) RAWA INDAH RT 04/03 NO 55 D17.7 - Benign lipomatous neoplasm of RUJUKAN
other sites
36 NIK : 317206610387004
No. RM : 01-015731 BPJS : 0000377140162
JOCHEBED MELODY SIHOTANG (P) TANAH MERAH 022/07 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
GUMILANG CHANDRA RINI, NY (P) KLP KOPYORV CJ2/4 H66.0 - Acute suppurative otitis media

38 NIK : 3172064811690002
No. RM : 01-061635 BPJS : 0001381926407
K.RETNO KUSTRIAH (P) JL. PULAU TEMIANG I N80.9 - Endometriosis, unspecified (0114R030) RS PERTAMINA
JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 11:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
JASPER E SIHOTANG (L) JL RAWA SENGON BLK G NO.34 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
40 MG
2019-09-09 13:37 Hal. 655 dari 1322

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SYURMI ALFISAH, NY (P) JL SUKA MULIA VI NO 24 RT 014 RW H26.9 - Cataract, unspecified RUJUKAN
001
41
No. RM : 01-086526 NIK : 3171035911680007
NASSA NWIDIRA TICANNY,AN (P) TANAH MERAH ATAS JL DUKU RT J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
06/08 J03.9 - Acute tonsillitis, unspecified PARASETAMOL TAB 500 MG
42 SETIRIZIN 10MG
MOH, BOHARI (L) TANAH MERAH J00 - Acute nasopharyngitis [common cold] NATRIUM DIKLOFENAK 50 MG
M79.1 - Myalgia AMBROKSOL TAB 30 MG
No. RM : 01-086528 BPJS : 0001794982779 MG
SUPRIYADI, TN (L) JL ISNPEKSI KALI SUNTER RT 09/04 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
44 NIK : 317206020967003 MG
RINI SURYANI (P) TELUK RATAI V NO.1 010/010 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
45 NIK : 3175076005670012 MG
AHMAD CAHYO PRAYOGA (L) PGS2 RT007/03 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
46 NIK : - MG
NASWA AINUN NISA (L) RT 03/13 PEGANGSAAN DUA J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
No. RM : 05-001498 BPJS : 0001225838046 AMOKSISILIN SYR KERING 125 MG/5ML
2019-09-09 13:37 Hal. 656 dari 1322

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MEYSHA AMELIA AHMAD (P) rt.06/05 pegangsaan dua J06.9 - Acute upper respiratory infection, AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 05-000227 BPJS : 0002738237973 MG
RISKA (P) JL H OYAR RT 03/02 N60.2 - Fibroadenosis of breast

49 NIK : -
No. RM : 01-046912 BPJS : 0000378360674
MUHAMMAD MARYADI NUR, TN (L) JL. MELATI J00 - Acute nasopharyngitis [common cold] ANTASIDA DOEN
MULTIVITAMIN DEWASA
No. RM : 01-086453 BPJS : 0001725486366
ALMA HAWA APRILIONA (P) JL PERINTIS I RT 01/04 J15.9 - Bacterial pneumonia, unspecified AMOKSISILIN SYR KERING 125 MG/5ML
AMBROKSOL TAB 30 MG
No. RM : 01-053593 BPJS : 0002332758846 MG
SUBIYONO, TN (L) DUSUN I 005/002 N18.5 - CHRONIC KIDNEY DISEASE, (0905R001) RS KOJA
STAGE 5 (HDL) HEMODIALISA
No. RM : 01-004718 BPJS : 0001125290182 Faskes : (0905R001) RS KOJA
Tgl Diagnosis : 04 February 2019 11:38 AM Alamat : JALAN DELI NO.4,
RT.11/RW.7, K
Telp : 021-43938478
Kelas : B
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal :
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 657 dari 1322

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KAYSAH YARA FAJRIHAN, AN (P) JL MURAI I BLOK B 3 NO 18 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
53 NIK : 3172046310141007 MG
No. RM : 01-086533 BPJS : 0001767761662 AMOKSISILIN KAPS 250 MG
ZIDAN RADITYA PUTRA (L) JL DAHLIA 1 NO 15 KOMP BERMIS J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
54 NIK : - MG
No. RM : 01-040685 BPJS : 0002332916752
NANCY RUNTU (P) JL TAMAN PGS INDAH BLOK F A NO 21 H52.1 - Myopia RUJUKAN

55 NIK : 3172064801870001
No. RM : 01-050972 BPJS : 0001632439664
AGUNG WIBOWO (L) JL TEGUH IX NO 11 RT 09/01 B37.2 - Candidiasis of skin and nail METRONIDAZOL 500 MG
L30.9 - Dermatitis, unspecified NATRIUM DIKLOFENAK 50 MG
Tgl Diagnosis : 04 February 2019 11:53 AM SETIRIZIN 10MG
NAZWA ADZRA NAFISA, AN (P) JL RAWA SENGON BLOK B RT 02/22 J00 - Acute nasopharyngitis [common cold] AMOKSISILIN 500 MG
089501786615 K30 - Dyspepsia PARASETAMOL TAB 500 MG
57 L08.8 - Other specified local infections of GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-028608 NIK : 3171035112040001 skin and subcutaneous tissue ANTASIDA DOEN
PARTINI SADIIN, NY (P) JL MATRAMAN SALEMBA V/10 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
M79.1 - Myalgia MULTIVITAMIN DEWASA
58 NIK : 1802075401780003
No. RM : 01-079250 BPJS : 0001145065926
NAZWA ADZRA NAFISA, AN (P) JL RAWA SENGON BLOK B RT 02/22 J00 - Acute nasopharyngitis [common cold] AMOKSISILIN 500 MG
089501786615 K30 - Dyspepsia PARASETAMOL TAB 500 MG
59 L08.8 - Other specified local infections of GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-028608 NIK : 3171035112040001 skin and subcutaneous tissue ANTASIDA DOEN
2019-09-09 13:37 Hal. 658 dari 1322

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M ADRIAN (L) JL DANAU INDAH BLK AII NO.8 005/013 B37.2 - Candidiasis of skin and nail MIKONAZOL KRIM 2 % (0903R014) RSI JIWA KLENDER
F20.9 - Schizophrenia, unspecified (JIW) JIWA - (111) JIWA - (0)
No. RM : 01-012566 BPJS : 0001170584605 Faskes : (0903R014) RSI JIWA
Tgl Diagnosis : 04 February 2019 12:04 PM KLENDER
Alamat : JL. BUNGA RAMPAI X
PERUMNAS K
Telp : 021-8622491
Kelas : C
Jumlah Rujukan : 19
Kapasitas : 0
Jadwal : Senin : 07:00 - 14:00,
10:00 - 16:00;15:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
ALDILAH NIKEN RIYANI, AN (P) KODAMAR 3 TEGUH VI /55 RT 07/01 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
61 NIK : 3172064905020004 MG
M ADRIAN (L) JL DANAU INDAH BLK AII NO.8 005/013 B37.2 - Candidiasis of skin and nail MIKONAZOL KRIM 2 % (0903R014) RSI JIWA KLENDER
F20.9 - Schizophrenia, unspecified (JIW) JIWA - (111) JIWA - (0)
No. RM : 01-012566 BPJS : 0001170584605 Faskes : (0903R014) RSI JIWA
Tgl Diagnosis : 04 February 2019 12:04 PM KLENDER
Alamat : JL. BUNGA RAMPAI X
PERUMNAS K
Telp : 021-8622491
Kelas : C
Jumlah Rujukan : 19
Kapasitas : 0
2019-09-09 13:37 Hal. 659 dari 1322

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Jadwal : Senin : 07:00 - 14:00,
10:00 - 16:00;15:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
RASDI, TN (L) RAWA INDAH RT 03/03 B05.9 - Measles without complication PARASETAMOL TAB 500 MG
ASIKLOVIR 400 MG
63 NIK : 3172061706780005
No. RM : 01-069144 BPJS : 0000378946563
DWI SARTIKA WAHYUNINGSIH, NY (P) PULO NANGKA J00 - Acute nasopharyngitis [common cold] GLISERIL GUAIAKOLAT (GG) 100 MG
64 NIK : 3306087112800010 MG
FITRIANA (P) RAWA INDAH 06/10 L08.9 - Local infection of skin and ANTASIDA DOEN
subcutaneous tissue, unspecified OMEPRAZOL KAPS 20 MG
65 NIK : 1801134202950009 SETIRIZIN 10MG
DJOKO SUGIRI, TN (L) JL TEGUH VI NO 55 RT 007/001 KGB J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
66 NIK : 3172061312700001 MG
FAUZI RACHMAN (L) APT GADING MEDITERANIA LT 19 APR J00 - Acute nasopharyngitis [common cold] DEKSAMETASON 0,5 MG
67 NIK : -
No. RM : 01-050732 BPJS : 0002143407093
ADY, TN (L) RAWA INDAH RT 02/03 J18.0 - Bronchopneumonia, unspecified (0114R030) RS PERTAMINA
JAYA
(PAR) PARU - (94) PARU - (0)
2019-09-09 13:37 Hal. 660 dari 1322

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BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
NUR HALISAH FITRIANI (P) RAWA INDAH 03/03 J00 - Acute nasopharyngitis [common cold] ANTASIDA DOEN
R11 - Nausea and vomiting PARASETAMOL TAB 500 MG
69 NIK : 3172065411040001
No. RM : 01-017591 BPJS : 0001843038999
DEVY YULIANTI (P) SEUDATI V 18 NO 4 K59.9 - Functional intestinal disorder,
unspecified
70 NIK : 3172064807810002
No. RM : 01-071761 BPJS : 0001808676494
TIURMA S. SIHOMBING, NY (P) JL. KEBON BAWANG VI/35 RT 004/006 B37.3 - Candidiasis of vulva and vagina NISTATIN TAB VAGINAL 100.000 UI/TAB
I15.8 - Other secondary hypertension SETIRIZIN 10MG
No. RM : 01-001515 BPJS : 0001225966735 MCG
RUTH ANGELA C.R, NN (P) JL.KB BAWANG VI/.35 04/06 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
72 NIK : 3172025103990009 MG
MIKHAYLA ALMEERA NUGROHO, AN (P) KOMP WALIKOTA, JL GELATIK BLOK J00 - Acute nasopharyngitis [common cold] KLORFENIRAMIN MALEAT (CTM) TAB 4
A2/18 MG
Tgl Lahir : 12-Nov-2015 ( 3 Thn 9 Bln 28 Hr ) AMBROKSOL TAB 30 MG
73
No. RM : 01-043234 NIK : 3172042104151009
2019-09-09 13:37 Hal. 661 dari 1322

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AULIA SYIFA RAMADHANI (P) JL PERINTIS KEMERDEKAAN RT 11/04 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
74 NIK : 3172065406170001 MG
MEISON AMIR SIREGAR (L) JL SWASEMBADA BRT XXVI/23 C90.0 - Multiple myeloma RUJUKAN (0114R030) RS PERTAMINA
JAYA
75 NIK : 3172021505620006 Penyakit
Telah Dalam :- (0)
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 21
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
LENNY FRANSICA L, NY (P) JL PAL BATU IV NO 35 RT 010 RW 004 H25.9 - Senile cataract, unspecified RUJUKAN (0113R034) MEDIROS
H50.9 - Strabismus, unspecified (MAT) MATA - (65) Mata - (0)
KEMERDEKAAN KAV
Telp : 021-4721336
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 09:30 - 13:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 662 dari 1322

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NETA MARIA DELLA PUTRI, NY (P) JL WADAS RAYA NO 19 M13.98 - Arthritis, unspecified, other sites DEKSAMETASON 0,5 MG
No. RM : 01-029519 BPJS : 0002204071121
ISMET IRFAN FAUZAN (L) JL PERMATA BIRU II BLOK J 3 NO 7 L30.9 - Dermatitis, unspecified DEKSAMETASON 0,5 MG
SETIRIZIN 10MG
No. RM : 01-035628 BPJS : 0001636504481
ARDIANTO (L) JL JOGET Q/16 J00 - Acute nasopharyngitis [common cold] AMBROKSOL TAB 30 MG
79 NIK : 3172060806960001 MG
INEKE YUSTINAWATI, NY (P) KOMP WALIKOTA JL GELATIK BLOK A H81.1 - Benign paroxysmal vertigo ASAM MEFENAMAT KAPS 500 (0905R004) RS ISLAM JKT
2/18 RT 01/06 L04.0 - Acute lymphadenitis of face, head ANTASIDA DOEN SUKAPURA
80 and neck RUJUKAN Telah Diberikan :
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 09:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
MEGA IFRANI NURDIN (P) JL BARONG NO 2 RT 006 RW 007 I21.9 - Acute myocardial infarction, RUJUKAN (0116R021) Royal Progress
unspecified (JAN) JANTUNG DAN
81 NIK : 3172065701820004 PEMBULUH
Telah DARAH
Diberikan : - (89)
Faskes : (0116R021) Royal
Progress
UTARA
2019-09-09 13:37 Hal. 663 dari 1322

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Telp : 021-6400261
Kelas : B
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
09:30 - 17:00
TACC : Tanpa TACC

Alasan TACC :
ILHAM BUDIAWAN, AN (L) HAJI OYAR RT 2/2 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN KAPS 250 MG
MG
HARYANTO GUNADI, TN (L) JANUR HIJAU II TQ 2 NO 12 I25.1 - Atherosclerotic heart disease RUJUKAN (0905R004) RS ISLAM JKT
SUKAPURA
(JAN) JANTUNG DAN
83 NIK : 3172061005530003 PEMBULUH
: - (89)
Faskes DAN PEMBULUH
: (0905R004) RS ISLAM
JKT SUKAPURA
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Senin : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
AMBRUSIO TUNGGA DINATA (L) JL PULOA PENYENGAT II NO 50 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-086381 BPJS : 0001224714802 MG
2019-09-09 13:37 Hal. 664 dari 1322

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RAHEL (P) JL GADING PUTIH RT 11/2 H52.1 - Myopia RUJUKAN (0113R074) RS KHUSUS MATA
SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 82
Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
SRI IZZATI, NY (P) JL KELAPA NIAS III PC 6/17 012/017 L30.9 - Dermatitis, unspecified HIDROKORTISON KRIM 2,5 %
L74.0 - Miliaria rubra SETIRIZIN 10MG
86 NIK : 3172065807660002
No. RM : 01-005913 BPJS : 0001649902825
RONY (L) KOMP BPP O/7 04/08 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 5 MG
E79.9 - Disorder of purine and pyrimidine SIMVASTATIN 10 MG
87 NIK : 3172041212780012 metabolism, unspecified ALOPURINOL 100 MG
No. RM : 01-033523 BPJS : 0001094318155 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK 50 MG
MCG
DEKSAMETASON 0,5 MG
AFIA KHLAISA ZUHRY, AN (P) JL KEPODANG C3 16 RT 06/06 J18.90 - COMMUNITY ACQUIRED AMOKSISILIN SYR KERING 125 MG/5ML
PNEUMONIA KLORFENIRAMIN MALEAT (CTM) TAB 4
88 NIK : 3172041704131018 MG
2019-09-09 13:37 Hal. 665 dari 1322

