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FORMAT PENGKAJIAN

DEVELOPMENTAL SCREENING TEST II

Nama Mahasiswa : Luh Putu Yuli Pratami, S.Kep


NIM :17089142080

1. IDENTITAS ANAK
Nama :
Tanggal lahir :
Jenis kelamin :
Agama :
Pendidikan :
Alamat :

2. IDENTITAS ORANG TUA


Nama :
Tanggal lahir :
Jenis kelamin :
Agama :
Pendidikan :
Pekerjaan :
Alamat :

3. RIWAYAT PERTUMBUHAN DAN PERKEMBANGAN


a) Personal sosial/kemandirian bergaul
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b) Motorik Halus
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c) Bahasa
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d) Motorik Kasar
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4. PENGHITUNGAN UMUR
Tanggal test :
Tanggal lahir :
Umur anak :

5. PELAKSANAAN TEST DDST II

SEKTOR RESPON ANAK KESIMPULAN


Personal
sosial

Motorik
halus

Bahasa

Motorik
kasar
6. INTERPRETASI HASIL TEST DARI DDST II
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7. KESIMPULAN DARI KEEMPAT SEKTOR
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8. SARAN KEPADA ORANG TUA/PENGASUH


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LAPORAN
DENVER DEVELOPMENTAL SCREENING TEST (DDST) II
Pada An. Umur: Tanggal: Oktober 2017
Di RSUD Kabupaten Buleleng
Tahun 2017

OLEH :

Luh Putu Yuli Pratami, S.Kep


17089142080

SEKOLAH TINGGI ILMU KESEHATAN STIKES BULELENG


PROGRAM PROFESI NERS
2017

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