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REKAP KESELURUHAN PESERTA DM REKRUTMEN FKTP TAHUN 2019 Nama FKTP

: PUSKESMAS SOREANG

Duta Prolanis

:

Alamat

: JL. RAYA SOREANG- BANJARAN KM 3 DESA SOREANG KECAMATAN SOREANG KAB. BDG

No Tlp./HP

: (022) 5897420/ 081220460279

dr./FKTP Pembina

: dr.Diah Astrid L/P

P/I/S/A

DIAGNOS A

1391436134 417202931 1089435475 1296349828

P L P P

P P P P

I10; DM I10+DM DM I10+DM

IIN INDRIYANI

1319169183

P

I

DM

Pamekaran 1/2

6

DEDE RUHYAT

1319167912

L

P

DM

Pamekaran 1/2

7 8

KOSWARA ADE SUKAESIH

1105711841 52535981

L P

P I

9 10

TIA YATI MARYATI

1003628619 1455481743

L P

P I

11

POPON W

2085734474

P

I

I10 + DM Cingcin 3/9

12

JUJU JUARIAH

417767591

P

P

I10+DM Cibogor 1/6

NO

NAMA

NO KARTU PST

1 2 3 4

SATI AYAT RUKAYAT YAYAH K ENGKOM KOMARIAH

5

ALAMAT Legok keong 3/13 Bandawa 15/1 Cingcin kolot 2/17 Kramatmulya 2/1

DM Soreang 1/21 I10;E11 Sadu 1/12 DM DM

NO TELP/HP

Cigembreng 2/6 Soreang 5/10

081220749387

NAMA OBAT

SIGNA

JUMLAH

Amlodipin 10mg Metformin 500mg Glimpirid 2mg Corsaneuron Metformin 500mg Acarbose 50mg Metformin 500mg Glimperid

1x1 3x1 1x1 1x1 3x1 3x1 3x1 1x1

30 90 30 30 90 90 90 30

Metformin 500mg Amlodipin 10mg Rujuk RS Soreang Metformin 500mg Glibenklamid 5mg Metformin 500mg Glimperid 2mg Gemfibrozil Amlodipin 10mg

3x1 1x1

90 30

3x1 1x1 3x1 1x1 1x1 1x1

90 30 90 30 30 30

8997042188

081394329526

13

DUHARMAN

1391431015

L

S

I10+DM Cingcin 2/9

14

EUIS BADRIAH

202562796

P

I

I10;DM Gading 2

15

ENDANG SANUSI

56043202

L

P

I10;DM Gading 2

16

AI ARIYANAH TISNA

1391442309 53644825

P L

I p

DM+I10 Soreang 3/14 DM+I10 ciwaru 1/16

417485788

17

DADAH NORA

P P

p I

DM Pamekaran 4/8 I10;DM cibayondah 2/7

18 19

ENA SUMPENA YAYAT

416844303 54129205

L L

P S

20 21

ROKAYAH SUNDARI SINTA

417663988 417744606

P P

I I

DM Soreang 4/23 I10 + DM Cingcin 4/8

22 23

IDA ROSIDA EUIS KARTINI EUTIK SUMIATI WAHYUDIN BEBEN SYA'BAN

2214519366 2207555526 2044385774 1439446522 52863208

P P P L L

I I I P S

DM DM DM I10;DM DM+I10

24 25 26

ASEP KOMAR YATI CUCU HERLINA

1013357002 417130525 1391431645

L P P

P I P

DM Parken 3/10 I10;DM Panyirapan 2/8 DM Soreang 3/12

416200746

DM DM

Pamekaran 3/11 B.Sayang 3/2

Cingcin 2/1 Pananjung 2/1 Cangkuang 3/5 Parungserab 2/13 Soreang 3/5

0895601237840 082115275309

89613615105 85103407953

81260641454

Metformin 500mg 3x1 Glibenklamid 5mg 1x1 Glibenklamid 5mg 1x1 Amlodipin 10mg 1x1 Metformin 500mg 3x1 Simvastatin 5mg 1x1 Glimperid 1x1 Metformin 500mg 3x1 Glibenklamid 5mg 1x1 Amlodipin 5mg 1x1 meninggal pada tanggal 10 Juli 2017 Metformin 500mg 3x1 Amlodipin 10mg 1x1 meninggal pada tanggal 28 juli 2017 Metformin 500mg 3x1 Glimepirid 2mg 1x1 Amlodipin 5mg 1x1 Dirujuk Ke RS Soreang Metformin 500mg 3x1 Glibenklamid 5mg 1x1

90 30 30 30 90 30 30 90 30 30

Amlodipin 5mg 1x1 Metformin 500mg 3x1 Glibenklamid 5mg 1x1 PINDAH FASKES DAN NONAKTIF NON AKTIF

