10

20
30
40
50
60
70
80

0
JENIS KELAMIN

AGAMA

PEKERJAAN

GOLONGAN DARAH

Jika Ya apakah ke tempat pelayanan kesehatan

Jika Ya, apakah hasil pemeriksaannya normal?

Apakah dalam keluarga menderita penyakit tersebut?

Bila Ya Sebutkan Jenis penyakit …

Jika Ya apakah ke tempat pelayanan kesehatan?

Berapa lama obat itu telah dikonsumsi?

Ventlasi

Lantai

Sumber air bersih

Desa Kalawiran
Jenis Jamban

Sayuran dikonsumsi

Makanan yang mengandung protein

Makanan/Minuman Manis

Bumbu Penyedap

Mandi

Cuci Rambut

Cuci tangan sebelum makan

Bila Ya menggunakan air mengalir dan menggunakan sabun

Apakah keluarga melakukan pemeriksaan kesehatan secara berkala?

Jenis pemeriksaan yang dilakukan

Row 5

Row 48
Row 47
Row 46
Row 45
Row 44
Row 43
Row 42
Row 41
Row 40
Row 39
Row 38
Row 37
Row 36
Row 35
Row 34
Row 33
Row 32
Row 31
Row 30
Row 29
Row 28
Row 27
Desa Kalawiran
NO JENIS AGAMA PENDIDIKAN PEKERJAAN ALAMAT GOLONGAN
SAMPEL KELAMIN UMUR DARAH

