DATA PASIEN SKTM PEMDA 2012

DATA PASIEN SKTM PEMDA
RUANG HEMODIALISA
RSUD KAB. INDRAMAYU
BULAN JANUARI 2012

NO NAMA NO. MEDREK ALAMAT DATANG PULANG KET.

1 HARTONO 76884 LOBENER 02/01/2012 02/01/2012
2 CARNENGSIH 64989 SUKAURIP 02/01/2012 02/01/2012
3 WASTEM 65448 TAMBAK 02/01/2012 02/01/2012
4 KARNADI 73272 KERTASMAYA 02/01/2012 02/01/2012
5 ATIN 86228 PILANGSARI 02/01/2012 02/01/2012
6 ASEP 56724 PEKANDANGAN 03/01/2012 03/01/2012
7 TOMI 68821 PILANGSARI 03/01/2012 03/01/2012
8 TEDI 85246 LARANGAN 03/01/2012 03/01/2012
9 KUMINIH 70854 PAMAYAHAN 03/01/2012 03/01/2012
10 KARTONO 79633 LOSARANG 03/01/2012 03/01/2012
11 MUHAMAD 54000 CEMPEH LELEA 04/01/2012 04/01/2012
12 RAKYAD 60180 PATROL 04/01/2012 04/01/2012
13 RAHMAT 81107 GANTAR 04/01/2012 04/01/2012
14 MAUNAH 77560 DUKUH 04/01/2012 04/01/2012
15 ATIN 86228 PILANGSARI 04/01/2012 04/01/2012
16 HARTONO 76884 LOBENER 05/01/2012 05/01/2012
17 CARNENGSIH 64989 SUKAURIP 05/01/2012 05/01/2012
18 WASTEM 65448 TAMBAK 05/01/2012 05/01/2012
19 KARNADI 73272 KERTASMAYA 05/01/2012 05/01/2012
20 WARTA 62764 KEDOKAN AGUNG 05/01/2012 05/01/2012
21 ASEP 56724 PEKANDANGAN 06/01/2011 06/01/2011
22 TOMI 68821 PILANGSARI 06/01/2011 06/01/2011
23 TEDI 85246 LARANGAN 06/01/2011 06/01/2011
24 KUMINIH 70854 PAMAYAHAN 06/01/2011 06/01/2011
25 KARTONO 79633 LOSARANG 06/01/2011 06/01/2011
26 MUHAMAD 54000 CEMPEH LELEA 07/01/2012 07/01/2012
27 RAKYAD 60180 PATROL 07/01/2012 07/01/2012
28 RAHMAT 81107 GANTAR 07/01/2012 07/01/2012
29 MAUNAH 77560 DUKUH 07/01/2012 07/01/2012
30 ATIN 86228 PILANGSARI 07/01/2012 07/01/2012
31 HARTONO 76884 LOBENER 09/01/2012 09/01/2012
32 CARNENGSIH 64989 SUKAURIP 09/01/2012 09/01/2012
33 WASTEM 65448 TAMBAK 09/01/2012 09/01/2012
34 KARNADI 73272 KERTASMAYA 09/01/2012 09/01/2012
35 WARTA 62764 KEDOKAN AGUNG 09/01/2012 09/01/2012
36 ASEP 56724 PEKANDANGAN 10/01/2012 10/01/2012
37 TOMI 68821 PILANGSARI 10/01/2012 10/01/2012
38 TEDI 85246 LARANGAN 10/01/2012 10/01/2012
39 KUMINIH 70854 PAMAYAHAN 10/01/2012 10/01/2012
40 KARTONO 79633 LOSARANG 10/01/2012 10/01/2012
41 MUHAMAD 54000 CEMPEH LELEA 11/01/2012 11/01/2012
42 RAKYAD 60180 PATROL 11/01/2012 11/01/2012
43 RAHMAT 81107 GANTAR 11/01/2012 11/01/2012
44 MAUNAH 77560 DUKUH 11/01/2012 11/01/2012
45 CARNENGSIH 64989 SUKAURIP 12/01/2012 12/01/2012
46 HARTONO 76884 LOBENER 12/01/2012 12/01/2012
47 KARNADI 73272 KERTASMAYA 12/01/2012 12/01/2012
48 WARTA 62764 KEDOKAN AGUNG 12/01/2012 12/01/2012
49 SAKEM 86893 PAREAN GIRANG 12/01/2012 12/01/2012
50 ASEP 56724 PEKANDANGAN 13/01/2012 13/01/2012
51 TOMI 68821 PILANGSARI 13/01/2012 13/01/2012
52 TEDI 85246 LARANGAN 13/01/2012 13/01/2012
53 KUMINIH 70854 PAMAYAHAN 13/01/2012 13/01/2012
54 KARTONO 79633 LOSARANG 13/01/2012 13/01/2012
55 MUHAMAD 54000 CEMPEH LELEA 14/01/2012 14/01/2012
56 RAKYAD 60180 PATROL 14/01/2012 14/01/2012
57 RAHMAT 81107 GANTAR 14/01/2012 14/01/2012
