Rekapituilasi Sikda Maret 201

LAMPIRAN : DAFTAR PENYAKIT SESUAI KODE ICD 10
N0 Elemen Data
0 - 7 Hr 8-28 Hr 1bl-<1th
1. Peny.infeksi pada usus B L B L B
101.Kolera
102. Daire (termasuk tersangka kolera) 0
103. Disentri penyebab tak diketahui 1
104. Infeksi peny.usus lain 0 0 0 0 1
105. Tifus Perut/Disentri amoeba 0 0 0 0 0
106. Peritonitis 0 0 0 0 0
107. Post operasi apendictomy 0 0 0 0 0
108. Keracunan Makanan 0 0 0 0 0
108. Infeksi usus karena jasad renik tertentu
lain
0 0 0 0 0
109. Infeksi usus yang kurang jelas batasnya
0 0 0 0 0
2 Peny. Tuberkulosis 0 0 0 0 0
202. TB selain Paru (extra pulmoner) 0 0 0 0 0
203. Tuberkolosis alat pernpasan lain (suspeck
TBC)
0 0 0 0 0
204. TB Paru BTA (-), rontgen (+) 0 0 0 0 0
205. Pengobatan TBC 6 bulan 0 0 0 0 0
206. Pengobatan TBC 8 bulan 0 0 0 0 0
207. TBC Paru yang sembuh 0 0 0 0 0
208. TBC Kambuh 0 0 0 0 0
209. Pengobatan TBC Lengkap 0 0 0 0 0
2010. Tuberkulosis selaput otak dan susunan
syaraf pusat
0 0 0 0 0
2011. Tuberkolusis usus selaput perut dan
kelenjar mesenterium.
0 0 0 0 0
2012. Tuberkolosis tulang da dan sendi 0 0 0 0 0
2013. Tuberkolosis saluran kencing dan alat
kelamin
0 0 0 0 0
2014. Tuberkolosis lain 0 0 0 0 0
2012. Tuberkolosis tulang da dan sendi 0 0 0 0 0
2013. Tuberkolosis saluran kencing dan alat
kelamin
0 0 0 0 0
2014. Tuberkolosis lain 0 0 0 0 0
3 Penyakit Bakteri 0 0 0 0 0
301. Kusta I/T (MB) 0 0 0 0 0
302. Kusta B/L (PM) 0 0 0 0 0
303. Difteri 0 0 0 0 0
304. Batuk Rejan 0 0 0 0 0
305. Tetanus 0 0 0 0 0
306. Sampar Pes 0 0 0 0 0
307. Bruselosis 0 0 0 0 0
308. Radang tenggorok (karena) streptokokus
sakarlatina dan erispelos infeksi
meningokokus
0 0 0 0 0
309. Septikimia 0 0 0 0 0
310. Antrak 0 0 0 0 0
4 Penyakit Virus 0 0 0 0 0
401. Poliomyelitis Akut 0 0 0 0 0
402. Campak Morbili 0 0 0 0 0
403. Hepatitis/ Radang hati menular 0 0 0 0 0
404. Penyakit Gila Anjing (Rabies)/Lissa 0 0 0 0 0
405. DHF (demam berdarah dengue/DBD) 0 0 0 0 0
406. Cacar Air/Varicella 0 0 0 0 0
407. Candiloma Acuminata 0 0 0 0 0
408. Serosis Hepatitis/Demam Kuning 0 0 0 0 0
409. Tersangka DBD (DHF) 0 0 0 0 0
410. Rubela 0 0 0 0 0
411. Radang Otak (karena) virus serangga 0 0 0 0 0
412. Trachoma 0 0 0 0 0
413. Gondong 0 0 0 0 0
414. Penyakit karena virus lain 0 0 0 0 0
5 Riketsiasis dan Penyakit karena Arthropoda
0 0 0 0 0
501. Malaria dengan pemeriksaan
laboratorium
0 0 0 0 0
502. Malaria Klinis 0 0 0 0 0
503. Malaria tanpa pemeriksaan
laboratorium
0 0 0 0 0
504. Tifus dengan ruam kulit/toksoplamosis
0 0 0 0 0
505. Penyakit Ricketsia lain (Demam
Dengue/Demam cikungunya
0 0 0 0 0
506. Malaria tropika (p.falcifarum) 0 0 0 0 0
507. Malaria vivax 0 0 0 0 0
508. Malaria mix 0 0 0 0 0
509. Malaria Tertiana 0 0 0 0 0
509. Leishmaniasis 0 0 0 0 0
510. Tripanosomiasis 0 0 0 0 0
511. Penyakit tular serangga lain 0 0 0 0 0
6 PENYAKIT KELAMIN 0 0 0 0 0
601.Infeksi Gonokokus 0 0 0 0 0
602.Non gonokokus 0 0 0 0 0
603.IMS/Infeksi Menular Seksual 0 0 0 0 0
604. Sifilis 0 0 0 0 0
606. Gonorhoe (GO) 0 0 0 0 0
PENYAKIT INFEKSI KARENA PARASIT DAN
7 AKIBAT KEMUDIAN 0 0 0 0 0
701. Patek/Frambusia
703. Filariasis dan drakontiasis
704.Penyakit Kecacingan 0 0 0 0 0
705. Scabies 0 0 0 0 0
706. Ankilostomiasis 0 0 0 0 0
707. Askariasis 0 0 0 0 0
8 GANGGUAN MENTAL 0 0 0 0 0
801.Gangguan Psikotik 0 0 0 0 0
802.Gangguan Neurotik 0 0 0 0 0
803.Retardasi Mental 0 0 0 0 0
804.Gangguan Kesehatan Jiwa Bermula Pada
Bayi ,Anak Dan Remaja Dan Perkembangan
0 0 0 0 0
805. Penyakit jiwa lainnya 0 0 0 0 0
806. Psikosomatis 0 0 0 0 0
807. Gangguan extrapyramidal/tremor 0 0 0 0 0
808. Insomnia 0 0 0 0 0
809. Psikosa/schizofrenia 0 0 0 0 0
810. Depresi berat 0 0 0 0 0
811. Depresi ringan 0 0 0 0 0
812. Depresi sedang 0 0 0 0 0
813. Schizofren tak terkunci 0 0 0 0 0
814. Schizofren paranoid 0 0 0 0 0
815. Schizofren akut 0 0 0 0 0
9 PENYAKIT SUSUNAN SARAF 0 0 0 0 0
901. Epilepsi 0 0 0 0 0
902. Penyakit dan kelainan susunan saraf
lainnya
0 0 0 0 0
903. Migren 0 0 0 0 0
904. Neuropati 0 0 0 0 0
905. Kejang Demam 0 0 0 0 0
906. Vertigo 0 0 0 0 0
907. Hidrocephalus 0 0 0 0 0
908.Meningitis Bakterial 0 0 0 0 0
909.Trigeminal Neuralgia 0 0 0 0 0
910.Neuralgia 0 0 0 0 0
911. Tremor 0 0 0 0 0
912. Kelainan Nervus Fascialis 0 0 0 0 0
913. Ataksia 0 0 0 0 0
914. Polioneuropati 0 0 0 0 0
10 PENYAKIT MATA DAN ADNEKSA 0 0 0 0 0
1001. Glaukoma 0 0 0 0 0
1002. Katarak 0 0 0 0 0
1003. Kelainan Refraksi 0 0 0 0 0
1004. Kelainan Kornea 0 0 0 0 0
1005. Penyakit Mata Lain-lain 0 0 0 0 0
1006. Pemeriksaan buta warna 0 0 0 0 0
1007. Trauma pada palpebra 0 0 0 0 0
1008. Corpus alienum mata 0 0 0 0 0
1009. Pterygium 0 0 0 0 0
1010. Blepharitis 0 0 0 0 0
1011. Hordeolum 0 0 0 0 0
1012. Kalazion 0 0 0 0 0
1013. Kebutaan dan penglihatan kurang 0 0 0 0 0
1007. Radang selaput lendir mata 0 0 0 0 0
1008. Kelainan kelenjar mata 0 0 0 0 0
1009. Juling dan kelaianan mata 0 0 0 0 0
11 PENY. PADA TELINGA DAN MASTOID
1101. Radang/Infeksi Telinga Tengah 0 0 0 0 0
1102.Infeksi Mastoid (Mastoiditis)
1103. Sinusitas 0 0 0 0 0
1104. Sinusitas Etmoidalis 0 0 0 0 0
1105. Rhinitis Alergica 0 0 0 0 0
1106. Epistaxis 0 0 0 0 0
1107. Deviasi Septum 0 0 0 0 0
1108. Fisitula preaunikuler 0 0 0 0 0
1109. Tuli konduksi (SNHL) 0 0 0 0 0
1110. Gangguan telinga lain 0 0 0 0 0
1111. Kanker di lubang telinga 0 0 0 0 0
1112. Otalgia 0 0 0 0 0
12 PENYAKIT TEKANAN DARAH TINGGI 0 0 0 0 0
1201. Hypertensis essential 0 0 0 0 0
1202. Hypertensi Partial 0 0 0 0 0
1203. Stroke (CVA) 0 0 0 0 0
1204. Hypertensi malignan 0 0 0 0 0
1205. Oedema Anarsarka 0 0 0 0 0
PENY SALURAN PERNAPASAN BAGIAN ATAS
13
1301. Tonsilitis 0 0 0 0 0
1302. Infeksi saluran pernapasan atas akut
1 14 12
1303. Peny.lain pada Saluran pernapasan bgn
atas
1304. Dyptheria 0 0 0 0 0
1306. Laringitis dan trackhematis/pharingitis
akut
0 0 0 0 0
1307. Pharingitis chronis 0 0 0 0 0
1308. Batuk 0 0 0 0 0
1309. Peny.lain pada pita suara 0 0 0 0 0
1310. Nasopharingitis Akut 0 0 0 0 0
1311. Nasopharingitis Kronik 0 0 0 0 0
1312. Rhinitis 0 0 0 0 0
1313. Haemoptoe 0 0 0 0 0
1306. Sekat hidung bengkok dan polio hidung
0 0 0 0 0
PENY LAIN DR SALURAN PERNAPASAN
14 BAGIAN BAWAH
1401. Pneumonia 0 0 0 0 0
1402. Bronkitis Acut 0 0 0 0 0
1403. Asthma Bronchiale 0 0 0 0 0
1404. Peny lain dari sal pernapasan bagian
bawah
0 0 0 0 0
1405. Asthma cardiale 0 0 0 0 0
1406. Broncho Penumonia 0 0 0 0 0
1407. Bronchitis chronis (menahun dan tanpa
keterangan)
0 0 0 0 0
1408. Observasi Dispeneu 0 0 0 0 0
1409. Influenza 0 0 0 0 0
1410. Bronchitis menahun dan tanpa
keterangan
0 0 0 0 0
1411. Emphisema dan asthma 0 0 0 0 0
1412. Bronchiactasis 0 0 0 0 0
1413. Penyakit menahun lain yang
menyumbat paru-paru
0 0 0 0 0
1414. Pneumonia dan penyakit paru-paru
yang disebabkan dari luar.
0 0 0 0 0
1415. Pleuritas 0 0 0 0 0
15 PENYAKIT RONGGA MULUT
15A1. Karies Gigi 0 0 0 0 0
15A2. Karies Email tanpa kavitas 0 0 0 0 0
15A3. Karies Dentin/email dengan kavitas 0 0 0 0 0
15A4. Karies semen 0 0 0 0 0
15A5. Odonto Klasia 0 0 0 0 0
15B1. Penyakit Pulpa/iritasi pulpa 0 0 0 0 0
15B2. Hyperaemia pulpa/iritasi pulpa 0 0 0 0 0
15B3. Pulpitis kronik 0 0 0 0 0
15B4. Pulpa Nekrosis/Gangren 0 0 0 0 0
15B5. Periodentitis Apicalis 0 0 0 0 0
15B6. Abses Periopical Akut 0 0 0 0 0
15B7. Periodentitis Apikalis Kronik 0 0 0 0 0
15B8. Abses Periapikal Kronik 0 0 0 0 0
15C1. Penyakit Ginggivitis dan Periodental
(1503)
15C2. Ginggivitis Akut 0 0 0 0 0
15C3. Ginggivitis Kronik 0 0 0 0 0
15C4. Periodentitis Akut 0 0 0 0 0
15C5. Periodentitis Kronik 0 0 0 0 0
15C6. Periodontosis 0 0 0 0 0
15C7. Penyakit Periodental lainnya 0 0 0 0 0
15D1. Gangguan gigi dan jaringan Penyangga
lainnya (1504)
15D3. Gigi hilang sebab traumatik 0 0 0 0 0
15D4. Atrophy Alveolar Ridge 0 0 0 0 0
15D5. Radikses 0 0 0 0 0
15D6. Traoma Gigi 0 0 0 0 0
15D7. Kelainan bentuk ukuran 0 0 0 0 0
15D8. Gangguan Pendukung jaringan gigi lain
0 0 0 0 0
15D9. Erosi 0 0 0 0 0
15E1. Penyakit Rongga Mulut, Klenjar Ludah,
rahang dan lainnya (1505)
0 0 0 0 0
15E2. Kista Mulut 0 0 0 0 0
15E3. Peny. Kelenjar Ludah 0 0 0 0 0
15E4. Stomatitis 0 0 0 0 0
15E5. Bibir Sumbing 0 0 0 0 0
15E6. Penyakit pada lidah/Resorbsi eksternal
dan internal
0 0 0 0 0
15E7. Resorbsi eksternal dan internal 0 0 0 0 0
15E8. Perubahan warna eksterna 0 0 0 0 0
15E9. Atrisi 0 0 0 0 0
15F1. Abrasi 0 0 0 0 0
15F2. Dentin Hipersensitif 0 0 0 0 0
15F3. Granuloma/Penyakit Kelenjar Ludah 0 0 0 0 0
15F4. Kista Radikulair 0 0 0 0 0
15F5. Fraktur Mahkota 0 0 0 0 0
15F6. Impaksi 0 0 0 0 0
15F7. Eksostosis 0 0 0 0 0
15F8. Kelainan letak gigi 0 0 0 0 0
15F9. Infeksi Oromaksilofacial 0 0 0 0 0
15G1. Palatoschizis 0 0 0 0 0
15G2. Ulkus Lidah 0 0 0 0 0
0 0 0 0 0
16 PENYAKIT PD SALURAN KENCING 0 0 0 0 0
1601. ISK/Urethritis acut 0 0 0 0 0
1602. Nephrotic Syndrom 0 0 0 0 0
1603. Nephritis akut 0 0 0 0 0
1604. Nephritis chronic 0 0 0 0 0
1605. Chronic Renal Failure (NRF) 0 0 0 0 0
1606. Infeksi Kandung Kemih 0 0 0 0 0
1607. Urethro lithiasis 0 0 0 0 0
1608. Visico lithiasis 0 0 0 0 0
1609. Renal colix 0 0 0 0 0
1610. Abdominal colix 0 0 0 0 0
1611. BPH/Hiperplasia prostat 0 0 0 0 0
1612. Nephrolitiasis 0 0 0 0 0
1613. Poliuri 0 0 0 0 0
1614. Hematuri 0 0 0 0 0
1615. Sistisis 0 0 0 0 0
1616. Hipospadia 0 0 0 0 0
1617. Retensi Urin 0 0 0 0 0
SEBAB KELAINAN KEBIDANAN LANGSUNG
17
1701. Keguguran 0 0 0 0 0
1702. Perdarahan pd kehamilan, persalinan &
masa nifas (Uterus dan vagina)
0 0 0 0 0
1703. Keracunan Kehamilan 0 0 0 0 0
1704. Partus Lama 0 0 0 0 0
1705. Infeksi pd kehamilan, persalinan &
masa nifas
0 0 0 0 0
1706. Hyperemesis Gravidarum 0 0 0 0 0
1707. Abortus Imminen 0 0 0 0 0
1708. Abortus Insipien 0 0 0 0 0
1710. Abortus Provokatus 0 0 0 0 0
1711. Kelainan congenital 0 0 0 0 0
1712. Contact bleeding 0 0 0 0 0
1713. Amenorhroe secundair 0 0 0 0 0
1714. Amenorhoe primair 0 0 0 0 0
1715. Menometrorhagica 0 0 0 0 0
1716. Metrorrhagia 0 0 0 0 0
1717. Cysta coklat 0 0 0 0 0
1718. Myoma uteri 0 0 0 0 0
1719. Endometriosis 0 0 0 0 0
1720. Molahydatidosa 0 0 0 0 0
1721. Gemeli 0 0 0 0 0
1722. Letak sungsang 0 0 0 0 0
1723. Letak Lintang 0 0 0 0 0
1724. Letak obliqua 0 0 0 0 0
1725. KB Suntik Depoprovera 0 0 0 0 0
1726. KB Suntik Cyclofen 0 0 0 0 0
1727. Leuchorroe 0 0 0 0 0
1728. Vaginitis 0 0 0 0 0
1729. Fluor Albus 0 0 0 0 0
1730. Kista Bartolini 0 0 0 0 0
1731. Condiloma Acuminata 0 0 0 0 0
1732. Salpingitis 0 0 0 0 0
1733. SC disporposi kepala panggul 0 0 0 0 0
1734. Prolaps Uteri 0 0 0 0 0
1735. Kanker Serviks 0 0 0 0 0
18 KEADAAN TERTENTU PD MASA PERINATAL 0 0 0 0 0
1801.Trauma Lahir 0 0 0 0 0
1802. Asfiksia 0 0 0 0 0
1803. Tetanus neonatorum 0 0 0 0 0
1804. Kwshiorkor 0 0 0 0 0
1805. Gangguan laktasi (asi tidak produksi) 0 0 0 0 0
1806. Post Partum 0 0 0 0 0
1807. IUFD 0 0 0 0 0
19 KECELAKAAN DAN KERACUNAN
1901. Kecelakaan dan Rudapaksa/Trauma
Thorax
0 0 0 0 0
1902. Keracunan Bahan Kimia 0 0 0 0 0
1903. Keracunan Makanan 0 0 0 0 0
1904. Fraktur lengan atas dan bahu 0 0 0 0 0
1905. Fraktur lengan bawah 0 0 0 0 0
1906. Commotio Cerebri 0 0 0 0 0
1907. Contusio cerebri 0 0 0 0 0
1908. Vulnus apertum 0 0 0 0 0
1909. Vulnus scizum 0 0 0 0 0
1910. Vulnus Excoriasi 0 0 0 0 0
1911. Vulnus Laceriasi 0 0 0 0 0
1912. Naegel extracsi 0 0 0 0 0
1913. Haematom krn trauma 0 0 0 0 0
1914. Sincope 0 0 0 0 0
1915. Shock Anapylactic 0 0 0 0 0
1916. Shock hypovolemic 0 0 0 0 0
1917. Luxatio mandibula 0 0 0 0 0
1918. Luxatio Art Genu 0 0 0 0 0
1919. Fraktur Clavicula 0 0 0 0 0
1920. Alergi tanpa sebab yang jelas 0 0 0 0 0
1921. Post Vulnus 0 0 0 0 0
1922. Cedera kepala 0 0 0 0 0
1923. Dislokasi sendi dan ligamen leher 0 0 0 0 0
1924. Dislokasi sensi dan ligamen bahu 0 0 0 0 0
1925. Trauma pada jari kaki 0 0 0 0 0
1926. Vulnus Punctum 0 0 0 0 0
1927. Trauma jaringan otot Regio Ekstremitas
atas
0 0 0 0 0
1928. Multiple Lacerasi 0 0 0 0 0
1929. Post Fraktur 0 0 0 0 0
1930. Fraktur Nasal 0 0 0 0 0
1931. Fraktur mandibula 0 0 0 0 0
1932. Fraktur maxilla 0 0 0 0 0
1933. Fraktur gigi 0 0 0 0 0
1934. Fraktur Jari Tangan 0 0 0 0 0
1935. Fraktur Fibula 0 0 0 0 0
1936. Fraktur Femur 0 0 0 0 0
1937. Dislokasi Siku 0 0 0 0 0
1938. Corpus alienum di pharing 0 0 0 0 0
1939. Corpus alienum di kaki 0 0 0 0 0
1940. Corpus alienum di tangan 0 0 0 0 0
20 PENY KULIT DAN JARINGAN SUB KUTAN
2001. Penyakit Kulit Infeksi 0 0 0 1 1
2002. Penyakit Kulit Alergi 0 0 0 1 0
2003. Penyakit Kulit Karena Jamur 0 0 0 0 0
2004. Furuncel 0 0 0 0 0
2005. Carbuncel 0 0 0 0 0
2006. Exzema 0 0 0 0 0
2007. Psoriasis 0 0 0 0 0
2008. Urtikaria 0 0 0 0 0
2009. Impetigo 0 0 0 0 0
2010. Paronichia 0 0 0 0 0
2011. Dehisensi 0 0 0 0 0
2012. Acne 0 0 0 0 0
1213. Abses 0 0 0 0 0
1214. Purpura 0 0 0 0 0
1215. Insect Bite 0 0 0 0 0
1216. Candidiasis 0 0 0 0 0
1217. Melasma 0 0 0 0 0
1218. Tinea Corporis 0 0 0 0 0
1219. Basalioma 0 0 0 0 0
1220. Tinea Pedis 0 0 0 0 0
1221. Tinea Versicolor 0 0 0 0 0
1222. Miliaria (biang keringat) 0 0 0 0 0
1223. Tinea Cruris 0 0 0 0 0
1224. Tinea Fascialis 0 0 0 0 0
1225. Ichtiosis 0 0 0 0 0
1226. Fissure of nipple 0 0 0 0 0
1227. Oedema 0 0 0 0 0
1228. Iritasi Pampers 0 0 0 0 0
1229. Erisipelas 0 0 0 0 0
1230. Prurigo 0 0 0 0 0
2031. Tinea Manus 0 0 0 0 0
2032. Gangrene 0 0 0 0 0
2033. Hyperkeratosis 0 0 0 0 0
2034. Hiperhidrosis 0 0 0 0 0
2035. Keloid 0 0 0 0 0
2036. Eritema Multiformis tak spesifik 0 0 0 0 0
PENYAKIT PADA SISTEM OTOT DAN
21 JARINGAN PENGIKAT (PENYAKIT TULANG
BELULANG,RADANG SENDI TERMASUK 0
RHEUMATIK)
0 0 0 0
2101. Rheumatic arthritis acut 0 0 0 0 0
2102. Rheumatic arthritis chronic 0 0 0 0 0
2103. Lumbago 0 0 0 0 0
2104. Myalgia
2105. Athralgia 0 0 0 0 0
2106. Cephalgia 0 0 0 0 0
2107. Haemorhoid tanpa komplikasi 0 0 0 0 0
2109. LBP (Low Back Pain) 0 0 0 0 0
2110. Neuritis perifer 0 0 0 0 0
2111. Osteoporosis 0 0 0 0 0
2112. Penyakit Otot & Jaringan Ikat 0 0 0 0 0
2113. Chest Pain on breathing 0 0 0 0 0
2114. Chest Pain tak spesifik 0 0 0 0 0
2115. Unguinum 0 0 0 0 0
2116. Tortikolosis 0 0 0 0 0
2119. Gout arthritis 0 0 0 0 0
2120. Verucca 0 0 0 0 0
2121. Fraktur patella 0 0 0 0 0
2122. Dislokasi pergelangan tangan 0 0 0 0 0
2123. Spain dan Strain 0 0 0 0 0
2124. Kontraktur sendi 0 0 0 0 0
2125. Papiloma 0 0 0 0 0
22 PENYAKIT LAINNYA 0 0 0 0 0
2201. Appendicitis acuta 0 0 0 0 0
2202. Appendicitis chronica 0 0 0 0 0
2203. Ascites 0 0 0 0 0
2204. Alergi udara dingin 0 0 0 0 0
2205. Fisioterapi 0 0 0 0 0
2206. Angina pectoris 0 0 0 0 0
2207. Haematemesis 0 0 0 0 0
2208. Melena 0 0 0 0 0
2209. Colix abdomen 0 0 0 0 0
2210. Conjunctivitis 0 0 0 0 0
2212. Cerumen prop. 0 0 0 0 0
2213. Corpus alienum hidung 0 0 0 0 0
2214. Corpus alienum telingan 0 0 0 0 0
2215. Colecystitis 0 0 0 0 0
2216. Cerebral paisy 0 0 0 0 0
2217. Dawir 0 0 0 0 0
2218. Gastritis acut 0 0 0 0 0
2219. Gastritis Chronic 0 0 0 0 0
2220. Ikterus 0 0 0 0 0
2221. Kanker rektum 0 0 0 0 0
2222. Kanker Thyroid 0 0 0 0 0
2223. Hernia femoralis 0 0 0 0 0
2224. Hypermetropia 0 0 0 0 0
2226. Herpes zooster 0 0 0 0 0
2227. Herpes simplek 0 0 0 0 0
2228. HNP 0 0 0 0 0
2229. Illeus obstruktivus 0 0 0 0 0
2230. Illeus Paralitikus 0 0 0 0 0
2231. Influenza 0 0 0 0 0
2232. Iridocyclitis 0 0 0 0 0
2233. Ca. Mammae 0 0 0 0 0
2234. Infeksi telinga luar 0 0 0 0 0
2235. IHD 0 0 0 0 0
2236. Hemiparese 0 0 0 0 0
2237. Keratitis 0 0 0 0 0
2238. HHD tanpa gagal jantung 0 0 0 0 0
2239. Myopia 0 0 0 0 0
2240. Obstipasi 0 0 0 0 0
2241. Paraparese 0 0 0 0 0
2242. Parotitis 0 0 0 0 0
2243. Phymosis 0 0 0 0 0
2244. PKTB 0 0 0 0 0
2245. Rabun senja 0 0 0 0 0
2246. Sumbatan ductus lacrimalis 0 0 0 0 0
2247. Tes Bebas Buta Warna 0 0 0 0 0
2248. Struma 0 0 0 0 0
2249. Thypus Abdominalis 0 0 0 0 0
2250. Tumor abdomen 0 0 0 0 0
2251. TBC Milliaris 0 0 0 0 0
2252. Trauma Bulbi 0 0 0 0 0
2253. Tumor Jinak Mamae 0 0 0 0 0
2254. Uveittis 0 0 0 0 0
2255. Observasi febris 0
2256. Urolithiasis
2257. Penyakit Jantung Koroner (PJK) 0 0 0 0 0
2258. Decompensatio cordis 0 0 0 0 0
2259. Rematik Jantung 0 0 0 0 0
2260. Febris convulsi 0 0 0 0 0