1 2 3 4 5 6 7 8
1 2 45 2 4 5 2 1
2 2 80 2 6 5 2 5
3 2 58 2 7 1 2 2
4 2 43 2 5 5 2 5
5 2 67 2 6 3 2 1
6 2 21 2 4 5 2 3
7 2 67 2 5 5 2 5
8 2 36 2 5 5 2 5
9 1 57 2 6 3 2 5
10 2 84 2 5 5 2 1
11 2 26 2 4 5 1 5
12 2 51 2 4 3 1 1
13 2 40 2 3 5 2 5
14 1 90 2 5 5 2 1
15 1 58 2 4 3 2 5
16 2 36 2 3 5 1 1
17 2 56 2 5 5 1 5
18 2 41 2 5 5 1 5
19 2 42 2 3 5 1 1
20 2 53 2 3 5 1 1
21 1 41 2 3 2 1 1
22 1 54 2 5 3 1 1
23 2 44 2 5 5 1 5
24 2 40 2 4 5 1 3
25 2 50 2 6 5 1 5
26 1 61 2 5 3 2 1
27 1 52 2 3 3 1 4
28 2 54 2 5 5 1 1
29 2 47 2 3 3 2 1
30 2 76 2 3 1 1 1
31 2 32 2 5 5 1 5
32 2 44 2 4 5 1 5
33 2 33 2 3 5 2 5
34 2 54 2 4 5 2 5
35 2 25 2 2 1 2 3
36 1 63 2 3 1 3 3
37 1 29 2 3 2 3 5
38 1 25 2 3 1 3 5
39 2 49 2 5 5 3 5
40 1 54 2 5 3 3 5
41 1 35 2 4 3 3 5
42 1 41 2 3 1 1 1
43 2 59 2 5 5 2 5
44 1 63 2 5 3 1 3
45 2 36 2 5 5 1 1
46 2 85 2 4 5 3 1
47 1 50 2 4 5 3 1
48 2 41 2 4 5 3 4
49 2 60 2 3 5 3 1
50 2 52 2 3 5 3 1
51 2 54 2 4 2 3 2
52 2 53 2 3 1 2 1
53 2 40 2 4 5 2 1
54 2 35 2 4 5 2 4
55 2 32 2 3 5 2 4
56 2 60 2 4 5 3 1
57 2 55 2 4 3 3 1
58 2 41 1 3 2 3 2
59 2 51 2 7 1 3 4
60 2 83 2 4 5 3 1
61 1 35 1 4 2 3 1
62 2 56 2 4 5 1 1
63 2 60 2 3 5 2 1
64 2 57 2 4 5 2 4
65 2 59 2 6 3 1 3
66 2 32 2 3 1 1 1
67 2 40 2 3 5 1 1
68 1 60 2 5 3 3 1
69 2 22 2 3 5 3 1
70 2 28 2 3 5 3 1
71 2 27 2 2 2 3 1
72 1 50 2 3 1 3 1
73 1 48 2 3 3 3 1
74 2 47 2 4 5 1 4
75 1 60 2 4 3 1 4
76 2 41 2 3 5 1 1
77 2 39 2 3 5 1 4
78 1 59 2 4 5 3 4
79 1 46 2 4 3 3 4
80 2 68 2 2 4 3 3
81 2 47 2 4 5 3 4
82 2 51 2 7 1 3 1
 83 2 54 2 4 5 1 4
84 2 26 2 3 5 1 1
85 2 55 2 4 5 1 3
86 2 36 2 4 5 1 1
87 2 44 2 3 1 2 1
88 2 48 2 3 5 2 1
89 2 53 2 4 5 1 1
90 2 28 2 3 5 1 1
91 2 23 2 5 5 1 5
92 2 40 2 4 5 1 5
93 2 23 2 5 5 1 5
94 2 41 2 3 5 1 5
95 2 32 2 4 5 1 5
96 2 48 2 5 3 1 5
97 2 44 2 5 5 1 5
98 2 44 2 7 1 1 1
99 2 38 2 4 5 1 5
100 2 50 2 5 5 1 1
101 1 85 2 6 3 2 4
102 2 45 2 3 5 1 5
103 2 41 2 5 5 1 5
104 1 72 2 4 3 1 3
105 2 27 2 4 5 1 5
106 2 34 2 3 5 1 2
107 2 55 2 5 5 1 1
108 2 42 2 5 5 1 5
109 2 41 2 4 5 1 1
110 2 39 2 3 5 1 5
111 2 32 2 3 5 1 5
112 2 36 2 3 5 1 5
113 2 30 2 3 5 1 1
114 2 25 2 3 5 1 1
