Copy of Jamkes Januari 2012

8/16/2019 Copy of Jamkes Januari 2012

1/166

Page 1

REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM

UPT PUSKESMAS PALIMANAN KABUPATEN CIREBON

BULAN JANUARI 2011LOKASI SARANA : PUSKESMAS

NO TANGGAL NAMA PASIEN NO KARTU

UMUR KUNJUNGAN

ALAMAT DIAGNOSA UNITL P BARU LAMA KARCIS

1 2-1-2012 Sri Nayah 1161784934 38 Beberan J00 BP.Umum Rp 42 2-1-2012 Hamidah 1156249528 34 Lungbenda J025 BP.Umum Rp 43 2-1-2012 R!iah 1156192312 56 Panngan L30"9 BP.Umum Rp 44 - - #minah 1156305892 57 $ia%i &29 . mum p 5 - - 'ayina 1163371375 55 Pa()im Ru*u+an . mum p 6 2-1-2012 Rumina 1156320933 40 $eng+uang Ru*u+an BP.Umum Rp 47 2-1-2012 ,i%in 1161231546 41 Pegagan Ru*u+an BP.Umum Rp 48 2-1-2012 -u)i 1161239466 30 Pegagan Ru*u+an BP.Umum Rp 49 2-1-2012 Rna 1156284134 56 Beberan Ru*u+an BP.Umum Rp 410 - - .ryan) 1163359629 29 Pa()im Ru*u+an . mum p 11 - - Ri/an 1156320358 10 $eng+uang Ru*u+an . mum p 12 2-1-2012 Su!)i)in 1156316657 40 $eng+uang Ru*u+an BP.Umum Rp 413 2-1-2012 'ei 1163363433 11 Pa()im .09 BP.Umum Rp 414 2-1-2012 Rm(i 116777341 7 Beberan Ru*u+an BP.Umum Rp 415 - - nah 1163361047 44 Pa()im L30"9 . mum p 16 - - andi 1163361508 16 Pa()im Ru*u+an . mum p 17 2-1-2012 Syari 1161776621 12 Beberan Ru*u+an BP.Umum Rp 418 2-1-2012 R+i(a 1161803564 51 $eng+uang 79"1 BP.Umum Rp 419 2-1-2012 arini 1156275821 44 Beberan J029 BP.Umum Rp 420 2-1-2012 -i+a 1162694035 14 Beberan J00 BP.Umum Rp 421 - - Lingga 1162694046 12 Beberan J45 . mum p 22 - - gi - 1163694827 9 Beberan J029 . mum p 23 2-1-2012 ar+ad 1156301256 70 $ia%i 79"1 BP.Umum Rp 424 2-1-2012 Sri Muniarti 1161777339 28 Beberan A! "#A Rp 425 2-1-2012 Sunarti 1163360711 49 Pa(tim St+ "B "#A Rp 426 2-1-2012 R'+mina* 116274421 43 Beberan "08 Rp 427 - - em'n 1162768 36 Beberan p 28 2-1-2012 $ae(atu( 1161746878 6 Beberan "08 Rp 429 2-1-2012 Ri+i 1495-01"et2012 2 Beberan Ruu+an BP.Umum Rp 430 2-1-2012 niati 3793685-012012 36 $un/ben)a Ruu+an BP.Umum Rp 431 3-1-2012 (+ 1163379137 20 Lungbenda J00 BP.Umum Rp 432 - - .)mi 116220831 51 Pa()im 79"1 . mum p 33 - - #din 116283234 44 Beberan R50 . mum p 34 - - ni 116338303 61 -"&arang J00 . mum p 35 3-1-2012 a)im 116410730 27 Beberan J00 BP.Umum Rp 4


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UMUR KUNJUNGAN


36 - - din 116122011 24 Beberan 79"1 . mum p ,37 - - .rina 11621709 57 Pa()im Ru*u+an . mum p ,38 3-1-2012 Bei 1163201 58 $eng+uang 14 BP.Umum Rp 4,000

39 3-1-2012 Su+irman 116283842 48 Beberan J00 BP.Umum Rp 4,00040 - - arinah 1162849 45 Beberan Ru*u+an . mum p ,41 - - Ri+i ana 11633697 11 Pa()im J00 . mum p ,42 3-1-2012 .rina 116336964 50 Pa()im 79"1 BP.Umum Rp 4,00043 3-1-2012 .ri 11630307 31 $ia%i .06 BP.Umum Rp 4,00044 - - Ba+i 11628236 49 Beberan J00 . mum p ,45 - - Naiah 11620037 51 Lungbenda 14 . mum p ,46 3-1-2012 Su)ina 1161233144 53 Pegagan Ru*u+an BP.Umum Rp 4,00047 - - &u)ub 54 Lungbenda Ru*u+an . mum p ,48 - - 'arya)i 41 Pegagan H10 . mum p ,49 - - 5inar 116216 28 pa(tim t p ,50 3-1-2012 (i 1161718072 2 Beberan A! "#A Rp 4,00051 - - St.Umaa* 116177192 22 Pe/a/an A! p ,52 - - ubae)a* 11629488 27 Beberan A! p ,53 - - Mutini 1162891877 21 !en/+uan/ A! p ,54 3-1-2012 #+a 116121071 29 $un/ben)a A! "#A Rp 4,00055 - - $e*a 1161244 19 "epu* A! p ,

56 - - Sumeni 116338878 3 ."aran/ A! p ,57 - - Sri Ani 1161809309 19 !en/+uan/ A! p ,58 3-1-2012 Su(atri 116184089 30 Pe/a/an A! "#A Rp 4,00059 - - 5e)e 116179049 34 !en/+uan/ A! p ,60 - - Runia* 113629892 36 Beberan A! p ,61 - - :ati 1161263817 28 Beberan St+ "B p ,62 3-1-2012 Si;a 1164107428 7 !iai "08 Rp 4,00063 - - Aa( 116122044 9 Beberan "0 p ,64 - - Amira* 1161247634 3 !i(u+ra+ "0 p ,65 - - P'niem 116180476 60 Pe/a/an "0 p ,66 4-1-2012 ia* 116337983 2 $un/ben)a Ruu+an BP.Umum Rp 4,00067 - - uti 1161239466 30 Pe/a/an Ruu+an . mum p ,68 - - 5ari 11621723 82 $un/ben)a $69 . mum p ,69 4-1-2012 Pipit 116303067 16 !iai R68 BP.Umum Rp 4,00070 4-1-2012 "ari 116309468 64 ."aran/ Ruu+an BP.Umum Rp 4,000


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REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM JAMKES


LOKASI SARANA : PUSKESMAS


UMUR KUNJUNGAN


71 - - Su+ima 11631702 60 !en/+uan/ 00 . mum p ,72 - - rnaati 116278172 34 Beberan R68 . mum p ,73 - - a*(ia 11612464 6 Beberan 00 . mum p ,

74 - - unia* 116180779 38 !en/+uan/ "29 . mum p ,75 4-1-2012 ur+*'(i;a* 116180781 9 !en/+uan/ R1 BP.Umum Rp 4,00076 4-1-2012 Mara)i 116278071 42 Beberan 00 BP.Umum Rp 4,00077 - - St.Aia* 1163369024 18 Pa(tim Ruu+an . mum p ,78 - - M.A(pi)i 116123383 15 Beberan 029 . mum p ,79 - - A)e S 11617684 13 Pe/a/an $69 . mum p ,80 - - r(ina 11617673 22 Pe/a/an 00 . mum p ,81 4-1-2012 Ami 1161230984 60 Pe/a/an M79.1 BP.Umum Rp 4,00082 4-1-2012 Su*arti 1161799312 46 !en/+uan/ Ruu+an BP.Umum Rp 4,00083 4-1-2012 uaria* 116283033 42 Beberan M79.1 BP.Umum Rp 4,00084 - - Samiati 1163370813 38 Pa(tim 00 . mum p ,85 - - R'+ima* 1163369711 66 Pa(tim Ruu+an . mum p ,86 - - ureni 1162688736 24 Ba(erante A! p ,87 4-1-2012 Miria* 1162219 31 $un/ben)a A! "#A Rp 4,00088 4-1-2012 i % 42025-012012 20 Pe/a/an Ruu+an . mum p ,97 - - R'a)i 117800402 39 !en/+uan/ Ruu+an . mum p ,98 - - Sania* 1163992149 17 Pa(bar A! p , $99 -1-2012 Atin 119484771 38 pa(tim St+ "B "#A Rp 4,000100 -1-2012 St.Aia* 1163369024 19 pa(tim Ruu+an BP.Umum Rp 4,000101 - - arn !en/+uan/ Ruu+an . mum p ,102 - - an pa(tim Ruu+an . mum p ,103 - - unam Beberan Ruu+an . mum p ,104 -1-2012 Rumina 116320933 41 Beberan Ruu+an BP.Umum Rp 4,000105 -1-2012 S'i 116278429 41 pa(tim Ruu+an BP.Umum Rp 4,000


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UMUR KUNJUNGAN


106 - - ar n Pa(tim 00 . mum p ,107 - - u e a Beberan R0 . mum p ,108 -1-2012 Saniti 1161793618 48 Beberan 00 BP.Umum Rp 4,000

109 -1-2012 Ba+i 11628236 49 !en/+uan/ $30.9 BP.Umum Rp 4,000110 - - ar !iai $30.9 . mum p ,111 - - t a !iai 029 . mum p ,112 - - tara Beberan "0 p ,113 - - au !iai "02 p ,114 - - arn Pa(tim Ruu+an . mum p ,115 - - niati 3793685-012012 36 $un/ben)a Ruu+an . mum p ,116 -1-2012 Santi 47914-5012012 31 Pe/a/an Ruu+an BP.Umum Rp 4,000117 - - an 47918-5012012 Pe/a/an Ruu+an . mum p ,118 -1-2012


5/166

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UMUR KUNJUNGAN


141 - - an t !en/+uan/ 00 . mum p ,142 - - ame pa(tim 00 . mum p ,143 - - e !en/+uan/ 14 . mum p ,

144- - n a

."aran/ A16. mum p ,

145 - - ar Pa(bar M79.1 . mum p ,146 - - ' $un/ben)a $30 . mum p ,147 - - en n/ $un/ben)a Ruu+an . mum p ,148 - - ta Pe/a/an 00 . mum p ,149 - - ?ar $un/ben)a 00 . mum p ,150 - - art'r un/ en a Ruu+an . mum p ,151 - - ' a n en/ uan/ Ruu+an . mum p ,152 - - ar a . aran/ Ruu+an . mum p ,153 - - u ma a Ruu+an . mum p ,154 - - umar e/a/an Ruu+an . mum p ,155 - - ar en/ uan/ Ruu+an . mum p ,156 - - a en/ uan/ Ruu+an . mum p ,157 - - u arn e/a/an 00 . mum p ,158 - - ur aa pa m "29 . mum p ,159 - - a ma a ar 029 . mum p ,160 - - ama u n e eran 00 . mum p ,161 - - . e eran A16 . mum p ,

162- - r aa e eran

"29. mum p ,

163 - - en e eran 00 . mum p ,164 - - 'p a an'n/an $30 . mum p ,165 - - amuna un/ en a 00 . mum p ,166 - - e a R68 . mum p ,167 - - u n a M79.1 . mum p ,168 - - uraen . aran/ #10 . mum p ,169 - - u ant' pa t m 00 . mum p ,170 - - u en pa m R1 . mum p ,171 - - an e/a/an $30.9 . mum p ,172 - - e e/a/an =20 . mum p ,173 - - u rman e eran #10 . mum p ,174 - - Miria* 1162219 31 $un/ben)a A! p ,175 - - ara Beberan "0 p ,176 - - niati 3793685-012012 36 $un/ben)a Ruu+an . mum p ,177 - - rna%a)i 47001-5012012 36 Lungbenda Ruu+an . mum p ,


