FORMAT LAPORAN KUNJUNGAN

NAMA KLINIK : NU TULANGAN

BULAN : APRIL TAHUN : 2024

JENIS
KELAMIN CHOLESTERO
NO NAMA NIK ALAMAT TANGGAL LAHIR UMUR BB (KG) TB (CM) TENSI GULA DARAH TRIGLISERIDA DIAGNOSA
L
L P SISTOL DIASTOL
1 By Ny nahdha 0003558966298 modong 5 bln √ 6 75 URI
2 H. Masykur 0000097830347 singopadu 55 th √ 65 170 118 80 URI
3 ANAS FIRMANSYAH 0001249387942 TULANGAN 34 TH √ 78 179 120 78 COMMON COLD
4 SRIANAH 0001127128588 KEMANTREN 7/29/1978 48 TH √ 55 155 110 70 97 185 MYALGIA + OA
5 AGUNG BRAMANA 0001137211323 PILANG 35 TH √ 65 170 120 80 GIC
6 RIZA AYU P 0000787755497 GRINTING 25 TH √ 55 156 125 80 URI
7 HAFISHAH 0003298788819 GRINTING 2 TH √ 8.5 110 URI
8 DONY NURDIANTO 0002356263101 GRINTING 29 TH √ 65 160 120 80 URI
9 M. FURKON 0001534906574 GRINTING 35 TH √ 56 160 120 87 FOTOPSIA
10 EKA PRIVENA 0001288785093 KEMANTREN 2/2 3/22/1983 √ 55 153 140 80 PULPITIS
11 RIYANTO 0001381756836 PERUMTAS KEPUH KEMIRI 49 TH √ 52 160 135 75 DERMSTITIS ALERGI
12 SISWATI 0001702469169 KAJEKSAN 49 TH √ 65 155 125 80 ULKUS DM
13 INDAH NOVITA S 0001381759773 PERUMTAS 3 KEPUH KEMIRI 46 TH √ 55 156 124 87 DERMATITIS ALERGI
14 WIWIK MUFRIATIN 0001961987286 MODONG 44 TH √ 56 155 182 104 HT + MYALGIA
15 ABDUL MUKTI 0001307612812 KENONGO TULANGAN 62 TH √ 45 159 168 81 HT
16 AZZURA ANINDITA KIS GRINTING 6 TH √ 19 120 URI
17 AMELIA 0001258959969 PERUMTAS KEPUH KEMIRI 14 TH √ 35 130 110 70 PEDIKULOSIS
18 DONY NURDIANTO 0002356263101 SAMBI KEREP √ 60 160 110 80 URI
19 FANY INDRA 0001834047415 MODONG 20 TH √ 50 155 123 85 URI
20 M JAINUDIN 0001702346602 MODONG 49 TH √ 65 165 150 90 146 OA + HT
21 DARIYAH 0000721911284 KEPADANGAN 52 TH √ 45 55 116 75 URI
22 ARIEF MUSTOFA 000196379321 PERUMTAS KEPUH KEMIRI 40 TH √ 56 160 124 89 URI
23 MASRUCHAH 0002996159196 TULANGAN 56 TH √ 44 155 148 84 DERMATITIS + HT
24 REYHAN SAPUTRA 0001381765792 KEPUH KEMIRI 45 TH √ 54 165 120 80 ULKUS PEDIS
25 NANIK 0002421400285 JANTI 2/2 45TH √ 65 156 130 90 VERTIGO
26 M. FAIZ ABDUL 0002421400678 JANTI 2/2 19 TH √ 55 160 130 80 ABSES
27 Putri anggarawati rohmatul c 0001162243023 KEMANTREN Sidoarjo, 17-06-1993 31 TH √ 45 162 100 70 COMMON COLD
28 SAMIDI Modong 01/02 70 TH √ 62 157 150 80 106 164 HT + MYALGIA
29 ABDUL HADI 0001855270664 KEMANTREN 2/2 44 TH √ 65 172 110 70 GEA
30 MUTMAINAH 0000721978931 GRINTING 42 TH √ 55 156 120 80 GEA
31 IMRON ROSYADI 0000720948418 SINGOPADU 32 TH √ 81 175 120 70 GINGIVITIS
32 ANA ZALFA 0002281389546 MODONG SIDOARJO, 3-08-2017 6 TH √ 27 125 URI + VOMITUS