30 90 30

MENINGGAL Amlodipin 10mg 1x1 Metformin 500mg 3x1

90 30 90 30 30 90 30

30 90

27

NANING KURNIASIH

2032587595

P

I

DM

28

DADANG KOSASIH

2077146854

L

P

DM;I10 Pananjung 2/6

29 30

IMAS NURJANAH NUER ZENAH

1391431421 1837454916

P P

P I

DM Parungserab 2/4 DM+I10 Panyirapan 3/5

31

Hj. HALIMAH

1439446689

P

I

DM

Parungserab 2/13

32

TINI TRIANTINI

416059582

P

I

DM

Cingcin 2/16

33

IRAH SAMIRAH

1003642841

P

I

I10;DM Cingcin 1/4

34

SITI HAFSOH

53656119

P

P

I10+DM Kramat Mulya 2/11

35

YEYE INDRIYANI

53480092

P

P

36

ENI SURYANI

1852482947

P

I

I10+DM Soreang

37

YUMNI

417557867

P

I

I10+DM legok kunci 2/7

38

JAYADI

53023127

L

P

39

RADEN DUDI

25246236

L

P

I10+DM Panyirapan 2/4

40 41

YANI CARYANI ENTIN S

418956851 417931975

P p

I I

I10+DM Sekarwangi 3/11 DM Parungserab 3/14

42

IMAS TETI

1391431116

P

DM+i10 CINGCIN 2/9

43 44

MIMIN IMAS SAROH

4178663665 53459021

P P

DM PANYIRAPAN I10+DM PARKEN 3/13

DM

DM

Pananjung 2/6

Sangkanhurip

Ciseah

Metformin 500mg Simvastatin 10mg Glibenklamid 5mg Metformin 500mg Amlodipin 10mg

3x1 1x1 1x1 3x1 1x1

90 30 30 90 30

Metformin 500mg Amlodipin 10mg Metformin 500mg Glibenklamid 5mg Metformin 500mg Amlodipin 5mg Metformin 500mg Amlodipin 10mg Amlodipin 5mg Glibenklamid 5mg Metformin 500mg Acarbose 50mg Metformin 500mg Amlodipin 10mg Glibenklamid 5mg Metformin 500mg Metformin 500mg Glibenklamid 5mg Amlodipin 5mg Glibenklamid 5mg

3x1 1x1 3x1 1x1 3x1 1x1 3x1 1x1 1x1 1x1 3x1 3x1 3x1 1x1 1x1 3x1 3x1 1x1 1x1 1x1

90 30 90 30 90 30 90 30 30 30 90 90 90 30 30 90 90 30 30 30

Metformin 500mg Glibenklamid 5mg Amlodipin 10mg Metformin 500mg

3x1 1x1 1x1 3x1

90 30 30 90

Amlodipin 10mg

1x1

30

45 46

WAI KAMILAH NURWATI

2263745305 57689201

P P

DM SOREANG 1/3 DM+I10 PAMEKARAN 1/2

47

YATI ROKAYAH

2297733669

P

I10+DM SOREANG 1/2

48

ANA

1483621694

P

I10,DM PARUNGSERAB 1/1

49

ADE H SOBANDI

1003642514 L

I10, DM CINGCIN 1/5

50

DADAN A

1089435295 L

I10, DM CINGCIN 2/17

51

UUM UMAYAH

52

417242081

P

POPON

1089400836

P

DM

CINGCIN 3/17

53

SUSI KAMIATY

2056128434

P

DM

CILUNCAT 6/1

54

SUTISNA

55863224

L

I1O, DM SADU 2/12

55 56

YUYU YULIA IDA DARNATI

53396302 53571352 P

P

DM CINGCIN 5/11 I10+DM PAMEKARAN 3/5

57

DIAN SABRIATI

58625109 P

58

NINA SURPINAH

1846421886

I10,DM SUKARAME 3/9

DM P

CINGCIN 4/14

I25,E11,I10 PARUNGSERAB 2/5

Metformin 500mg

3x1

90

Metformin 500mg Simvastatin 10mg Metformin 500mg Amlodipin 5mg Amlodipin 10mg Captopril 25mg Metformin 500mg Amlodipin 5mg Simvastatin 10mg Metformin 500mg Amlodipin 10mg Metformin 500mg Glibenkamid 5mg Amlodipin Metformin 500mg Glimperid 2mg Acarbose 50mg Metformin 500mg Amlodipin 10mg Captopril 12,5mg Glimepirid 4mg Acarbose 100mg Metformin 500mg Metformin 500mg Amlodipin 5mh Metformin 500mg Aspilet Metformin 500mg Glimepid 2mg Acarbose 50mg Amlodipin 5mg

3x1 1x1 3x1 1x1 1x1 3x1 3x1 1x1 1x1 3x1 1x1 3x1 1x1 1x1 3x1 1x1 3x1 3x1 1x1 3x1 1x1 3x1 3x1 3x1 1x1 3x1 1x1 3x1 1x1 3x1 1x1

90 30 90 30 30 90 90 30 30 90 30 90 30 30 90 30 90 90 30 90 30 90 90 90 30 90 30 90 30 90 30