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INDAH ANISA, NN (P) INF X SUNTER RT 4/4 R59.9 - Enlarged lymph nodes, unspecified AMOKSISILIN 500 MG
89 NIK : 3172065308021001
No. RM : 01-028916 BPJS : 0001225559237
RIZA AL GHANIBARR (L) JL PGS II RT 2/1 B01.9 - Varicella without complication KLORFENIRAMIN MALEAT (CTM) TAB 4
Tgl Lahir : 22-Aug-2012 ( 7 Thn 0 Bln 18 Hr ) ASIKLOVIR 400 MG
90 NIK : 2172062208121002
ASIKLOVIR KRIM 5%
NURHAYATI KANIA HASTATRI, NY (P) JL. GADING IX D 28 N39.0 - Urinary tract infection, site not AMOKSISILIN 500 MG
specified ASAM MEFENAMAT KAPS 500
91 NIK : 3172066410830009
No. RM : 01-086535 BPJS : 0001788270557
ARIO DELI PRATAMA (L) RUKAN ARTHA GADING BLOK A NO 8- J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
9 unspecified MULTIVITAMIN DEWASA
BOEN HON MAN, TN (L) JL SIMPPONI MAS II B2/10 K76.0 - Fatty (change of) liver, not RUJUKAN (0903R012) RS KARTIKA
elsewhere classified PULOMAS
93 NIK : 3172061511630003 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 666 dari 1322

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MARSCHA JESSICA PESIK (P) JL. REOK BLOK M NO 17 N39.8 - Other specified disorders of urinary
system
94 NIK : 3172065011010001
No. RM : 01-059391 BPJS : 0001436888417
CHARLES RICHARD ONIBALA (L) JL BANGUN CIPTA SARANA B17.9 - ACUTE VIRAL HEPATITIS, RUJUKAN (0116R025) Rumah Sakit Firdaus
UNSPECIFIED (INT) PENYAKIT DALAM - (3)
95 NIK : 3175050605830003 Penyakit
Telah Dalam :- (0)
Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
ERI TANUWIDJAJA, NY (P) KEALAP SAWIT V AA/18 E11.8 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus with unspecified complications GLIBENKLAMIDA 5 MG
96 NIK : 3172066106620002
No. RM : 01-004494 BPJS : 0001791147093
PRAMITHA ARIE ANDHINI (P) JL KOMPI UDIN RT 06/05 R11 - Nausea and vomiting ANTASIDA DOEN
97 NIK : 3172065610101002
No. RM : 01-049566 BPJS : 0002079217372
EDI NASUTION, TN (L) KP.RAWA INDAH RT 002/03 B20.9 - HIV disease resulting in unspecified KOTRIMOKSAZOL DOEN I (DEWASA)
PEGANGSAAN infectious or parasitic disease (SULFAMETOKSAZOL 400 MG +
98
No. RM : 01-017015 NIK : 3304032201810001 TENOVOFIR (TDF)
Tgl Diagnosis : 06 February 2019 8:07 AM BPJS : 0001151183935 LAMIVUDINE (3TC) 150MG
NEVIRAPINE (NVP)200mg
2019-09-09 13:37 Hal. 667 dari 1322

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SRI ENI, NY (P) KLP GADING JL PELEPAH RAYA WX1/3 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
infectious or parasitic disease KOTRIMOKSAZOL DOEN I (DEWASA)
AZKA ALDIANO, BY (L) JL.PELEPAH RAYA WX.1/3 B20.9 - HIV disease resulting in unspecified RUJUKAN (0114R030) RS PERTAMINA
infectious or parasitic disease JAYA
(ANA) ANAK - (26) Anak - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
LITA KARLINA, NY (P) JL KEPODANG RT 9/6 B20.9 - HIV disease resulting in unspecified
infectious or parasitic disease
101 NIK : 3172046409870002
No. RM : 01-061493 BPJS : 0001831111299
TATAP SEREPINA O, NY (P) JL PATIMURA NO 11 RT 06/03 N89.9 - Noninflammatory disorder of vagina, NISTATIN TAB VAGINAL 100.000 UI/TAB
unspecified METRONIDAZOL 500 MG
102 NIK : 317505691260009
No. RM : 01-015694 BPJS : 0001224745885
WIWIK (P) JL KLP HIBRIDA2/RA7/5 B35.6 - Tinea cruris NISTATIN TAB VAGINAL 100.000 UI/TAB
N89.9 - Noninflammatory disorder of vagina, METRONIDAZOL 500 MG
103 NIK : - unspecified
No. RM : 01-058625 BPJS : 0002078549919
2019-09-09 13:37 Hal. 668 dari 1322

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ZUL'AFDI ARRIYANSYAH (L) JL. MAULANA HASANUDIN RT 002/003 J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG

104 NIK : 3671051201880003
No. RM : 01-022342 BPJS : 0001053993914
RIDZKY AMIRULLAH (L) JL KP PEGANGSAAN I RT 03/03 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
Tgl Diagnosis : 07 February 2019 11:14 AM LORATADIN 10 MG
ANDRI SUPRIYATNA, TN (L) KP RAWA INDAH RT 003/003 A54.9 - Gonococcal infection, unspecified AZITROMISIN
CEFIXIME
106 NIK : 3172060807951002
No. RM : 01-031429 BPJS : 0002077480067
CATUR BAGUS SUTARDI, TN (L) JL PUTIH SALJU D5 NO 16 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
107 NIK : 3273010607760007
No. RM : 01-033604 BPJS : 0001422780524
MINI BIN ROMIN, NY (P) KP RAWA INDAH Z11.4 - Special screening examination for
human immunodeficiency virus [HIV]
108 NIK : 3172065204780006
No. RM : 01-081594 BPJS : 0001293033249
ANDRYANSAH (L) JL GADING III NO 11 Z11.4 - Special screening examination for
109 NIK : 3322181910840002
No. RM : 01-086784 BPJS : 0001634496219
FIRMANSYAH, TN (L) JL PK WRG JENGKOL Z11.4 - Special screening examination for
110 NIK : 3172061909790002
No. RM : 01-086786 BPJS : 0000998907568
2019-09-09 13:37 Hal. 669 dari 1322

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M. SUPRIYADI, TN (L) GG. L NO. 105 JL. BANGUN CIPTA Z11.4 - Special screening examination for
SARANA human immunodeficiency virus [HIV]
111
No. RM : 01-086782 NIK : -
EKI PRANSETIAN, TN (L) JL H. OYAR Z11.4 - Special screening examination for

112 NIK : 3172060210960003
No. RM : 01-086794 BPJS : 0000378084857
TITIN PRIHATIN, NY (P) KP PULO GADUNG Z11.4 - Special screening examination for
113 NIK : 3172065209850002
No. RM : 01-086796 BPJS : 0001446934059
RICHI OKTAVIA, NY (P) KP WARUNG JENGKOL NO 53 Z11.4 - Special screening examination for
114 NIK : 1603075710880001
No. RM : 01-086330 BPJS : 0002511292915
FIRMANSYAH (L) H OYAR RT 4/2 Z11.4 - Special screening examination for
115 NIK : 3172062705960003
No. RM : 01-044662 BPJS : 0001326482368
APRILLYA KARTINI PUTRI (P) JL RAWA SENGON BLK G 007/022 B20.9 - HIV disease resulting in unspecified
116 NIK : 3172046104860018
No. RM : 01-017796 BPJS : 0001316531709
SUNENTI (P) JL H OYAR PGS II B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
117 NIK : 3212066201850001
No. RM : 01-079582 BPJS : 0002332824366
2019-09-09 13:37 Hal. 670 dari 1322

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LIA NOVITA (P) JL KLP PUAN TIMUR III NB 3/11 B20.9 - HIV disease resulting in unspecified DUVIRAL (ZDV+3TC)
infectious or parasitic disease NEVIRAPINE (NVP)200mg
118 NIK : 3172066411860003
No. RM : 01-038644 BPJS : 0002097396753
ROY LATIPYO ROKADJI, TN (L) JL TEGUH VII NO.74 008/001 A54.9 - Gonococcal infection, unspecified AZITROMISIN
CEFIXIME
119 NIK : 3172062944760001
No. RM : 01-031843 BPJS : 0001335429573
SUTISNA (L) KP SUKANGGALEUH 2 NO 09 RT 02/04 B20.9 - HIV disease resulting in unspecified DUVIRAL (ZDV+3TC)
120 NIK : 3201242011891001
No. RM : 01-027362 BPJS : 0001644886539
TULO MANGUN S, TN (L) TELUK RATAI III NO. 12 RT. 005/010 B20.9 - HIV disease resulting in unspecified DUVIRAL (ZDV+3TC)
KGB infectious or parasitic disease EFAVIRENZ (EFV)
121
No. RM : 01-002311 NIK : 3172062310480002
Rosidah (P) JL PADEMANGAN I GG 5 NO 23 RT 6/4 H93.1 - Tinnitus KOMBINASI BESI (II) SULFAT 200 MG, (0116R025) Rumah Sakit Firdaus
ASAM FOLAT 0,25 MG (THT) THT-KL - (66) THT-KL - (0)
Tgl Lahir : 23-Mar-1974 ( 45 Thn 5 Bln 17 Hr ) RUJUKAN
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 08:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 671 dari 1322

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MELISA PRAASETYA, NN (P) JL.JATINEGARA BARAT RATYA NO.171 N83.2 - Other and unspecified ovarian cysts RUJUKAN (0114R030) RS PERTAMINA
JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Senin : 11:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
LATIFAH, NY (P) JL PEGANGSAAN DUA RT 03/04 R51 - Headache PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
No. RM : 01-014726 BPJS : 0001225799651
HELIANA NURINA RATRI, NN (P) JL P PENYENGAT RAYA NO 20 2/03 J45.9 - Asthma, unspecified RUJUKAN (0114R030) RS PERTAMINA
RUJUKAN JAYA
(PAR) PARU - (94) PARU - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 672 dari 1322

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HARIJATI (P) GADING INDAH UTARA IV BLOK NH N89.9 - Noninflammatory disorder of vagina, NISTATIN TAB VAGINAL 100.000 UI/TAB
7/12 unspecified METRONIDAZOL 500 MG
126
No. RM : 01-005599 NIK : 35730149026400004
LITA KARLINA, NY (P) JL KEPODANG RT 9/6 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
infectious or parasitic disease RANITIDIN 150 MG
127 NIK : 3172046409870002
No. RM : 01-061493 BPJS : 0001831111299
TRIYANTO, TN (L) PGS II RT 2/1 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-013028 BPJS : 0001142254618 MG
HJ. ROMLAH SH, NY (P) JL PEIRNTIS KEMEMRDEKAAN NO 75 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
RT 011/04 mellitus without complications SIMVASTATIN 10 MG
129 TIAMIN (VITAMIN B1) 50 MG
MCG
ELIANDER KONDA PIRADE, TN (L) JL.HARPA V DD/10 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 5 MG
No. RM : 01-049647 BPJS : 0000036465636 R05 - Cough METFORMIN TAB 500 MG
FRIGZARD ERIC, TN (L) TANAH MERAH JL. DUKUH RT.006 R56.8 - Other and unspecified convulsions VITAMIN B KOMPLEKS (0905R004) RS ISLAM JKT
RW.008 KALSIUM LAKTAT (KALK) 500 MG SUKAPURA
5
Telp : 021-4400778
Kelas : C
2019-09-09 13:37 Hal. 673 dari 1322

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Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Selasa : 07:30 - 13:30,
15:00 - 18:00;19:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
YUAN ALISIA PUTRI, AN (P) JL. BANGUN CIPTA SARANA NO. 116 R50.9 - Fever, unspecified PARASETAMOL TAB 500 MG
No. RM : 01-087155 BPJS : 0001180737494
R RAMA NOVAN, TN (L) JL WALANG TIMUR NO.19 009/012 E11.9 - Non-insulin-dependent diabetes RETRIBUSI KLINIK UMUM
Tgl Lahir : 24-Nov-1971 ( 47 Thn 9 Bln 16 Hr ) K02.3 - Arrested dental caries
GERSON JOZUA TAMPI, TN (L) TARIAN RAYA BARAT RAYA BLOK U I51.7 - Cardiomegaly RUJUKAN (0905R004) RS ISLAM JKT
NO 5 AMLODIPIN 10 MG SUKAPURA
(JAN) JANTUNG DAN
134 ASAM ASETILSALISILAT 80 mg PEMBULUH
: - (89)
No. RM : 03-001002 NIK : 640712051843 (ASETOSAL) JANTUNG
Faskes DAN PEMBULUH
: (0905R004) RS ISLAM
Tgl Diagnosis : 11 February 2019 1:11 PM BPJS : 0001440469293 SIANOKOBALAMIN (VITAMIN B12) 50 DARAH - (0)
JKT SUKAPURA
MCG Alamat : JL. TIPAR CAKUNG NO.
TIAMIN (VITAMIN B1) 50 MG 5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 13:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
SALMA APRIANI, AN (P) RAWA SENGON RT 09/022 J02.9 - Acute pharyngitis, unspecified DOKTER UMUM
135 NIK : - unspecified AMBROKSOL TAB 30 MG
2019-09-09 13:37 Hal. 674 dari 1322

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MG
RANITIDIN 150 MG
WIDI HARTO WAHYONO, TN (L) PULO NANGKA 1 NO 34A E11.9 - Non-insulin-dependent diabetes DOKTER UMUM
Tgl Lahir : 19-Sep-1962 ( 56 Thn 11 Bln 21 Hr ) I10 - Essential (primary) hypertension
HERYANTO (L) JL. TANAH TINGGI I NO. 78A D17.3 - Benign lipomatous neoplasm of skin RUJUKAN (0905R004) RS ISLAM JKT
and subcutaneous tissue of other and SUKAPURA
Tgl Lahir : 27-Mar-1986 ( 33 Thn 5 Bln 13 Hr ) unspecified sites
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 09:00 - 11:00,
13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
BUDIONO (L) JL' JUNUR INDAH 14 LB 18 NO 7 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
138 NIK : - unspecified MG
VITAMIN B KOMPLEKS
MARTHA NAINGGOLAN, NY (P) JL JANUR KUNING IX WO 2/7 RT B20.5 - HIV disease resulting in other FDC (TDF+3TC+EFV)
07/016 mycoses
139
No. RM : 01-010299 NIK : 3172066405660003
2019-09-09 13:37 Hal. 675 dari 1322