6/166

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UMUR KUNJUNGAN


178 - - Samuna 1156251093 49 Lungbenda Ruu+an . mum p ,179 - - Su!ardi 1156170775 51 Pegagan M79.1 . mum p ,180 - - ,ar+ina 1156299377 65 $ia%i M79.1 . mum p ,181 - - ,u(anari 1156303225 9 $ia%i 00 . mum p ,182 - - a e eran Ruu+an . mum p ,183 - - a na e eran Ruu+an . mum p ,184 - - unam m Ruu+an . mum p ,185 - - a . aran/ Ruu+an . mum p ,186 - - an a . aran/ Ruu+an . mum p ,187 - - apar un/ en a Ruu+an . mum p ,188 - - uraen e eran Ruu+an . mum p ,189 - - ar na en/ uan/ Ruu+an . mum p ,190 - - mu e/a/an Ruu+an . mum p ,191 - - a pa m 00 . mum p ,192 - - 'p a e/a/an 14 . mum p ,193 - - ent un/ en a R1 . mum p ,194 - - aer a e eran 029 . mum p ,195 - - aen un/ en a "29 . mum p ,196 - - uart pa t m "29 . mum p ,197 - - . ur a a an'n/an A01 . mum p ,198 - - e a m en/ uan/ 029 . mum p ,199 - - e/a/an 00 . mum p ,200 - - a n un/ en a 00 . mum p ,201 - - r a A09 . mum p ,202 - - mu e/a/an Ama . mum p ,203 - - Maemun 116124441 3 Beberan .N$ p ,204 - - Marini 1162219 4 Beberan Paan/ #U5 p , Pe205 - - ar a Beberan "08 p ,206 - - Su)adi 115948164 ."aran/ Ruu+an . mum p ,207 - - a ur en/ uan/ Ruu+an . mum p ,208 - - u e/a/an Ruu+an . mum p ,209 - - arm . aran/ Ruu+an . mum p ,210 - - erman en/ uan/ Ruu+an . mum p ,211 - - r r en/ uan/ Ruu+an . mum p ,212 - - aruna un/ en a Ruu+an . mum p ,213 - - en n/ en/ uan/ Ruu+an . mum p ,214 - - ' mana e/a/an Ruu+an . mum p ,


7/166

Page 7

REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM JAMKESM




UMUR KUNJUNGAN


215 - - ur r'r e eran 029 . mum p ,216 - - a ma e/a/an 00 . mum p ,217 - - u em a 00 . mum p ,218 - - arn a a M79.1 . mum p ,219 - - a ur un/ en a b.Paru . mum p ,220 - - ar na a M79.1 . mum p ,221 - - ar na a M79.1 . mum p ,222 - - am Pe/a/an M79.1 . mum p ,223 - - erman ."aran/ %perteni . mum p ,224 - - arm Pe a an Ru u+an . mum p ,225 - - a m pa(tim Sup.*epatiti . mum p ,226 - - ana = 116274919 26 Pa(tim A! p , in227 - - St.Umaa* 116177192 23 Pe/a/an A! p , in228 - - Su+ei* 1163363117 39 PA$im "04 p ,229 - - Rana 116179126 33 !iai "0 p ,230 - - P'niem 116804476 62 Pe/a/an "08 p ,231 - - Ri+i 1495-01"et2012 2 Beberan u u an . mum p ,232 - - A(i 42030-5#2012 47 !iai Ruu+an . mum p ,233 - - ur*aati 116123236 38 Beberan Ruu+an . mum p ,234 - - R'*man 11617774 6 Pe/a/an Ruu+an . mum p ,235 - - Samian 11627793 0 Beberan Ru u+an . mum p ,236 - - Amita 1161804093 6 !en/+uan/ Ruu+an . mum p ,

237 - - Suna)i 1161231849 4 Pe/a/an Ruu+an . mum p ,238 - - 5ima 11623141 44 $un/ben)a Ruu+an . mum p ,239 - - S'ib 116338123 43 ."aran/ Ruu+an . mum p ,240 - - "a)in 116266487 76 "epu* Ruu+an . mum p ,241 - - ama(u)in 116337641 40 $un/ben)a Ruu+an . mum p ,242 - - Ra*ma 1161789849 11 !iai $30.9 . mum p ,243 - - Aia* 1163376426 34 $un/ben)a 00 . mum p ,244 - - Su+ina 1163379003 34 $un/ben)a 00 . mum p ,245 - - A.Mai) 1162108 67 $un/ben)a M79.1 . mum p ,246 - - "a)mini 11621903 62 pa(tim "29 . mum p ,247 - - Sri < 1161773662 6 !i(u+ra+ "08 p ,248 - - Su+ei* 1163363117 39 pa(tim "04 p ,249 - - 5ir*am 116122674 21 Beberan Ruu+an . mum p ,250 - - Sri Puranti 1161787746 21 Beberan Ruu+an . mum p ,251 - - Maear' 1163360092 46 Beberan 00 . mum p ,


8/166

Page 8





UMUR KUNJUNGAN


252 - - Supan)i 11612262 44 Beberan 00 . mum p ,253 - - Atmi 116220831 7 pa(tim M79.1 . mum p ,254 - - eti 1163360272 39 pa(tim R1 . mum p ,255 - -

Sri 1161784934 38 Beberan 00. mum p ,

256 - - 'ni 1163360283 pa(tim R68 . mum p ,257 - - St.ur*abiba* 116332902 12 Pan'n/an "29 . mum p ,258 - - Buni 11612238 18 Beberan 00 . mum p ,259 - - Sumina 116123776 48 Pe/a/an M79.1 . mum p ,260 - - ami(a* 116180206 46 Pe/a/an 40 . mum p ,261 - - "*a;i) 1161777429 46 Beberan M79.1 . mum p ,262 - - a;ia* 11621137 39 $un/ben)a 14 . mum p ,263 - - Su)iri 11632038 1 !en/+uan/ M79.1 . mum p ,264 - - Siti 116322889 17 !en/+uan/ A! p , i265 - - Arumari 116307973 18 !i+eua( A! p , i266 - - Sania* 1163992149 19 Pa(bar A! p , 267 - - Saeni 116324026 3 !en/+uan/ A! p , i268 - - Marini 11627821 4 Beberan Paan/ #U5 p , Pa269 - - an 47914-5012012 Pe/a/an Ruu+an . mum p ,270 - - #n)raati 116302123 29 !iai Ruu+an . mum p ,271 - - "utub 11624663 54 $un/ben)a Ruu+an . mum p ,272 - - ndra%a)i 29 $ia%i Ru*u+an . mum p ,273 - - "utub 11624669 4 $un/ben)a Ruu+an . mum p ,274 - - Maniaati 116124272 29 Beberan 00 . mum p ,275 - - 5amira 1161798682 54 !en/+uan/ M79.1 . mum p ,276 - - Suni 116313013 44 ."aran/ 14 . mum p ,277 - - Saera 116280207 2 Beberan 00 . mum p ,278 - - urati 1163389149 1 ."aran/ M79.1 . mum p ,279 - - Patmaati 11621699 37 pa(tim "29 . mum p ,280 - - Samuri 116313002 51 ."aran/ $30.9 . mum p ,281 - - A)e A 1161232097 34 Pe/a/an =20 . mum p ,282 - - arat pa(tim A06 . mum p ,283 - - ar pa !i(u+ra+ R68 . mum p ,284 - - u en pa(tim R68 . mum p ,285 - - Sria* 1163361161 38 Pa(tim Paan #U5 p , P286 - - aetun 1163362601 3 Pa(tim St+ "B p ,287 - - A)e A 11611232079 31 Beberan St+ "B p ,288 - - niati 3793685-012012 36 $un/ben)a Ruu+an . mum p ,


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UMUR KUNJUNGAN


289 - - ran ' pa(tim Ruu+an . mum p ,290 - - u u $un/ben)a Ruu+an . mum p ,291 - - arma Pe/a/an Ruu+an . mum p ,292 16-1-2012 riant' 116216386 42

pa(tim Ruu+anBP.Umum Rp 4,000

293 16-1-2012 !ati 1161261617 46 !en/+uan/ Ruu+an BP.Umum Rp 4,000294 16-1-2012 Mut';a 1163361611 63 pa(tim Ruu+an BP.Umum Rp 4,000295 16-1-2012 5aina 116337137 4 pa(tim Ruu+an BP.Umum Rp 4,000296 - - ia* 116337983 43 $un/ben)a Ruu+an . mum p ,297 - - ut 30 Pegagan Ruu+an . mum p ,298 - - S'iatin 11948603 3 !en/+uan/ Ruu+an . mum p ,299 - - Su)eni 116278396 24 Beberan Ruu+an . mum p ,300 - - Beni & 50 $eng+uang Ruu+an . mum p ,301 - - ,i%in 41 Pegagan Ruu+an . mum p ,302 - - Ri/an 10 $eng+uang Ruu+an . mum p ,303 16-1-2012 Rumina 116320933 40 $eng+uang Ruu+an BP.Umum Rp 4,000304 16-1-2012 Surani 1163390668 41 -"&arang 14 BP.Umum Rp 4,000305 16-1-2012 'urahman 1163361306 11 !a()im 00 BP.Umum Rp 4,000306 16-1-2012 S(ame) 1161804936 46 $eng+uang 00 BP.Umum Rp 4,000307 - - -i)in 50 !a()im . mum p ,308 - - Neneng 21 Ba(eran)e . . mum p ,309 - - "aniti 116336143 40 pa(tim M79.1 . mum p ,310 - - Munira 116267918 5 Ba(erante %7 . mum p ,311 - -


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UMUR KUNJUNGAN


324 - - P'niem 116804976 62 Pe/a/an "08 p ,325 16-1-2012 M.au;a( 1161784896 3 Beberan "04 Rp 4,000326 - - Suai* 1161776384 43 Beberan "08 p ,327 16-1-2012

5i(a 116336381 56 pa(tim "08 Rp 4,000

328 - - uria 1163371836 33 $un/ben)a "04 p ,329 17-1-2012 Atmi 116220831 7 pa(tim M79.1 BP.Umum Rp 4,000330 - - "aini 116123078 62 Pe/a/an 00 . mum p ,331 - - uaria* 1164002106 22 Pa(bar 00 . mum p ,332 - - Sa(ima* 1164002062 6 Pa(bar M79.1 . mum p ,333 - - 5e)i S 116129222 16 !iai 00 . mum p ,334 - - Su+ena 1163379003 34 $un/ben)a "29 . mum p ,335 - - Mina* 1161788062 48 Beberan 14 . mum p ,336 17-1-2012 "arnen/i* 116123936 4 Pe/a/an M79.1 BP.Umum Rp 4,000337 - - Maniaati 116122246 0 Beberan 00 . mum p ,338 - - Aia* 1163376426 34 $un/ben)a 00 . mum p ,339 - - a(i 116299636 56 !iai $30 . mum p ,340 - - ini 11612372384 40 Pe/a/an $30 . mum p ,341 - - Aira* 11633603 41 pa(tim Ruu+an . mum p ,342 - - Sania 1163386844 49 ."aran/ Ruu+an . mum p ,343 - - Amui 1161237791 42 Pe/a/an Ruu+an . mum p ,344 - - uria* 1161238768 0 Pe/a/an Ruu+an . mum p ,345 - - Sutina 1161233144 3 Pe/a/an Ruu+an . mum p ,346 - - ti 11612227 30 Beberan Ruu+an . mum p ,347 - - Mi+a) 116180768 44 !en/+uan/ Ruu+an . mum p ,348 - - 5u)i 1163369463 13 pa(tim Ruu+an . mum p ,349 - - ama(u)in 116337641 40 $un/ben)a Ruu+an . mum p ,350 - - Ari* 1161234011 84 Pe/a/an Ruu+an . mum p ,351 - - Aira* 11633603 41 pa(tim Ruu+an . mum p ,352 - - eti S 1163360272 3 pa(tim St+ "B p ,353 - - Sriani 11632203 19 !en/+uan/ A! p ,354 - - Maemuna* 116124441 3 Beberan A! p ,355 - - "arini 470-315#2012 39 Pe/a/an Ruu+an . mum p ,356 - - Mani 116122240 1 Beberan "29 . mum p ,357 - - St.R'*ma* 1163361363 38 pa(tim 00 . mum p ,358 - - :'ni 116177091 61 Pe/a/an M79.1 . mum p ,


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UMUR KUNJUNGAN


359 - - Suar' 1163381376 31 ."aran/ 00 . mum p ,360 - - St.ur*abiba* 116332802 18 Pan'n/an A01 . mum p ,361 - - #tiana* 116178439 17 Pe/a/an 00 . mum p ,