59

M YUNUS

2198555471

L

I10,E11 CINGCIN 5/15

60 61

ENUNG RATNASIH RITA S

1466412579 53637816

P P

E11 PAMEKARAN 2/2 I10, E11 CINGCIN 2/6

Metformin 500mg Simvastatin 10mg Amlodipin 5mg Glibenklamid 5mg

3x1 1x1 1x1 1x1

90 30 30 30

F

REKAP KESELURUHAN PESERTA HT REKRUTMEN FKTP TAHUN 2019 Nama FKTP

: PUSKESMAS SOREANG

Duta Prolanis

:

Alamat

: JL. RAYA SOREANG- BANJARAN KM 3 DESA SOREANG KECAMATAN SOREANG KAB. BDG

No Tlp./HP

: (022) 5897420/ 081220460279

dr./FKTP Pembina

: dr. Nina Hartini

NO

L/P

P/I/S/A

DIAGNOS A

417709798 1666575955 417769176 416496835 416579319 417568296 416927755 1391436055

P L P P P P P P

I P I P P P I P

I10 I10 I10 I10 I10 I10 I10 I10

Panyirapan 2/5 Legok kiraksa 1/12 Parungserab 3/6 Panyirapan 3/5 Panyirapan 4/9 Panyirapan 4/2 Cigembreng 6/4 Bandawa 2/15

AMIR JOJOH IRAH FATIMAH TATANG JAELANI

417946566 416560149 53820549 53540021 416775723

L P P P L

P P P I P

I10 I10 I10 I10 I10

Bandawa 1/15 Panyirapan 2/4 Pamekaran 3/7 Parungserab 1/6 Sukarame 2/9

KUSMIATI YATI ANISAH ETI ROHAYATI IJAH HADIJAH EDAH JUBAEDAH

1335814323 53686438 1003620969 417377169 416999564

P P P P P

P I I I I

I10 I10 I10 I10 I10

Soreang kolot 1/3 Parken 4/4 Panyirapan 2/16 Bandawa 2/15 Bandawa 15/2

NAMA

NO KARTU PST

1 2 3 4 5 6 7 8

ILAH MARLIAH NANA SUMARNA AMAH ENTAY INAH MASRI ONENG DODEH SUMARNI

9 10 11 12 13 14 15 16 17 18

ALAMAT

NO TELP/HP 088726865367

081324949639

NAMA OBAT

SIGNA

JUMLAH

Amlodipin 5mg

1x1

30

Amlodipin 10mg Captopril 50mg Aspilet

1x1 3x1 1x1

30 90 30

Amlodipin 5mg Simvastatin

1x1 1x1

30 30

Amlodipin 10mg Amlodipin 5mg

1x1 1x1

30 30

81220587852

0895344693582

19 20 21 22 23 24 25 26 27 28 29

ENANG MINANGSIH DEDEH KURNIAWATI RUKMINI TARMINI SRI HARTATI NUR ASIAH SUMINAR POPON SOPIAN ITA MIMIN AMINAH ENOK

416753008 1864681119 417522374 417331585 2088073517 417900936 417628449 168029043 1668166841 161129744 1426468667 417185414

P P P P P P P P L P P P

I I I I I I I P P P P P

I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10

Bandawa 15/2 Cimaung 2/2 Parungserab 3/10 Pamekaran Gandasoli 2/7 Pamekaran 2/5 Soreang 2/2 Pamekaran Tanjungsari 1/5 SIB Cingcin 3/2 Cingcin 2/20

30

ROSITA

416837373

P

I

I10

Cibolang 3/8

31

NUNUNG

417107766

P

I

I10

Soreang 2/23

32

YOYOH

1003641129

P

I

I10

Cingcin 2/6

33 34 35 36 37 38

DEDEH JUBAEDAH RITA ROHAYATI UNEH JATI ROKAJATININGSIH AKHMAD BABAN INAH KARWINAH

1324163496 1391432275 417828339 53006196 1484719773 1484720122

P P P P L P

I I P P I

I10 I10 I10 I10 I10 I10

Cipetir 3/14 Parungserab 1/6 Cingcin 1/10 Cingcin 1/6 Gandasari 2/16 Gandasari 2/16

39 40 41 42 43

AYEK 417776681 CUCU 416123728 AI SUMINAH 53813351 NENENG YUNENGSIH 56811521 H. MAMAT HERMAWAN 53686708

L P P P L

P I P I P

I10 I10 I10 I10 I10

Soreang 5/6 Cingcin 3/5 Sadu 4/11 P. Serab 2/15 Tanjung 4/7

MENINGGAL

089694149310 89649611244

085294570350

85795867011

085624036373 081220637506

Amlodipin 5mg Aspilet Simvastatin Amlodipin 10mg Captopril 50mg Aspilet

1x1 1x1 1x1 1x1 3x1 1x1

30 30 30 30 90 30

Aspilet Amlodipin 10mg Amlodipin 5mg Amlodipin 5mg Amlodipin 5mg Amlodipin 5mg Simvastatin 10mg