33 RAMA PRASATYA 0001856163475 PERUM MODONG 15 TH √ 45 150 120 70 CEPHALGIA
34 TRI WAHYUDIONO 0000209972193 KEMANTREN 70 TH √ 65 153 140 90 DM
35 ZIDAN 0001248368973 MODONG 15 TH √ 42 145 110 80 URI + DYSPEPSIA
36 CERRY ANDRIYANTI 0001970747032 PERUMTAS WONOAYU 4/3/1987 37 TH √ 55 155 107 68 URI
37 MOH SYAYIDI SOFYAN 0001703625669 GRINTING 6/28/1990 34 TH √ 65 175 113 68 CEPHALGIA
38 SOEDJALINAH 00001008899818 KAJEKSAN 67 TH √ 55 155 142 72 HT
39 M ARKHAN 0003525739986 MODONG 4/25/2023 1 TH √ 8 98 DERMATITIS
40 ABDUL ROHMAH 0001130028096 KREMBUNG 45 TH √ 62 162 110 80 URI
41 DYAH AYU A 0000721004433 SUDIMORO 33 TH √ 54 155 90 60 G3P0A0
42 M JAINUDIN 0001702346602 KENONGO 6/2 49 TH √ 69 172 150 70 OA
43 M LUKMAN S 0001837969694 GROGOL 38 TH √ 70 178 140 100 115 133 OA + HT
44 HILDA ZUAN P 0000721581388 PILANG 20 TH √ 55 160 110 70 STOMATITIS + GINGIVITIS
45 HARIYATI 0000721930228 SINGOPADU 52 TH √ 54 155 110 70 URI
46 DWI R 0001238079791 GROGOL 45 TH √ 55 157 120 70 85 226 DISPEPSIA + DISLIPIDEMIA
47 SRI WAHYUNI 0000099777025 GROGOL 56 TH √ 62 158 130 80 GASTRITIS
48 LAUREN BAGAS 0000099777036 GROGOL 24 TH √ 78 175 120 80 GASTRIRIS
49 RAHASBITHA GADING 0001168401802 PERUM MODONG 7/4/2002 21 TH √ 56 155 120 80 URI
50 WIDOWATI A 00007212977833 GROGOL 3/1 8/13/2007 17 TH √ 48 150 138 80 URI
51 AGUS SALIM 0001287255868 KEMANTREN 8/17/1975 45 TH √ 54 160 108 70 URI
52 DEWI NURAINI 0000718962568 DUSUN BENGOK 2/1/1999 25 TH √ 54 155 92 54 VERTIGO
53 VIONA SHEZA N 0003097003588 MODONG 2,5 TH √ 13 101 URTIKARIA
54 ELY PURWANTO 0001129968641 KEPADANGAN 53 TH √ 65 173 130 80 GEA
55 CAHYANINGRM AZKA 0002240688396 PERUM KEPUH KEMIRI 8 TH √ 21 93 SUSP DBD
56 CHUSNUL CHOTIMAH 0001238126062 KETIMANG 11/2/1975 49 TH √ 46 55 168 92 HT + DM
57 HARTINI 0001186474667 TANGGUNGAN KIDUL 41 TH √ 56 152 106 76 HAEMOROID
58 ZASKIA 0003110011312 MODONG 2,4 TH √ 14 102 URI
59 MASHELA AZZAHRA 0002943713351 WONOAYU 4 TH √ 20 102 ISPA
60 LILIK S 00012301236816 KAJEKSAN 69 TH √ 62 152 104 67 GINGIVITIS
61 YAYUK S 0001610929271 KEDONDONG 7/1/1686 38 TH √ 55 155 151 80 GINGIVITIS
62 FARIDA UMINTARI 0001309033888 GROGOL 9/26/1969 55 TH √ 42 152 141 82 DISPEPSIA
63 ZAHRA ADEEVA 0002996852051 PERUM TSK GROGOL 10/20/2015 9 TH √ 26 110 DERMATITIS ALERGI
64 BIBIT MULYANI 0001706623481 LUWUNG 2/2 52 TH √ 67 158 150 80 111 195 DM + HT + DISPEPSIA
65 KASTIN 0000721613676 PILANG 45 TH √ 68 159 164 90 OA
66 RUDI WAGIANTO 0000721905592 KEBARON 1/1 44 TH √ 72 172 MYALGIA
67 LAMINAH 0000569016551 PERUM KEPUH KEMIRI 26 TH √ 55 150 100 70 GASTRITIS