115 2 57 2 4 3 1 3
116 2 37 2 4 5 1 5
117 2 41 2 4 5 1 5
118 2 75 2 5 5 1 5
119 2 24 2 3 5 1 5
120 2 20 2 3 5 1 5
121 2 30 2 2 5 1 1
122 2 43 2 3 5 2 1
123 2 53 2 3 1 1 2
124 2 37 2 4 5 1 3
125 2 41 2 3 5 2 1
126 2 54 2 5 5 2 1
127 2 54 2 4 5 2 4
128 2 64 2 5 3 2 5
129 1 55 2 5 3 2 5
130 2 41 2 3 5 2 1
131 1 24 2 2 2 2 5
132 2 32 2 3 1 2 1
133 2 38 2 4 2 2 1
134 2 66 2 7 5 2 1
135 2 28 2 4 5 2 5
136 1 47 2 3 2 2 5
137 1 66 2 5 3 2 1
138 2 23 2 3 5 2 4
139 1 24 2 4 3 2 4
140 2 23 2 3 5 2 5
141 1 86 2 5 3 2 5
142 2 78 2 6 5 2 5
143 2 44 2 2 2 2 5
144 1 36 2 5 3 2 1
145 2 30 2 2 5 2 1
146 1 47 2 3 2 2 5
147 2 35 2 5 5 1 5
148 2 28 2 5 3 1 5
149 2 25 2 4 5 1 5
150 1 57 2 5 3 1 5
151 1 50 2 5 3 1 5
152 2 64 2 5 5 2 5
153 1 24 2 2 2 3 1
154 2 43 2 4 5 2 5
155 2 29 2 3 2 2 5
156 2 57 2 5 3 2 1
157 2 60 2 3 1 2 5
158 2 50 2 5 5 1 5
159 2 48 2 3 5 1 5
160 2 42 2 5 5 1 1
161 2 79 2 6 5 1 5
162 1 48 2 5 3 1 5
163 2 45 2 4 5 1 1
164 2 28 2 3 5 1 1
165 2 62 2 5 3 1 5
166 2 47 2 4 5 1 5
167 1 74 2 6 5 1 1
168 2 74 2 5 3 1 5
169 1 79 2 5 3 1 1
170 1 35 2 3 2 1 1
171 2 24 2 3 5 1 5
172 2 43 2 3 5 1 1
173 1 53 2 3 3 2 1
174 2 32 2 5 5 2 1
175 2 49 2 3 5 2 5
176 2 46 2 5 5 2 5
177 1 73 2 5 3 2 5
178 2 67 2 5 5 2 5
179 1 23 2 3 6 2 5
180 2 65 2 3 5 2 1
181 2 37 2 3 5 2 1
182 2 29 2 4 5 2 1
183 1 20 2 4 2 3 5
184 1 64 2 4 2 3 2
185 2 56 2 6 3 3 5
186 2 47 2 3 5 3 3
187 2 25 2 3 5 3 1
188 2 43 2 3 2 3 5
189 2 21 2 3 5 3 4
190 1 59 2 4 3 3 5
191 1 61 2 3 2 3 1
192 2 63 2 4 5 3 1
193 2 58 2 4 5 3 5
194 2 28 2 3 1 3 2
195 2 74 2 6 3 1 5
196 1 35 2 4 2 1 5
197 2 36 2 5 5 1 5
198 1 53 2 5 3 1 1
199 2 38 2 3 5 1 5
200 2 54 2 4 5 1 2
201 2 23 2 3 5 2 5
202 2 32 2 3 5 2 5
203 2 31 2 5 5 2 1
204 1 60 2 5 3 2 2
205 2 53 2 6 3 2 1
206 2 41 2 3 5 2 1
207 2 26 2 2 2 2 1
208 2 64 2 5 3 2 5
209 2 41 2 3 5 2 1
 Apakah sudah pernah
Apakah saat ini ada Jika Ya apakah ke dilakukan pemeriksaan Jika Ya, apakah hasil Jika tidak, adakah
anggota keluarga tempat pelayanan laboratorium (Lab)? pemeriksaannya penyakit yang
yang sedang sakit kesehatan normal? dicurigai diderita?