58 MAUNAH 77560 DUKUH 14/01/2012 14/01/2012
59 HARTONO 76884 LOBENER 16/01/2012 16/01/2012
60 KARNADI 73272 KERTASMAYA 16/01/2012 16/01/2012
61 WARTA 62764 KEDOKAN AGUNG 16/01/2012 16/01/2012
62 SAKEM 86893 PAREAN GIRANG 16/01/2012 16/01/2012
63 WASTEM 65448 TAMBAK 16/01/2012 16/01/2012
64 ASEP 56724 PEKANDANGAN 17/01/2012 17/01/2012
65 TOMI 68821 PILANGSARI 17/01/2012 17/01/2012
66 TEDI 85246 LARANGAN 17/01/2012 17/01/2012
67 KUMINIH 70854 PAMAYAHAN 17/01/2012 17/01/2012
68 KARTONO 79633 LOSARANG 17/01/2012 17/01/2012
69 MUHAMAD 54000 CEMPEH LELEA 18/01/2012 18/01/2012
70 RAKYAD 60180 PATROL 18/01/2012 18/01/2012
71 RAHMAT 81107 GANTAR 18/01/2012 18/01/2012
72 MAUNAH 77560 DUKUH 18/01/2012 18/01/2012
73 HARTONO 76884 LOBENER 19/01/2012 19/01/2012
74 KARNADI 73272 KERTASMAYA 19/01/2012 19/01/2012
75 WARTA 62764 KEDOKAN AGUNG 19/01/2012 19/01/2012
76 SAKEM 86893 PAREAN GIRANG 19/01/2012 19/01/2012
77 WASTEM 65448 TAMBAK 19/01/2012 19/01/2012
78 ASEP 56724 PEKANDANGAN 20/01/2012 20/01/2012
79 TEDI 85246 LARANGAN 20/01/2012 20/01/2012
80 KUMINIH 70854 PAMAYAHAN 20/01/2012 20/01/2012
81 KARTONO 79633 LOSARANG 20/01/2012 20/01/2012
82 MUHAMAD 54000 CEMPEH LELEA 21/01/2012 21/01/2012
83 RAKYAD 60180 PATROL 21/01/2012 21/01/2012
84 RAHMAT 81107 GANTAR 21/01/2012 21/01/2012
85 HARTONO 76884 LOBENER 23/01/2012 23/01/2012
86 KARNADI 73272 KERTASMAYA 23/01/2012 23/01/2012
87 WARTA 62764 KEDOKAN AGUNG 23/01/2012 23/01/2012
88 WASTEM 65448 TAMBAK 23/01/2012 23/01/2012
89 SAKEM 86893 PAREAN GIRANG 23/01/2012 23/01/2012
90 ASEP 56724 PEKANDANGAN 24/01/2012 24/01/2012
91 TEDI 85246 LARANGAN 24/01/2012 24/01/2012
92 KUMINIH 70854 PAMAYAHAN 24/01/2012 24/01/2012
93 KARTONO 79633 LOSARANG 24/01/2012 24/01/2012
94 MUHAMAD 54000 CEMPEH LELEA 25/01/2012 25/01/2012
95 RAKYAD 60180 PATROL 25/01/2012 25/01/2012
96 RAHMAT 81107 GANTAR 25/01/2012 25/01/2012
97 WASTEM 65448 TAMBAK 26/01/2012 26/01/2012
98 WARTA 62764 KEDOKAN AGUNG 26/01/2012 26/01/2012
99 SAKEM 86893 PAREAN GIRANG 26/01/2012 26/01/2012
100 KARNADI 73272 KERTASMAYA 26/01/2012 26/01/2012
101 ASEP 56724 PEKANDANGAN 27/01/2012 27/01/2012
102 TEDI 85246 LARANGAN 27/01/2012 27/01/2012
103 KARTONO 79633 LOSARANG 27/01/2012 27/01/2012
104 RAHMAT 81107 GANTAR 27/01/2012 27/01/2012
105 MUHAMAD 54000 CEMPEH LELEA 27/01/2012 27/01/2012
106 KUMINIH 70854 PAMAYAHAN 27/01/2012 27/01/2012
107 ATIN 86228 PILANGSARI 28/01/2012 28/01/2012
108 RAKYAD 60180 PATROL 28/01/2012 28/01/2012
109 WARTA 62764 KEDOKAN AGUNG 30/01/2012 30/01/2012
110 SAKEM 86893 PAREAN GIRANG 30/01/2012 30/01/2012
111 KARNADI 73272 KERTASMAYA 30/01/2012 30/01/2012
112 ASEP 56724 PEKANDANGAN 31/01/2012 31/01/2012
113 TEDI 85246 LARANGAN 31/01/2012 31/01/2012
114 MUKLAS 88463 HAURGEULIS 31/01/2012 31/01/2012
115 KARTONO 79633 LOSARANG 31/01/2012 31/01/2012
116 KUMINIH 70854 PAMAYAHAN 31/01/2012 31/01/2012