68 MOH AKBAR ILHAM 0001166480379 KEBARON 2/2 18 TH √ 72 178 110 70 FARINGITIS
69 SHEYNA MAURILLA DENAYA 0001421804529 MODONG 4/12/2013 11 TH √ 27 120 130 80 FEBRIS
70 RAFFASYA RAMADHAN 0001238085189 KEMANTREN 8/21/2011 13 TH √ 40 140 120 80 ULKUS
71 ACH NUR CHUSAINI MODONG 53 TH √ 72 153 125 75 ABSES
72 ADITYA PRASETYA PILANG 19 TH √ 65 170 120 75 FEBRIS
73 PURWANTO 0002067634866 DURUNG BEDUG 3/28/1986 38 TH √ 72 168 130 75 GINGIVITIS AKUT
74 MUJIATI 0001130028232 KEBARON 2/2 7/5/1974 50 TH √ 56 152 126 83 VERTIGO
75 SUKARNO 0001127194931 PERUM ISTANA RESIDENCE 2/15/1978 46 TH √ 56 170 147 99 HT
76 PRADITYA FABIAN FIRMANSY 0002218108419 PERUM GROGOL 3/12/2007 17 TH √ 62 178 132 85 URI
77 ASHADI 0002735819561 KEMANTREN 58 TH √ 75 178 130 80 OA
78 FEBRI LIANDANA 0002897076385 KEPUH KEMIRI 39 TH √ 52 156 129 80 ISPA
79 HASYIM ASHARI 0001704001509 KAJEKSAN 26 TH √ 72 180 117 80 URI
80 AHMAD AGUNG ZAINURI 0001486807711 PILANG 17/8 28 TH √ 56 159 130 70 URI
81 SRI DEVI 0001833526416 KEPADANGAN 23 TH √ 55 158 100 70 ABSES
82 DINAYAH 0000722208543 SUDIMORO 48 TH √ 68 156 100 70 OA
83 MOH NAJIMADIN 0000721047587 KEPUH KEMIRI 25 TH √ 67 178 120 79 URI
84 SITI ROMLAH MODONG 35 TH √ 55 150 123 85 GINGIVITIS
85 MOH KOIRUL ANAM 0000721554434 GROGOL 2/2 2 TH √ 62 170 110 60 COMMON COLD
86 BAI DJALAL GROGOL 65 TH √ 45 162 130 80 GINGIVITIS
87 SITI QORIAH 00007219974493 GRINTING 5/2 47 TH √ 74 158 110 60 KB
 88 NYONO SIREGAR 0000721885476 MEDALEM 6/1 51 TH √ 72 178 120 80 OA
89 JIHAN TALITA 0001445998612 PERUM MODONG 11 TH √ 45 135 SUSP KGB + URI
90 SYAHDAN MUMTAZEL HAQ 0001328092501 PERM MODONG 11 TH √ 55 135 GEA
91 WAHYU AJI JATIKALANG 10 TH √ 27 120 URI
92 AHMAD KAUTSAR 3525142911030002 PERUM MODONG 20 TH √ 65 178 140 85 POST TB
93 ABDUL ROCHIM 0002204746885 SUDIMORO UTARA 35 TH √ 55 168 120 70 SUSP OA
94 CAHYANINGRM AZKA 0002240688396 PERUM KEPUH KEMIRI 8 TH √ 21 93 SUSP DBD
95 SISWATI 0001702469169 KAJEKSAN 49 TH √ 65 155 125 80 ABSES PEDIS + DM
96 ROYCE GUNAWAN 0001541416443 KETIMANG 9/27/1983 41 TH √ 55 162 126 70 URI
97 M ROBI ABI W JL SUKO 23 TH √ 65 180 130 80 GEA
98 ANDINI NUR M 0001702750386 GROGROL 18 TH √ 54 152 125 78 DISPEPSIA
99 ROYCE GUNAWAN 0001541416443 KETIMANG 9/27/1983 41 TH √ 55 162 113 64 OBS FEBRIS
100 SITI URIPAH 0000721756437 KAJEKASAN 12/4/1982 42 TH √ 45 145 155 101 CEPHALGIA
101 HJ ULLA KIS MODONG 61 TH √ 65 162 130 70 FARINGITIS
102 M JAINUDIN 0001702346602 MODONG 49 TH √ 65 165 150 90 OA + HT
103 DAVIK SETIA ARDI 000258661315 PILANG 9/4 30 TH √ 52 170 120 80 MYALGIA
