KEMENTRIAN PENDIDIKAN DAN KEBUDAYAAN

UNIVERSITAS UDAYANA

RUMAH SAKIT UNIVERSITAS UDAYANA

Alamat : Jl. Rumah Sakit Universitas Udayana No 1, Jimbaran, Badung, Bali
Telepon : (0361) 8953670 email : [email protected]
Laman : https://rs.unud.ac.id
LAPORAN KUNJUNGAN PASIEN POLIKLINIK DETAIL

27-Jun-2022 s/d 27-Jun-2022

NO TANGGAL NRM NAMA TGL LHR NAMA DOKTER CARA BAYAR DIAGNOSA KETERANGAN

POLI BEDAH SARAF

1 27-Jun-2022 05.30.45 YOSEP NAZARIO RONALDO 19-Mar-06 dr. Dewa Putu Wisnu Wardhana, Sp.BS, FICS BPJS Intracranial injury, unspecified
POLI BEDAH UMUM

1 27-Jun-2022 05.30.38 I KADEK AGUS SRI SANDIK 29-Dec-00 dr. Ni Gusti Ayu Agung Manik Yuniawaty We BPJS Benign neoplasm, connective and other soft tissue, unspecified
2 27-Jun-2022 05.28.25 I NYOMAN PRADNYA DHAR 10-Jan-08 dr. Putu Astri Novianti, M.Biomed, Sp.B BPJS Follow-up examination after other treatment for other conditions
3 27-Jun-2022 05.29.14 I WAYAN WATER 08-Mar-73 dr. Putu Astri Novianti, M.Biomed, Sp.B BPJS Type 2 diabetes mellitus
4 27-Jun-2022 05.26.24 NI KETUT WENI 31-Dec-63 dr. Putu Astri Novianti, M.Biomed, Sp.B BPJS Toxic effect, snake venom
5 27-Jun-2022 05.28.00 NIA KURNIASIH 14-May-72 dr. Putu Astri Novianti, M.Biomed, Sp.B BPJS Other benign neoplasms of connective and other soft tissue
6 27-Jun-2022 05.13.25 R. MANIK BATHARA 20-Dec-94 dr. Putu Astri Novianti, M.Biomed, Sp.B BPJS Other benign neoplasms of connective and other soft tissue
7 27-Jun-2022 05.16.92 NI MADE ARY SANTI SUYAS 14-Feb-09 dr. Ni Gusti Ayu Agung Manik Yuniawaty We BPJS Fracture of upper end of radius, closed
POLI BEDAH UROLOGI

1 27-Jun-2022 05.27.41 KETUT PASEK 30-Sep-65 dr. Pande Made Wisnu Tirtayasa, Sp.U(K), Ph BPJS Follow-up examination after other treatment for other conditions
2 27-Jun-2022 05.30.44 JUN YONGKI SUHARYANA 15-Jun-75 dr. Ida Bagus Putra Pramana, Sp.U UMUM Follow-up examination after unspecified treatment for other conditions
3 27-Jun-2022 05.19.70 I GEDE NYOMAN AGUS ARD 20-May-60 dr. Pande Made Wisnu Tirtayasa, Sp.U(K), Ph BPJS Hyperplasia of prostate
POLI FISIOTERAPI

1 27-Jun-2022 04.06.77 NI KETUT PUTRI NURANI 06-Jul-50 None UMUM Other general examinations
POLI GIGI A