Indramayu, februari 2012

Penerima Yang Menyerahkan



NURJANAH


DATA PASIEN SKTM PEMDA
RUANG HEMODIALISA
RSUD KAB. INDRAMAYU
BULAN FEBRUARI 2012

NO NAMA NO. MEDREK ALAMAT DATANG PULANG KET.

1 MUHAMAD 54000 CEMPEH LELEA 01/02/2012 01/02/2012
2 RAKYAD 60180 PATROL 01/02/2012 01/02/2012
3 RAHMAT 81107 GANTAR 01/02/2012 01/02/2012
4 KARNADI 73272 KERTASMAYA 02/02/2012 02/02/2012
5 WARTA 62764 KEDOKAN AGUNG 02/02/2012 02/02/2012
6 SAKEM 86893 PAREAN GIRANG 02/02/2012 02/02/2012
7 WASTEM 65448 TAMBAK 02/02/2012 02/02/2012
8 ASEP 56724 KARANGANYAR 03/02/2012 03/02/2012
9 TEDI 85246 LARANGAN 03/02/2012 03/02/2012
10 KARTONO 54000 CEMPEH LELEA 03/02/2012 03/02/2012
11 KUMINIH 60180 PATROL 03/02/2012 03/02/2012
12 MUHAMAD 54000 CEMPEH LELEA 04/02/2012 04/02/2012
13 RAKYAD 60180 PATROL 04/02/2012 04/02/2012
14 RAHMAT 81107 GANTAR 04/02/2012 04/02/2012
15 KARNADI 73272 KERTASMAYA 06/02/2012 06/02/2012
16 WARTA 62764 KEDOKAN AGUNG 06/02/2012 06/02/2012
17 SAKEM 86893 PAREAN GIRANG 06/02/2012 06/02/2012
18 WASTEM 65448 TAMBAK 06/02/2012 06/02/2012
19 ASEP 56724 KARANGANYAR 07/02/2012 07/02/2012
20 TEDI 85246 LARANGAN 07/02/2012 07/02/2012
21 RAHMAT 81107 GANTAR 07/02/2012 07/02/2012
22 KARTONO 54000 CEMPEH LELEA 07/02/2012 07/02/2012
23 KUMINIH 60180 PATROL 07/02/2012 07/02/2012
24 RAKYAD 60180 PATROL 08/02/2012 08/02/2012
25 MUHAMAD 54000 CEMPEH LELEA 08/02/2012 08/02/2012
26 RUMINIH 89977 DADAP 08/02/2012 08/02/2012
27 KARNADI 73272 KERTASMAYA 09/02/2012 09/02/2012
28 WARTA 62764 KEDOKAN AGUNG 09/02/2012 09/02/2012
29 WASTEM 65448 TAMBAK 09/02/2012 09/02/2012
30 SAKEM 86893 PAREAN GIRANG 09/02/2012 09/02/2012
31 RAHMAT 81107 GANTAR 10/02/2012 10/02/2012
32 ASEP 56724 KARANGANYAR 10/02/2012 10/02/2012
33 TEDI 85246 LARANGAN 10/02/2012 10/02/2012
34 KARTONO 54000 CEMPEH LELEA 10/02/2012 10/02/2012
35 KUMINIH 60180 PATROL 10/02/2012 10/02/2012
36 RAKYAD 60180 PATROL 11/02/2012 11/02/2012
37 MUHAMAD 54000 CEMPEH LELEA 11/02/2012 11/02/2012
38 RUMINIH 89977 DADAP 11/02/2012 11/02/2012
39 SAEFUDIN 90341 ANJATAN 11/02/2012 11/02/2012
40 KARNADI 73272 KERTASMAYA 13/02/2012 13/02/2012
41 WARTA 62764 KEDOKAN AGUNG 13/02/2012 13/02/2012
42 WASTEM 65448 TAMBAK 13/02/2012 13/02/2012
43 SAKEM 86893 PAREAN GIRANG 13/02/2012 13/02/2012
