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FORMAT LAPORAN POSBINDU PTM

DARI POSBINDU

NAMA DESA : ..............................................................................

NAMA POSBINDU PTM : ...............................................................................

HARI/TANGGAL/BULAN : ...............................................................................

1. Jumlah sasaran : ..............................................................................


2. Jumlah kunjungan peserta
 Laki-laki : ..............................................................................
 Perempuan : ..............................................................................
3. Olahraga : ..............................................................................
4. Makan sayur buah(min 5x) : ..............................................................................
5. Merokok : ..............................................................................
6. Minum alkohol : ..............................................................................
7. Tekanan Darah
 Tinggi : ..............................................................................
 Rendah : ..............................................................................
8. Diabetes Melitus : ..............................................................................
9. Stroke : ..............................................................................
10. Jantung : ..............................................................................
11. Obesitas : ..............................................................................
12. Asma : ..............................................................................
13. Cholesterol : ..............................................................................
14. Benjolan Mammae : ..............................................................................
15. Iva Test : ..............................................................................

Kader Posbindu PTM

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