BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR

PUSKESMAS : SIDOTOPO
BULAN : januari
TAHUN : 2018

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO REGISTRASI NAMA
OK LENGKAP AN/
RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 12/26/2017 CATIN Antonius Didik Tri Wibowo 48 jl suripto swasta
2 12/26/2017 CATIN Estiarni 47 sukodonoswasta
3 1/2/2018 CATIN Ainul Yaqin 25 danakaryaswasta
4 1/2/2018 CATIN Hayyu Norma Susanti 26 sidotopo swasta
5 1/4/2018 CATIN Hikma Faruq Okbah 32 ampel gadswasta
6 1/4/2018 CATIN Rahmawati 24 sidotopo swasta
7 1/4/2018 CATIN Zakiya Husin Al-Amri 21 ampel wira swasta
8 1/4/2018 CATIN Muhammad Fauzan 21 nyamplung swasta
9 1/4/2018 CATIN Putri Rahayu 17 sidotopo swasta
10 1/4/2018 CATIN Abdul Halim 27 danakaryaswasta
11 1/4/2018 CATIN Nanang Sugiharto 54 petukangaswasta
12 1/4/2018 CATIN Imam Muslim 41 ampel racswasta
13 1/4/2018 CATIN Djabal Nur Ardiani 43 lemah putswasta
14 1/4/2018 CATIN Mahmudah 23 taman iraw swasta
15 1/6/2018 CATIN Lilik Maufiroh 19 sidotopo kswasta
16 1/6/2018 CATIN Maisyaroh 19 surtikanti swasta
17 1/6/2018 CATIN Prisca Dinavanni 22 sidotopo lswasta
18 6/1/2018 CATIN Herman Candra P 26 tenggumuswasta
19 6/1/2018 CATIN Rinanti Dea Sagita 20 komplek sswasta
20 8/1/2018 CATIN Eko Hadi P 26 dsn mulyoswasta
21 8/1/2018 CATIN Rinatul Mahmoeda 22 belakang swasta
22 8/1/2018 CATIN Busri Bunadi 40 sidotopo swasta
23 8/1/2018 CATIN Yahyakarta 40 sidotopo swasta
24 8/1/2018 CATIN Dwi Panglipur Ningsih 37 sidotopo swasta
25 8/1/2018 CATIN Muhammad 51 ampel wira swasta
26 9/1/2018 CATIN Ririn Sundari 24 nyamplunswasta
27 9/1/2018 CATIN M. Said Bachris 24 sukodonoswasta
28 10/1/2018 CATIN Fatimah 44 ampel kejswasta
29 10/1/2018 CATIN Vinajaha Farida 25 surtikanti swasta
30 13-1-18 CATIN Rizki Rahmadi 26 jl pyrus n swasta
31 13-1-18 CATIN Abdullah Mutahar 32 ketapang swasta
32 15-1-18 CATIN Benny 30 abimanyuswasta
33 15-1-18 CATIN Mee Nio 41 simolowaru swasta
34 15-1-18 CATIN Ekowandi 29 irawati 2/ swasta
35 17-1-18 CATIN Ngadimin 61 sidotopo swasta
36 17-1-18 CATIN Moch. Mustaim 22 sidotopo jswasta
37 1/17/2018 CATIN Tiffany Erica 19 Komplek S swasta
38 1/17/2018 CATIN Sakinah Al Machfud 21 nyamplung swasta
39 1/18/2018 CATIN M. Rafi 23 sumbo 62iswasta
40 1/18/2018 CATIN Pausieh 24 sambongaswasta
41 1/18/2018 CATIN M. Syamsul Arifin 27 sidotopo swasta
42 1/20/2018 CATIN M. Ridho 23 danakaryaswasta
43 1/20/2018 CATIN Nurul Fadiyah 24 bulak banswasta
44 1/20/2018 CATIN Andi Mochammad Ilham 33 sidotopo lswasta
45 1/20/2018 CATIN A. Dian Pratiwi Augria 26 Borong Raswasta
46 1/20/2018 CATIN M. Rizal 21 bolodewoswasta
47 1/22/2018 CATIN Nisriina Hamdoen 22 wijaya ku swasta
48 1/23/2018 CATIN Adief Hein Permana 31 nyamplung swasta
49 1/23/2018 CATIN Satumar 64 wonokusum swasta
50 1/23/2018 CATIN Siti Sundari 42 sidotopo jswasta
51 1/23/2018 CATIN Ach Nor Rony 23 kebon dalswasta
52 1/24/2018 CATIN Agustin Indahsari 21 sidotopo swasta
53 1/25/2018 CATIN Septiana Saraswati 22 sidotopo 5swasta
54 1/25/2018 CATIN Kamal Habibi Bagar 25 perum ITSswasta
55 1/25/2018 CATIN Anika 42 sidotopo swasta
N KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA PERNAH TEST HEP B