2261. Muntah Berak 0 0 0 0 0
2262. Hipoglikemia 0 0 0 0 0
2263. KB Pil 0 0 0 0 0
2264. Fibroma Mammae 0 0 0 0 0
2265. ANC Kehamilan Normal 0 0 0 0 0
2266. Supra Ventrrikel Takikardi 0 0 0 0 0
2267. Bartholini cyste 0 0 0 0 0
2268. Manorrhagica 0 0 0 0 0
2269. Cek Laboratorium 0 0 0 0 0
2270. Polyp Ccervik Uteri 0 0 0 0 0
2271. KB Kondom 0 0 0 0 0
2272. Infeksi kulit bekas caesar 0 0 0 0 0
2273. Infeksi kulit bekas episiotomi 0 0 0 0 0
2274. KB IUD 0 0 0 0 0
2275. KB Pil 0 0 0 0 0
2276. KB Susuk 0 0 0 0 0
2277. KB Kondom 0 0 0 0 0
2278. Sterilisasi pria/wanita 0 0 0 0 0
2279. Tumor 0 0 0 0 0
2280. KB Lainnya 0 0 0 0 0
2281. Kontrol IUD 0 0 0 0 0
2282. Erotio portiones uteri 0 0 0 0 0
2284. BBLR 0 0 0 0 0
2285. Tindik 0 0 0 0 0
2286. Infeksi jar kulit pos immunisasi 0 0 0 0 0
2287. Diabetes elitus 0 0 0 0 0
2289. Dismenorhe 0 0 0 0 0
2290. Bayi Sehat 0 0 0 0 0
2291. Tumor di wajah 0 0 0 0 0
2292. Invaginasi pada bayi 0 0 0 0 0
2294. Veruca vulgaria 0 0 0 0 0
2295. Hemagloma 0 0 0 0 0
2296. Lipoma 0 0 0 0 0
2297. Ganglion 0 0 0 0 0
2298. Pruritus 0 0 0 0 0
2299. Combustio 0 0 0 0 0
22A1. Keterangan sehat/Ktr Dokter 0 0 0 0 0
22A2. Ateruma 0 0 0 0 0
22A3. AMI 0 0 0 0 0
22A4. Anemia 0 0 0 0 0
22A5. Varicocel 0 0 0 0 0
22A6. Tinitus 0 0 0 0 0
22A7. Incontinensia urine 0 0 0 0 0
22A8. Post operasi 0 0 0 0 0
22A9. Gravid 0 0 0 0 0
22B1. Tumor Mata 0 0 0 0 0
22B2. Tumor Mulut 0 0 0 0 0
22B3. Tumor Hidung 0 0 0 0 0
22B4. Tumor Telinga 0 0 0 0 0
22B5. Tumor jaringan Kulit 0 0 0 0 0
22B6. Tumor jinak pada alat kelamin
perempuan 0 0 0 0 0
22B7. Tumor jinak kandung kencing 0 0 0 0 0
22B8. Tumor Usus 0 0 0 0 0
22B9. Tumor jinak pada alat kelamin laki-laki
0 0 0 0 0
22C1. Tumor Rahim 0 0 0 0 0
22C2. Cardiomegali 0 0 0 0 0
22C3. Vomitus 0 0 0 0 0
22C4. Anoreksia 0 0 0 0 0
22C5. Dispepsia
22C6. Kanker Paru 0 0 0 0 0
22C7. Abdomen pain 0 0 0 0 0
22C8. Mastitis 0 0 0 0 0
22C9. Kelainan saraf mata 0 0 0 0 0
22D1. Hipercholesterotemia 0 0 0 0 0
22D2. Malaise (lesu dan lelah) 0 0 0 0 0
22D3. Malnutrisi 0 0 0 0 0
22D4. Megakolon 0 0 0 0 0
22D5. General check up 0 0 0 0 0
22D6. Hipotensi 0 0 0 0 0
22D7. Limfadenitis 0 0 0 0 0
22D8. Gizi kurang 0 0 0 0 0
22D8. Hiperthyroid 0 0 0 0 0
22E1. Hernia Inguinalis 0 0 0 0 0
22E2. Dysphagia 0 0 0 0 0
22E3. Tension headache 0 0 0 0 0
22E4. Sirkumsisi 0 0 0 0 0
22E5. Limpanedopathy 0 0 0 0 0
22E6. Snake Bite 0 0 0 0 0
22E7. Hidrokel 0 0 0 0 0
22E8. Imunisasi Tetanus Toxoid 0 0 0 0 0
22E9. Kontrol setelah dirawat 0 0 0 0 0
22F1. Tumor Kepala 0 0 0 0 0
22F2. Aritmia Cordis 0 0 0 0 0
22F3. Tumor Axilla 0 0 0 0 0
22F4. Erupsi Obat 0 0 0 0 0
22F5. Lekositosis 0 0 0 0 0
22F6. Proteinuria 0 0 0 0 0
22F7. Cat Bite 0 0 0 0 0
22F9. Kanker Bibir 0 0 0 0 0
22G1. Dog Bite 0 0 0 0 0
22G2. Fistula Anus 0 0 0 0 0
22G3. Rat Bite 0 0 0 0 0
22G4. Persiapan Haji 0 0 0 0 0
22G5. Cor Pulmonale Chronic (CPC) 0 0 0 0 0
22G6. Paroxysmal tekkikardi. 0 0 0 0 0
22 NEOPLASMA 0 0 0 0 0
2301. Neoplasma ganas rongga mulut 0 0 0 0 0
23 Neoplasma ganas pada alat pencernaan dan
selaput perut (Peritonum)
0 0 0 0 0
24 NEOPLASMA GANAS ........ 0 0 0 0 0
2401. Neoplasma ganas kerongkongan 0 0 0 0 0
2402. Neoplasma ganas lambung 0 0 0 0 0
2403. Neoplasma ganas usus halus termasuk
usus dua belas jari.
0 0 0 0 0
2404. Neoplasma ganas usus besar 0 0 0 0 0
2405. Neoplasma ganas usus lurus dan
hubungan usus dengan sigmod
0 0 0 0 0
2406. Neoplasma ganas hati primer 0 0 0 0 0
2407. Neoplasma ganas kelenjar ludah perut
0 0 0 0 0
2408. Neoplasma ganas lain padaa alat
pencernaan dan selaput perut (peritonium)
0 0 0 0 0
25 NEOPLASMA GANAS PADA SUSUNAN
PERNAPASAN DAN ALAT RONGGA DADA
0 0 0 0 0
2501. Neoplasma ganas pangkal tenggorok
0 0 0 0 0
2502. Neoplasma ganas batang tenggorok
0 0 0 0 0
2503. Neoplasma ganas cabang tenggorok
dan paru-paru
0 0 0 0 0
2504. Neoplasma ganas lain pada susunan
pernapasan dan alat rongga dada
0 0 0 0 0
26 NEOPLASMA GANAS PADA JARINGAN DAN
PAYUDARA
0 0 0 0 0
2601. Neoplasma ganas tulang rawan 0 0 0 0 0
2602. Neoplasma ganas kulit 0 0 0 0 0
2603. Neoplasma ganas lain pada kulit 0 0 0 0 0
2604. Neoplasma ganas payudara 0 0 0 0 0
2605. Neoplasma ganas lain pada jaringan
dan payudara
0 0 0 0 0
27 NEOPLASMA PADA SALURAN KENCING 0 0 0 0 0
2701. Neoplasma ganas leher rahim 0 0 0 0 0
2702. Neoplasma ganas indung telur dan
ligamentum latum
0 0 0 0 0
2703. Neoplasma ganas prostat 0 0 0 0 0
2704. Neoplasma ganas buah pelir 0 0 0 0 0
2705. Neoplasma ganas kandung kencing 0 0 0 0 0
2706. Neoplasma lain pada alat kencing
kelamin
0 0 0 0 0
28 NEOPLASMA LAINNYA 0 0 0 0 0
2801. Neoplasma ganas otak 0 0 0 0 0
2802. Neoplasma ganas pada tempat tertentu
lain dan jaringan pembuat darah
0 0 0 0 0
30 NEOPLASMA JINAK 0 0 0 0 0
3001. Neoplasma jinak kulit 0 0 0 0 0
3002. Neoplasma jinak payudara 0 0 0 0 0
3003. Neoplasma jinak rahim 0 0 0 0 0
3004. Neoplasma jinak indung telur 0 0 0 0 0
3005. Neoplasma jinak ginjal dan alat kencing
lain
0 0 0 0 0
3006. Neoplasma jinak bagian susunan syaraf
0 0 0 0 0
3006. Neoplasma jinak bagian susunan syaraf
0 0 0 0 0
3007. Neoplasma jinak kelenjar endokrin 0 0 0 0 0
3008. Neoplasma jinak lain. 0 0 0 0 0
31 KARSINOMA 0 0 0 0 0
3101. Karsinoma insitu alat pencernaan 0 0 0 0 0
3102. Karsinoma insitu susunan pernapasan
0 0 0 0 0
3103. Karsinoma insitu kulit 0 0 0 0 0
3104. Karsinoma insitu lain tanpa penjelasan
0 0 0 0 0
3105. Karsinoma Insitu lain tanpa penjelasan
0 0 0 0 0
32 3201. KARSINOMA YANG SIFATNYA TIDAK
DIJELASKAN PADA ALAT PENCERNAAN DAN
PERNAPASAN.
0 0 0 0 0
33 Penyakit endokrin dan metabolik 0 0 0 0 0
3301. Penyakit gondok kekurangan yudium
0 0 0 0 0
3302. Penyakit kelenjar gondok lain 0 0 0 0 0
3303. Penyakit kencing manis 0 0 0 0 0
3304. Gangguan metobolisme lipid 0 0 0 0 0
3305. Tambun bukan karena gangguan
endokrin
0 0 0 0 0
3306. Penyakit endokrin dan penyakit
metabolise
0 0 0 0 0
34 MASALAH GIZI 0 0 0 0 0
3401. Gizi Kurang karena kekurangan protein
0 0 0 0 0
3402. Marasmus Gizi 0 0 0 0 0
3403. Penyakit Kekurangan Protein lain 0 0 0 0 0
3404. Kekurangan Vit.A 0 0 0 0 0
3405. Kekurangan Vit Lain 0 0 0 0 0
3406. Kekurangan gizi lain 0 0 0 0 0
35 PENYAKIT DARAH DAN ALAT PEMBULUH
DARAH
0 0 0 0 0
3501. Anemia 0 0 0 0 0
3502. Penyakit darah dan alat pembuat darah
lain
0 0 0 0 0
36 PENYAKIT JANTUNG 0 0 0 0 0
3501. Demam rematik Akut 0 0 0 0 0
3502. Penyakit jantung iskemik lain 0 0 0 0 0
37 0 0 0 0 0
3701. Demam rematik akut 0 0 0 0 0
3702. Penyakit jantung iskemik lain 0 0 0 0 0
38 0 0 0 0 0
3801. Embolisme paru-paru 0 0 0 0 0
3802. Kelainan irama jantung 0 0 0 0 0
3803. Penyakit lain pada peredaran darah
paru
0 0 0 0 0
3804. Penyakit jantung lain 0 0 0 0 0
39 PENYAKIT CEREBROVASKULER 0 0 0 0 0
3901. Perdarahan subaracnoid 0 0 0 0 0
3902. Perdarahan infracerebral dan
infracranial lain
0 0 0 0 0
3903. Infrak otak 0 0 0 0 0
3904. Penya. Cerebrovaskuler akut yang tidak
jelas keterangan
0 0 0 0 0
3905. Arteriosklerosis otak 0 0 0 0 0
3906. Peny. Cerebrovaskuler lain 0 0 0 0 0
40 PENYAKIT PADA SUSUNAN PEREDARAN
DARAH
0 0 0 0 0
4001. Arteriosklerosis 0 0 0 0 0
4002. Embolisme dan trombosis arteri 0 0 0 0 0
4003. Penyakit lain pada arteri 0 0 0 0 0
4004. Arteri dan Kapiler 0 0 0 0 0
4005. Flebitis, Trombophebitis, Embolimes
0 0 0 0 0
4006. Vena dan thrombosis 0 0 0 0 0
4007. Varises tungkai 0 0 0 0 0
4008. Wasir 0 0 0 0 0
4009. Peny.ian dari susunan peredaran darah
0 0 0 0 0
41 PENY. PADA OESEPAGUS, LAMBUNG DAN
PERUT.
0 0 0 0 0
4101. Penyakit kerongkongan 0 0 0 0 0
4102. Tukak lambung dan usus dua belas jari
0 0 0 0 0
4103. Radang umbai cacing 0 0 0 0 0
4104. Burut rongga perut 0 0 0 0 0
4105. Sumbatan usus tanpa penyebutan
burut.
0 0 0 0 0
4106. Divertikulum usus 0 0 0 0 0
4107. Gangguan faal lain pada alat
pencernaan
0 0 0 0 0
4108. Penyakit menahun dan pengerasan
pada hati.
0 0 0 0 0
4109. Batu empedu dan rahang kandung
empedu
0 0 0 0 0
42 PENYAKIT PADA ALAT KELAMIN PEREMPUAN
0 0 0 0 0
4201. Hipertrophy prostat 0 0 0 0 0
4202. Hidrokel 0 0 0 0 0
4203. Kulup berlebihan dan kulup sempit 0 0 0 0 0
4204. Kemandulan laki-laki 0 0 0 0 0
4205. Penyakit alat kelamin laki-laki lain 0 0 0 0 0
43 PENYAKIT SISTEM ALAT KELAMIN
PEREMPUAN
0 0 0 0 0
4301. Penyakit Payudara 0 0 0 0 0
4302. Radang saluran telur dan indung telur
0 0 0 0 0
4303. Penyakit infeksi sel-sel jaringan panggul
dan peritonium
0 0 0 0 0
4304. Penyakit infeksi rahim, vagina dan vulva
0 0 0 0 0
4305. Tumbung uterovaginal 0 0 0 0 0
4306. Gangguan haid 0 0 0 0 0
4307. Kemandulan perempuan 0 0 0 0 0
4308. Penyakit lain padaa alat perempuan
0 0 0 0 0
44 KEHAMILAN 0 0 0 0 0
4401. Keguguran spontan 0 0 0 0 0
4402. Pengguran atas indikasi sah 0 0 0 0 0
4403. Pengguran atas indiukasi tidak sah 0 0 0 0 0
4404. Bentuk kehamilan lain 0 0 0 0 0
45 4501.PENYAKIT TIDAK LANGSUNG PADA
KASUS OBSTETRIK
0 0 0 0 0
4601. Persalinan normal 0 0 0 0 0
47 KELAIANAN BAWAAN PADA FAKTORKelainan
Bawaan pada faktor Deformitas dan
Chromosomal
0 0 0 0 0
4701. Spina bifida dan busung kepala 0 0 0 0 0
4702. Cacat bentuk bawaan lainnya pada
susunan syaraf pusat
0 0 0 0 0
4703. Kelainan bawaan jantung dan susunan
peredaran darah.
0 0 0 0 0
4704. Langit-langit terbelah dan bibir
sumbang
0 0 0 0 0
0 0 0 0 0
4705. Cacat bentuk bawaan lain pada
susunan pencernaan
0 0 0 0 0
4706. Buah pelir tidak turun 0 0 0 0 0
4707. Pergeseran sendi bawah pangkal paha
0 0 0 0 0
4708. Kelainan bawaan lain dari susunan otot
rangka
0 0 0 0 0
4709. Kelainan bawaan 0 0 0 0 0
48 Tanda dan Gejala Umum 0 0 0 0 0
4801. Demam yang tidak diketahui
penyebabnya
0 0 0 0 0
4802. Gejala-gejala yang berhubungan
dengan jantung
0 0 0 0 0
4803. Kolik Ginjal 0 0 0 0 0
4804. Kencing tertahan 0 0 0 0 0
4805. Nyeri Kencing 0 0 0 0 0
4806. Kelembaban (karena) usia lanjut tanpa
penyebabnya psikosis
0 0 0 0 0
4807. Syndroma kematian mendadak pada
bayi
0 0 0 0 0
4808. Kegagalan pada alat pernapasan 0 0 0 0 0
4809. Penyakit yang kurang jelas batasannya
0 0 0 0 0
4890. Tanda-tanda gejala-gejala lainnya 0 0 0 0 0
49 Fraktur 0 0 0 0 0
4901. Fraktur tulang tengkorak dan muka 0 0 0 0 0
4902. Fraktur tulang leher dan togok 0 0 0 0 0
4903. Fraktur tulang lengan atas, pengupil
dan hasta
0 0 0 0 0
4904. Fraktur tulang leher, tulang paha 0 0 0 0 0
4905. Fraktur bagian lain tulang paha 0 0 0 0 0
4906. Fraktur tulang kering, betis dan mata
kaki
0 0 0 0 0
4907. Fraktur lain pada anggota gerak 0 0 0 0 0
4908. Fraktur tulang tanpa keterangan 0 0 0 0 0
4909. Fraktur Ganda 0 0 0 0 0
50 5001. Pergeseran terkilir pada sendi dan otot
0 0 0 0 0
51 5102. Geser Otak 0 0 0 0 0
5103. Cedera lain pada isi tenggorak 0 0 0 0 0
5104. Cedera pada sumsum syaraf lainnya
0 0 0 0 0
5105. Cedera dalam dada, perut dan panggul
0 0 0 0 0
52 Luka 0 0 0 0 0
5201. Luka terbuka pada mata, telinga dan
kepala
0 0 0 0 0
5202. Luka terbuka pada anggota gerak atas
0 0 0 0 0
5203. Luka terbuka pada anggota gerak
bawah
0 0 0 0 0
5204. Luka terbuka lain dan yang tanpa
keterangan
0 0 0 0 0
5205. Cedera pada pembuluh darah 0 0 0 0 0
53 Luka Bakar 0 0 0 0 0
5401. Luka bakar terbatas pada mata dan alat
pengeringnya
0 0 0 0 0
5402. Luka bakar pada pergelangan tangan
dan tangan
0 0 0 0 0
5403. Luka bakar pada muka kepala dan leher
0 0 0 0 0
5404. Luka bakar pada togok 0 0 0 0 0
5405. Luka bakar pada anggota gerak bawah
0 0 0 0 0
5406. Luka bakar pada organ dalam 0 0 0 0 0
5407. Luka bakar ganda dan yang tanpa
keterangan
0 0 0 0 0
53 0 0 0 0 0
5501. Keracunan oleh obat dan preparatnya
0 0 0 0 0
5502. Akibat tekhnis zat-zat yang ada
dasarnya
0 0 0 0 0
54 0 0 0 0 0
5601. Penyulit-penyulit selama perawatan
medis dan tindakan pembedahan
0 0 0 0 0
55 0 0 0 0 0
5701. Cedera dangkal 0 0 0 0 0
5702. Memar dengan permukaan kulit tetap
utuh
0 0 0 0 0
5703. Cedera bentur 0 0 0 0 0
5704. Penyulit rudapaksa tertentu dan cedera
tanpa keterangan
0 0 0 0 0
56 0 0 0 0 0
5801. Akibat kemudian dari cedera pada
susunan otot rangka dan jaringan ikat
0 0 0 0 0
5802. Akibat kemudian dari cedera pada kulit
dan jaringan bawah kulit
0 0 0 0 0
5803. Akibat kemudian dari cedera pada
susunan syaraf
0 0 0 0 0
5805. Akibat kemudian dari penyebab luar
lain dan tanpa keterangan
0 0 0 0 0
5806. Akibat kemudian dari penyebab luar
lain
0 0 0 0 0
57 0 0 0 0 0
5901. Kecelakaan kereta api 0 0 0 0 0
5902. Kecelakaan kendaraan bermotor dalam
lalu lintas
0 0 0 0 0
5903. Kecelakaan kendaraan jalan kaki 0 0 0 0 0
5904. Kecelakaan angkutan air 0 0 0 0 0
5905. Kecelakaan angkutan udara dan ruang
angkasa
0 0 0 0 0
5906. Kecelakaan kendaraan bermotor di luar
lalu lintas
0 0 0 0 0
5907. Kecelakaan angkutan lain 0 0 0 0 0
58. 0 0 0 0 0
6001.Kecelakaan selama perawatan reaksi
abnormal
0 0 0 0 0
59 0 0 0 0 0
6101. Jatuh karena kecelakaan 0 0 0 0 0
6102. Kecelakaan karena kebakaran api 0 0 0 0 0
6103. Kecelakaan karena faktor alam dan
lingkungan
0 0 0 0 0
6104. Tenggelam karena kecelakaan 0 0 0 0 0
6105. Benda masuk lubang tubuh karena
kecelakaan
0 0 0 0 0
6106. Kecelakaan karena mesin alat
pemotong dan alat pemasuk
0 0 0 0 0
6107. Kecelakaan karena peluru senjata api
0 0 0 0 0
6108. Kecelakaan lain dan tanpa keterangan
0 0 0 0 0
60 0 0 0 0 0
6401. Akibat merugikan dari pemakaian obat
dan preparatnya dalam pengobatan
0 0 0 0 0
61 0 0 0 0 0
6501. Bunuh diri dan cedera diri 0 0 0 0 0
62 0 0 0 0 0
6601. Pembunuhan dan pencederahan
disengaja oleh orang lain
0 0 0 0 0
63 0 0 0 0 0
6701. Cedera tanpa kepastian, apakah karena
kecelakaan atau disengaja
0 0 0 0 0
6702. Cedera akibat tindakan perang 0 0 0 0 0
6703. Campur tangan sah 0 0 0 0 0
64 0 0 0 0 0
6801. Pemeriksaan ibu hamil dan masa nifas
0 0 0 0 0
6802. Perawatan bayi sehat lahir di
Puskesmas
0 0 0 0 0
6803. Perawatan bayi sehat lahir di
perjalanan/sebelum masuk puskesmas
0 0 0 0 0
6804. Perawatan bayi lahir sehat di luar
puskesmas
0 0 0 0 0
6805. Pengkhitanan menurut agama/adat
0 0 0 0 0
6806. Pemasangan gigi 0 0 0 0 0
6807. Kunjungan pada unit pelayanan
kesehatan untuk pemeriksaan khususnya dan
perawatan lainnya
0 0 0 0 0
6808. Kunjungan pada pelayanan kesehatan
untuk sebab psiko sosial
0 0 0 0 0
6809. Pemeriksaan kesehatan untuk berbagai
keperluan
0 0 0 0 0
6810. Pemeriksaan fisik dan keadaan mental
lain
0 0 0 0 0
6811. Pemeriksaan dan penyelidikan terhadap
individu dan penduduk
0 0 0 0 0
6812. Vaksinasi pencegahan dan inokulasi
termasuk
0 0 0 0 0
6813. Perawatan untuk keperluan isolasi 0 0 0 0 0
6814. Pemeriksaan dan konsultasi bayi dan
anak
0 0 0 0 0
6815. Manajemen kontrasepsi termasuk
konsultasi
0 0 0 0 0
6816. Pemeriksaan untuk kontrol selanjutnya
0 0 0 0 0
6817. Keadaan lain tanpa pelaporan diagnosa
0 0 0 0 0
LAPORAN B
PUSKESMAS TENTANG BULAN JANUARI TA
J U M L A H P E N D E R I T A
1bl-<1th 1 - 4 Th 5 - 9 Th 10-14 Th 15-19 Th 20-44 Th
L B L B L B L B L B
4 1 1 0 3
0 1 1 1
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 1 0 2 0 1 0 1 0 1
0 0 0 0 0 0 0 0 0 0
0 0 0 6 4 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 1 1 5 4 2 0 1 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
1 1 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 5
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
BULAN JANUARI TAHUN 2017
N D E R I T A
20-44 Th 45-54 Th 55-59 Th 60-69 Th 70 Th TOTAL
L B L B L B L B L B
1 0 1 2 13
1 0 1 0 0 0 0 4
0 1 0 0 1 0 1 0 0 2
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 3 0 0 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
1 1 1 1 1 0 0 0 0 9
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 10
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
TOTAL
L
0
2
3
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
24
0
0
0
0
0
173
0
0
0
0
0
0
0
0
0
3
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8
0
0
0
0
0
0
0
7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
16
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
77
0
0
0
98
28
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
LAPORAN BULAN
REKAPITULASI SURVEILANS TERPADU PENYAKIT (STP)
PUSKESMAS TENTANG BULAN J
No Elemen Data 0-7 hr 8 - 28 hr < 1 thn 1-4 5-9

