LAPORAN SCREENING TUMBUH KEMBANG ANAK ..........USIA..........

(Disampaikan untuk memenuhi Tugas Mata Kuliah Kesehatan Ibu dan Anak)

Oleh:

Kelompok .... (Kelas A/B)

1. .................... (NIM)

2. .................. (NIM)

PROGRAM STUDI DIII KEPERAWATAN

STIKes MITRA KELUARGA

BEKASI

2017
 LAPORAN SCREENING TUMBUH KEMBANG ANAK

Tanggal Pengkajian : ………………………………………

Identitas Anak

Nama : ……………………... Jenis Kelamin : ……………………….

Tempat Tanggal Lahir: ……………………….. Agama : …………………………,

Identitas Orang Tua

Ibu Ayah

Nama

Usia

Pendidikan

Agama

Suku/Bangsa

Alamat Rumah

A. Riwayat Kesehatan

1. Riwayat Pertumbuhan dan Perkembangan

(Apakah ada gangguan dalam proses tumbuh kembang)

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2. Penyakit yang perna diderita

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3. Alergi

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4. Immunisasi

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B. Pengkajian Tumbuh Kembang

1. Pertumbuhan:

a. BB : ……………………………………………………

b. TB : …………………………………………………..

c. LK : …………………………………………………..

d. LLA : …………………………………………………..

e. Pertumbuhan Gigi : …………………………………………………

2. Perkembangan

Format KPSP Terlampir (Tuliskan hasil sreening di 4 sektor perkembangan dibawah

ini)

a. Motorik Kasar

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b. Motorik Halus

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c. Bahasa

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d. Sosialisasi

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C. Interpretasi Screening Pertumbuhan:

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D. Interpretasi Screening Perkembangan

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E. Intervensi

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F. Stimulasi yang dianjurkan kepada Orang tua

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Kelompok:

Anggota Kelompok

1. …………………………………………………………………………………

2. ………………………………………………………………………………….

3. ………………………………………………………………………………….

Lampiran:

1. Form KPSP

2. Dokumentasi Kegiatan