PEMERINTAH KABUPATEN PURBALINGGA

DINAS KESEHATAN
UPTD PUSKESMAS KALIKAJAR
Jl. Raya Selakambang Km. 2,5
PURBALINGGA

KLUB PROLANIS
" MUJI RAHAYU "
FKTP PUSKESMAS KALIKAJAR
Jl. Raya Selakambang KM. 2,5 Purbalingga

Penanggung jawab : MUJIMAN, SKM

Kepala Puskesmas Kalikajar Kabupaten Purbalingga

Ketua : SUKARNO
Ds. Kalikajar RT.01/RW.06 Kec. Kaligondang Kab. Purbalingga

NO NAMA NO KARTU JK P/I/S/A ALAMAT No Hp DIAGNOSA

1 SUKARNO 0000084979923 L P KALIKAJAR 1/8 - DM
2 SURENI 0000531917605 P I SLINGA 1/2 - DM
3 SUTRIYO 0000082931411 L P SLINGA 1/3 - DM +HT
4 SUPRIJATI 0000082687601 P I PENARUBAN 2/11 - DM
5 HARYANI 0001439370551 P P PENARUBAN 1/1 - DM
6 PARINAH 0001435456034 P P LAMONGAN 1/1 - DM
7 SUTINAH 0001017188109 P I KALIKAJAR 1/4 - DM+HT
8 SUDIRAH 0000531158602 P I PENARUBAN 2/10 - DM+HT
9 JUNEDI 0000531379157 L P KALIKAJAR 4/1 - DM
10 WASIMAH 0001969575028 P I PENARUBAN 1/8 - DM
11 SUPRAPTO 0001017194051 L P KEMBARAN WT 1/1 - DM
12 SURADAL 0000082863764 L P KALIKAJAR 3/7 - DM
13 BUDIYANTO 0000531484997 L P KALIKAJAR 1/1 - DM
14 MUSTIATI 0002079637222 P I SLINGA 3/2 - DM+HT
15 RUNI 0001386237982 P I SLINGA 2/5 - DM
16 PAINAH 0000531380698 P P PENARUBAN 1/8 - DM+HT
17 HARYATI 0000082686543 P I LAMONGAN 1/2 - DM +HT
18 JAMINGAH 0000084976841 P I SEMPOR LOR 1/4 081327412478 DM +HT
19 RAMELAN 0000082781662 P P KALIKAJAR - DM
20 SUMARTI 0000531512379 P KTB KALIKAJAR 2/5 - HT
21 NURSIN ALIMUFTI 0000531480947 L P LAMONGAN 1/1 - HT
22 SUPINAH 0001086125635 P P KEMBARAN WT 4/3 - HT
23 KUSMEDI 0000082681907 L P KALIKAJAR 3/3 - HT
24 PRIHATININGSIH 0000531589296 P I KALIKAJAR 1/7 - HT
25 SUKIRAH 0000529912304 P I SLINGA 3/5 - HT
26 SAMINAH 0001903828151 P P PENARUBAN 1/11 - HT
27 SUGIRAH 0000531438366 P I KALIKAJAR 2/7 - HT
28 SUDJINI 0000082567934 P P SLINGA 1/6 - HT
29 SANTOSA 0000082566955 L S KALIKAJAR 3/2 - HT