362- -

Supriatin 116186001 26 Pan'n/an A16. mum p ,

363 - - Su)eni 11632401 24 Pe/a/an 4 . mum p ,364 - - u(e+a 116176202 Pe/a/an "29 . mum p ,365 18-1-2012 5eti 11617623 pa(tim 00 BP.Umum Rp 4,000366 18-1-2012 Su(eni 11621791 Pe/a/an #10 BP.Umum Rp 4,000367 18-1-2012 Ri)an 1161240243 Pe/a/an %10 BP.Umum Rp 4,000368 - - R'*ma* 11617774 6 Pe/a/an Ruu+an . mum p ,369 - - St.Aia* 1163369024 19 pa(tim Ruu+an . mum p ,370 - - Rumari 1161761624 32 Pe/a/an Ruu+an . mum p ,371 - - u(e+*a 116123708 22 Pe/a/an A! p , in)372 - - Sri Atuti 1163381387 39 ."aran/ A! p , in373 - - St.Umaa* 116177142 24 Pe/a/an A! p , a374 - - Airi 116323741 21 !en/+uan/ A! p ,375 - - $e*a 116266448 19 "epu* A! p , in376 - - Sutami 116121673 0 Beberan "08 p ,377 - - ant 47914-5012012 Pe/a/an Ruu+an . mum p ,378 - - Rina 117074424 28 Bu(a+ $.30 . mum p ,379 - - R'*ima* 1163369711 6 pa(tim Ruu+an . mum p ,380 - - S'i 116278429 41 Beberan Ruu+an . mum p ,381 - - Amita 1161804093 0 !en/+uan/ Ruu+an . mum p ,382 - - ar+ami 11631893 42 Beberan Ruu+an . mum p ,383 19-1-2012 R'+mana 11618011 0 !en/+uan/ Ruu+an BP.Umum Rp 4,000384 19-1-2012 Su+iem 1161239332 60 Pe/a/an #10 BP.Umum Rp 4,000385 19-1-2012


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UMUR KUNJUNGAN


394 19-1-2012 Ab).Mai) 1162108 73 $un/ben)a "08 Rp 4,000395 19-1-2012 niati 3793685-012012 36 $un/ben)a Ruu+an BP.Umum Rp 4,000396 - - San//re+ 440135#2012 1 !en/+uan/ Ruu+an . mum p ,

397 - - Rai 1161778386 79 Beberan M79.1 . mum p ,398 20-1-2012 Su+ar' 1163366403 23 pa(tim R0 BP.Umum Rp 4,000399 - - !*aeru( 116123207 40 Pe/a/an 30 . mum p ,400 - - Sueti 116397837 2 Pa(bar %93 . mum p ,401 - - :ati 11612701 44 !iai "29 . mum p ,402 20-1-2012 uraeni 116338641 39 ."aran/ R0 BP.Umum Rp 4,000403 - - 5e)i S 116129222 16 !iai 00 . mum p ,404 - - Pii 11632401 42 !en/+uan/ 79"1 . mum p ,405 - - Ratna < 116178891 42 !iai 79"1 . mum p ,406 - - 5armi 116324307 60 !en/+uan/ R51 . mum p ,407 20-1-2012 Sar'* 116248077 40 $un/ben)a 79"1 BP.Umum Rp 4,000408 - - 5iana 116247831 17 $un/ben)a 79"1 . mum p ,409 - - a;ia* 11621137 1 $un/ben)a 14 . mum p ,410 - - S'ib 116338123 43 ."aran/ Ruu+an . mum p ,411 20-1-2012 Sri Pur%an)i 1161787746 22 Beberan Ru*u+an BP.Umum Rp 4,000412 - - Saniah 1163991149 19 Pa(bar .N$ p , 413 - - eni 1161785586 23 Beberan .N$ p ,

414 - - S)"na 1181782334 23 Beberan .N$ p , 415 20-1-2012 Jubaedah 1181252998 33 Beberan .N$ "#A Rp 4,000416 - - .yuna 1161304324 31 $eng+uang .N$ p ,417 - - Sa%eni 1156320426 37 $eng+uang R68 . mum p ,418 - - en)ra 116299478 74 !iai A16 . mum p ,419 - - Bei 1163201 8 !en/+uan/ 14 . mum p ,420 21-1-2012 Sanuri 116337381 38 $un/ben)a "29 BP.Umum Rp 4,000421 - - )a* 11617932 4 Pe/a/an 00 . mum p ,422 - - ami(a* 116180206 46 Pe/a/an 00 . mum p ,423 - - Atmi 116200831 7 pa(tim M79.1 . mum p ,424 21-1-2012 Su+ena 1163379003 34 $un/ben)a 00 BP.Umum Rp 4,000425 - - "aena 116339181 49 ."aran/ M79.1 . mum p ,426 - - =eriani 1161234448 44 Pe/a/an M79.1 . mum p ,427 - - Sartani 1163361339 9 pa(tim $029 . mum p ,428 21-1-2012 Muti+a 11612778 9 !iai $30 BP.Umum Rp 4,000


13/166

Page 13





UMUR KUNJUNGAN


429 - - #ma 1163361644 6 pa(tim M79.1 . mum p ,430 - - "arani 116217433 6 pa(tim Ruu+an . mum p ,431 21-1-2012 R'm(a* 11621227 46 $un/ben)a Ruu+an BP.Umum Rp 4,000

432 21-1-2012 ama(u)in 11633641 40 $un/ben)a Ruu+an BP.Umum Rp 4,000433 - - "arani 116217433 6 pa(tim Ruu+an . mum p ,434 - - #n)raati 116302123 29 !iai Ruu+an . mum p ,435 - - 5armi 116324307 60 !en/+uan/ Ruu+an . mum p ,436 - - Su)art' 1163391849 0 ."aran/ 14 . mum p ,437 21-1-2012 Santi 47914-5012012 31 Pe/a/an Ruu+an BP.Umum Rp 4,000438 - - "arani 116217433 6 pa(tim M79.1 . mum p ,439 - - 5armi 116324307 60 !en/+uan/ $30 . mum p ,440 - - =eriani 1161234448 44 Pe/a/an R68 . mum p ,441 21-1-2012 Maana* 1161786622 9 Beberan "29 BP.Umum Rp 4,000442 21-1-2012 uri 1181608 9 ."aran/ M79.1 BP.Umum Rp 4,000443 - - $iana 1163363681 10 pa(tim $30 . mum p ,444 - - Ania* 1162003 55 $un/ben)a 00 . mum p ,445 - - Mani 1161800414 51 !en/+uan/ 14 . mum p ,446 24-1-2012 M.Su+r'n 116120132 28 Beberan M79.1 BP.Umum Rp 4,000447 24-1-2012 Su)eni 11627839 24 Beberan =20 BP.Umum Rp 4,000448 - - Suna)i 116326772 15 Pe/a/an #10 . mum p ,

449 - - Mina* 1161788062 48 Beberan 14 . mum p ,450 - - "a)mini 1161806332 51 !en/+uan/ 14 . mum p ,451 24-1-2012 A;i; 1161787037 13 Beberan 029 BP.Umum Rp 4,000452 24-1-2012 S'(ima* 1164002062 65 Pa(bar R68 BP.Umum Rp 4,000453 - - S)"#mayah 1156177192 18 e/a/an p ,454 - - Surina 1161776799 23 e eran u u an . mum p ,455 - - .iyah 1163376426 34 un/ en a u u an . mum p ,456 - - Sani*a 1163382107 61 . aran/ u u an . mum p ,457 24-1-2012 eri 1156280591 18 Beberan Ruu+an BP.Umum Rp 4,000458 24-1-2012 arinah 1156284595 55 Beberan Ruu+an BP.Umum Rp 4,000459 - - Bari 1156247493 55 un/ en a u u an . mum p ,460 - - uri 1159485974 64 a u u an . mum p ,461 - - i+ad 1161807658 44 en/ uan/ u u an . mum p ,462 24-1-2012 Su!ari 115624899 58 $un/ben)a Ruu+an BP.Umum Rp 4,000463 24-1-2012 niati 3793685-012012 36 $un/ben)a Ruu+an BP.Umum Rp 4,000


14/166

Page 14





UMUR KUNJUNGAN


464 - - San//re+ 440135#2012 1 !en/+uan/ Ruu+an . mum p ,465 24-1-2012 rna%a)i 47001-5012012 36 Lungbenda Ruu+an BP.Umum Rp 4,000466 - - ."Su+ri 140'282012 10 Beberan Ruu+an . mum p ,

467 - - St.ur*abiba* 116332802 18 Pan'n/an R0 . mum p ,468 2-1-2012 St.Ami 116180060 37 !en/+uan/ $30.9 BP.Umum Rp 4,000469 2-1-2012 Munia* 116337943 42 $un/ben)a 14 BP.Umum Rp 4,000470 - - Suena* 116121324 2 Beberan 00 . mum p ,471 - - A)e U 116287691 49 Seran/ M79.1 . mum p ,472 2-1-2012 Rani 1162876331 11 Seran/ 40 BP.Umum Rp 4,000473 - - A(ima* 1162417 39 $un/ben)a "29 . mum p ,474 - - Apa 1161783 61 Pe/a/an R68 . mum p ,475 2-1-2012 Sar'* 116336468 42 pa(tim M79.1 BP.Umum Rp 4,000476 2-1-2012 M.#ba( 116122606 10 Beberan 00 BP.Umum Rp 4,000477 - - Ar(ia* 1163377293 12 $un/ben)a %10 . mum p ,478 - - umina* 1161249761 33 Beberan 00 . mum p ,479 2-1-2012 $ina M 11948478 31 $un/ben)a R68 BP.Umum Rp 4,000480 - - Sa+ur 11623286 46 $un/ben)a Ruu+an . mum p ,481 - - armi 116179341 Pe/a/an Ruu+an . mum p ,482 - - Sar'ni 1164084772 3 &emp'( Ruu+an . mum p ,483 2-1-2012 !arti 1161261617 46 !en/+uan/ Ruu+an BP.Umum Rp 4,000

484 - - Su*arti 1161799312 46 !en/+uan/ Ruu+an . mum p ,485 - - ''rtitin 1162684416 23 Ba(erante Ruu+an . mum p ,486 2-1-2012 "arani 116217433 6 pa(tim Ruu+an BP.Umum Rp 4,000487 2-1-2012 Santi 47914-5012012 31 Pe/a/an Ruu+an BP.Umum Rp 4,000488 - - Runani 1161792145 30 $eng+uang Ruu+an . mum p ,489 - - .!a 1156175853 61 $eng+uang Ruu+an . mum p ,490 2-1-2012 J"au:i 1162884416 2 Beberan Ruu+an BP.Umum Rp 4,000491 - - Runani 1161782148 30 en/ uan/ p ,492 - - Pu)ri 1161784857 6 a "08 p ,493 2-1-2012 Sa)ri 1161252156 6 Beberan "08 Rp 4,000494 - - Sri uniar)i 1156276719 40 e eran p ,495 - - .iah 1156258978 23 a erante p ,496 - - di J 1156276721 45 e eran . . mum p ,497 26-1-2012 .)mi 1156220831 57 pa(tim M79.1 BP.Umum Rp 4,000498 26-1-2012 .!a 1156175853 61 Pe/a/an 00 BP.Umum Rp 4,000


15/166

Page 15

REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM JA




UMUR KUNJUNGAN


499 26-1-2012 Su)ini 1159485884 44 √ !iai M79.1 BP.Umum Rp 4,500 26-1-2012 Naiah 1156251137 51 $un/ben)a $30 BP.Umum Rp 4,

50126-1-2012 Suherman 1159484747 46 pa(tim "29 BP.Umum Rp 4,

502 - - urni 1162222806 45 e/a/an . . mum p ,503 - - .!a 1156175853 61 $eng+uang M79.1 . mum p ,504 26-1-2012 Rm(ah 1156276711 43 Beberan "29 BP.Umum Rp 4,505 26-1-2012 &aini 1161230758 62 Pe/a/an M79.1 BP.Umum Rp 4,506 26-1-2012 ,ar+ina 115899377 65 !iai "29 BP.Umum Rp 4,507 26-1-2012 ,ar+ina 115899377 65 !iai M79.1 BP.Umum Rp 4,508 26-1-2012 Su+ri 1159485276 66 Pegagan L30 BP.Umum Rp 4,509 - - Sah(a 1156252836 32 Lungbenda J00 . mum p ,510 26-1-2012 Na!iah 1156251137 51 Lungbenda &29 BP.Umum Rp 4,511 26-1-2012 Su)armi 1161765645 49 Pegagan Ru*u+an BP.Umum Rp 4,512 - - Rumina 1156320933 41 $eng+uang Ru*u+an . mum p ,513 26-1-2012 Su!)i)in 1156316637 40 $eng+uang Ru*u+an BP.Umum Rp 4,514 26-1-2012 Samiah 1156277935 50 Beberan Ru*u+an BP.Umum Rp 4,515 - - Samiya 1156277533 46 e eran Ru*u+an . mum p ,516 26-1-2012 "a)ah 1163364377 52 pa(tim Ru*u+an BP.Umum Rp 4,517 26-1-2012 'irham 1161253674 21 Beberan Ru*u+an BP.Umum Rp 4,518 - - .am 1161261472 38 en/ uan/ Ru*u+an . mum p ,519 - - -ri .+hir 1156322665 44 en/ uan/ Ru*u+an . mum p ,520 26-1-2012 Sa%eni 11563324026 47 !en/+uan/ Ru*u+an BP.Umum Rp 4,521 26-1-2012 Runingih 1163374007 17 $un/ben)a Ru*u+an BP.Umum Rp 4,522 - - R+mana 1161805151 46 en/ uan/ &08 p ,523 26-1-2012 .iyah 1156258978 24 Ba(erante "04 Rp 4,524 27-1-2012 &u)ub 1156254669 54 $un/ben)a Ruu+an BP.Umum Rp 4,525 - - &arina 1156300511 53 . aran/ u u an . mum p ,526 27-1-2012 Sri Nayah 116184934 38 Beberan Ruu+an BP.Umum Rp 4,527 27-1-2012 Saniah 11633922142 19 Pa(bar 00 BP.Umum Rp 4,528 - - &eih 1163331117 41 !a()im . mum p ,529 - - Nni 1163360283 12 !a()im . mum p ,530 27-1-2012 Sumiah 1163371432 46 !a()im "04 Rp 4,531 27-1-2012 Rbiah 116336995 61 !a()im M79.1 BP.Umum Rp 4,532 - - Saniah 1163992149 19 a ar p ,