1 27-Jun-2022 05.24.47 I MADE KARYANA 18-Feb-86 drg. Putu Ratna Kusumadewi giri, Sp.KG BPJS Acute periodontitis
2 27-Jun-2022 05.30.39 FISKHA HARUNI AMALIA 29-Sep-92 drg. I Putu Gde Ariastawa, SKG UMUM Pulpitis
3 27-Jun-2022 05.26.64 CHANDRA HENDRAWAN 01-May-01 drg. Putu Ratna Kusumadewi giri, Sp.KG BPJS Necrosis of pulp
4 27-Jun-2022 05.27.70 NI KOMANG SURYANI 17-Mar-72 drg. Putu Ratna Kusumadewi giri, Sp.KG BPJS Necrosis of pulp
5 27-Jun-2022 05.29.28 KOMANG MERI JAYANTI 28-Jun-06 drg. Nyoman Ayu Anggayanti, SKG BPJS Chronic apical periodontitis
6 27-Jun-2022 05.25.87 NI LUH SUKAMANI 07-Apr-77 drg. Putu Ratna Kusumadewi giri, Sp.KG BPJS Pulpitis
7 27-Jun-2022 05.21.90 I GEDE BAGATI KUSUMA 03-Apr-99 drg. Putu Ratna Kusumadewi giri, Sp.KG BPJS Pulpitis
8 27-Jun-2022 05.26.73 DAVID ANGKI 18-Jul-82 drg. Putu Ratna Kusumadewi giri, Sp.KG BPJS Necrosis of pulp
9 27-Jun-2022 00.80.13 PIERRE SAINT MACARY 04-Apr-46 drg. Ida Ayu Wirastuti EXECUTIVE Chronic gingivitis
POLI KARDIO

1 27-Jun-2022 03.55.81 FILLYA SHIOFANUS 17-Jul-69 dr. Luh Oliva Saraswati Suastika, Sp.JP, FIH BPJS Hypertensive heart disease
2 27-Jun-2022 03.84.14 TAN HERU HAMIJOYO 22-Jul-67 dr. Luh Oliva Saraswati Suastika, Sp.JP, FIH BPJS Other benign neoplasms of connective and other soft tissue
3 27-Jun-2022 05.25.79 NI MADE RIMBEN 08-Feb-53 dr. Cyndiana Widia Dewi Sinardja, M.Biomed BPJS Heart failure, unspecified
4 27-Jun-2022 03.47.78 I KADEK PURNATHA 16-Nov-65 dr. Cyndiana Widia Dewi Sinardja, M.Biomed BPJS Personal history of medical treatment
POLI PARU

1 27-Jun-2022 05.28.60 ANDRE SETYO WAHYUDI 19-Jan-93 dr. Desak Putu Agung Krisdanti, Sp.P BPJS Respiratory disorder, unspecified
2 27-Jun-2022 05.23.92 DIAJENG PRAMESWARI 17-Jun-91 dr. Desak Putu Agung Krisdanti, Sp.P BPJS Follow-up examination after other treatment for other conditions
3 27-Jun-2022 05.29.33 YULIANTI 12-Nov-91 dr. Desak Putu Agung Krisdanti, Sp.P BPJS Pneumonia, unspecified
4 27-Jun-2022 04.24.16 YULINDA CHRISTINE 14-Jul-77 dr. Desak Putu Agung Krisdanti, Sp.P BPJS Chronic obstructive pulmonary disease with acute exacerbation, unspecified
5 27-Jun-2022 05.29.36 I NYOMAN SENGKEG 31-Dec-55 dr. Desak Putu Agung Krisdanti, Sp.P BPJS Cough
6 27-Jun-2022 05.27.65 KADEK SUARTINI 02-Mar-03 dr. Desak Putu Agung Krisdanti, Sp.P BPJS Miliary tuberculosis, unspecified
7 27-Jun-2022 04.08.12 ISNAINI LATIFAH 11-Oct-71 dr. Desak Putu Agung Krisdanti, Sp.P BPJS Other general examinations
8 27-Jun-2022 05.25.21 SAMUDAN 20-Apr-84 dr. Desak Putu Agung Krisdanti, Sp.P UMUM Other general examinations
POLI SPESIALIS ANAK

1 27-Jun-2022 05.28.63 BAYI IDA AYU SRI ARTATI 20-Jun-22 dr. Ayu Setyorini Mestika Mayangsari, M.Sc. UMUM Cough
2 27-Jun-2022 05.26.75 IDA BAGUS JUJU SURYABA 06-Dec-14 dr. Ayu Setyorini Mestika Mayangsari, M.Sc. BPJS Acute upper respiratory infection, unspecified
3 27-Jun-2022 01.01.15 IDA AYU RUNA ATIKA GRAH 01-Apr-12 dr. Ayu Setyorini Mestika Mayangsari, M.Sc. BPJS Haemorrhage of anus and rectum
POLI SPESIALIS KANDUNGAN DAN KEBIDANAN

