Form Pelaporan KIPI

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Daftar Kunjungan Pasien

Umur
NO Tanggal Nama KK Alamat Desa
L P

1 01-10-2018 SITI SAADATUTDARAINI - 1 Thn 11 Bln 25 Hari (SITI SAADATUTDARAINI) LD KEKAH TAMPAK SIRING

2 04-10-2018 GILANG HAMIZAN PURNAMA 2 Thn 0 Bln 24 Hari - (GILANG HAMIZAN PURNAMA) LD KEKAH TAMPAK SIRING

3 10-10-2018 GALANG HAMIZAN 2 Thn 1 Bln 0 Hari - (GALANG HAMIZAN) LEDANG KEKAH TAMPAK SIRING

4 13-10-2018 TEGUH ADRIAN 6 Thn 0 Bln 28 Hari - DASAN BARU TAMPAK SIRING
5 14-10-2018 INAQ SUHARNI - 56 Thn 0 Bln 18 Hari (INAQ SUHARNI) DASAN BARU TAMPAK SIRING

6 16-10-2018 NOVA MAULAN RISKI 3 Thn 2 Bln 0 Hari - (NOVA MAULAN RISKI) TAMPAK SIRING TAMPAK SIRING

7 23-10-2018 EG DANIS 1 Thn 0 Bln 18 Hari - LENDANGB KEKAH TAMPAK SIRING

8 23-10-2018 DANIS 1 Thn 0 Bln 16 Hari - (DANIS) LENDANG KEKAH TAMPAK SIRING

9 24-10-2018 H. SARAJUDIN 80 Thn 4 Bln 10 Hari - (H. SARAJUDIN) DSN BARU TAMPAK SIRING
Kasus
Kecamatan Kode Dianosa Diagnosa Therapy
B L

- GARAM ORALIT 200 ML,-


- Diarrhoea and gastroenteritis of
BATUKLIANG - A09 -v KOTRIMOXAZOLE SYR KOMB,-
presumed infectious origin PARACETAMOL 500 MG TAB - BPJS

- Parasetamol sirup 120 mg / 5


ml,- Ringer Laktat larutan infus
- Diarrhoea and gastroenteritis of steril,- IV CATHETER ( ABBOCATH )
BATUKLIANG - A09 -v
presumed infectious origin 24 G - BPJS,- INFUS SET ANAK -
BPJS,- ZINK SYRUP - BPJS,-
Ampisilina injeksi - BPJS

- GARAM ORALIT 200 ML,-


- Diarrhoea and gastroenteritis of
BATUKLIANG - A09 -v KOTRIMOXAZOLE SYR KOMB,-
presumed infectious origin Parasetamol sirup 120 mg / 5 ml

- ZINC TAB 20 MG,- AMOXICILLIN


125 MG / 5 ML SYR KERING,-
PARACETAMOL SYR 120 MG/5
- Diarrhoea and gastroenteritis of ML,- Metocloperamide inj,- Ringer
BATUKLIANG - A09 -v
presumed infectious origin Laktat larutan infus steril,- IV
CATHETER ( ABBOCATH ) 24 G -
BPJS,- INFUS SET ANAK - BPJS,-
Ampisilina injeksi - BPJS
- PARACETAMOL 500 MG TAB -
BPJS,- INFUS SET DEWASA - BPJS,-
IV CATHETER ( ABBOCATH ) 20 G,-
- Diarrhoea and gastroenteritis of AMOXICILLIN 500 MG TAB,-
BATUKLIANG - A09 -v
presumed infectious origin ANTASIDA DOEN TAB KUNYAH,-
ATTAPULGIT TABLET 600 MG,-
RANITIDIN INJ 25 MG/2 ML,-
Ringer Laktat larutan infus steril

- DEXAMETASON 0,5 MG TAB,-


AMOXICILLIN 125 MG / 5 ML SYR
KERING,- Zinc tablet 20 mg,-
- Diarrhoea and gastroenteritis of
BATUKLIANG - A09 -v combivent nebules - BPJS,-
presumed infectious origin PARACETAMOL 500 MG TAB -
BPJS,- Gliseril Guayakolat tablet
100 mg - BPJS

- RANITIDIN 150 MG TAB,- ZINC


- Diarrhoea and gastroenteritis of
BATUKLIANG - A09 -v TAB 20 MG,- AMOXICILLIN 125
presumed infectious origin MG / 5 ML SYR KERING

- AMOXICILLIN 500 MG TAB,- ZINC


- Diarrhoea and gastroenteritis of
BATUKLIANG - A09 -v TAB 20 MG,- RANITIDIN INJ 25
presumed infectious origin MG/2 ML

- ATTAPULGIT TABLET 600 MG,-


- Diarrhoea and gastroenteritis of
BATUKLIANG - A09 -v CAPTOPRIL 25 MG TAB,-
presumed infectious origin PIROKSIKAM 20 MG TAB - BPJS

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