16/166

Page 16

REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM JAM




UMUR KUNJUNGAN


533 - - Leha 1162664458 19 epu p ,534 27-1-2012 -i)in 1161782227 27 Pe/a/an A! "#A Rp 4,00535 - - .gung 1163386348 18 -"&arang . mum p ,536 28-1-2012 &aari 1156299478 52 Beberan M79.1 BP.Umum Rp 4,00537 28-1-2012 Nendra 1156299478 73 $ia%i R68 BP.Umum Rp 4,00538 28-1-2012 Haim 1161777328 38 Beberan $029 BP.Umum Rp 4,00539 28-1-2012 a)i 1156317715 39 $eng+uang 14 BP.Umum Rp 4,00540 - - Sugian)i 1156278723 46 Beberan . . mum p ,541 28-1-2012 uniah 1163375943 42 Lungbenda 14 BP.Umum Rp 4,00542 - - Rudi 1156276258 72 Beberan u u an . mum p ,543 28-1-2012 San)i 1156217433 65 !a()im Ruu+an BP.Umum Rp 4,00544 - - Sumani 1161259919 33 !a()im u u an . mum p ,545 28-1-2012 -uminah 1156277439 38 $ia%i Ruu+an BP.Umum Rp 4,00546 28-1-2012 ndra%a)i 1156302123 29 $ia%i Ruu+an BP.Umum Rp 4,00547 - - Si)i .mi 1161800605 37 $eng+uang u u an . mum p ,548 28-1-2012 &u)ub 1156254669 54 Lungbenda Ruu+an BP.Umum Rp 4,00549 - - &arani 1156217433 65 !a()im . . mum p ,550 28-1-2012 man 1156277992 53 Beberan &29 BP.Umum Rp 4,00551 - - " /i+i 1161240085 5 Pegagan J00 . mum p ,

552 28-1-2012 Sami 1161721472 51 Pegagan L30 BP.Umum Rp 4,00553 - - aearh 1163360092 46 !a()im 79"1 . mum p ,554 28-1-2012 in 1163360305 45 !a()im J00 BP.Umum Rp 4,00555 28-1-2012 "urnia* 1161721472 72 amb(an/ M79.1 BP.Umum Rp 4,00556 28-1-2012 Rumina* 1163363207 44 pa(tim "29 Rp 4,00557 28-1-2012 uniah 1156215802 28 Pa(tim St+ "B "#A Rp 4,00558 - - #niah 1163377596 28 un/ en a p ,559 28-1-2012 in 1163364205 45 Pa(tim "'ntr'( "B t+ "#A Rp 4,00560 - - an n/ 116309468 a u u an . mum p ,561 30-1-2012 Rumina 116320933 48 !en/+uan/ Ruu+an BP.Umum Rp 4,00562 - - aeru 1161232067 e/a/an u u an . mum p ,563 - - a a a . aran/ u u an . mum p ,564 30-1-2012 Arant' 116339629 39 pa(tim Ruu+an BP.Umum Rp 4,00565 - - n e/a/an u u an . mum p ,566 30-1-2012 A(a+ina* 11617842 14 Beberan Ruu+an BP.Umum Rp 4,00567 - - a r a e eran u u an . mum p ,


17/166

Page 17





UMUR KUNJUNGAN


568 - - am a 1162773 e eran u u an . mum p ,569 - - r 11618178 e/a/an u u an . mum p ,570 - - u ae a 116278238 e eran u u an . mum p ,571 - - uraen 116278069 e eran u u an . mum p ,572 - - ' un 116312271 . aran/ u u an . mum p ,573 - - u en 116278396 e eran u u an . mum p ,574 - - ar na . aran/ u u an . mum p ,575 - - am e/a/an u u an p ,576 - - a u pa t m . . mum p ,577 - - aram e/a/an . mum p ,578 - - '/a u ra p ,579 - - na . aran/ p ,580 - - urat pa t m . mum p ,581 - - an eran/ . mum p ,582 - - at e eran . mum p ,583 - - an aat e eran p ,584 - - u u eua . mum p ,585 - - r e/a/an . mum p ,586 - - n a en/ uan/ . mum p ,587 - - at en/ uan/ . mum p ,588 - - u atr pa t m . mum p ,589 - - p a e/a/an . mum p ,590 - - at n . aran/ . mum p ,591 - - apar un/ en a . mum p ,592 30-1-2012


18/166

Page 18

REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM JAMK




UMUR KUNJUNGAN


603 - - am n e eran . mum p ,604 31-1-2012 M'*. =a)i( 11612412 7 Beberan 02 BP.Umum Rp 4,000605 - - ar a a ar p ,

606 - - uren an'n/an . mum p ,607 31-1-2012 Samuri 116313002 62 ."aran/ %CD BP.Umum Rp 4,000608 31-1-2012 M. =ai* 11630196 7 !iai %CD BP.Umum Rp 4,000609 - - r a pa t m . mum p ,610 - - a . aran/ . mum p ,611 - - at en/ uan/ . mum p ,612 - - an . aran/ . mum p ,613 31-1-2012 5aini 116310763 20 ."aran/ BP.Umum Rp 4,000614 - - an . pa t m . mum p ,615 - - a m n e eran . mum p ,616 31-1-2012 Surina 1161776799 Beberan BP.Umum Rp 4,000617 - - u na e/a/an . mum p ,618 - - an a . aran/ . mum p ,619 31-1-2012


19/166

Page 19

TOTAL (Rp) BIAYA (Rp)

p ,Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

Rp 4,000Rp 4,000 p ,

p , p , p , p ,

p , p , p , p , p , p , p ,

p , p , p , p , p , p ,

Rp 4,000


20/166

Page 20


p , p , p , p , p ,

Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

p , p ,Rp 4,000 p ,

Rp 4,000Rp 20,000 Rp 24,000

Rp 4,000Rp 4,000 p , p , p , p , p , p ,


21/166

Page 21


p ,Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

Rp 4,000Rp 4,000 p ,

p , p ,

p , p , p , p , p , p , p , p ,

p , p , p , p , p , p , p , p ,

Rp 4,000


22/166


23/166

Page 23


p ,Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

p , p , p , p , p , p , p , p , p , p , p , p ,

p , p , p , p ,


24/166

Page 24


p , p , p , p ,

p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

p , p , p , p ,

p , p , p , p ,

p , p , p , p , p , p , p , p , p ,


25/166


26/166

Page 26


p , p , p , p ,

p , p , p , p , p , p , p , p ,

p , p , p , p , p , p , p , p , p , p ,

p , p , p , p , p ,

p , p , p , p , p , p , p , p , p , p , p ,

p , p , p , p , p ,


27/166

Page 27


p , p ,

Rp 4,000Rp 4,000

p , p , p , p , p , p , p , p , p ,

Rp 4,000Rp 4,000 p , p , p , p , p , p ,

p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

p ,


28/166


29/166

Page 29


p ,Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p ,

p , p , p , p , p , p ,

p , p , p ,

p ,Rp 4,000Rp 4,000 p ,

p , p , p , p , p , p , p , p , p , p , p , p , p ,

Rp 4,000


30/166

Page 30


p ,Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

Rp ,000 Rp 9,000Rp ,000 Rp 9,000 p , p ,

p , p , p , p , p , p , p , p , p , p , p , p , p ,

Rp 4,000


31/166

Page 31


p , p , p , p , p ,

Rp 4,000 p ,

Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p ,

p , p , p , p , p , p , p , p ,

Rp 4,000Rp 4,000 p ,

Rp 4,000Rp 4,000 p ,


32/166

Page 32


p , p , p , p , p ,


p , p ,Rp 4,000 p ,

Rp 4,000Rp 4,000

Rp ,000 Rp 9,000Rp 4,000 p , p , p , p , p , p ,


33/166

Page 33


Rp 4,000 p , p ,

p , p , p ,

Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p , p ,

Rp 4,000Rp 4,000Rp 4,000Rp 4,000 p , p , p ,

p , p ,


34/166

Page 34


p , p , p ,

p , p , p ,


p , p ,Rp 4,000 p ,

Rp 4,000Rp 4,000Rp 4,000Rp 4,000 p , p , p , p , p , p ,


35/166

Page 35


p , p , p , p , p ,

Rp 4,000 p ,

Rp 4,000Rp 4,000 p , p , p , p , p , p , p , p , p , p , p , p ,

p , p , p , p , p , p , p , p ,

Rp 4,000Rp 4,000 p ,

Rp 4,000Rp 4,000 p ,


36/166

Page 36


Rp 4,000Rp 4,000 p ,

Rp 4,000 p , p , p ,

Rp 4,000 p , p ,

Rp 4,000 p , p ,

Rp 4,000Rp 4,000 p , p ,

Rp 4,000

Rp 561,500 Rp 3,041,500

a(imanan; 30 Januari 2011nge((a Prgram Jam+ema

Sri Rahayu

P"19700305 199203 2 007


37/166

REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM JAMKESMAS


BULAN JANUARI 2012

LOKASI SARANA : PUSTU

NO TANGGAL NAMA PASIEN

NO KARTU UMUR

ALAMAT

DIAGNOSA UNIT JU

JAMKESMASL P

KODE ICD PELAYANANKARCIS

B L B L (Rp)

1 212012 Rni 1161794046 37 $eng+uang J00 B! #mum R! 4;000

2 212012 Sarina 1161802023 43 $eng+uang R51 B! #mum R! 4;000

3 212012 ,arnadi 1161262556 12 $eng+uang L30 B! #mum R! 4;000

4 212012 $u%a)i 1156316332 24 $eng+uang L30 B! #mum R! 4;0005 212012 Rumina 1156320933 40 $eng+uang "79"1 B! #mum R! 4;000

6 212012 Nurhe)i 1164107924 22 $eng+uang "79"1 B! #mum R! 4;000

7 212012 Sania 1161800572 30 $eng+uang J00 B! #mum R! 4;000

8 212012 ,arini 1156316084 30 $eng+uang &29 B! #mum R! 4;000

9 212012 'niyani 1156316106 9 $eng+uang L30 B! #mum R! 4;000

10 212012 Ramadi 1161262045 48 $eng+uang .091 B! #mum R! 4;000

11 212012 S(ame) 1161804936 46 $eng+uang "79"1 B! #mum R! 4;000

12 212012 &arni 1156327266 71 $eng+uang J00 B! #mum R! 4;000

13 212012 .hmad 'arma 1156326557 41 $eng+uang "79"1 B! #mum R! 4;000

14 212012 Ramadi 1161262045 48 $eng+uang H10 B! #mum R! 4;000

15 212012 .de ha(im 1161800627 6 $eng+uang J00 B! #mum R! 4;000

16 212012 Si)i 1156322889 17 $eng+uang R68 B! #mum R! 4;000

17 212012 Surinah 1156327457 61 $eng+uang "79"1 B! #mum R! 4;000

18 212012 e)ani 1156322878 36 $eng+uang J00 B! #mum R! 4;000

19 212012 .niah 1161804014 38 $eng+uang &29 B! #mum R! 4;000

20 212012 'ede &ueri 1161795047 24 $eng+uang R68 B! #mum R! 4;000

21 212012 Sania 1161800572 30 $eng+uang "79"1 B! #mum R! 4;000

22 212012 .drim 1156327345 69 $eng+uang "79"1 B! #mum R! 4;000

23 212012 a)im 1156323958 22 $eng+uang L30 B! #mum R! 4;000

24 212012 -uriah 1161794125 63 $eng+uang &29 B! #mum R! 4;000

25 212012 -aini 1161801337 62 $eng+uang "79"1 B! #mum R! 4;000

26 212012 .bd" Rhman 1161808007 7 $eng+uang J00 B! #mum R! 4;000

27 212012 ,aruni 1156322823 41 $eng+uang J00 B! #mum R! 4;000


38/166



BULAN JANUARI 2012



NO KARTU UMUR

ALAMAT

DIAGNOSA UNIT JU

JAMKESMASL P


B L B L (Rp)

