dr.Zam data awalDATA OBAT RUJUK BALIK dr. ZAM ZAM PAHLAFIBULAN JUNI 2013NOTGL KUNJUNGAN JUNI 2013NAMANO KAALAMATTELP/HPDXTERAPISIGNAJMLTANDA TANGAN PESERTAKETERANGAN1JULIANA ABISAY0000169553698ENTROP081344291847DMLODEM 30MG3X190METFORMIN 500MG3X1902A. RAUF AHMAD0000153803801SAMPING BOSOWA KOTARAJA082198036290HTAMDIXAL 5MG1X1303ABDUL SYUKUR0000150564497JL. RAYA KOTARAJA NO.4208123795931HTINTERVASK 10MG1X130OMEPRAZOL 20 MG1X1304AMOS KAPITARAW0000153840183PERUMNAS IV PADANG BULAN ABEPURA082198105173HTAMDIXAL 5MG1X1305BAKRI SAAD0000154260819KOMPLEKS BPD KOTARAJA085244061527ASTHMASERETIDE INHALER1X1 SEMPROT16DRS.MASDJOEDI0000154271248FURIA PUSKOPAD081248057100DMGLURENORM 30MG3X190SIMVASTATIN 10 MG1X130NOVORAPID FLEXPEN4/4/417HARTINI0000154228375KPR BTN PUSKOPAD085235066717HTINTERVASK 10 MG1X130HCT1x1/215BISOPROLOL 5 MG1X1308JOHANIS KORAREY0000154347895JL. GERILYAWAN NO. 39 ABEPURA085254922820HTVALSARTAN 80 MG1X130MELOXICAM 15 MG1X130HCT1X1/2159JULIANTJE JACOB0000154287472JL. KEIMANA ABEPURA081248388406HTHCT1X1/215NOPERTEN 10 MG1X13010LEO KOGOYA0000154498746BTN PUSKOPAD TANAH HITAM081248930432DMLODEM1X130METFORMIN3X190SOHOBION1X13011DRS.DAAN DIMARA, MA0000154269516PERUM UNCEN PADANG BULANDM +HTGLURENORM 30MG3X190INTERVASK 10 MG1X130SIMVASTATIN 10 MG1X13012SITI SOLIKHAH0000154271259FURIA PUSKOPAD081248057100HTAMDIXAL 10MG1X130HCT1X1/21513SUJATMAN B. HARDJOPROWITO0000154241021FURIA JLR. II NO.81081344830811DMGLURENORM3X190AMDIXAL 5 MG1X13014TAUFIK NIODE0000154202769PERUMNAS IV PADANG BULAN081344259142HTINTERVASK 10MG1X130HCT1X1/21515TUKIRAN0000167643145JL. RAYA SENTANI ABEPURA08124803217HTINTERVASK 10MG1X130SIMVASTATIN 10MG1X13016WAKIMO0000162471385JL. RAWA II NO.12 HAMDI085244443140DMAMDIXAL 5MG1X130SERETIDE INHALER1X11HCT1X1/21517MARTHEN LUTHER SARAMBU0000154229769TANAH HITAM081330227302ASTHMASPIRIVA REFILL1X130KAPSUL SESAK1X190BEROTEC1X11OBH SIRUP3X1 sdm118WARNO0000154316283JL. ABEPANTAI NO.196081248745609HTINTERVASK 10MG1X130MICARDIS1X13019NASIR ACHMAD0000154231187BTN PUSKOPAD KAMKEY081344460199HTINTERVASK 10 MG1X130BISOPROLOL 5 MG1X13020WARDHONO0000153853031Desa Dosay085244669976DM+HTAMDIXAL 10 MG1X130ISDN 5 MG3X190BISOPROLOL 5 MG1X130GLIMEPIRIDE 2 MG1X130METFORMIN 500 MG3X190RAMIXAL 5 MG1X130VACLO1X130SIMVASTATIN 10 MG1X13021MARIA SIKALA0000160187973JL. KESEHATAN085254393160HTHCT1/2-0-015MICARDIS 80 MG1X13022ATIK ARTINI0000164410569BTN PUSKOPAD KAMKEY081248308468HTMICARDIS 80 MG1X130HCT1X 1/21523NOVITA HOWAY, SPD0000204527876BELAKANG ASRAMA HAJI081248239247HTINTERVASK 10 