ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAH
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DAFTAR NAMA ODGJ BERAT (SPM) KOTA CIMAHI 2025
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NOPUSKESMASNOMOR NIKNAMATANGGAL LAHIRUMUR (TAHUN)ALAMATKELURAHANL/PSTATUS PASIEN K/TK/J/DKODE DIAGNOSA (SKIZOFRENIA & PSIKOTIK)PENYEBAB UTAMA MASALAHSTATUS JAMINANPEMERIKSAAN STATUS MENTALWAWANCARAEDUKASI KEPATUHAN MINUM OBATPENATALAKSANAAN AWAL DAN RUJUKANRUJUK BALIKOBAT YANG DIBERIKAN DARI PUSKESMASNAMA RS RUJUKANOBAT YANG DI KONSUMSI PEMANTAUAN MINUM OBAT
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UMUMJKNJANUARIFEBRUARIMARETAPRIL MEI JUNIJULIAGUSTUSSEPTEMBEROKTOBERNOVEMBERDESEMBER
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1CIPAGERAN3277031003800001IIM SOLIHIN10/03/198044JL SANGKURIANG GG MAWAR NO 33 RT 7 RW 5CIPAGERANLTKF20PUTUS CINTA-CLOZAPIN 25 MG 0-0-1-CLOZAPIN 25 MG 0-0-103/01/202501/02/202505/03/202507/04/202514/05/202513/05/202512/07/202511/08/202510/09/202511/10/202511/11/202512/12/2025
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2CIPAGERAN3277030506940001
IHSAN FADILLAH05/06/199430KP KEBON JERUK 04/22CIPAGERANLTKF20MEMAKAI LEM AIBON-INJ SIKZONOAT IM 1 AMPUL
KLOZAPIN 25 MG 0-0-1
-INJ SIKZONOAT IM 1 AMPUL
KLOZAPIN 25 MG 0-0-1
15/01/202510/02/202513/03/202510/04/202505/05/202502/06/202514/07/202511/08/202508/09/20258/10/202506/11/202506/12/2025
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3CIPAGERAN3277030410860007ASEP PURNAMA04/10/198638KP PASIR KIARA 2/16CIPAGERANLTKF20PUTUS CINTA-HALOPERIDOL 2X 5 MG
THF 2X 2 MG
KLOZAPIN 25 MG 0-0-1
-HALOPERIDOL 2X 5 MG
THF 2X 2 MG
KLOZAPIN 25 MG 0-0-1
21/01/202505/02/202507/03/202508/04/202510/05/202510/06/202510/07/202509/08/202523/09/202523/10/202521/11/202520/12/2025
9
4CIPAGERAN3277032103540005YAYAN YANI21/03/195470KP PAKUHAJI 2/17 CIPAGERANLKF20SEDIH TIDAK BISA MENDENGAR-RISPERIDON 2X 2MG
THF 2X 2 MG
AMITRIPTILIN 25 MG 0-0-1
-RISPERIDON 2X 2MG
THF 2X 2 MG
AMITRIPTILIN 25 MG 0-0-1
16/01/202514/02/202518/03/202519/04/202502/05/202514/06/202502/07/202502/08/202503/09/202503/10/202501/11/202502/12/2025
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5CIPAGERAN3204105502880003ERNI NURJANAH15/02/198837JL. CIPAGERAN KP KEBON JERUK NO 45 3/22,CIPAGERANPKF20EPILEPSI-RISPERIDON 2 MG 2X1
CARBAMAZEPIN 200 MG 2X1
THF 2 MG 1/2-0-1
-RISPERIDON 2 MG 2X1
CARBAMAZEPIN 200 MG 2X1
THF 2 MG 1/2-0-1
-10/2/202510/03/202508/04/202503/05/202505/06/202508/07/202512/08/202525/09/202528/10/202528/11/2025
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6CIPAGERAN3277031606790012SUHERMAN16/06/197945SANGKURIANG BARAT 3/7CIPAGERANLDF20PERCERAIAN-RISPERIDON 2X 2MG
THF 2X 2 MG
KLOZAPIN 100 MG 0-0-1
CIBABATRISPERIDON 2X 2MG
THF 2X 2 MG
KLOZAPIN 100 MG 0-0-1
--08/03/202517/04/202520/05/202516/06/202522/07/202521/08/202520/09/202522/10/202521/11/202519/12/2025
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7CIPAGERAN3277031506920005DODI ROHENDI15/06/199232JL PASIR KIARA 3/16CIPAGERANLTKF20NGILMU-ARIPRIPAZOLE 10 MG
KLOBAZAM 10 MG
THF 2 MG
MITRA KASIHARIPRIPAZOLE 10 MG
KLOBAZAM 10 MG
THF 2 MG
---07/04/202512/05/202514/06/202517/07/202518/08/202516/09/202517/10/202517/11/2025
13
8CIPAGERAN3277030510670011NANDANG05/10/196749JL KARYA BAKTI 1/16CIPAGERANLTKF20ORANG TUA MENINGGAL-HALOPERIDOL 2X 5 MG