2x1 1x1 1x1 1x1 1x1 1x1 1x1

60 30 30 30 30 30 30

Amlodipin 10mg

1x1

30

Amlodipin 5mg

1x1

30

44 45 46 47 48 49 50 51

IMAS ROHIMAH YATI SUMIATI ADANG MULYADI IKAH DEDE ROSMALA OLIH SOLIHIN SUNARDI DIDI SANTOSA

417774791 1321272371 53744613 416882081 1079213635 418857153 418735247 418010905

P P L P P L L L

I P S P I P P P

I10 I10 I10 I10 I10 I10 I10 I10

Soreang 2/7 Ciburial barat 3/5 Parung serab 1/14 cingcin 3/4 Ciluncat 2/5 Muyasari 3/7 Cipeer 3/4 cingcin 3/5

52 53 54 55

TJARMINAH AI SUMINAH AI SUHARTINI ILAH KARTILAH

53825376 417451656 1003640668 1811623465

P P p P

I I I I

I10 I10 I10 I10

Cipetir 3/14 sekarwangi 3/13 Cingcin 2/5 Pamekaran 3/5

56 57 58 59 60 61

ETI RUMYATI ADE DAHLIA E.KARMINI ROKAYAH N. ROSITA I. ROHATI IMAS MASITOH NONENG KARMINI MIMIN SUMINARSIH EDEH DARLIAH TATANG EUIS ERNAWATI ATJIB HASIB LILI SUMANTRI ADE VITA ASEP SURAHMAN

1324181081 1003632895 417923447 417735573 1446985866 1089435868 53448671 1280397036 417943315 2240995364 166952327 53884045 55890189 1391442298 1303440614 56573245 417753887

P L P P P P P P P P P L P L L P L

I P I P P P I I I I I P I P P I P

I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10

Pamekaran 1/2 Parungserab 3 Soreang 5/4 Tegal ilat 2/13 Sadu 1/8 Cingcin 1/11 Pamekaran 4/2 Cingcin 3/13 Parungserab 3/14 Parken 3/6 Soreang 1/23 Pamekaran 1/14 SIB 4/6 Cingcin 1/4 Pamekaran 2/1 Pananjung 4/2 Babakan Cibolang

62 63

64 65 66 67 68 69

081220724759 085352207172 0811214609928

Amlodipin 10mg Amlodipin 10mg Amlodipin 10mg

1x1 1x1 1x1

30 30 30

082318191428

Amlodipin 5mg Amlodipin 10mg Amlodipin 10mg Captopril 25mg Furosemid Aspilet

1x1 1x1 1x1 3x1 1x1 1x1

35 30 30 90 30 30

Amlodipin 5mg Amlodipin 5mg Amlodipin 5mg Simvastatin Amlodipin 5mg

1x1 1x1 1x1 1x1 1x1

30 30 30 30 30

0813443588

85624237813

Rujuk RSUD Soreang Amlodipin 5mg 1x1 Amlodipin 10mg 1x1 GANTI FASKES KE AFIATI

30 30

Amlodipin 5mg

1x1

30

Amlodipin 10mg Amlodipin 10mg Aspilet

1x1 1x1 1x1

30 30 30

70

YUYUM

58177787

P

P

I10

Soreang

71 72 73 74 75 76 77 78 79 80 81 82 83

IA MULYANA NANDANG TINI SUMARTINI ADE SUHENDI ATIN CUCU SUMINAR ENCIH SUKAESIH ROSWENDI IKAH DAIKAH O ROHENDI AI WARIAH IMAS WARIAH UNTUNG

1804730319 417607896 416861043 417012581 417727067 1291421823 1003626898 54044651 1003627686 1391438777 1912970709 416875353

L L P L P P P L P L p P L

P P I P I I

I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 i10 I10 I10

Buninagara Panyirapan 2/2 legok kunci Soreang 5/10 Soreang 1/16 Cangkuang 1/3 Pamekaran 3/14 CIPUTIH PAMEKARAN 1/5 SUKANAGARA 3/5 soreang 2/14 CINGCIN 2/16 CINGCIN

84 85 86

ELLY HALIMAH HOERUDIN IYOS

54295503 2265880476

P L P

I10 I10 I10

BANDASARI CINGCIN SEKAWANGI 3/2

87 88

T KARTIKA TATI SUARTI

P

I10 I10

SOREANG 5/3 CINGCIN 2/9

89

SITI USWATUN

P

I10

GADING 2

418833009

1844556524

53828234 416776419 P

1273931065

P

85295863949

Captopril 25 HCT Amlodipin 10mg Amlodipin 10mg

2x1 1x1 1x1 1x1

60 30 30 30

Amlodipin 5mg

1x1

30

Amlodipin 10mg Amlodipin 5mg Amlodipin 10mg Amlodipin 10mg Amlodipin 5mg Amlodipin 10mg Captopril 50 Amlodipin 5mg

1x1 1x1 1x1 1x1 1x1 1x1 3x1 1x1

30 30 30 30 30 30 90 30

Amlodipin 10mg Aspilet Amlodipin 5mg Amlodipin 10mg Aspilet Simvastatin Amlodipin 10mg

1x1 1x1 1x1 1x1 1x1 1x1 1x1

30 30 30 30 30 30 30

089620570176

REKAP DATA PEMANTAUA PESERTA PROLANIS C TAHUN 201 No Register Club Prolanis

: diisi petugas BPJS

Nama FKTP

: PUSKESMAS SOREANG

Duta Prolanis

:

Alamat

: JL. RAYA SOREANG- BANJARAN KM 3 DESA SOREANG KECAMATAN SOREANG KA

No Tlp./HP

: (022) 5897420/ 081220460279

dr./FKTP Pembina

: dr. Diah Astrid

NO

NO KARTU

L/P PISA

BULAN MULAI TERDAFTAR

DIAGNOSA

001391436134 000417202931 001089435475 001296349828 0001319169183 0001319167912 0001105711841 0000052535981 0001003628619 0001455481743

P L P P P L L P L P P P L P L P

P P P P I P P I P I I P S I P I

DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 JAN 2017 JAN 2017 JAN 2017 JAN 2017

I10; DM I10+DM DM I10+DM DM DM DM I10+DM DM DM I10 + DM I10+DM I10+DM DM DM DM

0000053644825 0000417485788 0000416200764 0000416844303 0000054129205 0000417663988

L

p

DM

P P L L P

p I P S I

FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017

0000417744606 0002214519366 0002207555526 0002044385774

P

I

I10 + DM

P P P

I I I

FEB 2017 MAR 2017 MAR 2017 MAR 2017

NAMA PESERTA

1 SATI 2 AYAT RUKAYAT 3 YAYAH K 4 ENGKOM KOMARIAH 5 IIN INDRIYANI 6 DEDE RUHYAT 7 KOSWARA 8 ADE SUKAESIH 9 TIA 10 YATI MARYATI 11 POPON W 12 JUJU JUARIAH 13 DUHARMAN 14 EUIS BADRIAH 15 ENDANG SANUSI AI ARIYANAH 16 TISNA DADAH 17 NORA 18 ENA SUMPENA 19 YAYAT 20 ROKAYAH 21 SUNDARI SINTA IDA ROSIDA EUIS KARTINI 22 EUTIK SUMIATI

0002085734474 0000417767591 0001391431015 0000202562796 0000056043202 0001391442309

JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017

DM DM DM DM DM DM DM DM

WAHYUDIN 23 BEBEN SYA'BAN 24 ASEP KOMAR 25 YATI 26 CUCU HERLINA 27 NANING KURNIASIH

0001439446522 0000052863208 0001013357002 0000417130525 0001391431645

L L L P P

P S P I P

MAR 2017 MAR 2017 MAR 2017 APRIL 2017 APRIL 2017

I10;DM I10+DM DM I10;DM DM

0002032587595

P

I

APRIL 2017

DM

28 DADANG KOSASIH

0002077146854

L

P

APRIL 2017

DM;I10

29 IMAS NURJANAH

0001391431421

P

P

APRIL 2017

DM

30 NUER ZENAH

0001837454916

P

I

APRIL 2017

I10

31 Hj. HALIMAH

0001439446689 0000416059582 0001003642841 0000053656119 0000053480092 0018522482947 0000417607896 0000053023127 0000025246236 0000418956851 0000417931975 0001391431116 0004178663665 0000053459021 0002263745305 0000057689201 0002297733669 0001483621694 0001003642514 0001089435295 0000417242081 0001089400836 0002056128434 0000055863224 0000053396302 0000053571352 0000058625109 0001846421886 002198555471 0001466412579 0000053637816

P P P P P P L L L P P P P P P P P P L L P P P L P P P P L P P

I I I P P I P P P I I

APRIL 2017 MEI 2017 MEI 2017 MEI 2017 MEI 2017 JULI 2017 JULI 2017 AGUSTUS 2017 AGUSTUS 2017 AGUSTUS 2017 AGUSTUS 2017 SEPTEMBER 2017 SEPTEMBER 2017 SEPTEMBER 2017

32 TINI TRIANTINI 33 IRAH SAMIRAH 34 SITI HAFSOH 35 YEYE INDRIYANI 36 ENI SURYANI 37 YUMNI 38 JAYADI 39 RADEN DUDI 40 YANI CARYANI 41 ENTIN S 42 IMAS TETI 43 MIMIN 44 IMAS SAROH 45 WAI KAMILAH 46 NURWATI 47 YATI ROKAYAH 48 ANA 49 ADE H SOBANDI 50 DADAN A 51 UUM UMAYAH 52 POPON 53 SUSI KAMIATY 54 SUTISNA 55 YUYU YULIA 56 IDA DARNATI 57 DIAN SABRIATI 58 NINA SURPINAH 59 M YUNUS 60 ENUNG RATNASIH 61 RITA S

DM I10+DM I10+DM I10+DM DM I10+DM I10+DM DM I10+DM I10+DM DM DM DM I10+DM DM DM+I10 DM I10,DM I10+DM I10+DM I10+DM DM DM I10+DM DM DM DM DM I10,E11 DM DM

P DATA PEMANTAUAN KESEHATAN ESERTA PROLANIS CLUB (DM) TAHUN 2019

AMATAN SOREANG KAB. BDG

BULAN JANUARI TEK. DARAH IMT (Kg/m2)

