Ponkesdes - Selobanteng 2023 10 01 2023 10 31

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<table width="1943" border="1" cellpadding="0" cellspacing="0"

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<tr height="17" style='height:12.75pt;'>
<td height="34" width="38" rowspan="2"
style='height:25.50pt;width:28.50pt;'>No.</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>No.
Bpjs</td>
<td align="center" width="93" rowspan="2"
style='width:69.75pt;'>Tangal</td>
<td align="center" width="305" rowspan="2" style='width:228.75pt;'>Nama</td>
<td align="center" rowspan="2">JK</td>
<td align="center" width="305" rowspan="2" style='width:228.75pt;'>Alamat</td>
<td align="center" width="150" rowspan="2" style='width:112.50pt;'>No.
Kartu Peserta</td>
<td align="center" width="150" rowspan="2" style='width:112.50pt;'>Jenis</td>
<td align="center" width="565" colspan="9"
style='width:423.75pt;'>Pelayanan</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>Diagnosa</td>
<td align="center" width="200" rowspan="2" style='width:200.00pt;'>Terapi</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>BB/TB</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>TD</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>HR</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>RR</td>
<td align="center" width="88" rowspan="2" style='width:66.00pt;'>TTD</td>
<td align="center" width="88" rowspan="2"
style='width:66.00pt;'>STATUS</td>
</tr>
<td align="center">Umum (BP)</td>
<td align="center">Gigi</td>
<td align="center">KIA</td>
<td align="center">Kebid.</td>
<td align="center">KB</td>
<td align="center">UGD</td>
<td align="center">Jiwa</td>
<td align="center">Rujukan</td>
<td align="center">Kunj. Sehat</td>
</tr>
<td height="17" align="right">1.</td>
<td align="center">23</td>
<td class="xl67" align="center" > 02/10/2023</td>
<td>MASDAN</td>
<td>L</td>
<td>SELOANTENG</td>
<td align="center"> 0000706942596</td>
<td align="center">PBI (APBN)</td>
<td align="center"></td>
<td align="center">✔</td>
<td>Z00</td>
<td></td>
<td align="center">55/156</td>
<td align="center">DILAYANI</td>
</tr>
<td>LIATUL KHOIRIYAH</td>
<td>P</td>
<td>SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAMUSLIM</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARMI</td>
<td>P</td>
<td>selobanteng</td>
<td>Z00</td>
<td></td>
</tr>
<td>AMINA</td>
<td>P</td>
<td align="center">PEGAWAI SWASTA</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAMRATUN</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAIFULLAH</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMARNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>NIJA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>B.SAMAN</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>P.SURO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NIRA</td>
<td>P</td>
<td>SELOBANTENNG</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISDAR</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MOH FAHIM FATHULLAH</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NASERON</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>BUARI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MA'ATI</td>
<td>P</td>
<td>BRINGIN SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAFI'A</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MULYADI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ELIS SUHARTINI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISNADN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUDIMAN</td>
<td>L</td>
<td>BRINGIN, SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>QURROTUL A'YUN</td>
<td>P</td>
<td>KRAJAN BANYUGLUGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>NURHASANAH</td>
<td>P</td>
<td>BERINGIN</td>
<td>Z00</td>
<td></td>
</tr>
<td>DONI JEFRIANTO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SANIMO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>AHMAD FERDIYONO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SATRI</td>
<td>P</td>
<td>JATIAN SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISNO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUNIRA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MOH. ABU YANTO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>RASTI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MIYARSO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARSI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ANTON</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SYAHIDI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUHAMMAD HAMDAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>KANAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>YULIATIN</td>
<td>P</td>
<td>Bunut - Selobanteng</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARPIYA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>KUSNAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUMA'ATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISKALI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>YATIK</td>
<td>P</td>
<td>BUNUT SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>DESIYA</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MA'ATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUGIANTORO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>BUATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>FATHOR RAHMAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>TOMI</td>
<td>P</td>
<td align="center">KEPALA DESA DAN PERANGKAT DESA</td>
<td>Z00</td>
<td></td>
</tr>
<td>ATINA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAMI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAGI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ABDULLAH</td>
<td>L</td>
<td align="center">KEPALA DESA DAN PERANGKAT DESA</td>
<td>Z00</td>
<td></td>
</tr>
<td>LIATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUTRI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISTALI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUMANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SARMINA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUHA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>BUSARI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARTI</td>
<td>P</td>
<td>BERINGIN SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>TOLI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>TIYAM</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SNIMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>JENA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>BURANA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISYATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TINA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SANIBA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ATI .</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TOYA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SARIMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>IYA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUNA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SALIMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISLENG</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ASIM</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>YULIATIN</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SRI AMAMI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SARMIDEN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ENA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SARI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ETTI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ASMAT</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SATI</td>
<td>P</td>
<td>SELOBANTENNG</td>
<td>Z00</td>
<td></td>
</tr>
<td>DURRATUN NASIHAH</td>
<td>P</td>
<td>dusun bringin RT 03/ 02 selobanteng kec Banyuglugur kab situbondo</td>
<td>Z00</td>
<td></td>
</tr>
<td>TOYANI</td>
<td>P</td>
<td>Selobanteng</td>
<td align="center">PBI (APBD)</td>
<td>Z00</td>
<td></td>
</tr>
<td>TIAMI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISTINA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAMI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SULFA ALFIAH</td>
<td>P</td>
<td>KRAJAN SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>SULI</td>
<td>L</td>
<td>KRAJAN BANYUGLUGUR</td>
<td>Z00</td>
<td></td>
</tr>
<td>SA'I</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>PAKMU / P. SUJARI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>TASYA</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ABDUL HARI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>RAHMATULLAH</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUSILOWATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUHAMMAD MUTAWAKKIL</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUHA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>DINAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ASNAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MOH. AYOS</td>
<td>L</td>
<td>BRINGIN SELOBANTENG </td>
<td>Z00</td>
<td></td>
</tr>
<td>MAHMUT</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MARTIK</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARNIT</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SNIRI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAMIAN</td>
<td>L</td>
<td align="center">PNS PUSAT</td>
<td>Z00</td>
<td></td>
</tr>
<td>JENA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAIMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>B SURYO AKWI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ZAHRO NAURA IZZEH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SURYANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TRANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TANTI AZARIMA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TOYANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>HARDIYOTO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARBI'</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISLENG</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMARNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>JUMANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>PURWANTO</td>
<td>L</td>
<td align="center">PNS DAERAH</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARDIMU</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MINA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TIYAM</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>NUR LAILY</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>DARTI WAHYUNI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUHAMMAD YONGKI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISNAI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISANI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARPIYA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>DIKAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MIYARSO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>ALEM</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MUNIRA</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>SAMARNING</td>
<td>P</td>
<td align="center">PNS DAERAH</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUMIATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ANTON</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>BUSAHRI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>HADI SISWANTO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>NISBATUL ISTIQOMAH</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISKAN</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>SUTRI</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MASDAN</td>
<td>L</td>
<td>SELOANTENG</td>
<td>Z00</td>
<td></td>
</tr>
<td>P.SURO</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>TALLEP</td>
<td>L</td>
<td>Z00</td>
<td></td>
</tr>
<td>MISNAI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>ARBI'</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>LIATI</td>
<td>P</td>
<td>Z00</td>
<td></td>
</tr>
<td>TORAJI</td>
<td>L</td>
<td>BERINGIN SELOBANTENG</td>
<td>Z00</td>
<td></td>
</tr>
</table>
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Ponkesdes - Selobanteng 2023 10 01 2023 10 31

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