9 10 11 12 13
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 1 2 1
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 2 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 2 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 1 1 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 1 1 0
1 1 2 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 2 0 0
1 2 0 0 0
1 2 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
1 1 1 2 2
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 2 0 3
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 1 2 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
1 2 0 0 0
1 1 2 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 2 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
1 1 1 1 0
1 1 2 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 1 2 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
2 0 0 0 0
2 0 0 0 0
1 2 0 0 0
 Apakah dalam Bila Ya
Apakah dalam Apakah ada anggota Jika Ya apakah ke
keluarga memiliki Sebutkan
keluarga menderita penyakit keturunan? Jenis penyakit keluarga yang sakit 6 tempat pelayanan
penyakit tersebut? … bulan terakhir? kesehatan?

14 15 16 17 18
0 2 0 1 1
0 1 3 1 1
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 1 1 2 0
0 1 1 1 1
0 1 1 1 2
0 1 1 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 1 1 1 1
0 1 1 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 1 2
0 2 0 2 0
0 2 0 1 1
0 2 0 1 1
0 2 0 1 1
2 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 1 1 1 1
0 1 1 2 0
0 1 3 1 1
0 1 1 2 0
0 2 0 2 0
0 1 3 1 1
0 2 0 2 0
0 2 0 2 0
0 1 4 2 0
0 1 2 2 0
0 1 2 2 0
0 2 0 2 0
0 1 1 1 2
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 1 1 1 1
0 2 0 1 1
0 1 1 1 1
0 2 0 1 1
0 2 0 2 0
0 1 3 2 0
0 2 0 2 0
0 2 0 1 1
0 1 1 1 1
0 2 0 2 0
0 2 0 2 0
0 1 1 2 0
0 2 0 2 0
0 1 1 1 1
0 1 2 2 0
0 2 0 2 0
0 1 1 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 1 3 2 0
0 2 0 1 1
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 1 2
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 2 0 1 2
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 1 3 1 1
0 2 0 1 1
2 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 1 2
2 1 3 1 1
0 2 0 1 1
0 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 1 3 2 0
0 2 0 2 0
0 1 5 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 1 2
0 2 0 1 2
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 1 2
0 2 0 2 0
0 2 0 1 1
0 2 0 1 2
0 2 0 1 2
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 1 1 2 0
0 1 3 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 1 1 1 1
0 2 0 1 1
0 2 0 2 0
0 1 3 2 0
0 2 0 2 0
0 2 0 2 0
0 1 1 2 0
0 2 0 1 1
0 1 3 1 1
0 2 0 2 0
0 2 0 1 1
0 2 0 1 1
0 2 0 1 1
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 1 3 1 1
0 2 0 1 1
0 2 0 1 1
0 1 3 1 1
0 2 0 1 1
0 2 0 2 0
0 1 3 1 1
0 1 4 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 1 1
0 1 3 1 1
0 2 0 2 0
0 2 0 1 2
0 1 1 1 1
0 2 0 1 1
0 2 0 1 2
0 2 0 1 1
0 1 1 1 1
0 2 0 1 2
0 2 0 2 0
0 2 0 1 2
0 2 0 1 1
0 2 0 1 1
0 2 0 1 2
0 2 0 1 2
0 2 0 2 0
0 2 0 1 1
0 2 0 2 0
0 2 0 2 0
0 1 1 2 0
0 2 0 2 0
0 1 3 1 1
0 2 0 2 0
0 2 0 2 0
0 2 0 2 0
0 2 0 1 1
0 2 0 1 1
0 2 0 1 2
0 1 1 2 0
0 2 0 1 1
0 1 1 2 0
0 2 0 2 0
0 2 0 1 1
0 1 1 2 0
0 2 0 1 1
0 1 3 2 0
0 2 0 1 2
0 2 0 2 0
0 2 0 1 1
0 1 1 1 1
0 2 0 1 1
0 2 0 1 2
0 2 0 1 1
0 2 0 2 0
0 2 0 1 2
 Apakah sampai saat ini masih Penerangan/P
Jika Ya apakah Berapa lama obat itu mengkonsumsi obat tersebut dan
mengkonsumsi obat? telah dikonsumsi? terkontrol oleh tenaga kesehatan? Ventilasi encahayaan Lantai

