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REKAPITULASI JUMLAH PESERTA TERDAFTAR PPDM TIPE 2
BULAN : JANUARI - DESEMBER TAHUN : 2016
NO BULAN NAMA FASKESLama Baru
1 JANUARI KLINIK LINAWATI JANUARI 6 1
2 FEBRUARI KLINIK LINAWATI FEBRUARI 3
3 MARET KLINIK LINAWATI MARET
4 APRIL KLINIK LINAWATI APRIL
5 MEI KLINIK LINAWATI MEI
6 JUNI KLINIK LINAWATI JUNI
BULANTERDAFTAR
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JML PESERTA
Keuar Me!"!##a T$%a Pe&er%a
7
3
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F!"#$ % 10 & I
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PESERTA TERDAFTAR PPDM TIPE 2
BULAN : FEBRUARI TAHUN : 2016
NO KAB / KOTA
PESERTA
NAMA NO KARTU PST P / I / S ALAMAT
1 BANYUWANGI MUHAMMA A!I 000 1"02#$0#67 % ! K&MI'&N BA'A(,&)A K&MI'&N,K&*AMA(AN G!AGA
2 BANYUWANGI MA'IAM 0000 11+17+ I % !&MA'ANG, &)A K&MI'&N K&*AMA(AN G!AGAH BA
BANYUWANGI NU' )AM)I 00000 #$#+6+7# % ! W-N-)A'I,&)A (AMAN)U'UH,K&*AMA(AN G!AGA
#
+
6
7
"
$
10
JENIS
KELAMIN
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FASKES PENGELOLA
NO TELP/HP NAMA FASKES KODE FASKES ALAMAT
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
0"+ 21 +22 60# K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
Banyuwangi, 07 Februari 2016
Kepala
(…………………………)
NO TELP
ALTERNATIF
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LAPORAN JUMLAH PESERTA PPDM TIPE 2 YANG DILAKUKAN PEMERIKSAAN RUTIN BULANAN
BULAN : MARET TAHUN : 2016
NO KAB / KOTA NAMA PESERTA NO KARTU P / I / S
1 BANYUWANGI M-HAMA A!I 0001 "02#$0#67 % ! K!INIK !INAWA(I 01$0U0## .an1+
2 BANYUWANGI MA'IYAM 0000 11+217+ I % K!INIK !INAWA(I 01$0U0## Feb1+
BANYUWANGI NU' )AM)I 0000 0#$#+6+7# ! ) K!INIK !INAWA(I 01$0U0## Apr1+
#
+
6
7
"$
10
11
12
1
1#
1+
(-(A!
KODEKC
JENISKELAMIN
NAMA ASKESPRIMER
KODEASKESPRIMER
BULANMULAITERDATAR
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DIAGNOSA
BULAN MARET 2016
BB TB GDP GDPP GDS HBA1CTEK. DARAH
SISTOLE
%%M +$ 161 22/7 22" 10 70
%%M 61 1# 0/+ 2 1+0 $0
%%M 61/# 16# 22/7 #7 1#0 $0
0 0 0 0 0 0 0 0
IMT(K!/"2)
CHOLTOTAL
CHOLLDL
CHOLHDL
TRIGLISERIDA DIASTOLE
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PESERTA TERDAFTAR PPHT
BULAN : MARET TAHUN : 2016
NO KAB / KOTA
PESERTA
NAMA NO KARTU PST P / I / S ALAMAT
1 BANYUWANGI )(&ANU) HA'I .UANG 0000 11+216# % ! (AMAN)U'UH, K&*/ G!AGAH
2 BANYUWANGI MAHANI 0000 1$6"$22# % % K&MI'&N,K&*/ G!AGAH