L P L P L P L P L
I Total STP:
1 Kolera 0 0 0 0 0 0 0 0 0
2 Diare 0 0 0 0 1 3 0 0 0
3 Diare Berdarah 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis 0 0 0 0 0 0 0 0 0
5 TBC Paru BTA 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis 0 0 0 0 0 0 0 0 0
14 Malaria Klinis 0 0 0 0 0 0 0 0 0
15 Malaria Vivax 0 0 0 0 0 0 0 0 0
16 Malaria Falcifarum 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0
18 Demam Berdarah
Dengue 0 0 0 0 0 0 0 0 0
19 Deman Dengue 0 0 0 0 0 0 0 0 0
20 Pneumonia 0 0 0 0 0 0 1 0 0
21 Sifilis 0 0 0 0 0 0 0 0 0
22 Gonorrhoe 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 0 0 0 0 0 0 0
Mengetahui,
LAPORAN BULANAN
ERPADU PENYAKIT (STP) BARU DI PUSKESMAS DAN JEJARINGNYA
MAS TENTANG BULAN JANUARI TAHUN 2017
5-9 10 - 14 15 - 19 20 - 44 45 - 54 55 - 59 60 - 69 70+ Total

P L P L P L P L P L P L P L P L
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 1 0 1 0 0 1 2 0 0 1 1 0 2 0 7
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 0 0 0 0 0 0 0 3 0 0 0 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang Melapor,
Total
P L+P
0 0
0 0
6 13
0 0
0 0
1 4
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 1
0 0
0 0
0 0
0 0
0 0
ang Melapor,
LAPORAN BULA
REKAPITULASI KEKERASAN TERHADA
PUSKESMAS TENTANG BULAN
No Elemen Data Tentang Golo Bore Pong Narang Golo Ru'a Golo Poleng Golo Keli
L P L P L P L P L P L P
I Kekerasan :
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0
II Jenis Kekerasan :
1 Seksual
0 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0
15 - 18 tahun 0 0 0 0 0 0 0 0 0 0 0 0
19 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0
2 Fisik
0 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0
15 - 18 tahun 0 0 0 0 0 0 0 0 0 0 0 0
19 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0
3 Emosional
0 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0
15 - 18 tahun 0 0 0 0 0 0 0 0 0 0 0 0
19 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0
4 Penelantaran
0 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0
15 - 18 tahun 0 0 0 0 0 0 0 0 0 0 0 0
19 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0
5 Trafiking
0 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0
15 - 18 tahun 0 0 0 0 0 0 0 0 0 0 0 0
19 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0
6 Mental
0 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0
15 - 18 tahun 0 0 0 0 0 0 0 0 0 0 0 0
19 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0
III Tempat Penanganan :
1. Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0
2. R.Sakit 0 0 0 0 0 0 0 0 0 0 0 0
3. Dirujuk 0 0 0 0 0 0 0 0 0 0 0 0
4. Dll 0 0 0 0 0 0 0 0 0 0 0 0
IV Asal Pasien
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader/masyarakat 0 0 0 0 0 0 0 0 0 0 0 0
V Sarana yang dibina
1 Sekolah Luar Biasa (SLB) 0 0 0 0 0 0 0 0 0 0 0 0
2 Lapas/Rutan anak 0 0 0 0 0 0 0 0 0 0 0 0
3 Lapas/Rutan 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
Kasubag Pelaporan
Cat : Kolom jumlah Puskesmas bisa ditambahkan atau dikurangi sesuai kondisi di Kab.
LAPORAN BULANAN
KEKERASAN TERHADAP ANAK DAN PEREMPUAN
S TENTANG BULAN JANUARI TAHUN 2017
Pateng
Lumut Wae Buka Ndoso Momol Waning Tehong Raka Kasong TOTAL
Lesu
L P L P L P L P L P L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI RAWAT INAP DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS TENTANG BULAN JANUARI TAHUN 2017
JANUARI FEBRUARI MARET APRIL MEI JUNI JULI

L P L P L P L P L P L P L
No Elemen Data
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
I Total Pasien Rawat Inap :
1 Bulan ini 4 5
2 Kumulatif s.d. bulan lalu
II Kategori Penduduk :
1 Keluarga miskin 4 5
2 Bukan keluarga miskin
III Kelompok Umur Pasien :
1 0-7 hari 0 0
2 8-28 hari 0 0
3 29 - < 1 tahun 0 0
4 1 4 tahun 0 0
5 5 9 tahun 0 0
6 10 14 tahun 0 0
7 15 19 tahun 1 0
8 20 44 tahun 1 5
9 45 54 tahun 2
8 55 59 tahun
9 60 69 tahun
10 > 70 tahun
IV Diagnosa Penyakit sesuai kode ICD
10 :
Dilaporkan melalui lamp.ICD10

sesuai kasus yg ada saja
V Jenis Pelayanan : 4 5
1 Persalinan 0 5
2 Tindak medis yang bukan akibat 0 0
3 kecelakaan
Kecelakaan 0 0
4 Dll 4 0
V Asal Pasien :
1 Datang sendiri 4 5
2 Rujukan - -
3 Kiriman kader
VI Rujukan :
Jumlah pasien yang dirujuk
VII Kondisi Pasien Keluar :
1 Sembuh 4 5
2 Cacat 0 0 0
3 Pulang paksa 0 0 0
4 Meninggal 48 Jam 0 0 0 -
5 Meninggal > 48 Jam 0 0 0
VIII Jumlah Pasien Keluar :
1 Bulan ini 4 5
2 Kumulatif s.d. bulan ini
VIX Jumlah Hari Perawatan :
1 Bulan ini 12 12
X Pembayaran : 4 4
1 Jamkesmas 0 0 0
2 Jamkesda 0 0 0
Asuransi /BPJS 4 5
Gratis 0 0 0
Tunai 0 0 0
Dll 0 0 0
XII Diagnosa Akhir (sesuai) Kode ICD 15 ** Dilaporkan dalam Format 15 Besar Penyakit Terbanyak (Format terlampir)
Mengetahui Yang melap

Kepala Puskesmas Tentang
Jakobus Nentu Frans Edison

NIP 19740908 199903 1 005 NIP 1986012
LAPORAN BULANAN
REKAPITULASI 15 BESAR PENYAKIT TERBANYAK DI PUSKEMAS RAWAT INAP
PUSKESMAS TENTANG BULAN JANAURI TAHUN 2017
Total Penderita
No Jenis Penyakit
L P L+P
1. Post prtm 5 5
2. GEA 1 1
3. Colik Abdomen 1 1
4. ISK 1 1
5. Disfagia 1 1
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Cat : ** Jenis Diagnosa sama dengan yang ada pada daftar Diagnosa LB1 (Poli Umum), namun yang dikirim ke
Kab/Kota adalah 15 Patron Penyakit Terbesar di Rawat Inap
AGUSTUS SPTEMBER OKTOBER NOVEMBER DESEMBER
P L P L P L P L P P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru
1 2 5 4 - -
g melapor
s Edison
19860129201001009
DESEMBER TOTAL
P L P
(Baru+La (Baru+La L+P
Lama ma) ma)
LAPORA
REKAPITULAS
PUSKESMAS TENTANG B
Tentang Golo Bore P.Narang Golo Ru'a G.Poleng Golo Keli Lumut
No Elemen Data
I Total Kunjungan Poli Gizi : 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0
II Pelayanan : - - - - - - - - - - - - -
1 Konseling 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Bumil 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Menyusui 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Baduta 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Balita 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diet 0 0 0 0 0 0 0 0 0 0 0 0 0
a. DM 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Hipertensi 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Ginjal 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Jantung 0 0 0 0 0 0 0 0 0 0 0 0 0
e. TBC 0 0 0 0 0 0 0 0 0 0 0 0 0
f. HIV/AIDS 0 0 0 0 0 0 0 0 0 0 0 0 0
g. Dll 0 0 0 0 0 0 0 0 0 0 0 0 0
III Asal Pasien : - - - - - - - - - - - - -
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Yang melapor

Kasubag Pelaporan Pengelola SIK Kabupaten
LAPORAN BULANAN
REKAPITULASI KONSULTASi GIZI
SKESMAS TENTANG BULAN JANUARI TAHUN 2017
Lumut Wae Buka Ndoso Momol Waning P.Lesu Tehong Raka Kasong TOATAL
P L P L P L P L P L P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- - - - - - - - - - - 0 - - - - - 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- - - - - - - - - - - 0 - - - - - 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
elola SIK Kabupaten

TOATAL
P L+P
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
LAPORAN BULANAN
REKAPITULASI POLI UMUM DI PUSKESMAS DAN JEJARINGNYA
Tentang Golo Bore Pong Narang Golo Ru'a Golo Poleng Golo Keli
No Elemen Data L P L P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
I Total Kunjungan Poli Umum :
1 Bulan ini 58 83 2 - 25 36 5 6 12 38 3 3 35 44 4 3 41 54 6 9 30 55 9 4
2 Kumulatif s.d. Bulan lalu
II Kelompok Umur Pengunjung Poli 58 83 2 - 25 36 5 6 12 38 3 4 35 44 4 3 41- 54- 6- 9- 30 55 9 4
Umum :
1 0-7 hari - -
2 8-28 hari - - -
3 29 - < 1 tahun 2 6 1 - - 2 1
4 1 < 5 tahun 4 2 - - - 1 1 2 - 1 2 1
5 5 9 tahun 6 4 - - - 1 1 1 2 3 2 2 1 1
6 10 14 tahun 6 6 2 2 2 3 3 2 - 1 1 2 2 1
7 15 19 tahun 7 5 1 6 2 1 1 1 6 5 4 2 1 5 6 1 1 3 12 2 2
8 20 44 tahun 14 30 1 - 10 23 4 3 7 16 3 2 12 24 1 1 21 27 2 4 20 33 4 2
9 45 54 tahun 12 21 4 5 2 1 8 1 9 6 1 1 10 14 1 2 2 3 2
10 55 59 tahun 6 14 3 1 1 1 2 1 2 3 2 1 1
11 60 69 tahun 2 1 2 1 1 2 1 2
12 > 70 tahun 1 - 1 -
III Kategori Penduduk : 53 78 2 - 25 36 5 6 12 38 3 4 35 44 4 3 41- 54- 6- 9- 30 55 9 4
1 Keluarga miskin 48 67 - - 20 26 5 6 6 28 3 4 23 33 4 3 27 30 6 9 30 46 9 4
2 Bukan keluarga miskin 5 11 2 - 5 10 6 10 12 11 14 24 - - 9 - -
IV Diagnosa Penyakit sesuai kode - - - -