104 MULYONO 000119098427 KEMANTREN 3/28/1980 44 TH √ 65 170 140 80 OA
105 NARUK 0002757689886 PILANG 4/1/1950 74 TH V 45 160 142 79 OA + GASTRITIS
106 JIHAN TALITA 0001445998612 PERUM MODONG 11 TH √ 45 135 PEROTITIS
107 M JAINUDIN 0001702346602 MODONG 49 TH √ 65 165 150 90 OA + HT
108 SUMEH 0001715892052 PILANG 3/7/1973 51 TH √ 75 156 151 89 CEPHALGIA
109 MUDAHINI 0003073101658 MEDALEM 3/5/1973 51 TH √ 55 152 149 80 DM +HT + CEPALGIA
110 HARYONO 0001165515603 LEBO 11/3/1971 53 TH √ 65 178 120 89 GEA
111 USWATUN KHASANAH 0002897077331 MODONG 4/24/1982 42 TH √ 55 156 143 80 CTS + HT
112 SAI'IN WONOKASIAN 0001705163005 WONOAYU 8/23/1973 51 TH √ 56 178 136 86 ISPA + GASTRITIS
113 M ASHVI RIZKY 0001544518517 MODONG 6/13/2008 16 TH √ 55 162 130 80 FEBRIS + DISPEPSIA
114 BIBIT MULYANI 0001706623481 LUWUNG 2/2 52 TH √ 67 158 150 80 DISPEPSIA
115 SUBAGIO KIS KEMANTREN 5/2/1967 57 TH √ 55 160 99 54 URI
116 RIZQULLAH 0001803701248 GRESIK 45 TH √ 65 178 124 77 CEPALGIA
117 M JAINUDIN 0001702346602 MODONG 49 TH √ 65 165 150 90 LBP
118 NURUL WAHYUDI 0001715892039 KAJEKASAN 5/7/1968 56 TH √ 72 178 120 80 URI
119 ASCHAH 0000098298134 KENONGO 12/4 12/17/1952 72 TH √ 56 155 125 82 HT
120 MUSALMAH 0000722143743 KEPUH KEMIRI 10/7/1968 56 TH √ 58 162 123 78 DISPEPSIA
121 RINDA HIKMATU ANITA SUMBEREJO WONOAYU 19 TH √ 50 155 90 60 URI
122 DJAHIT 0002467960749 PILANG 17/8 57 TH √ 59 159 150 90 HT + DM
123 ANDRI SUSANTO 0000720990371 SINGOPADU 9/20/1982 42 TH √ 62 162 120 80 GEA
124 DEWI TRIASARI 0000721429942 MODONG 3/1 22 TH √ 55 155 120 70 G2P1A0
125 SULASTRI 0000721429266 MEDALEM 3/1 57 TH √ 65 158 100 60 URI
126 SITI URIPAH 0000721756437 KAJEKASAN 12/4/1982 42 TH √ 45 145 150 100 DYPEPSIA + HT
127 ABDUL RO'UF 0002039518427 KREMBUNG 8/8/1994 30 TH √ 65 170 144 80 MYALGIA
128 SITI LAILATUL N 0000721058038 GRINTING 19/01 26 TH √ 60 157 110 70 FARINGITIS
129 NUR ASFA'ANI 0001170975677 GRINTING 5/12/1983 41 TH √ 61 156 118 80 KONJUNGTIVITIS
130 MUJIATI 0001130028232 KEBARON 02/02 50TH √ 65 158 120 80 MYALGIA
131 M ZAFRAN EL 0002463612254 TARIK SIDOARJO 6/19/2018 6 TH √ 25 101 URI
132 SUHARDI MODONG 3/3 65 TH V 65 168 160 80 OA + HT
133 PANGI 0001885343556 MODONG 1/1/1960 64 TH V 55 160 118 74 FEBRIS
134 SUBAGIO
135 SUBAGIO KIS KEMANTREN 5/2/1967 57 TH √ 55 160 90 60 URI + HIPOTENSI
 136 WIJI 0002160333461 KAJEKSAN 10/15/1982 42 TH √ 58 162 160 80 HT
137 SYAHRUL SOFI MUBAROK 0002074223035 DURUNG BEDUG 18/4 24 TH √ 75 175 130 70 DYSPEPSIA
138 VIONA SHEZA N 0003097003588 MODONG 2,5 TH √ 13 101 URTIKARIA