30 TURINI 0000531263531 P P TEJASARI 2/4 - HT
31 KARISEM 0000530954212 P I KEMBARAN WT 2/2 - HT
32 PONISEM 0000530634104 P I BRECEK 2/1 - HT
33 BAWONO 0001892306351 L P SEMPOR LOR 1/2 - HT
34 SUYINI 0000530996859 P I KALIKAJAR 1/3 - HT
35 YAMTI 0000530912507 P P KEMBARAN WT 4/2 - HT
36 TURMINI 0001017193329 P I KALIKAJAR 4/3 - HT
37 SRI MAHYATI 0001885965028 P I PENARUBAN 2/10 - HT
38 SULASMI 0000532040984 P I KALIKAJAR 3/2 - HT
39 CHAMBALI 0000530782569 L P KEMBARAN WT 4/1 - HT
40 SRI HARTATI 0001745617239 P I KALIKAJAR 3/7 - HT
41 SURANTI 0001888635521 P I SEMPOR LOR 2/1 - HT
42 KAPINAH 0000532086456 P KTB KALIKAJAR 2/6 - HT
43 KARSINEM 0000530858261 P I SEMPOR LOR 2/1 - HT
44 SUWITRI 0000531623125 P I KALIKAJAR 2/7 - HT
45 SUWINI 0000532096582 P I SIDANEGARA 1/2 - DM
46 SATIRAH 0000532157027 P I SLINGA 1/2 - DM
47 UNTUNG ROCHMAT 0000532356254 L P PENARUBAN 2/5 - DM
48 SUKIRMAN HADI SUWART0000531530109 L P SIDANEGARA 1/2 081318531384 DM
49 HADI TARYO 0000531466435 L P KALIKAJAR 2/8 - DM
50 MISWAN 0002075569446 L P SLINGA 2/4 085697841849 DM
51 SULASTRI 0000082566944 L P KALIKAJAR 3/2 085747544737 DM
52 MANISAH 0000531154157 P I PENARUBAN 2/8 - DM
53 SALIMAH 0000531895724 P I SLINGA 3/7 085702316187 DM
54 GUNARSIH 0000531520075 P I KALIKAJAR 3/7 - DM
55 MASTURI 0000082682379 L P KALIKAJAR 1/6 - DM
56 JOKO 0001017185927 L P BRECEK 1/1 082135360570 DM
57 FX. SAYUDI 0000082905142 L P KALIKAJAR 1/6 085869932753 DM
58 SUKINI 0000531024399 P I PENARUBAN 1/9 - DM
59 RITA APRIYANI 0001296533856 P P PENARUBAN 3/4 - DM
60 WIATMINAH 0000082824254 P I KALIKAJAR 1/6 - DM
61 WATIRAH 0000531442023 P I KALIKAJAR 1/4 - DM
62 INDRI PURWANTI 0000531629662 P I KALIKAJAR 2/6 081215593968 DM
63 KUWATMI 0002046315273 P I KALIKAJAR 1/5 - DM
64 SUWARNO 0000082833805 L P KALIKAJAR 1/4 08156998103 DM
65 SANDIYAH 0000530997941 P I KALIKAJAR 1/7 - HT