ICD 10 :
Dilaporkan melalui lamp.ICD10
sesuai kasus yg ada saja
V Jenis Pelayanan : 128 137 - - 39 64 5 6 12 63 3 4 65 70 4 3 66 74 6 9 42 89 9 4

1 Konsultasi
2 Obat 53 78 2 - 25 36 5 6 12 38 3 4 35 44 4 3 41 54 6 9 30 55 9 4
3 Laboratorium
4 Rontgen
5 Tindak medis
6 Promkes
7 Preventif
8 Konseling - -
9 Pengukuran Tekanan darah 25 50 - - 14 28 - - - 25 - - 30 26 25 20 - - 12 34
10 Pemeriksaan Obesitas - - - - 65 70 - 42 -
11 Lainnya
VI Asal Pasien : 53 78 2 - 25 36 5 6 12 38 - - 35 44 - - 41 54 6 9 30 55 - -
1 Datang sendiri 53 78 2 - 25 36 5 6 12 38 - - 35 44 - - 41 54 6 9 30 55 - -
2 Rujukan
3 Kiriman kader
VII Rujukan : - - - - - - - - - - - - - - - - - - - - - - - -
1 Puskesmas
2 Rumah sakit
3 Faskes lainnya
VIII Pemberi Layanan : 53 78 2 - 25 36 5 6 12 38 - - 35 44 - - 41 54 6 9 30 55 - -
1 Dokter 53 78 2 - 25 36 5 6 12 38 - - 35 44 - - 41 54 6 9 30 55 - -
2 Nakes lain
3 Perawat Gigi -
4 Perawat - - - - - -
5 Bidan
Catatan :
1. Tambahan Elemen data ini adalah hasil masukan dari Kab/Kota saat dilakukan Bimtek SIKDA bulan April s/d Mei 2014
2. Tambahan elemen data dimasukkan dalam lembaran tambahan agar tidak merubah file aslinya, sehingga saat entri data (copy paste) tidak sulit
3. Jika ada elemen yang ingin ditambahkan, harap ditambahkan pada lembaran tambahan ini, agar tidak mengganggu file aslinya.
4. Untuk semua kelompok umur pembagiannya mengalami perubahan karena menyesuaikan dari Kementerian Kesehatan
Cat : ** Jenis Diagnosa sama dengan yang ada pada daftar Diagnosa LB1 (Poli Umum), namun yang dikirim ke Kab/Kota dan Provinsi adalah 15 Patron Penyakit Terbesar di yang ada di Poli Umum
Kolom jumlah Puskesmas bisa ditambahkan atau dikurangi sesuai kondisi di Kab.
Mengetahui Yang mel
LAPORAN BULANAN
REKAPITULASI 15 BESAR PENYAKIT TERBANYAK RAWAT JALAN DI PUSKESMAS
PUSKESMASTENTANG BULAN JANUARI TAHUN.2017
Total Penderita
No Nama Penyakit
L P L+P
1. ISPA 52 102 154
2. Myalgia 38 89 127
3. Reumatic Artritis (RA) 36 63 99
4. Gastritis 18 35 53
5. Tekanan Darah Tinggi (Hipertensi) 17 30 47
6. Penyakit Kulit Alergi 12 31 43
7. Penyakit Kulit Infeksi 21 20 41
8. Cephalgia 8 16 24
9. Caries Gigi 7 10 17
10. Infeksi Penyakit Usus Lainnya (IPL) 5 10 15
11. Diare 9 6 15
12. Observasi Febris 9 3 12
13. Disentri 5 6 11
14. Asma Bronchiale 4 6 10
15. Ginggivitis dan Periodontitis 3 6 9
Cat : ** Jenis Diagnosa sama dengan yang ada pada daftar Diagnosa LB1 (Poli Umum), namun yang dikirim ke
Kab/Kota adalah 15 Patron Penyakit Terbesar di Rawat Inap
Kasubag Pelaporan Pengelola SIK Kabupaten
Lumut Wae Buka Ndoso Momol Waning Pateng Lesu Tehong
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru
16 45 - - 16 18 36 55 - - 32 42 - - 35 47 - 1 20 27 1 1 15
16 45 - - 16 18 - - 36 55 - - 32- 42- -- -- 37 47 - 1 20 27 1 1 15
- 1 1 - 2
2 1 1 - 2 1 - 1 3 1 2 -
1 1 1 1 1 2 2 2 2 4 1 1 -
3 1 1 2 1 3 2 1 2 3 2 2
8 6 4 2 5 6 5 6 4 10 2 5 3
2 28 7 9 15 28 11 22 17 15 1 10 10 1 5
1 5 - 1 2 8 14 10 7 9 10 2 4 1 4
1 1 - 1 1 2 3 - 3 3 1 1 2 1
1 2 1 1 2 1
- - -
16 45 - - 16 18 - - 36 55 - - 32- 42- -- -- 35 47 - 1 20 37 1 1 15
16 30 10 12 30 30 30 32 30 40 1 20 37 1 1 10
- 15 6 6 6 25 2 10 5 7 5
- - - -
18 60 - - 26 26 - - 48 69 - - 48 59 - - 60 68 - 1 30 41 1 1 24
16 45 - - 16 18 36 55 - - 32 42 - - 35 47 - 1 20 27 1 1 15
2 15 10 8 12 14 16 17 23 22 21 10 14 9
16 45 - - 16 18 36 55 - - 32 42 - - 35 47 - 1 20 27 1 1 15
16 45 - - 16 18 36 55 - - 32 42 - - 35 47 - 1 20 27 1 1 15
- - - - - - - - - - - - - - - - - - - - - - - - -
16 45 - - 16 18 36 55 - - 32 42 - - 35 47 - 1 20 27 1 1 15
- 5 - - - - - - - - - - - - - - - - - - - - -
17 1 1 -
6 25 6 10 15
10 15 16 18 30 45 32 42 20 30 1 20 27 15
Yang melapor
Tehong Raka Kasong Total Total
L P L P L P L P L P
(Baru+La (Baru+La
ma) ma) L+P
Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
0 0 0 0 0 0 0
25 - - 15 20 - - 17 15 - 1,064 102 134 1 1066 236 1067 1303
0 0 0 0 0 0 0
25 - - 15 20 - - 17- 25- -- -- 405- 614- 30 28 1019 58 1077
1 2 6 0 0 8 0 8
1 1 1 3 8 #VALUE! 0 11 #VALUE! #VALUE!
3 1 1 1 7 9 0 0 16 0 16
2 2 1 1 3 12 21 0 0 33 0 33
16 7 2 8 5 47 48 0 2 95 2 97
1 6 10 4 8 25 33 1 0 58 1 59
1 4 2 6 7 14 0 0 21 0 21
1 1 1 1 5 0 0 6 0 6
0 0 0 0 0 0 0
25 - - 15 25 - - 17- 25- -- -- -
102 -
159 1 2 261 3 264
15 15 25 17 25 92 142 1 2 234 3 237
10 10 17 0 0 27 0 27
- - - - - -
0 0 0 0 0 0 0
35 - - 24 35 - - 29 28 - 102 167 207 1 104 374 105 479

0 0 0 0 0 0 0
25 - - 15 25 - - 17 15 - 102 139 1 2 241 3 244
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
10 - 7 10 12 13
0 0 0 0 0 0 0
25 - - 15 20 - - 17 15 - 102 102 134 1 104 236 105 341

25 - - 15 20 - - 17 15 - - 102 134 1 2 236 3 239
0 0 0 0 0 0 0
0 0 0 0 0 0 0
- - - - - - - - - - - 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
25 - - 15 20 - - 17 15 102 102 134 1 104 236 105 341

- - - - - - - - - 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 17 1 1 17 2 19
- - - - - 15 0 0 0 15 0 15
25 15 25 17 25 87 132 0 1 219 1 220
LAPORAN BULANAN
REKAPITULASI KUNJUNGAN HARIAN DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS TENTANG BULAN JNUARI TAHUN 2017
Tentang Golo Bore Pong Narang Golo Ru'a Golo Poleng Golo Keli Lumut
No Elemen Data Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru
L P L P L P L P L P L P L P L P L P L P L P L P L
I Total Pengunjung R. 60 93 3 - 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16
Jalan Puskesmas :
II Total Kunjungan R. 4 4
Inap Puskesmas :
III Total Kunjungan
Pustu
IV Total Kunjungan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas Keliling
IV Kelompok Umur : 60 93 3 - 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16
1 - -
0-7 hari
2 - - 0
8-28 hari
3 29 - < 1 tahun 2 6 1 0 - 2 1
4 1 4 tahun 5 12 0 - - 2 1 2 2
1 1 - 1
5 5 9 tahun 6 4 - 0 - 1 1 3 2 1 1
1 2 2 1
6 10 14 tahun 6 6 0 2 2 2 2 1 2
3 3 - 1 2 1
7 15 19 tahun 7 5 1 0 6 2 1 1 1 4 7 3 8
6 5 2 1 5 1 1 12 2 2
8 20 44 tahun 15 25 1 0 10 33 4 10 7 34 35 20 2
25 3 6 12 1 5 21 2 4 43 4 8
9 45 54 tahun 10 20 0 4 5 2 1 10 16 2 1
8 1 9 1 1 10 1 2 5 2
8 55 59 tahun 6 14 0 3 1 1 3 1
1 1 2 2 2 1 2
9 60 69 tahun 2 1 0 2 2 1
1 1 1 2
10 > 70 tahun 1 - 0
1 -
LAPORAN BULANAN
-
II Kategori Penduduk : 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16
1 Keluarga miskin 82 1 20 20 36 5 13 6
55 37 3 8 23 49 4 7 27 42 6 9 30 50 9 10 16
2 Bukan keluarga 5 11 2 20 5 10 6 10 12 11 14 24 - - 18 - - -
miskin
III Asal Pasien : 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16

1 Datang sendiri 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16
2 Rujukan
3 Kiriman kader
VI Domisili : 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16
1 Dalam wilayah 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16
2 Luar wilayah
VII Jenis Pelayanan : 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16

1 Poli umum 58 87 2 - 25 36 5 6 12 38 3 8 35 44 4 7 41 54 6 9 30 55 9 10 16
2 KIA - ibu 20 10 7
9 10 3 5
3 KIA - anak
4 KB 6
6 9 8
5 Poli gigi 2
6 Unit gawat darurat 1
LAPORAN BULANAN
7 Unit rawat inap
8 MTBS/MTBM - -
9 Lain-lain
VIII Cara Pembayaran :

60 93 3 20 25 46 5 13 6 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16
1 Jamkesmas
2 Jamkesda
3 Asuransi Kes./BPJS 82 1 20 20 36 5 13 6
55 37 3 8 23 49 4 7 27 42 6 9 30 50 9 10 16
4 5 11 2 - 5 10 6 10 12 11 14 24 - - 18 - - -
Tunai
5 Gratis
6 Dll
Catatan :
Lumut Wae Buka Ndoso Momol Waning Pateng Lesu Tehong Raka
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru
P L P L P L P L P L P L P L P L P L P L P L P L P L P L
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
53 0 0 19 31 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
0 0
0 0 0 0 0 0
0 0 - 0 0 1 0 0 1 0 0 - 2 0
1 0 0 1 - 0 0 1 0 0 0 0 1 3 0 1 - 1
2 - 2
1 0 0 1 1 0 0 2 0 0 2 0 0 2 4 0 1 - 1
1 2 1
3 0 0 1 1 0 0 1 0 0 2 0 0 1 2 0 3 2 3
2 3 2
7 0 0 4 2 0 0 7 0 0 7 0 0 4 12 0 2 3 5
5 5 4 2
34 0 0 10 19 0 0 35 0 0 32 0 0 17 25 0 6 10 1 5 24
15 11 21 7
6 0 0 1 5 0 0 21 0 0 10 0 0 9 15 0 2 1 4 2
8 10 6 6
1 0 0 1 1 0 0 3 0 0 3 0 0 3 1 0 1 1 1
2 - 4
0 0 2 0 0 0 0 0 0 2 0
1 1 1
0 0 - 0 0 0 0 0 0 0
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
10 41 30
30 46 30 40 27 42 6 20 30 10 20 15
23 9 18 6 25 2 17 10 24 11 1 1 5 17
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
45 - - 16 18 35 47 - 1 20 27 1 1 15
36 55 - - 32 42 - - 25 - - 15
5 21 10 10
6 5 5
3 10 5 10
10 5 5
3 5 4 4
- 5
5 1
2
53 - - 19 59 - - 36 71 - - 32 57 - - 37 66 - 6 20 41 1 1 15 37 - - 15
10 41 30
30 46 30 40 27 42 6 20 30 10 20 15
23 9 18 6 25 2 17 10 24 11 1 1 5 17
Raka Kasong Total
Total : L+P
Baru Lama Baru Lama Baru Lama Total
P L P L P L P L P L P L P
31 - - 23 42 -
- #REF! 1,253 #REF!
416 837 #REF!
0 0 0 0 0 0 0
31 - - 23 42 - - #REF! #REF! #REF! #REF! #REF! #REF! #REF!
#REF! #REF! #REF! #REF! #REF! #REF! #REF!

1 1 #REF! #REF! #REF! #REF!
#REF! #REF! #REF!
1 #REF! #REF! #REF!
1 #REF! #REF! #REF!
8 #REF! #REF! #REF!
10 #REF! #REF! #REF!
2 #REF! #REF! #REF!
1 #REF! #REF! #REF!
Raka Kasong Total
Total : L+P
#REF! #REF! #REF!
31 - - 23 42 - - #REF! #REF! #REF! #REF! #REF!
31 23 42 #REF! #REF! - #REF! #REF!

#REF! #REF!
#REF! #REF! #REF! #REF!
#REF!
#REF! #REF! #REF!
31 - - 23 42 - #REF! #REF! #REF! #REF! #REF!
31 - - 23 42 - #REF! #REF! #REF! #REF!
#REF! #REF! #REF!
#REF! #REF! #REF!
31 - - 23 42 - #REF! #REF! #REF! #REF!
#REF! #REF! #REF!
#REF! #REF! #REF!
20 - - 17 15 936 #REF! #REF! #REF! #REF! #REF! #REF! #REF!

11 #REF! #REF! #REF! #REF! #REF! #REF! #REF!
1 12 #REF! #REF! #REF! #REF! #REF! #REF! #REF!
Raka Kasong Total
Total : L+P

- #REF! #REF! #REF! #REF! #REF! #REF! #REF!
#REF! #REF! #REF!
#REF! #REF! #REF! #REF! #REF!
31 - - 23 42 - -
31 23 42
LAPORAN BULANAN
REKAPITULASI INDUK DI PUSKESMAS DA
PUSKESMAS TENTANG BULAN JANUAR
Tentang Golo Bore Pong Narang Golo Ru'a

No Elemen Data
L P L P L P L P L P L P L P L
I Total Pengunjung
Baru :
1 Bulan ini 60 93 3 - 25 46 5 13 12 47 3 8 35 60 4
2 Kumulatif s.d. bulan
lalu
II Umur : 60 93 3 - 25 46 5 13 12 47 3 8 35 60 4
1 - -
0-7 hari
2 - - -
8-28 hari
3 29 - < 1 tahun 2 6 1 - - 2
4 1 4 tahun 5 12 - - - 2
1 1
5 5 9 tahun 6 4 - - - 1 1 3
1 2
6 10 14 tahun 6 6 2 2 2 2
3 3
7 15 19 tahun 7 5 1 6 2 1 1 1 4
6 5 2
8 20 44 tahun 15 25 1 - 10 33 4 10 7 34
25 3 6 12 1
9 45 54 tahun 10 20 4 5 2 1 10
8 1 9 1
10 55 59 tahun 6 14 3 1 1
1 1 2
11 60 69 tahun 2 1 2 2
1 1
12 > 70 tahun 1 - 1
- -
III Domisili : 60 93 3 - 25 46 5 13 12 47 3 8 35 60 4
1 Dalam wilayah 60 93 3 - 25 46 5 13 12 47 3 8 35 60 4
2 Luar wilayah
IV Kategori Penduduk :
60 93 3 - 25 46 5 13 12 47 3 8 35 60 4
1 Keluarga miskin 82 1 - 20 36 5 13 6
55 37 3 8 23 49 4
2 Bukan keluarga miskin 5 11 2 - 5 10 6 10 12 11
V Cara Pembayaran :
60 93 3 - 25 46 5 13 6 47 3 8 35 60 4
1 Jamkesmas
2 Jamkesda
3 Asuransi Kes./BPJS 82 1 - 20 36 5 13 6
55 37 3 8 23 49 4
4 Tunai 5 11 2 - 5 10 6 10 12 11
5 Gratis
6 Dll
Mengetahui
Jakobus Nentu
NIP 19740908 199903 1 005
AN
S DAN JEJARINGNYA
UARI TAHUN 2017
Golo Poleng Golo Keli Lumut Wae Buka Ndoso

P L P L P L P L P L P L P L P L P L P
7 41 66 6 9 30 68 9 10 16 53 - - 19 59 - - 36 71
7 41 66 6 9 30 68 9 10 16 53 - - 19 31 - - 36 71
1 - 1
1 2 2 1 1 - 1
- 1 2
2 1 1 1 1 1 2
2 1 1
1 2 3 1 1 1
- 1 2 1 2
7 3 8 7 4 2 7
1 5 1 1 12 2 2 5
35 20 2 34 10 19 35
5 21 2 4 43 4 8 15
16 2 1 6 - 1 5 21
1 10 1 2 5 2 8
3 1 1 - 1 1 3
2 2 1 2 2
1 2
1 2 1
- - - -
7 41 66 6 9 30 68 9 10 16 53 - - 19 59 - - 36 71
7 41 66 6 9 30 68 9 10 16 53 - - 19 59 - - 36 71
7 41 66 6 9 30 68 9 10 16 53 - - 19 59 - - 36 71
10 41 30
7 27 42 6 9 30 50 9 10 16 30 46
14 24 - - 18 - - - 23 9 18 6 25
7 41 66 6 9 30 68 9 10 16 53 - - 19 59 - - 36 71
10 41 30
7 27 42 6 9 30 50 9 10 16 30 46
14 24 - - 18 - - - 23 9 18 6 25
Yang melapor
Ke
Frans Edison
NIP 19860129201001009
NIP
Momol Waning Pateng Lesu Tehong
L P L P L P L P L P L P L P L P
- - 32 57 - - 37 66 - 6 20 41 1 1 15 37
- - 32 57 - - 37 66 - 6 20 41 1 1 15 37
1 - 2
1 3 1 - 1
- 2
2 2 4 1 - 1
2 1
2 1 2 3 2 3
3 2
7 4 12 2 3 5
5 4
32 17 25 6 10 1 5 24
11 21
10 9 15 2 1 4 2
10 6
3 3 1 1 1 1
- 4
2
1 1
- - 32 57 - - 37 66 - 6 20 41 1 1 15 37
- - 32 57 - - 37 66 - 6 20 41 1 1 15 37
- - 32 57 - - 37 66 - 6 20 41 1 1 15 37
30 40 27 42 6 20 30 10 20
2 17 10 24 11 1 1 5 17
- - 32 57 - - 37 66 - 6 20 41 1 1 15 37
30 40 27 42 6 20 30 10 20
2 17 10 24 11 1 1 5 17
Mengetahui
Jakobus Nentu
NIP 19740908 199903 1 005
Raka Kasong Total
Total
L P L P L P L P L P L P L P
- - -
- - 15 31 - - 23 42 -
31 54 416 837 1,253
- - -
- - 15 31 - - 23 42 - -
416 837 1,253
8 13 21
1 1
20 32 52
1 1
1 28 32 60
1 3
2 1 61 84 145
5 6
7 8 170 396 566
17 23
6 10 87 169 256
5 7
2 24 48 72
1 1
1 8 15 23
2 0 2
- - 0
- - 15 31 - - 23 42 - -
416 837 1,253
- - 15 31 - - 23 42 -
416 837 1,253
- - -
1,197
- - 15 31 - - 23 42 - - 416 837 1,253
15 31 23 42 348 618 966
68 219 287
-
- - 15 31 - - 23 42 - 416 837 1,253
- - -
- - -
15 31 23 42 348 618 966
68 219 287
Yang melapor
Frans Edison
NIP 19860129201001009
LAPORAN BULANAN
REKAPITULASI POLI GIGI DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli lumut W.Buka Ndoso Momol Waning P.Lesu Tehong
No Elemen Data B B B B B B B
L P L P L P L P L P L P L P L P L P L P L P L P L P
I Total Kunjungan Poli Gigi : 5 5 2 2 1 2 0 0 0 0 0 0 1 0 0 0 1 1 3 3 2 1 2 2 0 0
1 Bulan ini 5 5 2 2 1 2 0 0 0 0 0 0 1 0 0 0 1 1 3 3 2 1 2 2 0 0
2 Kumulatif s.d. Bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Kelompok Umur :
1 5 tahun 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 5 9 tahun 2 2 1 1 1 1 0 0 0 0 0 0 1 0 0 0 1 0 1 2 1 0 0 2 0 0
3 10 14 tahun 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 2 1 1 1 1 0 0 0
4 15 19 tahun 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
5 20 44 tahun 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0
6 45 54 tahun 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0
7 55 59 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 60 69 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 > 70 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Kelompok Sasaran :