139 SIMAH 0000722703194 GROGOL 4/2 60 TH √ 55 155 150 80 358 DM + HT + VERTIGO
140 ABDUL RAHMAN 0001130028096 KREMBONG 4/2 47 TH √ 56 155 110 70 URI
141 EKA DEWI W 000721333945 JABON 24 TH √ 58 155 128 75 URI
142 SUYATNO 0000721613608 PILANG 6/13 45 TH √ 60 160 141 80 URI
143 SARIMAH 0000721322987 GROGOL 3/1 6/1/1976 48 TH √ 70 159 120 80 SUNTIK KB
144 MUJAYAH 0000721625785 GRINTING 18/5 10/12/1970 54 TH √ 55 152 113 71 MYALGIA
145 M ROISUL 000721626221 GRINTING 18/5 14 TH √ 45 135 101 78 ISPA
146 KUROTIN 0001043308326 KEPUNTEN 2/1 5/10/1991 33 TH √ 56 150 130 80 DYSPEPSIA
147 MIAJI 0002905840259 MODONG 4/13/1981 43 TH √ 65 160 130 80 FEBRIS + TTH
148 SUTINAH GRINTING 62 TH √ 55 155 139 82 ABSES GLUTEN
149 SITI AGUSTININGTIAS 0000721911306 GROGOL 8/20/1995 29 TH √ 80 156 130 80 G3P2A2
150 SULKAN 0000721930656 KEBARON 2/17/1979 45 TH √ 62 172 110 90 ULKUS KORNEA
151 YAYUK SETIAWAN 0001127695645 KEPADANGAN 42 TH √ 55 155 154 103 HT
152 PRADITYA FABIAN FIRMANSY 0002218108419 PERUM GROGOL 3/12/2007 17 TH √ 62 178 132 85 URI
153 SUKARNO 0001127194931 PERUM ISTANA RESIDENCE 2/15/1978 46 TH √ 56 170 147 99 URI + HT
154 LARASATI 0001162451237 MODONG 1/16/2000 24 TH √ 58 162 128 78 CONFUSIO MUSKULAR
155 SUTRISNO 0000722701157 GROGOL 4/2 7/5/1968 56 TH √ 65 163 130 80 ULKUS
156 PRATIWI MEININGSIH 0000721230647 KREMBUNG 5/25/1993 31 TH √ 55 152 154 108 COLIC ABDOMEN + HT
157 SABARIAH 0001166492147 MODONG 11/11/1968 56 TH √ 70 156 183 89 LBP + HT
158 SITI SUMI'AYAH 0003071163396 JIMBARAN WETAN 12/12/1973 51 TH √ 55 155 180 100 HT + URI
159 SUTIMAH 62 TH √ 55 156 139 82 ABSES GLUTEN
160 ERIK YOGA PRATAMA 0001039802556 KAJEKSAN 3/20/2003 19 TH √ 56 160 120 80 CEPALGIA
161 ADZRA NAUFAL 0002909846384 KEMANTREN 12/2/2019 5 TH √ 12 120 FEBRIS + TTH
162 MOH ROSIDIN 0001080809537 GROGOL 2/14/1982 42 TH √ 65 168 128 83 ISK
163 TARDI 0001398401447 MODONG 5/8/1989 35 TH √ 55 160 142 100 MYALGIA
164 MOCH ZAINI 0001798056257 PILANG 9/16/1969 55 TH √ 65 168 131 89 URI
165 REYVAN RADITYA AZHAR 0001173846767 MEDALME 26 TH √ 55 160 130 80 URI
166 FATONI 0000721905759 KEBARON 10/30/1997 26 TH √ 59 162 120 70 DYSPEPSIA
167 ARKA DEWI 0003500369627 KEPUH KEMIRI 1 TH √ 9.4 89 STOMATITIS
168 EKA 0001445998544 MODONG 41 TH √ 62 165 140 90 PERIOD KRONIS
169 SITI LAILATUL N 0000721058038 GRINTING 19/01 26 TH √ 60 157 110 70 FARINGITIS
170 NUR ASFA'ANI 0001170975677 GRINTING 5/12/1983 41 TH √ 61 156 118 80 KONJUNGTIVITIS
171 MUJIATI 0001130028232 KEBARON 2/2 7/5/1974 50 TH √ 56 152 120 80 MYALGIA