THF 2X 2 MG
KLOZAPIN 25 MG 0-0-1
-HALOPERIDOL 2X 5 MG
THF 2X 2 MG
KLOZAPIN 25 MG 0-0-1
---07/04/202502/05/202516/06/202515/07/202514/08/202513/09/202513/10/202512/11/202512/12/2025
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9CIPAGERAN3277031508790014SETIANA RAHMAT15/08/197944JLN KARYA BAKTI 4/16CIPAGERANLDF20ISTRI MENINGGAL + PHK-INJ SIKZONOAT IM 1 AMPUL-INJ SIKZONOAT IM 1 AMPUL---08/04/202507/05/202505/06/202503/07/202512/08/202510/09/20257/10/202518/11/202516/12/2025
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10CIPAGERAN3277030107550001UDIN SAMSUDIN01/07/195568KP ANGGARAJA 1/7CIPAGERANLKF20TIDAK MENDAPAT UPAH SAAT KERJA-RISPERIDON 2 MG 2x1
THF 1 -0- 1
CLOZAPIN 25 MG 0-0-1
MITRA KASIHRISPERIDON 2 MG 2x1
THF 1 -0- 1
CLOZAPIN 25 MG 0-0-1
---07/04/202507/05/202505/06/202507/07/202506/08/202508/09/20256/10/20257/11/20258/12/2025
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11CIPAGERAN3277030204740011SUNJANI02/04/197451KP PONDOK CIBALIGO 3/10CIPAGERANLKF20CEDERA KEPALA, MIRAS -HALOPERIDOL 5 MG 2X1
THF 2 MG 0- 0 -1
-HALOPERIDOL 5 MG 2X1
THF 2 MG 0- 0 -1
---08/04/202505/05/202516/06/202517/07/202519/08/202515/09/202520/10/202525/11/202515/12/2025
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12CIPAGERAN3277030904800031RONI SAEPUL09/04/198045KP KEBON JERUK 4/22CIPAGERANLTKF20DIPECAT DARI KERJAAN-OLANZAPIN 10 MG
THF 2 MG
MITRA KASIHOLANZAPIN 10 MG
THF 2 MG
---25/04/202528/05/202526/06/202525/07/202527/08/202526/09/202524/10/202526/11/202502/12/2025
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13CIPAGERAN3277030310700023BUDIYANTO03/10/197054JL PASIR KIARA 3/16CIPAGERANLDF20BERGURU DI PADEPOKAN-HALOPERIDOL 2X 5 MG
THF 2X 2 MG
KLOZAPIN 25 MG 0-0-1
-HALOPERIDOL 2X 5 MG
THF 2X 2 MG
KLOZAPIN 25 MG 0-0-1
----08/05/202523/06/202522/07/202525/08/202525/09/202529/10/202528/11/202522/12/2025
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14CIPAGERAN3277035407740022RUBIYATI14/07/197450JL KOLONEL MASTURI NO 15 GG BANTEN CIPAGERAN RT 1 RW 22CIPAGERANPJF20DITIPU SAAT MENGIKUTI ARISAN-HALOPERIDOL 2X 2,5 MG
THF 2X 2 MG
-HALOPERIDOL 2X 2,5 MG
THF 2X 2 MG
----09/05/202504/06/202526/07/202509/08/202502/09/20253/10/202503/11/202502/12/2025
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15CIPAGERAN3277033007860001NANA SURYANA 30/07/198637KP CILEUTIK 5/14CIPAGERANLDF20PERCERAIAN-RISPERIDON 2X1
THF 2X1
CLOZAPINE 0-0-1
-RISPERIDON 2X1
THF 2X1
CLOZAPINE 0-0-1
----03/05/202502/06/202521/07/202505/08/202502/09/202507/10/202507/11/202510/12/2025
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16CIPAGERAN3277036101980009FITRIA ALSIAMI21/01/199827JL KOLONEL MASTURI NO 15 GG BANTEN . 1/22CIPAGERANLKF20DIBULLY TEMAN, DITUDUH PENCURI-HALOPERIDOL 1,5 MG
VALPROAT 250 MG
MITRA KASIHHALOPERIDOL 1,5 MG
VALPROAT 250 MG
-----09/06/202509/07/202508/08/202503/09/202506/10/202505/11/202502/12/2025
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17CIPAGERAN3277036204990007SITI MARIAM23/01/199926KP CILEUTIK 1/14CIPAGERANPTKF20KOMA 40 HARI-LITIUM KARBONAT 200MG
LORAZEPAM 0,5 MG
RISPERIDONE 2 MG
CIBABATLITIUM KARBONAT 200MG
LORAZEPAM 0,5 MG
RISPERIDONE 2 MG
-----14/06/202517/07/202519/08/202517/09/202520/10/202519/11/202518/12/2025