BANYUWANGI NIKMAH 0000 700+20"+$ % % (AMAN)U'UH, K&*/ G!AGAH
# BANYUWANGI A)NAN 0000 700+2071# % ! (AMAN)U'UH, K&*/ G!AGAH
+ BANYUWANGI A*HYA' )UWA'I 0000 07+2$ % ! AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
6 BANYUWANGI &NANG 0000 701702$# I % (AMAN)U'UH, K&*/ G!AGAH
7 BANYUWANGI MU)(A.AB 0000 701702#0 % ! (AMAN)U'UH, K&*/ G!AGAH
" BANYUWANGI UKI' )&NI'I 0000 17010677 % % K&MI'&N,K&*/ G!AGAH
$ BANYUWANGI )A%IAH 0000 700+6 % % (AMAN)U'UH, K&*/ G!AGAH10 BANYUWANGI (-NY )UHA'(-N- 0000 11+26102$ % ! BAN.A')A'I, K&*/ G!AGAH
11 BANYUWANGI MI)NAI 0000 70121++0 % ! AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
12 BANYUWANGI MA'KANI 0000 107++666 % ! W-N-)A'I, &)A (AMAN)U'UH, K&*/ G!AGAH
1 BANYUWANGI .AMIAH 0000 107++677 I % W-N-)A'I, &)A (AMAN)U'UH, K&*/ G!AGAH
1# BANYUWANGI MI)KANAH 0000 70127226 I % (AMAN)U'UH, K&*/ G!AGAH
1+ BANYUWANGI A)IH 0000 7012+"1$ I % (AMAN)U'UH, K&*/ G!AGAH
16 BANYUWANGI A)MUNI 0000 7012+67# % ! (AMAN)U'UH, K&*/ G!AGAH
17 BANYUWANGI )U)WA(I 000 12#17++01 % % !&MA'ANG, &)A (AMAN)U'UH K&*/ G!AGAH
1" BANYUWANGI A')- 0000 700612211 % ! -!&H)A'I, K&*/ G!AGAH
1$ BANYUWANGI )U!I)(I-WA(I 0000 70120"6"+ % % AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH20 BANYUWANGI MUIAH 0001 "1717""#$ I % %-'-NG, &)A B-Y-!ANGU, K&*/ GI'I
21 BANYUWANGI )UN-(- 0000 701$1$0++ % ! K&MI'&N,K&*/ G!AGAH
22 BANYUWANGI HANIAH 0000 16++6$1$ p % (AMAN)U'UH, K&*/ G!AGAH
2 BANYUWANGI HA'I MA)(U(I 0000 11+26102$ % ! BAN.A')A'I, K&*/ G!AGAH
2# BANYUWANGI M&HA(I 0000 7020""7$+ % % K&MI'&N,K&*/ G!AGAH
2+ BANYUWANGI UN(UNG 0001 "02#$2"7+ % ! K&MI'&N,K&*/ G!AGAH
26 BANYUWANGI AIYAH 0000 7012++2#" I % (AMAN)U'UH, K&*/ G!AGAH
JENIS
KELAMIN
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27 BANYUWANGI UN(UNG !I)WA(I 0001 #"02#$++2 % % K&MI'&N,K&*/ G!AGAH
2" BANYUWANGI WIY-N- 0001 2$700#0$+ % ! BAN.A')A'I, K&*/ G!AGAH
2$ BANYUWANGI )U'AHMAN 0000 11+2606$ % ! !&MA'ANG, &)A (AMAN)U'UH K&*/ G!AGAH
0 BANYUWANGI )I(I NAWIYAH 0000 11+2+$$" % % K&MI'&N,K&*/ G!AGAH
1 BANYUWANGI U)NIYAH 0000 701216#6 % I AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
2 BANYUWANGI )U!A)('I 000 17$#7010+ % I K&MI'&N,K&*/ G!AGAH
BANYUWANGI )U('I) 000 17$#6+#+" ! % K&MI'&N,K&*/ G!AGAH
# BANYUWANGI NAH'AWI 0000 107+6#6+ ! % K&MI'&N,K&*/ G!AGAH
+ BANYUWANGI .AMA!AH 0000 7016"06$1 % I K&MI'&N,K&*/ G!AGAH
6 BANYUWANGI )UI'MAN 000 1""#$2706 ! I BU!U%AYUNG,&)A KAM%UNGANYA', K&*/ G!AG
