PEMERINTAH KABUPATEN KAYONG UTARA

DINAS KESEHATAN DAN KELUARGA BERENCANA

PUSKESMAS SUKADANA
Alamat : Jln. Bhayangkara. No: 31 Kabupaten Kayong Utara

LAPORAN RUJUKAN

BULAN : APRIL 2019

JENIS PEMBIAYAAN
TERDAFTAR BPJS BELUM
NO NAMA UMUR DIAGNOSA PERMATA RS. M
PBI NON PBI TERDAFTAR AGUSDJAM FATIMA SOEDARSO
BUNDA DJAMALUDIN
L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 15 15
1 Ny. Saniah 31 th Acute vaginitis
G5P4A0M0 hamil 37
mg √ √

2 Ny. Sumarai 32 th Mild hyperemisis

gravidarum
√ √

3 Ny. Maimunah 41 th Antenatal screening,

unspecified
√ √

4 Ny. Wahda 33 th Antenatal screening,

unspecified √ √

5 Ny. Yanti 38 th Antenatal screening,

unspecified
√ √
6 Ny. Hasanah 35 th Antenatal screening,
unspecified √ √

7 Ny. Irmadiahita 25 th Prolonged pregnancy

√ √

8 Ny. Lilis 34 th G4P3A0M2 hamil 39

mg dengan FEB dan
presbok √ √

9 Ny. Mistira 34 th Abnormal uterine and

vaginal bleeding,
unspecified √ √

10 Ny. Halimatussa'diah 42 th Abnormal uterine and

vaginal bleeding, √
unspecified

11 Ny. Rumiati 25 th Other specified

noninflammatory
disorders of vagina √ √

12 Ny. Jasimah 41 th A2M0 hamil 38 mg,

kala I fase aktif dengan
preeklamsia dan resti √ √
umur

13 Ny. Rosita 31 th Antenatal screening,

unspecified, false labore
before 37 completed √ √
weeks of gestatio

14 Ny. Delima 30 th Other and unspecifed

ovarium cyst √ √

15 Ny. Suryanti 25 th Polycystic ovariun

syndrom √ √
16 Ny. Sri Rahayu 27 th Antenatal screening,
unspecified √ √

17 Ny. Eka Pratiwi 28 th Antenatal screening,

unspecified √ √

18 Ny. Darmawati 30 th G2P1A0M0 hamil

aterm, inpartu kala I fase
aktif suspek lintang √ √

19 Ny. Sri Afriayani 31 th Surveilance of

contraseptive drugs
√ √

20 Ny. Hasimtan 27 Th Threatened abortion

G2P1A0M0 hamil 9 mg √ √

21 Ny. Aisyah 58 th Abnormal uterine and

vagina √ √

22 Ny. Ira Masurah 34 th maternal care for

mallpresentasion
G3P2A0M0 hamil 26 √ √
mg

23 Ny. Nia Kusniawati 23 th Antenatal screening,

unspecified, G1P0A0M0
√ √
H 30 mg

24 Ny. Evi Tamala 27 TH Ectopic pregnancy,

unspecified √ √

25 Ny. Ida 39 Th False labour before 37

weeks complete of
gestation G5P4AMM0 √ √
39 mg

26 Ny. Evi Sutriani 36 th Abnormal uterine and

vaginal bleeding √ √
unspecifed
27 Ny. Enny Herpayani 30 th Antenatal screening,
unspecified √ √

28 Ny. Halimatussa'diah 42 Th Secondary amenorrhea

√ √

29 Ny. Ummi Fadillah 35 th Follow up examination

after surgary for other √ √
conditions

30 Ny. Mistira 34 th Abnormal uterine and

vaginal bleeding
unspeccifed √ √

31 Ny. Suryanti 25 th Polycystic ovariun

syndrom √ √

32 Ny. Wahda 33 th Maternal care for poor

fetal growth √ √

33 Ny. Syf. Lusi Dian Atari 19 th Threatened abortion

√ √

34 Ny. Jumiati 22 th Inflammatory disorders

of breast
√ √

35 Ny. Isti Rahmawati 35 th G5P4A0M0 H 38 mg

inpartu kala I dengan
fase laten memanjang √ √

36 Ny. Mistira 34 th Excessive and frequent

menstruation with
√ √
reguler cycle

37 Ny. Pitriani 32 th Antenatal screening,

unspecified √ √

38 Ny. Asmawati 33 th Antenatal screening,

unspecified √ √
39 Ny. Shopia Hariati 34 th Antenatal screening,
unspecified √ √

40 Ny. Rukiah 37 th Non insulin dependent

diabetes melitus,
gestasional.
√ √
Hypertension without
significant proteunuria

41 Ny. Sa'baniah 37 th Antenatal screening,

unspecified √ √

42 Ny. Sumartini 33 th Antenatal screening,

unspecified √ √

43 Ny. Sumiati 27 th G3P2A0M0 hamil 36

mg inpartu kala I fase √ √
laten

44 Ny. Yanti 38 th Follow up examination

after surgary for other √ √
conditions
45 Ny. Sri Rahayu 27 th False laboor before 37
complete week of
gestational G4P2A1M0 √ √
H 32 mg

46 Ny. Mariamah 25 th Gestational pregnancy

induced hypertension
without significant √ √
proteinuria

47 Bunga 11 th Febris

√ √

48 Soleh 13 th Astma

√ √
49 M.Akbar Ibrahim 13 bln KDS

√ √

50 M.Farhan R 1 th Corpus Alenium

√ √

51 Supiana 2 th Febris

√ √

52 Timiliana 36 th Astma

√ √

53 Mat Saleh 64 th PPOK

√ √

54 Mirni Ati 15 th Susp APP

√ √

55 Widia Sari 17 th Susp HNP

√ √

56 Fi'i 61 th CHF + IHD

√ √
57 Sadikin 53 th ISK

√ √

58 Toni 7 hari Prematur

√ √

59 Ardiansyah 19 bln Brophenumonia

√ √

60 Ardianto 12 th Susp APP

√ √

61 Mi'an 55 th Melena

√ √

62 Sopiana 35 th Penurunan Kesadaran

√ √

63 Erik Syaputra 4 th Fraktur

√ √

64 Mia Darmiyani 20 th Anemia

√ √
65 Mas'ud 42 th Anemia

√ √

66 Azril 2 th Brophenumonia
√ √

Mengetahui,
Kepala Puskesmas Sukadana

dr. Abdul Karim Lubis, M.Ked (for)Sp.F

NIP. 197002232002121003