19 20 21 22 23 24
1 1 2 3 3 3
1 5 1 3 3 3
1 1 2 3 3 3
0 0 0 2 2 3
0 0 0 2 2 3
1 1 1 2 2 3
0 0 0 2 3 1
1 2 2 2 3 1
0 0 0 3 3 3
1 1 2 3 3 3
0 0 0 3 3 3
0 0 0 2 3 3
0 0 0 2 2 3
1 1 1 2 2 3
1 5 1 2 2 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 1
1 3 1 1 3 3
1 1 2 3 3 3
1 1 2 3 3 1
1 2 1 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 2 1 3 3 3
1 2 1 3 3 3
0 0 0 3 3 3
1 1 2 3 3 2
0 0 0 1 1 3
0 0 0 2 2 3
1 1 2 2 2 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 2 3 3
0 0 0 2 2 3
0 0 0 2 2 3
0 0 0 2 2 3
0 0 0 1 2 3
0 0 0 3 2 1
0 0 0 3 2 1
0 0 0 3 3 3
1 1 2 3 3 3
0 0 0 2 2 3
1 1 2 3 3 3
1 1 2 3 3 3
1 2 2 3 3 3
1 1 2 2 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 1 2 3 3 3
1 1 2 2 2 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 2 2 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 4 1 3 3 3
0 0 0 3 3 3
0 0 0 2 2 3
1 1 2 2 3 3
0 0 0 1 1 1
0 0 0 3 3 3
0 0 0 3 3 3
1 3 1 3 3 3
0 0 0 3 3 3
1 1 1 3 3 3
1 1 1 2 3 3
0 0 0 3 2 3
0 0 0 1 3 3
0 0 0 2 2 3
1 1 1 2 3 3
0 0 0 3 3 3
0 0 0 1 3 3
0 0 0 3 3 3
1 1 2 2 3 3
0 0 0 3 3 3
0 0 0 2 3 3
0 0 0 3 3 3
0 0 0 1 3 3
0 0 0 1 2 3
0 0 0 3 3 3
1 2 1 3 3 1
1 1 2 3 3 2
0 0 0 3 3 3
1 1 2 3 3 3
0 0 0 3 3 1
0 0 0 3 3 1
0 1 2 2 2 1
1 1 2 3 2 1
1 3 2 3 3 3
0 0 0 3 3 3
1 1 2 3 3 3
0 0 0 2 3 3
0 0 0 2 3 3
1 1 2 2 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 1 2 3
0 0 0 1 3 3
1 1 1 2 2 1
0 0 0 3 3 3
0 0 0 2 2 3
0 0 0 3 3 3
0 0 0 1 2 1
0 0 0 2 2 3
0 0 0 3 3 3
1 1 1 2 3 3
0 0 0 3 3 3
0 0 0 2 3 1
0 0 0 2 3 3
1 4 1 1 3 1
1 4 1 2 3 3
0 0 0 1 3 1
0 0 0 1 2 3
0 0 0 2 2 1
1 1 1 2 2 1
0 0 0 1 2 3
0 0 0 3 3 3
2 1 2 3 3 3
0 0 0 3 3 3
0 0 0 2 2 3
2 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 2 3
0 0 0 3 2 3
0 0 0 2 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 2 2 3 3 1
0 0 0 3 3 3
1 1 2 2 2 3
1 1 2 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 1 2 2 2 3
1 1 2 3 3 3
0 0 0 3 3 3
1 1 2 3 3 3
1 1 2 3 3 3
1 1 2 1 2 3
1 1 1 1 3 1
0 0 0 3 3 3
0 0 0 2 3 3
0 0 0 2 3 1
1 1 1 2 3 3
1 1 2 3 3 3
1 1 2 3 3 2
1 1 2 3 3 3
1 2 2 3 3 3
0 0 0 3 3 3
1 1 2 2 3 3
0 0 0 3 3 3
0 0 0 2 3 3
0 0 0 2 2 3
0 0 0 1 1 1
1 1 2 3 3 3
1 1 2 3 3 3
1 1 2 2 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 5 1 2 3 3
1 5 1 1 1 1
0 0 0 3 3 3
1 1 2 3 3 3
1 1 2 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 1 2 3 3 1
1 1 2 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 1
1 1 2 3 3 3
0 0 0 3 3 1
0 0 0 3 3 3
0 0 0 2 3 3
0 0 0 3 3 3
1 5 1 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 1 2 3 3 3
1 1 2 3 3 3
0 0 0 2 3 3
0 0 0 3 3 3
1 1 2 3 3 3
0 0 0 2 2 3
0 0 0 2 3 3
1 1 2 2 3 1
0 0 0 3 3 3
1 1 2 2 2 3
0 0 0 3 3 3
0 0 0 3 3 3
0 0 0 3 3 3
1 1 2 3 3 1
1 2 2 3 3 3
1 1 1 3 3 3
0 0 0 2 2 3
1 1 2 3 3 3
0 0 0 3 2 3
0 0 0 2 2 3
 Tempat Makanan
Tempat Sumber Buang Air Jenis pokok yang Sayuran Buah Makanan yang
Pembuanga selalu mengandung
n Sampah air bersih Besar (BAB) : Jamban dikonsumsi : dikonsumsi dikonsumsi protein