28 212012 e)ani 1156322878 36 $eng+uang L30 B! #mum R! 4;000

29 212012 R+i(a 1161803564 59 $eng+uang H10 B! #mum R! 4;000

30 212012 Surinah 1156327457 62 $eng+uang "79"1 B! #mum R! 4;000

31 212012 .)i+a 1161800638 53 $eng+uang J00 B! #mum R! 4;00032 212012 Rani)i 1161794417 53 $eng+uang L30 B!" #mum R! 4;000

33 212012 Sumina 1156327233 73 $eng+uang &02 B! #mum R! 4;000

34 212012 $amini 1161807998 43 $eng+uang &29 B!" #mum R! 4;000

35 212012 ni 1161799773 35 $eng+uang "79"1 B! #mum R! 4;000

36 212012 -amira 1156321247 40 $eng+uang &02 B! #mum R! 4;000

37 312012 Barna%i 1161795172 44 $eng+uang "79"1 B! #mum R! 4;000

38 312012 Suher)i 1161794349 46 $eng+uang "79"1 B! #mum R! 4;000

39 312012 .yu 1156320966 15 $eng+uang J00 B! #mum R! 4;000

40 312012 #min 1163745718 64 $eng+uang J00 B! #mum R! 4;000

41 312012 -uriah 1161794125 7 $eng+uang &29 B! #mum R! 4;000

42 412012 .:i: 1161797073 17 $eng+uang R05 B! #mum R! 4;000

43 412012 eriana)i 1161793989 63 $eng+uang L30 B! #mum R! 4;000

44 412012 adnga(i 1156327446 40 $eng+uang 10 B! #mum R! 4;000

45 412012 Riai 1156320674 34 $eng+uang &29 B! #mum R! 4;000

46 412012 .ini 1161797062 37 $eng+uang &29 B! #mum R! 4;000

47 512012 Su+ini 1161800594 14 $eng+uang "79"1 B! #mum R! 4;000

48 512012 Heri S 1156320696 35 $eng+uang &29 B! #mum R! 4;000

49 512012 &arnen)i 1161806163 25 $eng+uang .091 B! #mum R! 4;000

50 512012 'ede &ueri 1161795047 35 $eng+uang R68 B! #mum R! 4;000

51 512012 ina 1161795789 66 $eng+uang J00 B! #mum R! 4;000

52 512012 .rni)i 1156326671 38 $eng+uang L30 B! #mum R! 4;000

53 612012 Baeda 1156539745 53 $eng+uang "79"1 B! #mum R! 4;000

54 612012 aia( 1161792314 8 $eng+uang L30 B! #mum R! 4;000


39/166



BULAN JANUARI 2012



NO KARTU UMUR

ALAMAT

DIAGNOSA UNIT JU

JAMKESMASL P


B L B L (Rp)

55 612012 $amini 1161807996 44 $eng+uang "79"1 B! #mum R! 4;000

56 612012 .na 1161793978 41 $eng+uang "79"1 B! #mum R! 4;000

57 612012 Sariah 1161805656 37 $eng+uang H93 B! #mum R! 4;000

58 712012 &arini 1161793664 44 $eng+uang &29 B! #mum R! 4;00059 712012 -ureni 1156327277 57 $eng+uang "79"1 B! #mum R! 4;000

60 712012 .rnei 1161792314 29 $eng+uang .091 B! #mum R! 4;000

61 912012 .)i+a 1161800638 53 $eng+uang "79"1 B! #mum R! 4;000

62 912012 Saniri 1156318018 46 $eng+uang &02 B! #mum R! 4;000

63 912012 aia( 1161792314 8 $eng+uang L30 B! #mum R! 4;000

64 1012012 Sambudi 1161807985 54 $eng+uang J00 B! #mum R! 4;000

65 1012012 aruni 1161799558 34 $eng+uang "79"1 B! #mum R! 4;000

66 1012012 Sani)i 1161793618 49 $eng+uang L30 B! #mum R! 4;000

67 1112012 Sar)iya 1156317759 75 $eng+uang J00 B! #mum R! 4;000

68 1112012 S)".mi 1161800605 38 $eng+uang J00 B! #mum R! 4;000

69 1212012 (!i 1161792279 37 $eng+uang "79"1 B! #mum R! 4;000

70 1212012 Su+im 1161800594 37 $eng+uang "79"1 B! #mum R! 4;000

71 1212012 S)"La)ia 1161792448 30 $eng+uang J00 B! #mum R! 4;000

72 1212012 -aini 1161801235 53 $eng+uang "79"1 B! #mum R! 4;000

73 1212012 Lena 1161799841 34 $eng+uang J00 B! #mum R! 4;000

74 1312012 &arini 1161793664 46 $eng+uang "79"1 B! #mum R! 4;000

75 1312012 adnga(i 1156327446 64 $eng+uang L30 B! #mum R! 4;000

76 1312012 .niah 1161804014 39 $eng+uang J00 B! #mum R! 4;000

77 1312012 .)mi 1161804947 45 $eng+uang J00 B! #mum R! 4;000

78 1412012 -uriah 1161794125 64 $eng+uang "79"1 B! #mum R! 4;000

79 1412012 &urdina 1161801055 38 $eng+uang J00 B! #mum R! 4;000

80 1412012 Ririn 1161795104 13 $eng+uang J00 B! #mum R! 4;000

81 $eng+uang B! #mum R! 4;000


40/166


41/166



BULAN JANUARI 2012



NO KARTU UMUR

ALAMAT

DIAGNOSA UNIT

JAMKESMASL P


B L B L (Rp)

109 R! 4;00

110 R! 4;00

111 R! 4;00112 R! 4;00

113 R! 4;00

114 R! 4;00

115 R! 4;00

116 R! 4;00

117 R! 4;00

118 R! 4;00

119 R! 4;00

120 R! 4;00

121 R! 4;00

122 R! 4;00

123 R! 4;00

124 R! 4;00

125 R! 4;00126 R! 4;00

127 R! 4;00

128 R! 4;00

129 R! 4;00

130 R! 4;00

131 R! 4;00

132 R! 4;00

133 $eng+uang B! #mum R! 4;00

134 R! 4;00

135 R! 4;00


42/166

REKAPITULASI PENGAJUAN KLAIM RAWAT JALAN PESERTA PROGRAM JAMK


BULAN JANUARI 2012



NO KARTU UMUR

ALAMAT

DIAGNOSA UNIT

JAMKESMASL P

KODE ICD PELAYANANB L B L

136 R!

137 $eng+uang B! #mum R!138 $eng+uang B! #mum R!

JUMLAH TOTAL Rp

&e!a(a Pu+ema Pa(imanan

dr" H" .e! irman*ah

NP"19700904 200112 1 002


43/166

TOTAL (Rp)

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000


44/166

TOTAL (Rp)

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000


45/166

TOTAL (Rp)

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000


46/166

TOTAL (Rp)

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000


47/166

TOTAL (Rp)

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000

R! 4;000


48/166

TOTAL (Rp)

R! 4;000

R! 4;000

R! 4;000

Rp 552,000

2011

ema

2 007


49/166



BULAN JANUARI 2011

LOKASI SARANA : PUSLING


UMUR KUNJUNGAN


1 282011 BP ## R! 4;000

2 282011 BP ## R! 4;000 3 282011 BP ## R! 4;000

4 282011 BP ## R! 4;000

5 282011 BP ## R! 4;000

6 282011 BP ## R! 4;000

7 282011 BP ## R! 4;000

JUMLAH TOTAL Rp 2!,000

&e!a(a Pu+ema Pa(imanan

dr" H*" NL.,.-

NP"19621030 200210 2 001


50/166


51/166



BULAN JANUARI 2011



UMUR KUNJUNGAN



52/166



BULAN JANUARI 2011



UMUR KUNJUNGAN



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BULAN JANUARI 2011



UMUR KUNJUNGAN



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BULAN JANUARI 2011



UMUR KUNJUNGAN



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BULAN JANUARI 2011



UMUR KUNJUNGAN



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BULAN JANUARI 2011



UMUR KUNJUNGAN



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BULAN JANUARI 2011



UMUR KUNJUNGAN



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BULAN JANUARI 2011



UMUR KUNJUNGAN



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BULAN JANUARI 2011



UMUR KUNJUNGAN



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76/166



BULAN JANUARI 2011

LOKASI SARANA : POSKESDES


UMUR KUNJUNGAN


26 212012 Saia 116280376 3 √ Beberan "2 BP.Umum Rp 4,00027 212012 Amami 116282817 41 √ Beberan M79.1 BP.Umum Rp 4,00028 212012 R')ia* 1161777431 32 √ Beberan A09 BP.Umum Rp 4,00029 212012 Ama S 116280396 37 √ Beberan "2 BP.Umum Rp 4,000

30 212012 Sa(ima* 11628473 68 √ Beberan A09 BP.Umum Rp 4,00031 212012 uu 11628618 3 √ Beberan "2 BP.Umum Rp 4,00032 212012 Maear'* 1161787026 32 √ Beberan A! "#A Rp 4,00033 212012 Sara* 11628269 69 √ Beberan #10 BP.Umum Rp 4,00034 212012 Matur' 116177326 31 √ Beberan M79.1 BP.Umum Rp 4,0003 212012 ari* 116278407 6 √ Beberan "2 BP.Umum Rp 4,00036 212012 'ar 116278846 61 √ Beberan M79.1 BP.Umum Rp 4,00037 212012 Rapia* 116278486 61 √ Beberan R68 BP.Umum Rp 4,00038 212012 urapi 116249794 64 √ Beberan M79.1 BP.Umum Rp 4,00039 212012 uina 11627663 61 √ Beberan M79.1 BP.Umum Rp 4,00040 212012 St.amina* 116122066 33 √ Beberan 00 BP.Umum Rp 4,00041 212012 Sara* 11627909 46 √ Beberan $30 BP.Umum Rp 4,00042 212012 :uni 1161774314 8 √ Beberan $30 BP.Umum Rp 4,000

43 212012 Su*ati 1162786 0 √ Beberan M79.1 BP.Umum Rp 4,00044 212012 Pui 116281063 12 √ Beberan $30 BP.Umum Rp 4,0004 212012 uu 11628612 3 √ Beberan "2 BP.Umum Rp 4,00046 212012 "'maria 116178620 9 √ Beberan 00 BP.Umum Rp 4,00047 212012 RiE*a 11612669 37 √ Beberan $30 BP.Umum Rp 4,00048 212012 St.=atima 116178136 33 √ Beberan M79.1 BP.Umum Rp 4,00049 212012 Murteni 116282378 3 √ Beberan M79.1 BP.Umum Rp 4,0000 212012 uti 116177078 2 √ Beberan St+ "B BP.Umum Rp 4,000


77/166



BULAN JANUARI 2011



UMUR KUNJUNGAN


1 212012 Amina* 1161777622 32 √ Beberan 00 BP.Umum Rp 4,0002 212012 armina* 116177743 61 √ Beberan #10 BP.Umum Rp 4,0003 212012 uri(a* 1163363769 9 √ Pa(tim M79.1 BP.Umum Rp 4,0004 212012 Pia* 1162147 36 √ Pa(tim M79.1 BP.Umum Rp 4,000