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18CIPAGERAN3277034301860014ERNAWATI03/01/198639KP. PD CIBALIGO 2/10CIPAGERANPKF20RIBUT MASALAH EKONOMI DENGAN SUAMI-RISPERIDON 2 MG 0-0-1
THF 2 MG 0-0-1/2
-RISPERIDON 2 MG 0-0-1
THF 2 MG 0-0-1/2
------19/07/202520/08/202511/09/202523/10/202527/11/2025
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19CIPAGERAN3277031808920010EMAT18/08/199233KP BOBOJONG NO.43 7/16CIPAGERANLTKF20KEPALA TERKENA BATU-HALOPERIDOL 5 MG 2 x 1
THF 2 MG 2X1
CLOZAPIN 25 MG 0-0-1
-HALOPERIDOL 5 MG 2 x 1
THF 2 MG 2X1
CLOZAPIN 25 MG 0-0-1
------21/07/202525/08/202524/09/202521/10/202514/11/202508/12/2025
25
20CIPAGERAN3277030510010019HARI MUKTI05/10/200123KP BOBOJONG NO.43 7/15CIPAGERANLTKF20FRUSTASI EKONOMI-HALOPERIDOL 5 MG 2 x 1
THF 2 MG 2X1
CLOZAPIN 25 MG 0-0-1
-HALOPERIDOL 5 MG 2 x 1
THF 2 MG 2X1
CLOZAPIN 25 MG 0-0-1
------21/07/202525/08/202524/09/202521/10/202514/11/202508/12/2025
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21CIPAGERAN3277032605710008SOLIHIN12/01/197352KP CILEUTIK RT 1 RW 14CIPAGERANLDF20PERCERAIAN-RISPERIDON 2 MG 2x1
THF 1 -0- 1
CLOZAPIN 25 MG 0-0-1
-RISPERIDON 2 MG 2x1
THF 1 -0- 1
CLOZAPIN 25 MG 0-0-1
-------07/08/202508/09/20256/10/202510/11/202508/12/2025
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22CIPAGERAN3277031103880001BANGKIT HENDRA 11/03/198837KP LEGOK VETERAN 3/6CIPAGERANLKF20MEMAKAI OBAT-OBATAN TERLARANG-CPZ 100 MG
TRIFLUOPERAZINE 5 MG
THF 2X1
CLOZAPINE 100 MG 0-0-1
ASAM VALPROAT 500MG
MITRA KASIHCPZ 100 MG
TRIFLUOPERAZINE 5 MG
THF 2X1
CLOZAPINE 100 MG 0-0-1
ASAM VALPROAT 500MG
-------13/08/202515/09/202515/10/202515/11/202515/12/2025
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23CIPAGERAN3277032610950001ANDI SUPRIYATNA26/10/199529TEGAL KAWUNG 1/8CIPAGERANLTKF20MEMAKAI OBAT-OBATAN TERLARANG-THF 2MG 0-0-1
RISPERIDON 2 MG 2X1
-THF 2MG 0-0-1
RISPERIDON 2 MG 2X1
-------20/08/202517/09/202522/10/202512/11/202517/12/2025
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24CIPAGERAN3277034712990001RIANTI WULANDARI 07/12/199926TEGAL KAWUNG 3/8CIPAGERANPTKF20KEINGINAN SERING TIDAK DITURUTI ORANG TUA-RISPERIDON 2X1
THF 2X1
CLOZAPINE 100 MG 0-0-1
ASAM VALPROAT 500MG
MITRA KASIHRISPERIDON 2X1
THF 2X1
CLOZAPINE 100 MG 0-0-1
ASAM VALPROAT 500MG
--------18/09/202520/10/202519/11/202517/12/2025
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25CIPAGERAN3277030111820013WAHYU KURNIA 01/11/198243KP BABAKAN ANGGARAJA 2/6CIPAGERANLTKF20NARKOBA-RISPERIDON 2X1
CLOZAPINE 100 MG 0-0-1
MITRA KASIHRISPERIDON 2X1
CLOZAPINE 100 MG 0-0-1
--------15/19/202515/10/202514/11/202515/12/2025
31
26CIPAGERAN3277030511970013FAZAR FATHURRAHMAN05/11/199728KP ANGGARAJA 1/7CIPAGERANLTKF20DISABILITAS -RISPERIDON 2X1
THF 2X1
CLOZAPINE 100 MG 0-0-1
ASAM VALPROAT 500MG
MITRA KASIHRISPERIDON 2X1
THF 2X1
CLOZAPINE 100 MG 0-0-1
ASAM VALPROAT 500MG
--------12/09/202513/10/202512/11/202512/12/2025
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27CIPAGERAN3277032305990014KIKI KUSNADI25/01/190026KP PASIR KIARA 5/16CIPAGERANLTKF20DIBULLY OLEH TEMAN SAAT SEKOLAH SMK SANGKURIANG 1--MITRA KASIH----------01/10/202503/11/202503/12/2025
33
28CIPAGERAN3277030705960004ANDI SELESTIAN07/05/199629KP. BOBOJONG 1/15CIPAGERANLTKF20EKONOMI--MITRA KASIH----------08/10/202512/11/202512/12/2025