MG1X130NOPERTEN 10 MG1X130NEURODEX1X110DEXANTA SYRP3X1 ac1OMEPRAZOLE2X1 pc1024SARAH KABEY0000154308104KOMPLEKS RSUD ABE0967581254DMGLIMEPIRIDE 2 MG1x130METFORMIN 500 MG3X190INTERVASK 10 MG1X13025ADAM USMAN0000154254789TANAH HITAM081240532751HT + DMMETFORMIN 500 MG3X190(0967)583894MICARDIS 80 MG1X130HCT1X1/21526DRS. SUGITO0000154268526BTN PUSKOPAT ABEPURA081344537474HT + DMMETFORMIN 500 MG3X190GLURENORM 30 MG2X160MICARDIS 80 MG1X130SIMVASTATIN 10 MG1X13027SRI SULASTRI0000153787476BTN PUSKOPAT ABEPURA081344537474HT + DMMETFORMIN 500 MG3X190GLIMEPIRIDE 1 MG1X130INTERVASK 10 MG1X130HCT1X1/21528ENDANG .R0000153900178LAPANGAN TRIKORA II/3081527006093HTINTERVASK 10 MG1X13029DRS. SUKIYADI0000154312582PERUMNAS IV586008HTINTERVASK1x130085254089941VALSARTAN1x130MELOXICAM1x11530DRA. SULASTRI, SH0000154198168JL. PERCETAKAN NO.88085254005407HTINTERVASK 10 MG1X13031ASRINI0000154234067JL. BTN PUSKOPAD081344458060HTMICARDIS 80 MG1X130HCT1x1/21532INDRIA SARI DALLE0000149134522JL. SORONG ABEPURA081248631745HTAMDIXAL 5MG1X130ASPILET1X130ISDN1X13033ST. HADRAH KAIMUDDIN0000154311579JL. JERUK NIPIS NO.26085244061527HT + RAINTERVASK 10 MG1X130HCT1X1/215ANTASIDA SYR3X1334MUSLIKIN0000194895066ABEPURA085244331631HTINTERVASK 5 MG1X130ISDN3X190MICARDIS 80 MG1X130ASPILET1X130METFORMIN 500 MG3X190GLIMEPIRIDE 2 MG1X130SIMVASTATIN 10 MG1X13035FINE BOGAR0000154293759JL. KAIMANA NO.29081344266309HTINTERVASK 10 MG1X130MICARDIS1X13036ELLEN L. RAHAKBAUW0000154288732KAMKEY082193349722HT + RAINTERVASK 10 MG1X130MICARDIS 80 MG1X130MELOXICAM 15 MG1X13037MARIA SRI LESTARI0000154233808BTN PUSKOPAT TANAH HITAM085245459393HTINTERVASK 10 MG1X130MELOXICAM 15 MG1X13038RIYANTONO0000207212084BTN PUSKOPAT081247326249DMGLURENORM 30 MG2X160METFORMIN 500 MG3X190SIMVASTATIN 10 MG1X13039NICODEMUS TAMAELA0000154330255JLN. MUNAWIR NO.20 ABEPURA081248000362DMGLURENORM 30 MG1X130AMLODIPIN 5 mg1X130ASPILET1X130NEURODEX1X130SIMVASTATIN1X13040MARIANA RUMSOWEK0000154293039JLN. BIAK NO. 09 ABEPURA082198802433HTINTERVASK 10 MG1X130HCT1X1/21541ANI PATASIK0000154247343JLN. KESEHATAN085796300260HTINTERVASK 10 MG1X130HCT1X1/21542ORPA KALASE0000154033626JL. KAIMANA081354042338DMMETFORMIN 500 MG3X190GLURENORM 30 MG2X16043TITUS KUAYO0000154204132BTN PUSKOPAD ABEPURA081248240813JANTUNGFUROSEMIDE1X130SPINOLACTONE 25 MG1X130DYGOXYN1X115NOPERTEN 5 MG1X130OBH SIRUP3X11OMEPRAZOLE1X120ANTASIDA SUSP3X1145TUTILOWATI0000154235259JLN. ASPOL ABEPURA085254637066DMPESERTA BARU46HASAN KASMALI0000154277728GRAND KOTARAJA B.80967-583073DMPESERTA BARU47TIMBOEL0000154241256JLN. CAMAR