44 SAEFUDIN 90341 ANJATAN 13/02/2012 13/02/2012
45 RAHMAT 81107 GANTAR 14/02/2012 14/02/2012
46 TEDI 85246 LARANGAN 14/02/2012 14/02/2012
47 KUMINIH 60180 PATROL 14/02/2012 14/02/2012
48 RAKYAD 60180 PATROL 15/02/2012 15/02/2012
49 MUHAMAD 54000 CEMPEH LELEA 15/02/2012 15/02/2012
50 RUMINIH 89977 DADAP 15/02/2012 15/02/2012
51 KARNADI 73272 KERTASMAYA 16/02/2012 16/02/2012
52 WARTA 62764 KEDOKAN AGUNG 16/02/2012 16/02/2012
53 WASTEM 65448 TAMBAK 16/02/2012 16/02/2012
54 SAKEM 86893 PAREAN GIRANG 16/02/2012 16/02/2012
55 RAHMAT 81107 GANTAR 17/02/2012 17/02/2012
56 TEDI 85246 LARANGAN 17/02/2012 17/02/2012
57 KUMINIH 60180 PATROL 17/02/2012 17/02/2012
58 RAKYAD 60180 PATROL 18/02/2012 18/02/2012
59 MUHAMAD 54000 CEMPEH LELEA 18/02/2012 18/02/2012
60 RUMINIH 89977 DADAP 18/02/2012 18/02/2012
61 RUMINIH 89977 DADAP 20/02/2012 20/02/2012
62 KARNADI 73272 KERTASMAYA 20/02/2012 20/02/2012
63 WARTA 62764 KEDOKAN AGUNG 20/02/2012 20/02/2012
64 WASTEM 65448 TAMBAK 20/02/2012 20/02/2012
65 SAKEM 86893 PAREAN GIRANG 20/02/2012 20/02/2012
66 RAHMAT 81107 GANTAR 21/02/2012 21/02/2012
67 TEDI 85246 LARANGAN 21/02/2012 21/02/2012
68 KUMINIH 60180 PATROL 21/02/2012 21/02/2012
69 RAKYAD 60180 PATROL 22/02/2012 22/02/2012
70 MUHAMAD 54000 CEMPEH LELEA 22/02/2012 22/02/2012
71 RUMINIH 89977 DADAP 22/02/2012 22/02/2012
72 KARNADI 73272 KERTASMAYA 23/02/2012 23/02/2012
73 WARTA 62764 KEDOKAN AGUNG 23/02/2012 23/02/2012
74 WASTEM 65448 TAMBAK 23/02/2012 23/02/2012
75 SAKEM 86893 PAREAN GIRANG 23/02/2012 23/02/2012
76 RAHMAT 81107 GANTAR 24/02/2012 24/02/2012
77 KUMINIH 60180 PATROL 24/02/2012 24/02/2012
78 RAKYAD 60180 PATROL 25/02/2012 25/02/2012
79 MUHAMAD 54000 CEMPEH LELEA 25/02/2012 25/02/2012
80 RUMINIH 89977 DADAP 25/02/2012 25/02/2012
81 KARNADI 73272 KERTASMAYA 27/02/2012 27/02/2012
82 WARTA 62764 KEDOKAN AGUNG 27/02/2012 27/02/2012
83 WASTEM 65448 TAMBAK 27/02/2012 27/02/2012
84 SAKEM 86893 PAREAN GIRANG 27/02/2012 27/02/2012
85 RAHMAT 81107 GANTAR 28/02/2012 28/02/2012
86 KUMINIH 60180 PATROL 28/02/2012 28/02/2012
87 ADAM 92101 ANJATAN 28/02/2012 28/02/2012
88 RAKYAD 60180 PATROL 29/02/2012 29/02/2012
89 MUHAMAD 54000 CEMPEH LELEA 29/02/2012 29/02/2012
90 RUMINIH 89977 DADAP 29/02/2012 29/02/2012