7 BANYUWANGI BUHA'I 0000 7016"0#76 ! % K&MI'&N,K&*/ G!AGAH
" BANYUWANGI )AH'I 0000 701$#$$6 ! % GA-G, &)A (AMAN)U'UH, K&*/ G!AGAH
$ BANYUWANGI A&NAN 0000 7012++1#7 ! % AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
#0 BANYUWANGI .UMANI 0000 107+#2+$ l p !&MA'ANG, &)A (AMAN)U'UH K&*/ G!AGAH
#1 BANYUWANGI HA'(A(IK 0000 107+2$## % % !&MA'ANG, &)A (AMAN)U'UH K&*/ G!AGAH
#2 BANYUWANGI )U!I)(I- NING)IH 0000 11#"#70#2 % I AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
# BANYUWANGI I'IK 0000 701261+#" ! % AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
## BANYUWANGI .UMHA' 0000 7012"$6 ! % AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
#+ BANYUWANGI )A%(ANI 0000 7012"6## % I AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
#6 BANYUWANGI &WI '&)I )A'I 0001 16"22"$# I % %&'UM/ G!AGAH, K&*/G!AGAH
#7 BANYUWANGI )U.-N- 0000 701$+6607 % ! AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
#" BANYUWANGI (A)'I%AN 000 1+#12#27# % ! &)A (AMAN)U'UH, K&*/ G!AGAH
#$ BANYUWANGI )AIYAH 000 1"+6#2#161 I % &)A K&MI'&N, K&*/ G!AGAH
+0 BANYUWANGI MIYA(IN 000 1+"##71$ I % &)A K&MI'&N, K&*/ G!AGAH
+1 BANYUWANGI )AH'-NI 000 16117+++ % ! &)A (AMAN)A'I, K&*/ !I*IN
+2 BANYUWANGI )UY-N- 000 161162" % ! &)A (AMAN)A'I, K&*/ !I*IN+ BANYUWANGI )UKA'M- 000 16116#$7 % ! &)A (AMAN)A'I, K&*/ !I*IN
+# BANYUWANGI )U)IAN(- 000 1611617 % ! &)A (AMAN)A'I, K&*/ !I*IN
++ BANYUWANGI )UKA'MAN 000 1611+#06 % ! U)UN '&.-%U'-, &)A KAM%UNGANYA', K&*/
+6 BANYUWANGI 'A)I.- 0000 107+700+ % ! U)UN W-N-)A'I, &)A (AMAN)U'UH K&*/ G
+7 BANYUWANGI A'I%IN 000 1"+6#22$# % ! K&MI'&N,K&*/ G!AGAH
+" BANYUWANGI BAIYAH 000 1+#12#16$ I % W-N-)UK-, K&* KA!I%U'-
+$ BANYUWANGI )U'A.I 000 1+#12#162" % ! W-N-)UK-, K&* KA!I%U'-
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60 BANYUWANGI 'IWAYA( 0000 702#"##+7 I % .AMB&)A'I, K&* GI'I
61 BANYUWANGI A'IYAH 0000 106$#2"6 I % -!&H)A'I, K&*/ G!AGAH
62 BANYUWANGI )UMAI 000 161161$# % ! (AMAN)A'I, K&* !I*IN
6 BANYUWANGI U!FA 0000 11+26070# I % !&MA'ANG, &)A (AMAN)U'UH K&*/ G!AGAH
6# BANYUWANGI AHMA (A'MII 000 1+#12#0$0" % ! '&MBANG, K&* !I*IN
6+ BANYUWANGI &I )U'AIA 000 1#$+1"0#" I % K&MI'&N,K&*/ G!AGAH
66 BANYUWANGI MA')IYA(I 0000 11+2+$0" I % W-N-)A'I, &)A (AMAN)U'UH, K&*/ G!AGAH67 BANYUWANGI MA'.ANI 0000 11+2+$26# % ! W-N-)A'I, &)A (AMAN)U'UH, K&*/ G!AGAH
6" BANYUWANGI )UMA'(- 000 1#767#20$# % ! K-%&N*UNGKING, K&*/ G!AGAH
6$ BANYUWANGI '-HMAN 0000 700$+2+# % !
