Jemaah Haji 2019.xlsx

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FORM CEKLIS KELENGKAPAN PEMERIKSAAN TAHAP 2 PUSKESMAS…….. NO NO. PORSI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

NAMA

1000521978 1000527068 1000518363 1000521848 1000509754 1000527067 1000516876 1000514605 1000516875 1000518365 1000533949 1000523979 1000508189

AGUS RAFLI RUMAMBI AGUSTINA INDRIANI, S.PD.BIO. CECEP YANTO DARSONO DEDEH KURNIASIH DRS. NGADINO RIADI, M.PD. ECIN EKA KURNIAWAN ERIS RISRIANTO ETI C. JEMBRANG KASMAH KASMINI

1000524267 1000539678 1000508190

KASWANDI KIROAH KUSMANA

1000527122 1000521409 1000513017 1000531604 1000508191

MARGONO, S.PD. MARYATI MOHAMMAD YAZID, DRS. N. NESIH NARSIAH

1000535615 1000511250 1000546790

NUNUNG MAMNU'AH RAS'AN MOMON SUDIRMAN RIA YULIANTI

USIA 18/05/1965 17/08/1967 10/04/1956 25/04/1964 03/06/1961 16/01/1966 19/05/1971 28/11/1975 12/04/1971 06/05/1959 12/07/1964 16/03/1970 1944-04-06 16/12/1937 16/06/1966 1961-06-15 16/05/1963 17/08/1958 25/08/1949 02/03/1947 1969-04-04 23/02/1968 07/08/1952 25/07/1969

ALAMAT

PEMERIKSAAN TAHAP 2 (hal.1) (hal.2) (hal.3) (hal.4)

PEMBINAAN M.K

OBT BAWAAN

DSN. PANGANDARAN RT 03/01 DSN. KEDUNGREJO RT 02/02 DSN. PANGANDARAN RT 02/02 DSN. KALAPATIGA RT 01/08 DSN. PANGANDARAN BARAT RT 01/04 DSN. KEDUNGREJO RT 02/02 DSN. PADASUKA RT 01/15 DSN. KARANGSARI RT 02/03 DSN. PADASUKA RT 01/15 DSN. PANGANDARAN RT 02/02 DSN. SIDOMULYO RT 01/01 DSN. CICURUG RT 04/01 DSN. PADASUKA RT 01/20 DSN. BOJONGJATI RT 05/06 DSN. KARANG SALAM RT 03/01 DSN. KARANGGEDANG RT 02/04 DSN. WONOHARJO RT 02/14 DSN. KAMURANG RT 04/10 KARANGGEDANG RT 05/06 DSN. MUNGGANG GONDANG RT 04/04 DSN. KARANGGEDANG RT 02/04 DSN. KAMURANG RT 02/11 DSN. KALAPATIGA RT 02/08 JL. PARAPAT RT 01/07

abnormal EKG , istitaah tidak? yang udah dirujuk hasil spesialis nya mana?

25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

1000511252 1000523953 1000524291 1000524297 1000535612 1000509323 1000521420 1000509325 1000539675 1000521419 1000521405 1000521412 1000509180 1000521414 1000509329 1000521977 1000514608 1000546791

RUMSIH RUSDI SAMINGAN SAMIYEM SAPRI, S.PD SLAMET SAEPUDIN A. SRI HAYATI SUGIYANTI SUHARTO SUKINO SULAEMAN SUPRIYATI TASMAN SUKEMI TOTO PRIYANTO UMIYATI YENI SURYANI YOYOH ROKAYAH ZUL TABRANI MIMIN ROHAYATI ENDID M. ARIEF FAHMI RACHLAN KARMAWAN

07/06/1960 23/08/1970 08/04/1967 16/12/1938 05/10/1963 19/02/1983 28/01/1978 17/08/1987 27/06/1959 31/05/1971 10/09/1956 20/09/1978 01/01/1944 28/11/1975 09/12/1948 02/07/1978 05/05/1956 05/05/1969