1 Bumil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Balita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Anak SD/MI 3 3 1 1 1 2 0 0 0 0 0 0 1 0 0 0 1 1 2 2 1 1 1 1 0 0
4 Lain-lain 2 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0
IV Asal Pasien :
1 Datang sendiri 5 5 2 2 1 2 0 0 0 0 0 0 1 0 0 0 1 1 3 3 2 1 2 2 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Diagnosa :
1 Karies 2 2 2 2 1 1 2 1 0 0 1 2 0 0 0 0 1 2 1 2 1 0 0 0 0 0
2 Penyakit Gusi 1 1 2 1 1 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 0 0 0 0
3 Penyakit Pulpa 1 1 1 1 1 1 0 2 1 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0
4 Lain - lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tindakan :
701 Konsultasi Dokter Gigi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
702 Konsultasi Dokter Gigi Diluar Jam Dinas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
703 Tumpatan sementara 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
704 Tumpatan tetap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
705 Pembersihan karang gigi 3 2 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
706 Insisi abses 1 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
707 Pencabutan gigi sulung 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
708 Pencabutan gigi permanen 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
709 Uperculektomy 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Rujukan :
1 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
ASI POLI GIGI DI PUSKESMAS DAN JEJARINGNYA
AS TENTANG BULAN JANUARI TAHUN 2017
Raka Kasong TOATAL

B
L P L+P
L P L P
0 0 0 0 16 15 31
0 0 0 0 16 15 31
0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 8 8 16
0 0 0 0 5 4 9
0 0 0 0 1 1 2
0 0 0 0 1 2 3
0 0 0 0 2 0 2
0 0 0 0 0 1 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 11 11 22
0 0 0 0 6 4 10
0 0 0 0 16 15 31
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 11 12 23
0 0 0 0 8 7 15
0 0 0 0 7 6 13
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 7 4 11
0 0 0 0 3 1 4
0 0 0 0 2 1 3
0 0 0 0 4 3 7
0 0 0 0 - - -
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KEGIATAN UKGS DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli lumut W.Buka Ndoso Momol Waning
No. ELEMEN DATA
L P L P L P L P L P L P L P L P L P L P L P
I Total Kunjungan UKGS : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Jumlah SD seluruhnya 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
Jumlah SD/MI yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah murid SD seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah SD/MI yang diperiksa : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Murid Kelas I seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu perawatan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kelas II seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kelas III seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Kelas IV seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Kelas V seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Kelas VI seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Jumlah SMP seluruhnya : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah SMP yang diperiksa : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah murid SMP seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah murid SMP yang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

diperiksa :
1 Kelas I seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kelas II seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kelas III seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Jumlah SMU/SMK/SEDERAJAT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
seluruhnya :
Jumlah SMU/SMK/SEDERAJAT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DIPERIKSA :
No. ELEMEN DATA
Jumlah murid SMU/SMK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
seluruhnya
Jumlah murid SMU/SMK yang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
diperiksa :
Kelas I seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas II seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas III seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirawat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Diagnosa :
1 Karies 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Penyakit gusi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Penyakit pulpa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Penyakit Periodontal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Tindakan/Perawatan :
1 Tumpatan sementara 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tumpatan tetap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Pencabutan gigi sulung 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Pencabutan gigi permanen 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VII Sikat Gigi Massal :
1 Sekolah yang melakukan keg. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sikat Gigi Massal
No. ELEMEN DATA
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VIII Penyuluhan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang mendapat penyuluhan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
YA
P.Lesu Momol Waning P.LESU TEHONG RAKA KASONG TOTAL

L P L P L P L P L P L+P
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KEGIATAN UKS DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli lumut W.Buka Ndoso Momol Waning P.Lesu Tehong Raka
No. ELEMEN DATA
L P L P L P L P L P L P L P L P L P L P L P L P L P L
I Total Kunjungan UKS :
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Jumlah SD/MI seluruhnya
Jumlah SD/MI yang diperiksa
a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah murid SD/MI
seluruhnya dari sekolah yang
diperiksa
b 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Murid SD/MI yang
diperiksa :
c 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kelas II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kelas III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
4 Kelas IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Kelas V 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Kelas VI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk
III Jumlah SMP seluruhnya :
Jumlah SMP yang diperiksa :
a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b Jumlah murid SMP
diperiksa:
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c Jumlah murid SMP yang
diperiksa :
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Jumlah
SMA/SMK/SEDERAJAT
seluruhnya :
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a Jumlah
SMA/SMK/SEDERAJAT
DIPERIKSA :
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b Jumlah murid SMA/SMK
diperiksa
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c Jlh murid yang diperiksa : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas 1 : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelas III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang perlu mendapat
perawatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Status Gizi : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gizi buruk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
Gizi kurang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gizi baik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gizi lebih 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Gizi berlebih (obesitas) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Identifikasi Murid : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Yang mendapat konseling
Kes. remaja
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Yang mendapat yodium 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Yang mendapat Obat Cacing
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Yang ditimbang BB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Yang Merokok 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Pengguna NAPZA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Yang mendapat Penyuluhan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Imunisasi campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Imunisasi DT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Imunisasi Td 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Jumlah sekolah yang
diperiksa Kes.Lingk.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sekolah yang memenuhi
syarat kesehatan
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VIII Murid Dirujuk : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Jumlah SD yang ada di wilayah Puskesmas. LT

No. ELEMEN DATA
Jumlah murid binaan UKS di wilayah Puskesmas kelas 1 sd VI (Laki-laki)
Jumlah murid binaan UKS di wilayah Puskesmas kelas 1 sd VI (Perempuan)
Jumlah siswa kelas I dengan kegiatan penjaringan kesehatan (Laki-laki).
Jumlah siswa kelas I dengan kegiatan penjaringan kesehatan (Perempuan)
Jumlah STLP yang ada di wilayah Puskesmas.
Jumlah SLTP kelas I dengan kegiatan Penjaringan kesehatan.
Jumlah STLA yang ada di wilayah Puskesmas.
Jumlah SLTA kelas I dengan kegiatan penjaringan kesehatan.
Jumlah Sekolah yang diperiksa sarana kesehatan lingkungan ( Sarana Air -
Bersih, pembuangan Sampah, Jamban dan Saluran Air Limbah ).
Jumlah Sekolah yang memenuhi syarat kesehatan Lingkungan ( Tempat -
Sampah, Jamban, Air Bersih dan Saluran Air Limbah ).
Jumlah kunjungan pembinaan UKS ke Sekolah.
Jumlah Murid yang mendapat pemeriksaan kesehatan Laki-laki
Jumlah Murid yang mendapat pemeriksaan kesehatan Perempuan
Jumlah Murid yang Perlu perawatan kesehatan Laki-laki
Jumlah Murid yang Perlu perawatan kesehatan Perempuan
Jumlah Murid yang dirujuk ke sarana kesehatan Laki-laki
Jumlah Murid yang dirujuk ke sarana kesehatan Perempuan
Jumlah Murid yang memperoleh konseling Kesehtan Remaja
Jumlah murid yang mendapat Yodium
Jumlah murid yang mendapat obat cacing
Jumlah murid yang ditimbang Berat Badan dan Tinggi Badan Laki-laki
Jumlah murid yang ditimbang Berat Badan dan Tinggi Badan Perempuan
LAPORAN BULANAN
ITULASI KEGIATAN UKS DI PUSKESMAS DAN JEJARINGNYA
USKESMAS TENTANG BULAN JANUARI TAHUN 2017
Raka Kasong Total

P L P L P L+P
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Raka Kasong Total
P L P L P L+P
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
- - -
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Raka Kasong Total
P L P L P L+P
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Raka Kasong Total
P L P L P L+P
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Yang Melapor,
LAPORAN BULANAN
REKAPITULASI LABORATORIUM DI PUSKESMAS DAN JEJARINGNYA
Jumlah
No Elemen Data
L P
I Total Kunjungan Laboratorium : 17 53
1 Bulan ini 17 53
2 Kumulatif s.d. bulan lalu 0
II Peminta Tes Laboratorium :
1 Poli umum 17 29
2 KIA 0 21
3 Rawat inap 0 3
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0

801 Golongan darah 0 21
802 Hb 0 24
803 Leukosit 0 0
804 Eritrosit 0 0
805 Thrombosit 0 0
806 Laju Endap Darah (LED) 0 0
807 Hitung jenis 0 0
808 Waktu perdarahan dan waktu pembekuan 0 0
809 Gula darah sewaktu 10 10
810 Gula darah puasa 0 0
811 Gula darah 2 jam PP 0 0
812 Urid Acid 12 23
813 SGOT 0 0
814 SGPT 0 0
815 HBSAg 0 0
816 Malaria (Jika positip isi jenis plasmodiumnya) 0 21
817 Widal 0 0
818 Sputum BTA 0 0
819 Test Kehamilan 0 5
820 Tinja 0 0
821 Urine Lengkap 0 0
822 Urine Sedimen 0 0
LAPORAN BULANAN
REKAPITULASI HASIL PENIMBANGAN
PUSKESMAS TENTANG BULAN JANUAR
Tentang Golo Bore Pong Narang Golo Rua Golo Poleng Golo Keli
No Elemen Data
L P L P L P L P L P L
I Jumlah Posyandu :
a. Ada 5 - 2 - 2 - 3 - 2 -
b. Lapor 5 - 2 - 2 - 3 - 2 -
II Jumlah Kader :
a. Ada - 25 10 10 15 10
b. Aktif - 25 10 10 15 10
3 Balita yang ada (S) :

0 - 5 bulan 21 25 9 9 10 10 13 14 5 4 6
6 - 11 bulan 24 26 13 14 8 10 8 10 4 7 11
12 - 23 bulan 20 22 12 18 12 11 14 16 6 7 8
24 -59 bulan 40 53 17 21 14 14 35 37 13 15 11
4 Jlh Balita Terdaftar & Punya
KMS/buku KIA (K) :
0 - 5 bulan 21 25 9 9 10 10 13 14 5 4 6
6 - 11 bulan 24 26 13 14 8 10 8 10 4 7 11
12 - 23 bulan 20 22 12 18 12 11 14 16 6 7 8
24 -59 bulan 40 53 17 21 14 14 35 37 13 15 11
3 Jlh Balita yang Ditimbang (D) :
0 - 5 bulan 18 20 9 8 8 10 10 12 5 4 6
6 - 11 bulan 21 24 10 14 8 7 8 10 4 5 9
12 - 23 bulan 17 17 12 14 10 9 10 13 5 6 8
24 -59 bulan 36 49 14 17 10 12 30 30 10 10 10
II Hasil penimbangan :
1 Balita yang BB Naik (N) :
0 - 5 bulan 16 18 7 6 7 9 10 11 4 3 6
6 - 11 bulan 20 24 10 11 8 7 8 8 4 5 9
12 - 23 bulan 15 13 12 10 8 7 10 10 5 4 8
24 -59 bulan 30 46 11 13 8 9 27 25 7 6 7
2 Balita yang tidak naik (T) :
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 1 2 0 3 2 0 0 1 0 2 0
24 -59 bulan 4 1 1 1 1 1 2 2 0 2 2
3 Balita yang tidak naik 2 kali berturut-turut (2T):
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 0 0 1 0 0 0 0 0 0 0
24 -59 bulan 2 1 0 0 0 0 1 0 0 0 0
4 Balita Bawah Garis Merah (BGM) :
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 0 0 0 0 0 0 0 0 0 0
24 -59 bulan 1 1 0 0 0 0 1 0 0 0 0
5
Balita ditimbang bulan ini tidak
hadir bulan lalu (O) :
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 3 0 0 0 2 0 0 0
12 - 23 bulan 0 0 0 1 0 2 0 2 0 0 0
24 -59 bulan 1 1 2 3 1 2 1 3 3 2 1
6 Balita yang baru hadir bulan ini
(B) :
0 - 5 bulan 3 2 1 1 1 0 0 1 0 1 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 0 0 0 0 0 0 0 0 0 0
24 -59 bulan 0 0 0 0 0 0 0 0 0 0 0
III Status Gizi (Konfirmasi BGM &

a. 2 T /yang
Status Gizidiberdasarkan
identifikasi berat
bermasalah)
badan menurut tinggi badan :
1 Kurus/Gizi kurang (BB/TB)
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 1 0 0 0 0 0 0 0 0 0
12 - 23 bulan 1 0 0 1 1 0 1 0 0 0 0
24 -59 bulan 2 1 1 1 1 1 1 1 1 1 1
2 Sangat Kurus/Gizi buruk : (BB/TB)
a. Baru :
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 0 0 0 0 0 0 1 0 1 0
24 -59 bulan 0 1 0 0 0 0 0 0 0 0 0
b. Kumulatif sampai bulan ini :
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 1 0 0 0 0 0 1 0 0 0
24 -59 bulan 0 0 0 0 0 0 0 0 0 0 0
3 Gizi Lebih (B+)
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 0 0 0 0 0 0 0 0 0 0
24 -59 bulan 0 0 0 0 0 0 0 0 0 0 0
4 Gizi Baik (B)

0 - 5 bulan 18 20 9 8 8 10 10 12 5 4 6
6 - 11 bulan 21 23 10 14 8 7 8 10 4 5 9
12 - 23 bulan 16 17 12 13 9 9 9 12 5 6 8
24 -59 bulan 34 47 13 16 9 11 29 29 9 9 9
b. Status Gizi berdasarkan

indikator Tinggi Badan
menurut Umur(TB/U) :
1 Pendek (TB/U) 0 0 0 0 0 0 0 0 0 0 0
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 0 0 0 0 0 0 0 0 0 0
24 -59 bulan 0 0 0 0 0 0 0 0 0 0 0
2 Sangat Pendek (TB/U) 0 0 0 0 0 0 0 0 0 0 0
0 - 5 bulan 0 0 0 0 0 0 0 0 0 0 0
6 - 11 bulan 0 0 0 0 0 0 0 0 0 0 0
12 - 23 bulan 0 0 0 0 0 0 0 0 0 0 0
24 -59 bulan 0 0 0 0 0 0 0 0 0 0 0
3 Normal 89 107 44 51 34 37 56 63 23 24 32
4 Tinggi 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
IV
Penanganan Gizi Kurang dan
Gizi Buruk
1 Gizi Kurang yang ditangani 0 0 0 0 0 0 0 0 0 0 0
a. Konseling/Penyuluhan saja 2 1 1 2 2 1 2 1 1 1 1
b. Diberi PMT Pemulihan 1 1 0 0 0 0 0 0 0 0 0
2 Gizi Buruk yang mendapat
perawatan 0 0 0 0 0 0 0 0 0 0 0
Baru : 0 0 0 0 0 0 0 0 0 0 0
a. Rawat Inap 0 0 0 0 0 0 0 0 0 0 0
b. Rawat Jalan 0 0 0 0 0 0 0 0 0 0 0
Lama : 0 0 0 0 0 0 0 0 0 0 0
a. Rawat Inap 0 0 0 0 0 0 0 0 0 0 0
b. Rawat Jalan 0 1 0 0 0 0 0 1 0 0 0
3 Kasus Gizi Buruk Yang Meninggal 0 0 0 0 0 0 0 0 0 0 0

Bulan ini : 0 0 0 0 0 0 0 0 0 0 0
Kumulatif s/d bulan lalu 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
V Pemberian ASI Eksklusif (0-6)
1 Eksklusif () 2 2 2 2 1 1 0 2 1 1 1
2 Tidak Eksklusi (X) 0 0 0 0 0 0 0 0 0 0 0
3 Tidak hadir (A) 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
PORAN BULANAN
ASIL PENIMBANGAN BAYI BALITA
NG BULAN JANUARI TAHUN 2017
Golo Keli Lumut Wae Buka Ndoso Momol Waning Pateng Lesu Tehong Raka Kasong
P L P L P L P L P L P L P L P L P L P
3 - 3 - 3 - 5 - 2 - 2 - 2 - 3 - 3 - 3
3 - 3 - 3 - 5 - 2 - 2 - 2 - 3 - 3 - 3
15 15 15 25 10 10 10 15 15 15
15 15 15 25 10 10 10 15 15 15
6 10 8 4 5 9 8 5 4 4 4 3 7 6 6 6 6 6 6
12 9 8 6 5 10 14 4 6 5 5 1 0 5 4 8 9 7 6
8 20 21 8 8 13 16 11 5 10 12 4 6 6 7 12 11 13 12
14 62 57 13 25 24 29 31 18 35 28 13 16 25 25 18 19 15 15
6 10 8 4 5 9 8 5 4 4 4 3 7 6 6 6 6 6 6
12 9 8 6 5 10 14 4 6 5 5 1 0 5 4 8 9 7 6
8 20 21 8 8 13 16 11 5 10 12 4 6 6 7 12 11 13 12
14 62 57 13 25 24 29 31 18 35 28 13 16 25 25 18 19 15 15
6 8 8 4 5 9 8 5 4 4 4 3 7 6 5 6 6 6 6
10 7 8 5 5 7 10 4 5 5 5 1 0 5 4 6 8 7 5
6 15 17 7 6 11 10 9 5 7 10 3 6 6 5 10 10 10 9
10 57 54 10 17 21 27 27 13 30 25 10 12 20 19 14 16 12 13
5 5 8 4 5 8 7 5 4 4 4 2 6 6 5 6 6 6 6
8 7 8 9 5 7 10 4 5 5 5 1 0 5 4 6 8 7 5
6 10 13 5 4 10 8 7 5 6 7 3 3 6 5 9 8 9 6
6 50 48 7 13 17 22 23 10 25 21 8 10 17 14 10 14 9 10
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 3 1 2 0 0 2 2 0 1 1 0 1 0 0 1 2 0 1
1 4 3 1 1 1 2 1 1 2 1 1 0 1 2 2 1 2 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
1 2 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 3 0 2 1 0 0 0 0 2 0 2 0 0 0 0 1 2
3 4 2 2 3 3 3 3 2 3 3 1 2 2 3 2 1 1 2
0 0 2 0 1 0 1 1 1 0 0 1 0 0 1 1 1 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 0 0 0 1 0 1 0 1 1 1 1 0 0 0 1 2
1 2 2 1 1 1 3 1 1 2 2 2 1 2 1 1 1 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 8 8 4 5 9 8 5 4 4 4 3 7 6 5 6 6 6 6
10 7 8 5 5 7 10 4 5 5 5 1 0 5 4 6 8 7 5
6 13 16 7 6 11 9 9 4 7 9 2 5 5 5 10 10 9 7
9 55 52 9 16 20 24 26 12 28 23 8 11 18 18 13 15 12 12
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 83 84 25 32 41 51 44 25 44 41 14 23 34 32 35 39 34 30
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 3 3 1 1 1 4 1 2 2 3 3 2 3 1 1 1 1 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 3 0 0 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total
L P L+P
- 43
- 43
215
215
117 122 239

123 136 259
169 180 349
366 386 752
117 122 239

123 136 259
169 180 349
366 386 752
107 113 220

107 120 227
140 143 283
311 272 583
96 103 199
107 113 220
123 109 232
256 267 523
0 0 0
0 0 0
12 16 28
24 21 45
0 0 0
0 0 0
1 2 3
5 4 9
0 0 0
0 0 0
0 0 0
2 1 3
0 0 0
0 7 7
4 16 20
30 35 65
15 7 22
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1
8 8 16
19 19 38
0 0 0
0 0 0
1 1 2
0 1 1
0 0 0
0 0 0
1 2 3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
107 113 220