66 ROKIYAH 0000082923513 P I KALIKAJAR 4/7 - HT
67 SULIYAH 0000530986443 P I KEMBARAN WTN 4/1 - HT
68 SITI SUDARTI 0001017189033 P P PENARUBAN 1/6 - HT
69 SALMINI 0001451349617 P I PENARUBAN 3/7 - HT
70 ONSIJAH 0000082683191 P P KALIKAJAR 3/4 - HT
71 RUSMINI 0000530882245 P I SLINGA 1/1 - HT
72 KASMINI 0000530889693 P KTB SLINGA 2/3 - HT
73 SATINI 0001017201903 P I SLINGA 2/6 - HT
74 YUSWEDI 0000529424943 L P BRECEK 3/1 - HT
75 SUDARTI 0000531387369 P I KALIKAJAR 3/5 - HT
76 WUSNIJATI 0000082541193 P I KEMBARAN WTN 5/2 08125651772 HT
77 SUJINAH 0000082846732 P P BRECEK 3/2 - HT
78 JUMINAH 0000082683336 P I PENARUBAN 2/8 - HT
79 SUYATI 0000531083193 P I KALIKAJAR 3/2 - HT
80 ALIYAH.HJ 0000073003814 P P KALIKAJAR 3/5 - HT
81 MURNI 0000531994555 P P SLINGA 2/7 - HT
82 MURTINI 0000082686947 P I KALIKAJAR 2/5 - HT
83 YUSWEDI 0000529424943 L P BRECEK 2/1 - HT
84 DJUMIARTI NASTITI 0000082521742 P I KALIKAJAR 4/7 085329044095 DM
85 SOPINAH 0001656295097 P I CILAPAR 12/4 08128548110 DM
86 WARIJO AL YATIN 0002236786323 L P ARENAN 1/7 082138684340 DM
87 ARDIYAH 0000082569903 P I LAMONGAN 4/1 DM
88 SUMARTI 0001017199056 P I SLINGA 3/4 08567483376 DM
89 WAGINAH 0000530356735 P I BRECEK 4/1 DM
90 DARYANTI 0001017223266 P I PBG WETAN 1/6 DM
91 SUMIASIH 0002063491727 P I PENARUBAN 3/4 DM
92 NDARI AGUSTINA 0000082638191 P P SEMPOR LOR 1/1 085747447471 DM
93 SULEMI 000082686756 L P SLINGA 1/2 HIPERTENSI
94 SURKIYEM 0000532089202 P I KALIKAJAR 2/1 HIPERTENSI
95 SUDJA ADANG 0001895958022 L P TEJASARI 3/4 HIPERTENSI
96 SUMIDAH 0000531000167 P I Klj 2/6 HIPERTENSI
 97 WASINI 0001017189584 P P PENARUBAN 3/4 HIPERTENSI
98 SAMIRAH 0000532044314 P I KALIKAJAR 3/8 HIPERTENSI
99 RASIMAH 0001814829017 P P PENARUBAN 2/8 HIPERTENSI
100 ADMIAH 0001017193234 P P KALIKAJAR 3/8 081903272626 HIPERTENSI
101 LUJENG WALUYO 0001478939477 L P KALIKAJAR 3/6 HIPERTENSI