172 INDAH 0003143727628 KEPUH KEMIRI 1/23/1978 46 TH √ 55 155 120 90 OA
173 ROBI PAMUNGKAS 0001853957608 PERUMTAS 3 WONOAYU 9 TH √ 42 145 URI
174 LULUK 0001170203949 PERUM HARMONI GROGOL 37 TH √ 58 155 99 82 DYSPEPSIA
175 RIZQI 0003046912479 PERUM HARMONI GROGOL 4 TH √ 15 120 ISPA
176 LILIK S 00012301236816 KAJEKSAN 69 TH √ 62 152 104 67 GINGIVITIS
177 WAHYUDIONO 0000209972193 KEMANTREN 72 TH √ 75 159 130 20 PULPITIS
178 M VIRZA 0002897077803 GEDANGAN 4/8/2015 9 TH √ 22 120 CONTUSIO MUSKULAR
179 M JAINUDIN 0001702346602 MODONG 49 TH √ 65 165 150 90 OA + HT
180 MOCH FAIZABDUL R 0002421400678 GROGOL 2/8/2005 19 TH √ 54 146 120 80 ONIKOKRIPTORIS
181 FAKHRIYATUL IFFADAH 0001161476008 MEDALEM 7/5/1995 29 TH √ 56 155 160 78 G1P0A0
182 PIR DITANINGSIH 0000721093252 TULANGAN 4/1/1967 57 TH √ 62 155 156 82 URI
183 M SHOLEHUDIN BADAR 000148021246 KEMANTREN 27/11/0983 41 TH √ 75 165 121 76 CEPALGIA DD BPPV
184 M MULKI 0000721785071 GROGOL 11/26/1995 29 TH √ 72 168 130 80 FEBRIS
185 DINDA PUTRI 0001261708277 TULANGAN 20 TH √ 55 150 120 80 GEA
186 AGUS SALIM 0001287255868 KEMANTREN 45 TH √ 54 160 108 70 GEA
187 SUKARNO 0001293668976 TARIK SIDOARJO 4/20/1989 35 TH √ 65 160 120 80 OA
188 ZUNAIDI 0001537303768 KENONGO 33 TH √ 72 168 118 83 CEPALGIA
189 KUMAIDAH 0000721257849 GROGOL 4/3 63 TH √ 56 156 140 80 ABSES + VERTIGO
190 REYVAN RADITYA AZHAR 0001173846767 MEDALEM 5/1/2010 13 TH √ 55 145 110 80 URI
191 SITI ROFIAH 0000720928787 KEPUNTEN4/3 4/13/1990 34 TH √ 56 155 130 80 URI
192 TIRTA DZIKRIYAH W 000273837681 TULANGAN 4/4 TULANGAN 1/4/2019 5 TH √ 18 89 110 80 PAROTITIS
193 JUNIAWAN ADI SAPUTRO 0001844279864 KEPATIHAN √ 56 160 130 89 URI + DYSPEPSIA
194 ALI MASCUNG 0002735658279 MODONG 9/12/1966 58 TH √ 72 172 128 77 URI
195 M ABIL M 0002093625821 KEPUNTEN 10/18/2016 8 TH √ 35 102 100 80 URI
196 WAGIMAN 0002736684235 KEDONDONG 5/2/1960 64 TH √ 70 168 160 90 OA + HT
197 EKA DEWI W 000721333945 JABON 24 TH √ 58 155 128 75 DISPEPSIA
198 MUTMAINAH 0000721978931 GRINTING 10/15/1981 42 TH √ 55 156 120 80 GEA
199 WIJI SISWATI 0002160333461 KAJEKSAN 10/15/1982 42 TH √ 58 162 160 90 [ERIOD OF KRONIS
200 ANDINI NUR M 0001702750386 GROGROL 18 TH √ 54 152 125 78 DISPEPSIA
201 SUNARMI 0000721510209 KEMNANTREN 10/2 8/23/1972 52 TH √ 72 156 143 86 URI + GEA
202 RIO HARDIAN 0001536829176 MODONG 5/19/1980 44 TH √ 70 175 130 80 DYSPEPSIA + CEPALGIA
203 RUDI WAGIANTO 0000721905592 KEBARON 1/1 44 TH √ 72 172 100 90 VERTIGO
√
 LAPORAN DIARE
NAMA KLINIK : NU TULANGAN
BULAN : APRIL 2024