TB

BB GDP GDPP GDS HBA1C CHOL TOTAL

CHOL LDL CHOL HDL TRIGLISERIDA

150 41 95 150 75 182 160 67 276 160 60 143 150 150 150 160 150 160

43 70 54 78 55 65

SISTOLE

140 120 130 Mohon diisi apabila peserta melakukan cek laboratorium. Jika tidak pernah melakukan cek lab Profilipid dan HBA1C maka biarkan kolom ini seperti ini

135

147 148 136 117

110 140 160 110 130 130

160 55 171

120

150 55 277

130

160 49 213

100

150 60 172

150

160 55 162

160

150 55 168

130

160 53 144

140

150 44 101

110

150 48 119

110

150 150 150 150 150 160 150 160

95 141 122 209 116 117 309 121

120 130 120 130 120 130 100 130

150 87 119 150 69 117

130 100

150 150 160 160 150 150 150 160 150 150 150 150

129 116 94 162 285 156 131 117 216 86

130 140 140 170 130 90 100 160 125 120 100 120

150 60 319 150 56 174

130 130

57 76 55 67 87 50 55 66

60 49 63 57 52 55 44 58 60 60 54 60

118

BULAN FEBRUARI TEK. DARAH IMT (Kg/m2)

DIASTOLE

90 70 70 90

TB

BB

150 150 150 160

GDP GDPP GDS

CHOL LDL

CHOL HDL TRIGLISERI DA

50 43 210 75 160 68 154

160 160 150 150

60 65 43 70

150 160 150 160

54 142 75 55 65

80

160

58 117

80

150

55 190

60

160

50 143

80

150

60 190

70 90 80 70 90 90

CHOL HBA1C TOTAL

Mohon diisi apabila peserta melakukan cek laboratorium. Jika tidak pernah melakukan cek lab Profilipid dan HBA1C maka biarkan kolom ini seperti ini

151 124 155 143 111

90

160

55

99

150

54 375

70

150

55 180

90

160

63

70

150

44 207

70

150

48 116

90 80 80 80 90 80 70 80

150 150 150 150 150 160 150 160

57 78 54 67 87 50 55 68

80 70

150 150

86 122 65 118

150

55 112

80 80 90 80 70 60 70 80 80 80 70 80

150 150 160 160 150 150 150 160 150 150 150 150

58 54 62 57 52 46 44 58 60 58 55 60

90 80

150 150

59 180 57 131

221

102 131 117 156 114 134 142 118

117 118 110 102 93 200 100 145 136 108 225 101

TEK. DARAH

SISTOLE

DIASTOLE

130 170 120 110

80 90 90 80

160 130 130 90

90 90 90 60

140 120 130 130

90 90 90 90

120

80

110

80

110

80

130

90

140

80

130

90

120

90

130

90

120

90

100

70

110 120 100 160 130 130 120 140

80 90 80 90 90 90 90 90

130 100

90 70

130

80

120 120 120 150 120 150 100 150 120 120 110 120

80 90 90 90 90 90 70 90 90 90 80 80

120 130

90 90

REKAP DATA PEMANTAUAN KESEH PESERTA PROLANIS CLUB (HT) TAHUN 2019 No Register Club Prolanis

: diisi petugas BPJS

Nama FKTP

: PUSKESMAS SOREANG

Duta Prolanis

:

Alamat

: JL. RAYA SOREANG- BANJARAN KM 3 DESA SOREANG KECAMATAN SOREANG KAB. B

No Tlp./HP

: (022) 5897420/ 081220460279

dr./FKTP Pembina

dr. Nina Hartini

NO

NAMA PESERTA

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

ILAH MARLIAH NANA SUMARNA AMAH ENTAY INAH MASRI ONENG DODEH SUMARNI AMIR JOJOH IRAH FATIMAH TATANG JAELANI KUSMIATI YATI ANISAH ETI ROHAYATI IJAH HADIJAH EDAH JUBAEDAH ENANG MINANGSIH DEDEH KURNIAWATI RUKMINI TARMINI SRI HARTATI NUR ASIAH SUMINAR POPON SOPIAN

22 23 24 25 26

NO KARTU

0000417709798 0001666575955 0000417769176 0000416496835 0000416579319 0000417568296 0000416927755 0001391436055 0000417946566 0000416560149 0000053820549 0000053540021 0004167757723 0001335814323 0000053686438 0001003620969 0000417377169 0000416999564 0000416753008 0001864681119 0000417522374 0000417331585 0002088073517 0000417900936 0000417628449 0000168029043 0001668166841

L/P PISA

P L P P P P P P L P P P L P P P P P P P P P P P P P L

I P I P P P I P P P P I P P I I I I I I I I I I I P P

BULAN MULAI TERDAFTAR

DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 DES 2016 JAN 2017

DIAGNOSA

I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10

27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63

64 65 66

ITA MIMIN AMINAH ENOK ROSITA NUNUNG YOYOH DEDEH JUBAEDAH RITA ROHAYATI UNEH JATI AKHMAD BABAN INAH KARWINAH AYEK AI ARIYANAH CUCU DADAH AI SUMINAH NENENG YUNENGSIH H. MAMAT HERMAWAN IMAS R YATI SUMIATI ADANG MULYADI IKAH DEDE ROSMALA OLIH SOLIHIN SUNARDI DIDI SANTOSA TJARMINAH AI SUMINAH AI SUHARTINI ILAH KARTILAH ETI RUMYATI ADE DAHLIA E.KARMINI ROKAYAH N. ROSITA I. ROHATI IMAS MASITOH NONENG KARMINI MIMIN SUMINARSIH EDEH DARLIAH TATANG EUIS ERNAWATI ATJIB HASIB