Indramayu, maret 2012
Penerima
Yang Menyerahkan



………………………………………. NURJANAH
……………………………………….


DATA PASIEN SKTM PEMDA
RUANG HEMODIALISA
RSUD KAB. INDRAMAYU
BULAN MARET 2012

NO NAMA NO. MEDREK ALAMAT DATANG PULANG KET.

1 WASTEM 65448 TAMBAK 01/03/2012 01/03/2012
2 SAKEM 86893 PAREAN GIRANG 01/03/2012 01/03/2012
3 KARNADI 73272 KERTASMAYA 01/03/2012 01/03/2012
4 KUMINIH 60180 PATROL 02/03/2012 02/03/2012
5 ADAM 92101 ANJATAN 02/03/2012 02/03/2012
6 RAKYAD 60180 PATROL 03/03/2012 03/03/2012
7 RUMINIH 89977 DADAP 03/03/2012 03/03/2012
8 WASTEM 65448 TAMBAK 05/03/2012 05/03/2012
9 SAKEM 86893 PAREAN GIRANG 05/03/2012 05/03/2012
10 KARNADI 73272 KERTASMAYA 05/03/2012 05/03/2012
11 WARTA 62764 KEDOKAN AGUNG 05/03/2012 05/03/2012
12 DAPILAH 92463 KEDOKAN AGUNG 05/03/2012 05/03/2012
13 KUMINIH 60180 PATROL 06/03/2012 06/03/2012
14 ADAM 92101 ANJATAN 06/03/2012 06/03/2012
15 RUSINAH 92410 RAMBATAN KULON 06/03/2012 06/03/2012
16 RAKYAD 60180 PATROL 7/3/2012 7/3/2012
17 RUMINIH 89977 DADAP 7/3/2012 7/3/2012
18 WASTEM 65448 TAMBAK 08/03/2012 08/03/2012
19 SAKEM 86893 PAREAN GIRANG 08/03/2012 08/03/2012
20 KARNADI 73272 KERTASMAYA 08/03/2012 08/03/2012
21 DAPILAH 92463 KEDOKAN AGUNG 08/03/2012 08/03/2012
22 KUMINIH 60180 PATROL 09/03/2012 09/03/2012
23 ADAM 92101 ANJATAN 09/03/2012 09/03/2012
24 RUSINAH 92410 RAMBATAN KULON 09/03/2012 09/03/2012
25 RAKYAD 60180 PATROL 10/03/2012 10/03/2012
26 RUMINIH 89977 DADAP 10/03/2012 10/03/2012
27 WASTEM 65448 TAMBAK 12/03/2012 12/03/2012
28 SAKEM 86893 PAREAN GIRANG 12/03/2012 12/03/2012
29 KARNADI 73272 KERTASMAYA 12/03/2012 12/03/2012
30 DAPILAH 92463 KEDOKAN AGUNG 12/03/2012 12/03/2012
31 KUMINIH 60180 PATROL 13/03/2012 13/03/2012
32 ADAM 92101 ANJATAN 13/03/2012 13/03/2012
33 RUSINAH 92410 RAMBATAN KULON 13/03/2012 13/03/2012
34 RAKYAD 60180 PATROL 14/03/2012 14/03/2012
35 RUMINIH 89977 DADAP 14/03/2012 14/03/2012
36 KARNADI 73272 KERTASMAYA 15/03/2012 15/03/2012