70 BANYUWANGI )U'I 0000 11#"#"02 % ! AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
71 BANYUWANGI )U)I )U%'IYA(I 000 1#7+02#"7 I % W-N-)A'I, &)A (AMAN)U'UH, K&*/ G!AGAH
72 BANYUWANGI )-IKIN 0000 701$222" % ! AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
7 BANYUWANGI MA)KANAH 0000 701$2#6+ I % AN-NG, &)A (AMAN)U'UH K&*/ G!AGAH
7# BANYUWANGI AGU) I'AWAN 000 1#$+1"07 % ! K&MI'&N,K&*/ G!AGAH
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FASKES PENGELOLA
NO TELP/HP NAMA FASKES KODE FASKES ALAMAT
0"1 2+ 6+$ 12 K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
0"1 0 $#1 160 K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
0"+ 21 +22 60# K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAHK!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
0"2 " 12 "6+ K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAHK!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH
NO TELP
ALTERNATIF
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K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
0"+ 2 22 +"# K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
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K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH 0
K!INIK !INAWA(I 01$0U0## U)UN K'A.AN '( 0# 'W 0 , &)A K&MI'&N, K&*/ G!AGAH "
BANYUWANGI, 06 MA'&( 2016
Kepala
(…………………………)
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8/18/2019 Prolanis Maret
15/29
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8/18/2019 Prolanis Maret
16/29
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8/18/2019 Prolanis Maret
17/29
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8/18/2019 Prolanis Maret
18/29
REKAPITULASI JUMLAH PESERTA TERDAFTAR PPHT
BULAN : MARET TAHUN : 2016
NO BULAN NAMA FASKES BULAN TERDAFTARLama Baru
1 JANUARI KLINIK LINAWATI 70
2 FEBRUARI KLINIK LINAWATI 70 3
3 MARET KLINIK LINAWATI 73 1
4 APRIL KLINIK LINAWATI
5 MEI KLINIK LINAWATI
6 JUNI KLINIK LINAWATI
7 JULI KLINIK LINAWATI
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8/18/2019 Prolanis Maret
19/29
JML PESERTA
Keuar Me!"!##a T$%a Pe&er%a
70
73
74
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8/18/2019 Prolanis Maret
20/29
LAPORAN JUMLAH PESERTA PPHT YANG DILAKUKAN PEMERIKSAAN RUTIN BULANAN
BULAN : MARET TAHUN : 2016
NO KAB / KOTA NAMA PESERTA NO KARTU P / I / S D
1 BANYUWANGI )(&ANU) HA'I .UANG 0000 11+216# % ! K!INIK !INAWA(I 01$0U0## .an1+
2 BANYUWANGI MAHANI 0000 1$6"$22# % % K!INIK !INAWA(I 01$0U0## .an1+
BANYUWANGI UKI' )&NI'I 0000 17010677 % % K!INIK !INAWA(I 01$0U0## .an1+