25 26 27 28 29 30 31 32
2 1 4 3 1 1 1 1
2 1 4 3 1 2 3 1
2 2 4 3 1 2 3 1
2 1 4 3 1 2 3 1
2 1 4 3 1 1 3 1
2 2 4 3 1 1 1 1
2 2 4 3 1 2 3 1
2 2 4 2 1 2 2 1
2 2 4 3 1 2 3 1
2 1 4 3 1 1 2 1
2 2 4 3 1 1 2 1
2 1 4 3 1 3 3 1
2 2 4 3 1 2 3 1
2 2 4 3 1 2 3 1
2 2 4 3 2 1 4 1
2 2 4 3 1 1 2 1
2 1 4 3 1 1 1 1
2 1 4 3 1 2 2 1
2 2 4 3 1 1 2 1
2 2 4 3 1 2 3 1
2 1 4 3 1 1 2 1
2 2 4 3 1 2 2 1
2 1 4 3 1 1 3 1
2 1 4 3 1 1 1 1
2 1 4 3 1 1 3 1
2 1 4 3 1 1 2 1
2 2 4 3 1 1 1 1
2 1 4 3 1 1 2 1
1 2 4 3 1 2 3 1
1 3 4 3 1 1 2 1
1 2 4 2 1 1 2 2
1 2 4 3 1 2 3 1
2 1 4 3 1 1 3 1
2 2 4 3 1 1 3 1
1 2 4 3 1 1 1 1
1 1 4 3 1 1 1 1
1 1 4 3 1 1 1 1
1 1 4 3 1 1 1 1
1 2 4 3 1 1 1 1
2 2 4 3 1 1 1 1
2 2 4 3 1 1 1 1
2 1 4 3 1 1 1 1
2 2 4 3 1 1 3 1
2 1 4 3 1 1 3 1
2 1 4 2 1 1 3 1
2 1 4 3 1 1 2 1
2 1 4 2 1 3 3 1
2 1 4 3 1 1 2 1
2 1 4 3 1 1 1 1
2 1 4 3 1 1 1 1
2 1 4 2 1 2 3 1
2 1 4 3 1 1 3 1
1 2 4 2 2 1 2 2
1 2 4 2 1 2 3 1
2 1 4 3 1 1 1 1
2 1 4 3 1 1 1 2
2 1 4 3 1 1 1 1
2 1 4 3 1 1 2 1
1 2 4 3 1 1 1 1
2 1 4 3 2 1 1 1
2 1 4 3 1 1 1 1
1 1 4 3 1 1 3 1
1 1 4 3 1 3 1 2
1 1 4 3 1 2 3 2
1 2 4 3 1 1 2 1
2 1 4 3 1 1 1 1
2 1 4 3 1 1 2 1
2 1 4 3 1 1 2 1
1 1 4 3 1 1 2 1
1 2 4 3 1 1 2 1
2 2 4 2 1 1 1 1
1 1 4 3 1 2 3 1
1 2 4 3 1 1 3 1
2 2 4 3 1 1 2 1
1 1 4 3 1 1 3 1
2 1 4 3 1 2 2 1
2 1 4 3 1 1 1 1
2 2 4 3 1 1 3 2
2 1 4 3 1 2 2 2
2 2 4 3 1 2 1 2
1 2 4 3 1 2 2 2
1 1 4 3 1 1 1 1
1 2 4 3 1 2 3 1
2 1 4 3 1 2 3 1
2 1 4 3 1 1 3 1
1 1 4 3 1 3 3 1
1 2 4 2 1 1 3 1
1 2 4 3 1 2 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 2 1
2 1 4 3 1 1 2 3
2 2 4 3 1 1 1 1
2 2 4 3 1 1 2 1
2 2 4 2 1 2 1 2
2 2 4 2 1 2 1 2
2 2 4 3 1 1 1 2
2 2 4 2 1 2 3 2
2 2 4 3 1 2 2 1
3 2 4 2 1 1 3 2
1 2 4 2 1 1 3 1
2 2 4 2 1 1 3 1
2 2 4 3 1 1 3 2
2 2 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 2 3 2
2 2 4 3 1 1 3 2
2 1 4 3 1 1 1 2
2 2 4 3 1 2 3 1
2 1 4 3 1 1 3 1
2 2 4 3 1 1 1 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 1 1
2 2 4 3 1 1 1 1
2 2 2 3 3 1 1 3
2 2 3 1 1 1 1 3
2 1 4 3 1 1 3 1
2 2 4 3 1 1 2 1
2 2 4 3 1 2 1 1
2 2 3 1 1 3 1 4
2 2 3 1 1 2 1 2
1 2 3 1 1 2 1 3
2 1 4 3 1 1 2 1
2 1 4 3 1 1 1 1
2 2 4 3 1 1 1 2
2 1 4 3 1 1 2 1
2 2 4 2 1 1 2 1
2 2 4 3 1 2 1 2
2 2 4 3 1 1 3 1
2 2 4 3 1 1 2 1
2 1 4 3 1 1 2 1
2 1 4 3 1 2 3 1
2 1 4 3 1 1 1 1
1 2 4 3 1 2 3 1
1 1 4 2 1 1 1 1
2 1 4 2 1 2 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 1 4 3 1 2 3 1
2 1 4 3 1 2 3 1
2 2 4 2 1 2 3 1
2 1 4 3 1 1 3 1
2 1 4 3 1 1 3 1
2 1 4 3 1 1 3 1
2 1 4 2 1 1 3 1
2 2 4 2 1 1 1 2
2 2 4 2 1 1 1 1
2 2 4 2 1 2 2 2
2 1 4 3 1 2 2 1
2 1 4 3 1 1 1 2
2 2 4 3 1 1 1 1
2 2 4 3 1 1 1 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 1 4 3 1 2 3 1
2 1 4 3 1 1 3 1
2 2 4 3 1 1 2 1
2 2 4 2 1 1 3 1
2 2 4 2 1 1 1 1
2 2 4 2 1 1 2 1
2 2 4 3 1 1 1 1
2 2 4 3 1 1 1 1
2 2 4 2 1 1 2 1
2 2 4 3 1 1 1 1
2 2 4 3 1 1 1 1
2 1 4 3 1 2 2 1
2 1 4 3 1 1 2 1
2 2 4 3 1 1 2 1
2 2 4 3 1 1 2 1
2 1 4 3 1 2 2 1
2 2 4 3 1 1 2 1
1 1 4 3 1 1 1 1
2 1 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 2 3 2
2 1 4 3 1 1 2 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 1 3 1
2 2 4 3 1 2 3 1
2 2 4 3 1 2 3 1
2 2 4 3 1 2 3 2
2 1 4 3 1 1 1 2
2 2 4 3 1 1 3 2
2 2 4 3 1 1 3 1
2 2 4 3 1 2 3 1
2 1 4 3 1 1 3 1
2 1 4 3 1 1 2 1
2 2 4 3 1 1 3 1
2 1 4 2 1 1 3 1
2 1 4 3 1 1 1 1
2 1 4 3 1 1 2 1
2 1 4 3 1 1 3 1
1 1 4 3 1 1 2 1
2 1 4 3 1 2 3 1
1 1 4 3 1 2 2 1
2 2 4 3 3 2 3 2
2 2 4 3 1 1 3 1
2 1 4 2 1 1 3 1
2 2 4 3 1 1 3 1
2 1 4 3 1 1 1 1
2 2 4 3 1 1 2 2
2 1 4 3 1 1 3 1
2 1 4 3 1 1 1 1
1 1 4 3 1 1 1 1
2 1 4 3 1 2 2 1
2 2 4 2 1 1 2 1
1 1 4 3 1 1 1 1
Makanan Makanan/ Minuman Kebiasaan
Bumbu Minuman Mandi Sikat Gigi Cuci
diawetkan Minuman berkafein Potong
Penyedap Beralkohol Rambut Kuku
Manis (Kopi,teh)

