Nama Pasien Diagnosa Tujuan Rujukan Tanggal Asuransi Melalui Call Center Nama

di Rujuk Pendamping
Rawat Rawat YA TIDAK
Jalan Inap
1 IJAS haemorrhoids without complication 02-06-2017 BPJS PBI
2 WIENI SOLEKHATUN Epilepsi, tidak spesifik 03-06-2017 BPJS NON PBI
AKHIRI NISA
3 IBRAHIM Peptic ulcer, unspecified as acute or 03-06-2017 BPJS NON PBI
chronic, without haemorrhage or
perforation
4 FUJI ASTUTI Abses, Furunkel, Karbunkel Kutan 03-06-2017 BPJS PBI
5 SAPUTRA Skizofrenia, tidak spesifik 03-06-2017 BPJS PBI
6 ARITI Gangguan mata dan adneksa lainnya, 03-06-2017 BPJS PBI
tidak spesifi
7 SUTANA Other chronic nonsuppurative otitis 03-06-2017 BPJS PBI
media
8 SUNENTI Low vision, both eyes 05-06-2017 BPJS PBI
9 JUENA Nyeri Haid, tidak spesifik 05-06-2017 BPJS PBI
10 ROKMA Unspecified haemorrhoids without 05-06-2017 BPJS PBI
complication
11 KUSHANDI Fever, unspecified 05-06-2017 BPJS PBI
12 WARDINI Acute cystitis 05-06-2017 BPJS PBI
13 SARI YANI Pre-Eklamasi ringan 05-06-2017 BPJS PBI
14 ANI Fetus and newborn affected by other 06-06-2017 BPJS PBI
malpresentation, malposi
15 RUNANI Otitis media nonsupuratif 07-06-2017 BPJS PBI
16 ANI SOFIYANI Benign neoplasm of unspecified site 07-06-2017 BPJS PBI
17 IDA SARI Anemia, tidak spesifik 07-06-2017 BPJS PBI
18 AMIRIN Tuberculosis of lung, without mention of 07-06-2017 BPJS PBI
bacteriological or
19 SARMINA Unspecified diabetes mellitus without 07-06-2017 BPJS PBI
complications
20 SUHENI Spontaneous abortion, incomplete, 07-06-2017 BPJS PBI
without complication
21 SAYONO Unilateral or unspecified inguinal hernia, 08-06-2017 BPJS PBI
with obstruction
22 ARTESI Anemia, tidak spesifi 08-06-2017 BPJS PBI
Hipertensi Maternal
23 YULYANI Pengawasan terhadap kehamilan normal, 08-06-2017 BPJS NON PBI
tidak spesifik
RUMAMI G1POAO Part.preterm kala 1 fase laten 08-06-2017 BPJS PBI Bidan Fitria
dgn PEB+GEMELI Juniati
24 KOSIM heart disease with (congestive) heart 09-06-2017 BPJS PBI
failure
25 ASDIRA Gastric ulcer, unspecified as acute or 09-06-2017 BPJS PBI
chronic, without haemorrhage or
perforation
26 INTISARI Pengawasan terhadap kehamilan normal, 10-06-2017 BPJS NON BPI
tidak spesifik
27 HEMA Contracture of joint, lower leg 10-06-2017 BPJS PBI
28 ARNISI Sequelae of stroke, not specified as 10-06-2017 BPJS PBI
haemorrhage or infarcti
29 SANUMI Other specified dermatitis 10-06-2017 BPJS PBI
30 UMAR Other specified dermatitis 10-06-2017 BPJS PBI
31 NURUL FADILAH Other specified dermatitis 10-06-2017 BPJS PBI
32 RUSTINI A1P0A0 grav 40 mgg pembukaan 2 cm 11-06-2017 BPJS PBI Bidan Ellis
dg kpd,+suspek IUGR Suhayati
33 ARSIJA Other specified intervertebral disc 12-06-2017 BPJS PBI
degeneration
34 IRMAWATI TBC Klinis 12-06-2017 BPJS PBI
35 RUSNATI Katarak senilis 13-06-2017 BPJS PBI
36 WARSAN Katarak senilis 13-06-2017 BPJS PBI
37 TUMIS Retensi Urine 13-06-2017 BPJS PBI
38 DANIRA Stroke, not specified as haemorrhage or 14-06-2017 BPJS NON PBI
infarction
39 AMPERA WATI Dispepsia 14-06-2017 BPJS PBI
40 KASINI Threatened abortion 14-06-2017 BPJS PBI
41 SARYANI Other and unspecified lesions of oral 14-06-2017 BPJS PBI
mucosa
42 CAYA Subsequent myocardial infarction of 14-06-2017 BPJS PBI
unspecified site
43 AMENI Pengawasan terhadap kehamilan resiko 14-06-2017 BPJS PBI
tinggi, tidak spesifik
44 MISNA Katarak, tidak spesifik 14-06-2017 BPJS PBI
45 TUMIS Retensi Urine 14-06-2017 BPJS PBI
46 SARANI Low vision, both eyes 15-06-2017 BPJS PBI
47 DANDI PRASETIO Tuberculosis of lung, without mention of 16-06-2017 BPJS PBI
bacteriological or
48 TANIRA Low back pain 16-06-2017 BPJS PBI
49 TARINI Palpitations 17-06-2017 BPJS PBI
50 UMIYANTI Placenta praevia with haemorrhage 19-06-2017 BPJS PBI Bidan Fitria
Juniati
51 SALEH Low vision, both eyes 19-06-2017 BPJS PBI
52 RASDAN Low vision, both eyes 20-06-2017 BPJS NON PBI
53 RASNIYA Penyakit gagal jantung (DC) 20-06-2017 BPJS PBI
54 JUNO KHALILUNA TBC Klinis 20-06-2017 BPJS PBI
55 RASIDA Calculus of kidney 22-06-2017 BPJS PBI
56 IIN KURNIATI Foreign body granuloma of skin and 22-06-2017 BPJS PBI
subcutaneous tissue
57 HELI SUHARLIN Bradycardia, unspecified 22-06-2017 BPJS PBI
58 HANDRIYANI G1POAO part.preterm 34 mgg kala 2 dgn 26-06-2017 UMUM Bidan Fitria
anemia Juniati
59 MERI Tuberculosis of lung, without mention of 29-06-2017 BPJS NON PBI
bacteriological or
60 NUR ANINDA Pengawasan terhadap kehamilan resiko 30-06-2017 BPJS PBI
tinggi, tidak spesifik
61 SUMENI Pengawasan terhadap kehamilan resiko 30-06-2017 BPJS NON PBI
tinggi, tidak spesifik
LAPORAN BULANAN RUJUKAN

Bulan/Tahun : JUNI
Puskesmas : JEMARAS

Mengetahui Cirebon, 4 Juli 2017

Kepala UPT Puskesmas Jemaras Pengelola keseshatan Rujukan

HJ.MAEMUNAH,SKM,M.Si
DEDE SUTARSIH
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