107 119 226
132 134 266
292 304 596
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
632 670 1302
0 0 0
0 0 0
0 0 0
26 27 53
1 1 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2 2 4
0 0 0
0 0 0
0 0 0
0 0 0
12 10 22
0 0 0
0 0 0
LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS TENTANG BULAN MEI TAHUN 2017
No Elemen Data
L P L P L P L P L P L P L P L P L P L P L P L P L P L P
A Ibu Bersalin
I Total Persalinan :
Bulan ini 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
Kumulatif s/d bulan lalu
II Asal Pasien Bulin :

1 Datang sendiri 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
2 Rujukan
3 Kiriman kader/dukun - - - -
III Bulin mendapat :

1 Fe 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
IV Deteksi Resiko Bulin :

1. Nakes 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
2. Mayarakat 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0
2 Puskesmas Memadai 0
3 Puskesmas Poned 0
4 RSUD Ponek 1 0 1 0 1 1 0 1 0 0 0 1 0 0
5 RSUD Non Ponek 0
6 RS SWASTA 0
7 RSIA/RSB 0
Fasilitas Keseh. Lainnya
8 (sebutkan)
VI Tempat Persalinan :
1 Non Faskes 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Faskes :
Puskesmas RI
Puskesmas Memadai
Puskesmas Poned 9 2 1 2 3 0 2 0 0 0 0 0 0 3
RSUD Ponek 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0
RSUD Non Ponek
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0
RSIA/RSB
(sebutkan)
VII Penolong Persalinan :

1 Bidan 9 2 1 2 3 0 0 2 0 0 0 0 0 0 3
2 Dokter 0 0 1 0 1 1 0 1 0 0 0 0 0 0
3 Nakes lainnya
4 Dukun 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
5 Keluarga/Lainnya
VIII Cara Persalinan :

1 Normal/spontan 9 2 2 2 3 0 0 2 0 0 0 0 0 0 3
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Sectio Caesaria 0 0 1 0 1 1 0 1 0 0 0 0 0 0
IX Kondisi Bulin
1 Sehat 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0
X Sebab Kematian Bulin : 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Ketuban Pecah DiniPersalinan
(KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Perdarahan Paska
2 (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Ibu NifasResti Bufas yang

Deteksi
I ditemukan dan ditangani : 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Nakes 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 (sebutkan)
III Bufas Komplikasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Perdarahan Paska: Persalinan
1 (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Kondisi Bufas/Nifas
1 Sehat 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bufas usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bufas Usia 35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Kunjungan Bufas :
1 KF1 9 2 2 3 2 4 1 2 1 0 0 0 0 1 0 3
2 KF2 9 2 2 3 2 3 1 2 0 0 0 0 0 1 0 3
3 KF3 5 2 2 1 1 5 1 3 2 1 0 0 3 1 1 1
NEONATAL
I Inisiasi Menyusui Dini (IMD) 9 2 1 2 2 0 2 0 0 0 0 0 0 0 3
II Lahir Kembar : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kondisi Neonatal Paska
III Persalinan
1 Lahir Hidup 9 2 2 2 4 1 2 1 0 0 0 0 1 0 3
2 Lahir mati 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Sebab Kematian Neonatus

(Dilaporkan pada Surveilan
Kematian)
1 Asfiksia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Sepsis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Trauma Lahir 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan) 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Berat Badan Lahir :
1 BBL < 2500 gram 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 BBL > 2500 gram 9 2 3 2 4 1 2 1 0 0 0 0 1 0 3
VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Trauma lahir 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Kunjungan Neonatus :

1 KN1 9 2 2 2 4 1 2 0 0 0 0 0 1 0 3
2 KN2 9 2 2 2 4 1 2 0 0 0 0 0 1 0 3
3 KN3 5 2 2 1 1 5 1 3 2 1 0 0 3 1 1 1
Kasong Pusk. Pusk. Total
L P L P L P L P L+P
2 30
2 30
- 0
2 30
2 30
2 30
2 30
1 0 7 0
0 1
1 23
1 5
0
0 0 0 1
1 23
1 5
0 1
1 0 0 24
0 0
1 5
2 30
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 30
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2 30
2 28
3 30
1 22 0
0 0 0 0 0 0 0 0 0
2 29
0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
2 30
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
2 28
2 28
3 30
LAPORAN BULANAN
REKAPITULASI BUMIL DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli lumut W.Buka Ndoso
B L B L B L B L B L B L B L B L B L
I Total Kunjungan ANC :
1 Seluruh kunjungan bulan ini 5 28 1 14 5 9 2 8 8 8 3 13 4 14 1 8 3 14
II K1 seluruhnya :
1 K1 Murni 5 0 5 0 5 0 2 0 6 0 3 0 3 0 1 0 3 0
2 K1 Akses 5 6 1 5 5 3 2 2 8 0 3 5 4 4 1 5 3 7
3 Kumulatif K1 s.d. bulan lalu
III K4 seluruhnya :
1 Kumulatif K4 s.d. Bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 K4 bulan ini 2 3 0 1 0 2 0 2 0 1 3 2 8 4 2 2 2 2
IV Ibu Hamil dengan faktor resiko :

1 Umur < 20 tahun 1 0 0 0 0 0 0 0 - 0 0 0 0 0 0 0 0 0
2 Umur > 35 tahun 1 0 0 0 1 0 1 0 1 0 0 0 2 0 - 0 0 0
3 Paritas > 4 1 0 1 0 3 0 0 0 2 0 0 0 2 0 0 0 0 0
4 Jarak kehamilan < 2 thn 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TB < 145 cm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 BB Trimester III < 45 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Pelayanan :
1 Buku KIA 5 28 1 14 5 9 2 8 8 8 3 13 4 14 1 8 3 14
2 Fe3 (90 tablet) 5 28 1 14 5 9 2 8 8 8 3 13 4 14 1 8 3 14
VI TT ibu hamil :
1 TT1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 TT2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 TT3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 TT4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TT5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Hasil Pemeriksaan Laboratorium :

1 Hepatitis (yang positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 HIV (yang positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 IMS (yang positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Malaria (yang positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB (yang positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VIII
Komplikasi Ibu hamil yang ditangani :
1 Pendarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Pre-eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0
4 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Hb < 11 gr % 4 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
6 LiLA < 23,5 Cm/ KEK : 0 6 0 1 4 1 1 2 2 4 1 4 1 0 0 0 0 6
7 Kelainan letak janin 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0
8 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 HDK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Penyakit penyerta(sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IX Kondisi Ibu Hamil
1 Sehat 5 28 1 14 5 9 2 8 8 8 3 13 4 14 1 8 3 14
2 Dirujuk : 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0
- Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Meninggal : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kematian bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia 35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kematian s/d bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Usia 35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Sebab Kematian 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pendarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pre-eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Penyakit penyerta (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Momol Waning P.Lesu Tehong Raka Kasong Total
B L B L B L B L B L B L B L
3 6 1 12 3 7 1 8 2 12 0 12 42 137
2 0 0 0 3 0 1 0 1 0 0 0 35 0 19
3 1 1 5 3 0 1 7 2 1 0 2 42 53
0 0 0 0 0 0 0 0 0 0 0 0 0
1 1 1 1 1 0 2 2 2 2 1 2 25 27
0 0 0 0 - 0 0 0 1 0 0 2
2 0 0 0 0 0 0 0 0 0 0 8
1 0 0 0 0 0 0 0 0 0 10
0 0 0 0 0 0 0 0 0 0 0 2
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
3 6 1 12 3 7 1 8 2 12 0 12 42 137
3 6 1 12 3 7 1 8 2 12 0 12 42 137
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 5 0 0 0 0 0 0 0 0 8 6
1 0 0 0 0 0 0 0 0 0 0 0 10 24
0 0 0 0 0 0 0 0 0 0 0 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 - 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 6 1 12 3 7 1 8 2 12 0 12 42 137
0 16 0 21 0 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI BAYI BALITA DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data
I Total Kunjungan Bayi/Balita ke
Puskesmas :
0 - 7 hr 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 - 28 hr 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 - <1 thn 10 3 1 1 2 - 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 - < 5 thn 26 19 4 1 1 1 4 4 - - 1 - 1 1 2 1 1 - 2 - 4 8
II Kategori Penduduk :
1 Keluarga miskin 36 23 5 2 3 1 8 5 - - 1 - 1 1 2 1 1 - 2 - 4 8
2 Bukan keluarga miskin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Pelayanan Bayi dan Balita
1 Vit.A Biru (6-11 bulan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Vit A Merah (12-59 bulan) 22 24 19 20 17 18 22 28 17 18 15 16 41 40 22 35 32 31 34 21 51 41
3 MTBM (0 < 2 bln) -
4 MTBS (2 bln - 5 thn) 36 23 5 2 3 1 8 5 - - 1 - 1 1 2 1 1 - 2 - 4 8
IV Diagnosa Penyakit
Dilaporkan melalui lamp.ICD10 sesuai
kasus yg ada saja
V Kondisi Bayi
a Sehat 36 23 5 2 3 1 8 5 - - 1 - 1 1 2 1 1 - 2 - 4 8
b Tidak Sehat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Rujuk
Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Faskes lainnya 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Penyebab Kematian : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI BAYI BALITA DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data
a. Bayi : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Pneumoni 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Diare 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Kelainan Saluran Pencernaan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Tetanus Neonatorum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Dll 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
b. Balita : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Pneumoni 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Diare 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Malaria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Dll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Dilakukan Deteksi Tumbuh Kembang : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Ya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Tidak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VIII Asal Pasien:
1 Datang sendiri 36 23 5 2 3 1 8 5 - - 1 - 1 1 2 1 1 - 2 - 4 8
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
ASI BAYI BALITA DI PUSKESMAS DAN JEJARINGNYA
P.Lesu Tehong Raka kasong

L P L P L P L
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
- - - - - - 1
- - - - - - 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
16 16 45 40 20 28 23
- - - - - - 1
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0
LAPORAN BULANAN
ASI BAYI BALITA DI PUSKESMAS DAN JEJARINGNYA
P.Lesu Tehong Raka kasong

L P L P L P L
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KB DI PUSKESMAS DAN JEJARINGNYA
No. ELEMEN DATA
I Total Kunjungan KB : 0 3 0 2 0 0 0 2 0 1 0 0 0 2 0 0 0 0 0 0 0 0
1 Bulan ini 0 3 2 0 0 2 1 0 0 2 0 0 0 0 0 0 0 0
2 Kumulatif s.d. Bulan lalu 0
II Peserta KB : 0 18 3 2 7 0 0 4 0 0 0 3
1 Baru 0 0 0 0 0 0 0 0 0 0 0 0
1 Pil 0 1 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Suntik 0 2 0 0 0 0 1 1 0 0 0 2 0 0 0 0 0 0 0
5 Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 MOP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Lain-lain (sebutkan) 0
2 Aktif : (KB Baru dan Lama) 0 400 0 219 0 170 0 194 0 166 0 133 0 11 0 4 0 232 0 89 0 263
1 Pil 0 158 0 109 74 73 107 15 0 2 2 162 11 83
2 IUD 0 36 13 0 7 2 6 0 0 0 12 37
3 Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Suntik 0 183 89 96 102 36 86 9 2 56 16 108
5 Implant 0 23 8 0 12 21 26 0 0 14 50 35
6 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Peserta KB Pasca Bersalin : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Pil 0 1 0 2 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Suntik 0 2 0 0 0 0 0 1 0 0 0 0 0 2 0 0 0 0 0 0 0 0
5 Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
6 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Kondisi Peserta KB : 0
1 Ada komplikasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lainnya sebutkan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kontrasepsi gagal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pil 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Ada efek samping 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
No. ELEMEN DATA
4 Drop-out 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - 0 0
IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2
Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - 0 0 0
MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Di rujuk : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Fasilitas Keseh. Lainnya (sebut 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Kontrasepsi diterima : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Pil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VII Penggunaan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Pil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
6 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Obat Vagina 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Sisa/Stok Kontrasepsi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Implant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Obat Vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
KB DI PUSKESMAS DAN JEJARINGNYA
NTANG BULAN JANUARI TAHUN 2017
P.Lesu Tehong Raka Kasong total Total

0 0 0 0 0 0 0 10 10
0 0 0 0 0 0 0 0 0 10 10
0 0 0
1 0 0 0 0 34 34
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 4 4
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 6 6
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0
0 78 0 23 0 97 0 948 2171
21 15 52 24 0 905 905
5 0 2 6 0 126 126
0 0 0 0 0 0 0 0 0 0 0
40 8 35 62 0 922 922
12 0 12 5 0 218 218
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 4 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 5 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 - -
0 0 0 0 0 0 0 0 0 2
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 - -
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KEGIATAN USILA DI PUSKESMAS D
PUSKESMAS TENTANG BULAN JANUARI T
Tentang G.Bore p.Narang G.Rua

No Elemen Data L P L P L P L
Lam Lam Lam Lam Lam Lam
Baru a Baru a Baru a Baru a Baru a Baru a Baru
I Total Kunjungan Usila : 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bulan ini
45-59 th 4 0 10 0 8 0 9 0 5 0 5 0 1
60 - 69 th 4 0 6 0 4 0 2 0 2 0 5 0 2
> 70 th 2 0 3 0 3 0 2 0 2 0 4 0
- Kumulatif s.d. bulan lalu
45-59 th 4 0 10 0 8 0 9 0 5 0 5 0 1
60 - 69 th 4 0 6 0 4 0 2 0 2 0 5 0 2
> 70 th 2 0 3 0 3 0 2 0 2 0 4 0 0
II Posyandu Usila :
- Jumlah : 0 0 0 0 0 0 0 0 0 0 0 0 0
- Yang melapor : 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
III Pelayanan :
Obat
45-59 th 4 10 8 9 5 5 1
60-69 4 6 4 2 2 5 2
> 70 th 2 3 3 2 2 4
Rujuk
45-59 th 0 0 0 0 0 0 0 0 0 0 0 0 0
Konseling 0 0 0 0 0 0 0 0 0 0 0 0 0
> 70 th 0 0 0 0 0 0 0 0 0 0 0 0 0
Konseling 0 0 0 0 0 0 0 0 0 0 0 0 0
45-59 th 0 0 0 0 0 0 0 0 0 0 0 0 0
Konseling 0 0 0 0 0 0 0 0 0 0 0 0 0
> 70 th 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
IV Lansia dengan kelainan : 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Kemandirian A 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kemandirian B 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kemandirian C 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Berat Badan (IMT) Normal 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Berat Badan (IMT) Lebih 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Berat Badan (IMT) Kurus 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Tekanan darah tinggi 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Tekanan darah rendah 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Mental Emosional 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Kencing manis 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Gagal ginjal 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
V Pelayanan : 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Obat 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujuk 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Konseling 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Penyuluhan : 0 0 0 0 0 0 0 0 0 0 0 0 0
- Mandiri 0 0 0 0 0 0 0 0 0 0 0 0 0
- Kelompok 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
ORAN BULANAN
SILA DI PUSKESMAS DAN JEJARINGNYA
G BULAN JANUARI TAHUN 2017
G.Rua G.Poleng G.Keli Lumut W.Buka

L P L P L P L P L P
Lam Baru Lam Baru Lam Baru Lam Baru Lam Baru Lam Baru Lam Baru Lam Baru Lam Baru Lam
a a a a a a a a a a
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 0 3 0 0 0 3 0 5 0 4 0 3 0 3 0 2 0
0 1 0 3 4 0 0 2 0 2 0 1 0 2 0 0 0 0 0
0 1 0 2 2 0 0 1 0 1 0 0 0 1 0 0 0 0 0
0 2 0 3 0 0 0 3 0 5 0 4 0 3 0 3 0 2 0
0 1 0 3 4 0 0 2 0 2 0 1 0 2 0 0 0 0 0
0 1 0 2 2 0 0 1 0 1 0 0 0 1 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 3 3 5 4 3 3 2
1 3 4 2 2 1 2
1 2 2 1 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ndoso Momol Waning p.Lesu Tehong
L P L P L P L P L
La
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru ma Baru Lama Baru
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 3 0 4 0 4 0 4 0 3 0 3 2 0 4
2 0 0 0 0 0 0 0 2 0 2 0 0 0 0 0 0
0 0 0 0 0 0 0 0 2 0 2 0 0 0 0 0 0
2 0 3 4 4 0 4 3 3 2 4
2 0 0 0 0 0 0 0 2 2
0 0 0 0 0 0 0 0 2 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 3 4 4 4 3 3 2 4
2 2 2
2 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tehong Raka kasong Total Total
L P L P L P L P L P
Lam Bar Lama Baru Lam Baru Lam Baru Lam Bar Lam Bar Lam Baru Lama (Baru+La (Baru+La L+P
a u a a a u a u a ma) ma)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
0 0 0 0 0 0 -
0 2 6 7 2 2
0 0 1 2
0 0 1 2
2 6 7 2 2
1 2
1 2
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
2 6 7 2 2
1 2
1 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KEMATIAN DI PUSKESMAS DAN JEJARINGNYA
Tentang G
G.Bore P.Narang G.Rua G.Poleng G.Keli Lumut w.Buka Ndoso momol Waning P.Lesu Tehong Raka Kasong To
No. ELEMEN DATA
L P L L P L P L P L P L P L P L P L P L P L P L P L P L P L P L
I Total Kematian : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan ini : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kumulatif s.d. bulan ini : 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
Kumulatif s.d. bulan lalu 0 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 -
II Kematian Menurut Kel : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 - 28 hr 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
29 hr - < 1 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 - 54 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 - 59 tahun 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
60 - 69 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
> 70 tahun 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
Kematian Bumil (Kel. umur &

Sebab kematian ada pada
rekapitulasi ibu hamil) 0 ###
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Kematian Ibu Bersalin(Kel.

umur & Sebab kematian ada
pada rekapitulasi bulin & nifas) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kematian Ibu Nifas (Kel. umur &

Sebab kematian ada pada
rekapitulasi ibu hamil) : 0 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
b. Sebab Kematian (Umum) : 1 0 ### 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 -
Malaria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diare 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TB. Paru 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DBD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sakit akut/mendadak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Sakit lama/kronis 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 -
Tentang G
G.Bore P.Narang G.Rua G.Poleng G.Keli Lumut w.Buka Ndoso momol Waning P.Lesu Tehong Raka Kasong To
No. ELEMEN DATA
L P L L P L P L P L P L P L P L P L P L P L P L P L P L P L P L
Kecelakaan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Asma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Stroke 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Lumpuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Kanker Hati 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Hipertensi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Hepatitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Ca Usus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Kanker Mamae 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Tumor 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Ca Kolon 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Suspek Hidrosefalus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll sebutkan 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Autopsi Verbal (AV ) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Dilakukan AV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tidak dilakukan AV 1 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 1 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 1
VII Asal Pasien : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Laporan Kepolisian/TNI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Masyarakat 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jakobus Nentu Frans Edison

NIP 19740908 199903 1 005 NIP 19860129201001009
Total
P L+P
1 2
- -
1
1 1
- -
1 1
- -
1 1
Total
P L+P
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1 2
1 2
LAPORAN BULANAN
REKAPITULASI MALARIA DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli Luwut W.Buka Waning Ndoso P.Lesu Tehong Momol Raka Kasong Total
No Elemen Data
L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L+P
I Total Penderita Malaria :
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Asal Pasien :
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Ibu Hamil :
1 Disekrening 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Positip 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Diagnosa :
1 Malaria Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Mikroskopis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 RDT/Dips 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Penderita Positip :
1 0-7 hari 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 8-28 hari 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 29 - < 1 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 1 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 5 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 10 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 15 19 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 20 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 45 54 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 55 59 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 60 69 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 > 70 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Jenis Plasmodium
1 Plasmodium falcifarum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Plasmodium vivax 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Plasmodium Malariae 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Plasmodium ovale 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Plasmodium mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VIII Keadaan Pasien :

1 Komplikasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Non komplikasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VIII Pengobatan :
1 ACT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Non ACT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IX Keadaan Pasien :
1 Sembuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
X Bumil Diberi Kelambu:

1 Diberi kelambu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif Diberi kelambu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Yang Melapor