33 34 35 36 37 38 39 40 41
3 3 1 1 4 1 2 2 1
4 4 4 1 4 1 1 2 1
4 4 3 3 4 1 2 2 2
3 3 1 3 3 1 1 2 1
3 3 1 1 4 1 2 2 1
1 1 1 1 3 1 2 2 1
4 4 1 1 4 1 1 2 1
1 4 1 1 1 1 1 1 1
4 4 1 1 2 1 2 2 1
2 3 1 1 3 2 1 2 2
3 3 1 1 3 1 2 2 1
4 4 1 1 3 1 2 2 2
4 4 1 1 3 1 2 2 1
4 4 1 1 4 1 1 2 1
4 4 1 1 4 1 2 2 2
4 4 1 1 2 1 2 2 1
3 3 1 1 3 1 2 2 1
2 4 1 1 1 1 2 2 1
2 4 1 1 2 1 2 2 1
3 2 2 1 4 1 1 2 2
2 1 2 1 3 2 2 2 1
3 2 1 1 1 1 1 2 1
3 2 1 1 4 1 2 2 1
4 1 1 1 1 1 2 2 1
4 4 1 1 4 1 2 2 1
4 4 1 3 4 1 2 2 1
4 4 1 1 1 1 2 2 1
2 3 1 1 4 1 2 2 1
1 3 1 1 2 1 2 2 1
3 3 1 3 3 1 2 2 1
2 2 1 1 3 2 2 2 1
2 2 1 1 3 2 2 2 1
2 1 1 1 3 1 2 2 1
3 4 1 1 2 2 2 2 1
3 3 2 1 4 2 2 2 1
2 3 1 1 1 2 2 2 2
2 3 1 1 1 2 2 2 2
2 3 1 1 1 2 2 2 2
3 1 1 1 4 1 1 2 1
2 3 1 1 3 1 2 2 1
2 3 1 1 3 1 2 2 1
1 2 1 1 1 2 2 2 1
3 3 1 1 3 2 2 2 1
3 3 1 3 4 1 2 2 1
4 4 1 1 4 1 2 2 2
3 4 1 1 4 1 1 2 1
3 4 2 1 4 1 1 2 2
3 4 1 4 3 2 2 2 2
3 4 1 4 4 1 1 2 2
4 4 1 1 4 1 1 2 2
4 4 1 4 3 2 2 2 1
3 3 1 1 3 1 2 2 1
2 4 2 4 4 2 2 2 2
3 4 1 1 2 1 2 2 2
2 4 1 2 1 2 2 2 2
3 3 3 1 4 1 1 1 2
3 2 1 1 4 2 2 2 1
3 1 1 1 4 1 2 2 1
3 3 1 1 3 1 2 2 1
3 2 1 3 4 2 2 2 1
3 3 1 1 1 2 2 2 1
3 4 1 1 4 1 2 2 1
4 1 1 2 1 2 2 2 1
4 4 1 1 4 1 1 2 1
2 4 1 1 4 1 1 2 2
3 3 1 1 3 2 2 2 1
3 1 1 1 3 1 2 2 1
2 4 1 1 1 2 2 2 1
2 3 1 1 4 2 2 2 2
2 3 1 1 2 1 1 2 2
3 3 1 1 4 1 1 2 1
3 3 1 1 1 1 1 2 1
3 3 1 1 4 1 1 2 1
4 4 1 1 4 1 2 2 1
3 4 1 1 3 1 2 2 1
3 4 1 1 2 1 2 2 1
3 4 1 1 4 1 1 2 1
3 3 1 1 3 1 2 2 1
3 1 1 1 2 1 1 2 1
2 3 1 2 3 2 2 2 1
3 2 1 1 3 1 2 2 1
2 3 1 1 3 1 2 2 1
1 4 2 1 1 1 2 2 1
1 3 1 1 3 2 2 2 1
4 4 2 1 4 1 2 2 2
3 3 1 1 3 1 2 2 1
3 3 1 1 4 2 2 2 2
4 4 1 1 3 1 2 2 2
3 3 1 1 1 1 2 2 1
2 2 1 1 3 2 2 2 1
3 3 2 1 2 2 2 2 1
3 3 1 1 3 1 2 2 1
2 3 1 1 3 1 2 2 2
3 1 1 1 3 1 1 2 1
3 1 1 1 3 1 1 2 1
3 3 1 1 3 2 2 2 1
3 3 1 2 4 1 2 2 1
3 2 1 1 4 2 2 2 1
3 3 1 1 3 1 1 2 1
3 3 1 1 4 1 2 2 1
3 3 1 4 4 2 2 2 2
3 4 1 1 2 1 2 2 1
4 4 1 1 1 1 2 2 1
3 4 1 1 3 1 1 2 1
2 3 1 1 1 1 2 2 1
2 4 1 1 4 2 2 2 1
4 4 1 1 4 1 2 2 1
4 4 1 1 1 2 2 2 1
3 4 1 1 1 1 2 2 1
3 4 1 1 4 1 2 2 1
4 4 1 1 3 1 2 2 1
3 3 1 3 1 2 2 1 1
4 3 1 1 2 2 2 2 1
3 4 4 1 3 1 2 2 1
4 4 1 4 2 2 2 2 1
1 3 3 1 1 2 2 2 2
4 1 1 2 1 2 2 1 1
3 4 1 1 1 1 1 2 1
2 1 2 2 1 1 2 1 1
2 2 1 1 3 1 2 2 1
4 1 2 1 1 1 2 1 1
3 2 3 1 1 2 1 1 1
3 1 1 4 2 2 2 1 1
4 4 1 2 2 1 2 2 2
2 4 4 1 3 1 1 2 1
3 3 1 3 1 2 2 2 1
3 2 1 1 3 2 2 2 1
3 2 1 2 2 2 2 2 1
2 2 1 1 2 1 2 2 1
3 1 1 1 2 1 2 2 1
4 2 1 4 1 2 2 2 1
4 2 1 1 4 2 2 2 1
3 3 1 1 3 2 2 2 1
3 4 3 1 3 2 2 2 2
2 3 1 1 2 1 2 2 1
1 3 1 1 2 2 2 2 1
3 3 1 1 2 1 1 2 1
2 4 1 1 3 2 2 2 2
3 3 1 1 2 1 1 2 1
3 3 1 1 3 1 1 2 1
3 3 1 4 3 2 1 2 2
3 3 1 1 4 2 1 2 1
3 1 1 4 2 2 2 2 2
4 3 1 1 4 1 2 2 1
4 4 1 1 4 2 2 2 2
1 3 1 1 2 2 2 2 1
3 3 1 1 1 1 2 2 1
3 3 1 1 4 1 2 2 1
2 2 1 1 3 1 2 2 1
1 3 1 1 3 1 1 2 1
4 4 1 1 1 1 1 2 1
4 4 2 1 3 1 2 2 1
3 1 1 1 3 2 2 2 1
1 4 1 1 2 1 2 2 2
2 4 1 1 3 1 2 2 2
3 4 1 1 4 1 2 2 2
3 1 3 1 2 2 2 2 2
3 3 1 1 1 1 1 2 1
3 1 1 1 3 1 2 2 1
3 3 1 1 2 2 2 2 1
3 4 1 1 4 1 2 2 1
2 1 1 1 1 1 1 2 1
1 3 1 1 1 1 2 2 2
3 1 1 1 3 2 2 2 2
3 3 1 1 4 2 2 2 1
3 4 1 1 4 2 2 2 1
3 1 1 3 3 2 2 2 1
3 2 1 2 1 2 2 2 1
3 3 1 1 3 1 1 2 1
3 3 1 1 3 1 1 2 1
3 2 1 1 3 2 2 2 1
3 1 1 1 1 2 2 2 1
3 3 1 4 1 2 2 2 1
3 1 1 1 2 1 2 2 1
3 1 1 1 3 1 2 2 1
3 3 1 1 4 1 2 2 1
3 2 1 1 4 2 2 2 1
3 2 1 1 1 1 2 2 1
3 2 1 1 1 1 2 2 1
3 1 1 1 4 2 2 2 1
2 1 1 1 3 1 2 2 1
3 3 4 1 3 1 2 2 1
3 4 2 1 2 2 2 2 1
2 3 1 1 4 1 1 2 1
3 4 1 1 2 1 1 2 1
3 3 1 1 4 1 2 2 1
3 3 1 1 4 2 2 2 1
3 3 1 1 3 1 2 2 2
3 3 1 1 3 1 2 2 2
4 4 1 1 4 1 2 2 2
4 4 1 1 1 2 2 2 1
4 3 2 1 4 1 1 2 2
4 4 1 1 3 1 2 2 1
3 3 1 1 3 2 2 2 2
4 4 1 1 4 1 2 2 1
3 3 1 1 3 1 1 2 1
3 3 1 1 3 1 1 2 1
3 4 1 1 4 1 2 2 1
3 3 1 1 2 1 1 2 1
3 3 1 1 1 1 2 2 1
3 2 1 1 4 2 2 2 1
3 4 1 1 4 2 2 2 1
3 4 1 1 1 2 2 2 1
3 3 1 4 1 1 1 2 1
4 3 1 1 3 1 2 2 1
2 4 4 1 3 1 1 2 1
2 4 2 1 3 1 2 2 1
3 2 1 2 2 2 2 2 1
2 4 4 1 3 1 1 2 1
 Apakah setiap Apakah keluarga
Cuci Jika Ya
