Laporan Kematian Neonatal, Bayi Anak Balita
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Laporan Kematian Neonatal, Bayi Anak Balita
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DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : RAAS
BULAN : Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT RIWAYAT KEHAMILAN
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
NO NAMA ALAMAT LAHIR
LAHIR (Gram) PERSALINAN KEMATIAN ANC BRP TEMPAT SUNTIK TT
IBU AYAH
YA TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Mengetahui Sumenep, .......................... 2017
KEPALA PUSKESMAS RAAS BIDAN KOORDINATOR
H. HERMANTO,S.Kep Hj. SUYATIK, S.ST
NIP. 19690717 199003 1 007 NIP. 19750208 200212 2 005
KEHAMILAN .
STATUS
TT
18
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun 2017
Jumlah
Kematian Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari) neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
DESA / Neonatal hari)
NO (0-6 hari)
POLINDES (0-28 hari)
kolom
KOLOM TETANUS KELAINAN TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN 12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN NEONATORUM BAWAAN
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 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
3 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
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 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
11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 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
18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kematian Bayi Anak Balita ( 12-59 )
Kematian post (0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
neonatal (29 hr-11 bln) ( neonatal+ post Kematian Sebab Kematian Anak Balita
neonatal) Anak Balita
kolom Kelainan (12-59) Diare Pneumonia Malaria Campak Demam
Pneumonia Diare Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
19+20+21+22+23+24+25 Saluran Cerna
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BALITA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Januari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL SEBAB KEMATIAN
FREKUENSI NO NAMA ALAMAT LAHIR
ak Balita IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
AMP DI KAB-
YA TIDAK ASPISIA BBLR
KOTA
Difteri Lain-lain 1 2 3 4 5 6 7 8 9 10 11 12 13
33 34 35
0 0
0 0
0 0
0 0
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 Kalianget, …………………………. 2017
0 0 KEPALA PUSKESMAS………………………………. Bidan Koordinator
0 0
0 0
0 0
0 0 HJ. NURUL HAYATI, M.Si SUMARIYATI, S.ST
0 0 NIP. ................................................ NIP.
0 0
0 0
0 0
A
RIWAYAT KEHAMILAN .
EBAB KEMATIAN
ANC BRP TEMPAT SUNTIK TT STATUS
LAIN2 KALI ANC HAMIL INI TT
14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Februari Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Februari Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Maret Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Maret Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : April Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : April Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Mei Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Mei Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Juni Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Juni Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Juli Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Juli Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Agustus Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Agustus Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : September Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : September Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Oktober Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Oktober Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : November Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : November Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK
KABUPATEN : Sumenep PUSKESMAS : KALIANGET
BULAN : Desember Tribulan I Tahun 2017
Jumlah
Kematian
Kematian
Neonatal Sebab Kematian Neonatal ( 0-6 hari)
DESA / Neonatal
NO (0-6 hari)
POLINDES (0-28 hari)
KOLOM TETANUS KELAINAN
KOLOM 4+11 BBLR ASFIKSIA SEPSIS LAIN-LAIN
5+6+7+8+9+10 NEONATORUM BAWAAN
1 2 3 4 5 6 7 8 9 10
1 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0
18 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0
20 0 0 0 0 0 0 0 0
21 0 0 0 0 0 0 0 0
22 0 0 0 0 0 0 0 0
23 0 0 0 0 0 0 0 0
24 0 0 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0 0 0
ESEHATAN SUMENEP
NEONATAL, BAYI DAN ANAK BALITA
Kematian
Kematian post
neonatal (7-28 Sebab Kematian Neonatal (7-28 hari)
hari) neonatal (29 hr-11 bln)
kolom
TETANUS KELAINAN kolom
12+13+14+15+16+1 BBLR ASFIKSIA SEPSIS LAIN-LAIN
NEONATORUM BAWAAN 19+20+21+22+23+24+25
7
11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 Kematian Bayi
(0-11 bln)
Sebab Kematian post neonatal (29 hr-11 bln)
( neonatal+ post Kematian
neonatal) Anak Balita
Pneumonia Diare
Kelainan
Tetanus Kelainan Saraf Malaria Lain-lain kolom 3+18
(12-59)
Saluran Cerna
19 20 21 22 23 24 25 26 27
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
KABUPATEN/KOTA
BULAN
Anak Balita ( 12-59 )
FREKUENSI NO
Sebab Kematian Anak Balita AMP DI KAB-
KOTA
Diare Pneumonia Malaria Campak Demam Difteri Lain-lain 1
28 29 30 31 32 33 34 35
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 KEPALA PUSKESM
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 HJ. NU
0 0 0 0 0 0 0 NIP. ............
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
DINAS KESEHATAN SUMENEP
LAPORAN KEMATIAN NEONATAL, BAYI DAN ANAK BA
KABUPATEN/KOTA : Sumenep PUSKESMAS : KALIANGET
BULAN : Desember Tribulan I Tahun.2017
NAMA ORANG TUA BAYI MENANGIS SAAT
TANGGAL BB LAHIR PENOLONG TANGGAL LAHIR
NAMA ALAMAT
IBU AYAH LAHIR (Gram) PERSALINAN KEMATIAN
YA
2 3 4 5 6 7 8 9 10
Mengetahui
KEPALA PUSKESMAS……………………………….
HJ. NURUL HAYATI, M.Si
NIP. ................................................
SUMENEP
BAYI DAN ANAK BALITA
BAYI MENANGIS SAAT RIWAYAT KEHAMILAN .
SEBAB KEMATIAN
LAHIR ANC BRP TEMPAT SUNTIK TT STATUS
TIDAK ASPISIA BBLR LAIN2 KALI ANC HAMIL INI TT
11 12 13 14 15 16 17 18
Kalianget, …………………………. 2017
Bidan Koordinator
SUMARIYATI, S.ST
NIP.
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