212012 Sunenti 1163362331 30 √ Pa(tim 00 BP.Umum Rp 4,0006 212012 iti A 1163363297 46 √ Pa(tim "29 BP.Umum Rp 4,0007 212012 >i % 116216318 17 √ Pa(tim 00 BP.Umum Rp 4,0008 212012 Su+arni 116217016 2 √ Pa(tim "29 BP.Umum Rp 4,0009 212012 A.%ami) 116336277 67 √ Pa(tim #10 BP.Umum Rp 4,00060 212012 a*ar' 1163363073 7 √ Pa(tim #10 BP.Umum Rp 4,00061 212012 Sutini 11633616 0 √ Pa(tim M79.1 BP.Umum Rp 4,00062 212012 Reina 11621610 79 √ Pa(tim #10 BP.Umum Rp 4,00063 212012 Ana 1163380476 26 √ ."aran/ "29 BP.Umum Rp 4,00064 212012 A(ia 11630971 73 √ ."aran/ M79.1 BP.Umum Rp 4,0006 212012 Sartiem 11630993 76 √ ."aran/ #10 BP.Umum Rp 4,00066 212012 Samira 11630619 4 √ ."aran/ 029 BP.Umum Rp 4,00067 212012 Ramina 116306217 4 √ ."aran/ "29 BP.Umum Rp 4,000

68 212012 5ari 11621723 83 √ $un/ben)a M79.1 BP.Umum Rp 4,00069 212012 Saniti 1163376393 6 √ $un/ben)a 00 BP.Umum Rp 4,00070 212012 Sana* 11620643 38 √ $un/ben)a St" "B BP.Umum Rp 4,00071 312012 uti 11628293 2 √ Beberan 00 BP.Umum Rp 4,00072 312012 %eraan 116278227 2 √ Beberan "02 BP.Umum Rp 4,00073 312012 Rumina* 116276124 4 √ Beberan M79.1 BP.Umum Rp 4,00074 312012 A+ma(u)in 1161784822 9 √ Beberan A010 BP.Umum Rp 4,0007 312012 =ari)a 116280174 42 √ Beberan "02 BP.Umum Rp 4,000


78/166



BULAN JANUARI 2011



UMUR KUNJUNGAN


76 312012 :unani 11612364 36 √ Beberan 00 BP.Umum Rp 4,00077 312012 ai 116123473 4 √ Beberan "2 BP.Umum Rp 4,00078 312012 #>an 119484027 17 √ Beberan 00 BP.Umum Rp 4,00079 312012 Amami 116282817 42 √ Beberan "2 BP.Umum Rp 4,000

80 312012 Sumarni 116284718 42 √ Beberan "2 BP.Umum Rp 4,00081 312012 Sunia* 11627606 40 √ Beberan M79.1 BP.Umum Rp 4,00082 312012 Mia 116276102 64 √ Beberan M79.1 BP.Umum Rp 4,00083 312012 Sara* 11628269 70 √ Beberan "2 BP.Umum Rp 4,00084 312012 Raia 119484084 63 √ Beberan M79.1 BP.Umum Rp 4,0008 312012 Samini 116279072 46 √ Beberan M79.1 BP.Umum Rp 4,00086 312012 =atima* 116178136 33 √ Beberan $30 BP.Umum Rp 4,00087 312012 ur+ini 116279724 9 √ Beberan "2 BP.Umum Rp 4,00088 312012 enab 11627638 64 √ Beberan R1 BP.Umum Rp 4,00089 312012 "*aneri 11630003 39 √ !iai R1 BP.Umum Rp 4,00090 312012 Ruani 11630036 39 √ !iai 00 BP.Umum Rp 4,00091 312012 Aniri 11630194 61 √ !iai #10 BP.Umum Rp 4,00092 312012 Ratni 116303686 62 √ !iai M79.1 BP.Umum Rp 4,000

93 312012 en 116299816 80 √ !iai 00 BP.Umum Rp 4,00094 312012 "atini 11629989 8 √ !iai M79.1 BP.Umum Rp 4,0009 312012 #na 116126048 28 √ !iai 00 BP.Umum Rp 4,00096 312012 Rapia* 11630936 88 √ !iai M79.1 BP.Umum Rp 4,00097 312012 "i+i 116128941 13 √ !iai 00 BP.Umum Rp 4,00098 312012 Mania* 116300817 42 √ !iai 00 BP.Umum Rp 4,00099 312012 "e>in 116126061 6 √ !iai $69 BP.Umum Rp 4,000

100 312012 Ratna 1161761681 4 √ Pe/a/an M79.1 BP.Umum Rp 4,000


79/166



BULAN JANUARI 2011



UMUR KUNJUNGAN


101 312012 "armi 1161761084 44 √ Pe/a/an M79.1 BP.Umum Rp 4,000102 312012 "emi 116176077 66 √ Pe/a/an 00 BP.Umum Rp 4,000103 312012 St.Rani 1161760779 29 √ Pe/a/an 029 BP.Umum Rp 4,000104 312012 An)ini 116123989 6 √ Pe/a/an 00 BP.Umum Rp 4,000

10 312012 %a)ia* 1161239826 79 √ Pe/a/an "29 BP.Umum Rp 4,000106 312012 ani S 116123981 4 √ Pe/a/an 00 BP.Umum Rp 4,000107 312012 Sutarni 116176064 49 √ Pe/a/an R0 BP.Umum Rp 4,000108 312012 Su+iem 1161239332 60 √ Pe/a/an #10 BP.Umum Rp 4,000109 312012 Aini 116124017 √ Pe/a/an "29 BP.Umum Rp 4,000110 312012 Su+arti 1161236698 4 √ Pe/a/an M79.1 BP.Umum Rp 4,000111 312012 aa 116181499 37 √ Pe/a/an =20 BP.Umum Rp 4,000112 312012 Ani) S 1163363646 2 √ Pa(tim M79.1 BP.Umum Rp 4,000113 312012 Sutina* 116336367 46 √ Pa(tim M79.1 BP.Umum Rp 4,000114 312012 Munia* 1163362961 2 √ Pa(tim M79.1 BP.Umum Rp 4,00011 312012 A)an 1163363826 67 √ Pa(tim "29 BP.Umum Rp 4,000116 312012 Suparti 1163362217 √ Pa(tim $30 BP.Umum Rp 4,000117 312012 "a)ina 116217027 74 √ Pa(tim 4 BP.Umum Rp 4,000

118 312012 Sria* 1163361161 36 √ Pa(tim 00 BP.Umum Rp 4,000119 312012 uri(a* 1163363769 0 √ Pa(tim R0 BP.Umum Rp 4,000120 312012 Sar'i 11631329 3 √ ."aran/ 00 BP.Umum Rp 4,000121 312012 $imut 116310897 72 √ ."aran/ 00 BP.Umum Rp 4,000122 312012 R'+aa 116310908 71 √ ."aran/ "29 BP.Umum Rp 4,000123 312012 Maria* 116310921 71 √ ."aran/ R68 BP.Umum Rp 4,000124 312012 Sa(ima* 116310932 6 √ ."aran/ 029 BP.Umum Rp 4,00012 312012 "arta 11631094 69 √ ."aran/ #10 BP.Umum Rp 4,000


80/166



BULAN JANUARI 2011



UMUR KUNJUNGAN


126 312012 Sartima 11631096 6 √ ."aran/ "29 BP.Umum Rp 4,000127 312012 urani 116310976 71 √ ."aran/ 029 BP.Umum Rp 4,000128 312012 "iati 1163386339 48 √ ."aran/ M79.1 BP.Umum Rp 4,000129 312012 Sunima 116310998 69 √ ."aran/ "29 BP.Umum Rp 4,000

130 312012 R'+eem 116311033 71 √ ."aran/ 00 BP.Umum Rp 4,000131 312012 %arun 116311044 69 √ ."aran/ $30.9 BP.Umum Rp 4,000132 312012 Maria* 1163110 6 √ ."aran/ $30.9 BP.Umum Rp 4,000133 312012 Ani(a 116311101 46 √ ."aran/ $30.9 BP.Umum Rp 4,000134 312012 Mareni 116311191 6 √ ."aran/ #10 BP.Umum Rp 4,00013 312012 R'bia* 11631127 47 √ ."aran/ M79.1 BP.Umum Rp 4,000136 312012 umari 116311933 61 √ ."aran/ M79.1 BP.Umum Rp 4,000137 412012 Ratnaati 1161782381 24 √ Beberan St+ "B "#A Rp 4,000138 412012 Ratnaati 1161782381 24 √ Beberan 00 BP.Umum Rp 4,000139 412012 ur(ae(a 116177828 27 √ Beberan St+ "B "#A Rp 4,000140 412012 Rai* 116279239 37 √ Beberan St+ "B "#A Rp 4,000141 412012 Rai* 116279239 37 √ Beberan $30 BP.Umum Rp 4,000142 412012 (i 116279239 30 √ Beberan 00 BP.Umum Rp 4,000

143 412012 Rumena 116122911 63 √ Beberan M79.1 BP.Umum Rp 4,000144 412012 "*a;i) 116278328 39 √ Beberan M79.1 BP.Umum Rp 4,00014 412012 Maria* 1161777429 39 √ Beberan M79.1 BP.Umum Rp 4,000146 412012 A.Su*i)in 116121616 33 √ Beberan A09 BP.Umum Rp 4,000147 412012 uria* 11612284 30 √ Beberan A! "#A Rp 4,000148 412012 Rumari 116280613 44 √ Beberan A02 BP.Umum Rp 4,000149 412012 #nu( 11617830 64 √ Beberan 4 BP.Umum Rp 4,00010 412012 ari* 1161777969 0 √ Beberan M79.1 BP.Umum Rp 4,000


81/166



BULAN JANUARI 2011



UMUR KUNJUNGAN


11 412012 Mani 116278407 41 √ Beberan R0 BP.Umum Rp 4,00012 412012 ti 1161242246 31 √ Beberan R2 BP.Umum Rp 4,00013 412012 Amina* 11612327 36 √ Beberan R2 BP.Umum Rp 4,00014 412012 ur(ae(a 116276642 26 √ Beberan M79.1 BP.Umum Rp 4,000

1 412012 enab 11627838 63 √ Beberan M79.1 BP.Umum Rp 4,00016 412012 uti 11628293 3 √ Beberan M79.1 BP.Umum Rp 4,00017 412012 ri pana 1161777881 27 √ Beberan M79.1 BP.Umum Rp 4,00018 412012 ri pana 1161777881 27 √ Beberan St+ "B BP.Umum Rp 4,00019 412012 ur(ae(a 116177828 26 √ Beberan R68 BP.Umum Rp 4,000160 412012 Sa(ima* 1168473 69 √ Beberan 00 BP.Umum Rp 4,000161 412012 "airi 116276473 76 √ Beberan M79.1 BP.Umum Rp 4,000162 412012 R'+*ima* 116279421 43 √ Beberan "02 BP.Umum Rp 4,000163 412012 Amami 116282817 42 √ Beberan A09 BP.Umum Rp 4,000164 12012 mi* 116123912 4 √ Pe/a/an M79.1 BP.Umum Rp 4,00016 12012 St.a*ar' 1161233998 42 √ Pe/a/an M79.1 BP.Umum Rp 4,000166 12012 "ureni 116126083 62 √ !iai M79.1 BP.Umum Rp 4,000167 12012 :eni 116126116 28 √ !iai A! "#A Rp 4,000

168 12012 Mina 11630036 68 √ !iai $30 BP.Umum Rp 4,000169 12012 Manira 116126004 62 √ !iai 00 BP.Umum Rp 4,000170 12012


82/166



BULAN JANUARI 2011



UMUR KUNJUNGAN


176 12012 A.%ami) 116336277 67 √ Pa(tim #10 BP.Umum Rp 4,000177 12012 Munia* 1163362961 61 √ Pa(tim M79.1 BP.Umum Rp 4,000178 12012 S'patin 116216342 1 √ Pa(tim M79.1 BP.Umum Rp 4,000179 12012 Reina 11621610 79 √ Pa(tim #10 BP.Umum Rp 4,000

180 12012 Suparti 1163362217 4 √ Pa(tim $30 BP.Umum Rp 4,000181 12012 A)an 1163363826 66 √ Pa(tim M79.1 BP.Umum Rp 4,000182 12012 Umira* 116217038 68 √ Pa(tim M79.1 BP.Umum Rp 4,000183 12012 Suneri 116216983 √ Pa(tim $30 BP.Umum Rp 4,000184 12012 Su+arni 116217016 2 √ Pa(tim #10 BP.Umum Rp 4,00018 12012 Ani) S 1163363646 1 √ Pa(tim M79.1 BP.Umum Rp 4,000186 12012 Sutina* 116336367 4 √ Pa(tim M79.1 BP.Umum Rp 4,000187 12012 Sumarni 1163362869 39 √ Pa(tim M79.1 BP.Umum Rp 4,000188 12012 iti A 1163363297 46 √ Pa(tim 00 BP.Umum Rp 4,000189 12012 >i % 116216318 17 √ Pa(tim 00 BP.Umum Rp 4,000190 12012 uri(a* 1163363769 69 √ Pa(tim M79.1 BP.Umum Rp 4,000191 12012 Sria* 1163361161 37 √ Pa(tim 00 BP.Umum Rp 4,000192 12012 "a)ina 116217027 73 √ Pa(tim 4 BP.Umum Rp 4,000

