| B0001 | PUTRI ANDREANI | drg. MUTIA AULIANY, Sp. B. M | BPJS | |
| B0002 | CUNG SUI CEN | dr. MUHAMMAD MA'RUF, Sp. OT | BPJS | |
| C0001 | SISKA ARIFIN | dr. ESA FREDIGUSTA, Sp.JP | BPJS | |
| B0003 | ANDRI | dr. YUDI YUSRIZAL, Sp.PD | BPJS | |
| D0001 | SUPITRA | dr. MELFIA NAVRATILOVA, Sp. P, M. Kes | BPJS | |
| C0002 | EN TJOENG | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| B0004 | RAFIZI | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0005 | SUKIRNO | dr. DAMERIA HASTARI, Sp. PD | BPJS | |
| B0006 | WARTINI | dr. MEILANO ROBINSYAH, Sp. PD | BPJS | |
| B0007 | HOLIPAH | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0008 | MUHAMMAD HEIKO DHANUGRAHA | drg. ANDI DAHNIAR, Sp, KG | BPJS | |
| B0009 | NUNNIAWATI | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0010 | REVA AURA AMESCA | dr. NOVIA NASIR, Sp. M | BPJS | |
| C0003 | SOPINA | dr. SHENY AGMA, Sp. N | BPJS | |
| B0011 | LILI ARYATI | dr. YUDI YUSRIZAL, Sp.PD | BPJS | |
| C0004 | A. RUSLI | dr. SHENY AGMA, Sp. N | BPJS | |
| C0005 | YULINA | dr. ESA FREDIGUSTA, Sp.JP | BPJS | |
| C0006 | YULIZAR | dr. LINGGAWATI, Sp. THT | BPJS | |
| C0007 | ABDUL HAMID | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| C0008 | M. NASIR HASAN | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| C0009 | SUMARLAN SUDARWA T | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| B0012 | MARIA AGNES TRISNANI | dr. NOVIA NASIR, Sp. M | BPJS | |
| C0010 | NURDIN | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| C0011 | RUSDI ISKANDAR | dr. SHENY AGMA, Sp. N | BPJS | |
| C0012 | PHANG SUI SIAM | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| B0013 | PUSPITASARI | dr. DAMERIA HASTARI, Sp. PD | BPJS | |
| C0013 | ROBUNA | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| C0014 | HAPPY KURNIA | dr. CARLES, Sp. KJ, M, Sc | BPJS | |
| C0015 | SRI WACHYU HARIYANTHIE | dr. SHENY AGMA, Sp. N | BPJS | |
| B0014 | PUTRI ANDREANI | drg. MUTIA AULIANY, Sp. B. M | BPJS | |
| B0015 | NAZAR RAFIANSYAH | drg. ANDI DAHNIAR, Sp, KG | BPJS | |
| A0001 | AULYA RACHMASARI | dr.H. SUANDI, Sp.OG,M.Kes | BPJS | |
| B0016 | SINTA DEWIE | dr. YUDI YUSRIZAL, Sp.PD | BPJS | |
| B0017 | LIONG MIE YUN | dr. GOKLASH APRYANTO, Sp.B | BPJS | |
| B0018 | RONDAMAYA HARAHAP | dr. GOKLASH APRYANTO, Sp.B | BPJS | |
| B0019 | ANNIKA | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0020 | SITI AISAH | dr. DAMERIA HASTARI, Sp. PD | BPJS | |
| C0016 | TJHIN A TJHIANG | dr. RISMAN SARAGIH, Sp.S | BPJS | |
| C0017 | ABDUL SOMAD | dr. SHENY AGMA, Sp. N | BPJS | |
| B0021 | HASNURYATI | dr. MUHAMMAD MA'RUF, Sp. OT | BPJS | |
| B0022 | FITRIA RAMADHANI | drg. MUTIA AULIANY, Sp. B. M | BPJS | |