1 27-Jun-2022 04.52.41 IDA AYU SRI ARTATI 21-Dec-95 dr. Ryan Saktika Mulyana, M.Biomed, Sp.OG BPJS Single spontaneous delivery
2 27-Jun-2022 05.06.25 NI PUTU DIAN APRIYANTI D 17-Apr-95 dr. Ryan Saktika Mulyana, M.Biomed, Sp.OG BPJS Supervision of normal pregnancy, unspecified
3 27-Jun-2022 05.30.43 NI WAYAN PANI VERAYANT 18-Feb-94 dr. Ryan Saktika Mulyana, M.Biomed, Sp.OG BPJS Supervision of high-risk pregnancy, unspecified
4 27-Jun-2022 03.48.08 MELANI PELIS PASANG 08-Nov-89 dr. Ryan Saktika Mulyana, M.Biomed, Sp.OG BPJS Maternal care for intrauterine death
POLI SPESIALIS KULIT DAN KELAMIN

1 27-Jun-2022 05.29.95 FIRDA FAT SA'DYAH 21-Apr-03 Dr. dr. Ketut Kwartantaya Winaya, Sp.KK BPJS Cyst of Bartholin`s gland
POLI SPESIALIS MATA

1 27-Jun-2022 05.30.41 MANARINA TITIN HANDIAN 24-Jan-12 dr. Ni Made Laksmi Utari, M.Biomed, SpM BPJS Disorders of accommodation
2 27-Jun-2022 05.16.74 I GUSTI KETUT PASTIKA 28-Jan-58 dr. Ni Made Laksmi Utari, M.Biomed, SpM BPJS Examination of eyes and vision
3 27-Jun-2022 05.30.47 PUTU INTARMINI 13-Apr-71 dr. Ni Made Laksmi Utari, M.Biomed, SpM BPJS Disorder of lens, unspecified
4 27-Jun-2022 05.30.48 RONALD FITRAH SATRIA A 15-Nov-03 dr. Ni Made Laksmi Utari, M.Biomed, SpM UMUM Other general examinations
5 27-Jun-2022 05.30.49 PUTU KHRISNA WEDA PRA 01-Oct-03 dr. Ni Made Laksmi Utari, M.Biomed, SpM UMUM Other general examinations
POLI SPESIALIS ORTHOPEDI

1 27-Jun-2022 05.29.81 ELVIRA AMANDA SALSABIL 04-Jul-02 dr. Komang Septian Sandiwidayat Sp. OT, M BPJS Fracture of clavicle
2 27-Jun-2022 05.20.07 RAFI JONATHAN 01-Jul-04 dr. Putu Feryawan Meregawa, M.Biomed.,Sp. IKS Follow-up examination after unspecified treatment for other conditions
3 27-Jun-2022 05.29.19 KADEK SUARTINI SUENDRA 22-Feb-92 dr. Komang Septian Sandiwidayat Sp. OT, M BPJS Injury of unspecified body region
4 27-Jun-2022 03.55.93 AFRA RAIHANGGA 13-Sep-11 dr. Putu Feryawan Meregawa, M.Biomed.,Sp. BPJS Fracture of upper end of radius, closed
5 27-Jun-2022 05.28.31 ARISTA KEYSHA SAVANA 08-May-17 dr. Komang Septian Sandiwidayat Sp. OT, M UMUM Other general examinations
POLI SPESIALIS PENYAKIT DALAM