193 12012 Surati 119486301 66 √ ."aran/ M79.1 BP.Umum Rp 4,000194 12012 Urip 1163383481 4 √ ."aran/ 029 BP.Umum Rp 4,00019 12012


83/166



BULAN JANUARI 2011



UMUR KUNJUNGAN


201 12012 "arna)i 116306961 69 √ ."aran/ 00 BP.Umum Rp 4,000202 12012 urina 116306972 64 √ ."aran/ #10 BP.Umum Rp 4,000203 12012 Saniem 116306994 70 √ ."aran/ "29 BP.Umum Rp 4,000204 12012 urini 116307027 34 √ ."aran/ R0 BP.Umum Rp 4,000

20 12012 Sania 11630701 2 √ ."aran/ M79.1 BP.Umum Rp 4,000206 12012 "u)un/ 116307128 63 √ ."aran/ M79.1 BP.Umum Rp 4,000207 12012 Su+ar)i 116307139 73 √ ."aran/ M79.1 BP.Umum Rp 4,000208 12012 Su+eri 116307141 70 √ ."aran/ M79.1 BP.Umum Rp 4,000209 12012 Amina 116307163 47 √ ."aran/ M79.1 BP.Umum Rp 4,000210 12012 Ania 116307196 76 √ ."aran/ M79.1 BP.Umum Rp 4,000211 12012 Sarina 11630723 66 √ ."aran/ 029 BP.Umum Rp 4,000212 12012 Samen 116307411 √ ."aran/ M79.1 BP.Umum Rp 4,000213 12012 Saina 116307433 6 √ ."aran/ M79.1 BP.Umum Rp 4,000214 12012 urimi 11630701 70 √ ."aran/ "29 BP.Umum Rp 4,00021 12012 Rumina* 1163074 76 √ ."aran/ M79.1 BP.Umum Rp 4,000216 12012 Samira 11630776 42 √ ."aran/ M79.1 BP.Umum Rp 4,000217 12012 Sarmini 116307602 70 √ ."aran/ 00 BP.Umum Rp 4,000

218 12012 Su+ei 116307848 9 √ ."aran/ A09 BP.Umum Rp 4,000219 12012 "a)mina 116307883 6 √ ."aran/ R0 BP.Umum Rp 4,000220 12012 Sri M 11630790 46 √ ."aran/ 029 BP.Umum Rp 4,000221 12012 Sua 116307949 7 √ ."aran/ $30.9 BP.Umum Rp 4,000222 12012 ina 11630791 71 √ ."aran/ 00 BP.Umum Rp 4,000223 12012 Sunai 116307984 33 √ ."aran/ R68 BP.Umum Rp 4,000224 12012 Maruni 116308074 67 √ ."aran/ M79.1 BP.Umum Rp 4,00022 12012 "ara 11630826 68 √ ."aran/ #10 BP.Umum Rp 4,000


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226 12012 Ratini 116308298 2 √ ."aran/ 029 BP.Umum Rp 4,000227 12012 "ariti 116308322 44 √ ."aran/ R0 BP.Umum Rp 4,000228 12012 uria* 1163371836 34 √ $un/ben)a "29 BP.Umum Rp 4,000229 12012 Samiri 1163376999 31 √ $un/ben)a St" "B BP.Umum Rp 4,000

230 12012 A)e S 116147277 29 √ $un/ben)a A! BP.Umum Rp 4,000231 12012 Suteni 11624873 42 √ $un/ben)a 00 BP.Umum Rp 4,000232 12012 ar' 116216 7 √ $un/ben)a "29 BP.Umum Rp 4,000233 612012 Maria 11631217 64 √ ."aran/ "29 BP.Umum Rp 4,000234 612012 R'pia* 11631061 6 √ ."aran/ #10 BP.Umum Rp 4,00023 612012 Sar'i 11630329 3 √ ."aran/ $30.9 BP.Umum Rp 4,000236 612012 Samina 116312798 71 √ ."aran/ "29 BP.Umum Rp 4,000237 612012 Sumiati 1163389634 38 √ ."aran/ "29 BP.Umum Rp 4,000238 612012 Ania 116312833 6 √ ."aran/ R1 BP.Umum Rp 4,000239 612012 ri A 1163389691 √ ."aran/ 00 BP.Umum Rp 4,000240 612012 urati 1163389149 1 √ ."aran/ M79.1 BP.Umum Rp 4,000241 612012 "aati 116312989 76 √ ."aran/ 00 BP.Umum Rp 4,000242 612012 Bu)i % 116312809 28 √ ."aran/ %erpe BP.Umum Rp 4,000

243 612012 Sentana 116312822 70 √ ."aran/ +29 BP.Umum Rp 4,000244 612012 Siti 116312844 27 √ ."aran/ 00 BP.Umum Rp 4,00024 612012 Sunai 116312888 43 √ ."aran/ #10 BP.Umum Rp 4,000246 612012 Satuti 116312923 11 √ ."aran/ R0 BP.Umum Rp 4,000247 612012 Subrata 116312934 8 √ ."aran/ M79.1 BP.Umum Rp 4,000248 612012 Rumini 11631294 1 √ ."aran/ M79.1 BP.Umum Rp 4,000249 612012 Samuri 116313002 1 √ ."aran/ $30.9 BP.Umum Rp 4,00020 612012 Suni 116313013 44 √ ."aran/ 00 BP.Umum Rp 4,000


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276 1012012 urati 1163389149 1 √ ."aran/ M79.1 BP.Umum Rp 4,000277 1012012 Sar'i 11631329 3 √ ."aran/ 00 BP.Umum Rp 4,000278 1012012 Sai* 116314464 66 √ ."aran/ M79.1 BP.Umum Rp 4,000279 1012012 Saima 116314486 66 √ ."aran/ M79.1 BP.Umum Rp 4,000

280 1012012 Atmi 116314497 70 √ ."aran/ #10 BP.Umum Rp 4,000281 1012012 atmini 11631421 29 √ ."aran/ $30.9 BP.Umum Rp 4,000282 1012012 "artani 11631443 81 √ ."aran/ R0 BP.Umum Rp 4,000283 1012012 Sar)ia* 1163144 4 √ ."aran/ R0 BP.Umum Rp 4,000284 1012012 Sait 11631487 66 √ ."aran/ $30.9 BP.Umum Rp 4,00028 1012012 :una 11631498 1 √ ."aran/ "29 BP.Umum Rp 4,000286 1012012 "emi 116314824 60 √ ."aran/ M79.1 BP.Umum Rp 4,000287 1012012 aria* 116314846 70 √ ."aran/ 029 BP.Umum Rp 4,000288 1012012 Mira 11631487 4 √ ."aran/ #10 BP.Umum Rp 4,000289 1012012 "a)mina 116314868 60 √ ."aran/ #10 BP.Umum Rp 4,000290 1012012 %ermi 116314879 4 √ ."aran/ 029 BP.Umum Rp 4,000291 1012012 Sani 116314903 37 √ ."aran/ M79.1 BP.Umum Rp 4,000292 1012012 ur+a(im 116314914 11 √ ."aran/ R0 BP.Umum Rp 4,000

293 1012012 Rabun 11631492 60 √ ."aran/ 029 BP.Umum Rp 4,000294 1012012 RiE*a 11612069 26 √ Beberan 00 BP.Umum Rp 4,00029 1012012 urapi 1161249794 64 √ Beberan "2 BP.Umum Rp 4,000296 1012012 uaria* 11627731 4 √ Beberan "2 BP.Umum Rp 4,000297 1012012 umina 1161776823 46 √ Beberan R68 BP.Umum Rp 4,000298 1012012 ur+ini 116279724 39 √ Beberan 00 BP.Umum Rp 4,000299 1012012 Maria* 116124406 3 √ Beberan A! "#A Rp 4,000300 1012012 Mitiria* 116120773 3 √ Beberan M79.1 BP.Umum Rp 4,000


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301 1012012 ti 116278148 4 √ Beberan 00 BP.Umum Rp 4,000302 1012012 rnaati 116278172 3 √ Beberan 00 BP.Umum Rp 4,000303 1012012 na 116284224 4 √ Beberan 00 BP.Umum Rp 4,000304 1012012 emi 1161774404 30 √ Beberan 00 BP.Umum Rp 4,000

30 1012012 5eni 11608012 61 √ Beberan M79.1 BP.Umum Rp 4,000306 1012012 Umina* 11612273 2 √ Beberan "2 BP.Umum Rp 4,000307 1012012 enab 11627838 63 √ Beberan 00 BP.Umum Rp 4,000308 1012012 uraeni 11617796 37 √ Beberan A! "#A Rp 4,000309 1012012 Mitara 116280163 9 √ Beberan R0 BP.Umum Rp 4,000310 1012012 M.=a*ru 1161781018 6 √ Beberan 00 BP.Umum Rp 4,000311 1012012 Sri 1161776891 27 √ Beberan St+ "B "#A Rp 4,000312 1012012 en S 116277079 40 √ Beberan St+ "B "#A Rp 4,000313 1012012 Suini 116121346 31 √ Beberan A! "#A Rp 4,000314 1012012 Su/iana 11627933 43 √ Beberan 00 BP.Umum Rp 4,00031 1012012 Sri M 1161777339 29 √ Beberan A! "#A Rp 4,000316 1012012 enti 11628304 39 √ Beberan 00 BP.Umum Rp 4,000317 1012012 M.Anar 116437426 11 √ Beberan 00 BP.Umum Rp 4,000

318 1012012 "ena* 116437404 31 √ Beberan 00 "#A Rp 4,000319 1012012 Mia 116277193 23 √ Beberan 00 BP.Umum Rp 4,000320 1012012 rin 116122088 19 √ Beberan A! BP.Umum Rp 4,000321 1012012 Samini 11627461 60 √ Beberan M79.1 BP.Umum Rp 4,000322 1012012 R'pia* 116278486 66 √ Beberan M79.1 BP.Umum Rp 4,000323 1012012 #)ru 116218129 4 √ Pa(tim $30 BP.Umum Rp 4,000324 1012012 "urina 116218322 √ Pa(tim "29 BP.Umum Rp 4,00032 1012012 "amira 1163367729 34 √ Pa(tim $30 BP.Umum Rp 4,000


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326 1012012 Sutira 1163002 8 √ !iai "29 BP.Umum Rp 4,000327 1012012 ati R 116302764 39 √ !iai R1 BP.Umum Rp 4,000328 1012012 Marini 11630317 66 √ !iai R0 BP.Umum Rp 4,000329 1012012 uni 116126961 60 √ !iai 029 BP.Umum Rp 4,000

330 1012012 en 116299816 80 √ !iai M79.1 BP.Umum Rp 4,000331 1012012 Me(i 11641073 23 √ !iai "29 BP.Umum Rp 4,000332 1012012 Mani 11630071 61 √ !iai M79.1 BP.Umum Rp 4,000333 1012012 Rapia* 11630936 87 √ !iai M79.1 BP.Umum Rp 4,000334 1012012 Pra'/a 1161790097 10 √ !iai R0 BP.Umum Rp 4,00033 1012012 Suratmi 116301032 70 √ !iai $30 BP.Umum Rp 4,000336 1012012 "atimi 11630791 6 √ !iai "29 BP.Umum Rp 4,000337 1012012 Aniri 11630194 61 √ !iai M79.1 BP.Umum Rp 4,000338 1012012 Ania* 1163376887 27 √ $un/ben)a St" "B BP.Umum Rp 4,000339 1012012 Marina 116249776 33 √ $un/ben)a St" "B BP.Umum Rp 4,000340 1012012 Saria* 116249877 38 √ $un/ben)a 00 BP.Umum Rp 4,000341 1012012 Saniti 1163376393 6 √ $un/ben)a #10 BP.Umum Rp 4,000342 1012012 Sapari 116248998 69 √ $un/ben)a A09 BP.Umum Rp 4,000

343 1012012 armi 1161239949 67 √ Pe/a/an #10 BP.Umum Rp 4,000344 1012012 Supriani 1161240377 46 √ Pe/a/an $30 BP.Umum Rp 4,00034 1012012 S'pia* 1161761049 4 √ Pe/a/an R1 BP.Umum Rp 4,000346 1012012 "armi 1161761084 44 √ Pe/a/an 00 BP.Umum Rp 4,000347 1012012 Satia 1161761679 67 √ Pe/a/an M79.1 BP.Umum Rp 4,000348 1012012 St.Saa)a* 116123778 16 √ Pe/a/an 00 BP.Umum Rp 4,000349 1212012 :ati 11628342 39 √ Beberan M79.1 BP.Umum Rp 4,00030 1212012 :ati 11628342 39 √ Beberan St+ "B BP.Umum Rp 4,000