# BANYUWANGI )A%IAH 0000 700+6 % % K!INIK !INAWA(I 01$0U0## .an1+
+ BANYUWANGI (-NY )UHA'(-N- 0000 11+26102$ % ! K!INIK !INAWA(I 01$0U0## .an1+
6 BANYUWANGI MI)NAI 0000 70121++0 % ! K!INIK !INAWA(I 01$0U0## .an1+
7 BANYUWANGI )U)WA(I 000 12#17++01 % % K!INIK !INAWA(I 01$0U0## .an1+
" BANYUWANGI )UN-(- 0000 701$1$0++ % ! K!INIK !INAWA(I 01$0U0## .an1+
$ BANYUWANGI HANIAH 0000 16++6$1$ p % K!INIK !INAWA(I 01$0U0## .an1+
10 BANYUWANGI HA'I MA)(U(I 0000 11+26102$ % ! K!INIK !INAWA(I 01$0U0## .an1+
11 BANYUWANGI M&HA(I 0000 7020""7$+ % % K!INIK !INAWA(I 01$0U0## .an1+
12 BANYUWANGI UN(UNG 0001 "02#$2"7+ % ! K!INIK !INAWA(I 01$0U0## .an1+
1 BANYUWANGI AIYAH 0000 7012++2#" I % K!INIK !INAWA(I 01$0U0## .an1+
1# BANYUWANGI WIY-N- 0001 2$700#0$+ % ! K!INIK !INAWA(I 01$0U0## .an1+
1+ BANYUWANGI )I(I NAWIYAH 0000 11+2+$$" % % K!INIK !INAWA(I 01$0U0## .an1+
16 BANYUWANGI U)NIYAH 0000 701216#6 % I K!INIK !INAWA(I 01$0U0## .an1+
17 BANYUWANGI )U!A)('I 000 17$#7010+ % I K!INIK !INAWA(I 01$0U0## .an1+
1" BANYUWANGI )U('I) 000 17$#6+#+" ! % K!INIK !INAWA(I 01$0U0## .an1+1$ BANYUWANGI NAH'AWI 0000 107+6#6+ ! % K!INIK !INAWA(I 01$0U0## .an1+
20 BANYUWANGI )AH'I 0000 701$#$$6 ! % K!INIK !INAWA(I 01$0U0## .an1+
21 BANYUWANGI A&NAN 0000 7012++1#7 ! % K!INIK !INAWA(I 01$0U0## .an1+
22 BANYUWANGI .UMANI 0000 107+#2+$ l p K!INIK !INAWA(I 01$0U0## .an1+
2 BANYUWANGI NIKMAH 0000 700+20"+$ % % K!INIK !INAWA(I 01$0U0## Feb1+
2# BANYUWANGI I'IK 0000 701261+#" ! % K!INIK !INAWA(I 01$0U0## Feb1+
2+ BANYUWANGI .UMHA' 0000 7012"$6 ! % K!INIK !INAWA(I 01$0U0## Feb1+
KODE
KC
JENIS
KELAMIN
NAMA ASKES
PRIMER
KODEASKES
PRIMER
BULANMULAI
TERDATAR
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8/18/2019 Prolanis Maret
21/29
26 BANYUWANGI )A%(ANI 0000 7012"6## % I K!INIK !INAWA(I 01$0U0## Feb1+
27 BANYUWANGI &WI '&)I )A'I 0001 16"22"$# % % K!INIK !INAWA(I 01$0U0## Feb1+
2" BANYUWANGI )U.-N- 0000 701$+6607 ! % K!INIK !INAWA(I 01$0U0## Feb1+
2$ BANYUWANGI A)NAN 0000 700+2071# % ! K!INIK !INAWA(I 01$0U0## Feb1+
0 BANYUWANGI A*HYA' )UWA'I 0000 07+2$ % ! K!INIK !INAWA(I 01$0U0## Feb1+
1 BANYUWANGI &NANG 0000 701702$# I % K!INIK !INAWA(I 01$0U0## Feb1+
2 BANYUWANGI MU)(A.AB 0000 701702#0 % ! K!INIK !INAWA(I 01$0U0## Feb1+ BANYUWANGI MA'KANI 0000 107++666 % ! K!INIK !INAWA(I 01$0U0## Feb1+
# BANYUWANGI UN(UNG !I)WA(I 0001 #"02#$++2 % % K!INIK !INAWA(I 01$0U0## Feb1+
+ BANYUWANGI HA'(A(IK 0000 107+2$## % % K!INIK !INAWA(I 01$0U0## Feb1+
6 BANYUWANGI .AMIAH 0000 107++677 I % K!INIK !INAWA(I 01$0U0## Feb1+
7 BANYUWANGI MI)KANAH 0000 70127226 I % K!INIK !INAWA(I 01$0U0## Mar1+
" BANYUWANGI A)IH 0000 7012+"1$ I % K!INIK !INAWA(I 01$0U0## Mar1+
$ BANYUWANGI MUIAH 0001 "1717""#$ I % K!INIK !INAWA(I 01$0U0## Mar1+