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GITTA ERIK, NN (P) JL KOMPI UDIN RT 06/05 Z11.4 - Special screening examination for
140 NIK : 3172066002961002
No. RM : 01-027890 BPJS : 0000378148566
WILDA YANTI KHOERIYAH (P) JL KP WARUNG JENGKOL Z11.4 - Special screening examination for
141 NIK : 3172065607950004
No. RM : 01-087248 BPJS : 0002332722374
PUTRI DEWI CHAIRUNNISA, NN (P) JL PULO GADUNG RT 01/05 Z11.4 - Special screening examination for
142 NIK : 3172066409950002
No. RM : 01-041960 BPJS : 0001371857365
MOHAMMAD UMARSDIANSYAH, TN (L) JL.P.PENYENGATB IV NO.51 03/03 Z48.8 - Other specified surgical follow-up PARASETAMOL TAB 500 MG
care AMOKSISILIN 500 MG
143 NIK : 3172061303680005
No. RM : 01-001317 BPJS : 0001134210723
ASRI WAHYUNI (P) DUSUN MANJUL 009/017 BUNISERI R51 - Headache PARASETAMOL TAB 500 MG
CIAMIS ASAM ASKORBAT (VITAMIN C) 50 MG
144
No. RM : 01-063968 NIK : 3207115402950003
SALSABILATUL MA,WA, NN (P) JL. PERINTIS KEMERDEKAAN H61.2 - Impacted cerumen PARASETAMOL TAB 500 MG
DEKSAMETASON 0,5 MG
145 NIK : -
No. RM : 01-087162 BPJS : 0000165532307
LO HWEE ING (P) JL KALI BESAR TIMUR NO 3 M17.9 - Gonarthrosis, unspecified RUJUKAN (0903R012) RS KARTIKA
M54.26 - Cervicalgia, lumbar region PULOMAS
2019-09-09 13:37 Hal. 676 dari 1322

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BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
JAIZ CAHYA PRASETYA (L) JANUR HIJAU I TK.I/1 H02.9 - Disorder of eyelid, unspecified DEKSAMETASON 0,5 MG
147 NIK : 3172061008011001
No. RM : 01-048656 BPJS : 0002231284094
YOHANA MAYA CHRISTI (P) JL KAPUAS IV BLOK O NO 270 RT 7/1 R42 - Dizziness and giddiness RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Kamis : 08:00 - 12:00,
08:30 - 11:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
MICHAEL KUMALA (L) PLUIT KARANG SARI BLOK E7S NO.24 L70.9 - Acne, unspecified GENTAMISIN SALEP KULIT
010/008 PENJARINGAN AMOKSISILIN 500 MG
149
No. RM : 01-006212 NIK : 3172011208800002
2019-09-09 13:37 Hal. 677 dari 1322

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HARINA YANTI, NY (P) JL.PUTIH SALJU C4/10 KGT RT 17/10 K29.7 - Gastritis, unspecified RUJUKAN
K30 - Dyspepsia
150 NIK : 3172065502640002
No. RM : 01-056450 BPJS : 0001435610878
MARIA MAGDALENA TAMPUBOLON, AN (P) JL PERJUANGANRAYA TANAH MERAH J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-031385 BPJS : 0001264922998 MG
RISWANDI, TN (L) JANUR ELOK BLOK 6Q K92.1 - Melaena RUJUKAN (0116R034) Rumah Sakit Umum
Pekerja
Telah Diberikan
Tgl Diagnosis : 13 February 2019 2:16 PM Sakit Umum Pekerja
Alamat : JL. RAYA CAKUNG
CILINCING
Telp : 021-29484848
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 11:00 - 15:00,
15:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
AHMAD EKA ALFARI (L) PEGANGSAAN 2 W57.0 - BITTEN OR STUNG BY AMOKSISILIN 500 MG
NONVENOMOUS INSECT AND OTHER DEKSAMETASON 0,5 MG
Tgl Lahir : 09-Oct-2003 ( 15 Thn 11 Bln 0 Hr ) NONVENOMOUS ARTHROPODS, HOME
No. RM : 01-087376 BPJS : 0001225752759 MG
SRI WIYANTI (P) JL PERJUANGAN RT 13/7 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-050067 BPJS : 0001315968041 MG
DOKTER UMUM
2019-09-09 13:37 Hal. 678 dari 1322

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LISA AMRU (P) JL. PIUL BLOK T/15 Z11.4 - Special screening examination for
155 NIK : 3172065903870002
No. RM : 01-087441 BPJS : 0001315191183
ANDIKA, TN (L) TNH MERAH ATAS NO.4A 003/008 B20.9 - HIV disease resulting in unspecified DUVIRAL (ZDV+3TC)
infectious or parasitic disease EFAVIRENZ (EFV)
156 NIK : 3173012506830025
No. RM : 01-026893 BPJS : 0001280441913
APRILLYA KARTINI PUTRI (P) JL RAWA SENGON BLK G 007/022 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
MG
INDRAJANA RAHARDJA, TN (L) JANUR INDAH XII LB.15/6 B20.3 - HIV disease resulting in other viral FDC (TDF+3TC+EFV)
infections KOTRIMOKSAZOL DOEN I (DEWASA)
ALBANON SRI HARTANTI, TN (P) APT GADING NIAS TWR ALAMANDA LT B20.3 - HIV disease resulting in other viral RETRIBUSI KLINIK FELASE / IMS
1 UNIT AS infections FDC (TDF+3TC+EFV)
No. RM : 01-017289 NIK : 3603064803910004
AHMAD FAUZY, TN (L) JL H OYAR RT 04/02 B20.3 - HIV disease resulting in other viral FDC (TDF+3TC+EFV)
infections
160 NIK : 31720613049900002
No. RM : 01-027210 BPJS : 0001380967817
RIAN AHDA ADISTA (L) TIPAR TIMUR RT. 002/004 CILINCING B20.3 - HIV disease resulting in other viral FDC (TDF+3TC+EFV)
Tgl Diagnosis : 18 February 2019 9:02 AM RETRIBUSI KLINIK FELASE / IMS
2019-09-09 13:37 Hal. 679 dari 1322

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ALBANON SRI HARTANTI, TN (P) APT GADING NIAS TWR ALAMANDA LT B20.9 - HIV disease resulting in unspecified RETRIBUSI KLINIK FELASE / IMS
1 UNIT AS infectious or parasitic disease FDC (TDF+3TC+EFV)
162
No. RM : 01-017289 NIK : 3603064803910004
DEWI SUMARYANTI, NY (P) JL.WARUNG JENGKOL 01/013 B20.9 - HIV disease resulting in unspecified METRONIDAZOL 500 MG
infectious or parasitic disease NISTATIN TAB VAGINAL 100.000 UI/TAB
Tgl Lahir : 09-Mar-1983 ( 36 Thn 6 Bln 0 Hr ) N89.9 - Noninflammatory disorder of vagina,
163 NIK : 3172064903830004
HENDRI KUSTIAWAN, TN (L) JL GADING KIRANA UTARA BLK F X B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
NO.2 infectious or parasitic disease
164
No. RM : 01-015400 NIK : 3206311305970002
KRISTIN JULITA PRIENY (P) JL.MERAH DELIMA A.4/3 B20.9 - HIV disease resulting in unspecified DUVIRAL (ZDV+3TC)
165 NIK : 3172065307800001
No. RM : 01-008394 BPJS : 0001876167516
DANIEL PRIESTLEY (L) JL MERAH DELIMA BLOK A 4 NO 3 RT B20.9 - HIV disease resulting in unspecified DUVIRAL (ZDV+3TC)
5/10 infectious or parasitic disease NEVIRAPINE (NVP)200mg
166
No. RM : 01-011801 NIK : 3172022810830010
DEDI WAHYUDI (L) RW INDAH RT 006/003 A54.0 - Gonococcal infection of lower

genitourinary tract without periurethral or
Tgl Lahir : 26-Dec-1991 ( 27 Thn 8 Bln 14 Hr ) accessory gland abscess
167 NIK : 3172062612910001
No. RM : 01-024223 BPJS : 0001772413964
RITA S, NY (P) JL. KAMPUNG SAWAH 009/008 N89.9 - Noninflammatory disorder of vagina, METRONIDAZOL 500 MG
unspecified NISTATIN TAB VAGINAL 100.000 UI/TAB
Tgl Lahir : 01-Jun-1984 ( 35 Thn 3 Bln 8 Hr ) Z11.4 - Special screening examination for
168 NIK : 3172065702850005
No. RM : 01-033309 BPJS : 0000377202666 human immunodeficiency virus [HIV]
2019-09-09 13:37 Hal. 680 dari 1322

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DIYAS ANJAR SARI (P) KP.PULO GADUNG 01/05 Z11.4 - Special screening examination for
169 NIK : 3172065409941001
No. RM : 01-058703 BPJS : 0000378059602
DIANA IRENE MARGARETHA L, NY (P) JL KLPA CENGKIR BRT VI FN 2/4 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
007/011 infectious or parasitic disease
170
No. RM : 01-047602 NIK : 3172065606800006
AGUSTINA WULANDARI, NN (P) JL. PEGANGSAAN DUA NO.49 Z11.4 - Special screening examination for
171 NIK : 3127066008941001
No. RM : 01-087938 BPJS : 0001226371566
PHILIPUS MALANTON, TN (L) JL. TEGUH VIII NO. 96 009/001 KELAPA A51.5 - Early syphilis, latent
GADING BARAT B20.9 - HIV disease resulting in unspecified
172 infectious or parasitic disease
No. RM : 01-063632 NIK : 3172060205950002
NURAINI, NY (P) JL RAWA INDAH 006/003 B20.9 - HIV disease resulting in unspecified DUVIRAL (ZDV+3TC)
173 NIK : 3172066909830001 RETRIBUSI KLINIK FELASE / IMS
No. RM : 01-014346 BPJS : 0001644652732
PUJI ASTOTO, TN (L) RAWA IDAH RT 06/03 B20.9 - HIV disease resulting in unspecified RETRIBUSI KLINIK FELASE / IMS
infectious or parasitic disease DUVIRAL (ZDV+3TC)
174 NIK : 3172062109800002 NEVIRAPINE (NVP)200mg
No. RM : 01-014420 BPJS : 0001644652721
TRIAWAN AHMATIBRATA, TN (L) PUTIH SALJU RT 16/10 N48.5 - Ulcer of penis GENTAMISIN SALEP KULIT

175 NIK : 3172061008890003
No. RM : 05-001852 BPJS : 0002099162834
2019-09-09 13:37 Hal. 681 dari 1322

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WILLIAM OTNIEL SIMANGUNSONG, AN (L) JL RAWA SENGON BLOK D NO 39 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
MG
DAISY KRISTYANTO (P) JL REOG BLK L NO.13 013/007 L30.9 - Dermatitis, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
L50.0 - Allergic urticaria RUJUKAN (KLT) KULIT KELAMIN - (110)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
SHEEREN (P) MENARA KONDOMINUUM BLOK A LT 2 R10.4 - Other and unspecified abdominal PARASETAMOL TAB 500 MG
pain RANITIDIN 150 MG
No. RM : 01-007521 BPJS : 0001602767878
SETIYO KURNIONO (L) KLP GADING TIMUR J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
Tgl Lahir : 06-Feb-1988 ( 31 Thn 7 Bln 3 Hr ) M54.26 - Cervicalgia, lumbar region
179 NIK : - MG
Tgl Diagnosis : 20 February 2019 8:47 AM NATRIUM DIKLOFENAK TAB 25 MG
ERDIN BIN MISKAR (L) KP. RAWA INDAH J06.9 - Acute upper respiratory infection, DOKTER UMUM
unspecified KOTRIMOKSAZOL DOEN I (DEWASA)
2019-09-09 13:37 Hal. 682 dari 1322

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MG
CHRISTIN (P) GREN GARDEN BLOK A4 NO 25 D21.4 - Other benign neoplasm of RUJUKAN (0116R029) Rumah Sakit
connective and other soft tissue of abdomen Hermina
(BED) Podomoro
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 08:00 - 12:00,
12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
YULIATI PURWANINGTYAS (P) JL TEGUH II NO.111 005/001 E78.2 - Mixed hyperlipidaemia AMBROKSOL TAB 30 MG
Tgl Diagnosis : 20 February 2019 9:10 AM SIMVASTATIN 20 MG
IRA NATALIA (P) APT GADING NIAS BLOK DAHLIA LT 9 J02.9 - Acute pharyngitis, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
J03.9 - Acute tonsillitis, unspecified (THT) THT-KL - (66) THT-KL - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
2019-09-09 13:37 Hal. 683 dari 1322

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Jadwal : Rabu : 08:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
YUSUF ARYA MAULANA, AN (L) JL PUTIH MELATI BLOK C3 NO 9 RT J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-007303 NIK : 3172061402121002 MG
Tgl Diagnosis : 20 February 2019 9:26 AM BPJS : 0001440869668 ASAM ASKORBAT (VITAMIN C) 50 MG
MERYNAWATI ACHMAD (P) JL HIJAU DAUN LK CIII NO.23 011/010 L30.9 - Dermatitis, unspecified BETAMETASON 0,1%,KRIM

185 NIK : 3172067105820002
No. RM : 01-044467 BPJS : 0001795082883
TUTI HANDAYANI (P) RAWA SENGON BLOK H 08/22 KGB J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
186 NIK : 101709508690008 MG
DOKTER UMUM
HARNITI (P) RAWA SENGON RT 009/022 H11.0 - Pterygium RUJUKAN (0116R025) Rumah Sakit Firdaus
(MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 684 dari 1322