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376 1212012 Ruani 116309323 22 √ ."aran/ R0 BP.Umum Rp 4,000377 1212012 Ratini 116309367 41 √ ."aran/ "29 BP.Umum Rp 4,000378 1212012 Mae)i 116309402 11 √ ."aran/ R0 BP.Umum Rp 4,000379 1212012 uri 116309446 73 √ ."aran/ #10 BP.Umum Rp 4,000

380 1212012 "ari 116309468 64 √ ."aran/ M79.1 BP.Umum Rp 4,000381 1212012 Arani 116309492 74 √ ."aran/ M79.1 BP.Umum Rp 4,000382 1212012 areni 11630914 68 √ ."aran/ M79.1 BP.Umum Rp 4,000383 1212012 Saem 1163092 62 √ ."aran/ 00 BP.Umum Rp 4,000384 1212012 Rum(i 11630971 73 √ ."aran/ M79.1 BP.Umum Rp 4,00038 1212012 Sarniti 11630993 73 √ ."aran/ M79.1 BP.Umum Rp 4,000386 1212012 R'*eni 116309648 3 √ ."aran/ M79.1 BP.Umum Rp 4,000387 1212012 Matini 116309918 68 √ ."aran/ M79.1 BP.Umum Rp 4,000388 1212012 uraa 116309931 46 √ ."aran/ M79.1 BP.Umum Rp 4,000389 1212012 &una 116309942 3 √ ."aran/ M79.1 BP.Umum Rp 4,000390 1212012 "arini 11630997 71 √ ."aran/ M79.1 BP.Umum Rp 4,000391 1212012 Sarina 116310008 68 √ ."aran/ 00 BP.Umum Rp 4,000392 1212012 "u)up 116310021 81 √ ."aran/ "29 BP.Umum Rp 4,000

393 1212012 uni 11631004 49 √ ."aran/ M79.1 BP.Umum Rp 4,000394 1212012 ari 1163101 6 √ ."aran/ M79.1 BP.Umum Rp 4,00039 1212012 Rumeni 116310199 3 √ ."aran/ $30.9 BP.Umum Rp 4,000396 1212012 Ab).A?i? 116310188 3 √ ."aran/ $30.9 BP.Umum Rp 4,000397 1212012 uu 116310201 1 √ ."aran/ 00 BP.Umum Rp 4,000398 1212012 Muri 116310223 79 √ ."aran/ M79.1 BP.Umum Rp 4,000399 1212012 Ai 11631026 70 √ ."aran/ #10 BP.Umum Rp 4,000400 1212012 Una* 11630497 78 √ !iai $30 BP.Umum Rp 4,000


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401 1212012 Sueni 1162993 6 √ !iai 00 BP.Umum Rp 4,000402 1212012 mi* 116123912 4 √ Pe/a/an M79.1 BP.Umum Rp 4,000403 1212012 $amina 11948491 23 √ Pe/a/an 00 BP.Umum Rp 4,000404 1212012 Mini 11620801 8 √ $un/ben)a #10 BP.Umum Rp 4,000

40 1212012 ia* 116337983 69 √ $un/ben)a "29 BP.Umum Rp 4,000406 1212012 Baena* 11620946 1 √ $un/ben)a M79.1 BP.Umum Rp 4,000407 1212012 en/i* 11620608 47 √ $un/ben)a M79.1 BP.Umum Rp 4,000408 1212012 Saniti 1163376393 6 √ $un/ben)a #10 BP.Umum Rp 4,000409 1312012 Maria 11631217 64 √ ."aran/ "29 BP.Umum Rp 4,000410 1312012 ina 1163389689 11 √ ."aran/ %10 BP.Umum Rp 4,000411 1312012 R'i)i 116339034 4 √ ."aran/ #10 BP.Umum Rp 4,000412 1312012 urati 1163389149 1 √ ."aran/ M79.1 BP.Umum Rp 4,000413 1312012 Rebin/ 116338696 61 √ ."aran/ MP BP.Umum Rp 4,000414 1312012 Munari 1163386607 60 √ ."aran/ M79.1 BP.Umum Rp 4,00041 1312012 Sriana 1163386618 29 √ ."aran/ "29 BP.Umum Rp 4,000416 1312012 ea 116338663 41 √ ."aran/ 00 BP.Umum Rp 4,000417 1312012 Uan/ 1163386697 8 √ ."aran/ A09 BP.Umum Rp 4,000

418 1312012 Sani 1163386708 74 √ ."aran/ "29 BP.Umum Rp 4,000419 1312012 Atima 1163386719 71 √ ."aran/ M79.1 BP.Umum Rp 4,000420 1312012 aia 1163386721 3 √ ."aran/ 00 BP.Umum Rp 4,000421 1312012 "urni 116311279 60 √ ."aran/ #10 BP.Umum Rp 4,000422 1312012 "atu 11631132 71 √ ."aran/ 00 BP.Umum Rp 4,000423 1312012 Satini 116311336 66 √ ."aran/ 00 BP.Umum Rp 4,000424 1312012 Ramini 116311382 69 √ ."aran/ M79.1 BP.Umum Rp 4,00042 1312012 R'bini 116311426 48 √ ."aran/ 00 BP.Umum Rp 4,000


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426 1312012 "aiem 116311483 7 √ ."aran/ 00 BP.Umum Rp 4,000427 1312012 atini 116311494 2 √ ."aran/ M79.1 BP.Umum Rp 4,000428 1312012 "apa 11631116 1 √ ."aran/ #10 BP.Umum Rp 4,000429 1612012


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41 1712012 aa 116181499 37 √ Pe/a/an =20 BP.Umum Rp 4,00042 1712012 Sri 1161240219 31 √ Pe/a/an 00 BP.Umum Rp 4,00043 1712012 Sri : 11640347 41 √ Pe/a/an 00 BP.Umum Rp 4,00044 1712012 "armi 1161761084 44 √ Pe/a/an M79.1 BP.Umum Rp 4,000

4 1712012 Satira 116218243 78 √ Pa(tim M79.1 BP.Umum Rp 4,00046 1712012 #)ru 116218129 4 √ Pa(tim 4 BP.Umum Rp 4,00047 1712012 :ati 1163367764 41 √ Pa(tim "29 BP.Umum Rp 4,00048 1712012 Pia 116217938 47 √ Pa(tim "29 BP.Umum Rp 4,00049 1712012 "arina 116218322 √ Pa(tim 00 BP.Umum Rp 4,000460 1712012 en)ri 116336773 47 √ Pa(tim 4 BP.Umum Rp 4,000461 1712012 S')ati 116218131 43 √ Pa(tim M79.1 BP.Umum Rp 4,000462 1712012 Sumia* 1161260684 36 √ !iai M79.1 BP.Umum Rp 4,000463 1712012 Suria* 116127973 46 √ !iai #10 BP.Umum Rp 4,000464 1712012 Aniri 11630194 63 √ $ia%i #10 BP.Umum Rp 4,00046 1712012 Rapia* 11630436 86 √ $ia%i 00 BP.Umum Rp 4,000466 1712012 urani 116301302 62 √ $ia%i M79.1 BP.Umum Rp 4,000467 1712012 n)an/ 116304722 43 √ $ia%i M79.1 BP.Umum Rp 4,000

468 1712012 Marini 11630317 67 √ $ia%i M79.1 BP.Umum Rp 4,000469 1712012 Ai 116337864 37 √ $un/ben)a #10 BP.Umum Rp 4,000470 1712012 Sapari 116248999 69 √ $un/ben)a A091 BP.Umum Rp 4,000471 1712012 Ma;tu+*a 11948489 34 √ $un/ben)a St" "B BP.Umum Rp 4,000472 1712012 Beberan BP.Umum Rp 4,000473 1712012 Beberan BP.Umum Rp 4,000474 1712012 Beberan BP.Umum Rp 4,00047 1712012 Beberan BP.Umum Rp 4,000


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476 1712012 Beberan BP.Umum Rp 4,0477 1712012 Beberan BP.Umum Rp 4,0478 1712012 Beberan BP.Umum Rp 4,0

4791712012 Beberan BP.Umum Rp 4,0

480 1712012 Beberan BP.Umum Rp 4,0481 1712012 Beberan BP.Umum Rp 4,0482 1712012 Beberan BP.Umum Rp 4,0483 1712012 Beberan BP.Umum Rp 4,0484 1712012 Beberan BP.Umum Rp 4,048 1712012 Beberan BP.Umum Rp 4,0486 1712012 Beberan BP.Umum Rp 4,0487 1712012 Beberan BP.Umum Rp 4,0488 1712012 Beberan BP.Umum Rp 4,0489 1712012 Beberan BP.Umum Rp 4,0490 1712012 Beberan BP.Umum Rp 4,0491 1712012 Beberan BP.Umum Rp 4,0492 1712012 Beberan BP.Umum Rp 4,0

493 1712012 ."aran/ BP.Umum Rp 4,0494 1712012 ."aran/ BP.Umum Rp 4,049 1712012 ."aran/ BP.Umum Rp 4,0496 1712012 ."aran/ BP.Umum Rp 4,0497 1712012 ."aran/ BP.Umum Rp 4,0498 1712012 ."aran/ BP.Umum Rp 4,0499 1712012 ."aran/ BP.Umum Rp 4,000 1712012 ."aran/ BP.Umum Rp 4,0


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01 1712012 ."aran/ BP.Umum Rp 4,0002 1712012 ."aran/ BP.Umum Rp 4,0003 1712012 ."aran/ BP.Umum Rp 4,0004 1712012 ."aran/ BP.Umum Rp 4,00

0 1712012 ."aran/ BP.Umum Rp 4,0006 1712012 ."aran/ BP.Umum Rp 4,0007 1712012 ."aran/ BP.Umum Rp 4,0008 1712012 ."aran/ BP.Umum Rp 4,0009 1712012 ."aran/ BP.Umum Rp 4,0010 1912012 $amina 11948491 20 √ Pe/a/an R1 BP UMUM Rp 4,0011 1912012 mi* 116123912 4 √ Pe/a/an M79.1 BP UMUM Rp 4,0012 1912012 Raina 116300997 69 √ !iai 029 BP UMUM Rp 4,0013 1912012 Fara A 116127387 √ !iai $30 BP UMUM Rp 4,0014 1912012 "urnia* 11612601 2 √ !iai 00 BP UMUM Rp 4,001 1912012 Se(a 1161260177 13 √ !iai 00 BP UMUM Rp 4,0016 1912012 Sutini 11620272 40 √ $un/ben)a 00 BP UMUM Rp 4,0017 1912012 Sarimi 11621677 4 √ $un/ben)a R0 BP UMUM Rp 4,00

18 1912012 5iana 116247831 11 √ $un/ben)a "29 BP UMUM Rp 4,0019 1912012 Munia* 116337943 42 √ $un/ben)a 00 BP UMUM Rp 4,0020 1912012 Saniti 1163376393 6 √ $un/ben)a "29 BP UMUM Rp 4,0021 1912012 Sari;a* 116249877 38 √ $un/ben)a R0 BP UMUM Rp 4,0022 1912012 .dari 1163363826 67 √ Pa()im 79"1 BP UMUM Rp 4,0023 1912012 S!a)in 116216342 42 √ Pa()im .09 BP UMUM Rp 4,0024 1912012 Sri < 11948478 40 √ Pa()im &29 BP UMUM Rp 4,002 1912012 Jahr 1163363073 76 √ Pa()im J00 BP UMUM Rp 4,00


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ALAMAT DIAGNOSA UNITL P BARU LAMA KARC

1 1912012 Beberan BP UMUM Rp 2 1912012 Beberan BP UMUM Rp 3 1912012 Beberan BP UMUM Rp

4 1912012 Beberan BP UMUM Rp 1912012 Beberan BP UMUM Rp 6 1912012 Beberan BP UMUM Rp 7 1912012 Beberan BP UMUM Rp 8 1912012 Beberan BP UMUM Rp 9 1912012 Beberan BP UMUM Rp 60 1912012 Beberan BP UMUM Rp 61 1912012 Jurina -"&arang BP UMUM Rp 62 1912012 &ari -"&arang BP UMUM Rp 63 1912012 .mina -"

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Copy of Jamkes Januari 2012