KALIACAI0976- 588324DMVALSARTAN 80 MG1X130AMLODIPIN1X13048JOHANES PURWANTO0000154227429BTN PUSKOPAD BLOK D NO.4085217391323HTINTERVASK 10 MG1X130BISOPROLOL 5 MG1X130SIMVASTATIN 10 MG1X13049DEMARCE M. MUDUMI0000153786374JLN. RAYA SENTANI, UNCEN BAWAH085254605614HTINTERVASK 10 MG1X130MICARDIS1X130FUROSEMID1X13050IJO SYUKUR0000150564508JLN. RAYA KOTARAJA NO.2408123795931HTAMDIXAL 5 MG1X13051PRIJONO BIN KASTUBI0000154240402FURIA INDAH NO. 219 KOTARAJA081344781711DMMETFORMIN 500 MG3X190GLURENORM 30 MG1X130SIMVASTATIN1X13052SUWARTINI0000154360473FURIA INDAH NO. 219 KOTARAJA081344781711HT+DMAMDIXAL 10 MG1X130METFORMIN 500 MG3X190SIMVASTATIN1X13053SUKANDAR0000154421166Perumnas IV Blok D 78 Waena081344154838DMPESERTA BARU54MARIE MEITY KALESARAN0000040126173Komplek Bina Marga Tanah Hitam085342323245HTINTERVASK 10 MG1X13055ROSJID MACHFUD0000153999832JL.JERUK NIPIS B6 K.RAJA081344343708HTINTERVASK 10 MG1X13056NINA DJAFAR0000153999718JL.JERUK NIPIS B6 K.RAJA081248390009HTCAPTROPRIL2X160HCT1/2-0-01557LEXY MAMUAYA ALIE0000154052919JL.GERILYAWAN LINGKARAN082199523480HTINTERVASK 10 MG1X130HCT1/2-0-01558YULI PRAYITNO0000154393367Perumahan BTN OrgandaHTAMLODIPIN1X130HCT1/2-0-01559WIJI LESTARI0000167643314JL.RAYA SENTANI ABEPURAHTNTERVASK 10 MG1X13060SURIALANG0000154389126JL Baru085344985427HTINTERVASK 10 MG1X13061MARTHINUS ANDRIAS L0000152252998JL. RAYA ABEPURAHTINTERVASK 10 MG1X130MICARDIS 80 MG1X13062Drs. SUYATNO0000152913778BTN PUSKOPAD BLOK08157945356DMGLIMEPIRIDE 2 MG1X130G.NO.02 ABEPURAMETFORMIN 50 MG3X19063FRANSISKA RANGA0000038543455Bucend IV Kotaraja081343320694HTINTERVASK 10 MG1X13064HARMONO ATIN0000967490572BTN PUSKOPAD ATAS081248773159HTINTERVASK 10 MG1X130MICARDIS 80 MG1X130HCT1/2-0-015METFORMIN 500 MG3X190GLIMEPIRIDE 1 MG1X13065SUKATMI0000163526938KOMP. BINA MARGA TANAH HITAM085259023344HTINTERVASK 10 MG1X13066IZAK RUMAINUM0000158116296PERUMNAS IV PADANG BULAN085269690118HTINTERVASK 10 MG1X130SIMVASTATIN 10 MG1X130HCT1/2-0-01567NURSAMBU0000154325777Komp. KPR BPD Kotaraja583414DMNOPERTEN 10 MG1X130CANDESARTAN 8 MG1X130INTERVASK 10 MG1X130ASPILET 80 MG1X130SIMASTATIN 10 MG1X130GLIMEPIRIDE 2 MG1X130METFORMIN 500 MG1X13068HAJJA ANISA SUMIANIK0000153666189KOMP. CINA ABEPURA081359257889JTG + DMNOVORAPID FLEXPEN20-20-206LEVEMIR FLEXPEN0-0-101ISDN2X160ASPILET 80 MG1X13069YAN PALLO0000154211106KORAMIL SENTANI0967-594368HTAMLODIPIN 5 mg1X13070MUR RAHARTI MUHENI0000154394278085244134087DMNOVORAPID14-0-102LEVEMIR0-0-81NEURODEX1X13071RIFKY NURULITA0000154458055JL.CENDERAWASIH