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CASMADI (L) JL. PEGANGSAAN DUA M54.26 - Cervicalgia, lumbar region NATRIUM DIKLOFENAK 50 MG
188 NIK : 3172062001820001 MCG
No. RM : 01-088032 BPJS : 0001648594945
SUSWANTI (P) JL KOMPI UDIN 006/005 N30.9 - Cystitis, unspecified DEKSAMETASON 0,5 MG
189 NIK : 3328084205800001
No. RM : 01-008274 BPJS : 0001673783559
AGUN GUNAWAN (L) JL BUNGUR BESAR 17 RT 02/04 J06.9 - Acute upper respiratory infection, DOKTER UMUM
ALICHA PUTRI NURFATWA (P) JL.PERINTIS RT 01/04 N0 32 KLP J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
GADING TIMUR unspecified DEKSAMETASON 0,5 MG
No. RM : 01-074806 NIK : 3172065011111003 MG
Tgl Diagnosis : 20 February 2019 10:16 AM BPJS : 0001773719447 SALBUTAMOL 2 MG
NAFI ZHORIF FADLULLAH, AN (L) JL RAWA SENGON E RT 05 / 022 R11 - Nausea and vomiting DOMPERIDON TAB 10 MG
192 NIK : - RETRIBUSI KLINIK UMUM
SUHENDRA (L) KOMP UKA BLOK R/82 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-035571 BPJS : 0001643914012 MG
MARLON RIONNY ALBERT.J, TN (L) JL. KELAPA PUYUH V BLOK KB/16 E78.2 - Mixed hyperlipidaemia RUJUKAN (0116R029) Rumah Sakit
004/019 K30 - Dyspepsia Hermina
(INT) Podomoro
194 M10.9 - Gout, unspecified Penyakit
Telah Dalam :- (0)
Diberikan
2019-09-09 13:37 Hal. 685 dari 1322

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BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 08:00 - 12:00,
09:00 - 11:00;20:00 - 22:00
TACC : Tanpa TACC

Alasan TACC :
ABDULHAIR, AN (L) KAMP SUKAPURA R50.9 - Fever, unspecified PARASETAMOL SYR 120 MG/5 ML

195 NIK : 3172042310131017
No. RM : 01-084971 BPJS : 0002326330618
ITONG SURJANA (L) JL. GAMBIR ANOM BLOK F 5 NO 15 A09 - Diarrhoea and gastroenteritis of KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 06-Feb-1963 ( 56 Thn 7 Bln 3 Hr ) KOTRIMOKSAZOL DOEN I (DEWASA)
196 NIK : 3172060602630005
TRIMETOPRIM 80 MG)
RANITIDIN 150 MG
ZINC 20 MG
KUSRINI (P) TELUK RATAI IV NO 6 RT 6/10 Z00.0 - General medical examination

197 NIK : 3172065605620002
No. RM : 01-024024 BPJS : 0001079484333
YANTI NIRMA HAREFA, NY (P) JL. H.PITANG SUKA PURA B20.4 - HIV disease resulting in candidiasis DOKTER UMUM
NISTATIN TAB VAGINAL 100.000 UI/TAB
198 NIK : 3671015002880003
No. RM : 01-088069 BPJS : 0001880090493
2019-09-09 13:37 Hal. 686 dari 1322

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ROHIMAH (P) MLAYA J06.0 - Acute laryngopharyngitis GLISERIL GUAIAKOLAT (GG) 100 MG
AMOKSISILIN 500 MG
199 NIK : 3304124807740004
No. RM : 01-088072 BPJS : 0000536941012
RESINI, NY (P) KELAPA HIBRIDA V RB 11 / 11 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
NURUL SAFITRI,NY (P) KP RAWA INDAH NO.45 B20.3 - HIV disease resulting in other viral FDC (TDF+3TC+EFV)
M.SUGENG PRANATA (L) RAWA INDAH RT003/003 PGS2 B20.3 - HIV disease resulting in other viral KOTRIMOKSAZOL DOEN I (DEWASA)
infections (SULFAMETOKSAZOL 400 MG +
202 NIK : 3172040707900014
No. RM : 01-081482 BPJS : 0001470097888 FDC (TDF+3TC+EFV)
YOBEL OROH, AN (L) JL PERJUANGAN RAYA NO 49 RT J06.9 - Acute upper respiratory infection,
DOKTER UMUM
03/07 unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
LIE HANUM ADITYA (P) JL LETJEN SUPRAPTO NO 82 A09.9 - GASTROENTERITIS AND COLITIS KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 05-Nov-1984 ( 34 Thn 10 Bln 4 Hr ) PARASETAMOL TAB 500 MG
204 NIK : 3171080511840002
2019-09-09 13:37 Hal. 687 dari 1322

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METTA RACHMA, NY (P) KOMP PT HII BLOK C/4 RT 03/05 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
JOSEPH SANTOSA (L) KELAPA CENGKIR BARAT 1 BLOK FH-1 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
NO.12 unspecified PARASETAMOL TAB 500 MG
No. RM : 06-002450 NIK : 3172060910920002 MG
PEGGY IVONE MEDELLU, NY (P) JL SUNGAI KAMPAR 4 NO 5 A09.9 - GASTROENTERITIS AND COLITIS KOMBINASI KAOLIN 550 MG, PEKTIN 20
Tgl Lahir : 17-Dec-1962 ( 56 Thn 8 Bln 23 Hr ) PIRIDOKSIN (VITAMIN B6) 10 MG
207 NIK : 64171035712620001
EVAN RIZKY (L) APT WGP TW C/LT 20/1 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-081808 BPJS : 0002332934515 MG
SARTUN, TN (L) JL. RAWA INDAH RT 05/010 K30 - Dyspepsia PARASETAMOL TAB 500 MG
RANITIDIN 150 MG
CHACHA PRASETIO UTOMO PUTRI, NY (P) ASRAMA BROMOB CIP ATAS BLOK A15.0 - Tuberculosis of lung, confirmed by FDC (TDF+3TC+EFV)
F/14 CIPINANG sputum microscopy with or without culture TIAMIN (VITAMIN B1) 50 MG
Tgl Lahir : 07-Feb-1989 ( 30 Thn 7 Bln 2 Hr ) B20.3 - HIV disease resulting in other viral
210 PIRIDOKSIN (VITAMIN B6) 10 MG
No. RM : 01-064170 NIK : 3175024703890005 infections
PHILIPUS MALANTON, TN (L) JL. TEGUH VIII NO. 96 009/001 KELAPA B20.3 - HIV disease resulting in other viral
GADING BARAT infections
211
No. RM : 01-063632 NIK : 3172060205950002
2019-09-09 13:37 Hal. 688 dari 1322

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VIVIRAWATI SUGITO (P) JL. TARIAN RAYA BARAT BL C 8 NO 18 N72 - Inflammatory disease of cervix uteri CEFIXIME
AZITROMISIN
212 NIK : 3171044604810006
No. RM : 01-058319 BPJS : 0000373079711
ZAENAL ARIPIN, TN (L) JL STM WALANG B20.3 - HIV disease resulting in other viral FDC (TDF+3TC+EFV)
infections RETRIBUSI KLINIK FELASE / IMS
213 NIK : 3212091506910006
No. RM : 01-059381 BPJS : 0001995549298
OMAN DUROHMAN (L) GADING V NO 4 RT 4/5 A09 - Diarrhoea and gastroenteritis of KOTRIMOKSAZOL DOEN I (DEWASA)
214 NIK : 3172061211780003
NURCAHYO (L) KOMP PLN BLOK B NO. 47 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
MG
VIONA VINIVERA (P) JL. PELEPAH ELOK 9 Q F2 J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
No. RM : 01-086358 BPJS : 0001796057651
ALICHA PUTRI NURFATWA (P) JL.PERINTIS RT 01/04 N0 32 KLP J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
GADING TIMUR unspecified AMOKSISILIN KAPS 250 MG
217 OBH SIRUP 100 ML
2019-09-09 13:37 Hal. 689 dari 1322

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ROHINING (P) JL PERJUNAGAN GG BUNTU NO.21 M13.9 - Arthritis, unspecified RUJUKAN (0905R003) RS PELABUHAN
001/007 JAKARTA
Tgl Diagnosis : 22 February 2019 3:25 PM BPJS : 0002241288663 PELABUHAN JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Jumat : 08:00 - 12:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
NAGA TARSONO (L) JL PERJUANGAN GG BUNTU NO 21 M54.57 - Low back pain, lumbosacral region RUJUKAN (0905R003) RS PELABUHAN
JAKARTA
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Jumat : 08:00 - 12:00,
17:00 - 19:00
TACC : Tanpa TACC

Alasan TACC :
DYAH AYU ARI PALUPI, NN (P) JL TRAMPIL III NO 12 RT 03/02 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
220 NIK : 3172064609950003 MG
2019-09-09 13:37 Hal. 690 dari 1322

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LITA KARLINA, NY (P) JL KEPODANG RT 9/6 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
221 NIK : 3172046409870002
No. RM : 01-061493 BPJS : 0001831111299
DANI PAMUNGKAS (L) JLN BINTARA RT 002/006 B20.9 - HIV disease resulting in unspecified FDC (TDF+3TC+EFV)
infectious or parasitic disease RETRIBUSI KLINIK FELASE / IMS
222 NIK : 3275022802820016
No. RM : 01-075034 BPJS : 0001375362977
IRFAN ARACHMAN, TN (L) JL TANGGUH I NO.1 Z11.4 - Special screening examination for
223 NIK : 3172063006910001
No. RM : 01-088555 BPJS : 0001637166284
TOYYIBAH (P) JL. PERINTIS KEMERDEKAAN Z11.4 - Special screening examination for
224 NIK : 3172066812920002
No. RM : 01-088566 BPJS : 0001476009369
APRILLYA KARTINI PUTRI (P) JL RAWA SENGON BLK G 007/022 B20.3 - HIV disease resulting in other viral VITAMIN B KOMPLEKS
dr. Rendi Dwi Herza

SANIMIN, TN (L) JL PERINTIS KEMERDEKAAN E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 10 MG
1 NIK : 3526111312560001 J44.9 - Chronic obstructive pulmonary HIDROKLORTIAZID 25 MG
No. RM : 01-086033 BPJS : 0002163203379 disease, unspecified ALOPURINOL 100 MG
2019-09-09 13:37 Hal. 691 dari 1322

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TEDJO SUWITO (L) KLP PUYUH III BLOK KH NO 43 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0905R003) RS PELABUHAN
mellitus without complications PARASETAMOL TAB 500 MG JAKARTA
2 NIK : 3172060805450001 METFORMIN TAB 500 MG (0)
Telah Diberikan :
No. RM : 01-015749 BPJS : 00014387851079 N40 - Hyperplasia of prostate Faskes : (0905R003) RS
AMLODIPIN 5 MG
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 12:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
DASMAN (L) KELAPA GADING H40.8 - Other glaucoma RUJUKAN (0113R074) RS KHUSUS MATA
SMEC
(MAT) MATA - (65) Mata - (0)
Telp : 021-4714848
Kelas : C
Jumlah Rujukan : 49
Kapasitas : 0
Jadwal : Senin : 00:00 - 00:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 16:00;16:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
HERMAWAN DHARSONO (L) KELAPA HYBRIDA IX RA.25/8 Z00.0 - General medical examination

4 NIK : 3172062505550001
No. RM : 01-074288 BPJS : 0001337034677
2019-09-09 13:37 Hal. 692 dari 1322

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IRIANTI SRI SETYANINGSIH (P) JL PERINTIS KEMERDEKAAN 011/004 I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
AMLODIPIN 5 MG
No. RM : 01-045747 BPJS : 0002098819991
CHANDRA KRISTIANTO, TN (L) JL. GAMBANG BLK. P NO. 26 RT. I25.1 - Atherosclerotic heart disease VITAMIN B KOMPLEKS
006/007 PGS II J06.9 - Acute upper respiratory infection, LORATADIN 10 MG
No. RM : 01-000851 NIK : 31723071806550004
TRESNAWATI WIRAWAN (P) PAL MERIAM RT 008/05 JAKARTA H25.9 - Senile cataract, unspecified RUJUKAN (0114R030) RS PERTAMINA
TIMUR I10 - Essential (primary) hypertension AMLODIPIN 5 MG JAYA
(MAT) MATA - (65) Mata - (0)
7 VITAMIN B KOMPLEKS Telah Diberikan :
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 8
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
PAULUS WARSITO (L) KLP HIBRIDA V BLOK RB 10/6 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 5 MG
No. RM : 01-008890 BPJS : 0001256054297
MICHAEL (L) JL KELAPA NIAS IV BLOK PB 9/9 H52.1 - Myopia RUJUKAN (0114R030) RS PERTAMINA
R05 - Cough AMBROKSOL TAB 30 MG JAYA
(MAT) MATA - (65) Mata - (0)
9 NIK : 3172062610900001 LORATADIN 10 MG Telah Diberikan :
RUJUKAN
BY PASS
2019-09-09 13:37 Hal. 693 dari 1322

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Telp : 0214211913
Kelas : C
Jumlah Rujukan : 12
Kapasitas : 0
Jadwal : Kamis : 13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
CHRIST AGATA SEMBIRING (L) JL RAWA SENGON BLOK D RT 04/022 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
AMBROKSOL TAB 30 MG
No. RM : 01-016506 BPJS : 0001295154639 MG
KHAIRUNNISA (P) JL CEMPAKA NO 15 RT 004/003 N94.6 - Dysmenorrhoea, unspecified ASAM MEFENAMAT KAPS 500
BERMIS KGT VITAMIN B KOMPLEKS
11
No. RM : 01-069950 NIK : -
SUCIADI, TN (L) JL. PEGANGSAAN DUA NO. 69 I10 - Essential (primary) hypertension AMLODIPIN 5 MG
VITAMIN B KOMPLEKS
12 NIK : 3172063110820010
No. RM : 05-001020 BPJS : 0001223482869
AHMAD TAUFAN HAMBALI YUSUF (L) KP RAWA INDAH 002/003 H81.3 - Other peripheral vertigo PARASETAMOL TAB 500 MG
ANTASIDA DOEN
No. RM : 01-029993 BPJS : 0001602767823
TARISNO (L) SEMPER RT.014/05 M54.5 - Low back pain NATRIUM DIKLOFENAK 50 MG
DEKSAMETASON 0,5 MG
2019-09-09 13:37 Hal. 694 dari 1322

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GINI SRIJATI, NY (P) PONDOK PEKAYON INDAH RT 005/018 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
unspecified LORATADIN 10 MG
FITRIA, NN (P) KP BARU M54.5 - Low back pain NATRIUM DIKLOFENAK 50 MG
DEKSAMETASON 0,5 MG
No. RM : 01-085838 BPJS : 0000377970017
KASIM ETENG, NY (L) KLP PUYUH VI KJ NO KLP GADING Z00.0 - General medical examination
TIMUR
17
No. RM : 01-076916 NIK : -
JOHNNY SUJANA (L) APT GADING NIAS E/19/EB Z00.0 - General medical examination