Jakobus Nentu Anggur Petrus

NIP: 19740908 199903 1 005 NIP:19621231 199903 1 026
LAPORAN BULANAN
REKAPITULASI DIARE DI PUSKESMAS DAN JEJARINGNYA
Tentang Golo Bore Pong Narang Golo Ru'a Golo Poleng Golo Keli Lumut Wae Buka Ndoso Momol Waning Pateng Lesu
No Elemen Data
L P L P L P L P L P L P L P L P L P L P L P L P
I Total Penderita Diare :
1 Bulan ini 1 1 0 0 0 0 0 0 1 0 0 0 - 1 1 1 1 0 - 1 0 1 1 0
< 1 tahun 0 - 0 0 0 0 0 0 0 0 0 0 ### ### 2 2 1 0 1 0 0 1 1 0
1 4 tahun 1 - 0 0 0 0 0 0 0 0 0 0 ### ### 1 1 - 0 4 0 0 0 0
> 5 tahun 0 1 0 0 0 0 0 0 0 0 0 0 2 1 1 1 1 0 - - 0 - 0 0
2 Kumulatif s.d. Bulan lalu 1 1 0 0 0 0 0 0 0 0 0 0 ### ### 0 0 3 0 4 - 0 2 0 0
II Asal Pasien :
1 Datang sendiri 1 1 0 0 0 0 0 0 1 0 0 0 - 1 1 1 1 0 - 1 0 1 1 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Jenis Diare :

1 Diare akut 1 1 0 0 0 0 0 0 1 0 0 0 2 1 1 1 2 0 1 - 0 1 1 0
2 Diare persisten 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare berdarah/lendir 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Status Dehidrasi :
1 Tanpa dehidrasi 1 1 0 0 0 0 0 0 1 0 0 0 - 1 1 1 1 0 - 1 0 1 1 0
2 Dehidrasi ringan/sedang - 1 - - - - - - - 2 1 - 2 2 1 - 1 - -
3 Dehidrasi berat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Pengobatan :
1 Antibiotika 1 1 0 0 0 0 0 0 1 0 0 0 - 1 1 1 1 0 - 1 0 1 1 0
2 Anti diare 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0
3 Oralit 1 1 0 0 0 0 0 0 1 0 0 0 - 1 1 1 1 0 - 1 0 1 1 0
4 Infus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0
5 Zink 1 1 0 0 0 0 0 0 1 0 0 0 - 1 1 1 1 0 - 1 0 1 1 0
VI Pemeriksaan Laboratorium :
1 Kolera positif 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Kondisi Pasien :

a. Rujuk : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Penderita Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 < 1 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 1 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 > 5 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LEMBARAN /ELEMEN DATA TAMBAHAN
Desa.......... Desa.......... Desa.......... Desa.......... Desa.......... Desa.......... Desa.......... Desa.......... Desa.......... Desa.......... Desa.......... Desa..........
No Elemen Data
I Kelompok umur penderita daire
0-7 hari
8-28 hari
29 - < 1 tahun
III Pengobatan Diare :

Anti diare :
1. Spasmolitik
2. Adsorben
3. Adstringensia
IV Penderita Meninggal
0-7 hari
8-28 hari
29 - < 1 tahun
> 1 - 4 tahun
5 - 9 tahun
10 - 14 tahun
15 - 19 tahun
20 - 44 tahun
45 - 54 tahun
55 - 59 tahun
60 - 69 tahun
> 70 tahun
Catatan :
Mengetahui,
AN BULANAN
PUSKESMAS DAN JEJARINGNYA
BULAN JANUARI TAHUN 2017
Tehong Raka Kasong Total

L P L P L P L P L+P
0 0 0 0 2 1 7 6 13
0 0 0 0 2 5 2 7
0 0 0 0 0 - 2 1 3
0 0 0 0 0 1 4 2 6
0 0 0 0 0 2 18 11 29
0 0 0 0 2 1 7 6 13
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 2 1 11 5 16
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 2 1 7 6 13
1 6 5 11
0 0 0 0 0 0 0 0 0
0 0 0 0 2 1 7 6 13
0 0 0 0 0 0 0 0 0
0 0 0 0 2 1 7 6 13
0 0 0 0 0 0 0 0 0
0 0 0 0 2 1 7 6 13
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
Desa.......... Total
L P L P L+P
Yang Melapor,
LAPORAN BULANAN
REKAPITULASI ISPA DI PUSKESMAS DAN JEJARINGNYA
Tentang Golo Bore Pong Narang Golo Ru'a Golo Poleng Golo Keli Lumut Wae Buka Ndoso Momol Waning Pateng Lesu
No Elemen Data
L P L P L P L P L P L P L P L P L P L P L P L
I Penderita ISPA/Pneumonia : 16 22 9 10 10 12 7 9 8 10 16 15 10 6 10 9 13 10 14 25 27 15 12
1 Bulan ini 16 22 9 10 10 12 7 9 8 10 16 15 10 6 10 9 13 10 14 25 27 15 12
II Asal Pasien : 16 22 9 10 10 12 7 9 8 10 16 15 10 6 10 9 13 10 14 25 27 15 12
1 Datang sendiri 16 22 9 10 10 12 7 9 8 10 16 15 10 6 10 9 13 10 14 25 27 15 12
2 Rujukan
3 Kiriman kader
III Klasifikasi Penyakit : 89 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 - 21
1 Pneumonia Berat 55 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 0 8
<1 thn 34 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 5
1 - 4 thn 21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 3
5 thn 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 2
2 Pneumonia 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 - 1
<1 thn 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1
1 - 4 thn 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 - 1
3 Bukan Pneumonia 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
<1 thn 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 - 4 thn 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Pengobatan : 1 - - - - - - - - - - - - - - - - - - - - - -
1 Diberi antibiotika 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Rujuk : - - - - - - - - - - - - - - - - - - - - - - -
1. Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. RS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3. Faskes Lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Kondisi Penderita : 16 22 9 10 10 12 7 9 8 10 16 15 10 6 10 9 13 10 14 25 27 15 12
1 Sembuh 16 22 9 10 10 12 7 9 8 10 16 15 10 6 10 9 13 10 14 25 27 15 12
2 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
Kasubag Pelaporan
AN JEJARINGNYA
ARI TAHUN 2017
Pateng Lesu Tehong Raka Kasong Total

P L P L P L P L P L+P
11 12 15 21 15 10 14 183 187 370
11 12 15 21 15 10 14 183 187 370
- - -
11 12 15 21 15 10 14 183 187 370
11 12 15 21 15 10 14 183 187 370
0 0 0 0 0 0 0 190 - 190
0 0 0 0 0 0 0 84 - 84
0 0 0 0 0 0 0 42 - 42
0 0 0 0 0 0 0 26 - 26
0 0 0 0 0 0 0 16 - 16
- - - - - - - 10 - 10
0 0 0 0 0 0 0 6 - 6
4 - 4
0 0 0 0 0 0 0 2 - 2
0 0 0 0 0 0 0 1 - 1
0 0 0 0 0 0 0 1 - 1
- - - - - - - 1 - 1
0 0 0 0 0 0 0 1 - 1
- - - - - - - - - -
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
11 12 15 21 15 10 14 183 187 370
11 12 15 21 15 10 14 183 187 370
0 0 0 0 0 0 0 0 0 0
Yang melapor
Pengelola SIK Kabupaten
LAPORAN BULANAN
REKAPITULASI KEGIATAN PROMOSI KESEHATAN DI PUSKESMAS DAN JEJARINGNYA
No. ELEMEN DATA Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli Tentang G.Bore
I Total Kegiatan Promkes :
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Jenis Kegiatan/Penyuluhan :
1 Penyuluhan individu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Penyuluhan keluarga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Penyuluhan masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Penyuluhan institusi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Jumlah Sasaran : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Individu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Keluarga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kelompok masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Institusi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Lokasi :
1 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Pustu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Poskesdes 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Posyandu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Pemukiman warga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Institusi pendidikan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Materi Promosi Kesehatan :
1 DIARE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 DBD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli Tentang G.Bore
4 IMUN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 VIT A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 GIZI/GAKI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KIA/KB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 TBC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Malaria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Ispa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Kesling 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Kes. Gigi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 HIV/AIDS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Sarana Air Bersih 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 PMS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 KESPRO/NAPZA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk.
No. ELEMEN DATA
L P L P L P L P L P L P L P L
Jenis Kegiatan/Penyuluhan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah kunjungan rumah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Penyebaran Informasi : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
Materi Promosi Kesehatan :
KADARSI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KIA/KB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
TAN PROMOSI KESEHATAN DI PUSKESMAS DAN JEJARINGNYA
G.Bore P.Narang G.Rua G.Poleng
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
G.Bore P.Narang G.Rua G.Poleng
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pusk. Pusk. Pusk. Pusk. Total

P L P L L P L+P
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
REKAPITULASI KEGIATAN KUNJUNGAN RUMAH SEHAT DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua g.Poleng G.Keli Lumut W.Buka Ndoso momol Waning p.Lesu
No. ELEMEN DATA
0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2
TOTAL RUMAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
I Total Kunjungan Rumah : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rumah sehat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rmh tdk sehat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. Bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Sarana Sanitasi :
1 Pembuangan kotoran/JAGA
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Penyediaan air bersih 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Pembuangan sampah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Pembuangan air 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
limbah/SPAL
5 Ventilasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lubang asap dapur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Ruang tidur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Penerangan/cahaya
III Kualitas Lingkungan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Bebas jentik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Bebas tikus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kepadatan lalat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Pekarangan bersih 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pekarangan dimanfaatkan
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Kandang pisah-bersih 0 0 0 0 0 0 0 0 0 0
IV STBM : 0 0 0 0
1 Stop buang air besar
sembarangan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Cuci tangan pakai sabun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Pengelolaan air minum dan
makanan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Pengelolaan sampah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 pengelolaan air limbah
rumah tangga
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Catatan/Keterangan : No. II : No. III : No. IV :

o tidak ada sarana 0 jika tidak ada 0 jika tidak ada
1 ada sarana tdak memenuhi syarata 2 jika ada 2 jika ada
2 Ada sarana MS
H SEHAT DI PUSKESMAS DAN JEJARINGNYA
AN JANUARI TAHUN 2017
Tehong Raka Kasong Total Persentase

0 1 2 0 1 2 0 1 2 0 1 2 0 1 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KEGIATAN INSPEKSI RUMAH SEHAT DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli Luwut W.Buka Waning

No. ELEMEN DATA
JML % JML % JML % JML % JML % JML % JML % JML % JML %
IJumlah seluruh rumah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Rumah yang dibina bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2
Kumulatif rumah yang dibina s.d.
bulan lalu 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Jenis SAB : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total SGL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tidak Memenuhi Syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Total Sumur Pompa Tangan (SPT) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Total Penampungan Air Hujan (PAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Total Penampungan Mata Air (PMA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Total Hidran umum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Total PP (Captering) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Total Sambungan rumah perpipaa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Air Kemasan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Jenis JAGA : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Total Jaga Leher angsa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Total Jaga Cemplung 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Total Jaga Plengsengan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI SPAL Diperiksa : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total SPAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KK Pemakai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jiwa Pemakai
AS DAN JEJARINGNYA
2017
Ndoso P.Lesu Tehong Momol Tehong Momol Raka Kasong Tehong

JML % JML % JML % JML % JML % JML % JML % JML %
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Raka Kasong
LAPORAN BULANAN
REKAPITULASI KEGIATAN ISNSPEKSI TTU DAN TPM DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli lumut W.Buka Ndoso Momol Waning P.Lesu
No. ELEMEN DATA
Jml % Jml % Jml % Jml % Jml % Jml % Jml % Jml % Jml % Jml % Jml % Jml
I Total Kegiatan Pembinaan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Sarana Yang Dibina : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1
Total Sarana Kesehatan yang
ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Jumlah seluruh R.Sakit : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tdk memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Jumlah seluruh Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Sarana Pendidikan yang ada : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Total SD/MI seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Total SMP seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Total SMA/Sederajat
seluruhnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Total PT/Akademi yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Depot air minum yang ada : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Perkantoran yang ada : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TPM/Industri rumah tangga
yang ada
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Pasar yang ada : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Tempat Ibadah yang ada : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Terminal yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Pelabuhan yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Pengolahan pestisida yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Hotel yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Hotel Berbintang : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Hotel Non Berbintang : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 TPM yang diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Total Jasa boga/katering yang a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b.Total RM/Restoran yang ada : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Total Kantin yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Total Depot Air Minum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Toko/Kios yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Tempat Pembuangan Sampah
(TPS) yang ada
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Salon Kecantikan yang ada 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Memenuhi syarat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
N ISNSPEKSI TTU DAN TPM DI PUSKESMAS DAN JEJARINGNYA
P.Lesu Tehong Raka Kasong

% Jml % Jml % Jml %
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KEGIATAN KLINIK SANITASI DI PUSKESMAS DAN JEJARINGNYA
No. ELEMEN DATA
I Total Kunjungan Klinik
Sanitasi :
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Asal Pasien : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Jenis Pelayanan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Konseling 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Edukasi Kesehatan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kunjungan rumah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Jenis Penyakit/Masalah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 GEA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 DBD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kecacingan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Malaria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Diare 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ispa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Penyakit Kulit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 TBC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Suspek TBC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Infeksi Telinga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Asma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Malaria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
ATAN KLINIK SANITASI DI PUSKESMAS DAN JEJARINGNYA

P L P L P L P L+P
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENDERITA FILARIASIS DI PUSKESMAS DAN JEJARINGNYA
TENTANG GOLO BORE PONG NARANG GOLO RUA GOLO POLENG GOLO KELI
No Elemen Data
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
I Total Penderita Filariasis : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. Bulanlalu 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Kelompok Umur : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
> 2 tahun - 5 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 - 15 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 45 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
> 15 tahun 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Asal Pasien : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Datang Sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman Kader 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Pengobatan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Diethyl carbamazine citrate 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Albendazole 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Paracetamol 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Alasan Ditunda : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Anak < 2 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Ibu hamil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Balita gizi buruk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Sedang sakit berat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Kronis Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Lain-lain 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Kasus Kronis : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Limfodema 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Lymph scrotum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiluria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Hidrokel 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Penanganan Kasus Kronis : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Operasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Obat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Rujukan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 RS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
Kasubag Pelaporan
NGNYA
GOLO KELI LUMUT WAE BUKA NDOSO MOMOL WANING

Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lam Baru Lama Baru Lama Baru Lama
a
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Yang melapor
Pengelola SIK Puskesmas
PATENG LESU TEHONG RAKA KASONG Total Total
L P L P L P L P L P
L P (Baru+La (Baru+La
ma) ma) L+P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI KEGIATAN PERKESMAS
No. ELEMEN DATA
A. Pembinaan Individu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Jumlah Pasien Rawat Jalan yang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
diberikan asuhan keperawatan
2 Jumlah Pasien Rawat Inap yang diberikan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
asuhan keperawatan
B. Pembinaan Keluarga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Jumlah Keluarga Binaan dengan Kasus : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kasus Maternal Risti/Rawan Kesehatan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kasus Bayi Risti/Rawan Kesehatan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kasus Balita Risti/Rawan Kesehatan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kasus Penyakit Menular : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kasus usia lanjut Risti/Rawan Kesehatan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kasus Penyakit Tidak Menular 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Panti/Kel. Khusus yang dibina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Jumlah kunjungan Ke Keluarga Binaan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Jumlah Kasus dalam Keluarga Binaan per 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

kode sasaran
A Jumlah Kasus Maternal Risti/Rawan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kesehatan:
- Bumil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Melahirkan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Nifas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Jumlah Kasus Bayi Risti/Rawan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kesehatan :
- Pneumonia Berat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
- BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Tetanus Neonatorum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C Kasus Balita Risti/Rawan Kesehatan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Jumlah Kasus Masalah Gizi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Jumlah Kasus Penyakit Menular : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- TB Paru 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Kusta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
E Jumlah kasus usia lanjut Risti/Rawan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kesehatan
F Jumlah kasus Balita Risti/Rawan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kesehatan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F Jumlah Kasus Penyakit Tidak Menular 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
G Jumlah Kasus Sasaran di Luar Kode A s/d 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

F:
G.1. Kasus ............................... 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
G.2. Kasus .............................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
G.3. Kasus ................................ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C. Pembinaan Kelompok 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Jumlah Kelompok Binaan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Jumlah kunjungan Ke Keluarga Binaan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Jumlah Kelompok Binaan dengan spesifik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

kasus sbb :
3.1. Jumlah kelompok Balita 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3.2. Jumlah Kelompok anak sekolah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3.3. Jumlah kelompok Maternitas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3.4. Jumlah Kelompok Calon Jemaah haji 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3.5. Jumlah Kelompok Usia lanjut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

No. ELEMEN DATA
3.6. Jumlah Kelompok dengan kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
penyakit menular
3.7. Jumlah Kelompok dengan kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
penyakit tidak menular
3.8. Jumlah kelompok binaan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D. Penemuan Kasus dan Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Jumlah kasus Baru yang ditemukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(deteksi dini)
2 Jumlah Kasus Yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II TINGKAT KEMANDIRIAN 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
1 Jumlah Tingkat Kemandirian Keluarga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
sebelum dibina
KM I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KM II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KM III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KM IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Jumlah Tingkat Kemandirian Kelompok 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
setelah dibina
KM I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KM II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KM III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KM IV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Raka Kasong Pusk. Total
L P L P L P L P L+P
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
L P L P L P L P L+P
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
L P L P L P L P L+P
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
Yang Melapor,
LAPORAN BULANAN
REKAPITULASI PENDERITA AFP DI PUSKESMAS DAN JEJARINGNYA
No. ELEMEN DATA
I Total Penderita AFP : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Umur
1 0 - 15 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 > 15 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Asal Pasien :
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Status Imunisasi Polio :
1 Lengkap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tidak lengkap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Belum imunisasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Pengambilan Spesimen :
1 Spesimen I positif 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Spesimen II positif 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Spesimen follow up 60 hr 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Rujukan :
1 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
TULASI PENDERITA AFP DI PUSKESMAS DAN JEJARINGNYA
P.Lesu Tehong Raka Kasong Total :

L P L P L P L P L+P
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENDERITA ANTRAKS DI PUSKESMAS DAN JEJARINGNYA
NO ELEMEN DATA
I Total Penderita Antraks : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Asal Pasien :
1 Datang Sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman Kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Klasifikasi Antraks :
1 AK = Anthraks kulit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 AI = Anthraks intestinal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 AK dan AI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Antraks Pernapasan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Antraks Lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Pengambilan Spesimen :
1 Diambil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Hasil positif 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tidak diambil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Tindakan :
1 Diobati 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tidak diobati 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Kondisi Terakhir :
1 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Sembuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VII Rujukan :
1 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
LASI PENDERITA ANTRAKS DI PUSKESMAS DAN JEJARINGNYA
P.Lesu Tehong Raka Kasong Pusk.
P L P L P L P L
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Yang melapor
LAPORAN BULANAN
REKAPITULASI PENDERITA CAMPAK DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data
I Total Penderita Campak : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Umur : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 < 1 th 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 1 - 4 th 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 5 - 9 th 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 10-14 th 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 15-19 th 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 > 20 th 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Vaksinasi Sebelumnya :
1 Pernah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tidak tahu/tidak pernah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
1 Darah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Darah positif Rubella 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Urin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Urin positif Rubella 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Pemberian Vit A :
1 Ya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tidak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VII Kondisi Akhir Penderita :
1. Sembuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Mati 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Rujukan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VIII KLASIFIKASI FINAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Lab. Positip (Rubella) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Epidemiologi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Klinis
I Kelompok Umur
0-7 hari
8-28 hari
29 - < 1 tahun
> 1 - 4 tahun
5 - 9 tahun
10 - 14 tahun
15 - 19 tahun
20 - 44 tahun
45 - 54 tahun
55 - 59 tahun
60 - 69 tahun
Catatan :
Mengetahui
Kasubag Pelaporan
NAN
USKESMAS DAN JEJARINGNYA
N JANUARI TAHUN 2017
P.Lesu Tehong Raka Kasong Pusk. Pusk. Total

L P L P L P L P L P L P L P L+P
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENDERITA LEPRA DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli
No Elemen Data Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
I Total Penderita Lepra : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kumulatif sampai bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Asal Pasien :
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Jumlah Penderita :
1. PB (Pausibasiler ) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Umur 0 - 14 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Umur > 15 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. MB (Multibailer) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Umur 0 - 14 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Umur > 15 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Tingkat Cacat : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Tingkat Cacat 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tingkat Cacat 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tingkat Cacat 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Pengobatan :
1 MB dapat MDT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MB Dapat MDT lengkap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 PB dapat MDT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Berhenti Pengobatan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 RFT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1. PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Default 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
ENDERITA LEPRA DI PUSKESMAS DAN JEJARINGNYA
G.Keli lumut W.Buka