0000161129744 0001426468667 0000417185414 0000416837373 0000417107766 0001003641129 0001324163496 0001391432275 0000417828339 0000053006196 0001484719773 0001484720122 0000417776681 0001391442309 0000416123728 0000417485788 0000053813351 0000056811521 0000053686708 0000417774791 0001321272371 0000053744613 0000416882081 0001079213635 0000418857153 0000418735247 0000418010905 0000053825376 417451656 0001003640668 0001811623465 0001324181081 0001003632895 0000417923447 0000417735573 0001446985866 0001089435868 0000053448671 0001280397036 0000417943315 0002240995364 0000166952327 0000053884045 0000055890189 0001391442298

P P P P P P P P P P L P L P P P P P L P P L P P L L L P P p P P L P P P P P P P P P L P L

P P P I I I P I I P P I P I I p P I P I P S P I P P P I I I I I P I P P P I I I I I P I P

JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 JAN 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 FEB 2017 MAR 2017 MAR 2017 APRIL 2017 APRIL 2017 APRIL 2017 APRIL 2017 MEI 2017 MEI 2017 MEI 2017 MEI 2017 MEI 2017 MEI 2017 MEI 2017 MEI 2017 MEI 2017 JUNI 2017

I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 DM I10 DM I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10

67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89

LILI SUMANTRI ADE VITA ASEP SURAHMAN YUYUM IA MULYANA NANDANG TINI SUMARTINI ADE SUHENDI ATIN CUCU SUMINAR ENCIH SUKAESIH ROSWENDI IKAH DAIKAH O ROHENDI AI WARIAH IMAS WARIAH UNTUNG ELLY HALIMAH HOERUDIN IYOS T KARTIKA TATI SUARTI SITI USWATUN

0001303440614 0000056573245 0000417753887 0000058177787 0018404730319 417607896 0000416861043 0000417012581 0000417727067 0001291421823 0001003626898 0000054044651 0001003627686 0001391438777 0001912970709 000416875353 0000417775948 0000054295503 0002265880476 0001844556524 0000053828234 0000416776419 0001273931065

L P L P L L P L P P P L P L P P L P L L P P P

P JUNI 2017 I JUNI 2017 P JULI 2017 P JULI 2017 P JULI 2017 P JULI 2017 I JULI 2017 P JULI 2017 I JULI 2017 I AGUSTUS 2017 SEPTEMBER 2017 SEPTEMBER 2017

I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10 I10

A PEMANTAUAN KESEHATAN A PROLANIS CLUB (HT) TAHUN 2019

AMATAN SOREANG KAB. BDG

BULAN JANUARI IMT (Kg/m2)

TB

160

BB

GDP GDPP GDS HBA1C

CHOL TOTAL

CHOL LDL

TEK. DARAH CHOL TRIGLISERIDA HDL SISTOLE DIASTOLE

74 Mohon diisi apabila peserta melakukan cek laboratorium. Jika tidak pernah melakukan cek lab Profilipid dan HBA1C maka biarkan kolom ini seperti ini

130

90

130

90

150

64

150

70

200

90

160 150 150 150

65 39 74 73

120 130 130 130

80 70 90 80

150 150 150 150 150 150 150 150 160 150

45 66 62 62 68 76 50 60 75 53

140 130 150 160 140 140 120 120 120 130

90 80 90 100 90 90 80 80 80 80

150

47

120

80

160 150 150 160

54 58 63 57

110 140 130 130

80 90 90 80

150 160 160

55 75 83

130 130 130

80 80 80

150 150 150 150

40 76 61 52

140 150 120 140

90 80 80 80

150 150

40 50

130 150

80 80

150

50

140

80

150

60

120

80

150 160 150 160

54 50 44 53

140 180 135 150

90 90 70 80

150

57

130

80

160 150 160 150 150 160 150

78 48 63 50 59 85 74

150 120 150 160 110 210 100

90 80 90 80 80 90 80

160 150

69 58

120 130

80 90

BULAN Februari IMT (Kg/m2)

TB

160

BB

GDP GDPP GDS HBA1C

CHOL TOTAL

CHOL LDL

CHOL TRIGLISERIDA HDL

74 Mohon diisi apabila peserta melakukan cek laboratorium. Jika tidak pernah melakukan cek lab Profilipid dan HBA1C maka biarkan kolom ini seperti ini