18 NIK : 3175081406490003
No. RM : 01-047107 BPJS : 0001468359707
LIM NYUK KIAUW (P) JL GADING PERMAI INDAH V BLO NF Z00.0 - General medical examination
3/5
19
No. RM : 01-016600 NIK : 3172066112580004
SUPRIYATNO, TN (L) RAWA INDAH RT 2/3 Z00.0 - General medical examination RUJUKAN

20 NIK : 3172062706770002
No. RM : 01-042114 BPJS : 0001225696004
WANTY WONGSO (P) TAMAN ASRI 1 N0 11 RT 001/016 H10.0 - Mucopurulent conjunctivitis DEKSAMETASON 0,5 MG
AMOKSISILIN 500 MG
21 NIK : 3175066710490002 OKSITETRASIKLIN 1% SM
2019-09-09 13:37 Hal. 695 dari 1322

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SUKARMANTO, TN (L) JL WESEL BLK A13 PGS II RT 06/10 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0905R004) RS ISLAM JKT
mellitus without complications SUKAPURA
Tgl Lahir : 13-Apr-1947 ( 72 Thn 4 Bln 27 Hr ) H91.1 - Presbycusis
5
Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Jumat : 08:00 - 10:00,
16:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
SUWARDO SUHARTONO, TN (L) JL PGS INDAH RT 7/16 J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
MUHAMMAD ARSIL MUNIR (L) JL TABANAS NO 18 RT 5/10 H10.3 - Acute conjunctivitis, unspecified AMOKSISILIN 500 MG
24 NIK : - OKSITETRASIKLIN 1% SM
No. RM : 01-051387 BPJS : 0001460365154
HERMAN KAHAR, TN (L) JL RAWA SENGON BLOK E RT 005/022 I25.1 - Atherosclerotic heart disease AMLODIPIN 5 MG (0116R027) Rumah Sakit
I50.0 - Congestive heart failure ASAM ASETILSALISILAT 80 mg Mulyasari
(JAN) JANTUNG DAN
25 NIK : 3174012904560001 (ASETOSAL) PEMBULUH
: - (89)
No. RM : 01-009187 BPJS : 0001282828004 HIDROKLORTIAZID 25 MG JANTUNG
Faskes DAN PEMBULUH
: (0116R027) Rumah
Tgl Diagnosis : 08 February 2019 8:52 AM RUJUKAN DARAH - (0)
Sakit Mulyasari
Semper No.19
Telp : 021-43931111
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
2019-09-09 13:37 Hal. 696 dari 1322

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Jadwal : Senin : 09:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
PARULIAN (L) PGS II RT 003/004 I10 - Essential (primary) hypertension ASAM ASETILSALISILAT 80 mg (0116R025) Rumah Sakit Firdaus
J44.9 - Chronic obstructive pulmonary (ASETOSAL) (PAR) PARU - (94) PARU - (0)
Tgl Lahir : 10-Nov-1949 ( 69 Thn 9 Bln 30 Hr ) KAPTOPRIL 12,5 MG
26 NIK : 3172061011490004 disease, unspecified Telah Diberikan :
No. RM : 01-004832 BPJS : 0001826834207 RUJUKAN Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Senin : 08:00 - 10:00,
09:00 - 12:00;16:00 - 21:00, 17:00
- 19:00
TACC : Tanpa TACC

Alasan TACC :
LIM NYUK KIAUW (P) JL GADING PERMAI INDAH V BLO NF N18.5 - CHRONIC KIDNEY DISEASE, RUJUKAN (0116S002) Klinik HD Lions
3/5 STAGE 5 (INT) PENYAKIT DALAM - (3)
27 Penyakit
Telah Dalam :- (0)
Diberikan
No. RM : 01-016600 NIK : 3172066112580004 Faskes : (0116S002) Klinik HD
Tgl Diagnosis : 08 February 2019 9:09 AM BPJS : 0001721230773 Lions
Alamat : Jl. Pluit Timur Raya Kav
B2
Telp : 021-6627657
Kelas : D
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Jumat : 08:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 697 dari 1322

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ROBIN UNG (L) WGP TOWER A LT 7/5 KGT E11.9 - Non-insulin-dependent diabetes RUJUKAN
Tgl Lahir : 05-Sep-1954 ( 65 Thn 0 Bln 4 Hr ) I25.1 - Atherosclerotic heart disease
28 NIK : 3171040509540002
No. RM : 01-001396 BPJS : 0001318763237
DODOK MULYANI, NY (P) JANUR ELOK VI QJ 12 NO 9 E11.9 - Non-insulin-dependent diabetes GLIBENKLAMIDA 5 MG
Tgl Lahir : 08-Feb-1955 ( 64 Thn 7 Bln 1 Hr ) E78.5 - Hyperlipidaemia, unspecified
29 NIK : 3523064802550001 KAPTOPRIL 25 MG
No. RM : 01-003100 BPJS : 0001256800252 I10 - Essential (primary) hypertension SIMVASTATIN 10 MG
ISA KRISTIYANTO (L) JL. GADING III NO 3 RT 03/05 A15.3 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
unspecified means GLIBENKLAMIDA 5 MG
22 unspecified means
31
No. RM : 01-075196 NIK : 3172040611770015
MARDURUM SIAHAAN, TN (L) INSPEKSI KALI SUNTER 09/04 A15.3 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
unspecified means METFORMIN TAB 500 MG
Tgl Lahir : 15-Oct-1961 ( 57 Thn 10 Bln 25 Hr ) E11.9 - Non-insulin-dependent diabetes
No. RM : 01-078951 BPJS : 0000039735279 mellitus without complications
VITAMIN B KOMPLEKS
LAY LIE TJENG, NY (P) APT GD.NIAS RESIDENCE CRUISSANT E10.9 - Insulin-dependent diabetes mellitus RUJUKAN
4.6 without complications
Tgl Lahir : 15-Sep-1956 ( 62 Thn 11 Bln 25 Hr ) I51.7 - Cardiomegaly
33
No. RM : 01-003375 NIK : 9109015509560003
VIONA VINIVERA (P) JL. PELEPAH ELOK 9 Q F2 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
34 NIK : - SETIRIZIN 10MG
2019-09-09 13:37 Hal. 698 dari 1322

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VIONA VINIVERA (P) JL. PELEPAH ELOK 9 Q F2 J06.9 - Acute upper respiratory infection,
unspecified
35 NIK : -
No. RM : 01-086358 BPJS : 0001796057651
AZRA AULIA (P) JL. RAWA INDAH 003/003 R50.9 - Fever, unspecified

36 NIK : 3172066912121001
No. RM : 01-019630 BPJS : 0001442325835
NAUFAL SIDQI , AN (L) PEGANGSAAN DUA J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 08-Nov-2013 ( 5 Thn 10 Bln 1 Hr ) AMBROKSOL TAB 30 MG
37 NIK : -
DEKSAMETASON 0,5 MG
NY ERMIYATI PRIJONO (P) JL GIRO T/20 E78.5 - Hyperlipidaemia, unspecified SIMVASTATIN 20 MG
E79.0 - Hyperuricaemia without signs of ALOPURINOL 100 MG
38 NIK : 3172067010530001 inflammatory arthritis and tophaceous ASAM ASETILSALISILAT 80 mg
No. RM : 01-006414 BPJS : 0001833944703 disease (ASETOSAL)
HUSNANI HUSEIN, NY (P) JL. PERMATA HARAPAN BARU C3/8 I10 - Essential (primary) hypertension RUJUKAN (0114R030) RS PERTAMINA
003/014 BEKASI M13.99 - Arthritis, unspecified, unspecified AMLODIPIN 5 MG JAYA
39 site AMBROKSOL TAB 30 MG Orthopedi
Telah - (0) :
Diberikan
SETIRIZIN 10MG
MIKONAZOL KRIM 2 %
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 699 dari 1322

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LILY HOLILAH, NY (P) PERMATA HARAPAN BARU RT 3/14 I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
AMLODIPIN 5 MG
SUTINI (P) JL PULOMAS I B NO 20 C56 - Malignant neoplasm of ovary RUJUKAN (0114R030) RS PERTAMINA
JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 5
Kapasitas : 0
Jadwal : Senin : 11:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
ALEX KOENTJORO (L) JL.PULO MAS I B 20 RT10/12 JAKARTA H25.9 - Senile cataract, unspecified RUJUKAN (0114R030) RS PERTAMINA
TIMUR JAYA
(MAT) MATA - (65) Mata - (0)
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 11
Kapasitas : 0
Jadwal : Senin : 15:00 - 16:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 700 dari 1322

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NGADIMAN THENARA, TN (L) JANUR KUNING VIII WM I8 RT 6/16 K30 - Dyspepsia ANTASIDA DOEN
43 NIK : 3172060908490004 (ASETOSAL)
NURBIANTI (P) GADING RAYA IIRT01/05 I10 - Essential (primary) hypertension SETIRIZIN 10MG (0903R012) RS KARTIKA
N18.5 - CHRONIC KIDNEY DISEASE, AMLODIPIN 10 MG PULOMAS
44 NIK : 3172065601510002 STAGE 5 RUJUKAN Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
SUZE MARGO MANENGKEY, NY (P) KLP HIBRIDA III RB 7/4 K29.5 - Chronic gastritis, unspecified RUJUKAN (0903R012) RS KARTIKA
M13.99 - Arthritis, unspecified, unspecified PULOMAS
45 NIK : 317206600352001 site Penyakit Dalam :- (0)
Telah Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 701 dari 1322

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OCTARINA SUSANTO, NY (P) KELAPA PUAN TIMUR VI BLOK NB 7/29 I10 - Essential (primary) hypertension AMLODIPIN 5 MG (0905R003) RS PELABUHAN
I86.8 - Varicose veins of other specified sites RUJUKAN JAKARTA
(BTK) BTKV (BEDAH THORAX
46 NIK : 3172066210540003 KARDIOVASKULER)
No. RM : 01-008906 BPJS : 0001338179973 BTKV - :(0)
Faskes (0905R003) RS
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Senin : 08:00 - 10:30
TACC : Tanpa TACC

Alasan TACC :
NABA MARSUDI, TN (L) JL SENTOSA II NO.12 0011/010 J18.0 - Bronchopneumonia, unspecified AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
47 NIK : 3172061010480004 SETIRIZIN 10MG
No. RM : 01-042700 BPJS : 0001314541282
HENDRY KURNIAWAN (L) KELAPA NIAS VIII PA 23/16 RT 5/14 A09.9 - GASTROENTERITIS AND COLITIS RUJUKAN (0903R012) RS KARTIKA
OF UNSPECIFIED ORIGIN PULOMAS
Telah Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 09:00 - 12:00,
10:00 - 12:00;14:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 702 dari 1322

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DJOENG SUN THIAM (L) JL SUMANGGUNG II 8/2 M79.1 - Myalgia DEKSAMETASON 0,5 MG
ANTASIDA DOEN
ANTONY CAHYADI, TN (L) JL,KLP KOPYOR TMR II BG2/10 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK 50 MG
R51 - Headache SETIRIZIN 10MG
No. RM : 01-066128 BPJS : 0002295383207
J.C ROMPAS, TN (L) JL PASAR INPRES NO 54 RT 006/006 M54.5 - Low back pain NATRIUM DIKLOFENAK 50 MG
DEKSAMETASON 0,5 MG
SUSATIO WIDIASUHARDJA (L) JL GADING PUTIH RT 011/002 E11.9 - Non-insulin-dependent diabetes SETIRIZIN 10MG
No. RM : 01-029165 BPJS : 0001447591667 L50.0 - Allergic urticaria VITAMIN B KOMPLEKS
MURTI ASTUTI (P) GRIYA PRATAMA 4 BLOK 3 NO 20 Z00.0 - General medical examination

53 NIK : -
No. RM : 01-087207 BPJS : 0001388905288
PARADJIT SINGH (L) GADING GRIYA LESTARI BLK B2 NO.28 Z00.0 - General medical examination
C010/012
54
No. RM : 01-049681 NIK : -
R.TAMMY MAULANI (P) JLN KEPODANG BLOK 04 /2 RT 09/06 Z00.0 - General medical examination

55 NIK : 3172046404790022
No. RM : 01-008408 BPJS : 0001647226236
2019-09-09 13:37 Hal. 703 dari 1322

P : 021-45853300 F : 021-45853301
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SITI AMINAH (P) JL. PEGANGSAAN 2 Z00.0 - General medical examination

56 NIK : 3172064804550002
No. RM : 01-087275 BPJS : 0002135142731
DWI HENDRO WURYANTO, TN (L) JANUR KUNING XII W[ 1 N0 2 KLP Z00.8 - Other general examinations
GADING
57
No. RM : 01-076775 NIK : 3313112705570001
MEILARD SAMAD POIRE (L) JL SWASEMBADA BARAT 1/9 RT 18/9 Z01.7 - Laboratory examination

58 NIK : 6171012901510003
No. RM : 01-060751 BPJS : 0000026112846
SURMI, NY (P) HARAPAN III NO. 3 RT. 003/001 KGB M13.9 - Arthritis, unspecified RUJUKAN (0114R030) RS PERTAMINA
JAYA
Telah - (0) :
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Rabu : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
liem kung kik (L) GADING GRIYA RESIDENT BLOK A4 7 I63.9 - Cerebral infarction, unspecified RUJUKAN (0114R030) RS PERTAMINA
D JAYA
2019-09-09 13:37 Hal. 704 dari 1322

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BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
HELLY BACHTIAR (P) PERUM GREEN GARDEN C20/16 M13.0 - Polyarthritis, unspecified RUJUKAN (0114R030) RS PERTAMINA
M54.5 - Low back pain JAYA
61 NIK : 3172045403580003 Orthopedi
Telah - (0) :
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
SRI MARINTEN, NY (P) JL. INSPEKSI KALI SUNTER 003/004 I20.9 - Angina pectoris, unspecified RUJUKAN (0114R030) RS PERTAMINA
KLP GADING BARAT I51.7 - Cardiomegaly ISOSORBID DINITRAT 5 MG JAYA
(JAN) JANTUNG DAN
62 ASAM ASETILSALISILAT 80 mg PEMBULUH DARAH
No. RM : 01-066307 NIK : - (ASETOSAL) JANTUNG
Faskes DAN PEMBULUH
: (0114R030) RS
Tgl Diagnosis : 13 February 2019 9:02 AM BPJS : 0000378280192 AMLODIPIN 10 MG DARAH
PERTAMINA- (0) JAYA
PEMBERIAN OKSIGEN (O2) Alamat : JL. AHMAD YANI NO. 2
EKG BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 7
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00
2019-09-09 13:37 Hal. 705 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
H. MASNAH BT MUHAMMAD (P) RT 005/003 KP RAWA INDAH H26.4 - After-cataract RUJUKAN (0905R003) RS PELABUHAN
L50.0 - Allergic urticaria HIDROKORTISON KRIM 2,5 % JAKARTA
(MAT) MATA - (65) Mata - (0)
Telp : 021-4403026
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 08:00 - 16:00,
08:00 - 13:00
TACC : Tanpa TACC