34
29CIPAGERAN3277031306890002CITRA 03/06/198936KP. ANGGARAJA 2/7CIPAGERANPTKF20KEJANG--DUSTIRA----------09/10/202517/11/202519/12/2025
35
30CIPAGERAN3277030107870161WAWAN03/06/198936KP. ANGGARAJA 2/7CIPAGERANLTKF20TIDA KETERIMA SEKOLAH TENTARA-ASAM VALPROAT LEPAS LAMBAT 400MGDUSTIRAASAM VALPROAT LEPAS LAMBAT 400MG---------11/10/202514/11/202515/12/2025
36
31CIPAGERAN3277031012800029KIKI10/12/198044KP. BOBOJONG 7/15CIPAGERANLDF20DIMARAHI MERTUA-TRIFLUOPERAZIN, THF, KLOZAPINMITRA KASIHTRIFLUOPERAZIN, THF, KLOZAPIN---------11/10/202512/11/202512/12/2025
37
32CIPAGERAN3277030904020007RESTU BUDIMAN09/04/200223KP. CIKENDAL 1/4CIPAGERANLTKF20PERCERAIAN ORANG TUA-QUETIAPINE, TRIFLUOPERAZINE, THFDUSTIRAQUETIAPINE, TRIFLUOPERAZINE, THF---------2010/202525/11/2025
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33CIPAGERAN3277031603830020EMAN SULAEMAN15/03/198342KP ANGGARAJA 1/7KP ANGGARAJA 1/7LTKF20NARKOBA-HALOPERIDOL 5 MG 2X 1/2
THF 3X1
CLOZAPIN 25 MG 0-0-1
XHALOPERIDOL 5 MG 2X 1/2
THF 3X1
CLOZAPIN 25 MG 0-0-1
----------20/11/202522/12/2025
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34CIPAGERAN3277031404770013ASEP SUPRIATNA14/04/197748
JL KOL MASTURI KP LIO III NO.25
CIPAGERANLTKF20MASALAH DENGAN ORANG TUA-AMITRIPTILLINE 25MG 1X1/2
RISPERIDONE 2MG 1X1/2
VALISANBE 2MG 1X1
KASIH BUNDAAMITRIPTILLINE 25MG 1X1/2
RISPERIDONE 2MG 1X1/2
VALISANBE 2MG 1X1
----------3/11/202510/12/2025
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KETERANGAN :
- TULISAN MENGGUNAKAN HURUF ARIAL 12
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- UMUR DI ISI TAHUN SAJA TIDAK DENGAN BULAN DAN HARI
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- ALAMAT DI ISI LENGKAP SESUAI KTP
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- STATUS PASIEN K = KAWIN, TK= TIDAK KAWIN, J= JANDA, D= DUDA
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- KODE DIAGNOSA DI ISI DENGAN KODE ICD
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- PENYEBAB UTAMA DI TULIS SINGKAT DAN JELAS
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- STATUS JAMINAN DI ISI DENGAN TANDA CEKLIS (V)
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- PEMERIKSAAN STATUS MENTAL DI ISI DENGAN TANDA CEKLIS (V)
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- WAWANCARA DI ISI DENGAN TANDA CEKLIS (V)
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- EDUKASI KEPATUHAN MINUM OBAT DI ISI DENGAN TANDA CEKLIS (V)
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- PENATALAKSANAAN AWAL DAN RUJUKAN DI ISI DENGAN TANDA CEKLIS (V)
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- RUJUK BALIK DI ISI DENGAN TANDA CEKLIS (V) JIKA ADA RUJUK BALIK, APABILA TIDAK ADA ISI DENGAN STRIP (-)
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- OBAT YANG DIBERIKAN DARI PUSKESMAS DI ISI DENGAN NAMA OBAT
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- NAMA RS RUJUKAN DI ISI DENGAN NAMA RUMAH SAKIT JIKA PASIEN DI RUJUK
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- OBAT YANG DI KONSUMSI DI ISI DENGAN NAMA OBAT
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- PEMANTAUAN MINUM OBAT DI ISI DENGAN TANDA CEKLIS (V) DAN WAJIB DILAKUKAN PEMANTAUAN OBAT SETIAP BULANNYA
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