NO NAMA NIK
1 ABDUL HADI 0001855270664
2 MUTMAINAH 0000721978931
3 ELY PURWANTO 0001129968641
4 SYAHDAN MUMTAZEL HAQ 0001328092501
5 M ROBI ABI W 0001853957608
6 HARYONO 0001165515603
7 ANDRI SUSANTO 0000720990371
8 DINDA PUTRI 0001261708277
9 AGUS SALIM 0001287255868
10 SUNARMI 0000721510209
11
12
 LAPORAN DIARE
NAMA KLINIK : NU TULANGAN
BULAN : APRIL 2024

JENIS
ALAMAT TANGGAL LAHIR KET
KELAMIN
KEMANTREN 2/2 L GEA
GRINTING P 10/15/1981 GEA
KEPADANGAN L 13-12-1969 GEA
PERM MODONG L GEA
JL SUKO L GEA
LEBO L GEA
SINGOPADU L GEA
TULANGAN P GEA
KEMANTREN L 8/17/1975 GEA
KEMNANTREN 10/2 P 8/23/1972 GEA
 LAPORAN PASIEN HIV
NAMA KLINIK/DPP/PPM : …
BULAN : …

TGL HAMIL
NO PEMERIKSAAN NAMA USIA ALAMAT USIA
HIV YA TIDAK
KEHAMILAN
MIL PENGOBATAN ARV
TEMPAT
GxPxAx YA TIDAK
PENGOBATAN
 LAPORAN PASIEN HEPATITIS B
NAMA KLINIK/DPP/PPM : …
BULAN : …