Cuci anggota keluarga melakukan
tangan Bila Ya menggunakan air dilakukan Jenis
tangan menggunakan pemeriksaan
sebelum sesudah mengalir dan setiap berapa pemeriksaan
selimut/handuk kesehatan secara
makan Buang Air menggunakan sabun bulan ? yang dilakukan
sendiri? berkala?
Besar
42 43 44 45 46 47 48
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 2 1 1 2
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 1 2 2
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 2 2 1 1 2
1 1 2 1 1 2 1
1 1 1 1 1 2 3
1 1 1 1 1 2 3
1 1 1 1 1 2 3
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 1 1 2
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 2 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 1 2 2
1 1 1 1 2 0 0
1 1 2 1 1 1 2
1 1 1 1 1 1 1
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 2 2
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 1 1 1
1 1 2 1 2 0 0
1 1 2 2 2 0 0
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 1 2 2
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 2 1 2 1 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 1 1 2
1 1 1 1 1 1 2
1 1 1 2 2 0 0
1 1 2 2 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 1 1 2
1 1 1 1 1 1 2
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 2 1 2 2 0 0
1 1 1 2 2 0 0
1 1 2 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 2 1 2 0 0
1 1 2 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 2 1 1 2
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 2 1 1 2
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 1 1 2
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 2 1 2 0 0
1 1 2 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 1 1 2
1 1 2 1 2 0 0
1 1 1 2 1 1 2
1 1 2 2 2 0 0
1 1 2 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 2 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 1 1 3
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 2 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
2 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 1 1 2
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 1 1 2
1 1 1 2 1 1 3
1 1 1 2 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 1 1 2 0 0
1 1 2 2 2 0 0
1 1 2 1 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 1 2 0 0
1 1 1 2 2 0 0
1 1 1 2 2 0 0
 Setelah
melakukan
pemeriksaan
upaya apa
yang dilakukan
:
49
0
0
0
0
0
0
0
1
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
3
3
2
2
2
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
3
3
0
0
0
0
2
0
0
2
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
3
2
0
0
0
0
0
0
0
0
0
0
3
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
2
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Jenis Kelamin 1 Laki-laki
2 Perempuan
Agama 1 Islam
2 Kristen Protestan
3 Khatolik
4 Hindu
5 Budha
Pendidikan 1 Strata 2
2 Strata 1
3 SLTA
4 SLTP
5 SD
6 Tidak sekolah
7 Diploma
Pekerjaan 1 PNS
2 Swasta
3 Petani
4 Nelayan
5 Tidak bekerja
6 Lainnya
Alamat 1 Jaga 1
2 Jaga 2
3 Jaga 3
Golongan Darah 1 A
2 B
3 O
4 AB
5 Tidak tahu
Pertanyaan 1 a
2 b
3 c
4 d
Penyakit 1 Malaria
2 DHF
3 Ginjal
4 TBC
5 Typoid
6 Kencing Manis
7 Hepatts / Liver
8 Asam Urat
9 Penyakit Cacing
10 Penyakit Mata
11 Tiroid Kista
12 Hipertensi
Penyakit Keturunan 1 Asam Urat
 2 Kolesterol
3 Hipertensi
4 DM
5 Jantung
Mandi & cuci rambut 1 < 2x
2 ≥ 2x
Potong Kuku 1 < 2 kali seminggu
2 ≥ 2 kali seminggu
Sikat Gigi 1 < 1x
2 ≥ 2x
3
3
3
3 Konsul dokt 6 22%
3 Konsul dokt 12 46%
3 Tdk konsul, 9 35% PEMERIKS
3 4. Setelah melaku
Takut konsu 0 0%
3 27 103% 12
3
2 6
2
2
2
2 i
a rga a hl
2 lu r
ke kte
2 kter
l do
do nsu
2 l
Ko
n su
2 Ko k
Td
2
2
2
1
1
1
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 DISTRIBUSI RESPONDEN
PEMERIKSAAN KESEHATAN SECARA BERKALA
4. Setelah melakukan pemeriksaan upaya apa yang dilakukan

12
9
6

i l0
a rga a hl ah
u
su
lu r rt on
ke kte da t k
er do ke ku
kt l s e Ta
do nsu ul
,
ul Ko ns
ns ko
k
Td