37 RUSINAH 92410 RAMBATAN KULON 16/03/2012 16/03/2012
38 KUMINIH 60180 PATROL 16/03/2012 16/03/2012
39 RAKYAD 70181 PATROL 17/03/2012 17/03/2012
40 RUMINIH 89977 DADAP 17/03/2012 17/03/2012
41 KUMINIH 60180 PATROL 20/04/2012 20/04/2012
42 RAKYAD 60180 PATROL 21/03/2012 21/03/2012
43 DANA 93882 RAWA DALEM 21/03/2012 21/03/2012
44 DANA 93882 RAWA DALEM 24/03/2012 24/03/2012
45 SUWARTO 94140 BUNDER 26/03/2012 26/03/2012
46 SUWARTO 94140 BUNDER 29/03/2012 29/03/2012
47 FATONAH 91754 SLEMAN KIDUL 29/03/2012 29/03/2012
48 TARKINIH 94996 PANYINGKIRAN 30/03/2012 30/03/2012
49 PURBA 94551 DUKUH JERUK 31/03/2012 31/03/2012
50 MARYONO 95088 KEDOKAN AGUNG 31/03/2012 31/03/2012

Penerima Indramayu, 13 april 2012
Yang Menyerahkan



………………………………………. NURJANAH
……………………………………….

DATA PASIEN SKTM PEMDA
RUANG HEMODIALISA
RSUD KAB. INDRAMAYU
BULAN APRIL 2012

NO NAMA NO. MEDREK ALAMAT DATANG PULANG KET.

1 SUGANDI 95273 HAURGEULIS 03/04/2012 03/04/2012
2 PURBA 94551 DUKUH JERUK 04/04/2012 04/04/2012
3 MARYONO 95088 KEDOKAN AGUNG 04/04/2012 04/04/2012
4 SUWARTO 94140 BUNDER 05/04/2012 05/04/2012
5 TARKINIH 94996 PANYINGKIRAN 05/04/2012 05/04/2012
6 MARYONO 95088 KEDOKAN AGUNG 07/04/2012 07/04/2012
7 FATONAH 91754 SLEMAN KIDUL 09/04/2012 09/04/2012
8 SUWARTO 94140 BUNDER 09/04/2012 09/04/2012
9 KASTANA 95935 MALANG SEMIRANG 10/04/2012 10/04/2012
10 NURYATI 96119 KERTICALA 12/04/2012 12/04/2012
11 SUWARTO 94140 BUNDER 12/04/2012 12/04/2012
12 NURYATI 96119 KERTICALA 16/04/2012 16/04/2012
13 SUPARDI 96545 SUKASARI ARAHAN 17/04/2012 17/04/2012
14 NURYATI 96119 KERTICALA 19/04/2012 19/04/2012
15 NURYATI 96119 KERTICALA 23/04/2012 23/04/2012
16 DANIKA 96712 KEDOKAN BUNDER 23/04/2012 23/04/2012
17 FATONAH 91754 SLEMAN KIDUL 23/04/2012 23/04/2012
18 NURYATI 96119 KERTICALA 26/04/2012 26/04/2012
19 DANIKA 96712 KEDOKAN BUNDER 26/04/2012 26/04/2012
20 NURYATI 96119 KERTICALA 30/04/2012 30/04/2012
21 DANIKA 96712 KEDOKAN BUNDER 30/04/2012 30/04/2012