Purbalingga, 6 Juli 2017

Kepala Puskesmas Kalikajar

Mujiman, SKM
NIP. 19720218 199403 1 004
 LAPORAN PEMANTAUAN STATUS KESEHATAN
KLUB PROLANIS DIABETES MELLITUS "MUJI RAHAYU" PUSKESMAS KALIKAJAR
TANGGAL 6 MARET 2018

Bulan
Jenis Baru /
No Nama No Kartu Alamat Alamat FKTP DX BB TB IMT*) DIABETES Tek. Drh
Kel Lama HR RR
(kg) (m) GDP GDPP GDS Sis Dis
1 Titin Suciati 0000082614543 P Kembaran Wetan Puskesmas Kalikajar Baru DM 56 1.61 21.60 99 136 130 60 80 20
2 Kuwatmi 0002046315273 P Kalikajar Puskesmas Kalikajar Lama DM 66 1.55 27.47 179 217 120 70 80 20
3 Suyini 0000530996859 P Kalikajar Puskesmas Kalikajar Lama DM 48 1.48 21.91 110 361 120 80 80 20
4 Wiatminah 0000082824254 P Kalikajar Puskesmas Kalikajar Lama DM 54 1.52 23.37 153 235 130 90 80 20
5 Sukarno 0000084979923 L Kalikajar Puskesmas Kalikajar Lama DM 52 1.63 19.57 194 294 140 70 80 20
6 Suprapto 0001017194051 L Kembaran Wetan Puskesmas Kalikajar Lama DM 53 1.65 19.47 186 207 120 80 80 20
7 Parinah 0001435456034 P Lamongan Puskesmas Kalikajar Lama DM 66 1.45 31.39 161 276 145 80 80 20
8 Sutriyo 0000082931411 P Slinga Puskesmas Kalikajar Lama DM 52 1.45 24.73 182 193 120 70 80 20
9 Edi Purwanto 0002051555409 L Kalikajar Puskesmas Kalikajar Lama DM 55 1.7 19.03 150 299 90 60 80 20
10 Painah 0000531380698 P Penarubah Puskesmas Kalikajar Lama DM 55 1.56 22.60 208 294 130 70 80 20
11 Surip 0000530872841 L Kalikajar Puskesmas Kalikajar Lama DM 49 1.63 18.44 131 223 150 80 80 20
12 Sulastri 0000531745165 P Kembaran Wetan Puskesmas Kalikajar Lama DM 52 1.5 23.11 168 193 170 80 80 20
13 Sumarti 0001017199056 P Slinga Puskesmas Kalikajar Lama DM 64 1.57 25.96 96 124 120 70 80 20
14 Sulasmi 0000531652061 P Kalikajar Puskesmas Kalikajar Lama DM 61 1.51 26.75 89 245 110 70 80 20
15 Ningsih Hartati 0002298495407 P Slinga Puskesmas Kalikajar Lama DM 55 1.48 25.11 207 327 140 90 80 20
16 Wasti 0000530749989 P Kembaran Wetan Puskesmas Kalikajar Lama DM 48 1.43 23.47 195 282 100 60 80 20
17 Wasimah 0001969575028 P Penaruban Puskesmas Kalikajar Lama DM 50 1.5 22.22 88 181 120 70 80 20
18 Mulyareja 0000531614564 L Slinga Puskesmas Kalikajar Lama DM 45 1.57 18.26 113 194 140 70 80 20
19 Mustari 0000530961118 L Slinga Puskesmas Kalikajar Lama DM 50 1.54 21.08 217 294 160 90 80 20
20 Sri Palupi 0000082852031 P Kalikajar Puskesmas Kalikajar Lama DM 58 1.5 25.78 171 188 140 80 80 20
21 Runi 0001386237982 P Slinga Puskesmas Kalikajar Lama DM 59 1.49 26.575 97 310 140 80 80 20
22 Manisah 0000531154157 P Penaruban Puskesmas Kalikajar Lama DM 67 1.58 26.84 184 255 180 100 80 20
23 Jamingah 0000084976841 P Sempor Lor Puskesmas Kalikajar Lama DM 80 1.56 32.873 137 209 120 80 80 20
24 Sudart 0000082913106 P Kembaran Wetan Puskesmas Kalikajar Lama DM 70 1.5 31.111 217 259 150 90 80 20
25 Sudirah 0000531158602 P Penaruban Puskesmas Kalikajar Lama DM 40 1.5 17.778 110 236 140 80 80 20
26 Nur Ika 0001316532521 P Penaruban Puskesmas Kalikajar Lama DM 62 1.5 27.556 75 267 110 70 80 20
27 Fx Sayudi 0000082905142 P Kalikajar Puskesmas Kalikajar Lama DM 72 1.6 28.125 174 198 120 80 80 20
28 Alfiah 0000532170753 P Slinga Puskesmas Kalikajar Lama DM 45 1.5 20 244 282 120 70 80 20
29 Ardiyah 0000082569903 P Lamongan Puskesmas Kalikajar Lama DM 65 1.49 29.278 148 174 130 80 80 20
30 Sukini 0000531024399 P Penaruban Puskesmas Kalikajar Lama DM 50 1.55 20.812 354 399 90 60 80 20
31 Ramelan 0000082781662 L Bancar Puskesmas Kalikajar Lama DM 57 1.65 20.937 175 202 160 80 80 20
32 Sri Maryati 0000082886297 P Kalikajar Puskesmas Kalikajar Lama DM 70 1.5 31.111 171 228 130 80 80 20
33 Sutinah 0001017188109 P Penaruban Puskesmas Kalikajar Lama DM 55 1.55 22.893 167 267 120 80 80 20