Alasan TACC :
SANTY SIMODIREDJO, NY (P) JL JANUR KUNING III WH /1 B00.1 - Herpesviral vesicular dermatitis AMLODIPIN 10 MG
I10 - Essential (primary) hypertension ASIKLOVIR 400 MG
SUNIARSIH, NY (P) JL SENTOSA I NNO 10 RT 9/10 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
L30.9 - Dermatitis, unspecified SETIRIZIN 10MG
NURBAITI (P) JL INSPEKSI KALI SUNTER 010/004 H25.9 - Senile cataract, unspecified ANTASIDA DOEN (0905R004) RS ISLAM JKT
I10 - Essential (primary) hypertension AMLODIPIN 10 MG SUKAPURA
(MAT) MATA - (65) Mata - (0)
66 NIK : 31720665025410001 K30 - Dyspepsia VITAMIN B KOMPLEKS Telah Diberikan :
RUJUKAN
5
2019-09-09 13:37 Hal. 706 dari 1322

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Telp : 021-4400778
Kelas : C
Jumlah Rujukan : 1
Kapasitas : 0
Jadwal : Rabu : 09:00 - 13:00,
15:00 - 17:00
TACC : Tanpa TACC

Alasan TACC :
MEILARD SAMAD POIRE (L) JL SWASEMBADA BARAT 1/9 RT 18/9 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
Tgl Lahir : 29-Jan-1951 ( 68 Thn 7 Bln 11 Hr ) E78.5 - Hyperlipidaemia, unspecified
TAN SOEI HONG (P) JL GADING ELOK BARAT II CC I/8 RT E04.1 - Nontoxic single thyroid nodule RUJUKAN
08/012 E11.9 - Non-insulin-dependent diabetes
68 mellitus without complications
No. RM : 01-015191 NIK : 3171026204510002
SJAFRIDIANA, NY (P) JL.IMPORT II D/13 I10 - Essential (primary) hypertension AMLODIPIN 10 MG

M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
No. RM : 01-028902 BPJS : 0001805948807
DJONGGAR PASARIBU, TN (L) JL 104 BARAT NO 2 A RT 1/6 F20.9 - Schizophrenia, unspecified RUJUKAN

70 NIK : 3172020408380003
No. RM : 01-007784 BPJS : 000005131269
SOBARI (L) JL PULAU PENYENGAT II NO 42 I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS
71 NIK : 3172063101470004 unspecified AMLODIPIN 10 MG
2019-09-09 13:37 Hal. 707 dari 1322

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HANDAYANI HARTANTO, NY (P) PELEPAH INDAH RAYA BLOK LB 24/6 H40.9 - Glaucoma, unspecified NATRIUM DIKLOFENAK TAB 25 MG (0116R025) Rumah Sakit Firdaus
VITAMIN B KOMPLEKS (MAT) MATA - (65) Mata - (0)
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Rabu : 10:30 - 16:00
TACC : Tanpa TACC

Alasan TACC :
TJAN HERRIJANTA (L) JL HARPA 6 FE/17 I34.8 - Other nonrheumatic mitral valve RUJUKAN (0116R029) Rumah Sakit
disorders Hermina Podomoro
(BTK) BTKV (BEDAH THORAX
Tgl Lahir : 09-Sep-1947 ( 72 Thn 0 Bln 0 Hr ) I50.0 - Congestive heart failure
73 NIK : - KARDIOVASKULER)
No. RM : 01-087337 BPJS : 0002332714825 BTKV - :(0)
Faskes (0116R029) Rumah
BLOK E3 NO 2
Telp : 021-64049710
Kelas : C
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 17:00 - 20:00
TACC : Tanpa TACC

Alasan TACC :
ENNY, NY (P) KP.WARUNG JENGKOL 01/13 H25.9 - Senile cataract, unspecified NATRIUM DIKLOFENAK TAB 25 MG (0113R074) RS KHUSUS MATA
I10 - Essential (primary) hypertension VITAMIN B KOMPLEKS SMEC
(MAT) MATA - (65) Mata - (0)
74 NIK : 317206690640003 M79.1 - Myalgia KAPTOPRIL 12,5 MG Telah Diberikan :
Telp : 021-4714848
Kelas : C
2019-09-09 13:37 Hal. 708 dari 1322

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Jumlah Rujukan : 55
Kapasitas : 0
Jadwal : Rabu : 08:00 - 16:00,
08:00 - 16:00;08:00 - 16:00, 08:00
- 15:00;16:00 - 20:00, 16:00 -
20:00
TACC : Tanpa TACC

ANNA CHEN, NY (P) PGS INDAH BRT 2 B BLK O/32 M13.9 - Arthritis, unspecified NATRIUM DIKLOFENAK TAB 25 MG (0903R017) RS OMNI MEDICAL
S32.00 - Fracture of lumbar vertebra, closed DEKSAMETASON 0,5 MG CENTER
(BSY) BEDAH SARAF - (92)
75 NIK : 3172066412590007 ANTASIDA DOEN BEDAH
Telah SARAF :- (0)
Diberikan
No. RM : 01-017925 BPJS : 0000037313436 Faskes : (0903R017) RS OMNI
VITAMIN B KOMPLEKS
Tgl Diagnosis : 13 February 2019 10:22 AM RUJUKAN MEDICAL CENTER
Alamat : JL PULO MAS BARAT
AMLODIPIN 10 MG
VI NO 20
Telp : 021-29779999
Kelas : B
Jumlah Rujukan : 0
Kapasitas : 0
Jadwal : Rabu : 08:30 - 10:30
TACC : Tanpa TACC

Alasan TACC :
LEONIE MAGDALENA URIA, NY (P) TAMAN MODERN B5/22 I11.9 - Hypertensive heart disease without RUJUKAN (0903R012) RS KARTIKA
Tgl Lahir : 20-Jul-1949 ( 70 Thn 1 Bln 20 Hr ) K29.7 - Gastritis, unspecified
76 NIK : 3172066007490002 Penyakit
Telah Dalam :- (0)
Diberikan
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00,
14:00 - 17:00
TACC : Tanpa TACC
2019-09-09 13:37 Hal. 709 dari 1322

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Alasan TACC :
ROIDA SIJABAT (P) P.GEBANG 15/04 H33.5 - Other retinal detachments RUJUKAN
RUJUKAN
77 NIK : 1217085007570001
No. RM : 01-054370 BPJS : 0001338134681
ASMAWATY, NY (P) RAWA INDAH 06/03 J18.0 - Bronchopneumonia, unspecified AMOKSISILIN 500 MG
AMBROKSOL TAB 30 MG
78 NIK : 3172066308880001
No. RM : 01-053680 BPJS : 0000378852254
HENDRO SUSANTO (L) JL HIBRIDA RAYA G1/8 I25.9 - Chronic ischaemic heart disease, RUJUKAN (0116R027) Rumah Sakit
unspecified Mulyasari
(JAN) JANTUNG DAN
79 NIK : - PEMBULUH
Telah DARAH
Diberikan : - (89)
Sakit - (0)
Mulyasari
Semper No.19
Telp : 021-43931111
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 09:00 - 12:00
TACC : Tanpa TACC

Alasan TACC :
MARTINUS SABAT, TN (L) JL RW SENGON Z01.9 - Special examination, unspecified

80 NIK : 3172060510801002
No. RM : 01-079769 BPJS : 0002041710276
2019-09-09 13:37 Hal. 710 dari 1322

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LULU THRESIA MAHARANI (P) TEGAL YOSO, BABADAN RT 003 J06.9 - Acute upper respiratory infection, DOKTER UMUM
NYAMIANTO (L) JL. PERINTIS KEMERDEKAAN J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
P.GADUNG PARASETAMOL TAB 500 MG
No. RM : 01-087369 NIK : - VITAMIN B KOMPLEKS
MG
IMAM MAULANA (L) PGS II RT 02/02 J02.9 - Acute pharyngitis, unspecified PARASETAMOL TAB 500 MG
VITAMIN B KOMPLEKS
NUGROHO EKO SAPUTRA S (L) KP PINTU AIR R05 - Cough RANITIDIN 150 MG
No. RM : 01-087349 BPJS : 0001157243231 MG
CICILIA NINDY AGUSTIN, AN (P) JL KETUK TILU BLOK R NO 26 J06.9 - Acute upper respiratory infection, GLISERIL GUAIAKOLAT (GG) 100 MG
85 NIK : - MG
Tgl Diagnosis : 13 February 2019 2:27 PM PARASETAMOL SYR 120 MG/5 ML
DOKTER UMUM
MARIA JACINTA SANI, NY (P) GGL BLOK B III /44 RT 10/12 M79.24 - Neuralgia and neuritis, unspecified, RUJUKAN (0114R030) RS PERTAMINA
hand JAYA
BY PASS
Telp : 0214211913
2019-09-09 13:37 Hal. 711 dari 1322

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Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Rabu : 10:00 - 11:00,
16:30 - 17:30
TACC : Tanpa TACC

Alasan TACC :
JUSNIAR SIALLAGAN (L) PUSKESMAS KEC.KELAPA GADING J06.9 - Acute upper respiratory infection, AMBROKSOL SYR 15MG/5ML 60 ML
No. RM : 01-020956 BPJS : 0000041700701 MG
ZINC 20 MG
MULTIVITAMIN DEWASA
EVA ARITONANG (P) JL DANAU INDAH RAYA II BLOK AB NO J06.9 - Acute upper respiratory infection, LORATADIN 10 MG
CANTIK EVLIN NAINGGOLAN (P) JL.DANAU INDAH RAYA II BLOK 1/08 J06.9 - Acute upper respiratory infection, KLORFENIRAMIN MALEAT (CTM) TAB 4
unspecified MG
Tgl Lahir : 07-Jul-2012 ( 7 Thn 2 Bln 2 Hr ) AMBROKSOL TAB 30 MG
89 NIK : 3273032004120005
MAARTJE JOHANNA TR, NY (P) JL BONGO IV J/3 0004/008 PGS II H33.0 - Retinal detachment with retinal RUJUKAN (0903R012) RS KARTIKA
break RUJUKAN PULOMAS
(MAT) MATA - (65) Mata - (0)
BLOK K NO.2
Telp : 021-4703333
Kelas : C
Jumlah Rujukan : 3
Kapasitas : 0
Jadwal : Selasa : 14:00 - 16:00
2019-09-09 13:37 Hal. 712 dari 1322

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TACC : Tanpa TACC

Alasan TACC :
PADMA, TN (L) BLOK AMPERA RT 005/009 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications KAPTOPRIL 25 MG
91 NIK : 3210132904530021 LORATADIN 10 MG
No. RM : 01-075106 BPJS : 0002611331166 J06.9 - Acute upper respiratory infection, ASAM ASKORBAT (VITAMIN C) 50 MG
Tgl Diagnosis : 19 February 2019 1:56 PM unspecified
JONG LILIS ILIAWATY, NY (P) APT GADIG NIAS 002/003 E11.9 - Non-insulin-dependent diabetes GLIBENKLAMIDA 5 MG
Tgl Lahir : 22-Feb-1942 ( 77 Thn 6 Bln 18 Hr ) M13.9 - Arthritis, unspecified
TJANDRA HARTOJO, TN (L) APT GADING NIAS RECIDENCE002/003 I10 - Essential (primary) hypertension LORATADIN 10 MG
No. RM : 01-003028 BPJS : 0001462651255 BEDAK SALISIL 2 %
ARIES PRIHADI (L) GADING INDAH UTARA III NH 4/17 I25.1 - Atherosclerotic heart disease RUJUKAN (0116R021) Royal Progress
(JAN) JANTUNG DAN
Faskes DAN PEMBULUH
: (0116R021) Royal
Progress- (0)
UTARA
Telp : 021-6400261
Kelas : B
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Selasa : 09:00 - 12:00,
09:30 - 18:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 713 dari 1322

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SURYANI SETIAWAN (P) JL KLP CENGKIR BRT I FH 1/21 M13.9 - Arthritis, unspecified DEKSAMETASON 0,5 MG
95 NIK : 3172061001 RANITIDIN 150 MG
No. RM : 01-032463 BPJS : 0000038815716
TRIAWAN AHMATIBRATA, TN (L) PUTIH SALJU RT 16/10 B00.9 - Herpesviral infection, unspecified

96 NIK : 3172061008890003
No. RM : 05-001852 BPJS : 0002099162834
SAUW CHRISTINA (P) JL PERMATA BIRU II BLK III NO.11 E11.9 - Non-insulin-dependent diabetes AMLODIPIN 10 MG
No. RM : 01-021598 NIK : 3172065607590002 GLIBENKLAMIDA 5 MG
AMBROKSOL TAB 30 MG
LORATADIN 10 MG
SAUW KIM LAN (P) JL. GADING NIAS EMERLAD BLK 9RG E11.9 - Non-insulin-dependent diabetes RUJUKAN (0116R025) Rumah Sakit Firdaus
mellitus without complications GLISERIL GUAIAKOLAT (GG) 100 MG (INT) PENYAKIT DALAM - (3)
Tgl Lahir : 17-Dec-1957 ( 61 Thn 8 Bln 23 Hr ) I64 - Stroke, not specified as haemorrhage
Telah Diberikan
No. RM : 01-021599 BPJS : 0001458353114 or infarction Faskes : (0116R025) Rumah
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 6
Kapasitas : 0
Jadwal : Selasa : 09:00 - 13:00,
16:00 - 18:00;18:00 - 21:00
TACC : Tanpa TACC

Alasan TACC :
DRG. DINI INDRAWATI, NY (P) JL BAMBU DURI XI NO 8 RT 12 / 6 R05 - Cough LORATADIN 10 MG
AMBROKSOL TAB 30 MG
99 NIK : 3175074605690003 CEFIXIME
No. RM : 01-016748 BPJS : 0000041679786
2019-09-09 13:37 Hal. 714 dari 1322