NO.05 ABEPURA085244134087TBRIFAMPISIN 300 MG1X130ISONIASID 200 MG1X130PIRAZYNAMID 450 MG1X130VITAMIN B6 1X1 30 TAB1X130CEFADROXIL 250 MG2X160OBH SYR3X1 Sendok makan172BERTHA SE MANUPAPAMI0000154109531PEMDA II CIGOMBONG081248270095DM + HTGLIMEPIRIDE 2 MG1 x 130METFORMIN 500 MG3X190INTERVASK 10 MG1X130OMEPRAZOLE1 x 13073BURHANUDIN0000153806275ABEPURAJTG + HTFUROSEMIDE 4 MG1 x 1 (PAGI)30SPIRONOLAKTON 25 MG1 x 1 (SIANG)30VALSARTAN 80 MG1 X 1 ( PAGI)30DYGOXIN 0,25 MG1 X 1 (PAGI)30SOHOBION TAB1 X 130ASPILET TAB1 X 130ALLUPURINOL 100 MG2 X 13074MARIA WINE0000154224459ABEPURA085244724724DMGLIMEPIRIDE1 x 1 (PAGI)30METFORMIN1 x 1 (MALAM)30GG3 X 1 ( PAGI)10CEFADROXIL2 X 1 (PAGI)1075SUMIYATI0000154366492ABEPURA08164320204HTASPILET TAB1 x 1 (PAGI)15ISDN3 x 130INTERVASK1 X 1 ( PAGI)3076PETRUS KAAWOAN0000154303479JL. PANTAI ENGGROSDM + HTGLURENORM 30 MG3X190MICARDIS 80 MG1X13077AMELIA0000154241267JL. CAMAR KALIACAI NO 16HTNOPERTEN 10 MG1X130HCT1X1/21578WALIULU ABDUL BASIR0000154237151KAMP. BARU TANAH HITAMHTINTERVASK 10 MG1X130HCT1X11579ABDUL SHOMAD BAUW0000154433463BTN WEMONI BLOK G/120HTINTERVASK1X130MICARDIS 80 MG1X13080SOELASTRI0000193872868BTN PUSKOPAD BLOK B. NO. 8DM + HTMETFORMIN 500 MG3X190GLIMEPIRIDE 1 MG1X130INTERVASK 10 MG1X13081ISKANDAR0000193872677BTN PUSKOPAD BLOK B. NO. 8HTINTERVASK 10 MG1X130HCT1X1/21582SOEKAR0000154234811PANTAI ENGGROSDMMETFORMIN 500 MG3X190GLIMEPIRIDE 2 MG1X13083SUKANDAR0000154421166PERUMNAS 4 BLOK D. 78DMMETFORMIN 500 MG3X19084MARTHAVINA MSIREN0000154139949BTN PUSKOPAD TANAH HITAMDM + HTMETFORMIN 500 MG3X190GLIMEPIRIDE 2 MG1X130INTERVASK 10 MG1X13085STIEN PANGEMANAN0000154312031JL.PASAR BARU MELATI/27HTAMDIXAL 5 MG1X13086TIURLINA SIMANJUNTAK0000154204198JL. ABEPANTAI TANAH HITAMHTINTERVASK 10 MG1X13087SUDARNO0000154235676BUCEND IV K-106 KOTARAJAHTINTERVASK 10 MG1X130HCT1X1/21588SRI WIDATI0000154235687BUCEND IV K-106 KOTARAJAHTINTERVASK 10 MG1X130VALSARTAN 80 MG1X130HCT1X1/21589DAHRI ADAM0000154034908GG.JATI III NO.127 WAENAHTINTERVASK 10 MG1X13090AMELIA HELENA HEIPON0000154337679JL.SEKOLAH ABEPURAHTINTERVASK 10 MG1X130MICARDIS 80 MG1X130SIMVASTATIN 10 MG1X13091HAMDIN0000154148398BTN BLOK J NO.169 KAMKEYHTINTERVASK 10 MG1X13092NATHALIA SUPARMI0000154226542BTN PUSKOPAD ABEPURADM+HTNOVORAPID FLEXPEN22/22/227LEVEMIR FLEXPEN0/0122MICARDIS 80 MG1X130SIMVASTATIN 10 MG1X130MELOXICAM 15 MG1X130NEURODEX1X130Data tambahanTolong diisi alamat / no telepon pasienJayapura, Juni 2013Yang MenyerahkanYang MenerimaApotek Berkat Jayadr. Zam Zam PahlafiDokter Keluarga