Kalikajar, 6 Maret 2018

Kepala Puskesmas Kalikajar

Mujiman, SKM
NIP. 19720218 199403 1 004
 LAPORAN PEMANTAUAN STATUS KESEHATAN
KLUB PROLANIS HIPERTENSI "MUJI RAHAYU" PUSKESMAS KALIKAJAR
TANGGAL 6 MARET 2018

Baru / BB TB IMT*) Tek. Drh Tanda Vital

No Nama No Kartu JK Alamat Alamat FKTP DX
Lama
(kg) (m) Sis Dias HR RR
1 Asminem 0000530961197 P Sempor Lor 2/2 Puskesmas Kalikajar Baru Hipertensi 59 1.54 24.88 140 80 80 20
2 Sumarti 0000531512379 P Kalikajar rt 2/5 Puskesmas Kalikajar Lama Hipertensi 49 1.54 20.66 130 70 80 20
3 Rasimah 0001814829017 P Penaruban rt 02/08 Puskesmas Kalikajar Lama Hipertensi 69 1.54 29.09 130 100 80 20
4 Witi 0000082682392 P Tejasari rt 1/4 Puskesmas Kalikajar Lama Hipertensi 49 1.56 20.13 150 90 80 20
5 Mudiyati 0000532237544 P Kalikajar. 2/6 Puskesmas Kalikajar Baru Hipertensi 67 1.6 26.17 130 90 80 20
6 Sulemi 0000082686756 L Slinga rt 1/3 Puskesmas Kalikajar Lama Hipertensi 38 1.52 16.45 150 80 80 20
7 Karlan Karjono 0001017171404 L Tejasari rt 4/3 Puskesmas Kalikajar Lama Hipertensi 49 1.56 16.45 140 90 80 20
8 Suwitri 0000531623125 P kalikajar rt 2/7 Puskesmas Kalikajar Lama Hipertensi 75 1.5 33.33 150 80 80 20
9 Turiyah 0002210168002 P Slinga rt 3/2 Puskesmas Kalikajar Lama Hipertensi 46 1.54 19.40 160 100 80 20
10 Murtini 0000082686947 P Kalikajar rt 2/5 Puskesmas Kalikajar Lama Hipertensi 60 1.54 19.40 150 90 80 20
11 Watirah 0000531442023 P Kalikajar 1/5 Puskesmas Kalikajar Lama Hipertensi 41 1.56 16.85 130 80 80 20
12 AT Hidajati 0000082924481 P Sempor rt 1/4 Puskesmas Kalikajar Lama Hipertensi 60 1.52 14.30 140 80 80 20
13 Sodirman 0000082886229 L Kembaran wetan rt 5/2 Puskesmas Kalikajar Lama Hipertensi 60 1.6 23.44 150 100 80 20
14 Sujinah 0000082846732 P brecek rt 3/2 Puskesmas Kalikajar Lama Hipertensi 47 1.49 21.17 140 90 80 20
15 Mashuri 0000084977302 L Slinga rt 1/3 Puskesmas Kalikajar Lama Hipertensi 51 1.63 19.20 130 70 80 20
16 Toebah 0000082688883 P slinga 1/1 Puskesmas Kalikajar Lama Hipertensi 48 1.5 21.33 160 100 80 20
17 Tuhidi 0000532410028 L penaruban rt 1/11 Puskesmas Kalikajar Lama Hipertensi 65 1.62 24.77 130 80 80 20
18 Suwarti 0000530909199 P Sempor Lor, 1/4 Puskesmas Kalikajar Baru Hipertensi 53 1.56 21.78 120 60 80 20
19 Suranti 0001888635521 P sempor rt 2/1 Puskesmas Kalikajar Lama Hipertensi 60 1.56 24.65 120 80 80 20
20 Kasmini 0000530889693 P Slinga, 2/3 Puskesmas Kalikajar Lama Hipertensi 35 1.5 15.56 150 100 80 20