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JANTO MARDISO, TN (L) JL. RAYA KKLP GADING PERMAI BLKO Z03.0 - Observation for suspected
AB NO 3 tuberculosis
100
No. RM : 01-088013 NIK : 3172060402670003
MOONA JYOTSNA RAVINDRA, NY (P) JL WALANG TIMUR III 009/012 Z03.0 - Observation for suspected
tuberculosis
101 NIK : 3171035305500003
No. RM : 01-021066 BPJS : 0001325482626
PANCA AGUNG WIDODO (L) JL.NURI A.2/5 Z03.0 - Observation for suspected
tuberculosis
102 NIK : 3172030802820010
No. RM : 01-048354 BPJS : 0001228920737
PRISMAWATI (P) PLASA PACIFIC K3 NO.71 M79.1 - Myalgia NATRIUM DIKLOFENAK TAB 25 MG
DEKSAMETASON 0,5 MG
103 NIK : 3173055404840004 RANITIDIN 150 MG
Tgl Diagnosis : 21 February 2019 8:15 AM ALOPURINOL 100 MG
ANDI KHRISTIANTO (L) APT CITY HOME GRV TWR SFB E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications AMOKSISILIN 500 MG
DJUMIATIN, NY (P) JL PENYENGAT IV NO.5 003/003 KGB E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
Tgl Lahir : 16-Nov-1948 ( 70 Thn 9 Bln 24 Hr ) E78.5 - Hyperlipidaemia, unspecified
105 NIK : 3172065611480001 RUJUKAN Penyakit Dalam :- (0)
Telah Diberikan
No. RM : 01-005583 BPJS : 0000046005489 E79.0 - Hyperuricaemia without signs of Faskes : (0114R030) RS
Tgl Diagnosis : 21 February 2019 9:49 AM inflammatory arthritis and tophaceous PERTAMINA JAYA
ALOPURINOL 100 MG
disease Alamat : JL. AHMAD YANI NO. 2
BY PASS
I51.7 - Cardiomegaly ASAM ASETILSALISILAT 80 mg Telp : 0214211913
(ASETOSAL) Kelas : C
AMLODIPIN 10 MG Cabang : JAKARTA PUSAT
RUJUKAN Jumlah Rujukan : 10
Kapasitas : 0
2019-09-09 13:37 Hal. 715 dari 1322

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Jadwal : Kamis : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
DUWARI (L) JL. PULAU PENYENGAT IV NO. 5 E78.5 - Hyperlipidaemia, unspecified AMLODIPIN 10 MG (0114R030) RS PERTAMINA
E79.0 - Hyperuricaemia without signs of ALOPURINOL 100 MG JAYA
(JAN) JANTUNG DAN
106 NIK : 3172061004410003 inflammatory arthritis and tophaceous SIMVASTATIN 20 MG PEMBULUH
Telah DARAH
Diberikan : - (89)
No. RM : 01-087918 BPJS : 0000046005478 disease JANTUNG DAN PEMBULUH
RUJUKAN
Tgl Diagnosis : 21 February 2019 9:54 AM H61.2 - Impacted cerumen DARAH - (0) JAYA
PERTAMINA
I10 - Essential (primary) hypertension Alamat : JL. AHMAD YANI NO. 2
R00.1 - Bradycardia, unspecified BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 9
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00,
10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
MASNIAR, NY (P) TMN PGS INDAH BLOK D/2 RT 1/19 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
mellitus without complications AMOKSISILIN 500 MG
Tgl Lahir : 17-Dec-1949 ( 69 Thn 8 Bln 23 Hr ) J18.0 - Bronchopneumonia, unspecified
107 NIK : 3172065712490004 LORATADIN 10 MG
H ABDUL RAUP (L) JL. WARUNG JENGKOL NO. 20 E11.9 - Non-insulin-dependent diabetes RUJUKAN
mellitus without complications RETRIBUSI KLINIK UMUM
No. RM : 01-087790 BPJS : 0001808065967 I10 - Essential (primary) hypertension METFORMIN TAB 500 MG
Tgl Diagnosis : 21 February 2019 11:11 AM N18.9 - Chronic renal failure, unspecified GLIBENKLAMIDA 5 MG
ALOPURINOL 100 MG
RUJUKAN
RUJUKAN
AMLODIPIN 10 MG
2019-09-09 13:37 Hal. 716 dari 1322

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SUMIYATI, NY (P) JL. WARUNG JENGKOL NO. 20 E11.9 - Non-insulin-dependent diabetes METFORMIN TAB 500 MG
No. RM : 01-087789 BPJS : 0001792702102 E79.0 - Hyperuricaemia without signs of SIMVASTATIN 20 MG
Tgl Diagnosis : 21 February 2019 11:13 AM inflammatory arthritis and tophaceous
RETRIBUSI KLINIK UMUM
disease
110
No. RM : 01-075196 NIK : 3172040611770015
H ABDUL RAUP (L) JL. WARUNG JENGKOL NO. 20 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
111 NIK : 3172060508530001 RUJUKAN Penyakit Dalam :- (0)
Telah Diberikan
No. RM : 01-087790 BPJS : 0001808065967 I10 - Essential (primary) hypertension Faskes : (0114R030) RS
RUJUKAN
Tgl Diagnosis : 21 February 2019 11:19 AM N18.9 - Chronic renal failure, unspecified PERTAMINA JAYA
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Kamis : 10:00 - 11:00
TACC : Tanpa TACC

Alasan TACC :
JUMINTEN, NY (P) PGS II RT 5/2 E11.9 - Non-insulin-dependent diabetes LORATADIN 10 MG
mellitus without complications AMBROKSOL TAB 30 MG
112 NIK : 3172065111790006
No. RM : 01-019469 BPJS : 0001328729455 Z03.0 - Observation for suspected
Tgl Diagnosis : 21 February 2019 11:23 AM tuberculosis
BUDIYANI, NY (P) JL KP RAWA INDAH RT 002/003 Z03.0 - Observation for suspected

tuberculosis
113 NIK : 3673054611880002
No. RM : 01-088009 BPJS : 0002332879626
2019-09-09 13:37 Hal. 717 dari 1322

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ANISSA RAHMALYA, NN (P) JL MUNDARI RT 05/02 NO 8 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
AMBROKSOL TAB 30 MG
TUHFATUL MUHTAZIRRIDHONI, TN (L) BLOK JATI CININI A15.0 - Tuberculosis of lung, confirmed by RETRIBUSI KLINIK PARU
sputum microscopy with or without culture OAT KAT. I (FASE AWAL)
MCG
AMBROKSOL TAB 30 MG
DURIAH (P) JL RW SNEGON RT 5/22 Z03.0 - Observation for suspected
tuberculosis
116 NIK : -
No. RM : 01-063965 BPJS : 0000377435057
TIRZA AMELIA LONGKUTOY, NY (P) JL. MELODI MAS RAYA A-8/1 RT Z03.0 - Observation for suspected AMOKSISILIN 500 MG
013/007 tuberculosis AMBROKSOL TAB 30 MG
117 LORATADIN 10 MG
No. RM : 01-016589 NIK : 3172065611700003
118
No. RM : 01-075196 NIK : 3172040611770015
TAUFIK HIDAYAT (L) RAWA INDAH 07/03 Z03.0 - Observation for suspected
tuberculosis
119 NIK : 3172061304930003
No. RM : 01-057519 BPJS : 0001225402907
2019-09-09 13:37 Hal. 718 dari 1322

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KRESNO HAJI (L) RW SENGON RT 7/22 RT 16/2 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
sputum microscopy with or without culture GLISERIL GUAIAKOLAT (GG) 100 MG
No. RM : 01-004408 BPJS : 0001816151758 MG
DHARMADI SUPANDI (L) SUMMAGUNG III X 2/3 RT 13/19 A15.3 - Tuberculosis of lung, confirmed by RUJUKAN
unspecified means
121 NIK : 3172060311540005
No. RM : 01-042286 BPJS : 0001389853012
MARIATIE (P) JL SUMAGUNG III X2/3 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE LANJUTAN)
No. RM : 01-078214 BPJS : 0001389853405
YOLANDA SOFTJE JACOBUS, NY (P) JL RAWA SENGON BLOK H RT 08/22 Z00.8 - Other general examinations

123 NIK : 31720543127900004
No. RM : 01-008530 BPJS : 0001426254153
SITI RAHAYU, NY (P) JL TEGUH IV NO 32 RT 06./01 E11.9 - Non-insulin-dependent diabetes RUJUKAN (0114R030) RS PERTAMINA
124 NIK : 317206503490002 Penyakit
Telah Dalam :- (0)
Diberikan
BY PASS
Telp : 0214211913
Kelas : C
Jumlah Rujukan : 10
Kapasitas : 0
Jadwal : Senin : 10:00 - 11:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 719 dari 1322

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NAISA ESTERIA GULTOM, NY (P) JL PRIHATIN NO 71 J18.0 - Bronchopneumonia, unspecified NATRIUM DIKLOFENAK TAB 25 MG
SIMVASTATIN 20 MG
DJUMIYAH, NY (P) GADING RAYA I NO.3 001/005 B00.9 - Herpesviral infection, unspecified ASIKLOVIR 400 MG
ASIKLOVIR KRIM 5%
MCG
MARDURUM SIAHAAN, TN (L) INSPEKSI KALI SUNTER 09/04 A15.0 - Tuberculosis of lung, confirmed by ALOPURINOL 100 MG
sputum microscopy with or without culture OAT KAT. I (FASE AWAL)
Tgl Lahir : 15-Oct-1961 ( 57 Thn 10 Bln 25 Hr ) E79.0 - Hyperuricaemia without signs of
No. RM : 01-078951 BPJS : 0000039735279 inflammatory arthritis and tophaceous
disease
MCG
RADITYA PUTRA, TN (L) JL. KELAPA MOLEK 6 BLOK Z1 NO. 2 A15.0 - Tuberculosis of lung, confirmed by OAT KAT. I (FASE AWAL)
ANTASIDA DOEN
129
No. RM : 01-075196 NIK : 3172040611770015
TJITJI SURJANI SADJAJA, NY (P) BUKIT GADING MEDITRANIA BN 15 T14.70 - Crush injury and traumatic NATRIUM DIKLOFENAK TAB 25 MG (0114R030) RS PERTAMINA
11/11 amputation of unspec body region, closed RUJUKAN JAYA
130 RUJUKAN Orthopedi - (0) :
Telah Diberikan
RUJUKAN
BY PASS
Telp : 0214211913
2019-09-09 13:37 Hal. 720 dari 1322

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Kelas : C
Jumlah Rujukan : 4
Kapasitas : 0
Jadwal : Senin : 09:00 - 10:00,
13:00 - 14:00
TACC : Tanpa TACC

Alasan TACC :
HABIBAH (P) JL P NANGKA BARAT II RT 7/16 I10 - Essential (primary) hypertension ZINC 20 MG
K29.7 - Gastritis, unspecified AMLODIPIN 10 MG
131 NIK : 3175025004580002 RANITIDIN 150 MG
MCG
BUDI HARTONO, TN (L) GD GRIYA LETARI BLOK G 2 RT I10 - Essential (primary) hypertension TIAMIN (VITAMIN B1) 50 MG
004/009 PIRIDOKSIN (VITAMIN B6) 10 MG
No. RM : 01-017333 NIK : 3172041007550004 MCG
SITI UMI HANI, NY (P) JL RAWA SENGON BLOK H RT 008/022 A30.9 - Leprosy, unspecified TIAMIN (VITAMIN B1) 50 MG
No. RM : 01-027228 BPJS : 0002332860142 MCG
Tgl Diagnosis : 25 February 2019 11:34 AM PREDNISON 5 MG
SUSILAWATI (P) JL. P. KECIL NO 4 A SUNTER Z03.0 - Observation for suspected
tuberculosis
134 NIK : -
No. RM : 01-088456 BPJS : 0000343963809
2019-09-09 13:37 Hal. 721 dari 1322

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HJ. SAODAH, S.SOS. (P) JL HIJAU DAUN D 7 NO 22 Z03.0 - Observation for suspected
tuberculosis
135 NIK : 3172061001
No. RM : 03-001114 BPJS : 0000041599282
LASMINI, NY (P) JL HIJAU DAUN BLK D7 NO.22 Z03.0 - Observation for suspected
tuberculosis
136 NIK : 3172064412481001
No. RM : 01-084745 BPJS : 0001223986724
ANTONI RIDWAN (L) JL PGS II 003/004 Z03.0 - Observation for suspected
tuberculosis
137 NIK : 3172063005750011
No. RM : 01-026658 BPJS : 0000378151536
DODOK MULYANI, NY (P) JANUR ELOK VI QJ 12 NO 9 I10 - Essential (primary) hypertension HIDROKLORTIAZID 25 MG
L30.9 - Dermatitis, unspecified VITAMIN B KOMPLEKS
No. RM : 01-003100 BPJS : 0001256800252
IFA FITRI JENNY (P) JL.MUSIK RAYA B/23 M13.9 - Arthritis, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
RUJUKAN (ORT) ORTHOPEDI - (93)
139 NIK : 3172066703490002 Orthopedi - (0) :
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
2019-09-09 13:37 Hal. 722 dari 1322

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OET JIN TATANG (L) JL.MUSIK RAYA B/23 M13.9 - Arthritis, unspecified RUJUKAN (0116R025) Rumah Sakit Firdaus
140 NIK : 3172061007440001 Orthopedi - (0) :
Telah Diberikan
KOMP.BEA CUKAI
Telp : 021-4407322
Kelas : C
Jumlah Rujukan : 2
Kapasitas : 0
Jadwal : Rabu : 13:00 - 15:00
TACC : Tanpa TACC

Alasan TACC :
DRG. DINI INDRAWATI, NY (P) JL BAMBU DURI XI NO 8 RT 12 / 6 R05 - Cough

141 NIK : 3175074605690003
No. RM : 01-016748 BPJS : 0000041679786
SUKIAT ADHI SURYA (L) PERMATA BIRU 1. I-3 N O 1 RT 2/002 J06.9 - Acute upper respiratory infection, SETIRIZIN 10MG
No. RM : 01-000161 BPJS : 0001439279245
ESTHER SETIADI (P) JL PAKARENA BLOK S NO 9 RT 7/1 I10 - Essential (primary) hypertension SETIRIZIN 10MG
AMLODIPIN 10 MG
RUTH SUPRAPTI, NY (P) JL HARAPAN II NO 10 H25.9 - Senile cataract, unspecified RUJUKAN
RUJUKAN
144 NIK : 3172066105520003 RUJUKAN
2019-09-09 13:37 Hal. 723 dari 1322