TEK. DARAH SISTOLE DIASTOLE

120

80

130

80

150

52

160

69

200

90

160 150 150 150

63 39 72 73

100 130 110 110

70 90 80 80

150 150 150 150 150 150 150 150 160

45 66 62 63 68 76 50 61 74

130 120 160 130 120 150 130 130 130

80 80 80 90 80 90 80 80 80

150

49

110

80

160 150

54 58

120 200

80 100

160

57

140

80

150 160

48 74

130 120

90 80

160

51

150

80

150 150 150 150

40 78 60 52

140 130 140 140

80 80 80 80

150 150

40 49

90 140

70 90

150

50

150

80

150

60

130

80

210

150 160 150 160 160

56 50 44 53 57

170 180 130 150 130

100 80 80 90 90

150

58

160

80

160 150 160 150 150 160 150

78 48 61 50 60 84 74

130 120 130 130 110 180 110

80 80 80 80 80 90 80

160 150 150

66 54 62

110 140 160

80 80 90

REKAP KEGIATAN KELOMPOK PESERTA PROLANIS CLUB (diisi nama klub prolanisnya) TAHUN 2019 Nama FKTP

: PUSKESMAS SOREANG

Duta Prolanis

:

Alamat

: JL. RAYA SOREANG- BANJARAN KM 3 DESA SOREANG KECAMATAN SOREANG

No Tlp./HP

: (022) 5897420/ 081220460279

dr./FKTP Pembina

dr. Yani R

NO

1

BULAN

KEGIATAN JENIS

TGL

Jan-19 1 Senam Sehat

2/1/2019 8/1/2019 9/1/2019 16/1/2019 23/1/2019 30/1/2019 8/1/2019 9/1/2019

2 Edukasi Kelompok NO

1

BULAN

KEGIATAN JENIS

TGL

Feb-19 1 Senam Sehat

6/2/2019 12/2/2019 13/2/2019 20/2/2019 27/2/2019 12/2/2019 13/2/2019

2 Edukasi Kelompok

JUMLAH YG HADIR

TTD PEMBINA

25 46 49 26 25 34 46 49 JUMLAH YG HADIR

31 48 47 31 24 48 47

TTD PEMBINA

REKAP KEGIATAN PROLANIS PESERTA PROLANIS CLUB (diisi nama klub prolanisnya) TAHUN 2019 Nama FKTP Duta Prolanis Alamat No Tlp./HP dr./FKTP Pembina

: PUSKESMAS SOREANG : : JL. RAYA SOREANG- BANJARAN KM 3 DESA SOREANG KECAMATAN SOREANG KAB. BDG : (022) 5897420/ 081220460279 : dr. YANI RACHMAWATI

JANUARI 2019 No

1 2 3 4 5 6 7 8 8

Tanggal Kegiatan

2/1/2019 8/1/2019 9/1/2019 16/1/2019 23/1/2019 30/1/2019 8/1/2019 9/1/2019

Jenis Kegiatan

senam Senam Senam Senam Senam Senam edukasi kelompok edukasi kelompok

Nama Klub Rist

hipertensi + diabetes diabetes hipertensi hipertensi + diabetes hipertensi + diabetes hipertensi + diabetes Diabetes Hipertensi

Materi Edukasi Rist

senam lansia senam diabetes senam jumsih senam sabilulungan senam rematik senam cerdik diabetes Penyebab Hipertensi

Pemberi Materi

instruktur Hj. Winarti instruktur Hj. Winarti instruktur Hj. Winarti instruktur Hj. Winarti instruktur Hj. Winarti instruktur Hj. Winarti dr. Yani Rachmawati dr. Ledimer Ambarita

1 2 3 4 5 7 8 8

150 61 89 150 150 150 61 89

Hadir

25 46 49 26 25 34 46 49

Honor 150,000

Biaya-Biaya Mamin Biaya Lain 125,000

Tanggal Kegiatan

6/2/2019 12/2/2019 13/2/2019 20/2/2019 27/2/2019 12/2/2019 13/2/2019

Jenis Kegiatan

senam Senam Senam Senam Senam edukasi kelompok edukasi kelompok

Nama Klub Rist

hipertensi + diabetes diabetes hipertensi hipertensi + diabetes hipertensi + diabetes Diabetes Hipertensi

Materi Edukasi Rist

Senam Poco-Poco senam diabetes Senam Lansia Senam Rematik senam jumsih Senam Kaki Diabetik Tanda dan Gejala Hipertensi

Pemberi Materi

instruktur Hj. Winarti instruktur Hj. Winarti instruktur Hj. Winarti instruktur Hj. Winarti instruktur Hj. Winarti dr. Diah Astrid dr. Nina Hartini

Peserta Terdaftar dalam Club

150 61 89 150 150 61 89

Hadir

31 48 47 31 24 48 47

Total Biaya 275,000

150,000 150,000

368,000 392,000

518,000 542,000

150,000

130,000

280,000

150,000 150,000

125,000 170,000

275,000 320,000

400,000 400,000

400,000 400,000 TOTAL

FEBRUARI 2019 No

Peserta Terdaftar dalam Club

3,010,000

Biaya-Biaya Mamin

150,000 150,000

155,000 384,000

305,000 534,000

150,000 150,000 150,000 400,000 400,000

376,000 155,000 120,000

526,000 305,000 270,000 400,000 400,000

TOTAL

Biaya Lain

Total Biaya

Honor

2,740,000

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