21 Nursin alimufti 0000531480947 L lamongan rt 4/1 Puskesmas Kalikajar Lama Hipertensi 44 1.54 18.55 150 90 80 20
22 Sunardi 0000082687026 L Penaruban, 3/8 Puskesmas Kalikajar Baru Hipertensi 55 1.54 23.19 140 80 80 20
23 Salmini 0001451349617 P Penaruban, 3/7 Puskesmas Kalikajar Lama Hipertensi 65 1.56 26.71 130 80 80 20
24 Santosa 0000082566955 L Kalikajar rt 3/2 Puskesmas Kalikajar Lama Hipertensi 70 1.63 26.35 150 90 80 20
25 Rokhimun 0000082837214 L Lamuk, 18/9 Puskesmas Kalikajar Baru Hipertensi 55 1.6 21.48 120 70 80 20
26 Sugirah 0000531438366 P Kalikajar rt 2/7 Puskesmas Kalikajar Lama Hipertensi 60 1.45 28.54 130 80 80 20
27 Sudarti 0000531387369 P Kalikajar, 3/5 Puskesmas Kalikajar Lama Hipertensi 49 1.5 21.78 120 70 80 20
28 Sri Mahyati 0001885965028 P Penaruban rt 2/10 Puskesmas Kalikajar Lama Hipertensi 72 1.58 15.02 150 90 80 20
29 Surkiyem 0000532089202 P Kalikajar rt 2/1 Puskesmas Kalikajar Lama Hipertensi 69 1.56 28.35 130 60 80 20
30 Sri Haryani 0000531056788 P Penaruban, 2/9 Puskesmas Kalikajar Baru Hipertensi 78 1.52 41.69 150 80 80 20
31 Sandiyah 0000530997941 P kalikajar rt 1/7 Puskesmas Kalikajar Lama Hipertensi 63 1.54 26.56 130 70 80 20
32 Aliyah 0000073003814 P kalikajar rt 3/5 Puskesmas Kalikajar Lama Hipertensi 83 1.56 34.11 120 80 80 20
33 Sokari 0000082685891 L Kalikajar 1/8 Puskesmas Kalikajar Lama Hipertensi 50 1.6 19.53 170 80 80 20
34 Murni 0000531994555 P Slinga 2/7 Puskesmas Kalikajar Lama Hipertensi 54 1.5 24.00 130 80 80 20
35 Sulasmi 0000532040964 P Kalikajar, 3/2 Puskesmas Kalikajar Lama Hipertensi 60 1.54 25.30 130 80 80 20
36 Kasmini 0000531241165 P Penaruban, 3/3 Puskesmas Kalikajar Lama Hipertensi 58 1.54 26.60 140 80 80 20
37 Saeri Mad Sagri 0000530922712 L Sempor Lor Puskesmas Kalikajar Lama Hipertensi 55 1.5 24.44 150 90 80 20
38 Satini 0001017201903 P Slinga rt 2/6 Puskesmas Kalikajar Lama Hipertensi 73 1.65 22.29 140 80 80 20
39 Sungeni 0000531055945 P Kalikajar, 2/2 Puskesmas Kalikajar Baru Hipertensi 65 1.54 20.14 130 70 80 20
40 Titi Safitri 0000082928215 P Kalikajar, 2/6 Puskesmas Kalikajar Baru Hipertensi 55 1.6 17.98 130 70 80 20
41 Suharti 0000530879411 P Sempor rt 2/4 Puskesmas Kalikajar Lama Hipertensi 75 1.56 15.83 180 100 80 20
42 Sinah 0000531163473 P Penaruban rt 2/2 Puskesmas Kalikajar Lama Hipertensi 31 1.5 7.21 160 90 80 20
43 Siti Sudarti 0001017189033 P Penaruban rt 1/8 Puskesmas Kalikajar Lama Hipertensi 44 1.5 5.06 110 80 80 20

Kalikajar, 6 Maret 2018

Kepala Puskesmas Kalikajar

Mujiman, SKM
NIP. 19720218 199403 1 004