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JUSNIAR SIALLAGAN (L) PUSKESMAS KEC.KELAPA GADING H61.2 - Impacted cerumen KLORAMFENIKOL TT 3%

145 NIK : 3172020501700013
No. RM : 01-020956 BPJS : 0000041700701
TINI HARTINI (P) JL MERAH DELIMA B 3 NO 8 Z00.0 - General medical examination RETRIBUSI KLINIK UMUM

146 NIK : 3172061001
No. RM : 03-000370 BPJS : 0000046164082
LINA YOSIANA (P) KELAPA P-UAN TIMUR II NB.3/34 I88.8 - Other nonspecific lymphadenitis GLISERIL GUAIAKOLAT (GG) 100 MG
147 NIK : 3172065112470001
No. RM : 01-064323 BPJS : 0001384348026
WONG OI JUNG (P) GADING NIRWANA BLOK PF 2/9 RT H40.0 - Glaucoma suspect AMOKSISILIN 500 MG
08/23 J06.9 - Acute upper respiratory infection, OBH SIRUP 100 ML
148 unspecified VITAMIN B KOMPLEKS
No. RM : 01-016685 NIK : 3172066901510002 RUJUKAN
SITI AMINAH (P) JL. PEGANGSAAN 2 I10 - Essential (primary) hypertension NATRIUM DIKLOFENAK TAB 25 MG
M13.9 - Arthritis, unspecified VITAMIN B KOMPLEKS
149 NIK : 3172064804550002
No. RM : 01-087275 BPJS : 0002135142731
LOK TJHU HIONG SURYANI (P) JL KLP PUAN TMR 1 NE 1/29 RT E11.9 - Non-insulin-dependent diabetes ASAM ASKORBAT (VITAMIN C) 50 MG
008/012 mellitus without complications DOKTER UMUM
Tgl Lahir : 05-Sep-1945 ( 74 Thn 0 Bln 4 Hr ) E78.5 - Hyperlipidaemia, unspecified
No. RM : 01-016899 NIK : 3172064509450002 SIMVASTATIN 20 MG
GLIBENKLAMIDA 5 MG
AMLODIPIN 10 MG
SETIRIZIN 10MG
VITAMIN B KOMPLEKS
2019-09-09 13:37 Hal. 724 dari 1322

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HJ. SAODAH, S.SOS. (P) JL HIJAU DAUN D 7 NO 22 Z00.0 - General medical examination

151 NIK : 3172061001
No. RM : 03-001114 BPJS : 0000041599282
HJ. SAODAH, S.SOS. (P) JL HIJAU DAUN D 7 NO 22 Z00.0 - General medical examination

152 NIK : 3172061001
No. RM : 03-001114 BPJS : 0000041599282
EFFENDY BENEDICTUS HARDI (L) JL.TARUMANEGARA I.7/6 Z00.0 - General medical examination

153 NIK : 3172042711550001
No. RM : 01-037184 BPJS : 0001603113388
DWI HENDRO WURYANTO, TN (L) JANUR KUNING XII W[ 1 N0 2 KLP Z11.1 - Special screening examination for RETRIBUSI KLINIK LANSIA
GADING respiratory tuberculosis
154
No. RM : 01-076775 NIK : 3313112705570001
TINI HARTINI (P) JL MERAH DELIMA B 3 NO 8 Z03.0 - Observation for suspected

tuberculosis
155 NIK : 3172061001
No. RM : 03-000370 BPJS : 0000046164082
LASMINI, NY (P) JL HIJAU DAUN BLK D7 NO.22 Z00.0 - General medical examination

156 NIK : 3172064412481001
No. RM : 01-084745 BPJS : 0001223986724
IMELDA KHOO (P) JL IMPOR 1 BLOK E NO 25 RT 08/10 Z00.0 - General medical examination RETRIBUSI KLINIK LANSIA

157 NIK : 1111135505570001
No. RM : 01-053384 BPJS : 0001122543393
2019-09-09 13:37 Hal. 725 dari 1322

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tuberculosis
158 NIK : 3172064412481001
No. RM : 01-084745 BPJS : 0001223986724
tuberculosis
159 NIK : 3172064412481001
No. RM : 01-084745 BPJS : 0001223986724
160
No. RM : 01-075196 NIK : 3172040611770015
TINI HARTINI (P) JL MERAH DELIMA B 3 NO 8 Z11.1 - Special screening examination for
respiratory tuberculosis
161 NIK : 3172061001
No. RM : 03-000370 BPJS : 0000046164082
LINA YOSIANA (P) KELAPA P-UAN TIMUR II NB.3/34 L04.9 - Acute lymphadenitis, unspecified

162 NIK : 3172065112470001
No. RM : 01-064323 BPJS : 0001384348026
dr. Retno Ayu Wulandari

ANI SYAFITRI, NY (P) PUSKESMAS KEC.KELAPA GADING J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
1 NIK : NULL DEKSAMETASON 0,5 MG
No. RM : 01-065173 BPJS : 0001153471781
2019-09-09 13:37 Hal. 726 dari 1322

P : 021-45853300 F : 021-45853301
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FARHAN MAULANA, AN (L) JL PEGANGSAAN DUA RT 01/02 J06.9 - Acute upper respiratory infection, AMOKSISILIN SYR KERING 125 MG/5ML
No. RM : 04-000034 BPJS : 0002354314509 MG
BERLYANA AUREL WIDJAJA, AN (P) JL JANUR KUN9ING I1 WG 2/8 RT 07/15 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-005976 BPJS : 0001225683674
NURLIA ERVANI, NY (P) JL. MAHONI II BLK E LAGOA KOJA J02.9 - Acute pharyngitis, unspecified AMOKSISILIN 500 MG
MULTIVITAMIN DEWASA
LORATADIN 10 MG
MUHAMMAD MARYADI NUR, TN (L) JL. MELATI J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
TIARA NUR CAHYATI, AN (P) JL PGS II J00 - Acute nasopharyngitis [common cold] PARASETAMOL TAB 500 MG
SITI MASTUROH, NY (P) JL. PERINTIS KEMERDEKAAN II NO. 90 L08.9 - Local infection of skin and PARASETAMOL TAB 500 MG
subcutaneous tissue, unspecified KLORFENIRAMIN MALEAT (CTM) TAB 4
7 NIK : 3172066005560005 MG
2019-09-09 13:37 Hal. 727 dari 1322

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NURJATI, NY (P) GADING INDAH UTR 4 NH7/12 023/012 K30 - Dyspepsia DEKSAMETASON 0,5 MG
PGS II RANITIDIN 150 MG
AGATHA FEBRIANA PALIPA DATON, AN (P) PEGANGSAAN DUA RT 01/04 J45.9 - Asthma, unspecified DEKSAMETASON 0,5 MG
9 NIK : 3175060711141027 MG
INHALASI (UGD)
SUGIHARTO KARIM, TN (L) SUMANGGUNG II C/2 J06.9 - Acute upper respiratory infection, AMLODIPIN 5 MG
VAREL SYAHPUTRA, AN (L) PGS II RT 004/01 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
11 NIK : 3172061812170002 MG
No. RM : 01-059332 BPJS : 0002143678781
KENDRICK HAPOSAN SITUMORANG, AN (L) RW SENGON RT 05/22 NO 1 KGB J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
12 NIK : 3172061209131034 MG
RAFKA RAFASSYA, AN (L) JL.TEGUH VII NO.86 R50.9 - Fever, unspecified AMBROKSOL TAB 30 MG
13 NIK : 3172062408170001 MG
Tgl Diagnosis : 03 February 2019 9:48 AM AMOKSISILIN SYR KERING 125 MG/5ML
2019-09-09 13:37 Hal. 728 dari 1322

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QINARA ARSYLA TIRTA, AN (P) JL. PERINTIS KEMERDEKAAAN NO. 42 R50.9 - Fever, unspecified

14 NIK : 3172064401180005
No. RM : 01-085967 BPJS : 0002326935688
ERNEST EMMANUEL, TN (L) PEGANGSAAN INDAH BARAT II OK/12 R50.9 - Fever, unspecified AMOKSISILIN 500 MG
DEKSAMETASON 0,5 MG
ROSMADELI SIHOMBING, NY (P) JL RAWA SENGON RT 005/022 K30 - Dyspepsia PARASETAMOL TAB 500 MG
R50.9 - Fever, unspecified RANITIDIN 150 MG
No. RM : 01-016208 BPJS : 0001634803648 MCG
NATALIA KRISTINA, AN (P) RAWA SENGON RT 05/022 J06.9 - Acute upper respiratory infection, RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-038078 BPJS : 0002235253048 MG
FAISOL HADI, TN (L) MUTIH KULON K02.1 - Caries of dentine AMOKSISILIN 500 MG
No. RM : 01-086458 BPJS : 0000601437339
LIANAWATI, NY (P) JL KINTAMANI I/48 I10 - Essential (primary) hypertension PARASETAMOL TAB 500 MG
N39.8 - Other specified disorders of urinary AMLODIPIN 10 MG
19 NIK : 3172064711550006 system
No. RM : 01-049140 BPJS : 0002262496206
2019-09-09 13:37 Hal. 729 dari 1322

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AIDIL ARIF HIDAYAH, AN (L) JL AGUNG UTARA 6D J02.9 - Acute pharyngitis, unspecified DEKSAMETASON 0,5 MG
TAN RIHANNA DHEA, AN (P) GADING ICON B.18/18 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
21 NIK : 3173036101170002 MG
SUPRIYANTI, NY (P) RAWA INDAH RT 4/3 K05.1 - Chronic gingivitis RETRIBUSI LAYANAN SIAGA 24 JAM
22 NIK : 3172035412931001 RANITIDIN 150 MG
GABRIELA HANA DETASYA, AN (P) APT GADING NIAS RESIDENCES RT J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
23 MG
HENDRO SUBROTO,TN (L) PERUM PTI KHUSUS J2/10 RT 05/10 M13.9 - Arthritis, unspecified RETRIBUSI LAYANAN SIAGA 24 JAM
No. RM : 01-008794 BPJS : 0001744985981 MCG
MELIANA LIE, NY (P) JL SERAMPANG XII T/26 I10 - Essential (primary) hypertension SIANOKOBALAMIN (VITAMIN B12) 50
MCG
Tgl Lahir : 10-Sep-1972 ( 46 Thn 11 Bln 30 Hr ) NATRIUM DIKLOFENAK 50 MG
25 NIK : 3173035009720007
BUN SIE KHIONG, TN (L) JL SERAMPANG XII BLOK T NO.26 I10 - Essential (primary) hypertension AMLODIPIN 10 MG
26 NIK : 3173031309640005 MCG
No. RM : 01-084122 BPJS : 0002103983223
2019-09-09 13:37 Hal. 730 dari 1322

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SARA SEPTIASHA, AN (L) KELAPA PUAN TIMUR V NO. 51 J06.9 - Acute upper respiratory infection, AMBROKSOL TAB 30 MG
RUDIANTO ANWAR, TN (L) JL. KELAPA PUAN TIMUR V NB-6/51 J06.9 - Acute upper respiratory infection, AMOKSISILIN 500 MG
MUHAMMAD FARID AZIZ, AN (L) JL H OYAR RT 4/2 J06.9 - Acute upper respiratory infection, PARASETAMOL TAB 500 MG
No. RM : 01-003519 BPJS : 0001225142998 MG
KEVIN YONATHAN, TN (L) JL KRAMA BARU I NO 20 Z09.8 - Follow-up examination after other PERAWATAN LUKA RINGAN (UGD)
treatment for other conditions DEKSAMETASON 0,5 MG
No. RM : 01-042653 BPJS : 0000072004331
ALOYSIUS BONHAR SIHOTANG, TN (L) KP. PANGKALAN MAJALAYA H60.8 - Other otitis externa PARASETAMOL TAB 500

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PUSKESMAS KECAMATAN KELAPA GADING

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

2019-09-09 13:37 Hal. 1 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

2019-09-09 13:37 Hal. 2 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

Tgl Lahir : 29-Dec-2018 ( 0 Thn 8 Bln 11 Hr )

2019-09-09 13:37 Hal. 3 dari 1322

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2019-09-09 13:37 Hal. 4 dari 1322

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2019-09-09 13:37 Hal. 5 dari 1322

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2019-09-09 13:37 Hal. 6 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

Tgl Lahir : 02-Jan-2018 ( 1 Thn 8 Bln 7 Hr )

Tgl Lahir : 04-Aug-2018 ( 1 Thn 1 Bln 5 Hr )

2019-09-09 13:37 Hal. 7 dari 1322

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2019-09-09 13:37 Hal. 8 dari 1322

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2019-09-09 13:37 Hal. 9 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

Tgl Lahir : 26-Jun-2017 ( 2 Thn 2 Bln 14 Hr )

2019-09-09 13:37 Hal. 10 dari 1322

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2019-09-09 13:37 Hal. 11 dari 1322

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2019-09-09 13:37 Hal. 12 dari 1322

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2019-09-09 13:37 Hal. 13 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

DIAN APRIANI, NY (P) KEL. SUNTER JAYA Z30.9 - Contraceptive management,

2019-09-09 13:37 Hal. 14 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

2019-09-09 13:37 Hal. 15 dari 1322

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2019-09-09 13:37 Hal. 16 dari 1322

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2019-09-09 13:37 Hal. 17 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

Tgl Lahir : 21-Aug-1991 ( 28 Thn 0 Bln 19 Hr )

Tgl Lahir : 27-Sep-1987 ( 31 Thn 11 Bln 13 Hr )

2019-09-09 13:37 Hal. 18 dari 1322

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2019-09-09 13:37 Hal. 19 dari 1322

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SALAMAH, NY (P) JL. PULO NANGKA BARAT II O48 - Prolonged pregnancy

Tgl Lahir : 07-Aug-1990 ( 29 Thn 1 Bln 2 Hr )

2019-09-09 13:37 Hal. 20 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

YUNILAWATI, NY (P) JL RAWA INDAH NO 13 RT 07/03 Z34.9 - Supervision of normal pregnancy,

2019-09-09 13:37 Hal. 21 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

2019-09-09 13:37 Hal. 22 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

2019-09-09 13:37 Hal. 23 dari 1322

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2019-09-09 13:37 Hal. 24 dari 1322

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2019-09-09 13:37 Hal. 25 dari 1322

No Pasien Alamat / NIK / BPJS Diagnosis Terapi Rujukan

WANIARTI (P) KP PULO GADUNG O82.9 - Delivery by caesarean section,