Indramayu, 12 mei 2012

Penerima yang menyerahkan



Hj. Nurjanah


DATA PASIEN SKTM PEMDA
RUANG HEMODIALISA
RSUD KAB. INDRAMAYU
BULAN MEI 2012

NAMA NO. MEDREK ALAMAT DATANG PULANG KET.

TARMAD 97321 JUNTINYUAT 01/05/2012 01/05/2012
NURYATI 96119 KERTICALA 03/05/2012 03/05/2012
DANIKA 96712 KEDOKAN BUNDER 03/05/2012 03/05/2012
TARMAD 97321 JUNTINYUAT 04/05/2012 04/05/2012
NURYATI 96119 KERTICALA 07/05/2012 07/05/2012
WASEM 98843 KARANGAMPEL 10/05/2012 10/05/2012
DANIKA 96712 KEDOKAN BUNDER 14/05/2012 14/05/2012
DANIKA 96712 KEDOKAN BUNDER 17/05/2012 17/05/2012
FATONAH 91754 SLEMAN KIDUL 21/05/2012 21/05/2012
DANIKA 96712 KEDOKAN BUNDER 21/05/2012 21/05/2012
ALI IMRON 99216 KONGSI JAYA 21/05/2012 21/05/2012
ALI IMRON 99216 KONGSI JAYA 26/05/2015 26/05/2015

Indramayu, 10 JUNI 2012

Penerima Yang Menyerahkan



NURJANAH
………………………………………. ……………………………………….



DATA PASIEN SKTM PEMDA
RUANG HEMODIALISA
RSUD KAB. INDRAMAYU
BULAN AGUSTUS 2012

NO NAMA NO. MEDREK ALAMAT DATANG PULANG KET.

1 IWAN EKA 106484 SINGAJAYA 01/08/2012 01/08/2012
2 IWAN EKA 106484 SINGAJAYA 04/08/2012 04/08/2012
3 IWAN EKA 106484 SINGAJAYA 08/08/2012 08/08/2012
4 IWAN EKA 106484 SINGAJAYA 15/08/2012 15/08/2012


Indramayu, 11-September-2012

Penerima Yang Menyerahkan



NURJANAH
………………………………………. ……………………………………….



DATA PASIEN SKTM PEMDA
RUANG HEMODIALISA
RSUD KAB. INDRAMAYU
BULAN SEPTEMBER 2012

NO NAMA NO. MEDREK ALAMAT DATANG PULANG KET.

1 EDI SUKATRI 11 1196 TUKDANA 15/09/2012 15/09/2012
2 EDI SUKATRI 12 1196 TUKDANA 18/09/2012 18/09/2012
3 DULNASIM 11 1747 GABUS KULON 19/09/2012 19/09/2012
4 EDI SUKATRI 13 1196 TUKDANA 21/09/2012 21/09/2012
5 EDI SUKATRI 14 1196 TUKDANA 25/09/2012 25/09/2012
6 KOYO 11 1475 HAURGEULIS 25/09/2012 25/09/2012
7 EDI SUKATRI 14 1196 TUKDANA 28/09/2012 28/09/2012
8 KOYO 11 1475 HAURGEULIS 28/09/2012 28/09/2012

INDRAMAYU, 02-September-2012

Penerima Yang Menyerahkan



NURJANAH
………………………………………. ……………………………………….
…………