#0 BANYUWANGI A)MUNI 0000 7012+67# % ! K!INIK !INAWA(I 01$0U0## Mar1+
#1 BANYUWANGI .AMA!AH 0000 7016"06$1 % I K!INIK !INAWA(I 01$0U0## Mar1+
#2 BANYUWANGI )UI'MAN 000 1""#$2706 ! I K!INIK !INAWA(I 01$0U0## Mar1+
# BANYUWANGI BUHA'I 0000 7016"0#76 ! % K!INIK !INAWA(I 01$0U0## Mar1+
## BANYUWANGI A')- 0000 700612211 % ! K!INIK !INAWA(I 01$0U0## Mar1+
#+ BANYUWANGI )U!I)(I-WA(I 0000 70120"6"+ % % K!INIK !INAWA(I 01$0U0## Apr1+
#6 BANYUWANGI )U'AHMAN 0000 11+2606$ % % K!INIK !INAWA(I 01$0U0## Apr1+
#7 BANYUWANGI )U!I)(I- NING)IH 0000 11#"#70#2 % I K!INIK !INAWA(I 01$0U0## May1+
#" BANYUWANGI )UMAI 000 161161$# % I K!INIK !INAWA(I 01$0U0## .un1+
#$ BANYUWANGI U!FA 0000 11+26070# % I K!INIK !INAWA(I 01$0U0## Aug1+
+0 BANYUWANGI AHMA (A'MII --- 1+#12#0$0" ! % K!INIK !INAWA(I 01$0U0## Aug1+
+1 BANYUWANGI &I )U'AIA 000 1#$+1"0#" % I K!INIK !INAWA(I 01$0U0## Aug1++2 BANYUWANGI MA')IYA(I 0000 11+2+$0" % I K!INIK !INAWA(I 01$0U0## Aug1+
+ BANYUWANGI MA'.ANI 0000 11+2+$26# ! % K!INIK !INAWA(I 01$0U0## Aug1+
+# BANYUWANGI )UMA'(- 000 1#767#20$# ! % K!INIK !INAWA(I 01$0U0## Aug1+
++ BANYUWANGI '-HMAN 0000 700$+2+# ! % K!INIK !INAWA(I 01$0U0## Aug1+
+6 BANYUWANGI (A)'I%AN 000 1+#12#27# ! % K!INIK !INAWA(I 01$0U0## )ep1+
+7 BANYUWANGI )AIYAH 000 1"+6#2#161 % I K!INIK !INAWA(I 01$0U0## )ep1+
+" BANYUWANGI MIYA(IN 000 1+"##71$ % I K!INIK !INAWA(I 01$0U0## )ep1+
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8/18/2019 Prolanis Maret
22/29
+$ BANYUWANGI )AH'-NI 000 16117+++ ! % K!INIK !INAWA(I 01$0U0## )ep1+
60 BANYUWANGI )UY-N- 000 161162" ! % K!INIK !INAWA(I 01$0U0## )ep1+
61 BANYUWANGI )UKA'M- 000 16116#$7 ! % K!INIK !INAWA(I 01$0U0## )ep1+
62 BANYUWANGI )U)IAN(- 000 1611617 ! % K!INIK !INAWA(I 01$0U0## )ep1+
6 BANYUWANGI )UKA'MAN 000 1611+#06 ! % K!INIK !INAWA(I 01$0U0## )ep1+
6# BANYUWANGI 'A)I.- 0000 107+700+ ! % K!INIK !INAWA(I 01$0U0## -341+
6+ BANYUWANGI A'I%IN 000 1"+6#22$# ! % K!INIK !INAWA(I 01$0U0## N051+66 BANYUWANGI BAIYAH 000 1+#12#16$ % I K!INIK !INAWA(I 01$0U0## N051+
67 BANYUWANGI )U'A.I 000 1+#12#162" ! % K!INIK !INAWA(I 01$0U0## N051+
6" BANYUWANGI 'IWAYA( 0000 702#"##+7 % I K!INIK !INAWA(I 01$0U0## N051+
6$ BANYUWANGI A'IYAH 0000 106$#2"6 I % K!INIK !INAWA(I 01$0U0## N051+
70 BANYUWANGI )U'I 0000 11#"#"02 % ! K!INIK !INAWA(I 01$0U0## .an1+
71 BANYUWANGI )U)I )U%'IYA(I 000 1#7+02#"7 I % K!INIK !INAWA(I 01$0U0## Feb16
72 BANYUWANGI )-IKIN 0000 701$222" ! % K!INIK !INAWA(I 01$0U0## Feb16
7 BANYUWANGI MA)KANAH 0000 701$2#6+ % I K!INIK !INAWA(I 01$0U0## Feb16
7# BANYUWANGI AGU) I'AWAN 000 1#$+1"07 ! % K!INIK !INAWA(I 01$0U0## Mar16
7+
77
(-(A!