Lama Baru Lama Baru Lama
P L P L P L P L
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENDERITA DBD DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data
I Total Penderita DBD : 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Penderita baru bulan ini 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1
1 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Kelompok Umur Penderita
1 Umur < 1 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Umur 1 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Umur 5 - 15 tahun 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Umur > 15 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2
1 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Asal Pasien :
1 Datang sendiri 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5
4 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Penanganan Penderita :
1 Diobati 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Dirujuk 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2
1 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Kondisi Terakhir :
1 Sembuh 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Meninggal
Mengetahui
LAPORAN BULANAN
PENDERITA DBD DI PUSKESMAS DAN JEJARINGNYA
P.Lesu Tehong Raka Kasong Total

0 0 0 0 0 0 0 2 0 2
0 0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 1 0 1
0
0 0
0 0
0 0
0 0
0 0
0 0
0 1
1 0
0 1
1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 2
1 0
0 2
1
0 0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 2
1 0
0 2
1
0 0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 1
1 0
0 1
1
0 0 0 0 0 0 0 0 0 0
- - -
LAPORAN BULANAN
REKAPITULASI PENDERITA FRAMBUSIA DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data Baru Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
I Total kunjungan/yang diperiksa : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Total Penderita yang ditemukan
1. Menular 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Umur < 10 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Umur > 10 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Tidak Menular 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Umur < 10 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Umur > 10 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Asal Pasien :
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Pemeriksaan :
1 Mikroscopik (positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Serologi VDRL/RPR (positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Serologi TPHA (positif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Pengobatan :
1 Penisilin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Bukan penisilin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VII Rujukan :
1 Dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Tidak dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
Kasubag Pelaporan
LAPORAN BULANAN
ERITA FRAMBUSIA DI PUSKESMAS DAN JEJARINGNYA
TENTANG BULAN JANUARI TAHUN 2017
Raka Kasong Total Total

Baru Lama L P L P
(B + L+P
L P L P Baru Lama Baru Lama (B + L)
L)
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENDERITA HIV/AIDS DI PUSKESMAS DAN JEJARINGNYA
No. ELEMEN DATA
I Total Penderita HIV/AIDS : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Asal Pasien :
1 Datang sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman LSM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Diagnosa/Penderita HIV/AIDS :
1 HIV 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 - 5 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 - 9 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 19 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 24 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 - 49 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
50 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 AIDS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 - 5 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 - 9 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 19 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 24 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 - 49 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
No. ELEMEN DATA
50 thn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Faktor Risiko :
1 Homoseksual 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Pengguna narkoba suntik 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Biseksual 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Seks multi- partner 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Seks Multi
Partner/Heteroseksual
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Kondisi Pasien :
1 Dalam pengobatan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Terminally ill 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Pengobatan :
1 ART (Bukan Kumulatif) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 IO (Infeksi Opportunity) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Kelompok Risti : 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
1 WPS (Wanita Pekerja Seks) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 PPS (Pria Pelanggan Seks) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Waria 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LSL (Laki-laki Seks dengan laki-
laki)
5 WBP (Warga Binaan Lapas) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 IDU (Pengguna Narkoba ) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Pasangan Risti 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VIII Mengikuti VCT 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
1. Mengikuti VCT & Menerima 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Hasil Post. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IX Kondisi Penderita :
No. ELEMEN DATA
Sembuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
XI Dirujuk ke :
1. RS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3. Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
LAPORAN BULANAN
NDERITA HIV/AIDS DI PUSKESMAS DAN JEJARINGNYA
S TENTANG BULAN JANUARI TAHUN 2017
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENDERITA IMS DI PUSKESMAS DAN JEJARINGNYA
Tentang Golo Bore Pong narang Golo Rua Golo poleng Golo Keli
No Elemen Data
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
I Total Penderita IMS : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Asal Pasien :
1 Datang Sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman Kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
III Jenis Kasus :
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 19 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 -- 54
59 tahun
tahun
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
60 - 69 tahun
> 70 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Diagnosa : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Laboratorium 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
V Kategori Klinis :
1 Duh tubuh vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Erosi Partio 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Condiloma acuminata 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Duh tubuh urethra 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Ulkus vagina 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Pemeriksaan Laboratorium :
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 STO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 GO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Clue cell 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Candida 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Tricho 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Syphilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 PMN > 30/LP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Pelayanan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Dapat kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Konseling 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Kasi Kondom 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
NYA
Golo Keli Lumut Wae Buka Ndoso Momol Waning

P L P L P L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Waning Pateng lesu Tehong Raka Kasong
P L P L P L P L P
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kasong Total Total
P L P L P
(Baru+La (Baru+La
ma) ma) L+P
Lama Baru Lama Baru Lama

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
LAPORAN BULANAN
REKAPITULASI PENDERITA INFLUENZA DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data
I Total Penderita Influenza : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. Bulanlalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
II Kelompok Umur Penderita
4 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 19 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 - 54 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 - 59 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 - 69 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
> 70 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Asal Pasien : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Datang Sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman Kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
IV Klasifikasi :
1 Suspek 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Probable 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Konfirmasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
1 Diambil 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Hasil positif 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VI Kondisi Terakhir pasien :
1 Sembuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
VII Rujukan :
1 Puskesmas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rumah sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Faskes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk. Pusk.
No Elemen Data
I Kelompok Umur Penderita

0-7 hari
8-28 hari
29 - < 1 tahun
> 1 - 4 tahun
5 - 9 tahun
10 - 14 tahun
15 - 19 tahun
20 - 44 tahun
45 - 54 tahun
55 - 59 tahun
60 - 69 tahun
> 70 tahun
II Kelompok Umur yang meninggal
0-7 hari
8-28 hari
29 - < 1 tahun
> 1 - 4 tahun
5 - 9 tahun
10 - 14 tahun
15 - 19 tahun
20 - 44 tahun
45 - 54 tahun
55 - 59 tahun
60 - 69 tahun
> 70 tahun
Catatan :
Mengetahui
Kasubag Pelaporan
LAPORAN BULANAN
SI PENDERITA INFLUENZA DI PUSKESMAS DAN JEJARINGNYA
ESMAS TENTANG BULAN JANUARI TAHUN 2017
Raka Kasong Total

P L P L P P+L
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0
0 0
0 0
0 0
0 0
0 0
0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Pusk. Pusk. Pusk. Pusk. Total
P L P L P L P L P P+L
LAPORAN BULANAN
REKAPITULASI PENDERITA RABIES DI PUSKESMAS DAN JEJARINGNYA
No Elemen Data
I Total Penderita Rabies : 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
1 Bulan ini 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. Bulan lalu
II Kelompok Umur
4 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 - 9 tahun 3 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 14 tahun 2 0 2 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
15 - 19 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 - 54 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 - 59 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 - 69 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
> 70 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Asal Pasien : 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
1 Datang Sendiri 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman Kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Jenis Hewan Penggigit : 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0

1 Anjing 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
2 Kera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kucing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Suntikan Vaksin: 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
1 HO (hari digigit) 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
2 H7 (hari setelah digigit) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 H21 (hari setelah digigit) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Kondisi Terakhir : 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
1 Sembuh 5 0 3 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0
2 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
LAPORAN BULANAN
RITA RABIES DI PUSKESMAS DAN JEJARINGNYA
NTANG BULAN JANUARI TAHUN 2017

L P L P L P L P L+P
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 9 2 11
0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 9 2 11
0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENYAKIT TIDAK MENULAR PADA PUSKESMAS
KUNJUNGAN MENURUT GOLONGAN UMUR (TAHUN)

NO NAMA PENYAKIT 0 - 7 hr 8 - 28 hr < 1 thn 1-4 5-9 10 - 14 15 - 19 20 - 44 45 - 54 55 - 59
L P L P L P L P L P L P L P L P L P L
1 Hipertensi 0 0 0 0 0 0 0 0 0 0 0 0 7 8 5 4 2
Jumlah kunjungan 0 0 0 0 0 0 0 0 0 0 0 0 7 8 5 4 2
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Penyakit Jantung Koroner 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah kunjungan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diabetes Melitus (Kencing 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Manis)
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Obesitas 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Penyakit Tiroid 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Stroke 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Asma 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 1 0 0 1
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 PPOK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Osteoporosis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Penyakit Ginjal Kronis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KUNJUNGAN MENURUT GOLONGAN UMUR (TAHUN)
NO NAMA PENYAKIT 0 - 7 hr 8 - 28 hr < 1 thn 1-4 5-9 10 - 14 15 - 19 20 - 44 45 - 54 55 - 59
L P L P L P L P L P L P L P L P L P L
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Tumor Payudara 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Retinoblastoma 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Leukemia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Lesi Pra Kanker Leher Rahim 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Cedera Akibat Kecelakaan Lalu 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lintas
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Cedera Akibat Kekerasan dalam 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Rumah Tangga
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Cedera Akibat Lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah
Cat : Sumber Data dapat digunakan dari Register Poli Umum pada Pusk. Rawat Inap dan Non Rawat Inap
Mengetahui,
USKESMAS
N 2017
HUN)
Total
55 - 59 60 - 69 70+
P L P L P L P L+P
3 4 5 3 0 21 23 44
3 4 5 3 0 21 23 44
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 1 1 0 0 5 2
0 1 1 0 0 5 2
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
HUN)
Total
55 - 59 60 - 69 70+
P L P L P L P L+P
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Yang Melapor,
LAPORAN BULANAN
REKAPITULASI PENDERITA TB DI PUSKESMAS DAN JEJARINGNYA
Tentang G.Bore P.narang G.Rua G.Poleng G.Keli Lumut W.Buka Ndoso Momol Waning P.Lesu
No Elemen Data
I Total Penderita TB : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Triwulan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. Triwulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II Asal Pasien : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Datang Sendiri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Rujukan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kiriman Kader 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III Tipe Penderita : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Kasus baru 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 - 4 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 - 14 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 24 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 - 34 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 - 54 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 - 65 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
> 65 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kasus kambuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kasus default 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Kasus gagal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Kasus Pindahan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IV Pengawas Minum Obat (PMO) : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Tidak ada PMO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Petugas Kesehatan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Kader/tomas/toga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Anggota keluarga 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lain-lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
V Lokasi Penyakit : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 TB Paru (P) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 TB Extra Paru (EP) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Pemeriksaan Dahak/RO : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Suspek Diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kumulatif Suspek diperiksa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Dahak (+) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Dahak (-) RO (+) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VII Hasil Pengobatan : 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Sembuh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Pengobatan lengkap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Pindah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Default 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Gagal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORAN BULANAN
A TB DI PUSKESMAS DAN JEJARINGNYA

0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PEMRIKSAAN K
PUSKESMAS TENTANG BULAN JANUA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli lumut

No. ELEMEN DATA
L P L P L P L P L P L P L P
Pemeriksaan Kanker : 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Pemeriksaan dini kanker 0 0 0 0 0 0 0 0 0 0 0 0 0 0
leher rahim :
1. Pemeriksaan IV A 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelompok Umur 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 19 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 - 54 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 - 59 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 - 69 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
> 70 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Pemeriksaan dini 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Payudara
Kelompok Umur 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 19 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 - 44 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 - 54 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
55 - 59 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
60 - 69 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
> 70 tahun 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PORAN BULANAN
ASI PEMRIKSAAN KANKER
W.Buka Ndoso Momol Waning P.Lesu Tehong Raka Kasong Total

L P L P L P L P L P L P L P L P L P L+P
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
REKAPITULASI PENYAKIT YANG DAPAT DICEGAH D
PUSKESMAS TENTANG BULAN JANUA
Tentang G.Bore P.Narang G.Rua G.Poleng G.Keli lumut

No. ELEMEN DATA
Jumlah Penderita PD3I : 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Penderita Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Pertusis 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tetanus Neonatorum 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tetanus Non Neonatorum 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Polio 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hepatitis 0 0 0 0 0 0 0 0 0 0 0 0 0
Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN
ANG DAPAT DICEGAH DENGAN IMUNISASI (PD3I)
TANG BULAN JANUARI TAHUN 2017
lumut W.Buka Ndoso Momol Waning P.Lesu Tehong Raka Kasong Total
P L P L P L P L P L P L P L P L P L P L+P
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
REKAPITULASI HASIL
PUSKESMAS TEN
Tentang G.Bore P.Narang G.Rua G.Poleng

No. ELEMEN DATA
L P L P L P L P L
I Total Kegiatan Penjaringan :
1 Bulan ini 0 0 0 0 0 0 0 0 0
2 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0
II Sekolah SD/MI :
1 Jumlah SD/MI seluruhnya 0 0 0 0 0 0 0 0 0
2 Jumlah SD/MI yang dilakukan penjaringan
0 0 0 0 0 0 0 0 0
3 Jumlah murid kelas I seluruhnya 0 0 0 0 0 0 0 0 0
4 Jumlah murid kelas I yang dijaring : 0 0 0 0 0 0 0 0 0
5. Jumlah SD/MI yang dilakukan penjaringan
secara berkala
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
III Sekolah SMP/MTs :
1 Jumlah SMP/MTs seluruhnya 0 0 0 0 0 0 0 0 0
2 Jumlah SMP/MTs yang dilakukan
penjaringan
0 0 0 0 0 0 0 0 0
5. Jumlah SMP/MTs yang dilakukan
penjaringan secara berkala
0 0 0 0 0 0 0 0 0
IV Sekolah SMA/SMK/SK :
1 Jumlah SMA/SMK/SK seluruhnya 0 0 0 0 0 0 0 0 0
2 Jumlah SMA/SMK/SK yang dilakukan
penjaringan
0 0 0 0 0 0 0 0 0
5. Jumlah SMA/SMK/SK yang dilakukan
penjaringan secara berkala 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
V Status Gizi : 0 0 0 0 0 0 0 0 0
1 Normal 0 0 0 0 0 0 0 0 0
2 Gemuk 0 0 0 0 0 0 0 0 0
3 Kurus 0 0 0 0 0 0 0 0 0
4 Kurus sekali 0 0 0 0 0 0 0 0 0
5 Obesitas 0 0 0 0 0 0 0 0 0
VI Tajam Penglihatan 0 0 0 0 0 0 0 0 0
1 Normal 0 0 0 0 0 0 0 0 0
2 Tidak Normal 0 0 0 0 0 0 0 0 0
VII Ada Serumen (kotoran Telinga) 0 0 0 0 0 0 0 0 0

1 Ya 0 0 0 0 0 0 0 0 0
2 Tidak 0 0 0 0 0 0 0 0 0
VIII Ada Otitis Media (OM) 0 0 0 0 0 0 0 0 0

1 Ya 0 0 0 0 0 0 0 0 0
2 Tidak 0 0 0 0 0 0 0 0 0
VIII Tajam Pendengaran 0 0 0 0 0 0 0 0 0

1 Normal 0 0 0 0 0 0 0 0 0
2 Tidak Normal 0 0 0 0 0 0 0 0 0
IX Keadaan Gigi : 0 0 0 0 0 0 0 0 0
1 Sehat 0 0 0 0 0 0 0 0 0
2 Karies : 0 0 0 0 0 0 0 0 0
- Lubang 0 0 0 0 0 0 0 0 0
- Tambal 0 0 0 0 0 0 0 0 0
- Hilang 0 0 0 0 0 0 0 0 0
- Sisa Akar 0 0 0 0 0 0 0 0 0
X Status Imunisasi TL
1 - Saat Bayi 0 0 0 0 0 0 0 0 0
2 - Imunisasi Kelas 1 0 0 0 0 0 0 0 0 0
3 - Imunisasi Kelas 2 0 0 0 0 0 0 0 0 0
4 - Imunisasi Kelas 3 0 0 0 0 0 0 0 0 0
XI Gangguan ME 0 0 0 0 0 0 0 0 0
1 Ya 0 0 0 0 0 0 0 0 0
2 Tidak 0 0 0 0 0 0 0 0 0
XII Masalah Kes.Produksi 0 0 0 0 0 0 0 0 0

1 Ya 0 0 0 0 0 0 0 0 0
2 Tidak 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
XIII Hasil Pemeriksaan Penunjang :
1 Hb Normal 0 0 0 0 0 0 0 0 0
2 Anemia 0 0 0 0 0 0 0 0 0
3 Cacingan 0 0 0 0 0 0 0 0 0
XIV Kesegaran Jasmani : 0 0 0 0 0 0 0 0 0

1 Bugar 0 0 0 0 0 0 0 0 0
2 Tidak Bugar 0 0 0 0 0 0 0 0 0
Mengetahui,
LAPORAN BULANAN
REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK
G.Poleng G.Keli lumut W.Buka Ndoso Momol Waning P.Lesu Tehong

P L P L P L P L P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0S 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
P L P L P L P L+P
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0
0
0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0

Rekapituilasi Sikda Maret 201

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Rekapituilasi Sikda Maret 201

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LAMPIRAN : DAFTAR PENYAKIT SESUAI KODE ICD 10

No Elemen Data 0-7 hr 8 - 28 hr < 1 thn 1-4 5-9

5-9 10 - 14 15 - 19 20 - 44 45 - 54 55 - 59 60 - 69 70+ Total

JANUARI FEBRUARI MARET APRIL MEI JUNI JULI

Dilaporkan melalui lamp.ICD10

Mengetahui Yang melap

Jakobus Nentu Frans Edison

Mengetahui Yang melapor

elola SIK Kabupaten

IV Diagnosa Penyakit sesuai kode - - - -

V Jenis Pelayanan : 128 137 - - 39 64 5 6 12 63 3 4 65 70 4 3 66 74 6 9 42 89 9 4

Mengetahui Yang mel

35 - - 24 35 - - 29 28 - 102 167 207 1 104 374 105 479

25 - - 15 20 - - 17 15 - 102 102 134 1 104 236 105 341

25 - - 15 20 - - 17 15 102 102 134 1 104 236 105 341

III Asal Pasien : 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16

VII Jenis Pelayanan : 60 93 3 20 25 46 5 13 12 47 3 8 35 60 4 7 41 66 6 9 30 68 9 10 16

VIII Cara Pembayaran :

31 - - 23 42 - - #REF! #REF! #REF! #REF! #REF! #REF! #REF!

#REF! #REF! #REF! #REF! #REF! #REF! #REF!

#REF! #REF! #REF!

31 - - 23 42 - - #REF! #REF! #REF! #REF! #REF!

31 23 42 #REF! #REF! - #REF! #REF!

20 - - 17 15 936 #REF! #REF! #REF! #REF! #REF! #REF! #REF!

#REF! #REF! #REF! #REF! #REF! #REF! #REF!

Tentang Golo Bore Pong Narang Golo Ru'a

Golo Poleng Golo Keli Lumut Wae Buka Ndoso

III Kelompok Sasaran :

Raka Kasong TOATAL

Jumlah murid SMP yang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

P.Lesu Momol Waning P.LESU TEHONG RAKA KASONG TOTAL

Jumlah SD yang ada di wilayah Puskesmas. LT

Raka Kasong Total

III Jumlah Pemeriksaan Laboratorium : 0

3 Balita yang ada (S) :

III Status Gizi (Konfirmasi BGM &

4 Gizi Baik (B)

b. Status Gizi berdasarkan

3 Kasus Gizi Buruk Yang Meninggal 0 0 0 0 0 0 0 0 0 0 0

117 122 239

117 122 239

107 113 220

107 113 220

II Asal Pasien Bulin :

III Bulin mendapat :

IV Deteksi Resiko Bulin :

V Ibu Bersalin dirujuk

VII Penolong Persalinan :

VIII Cara Persalinan :

X Sebab Kematian Bulin : 0 0 0 0 0 0 0 0 0 0 0 0 0 0

B Ibu NifasResti Bufas yang

II Ibu Bufas dirujuk

III Bufas Komplikasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0

IV Sebab Kematian Neonatus

VI Alasan Neonatus Dirujuk :

VII Kunjungan Neonatus :

IV Ibu Hamil dengan faktor resiko :

VII Hasil Pemeriksaan Laboratorium :

P.Lesu Tehong Raka kasong

P.Lesu Tehong Raka kasong

P.Lesu Tehong Raka Kasong total Total

Tentang G.Bore p.Narang G.Rua

G.Rua G.Poleng G.Keli Lumut W.Buka

Kematian Bumil (Kel. umur &