| B0023 | ANTI AVELLIA ANGREINI | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0024 | YUSWATI | dr. MUHAMMAD MA'RUF, Sp. OT | BPJS | |
| B0025 | LIANA | dr ARINAL PAHLEVI, SP.D.V. | BPJS | |
| C0018 | SUPARTI | dr. SHENY AGMA, Sp. N | BPJS | |
| B0026 | LAURENTIUS JULIANO DJANU R | dr. GOKLASH APRYANTO, Sp.B | BPJS | |
| D0002 | SIN HIONG | dr. MELFIA NAVRATILOVA, Sp. P, M. Kes | BPJS | |
| C0019 | KIVALYA BILGISA VINARA | dr. LINGGAWATI, Sp. THT | BPJS | |
| C0020 | MAHAYA | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| D0003 | GUSRIDAWATI | dr. MELFIA NAVRATILOVA, Sp. P, M. Kes | BPJS | |
| A0002 | NORMAH | dr.H. SUANDI, Sp.OG,M.Kes | BPJS | |
| C0021 | AJIS | dr. RISMAN SARAGIH, Sp.S | BPJS | |
| A0003 | DEBI MELISA | dr.H. SUANDI, Sp.OG,M.Kes | BPJS | |
| D0004 | BUDI | dr. MELFIA NAVRATILOVA, Sp. P, M. Kes | BPJS | |
| A0004 | FARIK ARRAZIQ | dr. REGGY AMBARDY DWI PUTRA, Sp. A | BPJS | |
| B0027 | FARAH ERNESTIN CLEOPHILA | drg. RETNO JAKA UMBARA, Sp. Ort | BPJS | |
| C0022 | LIM SIUW KIUN | dr. SHENY AGMA, Sp. N | BPJS | |
| C0023 | ELVI NOVITA | dr. SHENY AGMA, Sp. N | BPJS | |
| D0005 | RIDWAN BIN ALI | dr. MELFIA NAVRATILOVA, Sp. P, M. Kes | BPJS | |
| B0028 | AGUS SUSANTO | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0029 | ANNISA PUTRI ALCAHYA | drg. ANDI DAHNIAR, Sp, KG | BPJS | |
| D0006 | POMPIDAU | dr. MELFIA NAVRATILOVA, Sp. P, M. Kes | BPJS | |
| C0024 | AMIT DJALI | dr. SHENY AGMA, Sp. N | BPJS | |
| B0030 | NABILA | drg. F.X. DODDY SETIAWAN, Sp. Perio | BPJS | |
| A0005 | ALESHA NUR RACHMA | dr. REGGY AMBARDY DWI PUTRA, Sp. A | BPJS | |
| C0025 | MUSRIKA | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| B0031 | HENDRA SANJAYA | dr. MEILANO ROBINSYAH, Sp. PD | BPJS | |
| B0032 | DENIS DWI ANDIKA | drg. ANDI DAHNIAR, Sp, KG | BPJS | |
| B0033 | SURIPTO | drg. ANDI DAHNIAR, Sp, KG | BPJS | |
| B0034 | SABRIL MAULANA | dr. DAMERIA HASTARI, Sp. PD | BPJS | |
| C0026 | MASTURA | dr. RISMAN SARAGIH, Sp.S | BPJS | |
| C0027 | HAMILAH | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| D0007 | ICE KUSNA | dr. MELFIA NAVRATILOVA, Sp. P, M. Kes | BPJS | |
| B0035 | MARLINA | dr. GOKLASH APRYANTO, Sp.B | BPJS | |
| B0036 | IWAN TARUNA | dr. NOVIA NASIR, Sp. M | BPJS | |
| C0028 | WITA | dr. LINGGAWATI, Sp. THT | BPJS | |
| B0037 | AMINAH | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0038 | ZULFAKAR | dr. NOVIA NASIR, Sp. M | BPJS | |
| B0039 | YOKE YOHANES | dr. MUHAMMAD MA'RUF, Sp. OT | BPJS | |
| B0040 | HASMULYANA | dr. GOKLASH APRYANTO, Sp.B | BPJS | |
| C0029 | KUSMIATI | dr. ENDANG KUSRENI,, Sp. JP | BPJS | |
| A0006 | KENZIE KHALFANI YANTO | dr. REGGY AMBARDY DWI PUTRA, Sp. A | BPJS | |