TGL HAMIL
NO PEMERIKSAAN NAMA USIA ALAMAT USIA
HEP B YA TIDAK
KEHAMILAN
B

MIL PENGOBATAN HEP B

TEMPAT
GxPxAx YA TIDAK
PENGOBATAN
 LAPORAN PASIEN SIFILIS
NAMA KLINIK/DPP/PPM : …
BULAN : …

TGL HAMIL
NO PEMERIKSAAN NAMA USIA ALAMAT USIA
SIFILIS YA TIDAK
KEHAMILAN
MIL PENGOBATAN SIFILIS
TEMPAT
GxPxAx YA TIDAK
PENGOBATAN
 LAPO
NAMA K

No. Nama NIK Umur L/P Alamat Batuk

 LAPORAN PASIEN TB
NAMA KLINIK/DPP/PPM : …
BULAN: …

Gejala Lain Faktor Risiko

Pernah
Berkeringat
Demam berobat Diagnosa Dirujuk
Sesak malam hari Lansia
meriang DM Ibu Hamil Perokok TBC tapi
napas tanpa >60 th
>1 bulan tidak
kegiatan
tuntas
 Diperiksa
Fasyankes Hasil
TCM/Mikroskopis/
Rujukan Pemeriksaan
Foto Thorax
 LAPORAN KB
NAMA KLINIK : NU TULANGA
BULAN : MARET 2024

NO TANGGAL NAMA ALAMAT UMUR

1 16-Apr-24 SRI DEVI RAME PILANG - WONOAYU 23 TH
2 27-Apr-24 VYDDIA MANJA M GANGGANG PANJANG - TANGGULA 24 TH
3 25-Apr-24 DEVI TRIASARI MEDALM 3/1 TULANGAN 23 TH
4 14-Apr-24 ATMI SUKADARYANTI PERUM TSK GROGOL 48 TH
5 7-Apr-24 RATNA EKA W KEMANTREN 6/1 39 TH
6 22-Apr-24 SARIMAH GROGOL 3/1 TULANGAN 48 TH
7 17-Apr-24 SITI QORIAH GRINTING 5/2 TULANGAN 49 TH
8 8-Apr-24 NOVELIA PILANG 6/3 26 TH
9 18-Apr-24 ENI INDARTI KEMANTREN 1/1 25 TH
10 3-Apr-24 MUTMAINAH GRINTING 7/2 TULANGAN 43 TH
11 2-Apr-24 SITI NURZANNAH KEPATIHAN 2/2 TULANGAN 34 TH
 LAPORAN KB
AMA KLINIK : NU TULANGAN
BULAN : MARET 2024

JENIS KB
L/B
SKB 1 BULAN SKB 3 BULAN PIL KB PASANG/AFF IMPLANT
L √
L √
L √
L √
L √
L √
L √
L √
L √
L √
L √
PASANG/AFF IUD
 AN
NAM

NO NIK NAMA UMUR SUAMI

 ANTENATAL CARE (ANC)
NAMA KLINIK/DPP/PPM : …
BULAN : …

JUMLAH GRAVIDA K1
ALAMAT JENIS RESTI K4 HB
SKOR PARA
AKSES MURNI
GULA DARAH PROTEIN
LILA HPHT HPL
>140 g/dl URINE ( + )