DSN. KALAPATIGA RT 02/08 DSN. CICURUG RT 04/01 DSN. BOJONGJATI RT 06/08 DSN. BOJONGJATI RT 05/06 DSN. KAMURANG RT 02/11 DSN. KARANGSALAM RT 03/05 DSN. KAMURANG RT 01/11 DSN. KARANGSALAM RT 02/05 DSN. KARANG SALAM RT 03/01 DSN. KAMURANG RT 01/11 DSN. KAMURANG RT 04/10 DSN. KAMURANG RT 01/10 DSN. BOJONGJATI RT 06/04 DSN. KAMURANG RT 01/10 DSN. KARANGSALAM RT 02/05 DSN. PANGANDARAN RT 03/01 DSN. KARANGSARI RT 02/03 JL. PARAPAT RT 01/07

dr. Yati Nurhayati dr.H.Bambang Ekobroto, M.Kes

196603052002121000

dr. Yati Nurhayati

FORM KELENGKAPAN DATA CALON J PUSKESMAS PANGANDAR OBAT TB NO

NO. PORSI

NAMA

RUJUKAN 01 02

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47

RISTI

05

YA

TDK

1000521978 AGUS RAFLI RUMAMBI 1000527068 1000518363 1000521848 1000509754 1000527067 1000516876 1000514605 1000516875 1000518365 1000533949 1000523979 1000508189 1000524267 1000539678 1000508190 1000527122 1000521409 1000513017 1000531604 1000508191 1000535615 1000511250 1000546790 1000511252 1000523953 1000524291 1000524297 1000535612 1000509323 1000521420 1000509325 1000539675 1000521419 1000521405 1000521412 1000509180 1000521414 1000509329 1000521977 1000514608 1000546791 1000811860 1000695037 1001021679 1000881503 1000537012

AGUSTINA INDRIANI, S.PD.BIO. CECEP YANTO DARSONO

mengundurkan diri

DEDEH KURNIASIH DRS. NGADINO RIADI, M.PD. ECIN EKA KURNIAWAN ERIS RISRIANTO ETI C.

tidak istitaah

JEMBRANG KASMAH

a

KASMINI KASWANDI

mata katarak?

pendamp org

KIROAH KUSMANA MARGONO, S.PD.

meninggal gaada diagnosa dr

MARYATI MOHAMMAD YAZID, DRS. N. NESIH NARSIAH NUNUNG MAMNU'AH RAS'AN MOMON SUDIRMAN RIA YULIANTI RUMSIH RUSDI

a

SAMINGAN SAMIYEM SAPRI, S.PD SLAMET SAEPUDIN A. SRI HAYATI SUGIYANTI SUHARTO SUKINO SULAEMAN SUPRIYATI TASMAN SUKEMI

dengan pendampingan orang

TOTO PRIYANTO UMIYATI YENI SURYANI

TIDKA ADA FOTO

YOYOH ROKAYAH ZUL TABRANI

mengundurkandiri

MIMIN ROHAYATI ENDID

dengan pendampingan orang

M. ARIEF FAHMI RACHLAN KARMAWAN

pemeriksaan dokter belum

KAPAN DATA CALON JEMAAH HAJI KESMAS PANGANDARAN dr.H.Bambang Ekobroto, M.Kes DIAGNOSIS ICD Z00 E78, K29, H91, I84, J45 J45 E78.5 Z00 I10, E78.5 E78.5, M10.9 I10 Z00 I10, E78.5 D64.9, B90.9, J44 Z00 E78.5, I84, H26.9,M19.9 I10 E11, E78.5, I10 Z00 E11.9, I10, I25, K64.8 E11.9 Z00 A88.1, E78.5 I84.5, E78.5 K40 Z00 Z00 J30.4, J441 E78.5 D64.9 E78.5, G47.0, J30.4 E66 Z00 E78.5 Z00 Z00 Z00 Z00 H40, E78.5, H54.4 Z00 E78.5, I10

JENIS ISTHITA'AH DGN TDK ISTH TDK ISTHITA'AH PENDAMPINGAN SMNTR ISTHITA'AH a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a

18/05/1965 17/08/1967 10/04/1956 25/04/1964 03/06/1961 16/01/1966 19/05/1971 28/11/1975 12/04/1971 06/05/1959 12/07/1964 16/03/1970 1944-04-06 16/12/1937 16/06/1966 1961-06-15 16/05/1963 17/08/1958 25/08/1949 02/03/1947 1969-04-04 23/02/1968

dr.H.Bambang Ekobroto, M.Kes

07/08/1952 25/07/1969 07/06/1960 23/08/1970 08/04/1967 16/12/1938 05/10/1963 19/02/1983 28/01/1978

dr.H.Bambang Ekobroto, M.Kes

17/08/1987 27/06/1959 31/05/1971 10/09/1956 20/09/1978

a a a

LANSIA

01/01/1944 28/11/1975 09/12/1948 02/07/1978

E78.5

TIDAK ADA LAB

E78,5, K29.7

a a

05/05/1956 05/05/1969

dr. Yati Nurhayati

dr. Yati Nurhayati

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