1 27-Jun-2022 02.91.77 NI KADEK DWI YANTI ANGG 07-Sep-96 dr. Ni Wayan Anantika Riani, M.Biomed, Sp BPJS Thyrotoxicosis [hyperthyroidism]
2 27-Jun-2022 05.29.22 I GEDE PANCA 07-Jun-67 dr. Ni Wayan Anantika Riani, M.Biomed, Sp BPJS Dengue haemorrhagic fever
3 27-Jun-2022 05.30.13 TIAMIN M BR SIRAIT 10-May-50 dr. Ni Wayan Anantika Riani, M.Biomed, Sp UMUM Follow-up examination after unspecified treatment for other conditions
4 27-Jun-2022 03.83.97 KHO PAULUS WIBOWO 07-Jul-66 dr. Cokorde Istri Yuliandari Krisnawardani BPJS Follow-up examination after other treatment for other conditions
5 27-Jun-2022 03.83.96 SRI SURYOWATI 15-May-72 dr. Cokorde Istri Yuliandari Krisnawardani BPJS Follow-up examination after other treatment for other conditions
6 27-Jun-2022 04.77.16 OKKY INTAN SARI 29-Oct-97 dr. Ni Wayan Anantika Riani, M.Biomed, Sp BPJS Benign neoplasm of thyroid gland
7 27-Jun-2022 05.30.51 VIVI HUNG 15-Sep-78 dr. Ni Wayan Anantika Riani, M.Biomed, Sp EXECUTIVE Other general examinations
8 27-Jun-2022 04.01.84 ANAK AGUNG GEDE RAKA 29-Sep-74 dr. Cokorda Agung Wahyu Purnamasidhi, M UMUM Other general examinations
9 27-Jun-2022 05.28.88 HJ EUIS SUGIATI 28-Dec-54 dr. Ni Wayan Anantika Riani, M.Biomed, Sp BPJS Hypokalaemia
10 27-Jun-2022 05.26.43 INDRAWAN EKO BASKORO 03-Oct-77 dr. Ni Wayan Anantika Riani, M.Biomed, Sp BPJS Chronic kidney disease, unspecified
11 27-Jun-2022 05.30.58 JULIA SHANDY PUTRINDA 25-Jul-99 dr. Ni Wayan Anantika Riani, M.Biomed, Sp UMUM Follow-up examination after other treatment for other conditions
POLI SPESIALIS PSIKIATRI

1 27-Jun-2022 05.28.59 NGA DODI 15-Mar-73 dr. I Putu Dharma Krisna Aji, Sp.KJ BPJS Nonorganic sleep disorder, unspecified
2 27-Jun-2022 04.80.78 MICHAEL SIMON SEBASTIAN 22-Feb-79 dr. I Putu Dharma Krisna Aji, Sp.KJ BPJS Phobic anxiety disorders
3 27-Jun-2022 03.05.15 ANITA WIJAYA 04-Jul-90 dr. I Gusti Ayu Indah Ardani, Sp.KJ BPJS Bipolar affective disorder, unspecified
POLI SPESIALIS SARAF

1 27-Jun-2022 05.26.44 ARIF SUYADI 23-Apr-84 dr. Ni Made Susilawathi, Sp.S (K) BPJS Other general examinations
2 27-Jun-2022 05.30.46 NI MADE SENI 15-Jun-68 dr. Ni Made Susilawathi, Sp.S (K) BPJS Gastric ulcer
3 27-Jun-2022 00.65.78 NI NYOMAN SURATNI 20-May-72 dr. Ni Made Susilawathi, Sp.S (K) BPJS Low back pain
4 27-Jun-2022 04.02.16 I WAYAN SADA 30-Dec-65 dr. Putu Gede Sudira, S.Ked. M.Sc., Sp.S BPJS Follow-up examination after unspecified treatment for other conditions
POLI SPESIALIS THT - KL

1 27-Jun-2022 05.25.84 NURHAMSIAH 03-Nov-80 dr. Ni Putu Oktaviani Rinika Pranitasari, M BPJS Chronic sinusitis, unspecified
2 27-Jun-2022 05.19.95 REBECCA 23-Apr-14 dr. Ni Putu Oktaviani Rinika Pranitasari, M BPJS Follow-up examination after other treatment for other conditions
POLI UMUM

1 27-Jun-2022 05.30.53 DEZIDERIO BAQUITINHO T 10-Nov-97 dr. Ayu Waica Pratiwi EXECUTIVE Other general examinations
Kepala Unit Rawat Jalan Kepala Ruangan Rawat Jalan
Mengetahui
(dr. Ni Made Susilawathi, Sp.S(K)) Ka.Bid Pelayanan Medik dan Keperawatan (Ni Luh Putu Ety Juniawati, S.Kep., Ns.)
(dr. I Wayan Aryabiantara, Sp.An. (KIC))
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