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8/18/2019 Prolanis Maret
23/29
BULAN MARET 2016
GDP GDPP GDS HBA1C
TEK. DARAH
SISTOLE
20/76 17" 1$0 100
2#/"0
26/6 11+ 1"0 70
/00 121 10 "0
2+/6 17+ 10 $0
0/1 11+ 1+0 $0
17/# 16 1+0 "0
2+/" 12+ 160 70
20/# 1#7 $0 60
IMT(K!/"2)
CHOLTOTAL
CHOLLDL
CHOLHDL
TRIGLISERIDA DIASTOLE
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8/18/2019 Prolanis Maret
24/29
20/## 12" 10 "0
20/10 11" 160 100
2+/76 $6 170 100
22/+ 10 10 "0
2+/+ $+ 10 $0
27/# 1+6 160 $0
20/# 1+0 $0
26/2 167 10 "0
#/+ 12+ 10 70 22/66 12" 10 "0
22/00 1" 120 "0
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8/18/2019 Prolanis Maret
25/29
2/00 12$ 160 "0
0/# 12$ 10 70
2"/0$ 126 10 $0
21/#+ 1#0 120 $0
1/2+ 1+6 10 $0
26/0 11 10 "0
0 0 2# 0 0 0 0 0 2+ 2+
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8/18/2019 Prolanis Maret
26/29
LAPORAN IMPLEMENTASI PROLANIS
HOME VISIT
S/D BULAN PEMBEBANAN : MARET TAHUN : 2016
A. Laporan Kantor a!an" #$ D%&%'% R$"%ona(
N# BULAN
R$%&'%' A&%% K*+*!%
J$' P$,%-'
PPDM PPHT
1 .ANUA'I
2 F&B'UA'I
MA'&(
# A%'I!
+ M&I
TOTAL
K$$%!%: Banyuwangi, 2016
Kepala
Kl Ha8il Kun9ungan :ii8i :engan;
Kn:i8i Bai
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8/18/2019 Prolanis Maret
27/29
LAPORAN IMPLEMENTASI PROLANIS
EDUKASI KLUB RISTI )PEN*ULUHAN RUTIN+
S/D BULAN PEMBEBANAN : MARET TAHUN : 2016
A. Laporan Kantor Cabang ke Divisi Regional
NO KAB / KOTA
TARGET PPDM TIPE 2
KLUB REK BIAYA NAMA KLUB MATERI PERTEMUAN
1 2 # + 6 7 " $
1 BANYUWANGIK!INIK !INAWA(I 10.an16 K!INIK !INAWA(I
KANK&' !&H&' 'AHIM
2 BANYUWANGI K!INIK !INAWA(I 7Feb16 K!INIK !INAWA(I &MAM B&'A'AH ANGU&
BANYUWANGI K!INIK !INAWA(I 6MA'(2016 K!INIK !INAWA(I
#
+
6
7
"
$
10
11
12
TOTAL
TANGGALPELAKSANAA
N
TEMPATPELAKSANAAN
)&HA(
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8/18/2019 Prolanis Maret
28/29
PPHT
NARASUMBER NAMA KLUB MATERI PERTEMUAN NATERDATAR
10 11 12 1# 1+ 16 17
:r/ Ni=a Fa>y 7 6K!INIK !INAWA(I 10.an16 K!INIK !INAWA(I
KANK&' !&H&' 'AHIM :r/ N
:r/ Ni=a Fa>y 7 K!INIK !INAWA(I 7Feb16 K!INIK !INAWA(I &MAM B&'A'AH &NGU& :r/ N
' WI'A I(YA 7 K!INIK !INAWA(I 6Mar16 K!INIK !INAWA(I ' W
21 12
JUMLAH ANGGOTAKLUB
TANGGALPELAKSANAAN
TEMPATPELAKSANAAN
HADIRPERTEM
UAN
AN )&HA(
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8/18/2019 Prolanis Maret
29/29
1$ 20
70 2+
7 2$
7# 27
215 1
JUMLAH ANGGOTAKLUB
TERDATAR
HADIRPERTEM
UAN