STATUS PUNYA
MASA PERKAWINA KHAS
KERJA
(Tahun) N (Kawin/Tdk GEJALA
Kawin) BELUM HEPATITIS URINE GELAP IKTERIK
1X 2X 3X TEMPAT TES
PERNAH (Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

calon pengantv tdak puskesmas

calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
calon pengantv tdak puskesmas
HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKSI D

HBsAg Anti HBs Anti HBC SGPT/ALT Anti HBe

WAKTU
WAKTU MELAKUKAN TEMPAT TES MELAKUKAN
TES TES R NR (Titer IU/l) R NR (W : < 32) R

21 22 23 24 25 26 27 28 29 30

12/26/2017
12/26/2017
1/2/2018
1/2/2018
1/4/2018
1/4/2018
1/4/2018
1/4/2018
1/4/2018
1/4/2018
1/4/2018
1/4/2018
1/4/2018
1/4/2018
1/6/2018
1/6/2018
1/6/2018
6/1/2018
6/1/2018
8/1/2018
8/1/2018
8/1/2018
8/1/2018
8/1/2018
8/1/2018
9/1/2018
9/1/2018
10/1/2018
10/1/2018
13-1-18
13-1-18
15-1-18
15-1-18
 15-1-18
17-1-18
17-1-18
1/17/2018
1/17/2018
1/18/2018
1/18/2018
1/18/2018
1/20/2018
1/20/2018
1/20/2018
1/20/2018
1/20/2018
1/22/2018
1/23/2018
1/23/2018
1/23/2018
1/23/2018
1/24/2018
1/25/2018
1/25/2018
1/25/2018
 PERNAH
MENGGU
SAAN SEBELUM DETEKSI DINI PERNAH PUNYA NAKAN
PERNAH MENJALA PASANGA NARKOB
TRANSFU NI N SEKS A/JARUM
Anti HBe HBeAg HBV DNA Anti HCV SI DARAH HEMODI LAIN SUNTIK
(Ya/Tdk) ALISA (Ya/Tdk) BERSAM
NR R NR (IU/ml) R NR (Ya/Tdk) A
31 32 33 34 35 36 37 38 39
(Ya/Tdk)
40

tdak tdak tdak tdak

tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
 KELUARGA ADA
MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
ATAU C
YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R NR
Suami/Ist
41 42 43 44 45 46 47 48 49 50
LAH DETEKSI DINI REKOMENDASI DAN TINDAK LANJUT

HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif TGL IMUNISASI HEP B

Terapi 24-48 Terapi 48-72

R NR (IU/ml) R NR monitor Terapi mgg mgg 1

51 52 53 54 55 56 57 58 59 60
ASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

2 3 HEP B HEP C

61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR
PUSKESMAS : SIDOTOPO
BULAN : februari
TAHUN : 2018

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO NAMA
REGISTRASI OK LENGKAP AN/
RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 27-1-18 catn Syaiful Bahri 27 jl gersik swasta
2 27-1-18 catn Ulifatul Badriyah 23 petukangaswasta
3 29-1-18 catn Eliyana AS 40 ampel meswasta
4 29-1-18 catn Agung Pratomo Putro 26 tanggulang swasta
5 29-1-18 catn Yunita Sri Wijayanti 27 sombo 3/ swasta
6 29-1-18 catn Yanuar Erdian Prasatya 30 ampel kesswasta
7 30-1-18 catn Zainal Fatah 21 dsn gununswasta
8 30-1-18 catn Sri Handayani 18 sidotopo swasta
9 30-1-18 catn Dairul Hakim 20 nyamplung swasta
10 30-1-18 catn Anik Ummila 23 danakaryaswasta
11 31-1-18 catn Achmad Junaidi 20 arimbi bu swasta
12 1/2/2018 catn Nur Amalia S 15 nyamplunswasta
13 1/2/2018 catn Mochammad Lutfi 27 prabowo swasta
14 1/2/2018 catn Siti Nurhasanah 27 dsn pang swasta
15 1/2/2018 catn Farid Toriq 29 nyamplung swasta
16 1/2/2018 catn Halim 40 komplek sswasta
17 3/2/2018 catn Obed Bayagub 58 nyamplung swasta
18 3/2/2018 catn Ali Sukaesih 41 jenang swasta
19 3/2/2018 catn Husin Jabal 25 nyamplung swasta
20 3/2/2018 catn Noer Maghfiroh 23 ampel gadswasta
21 3/2/2018 catn Ismatul Hasanah 21 surtikanti swasta
22 5/2/2018 catn Sipul 23 dsn laodaswasta
23 5/2/2018 catn Mas Ruroh 23 sidotopo jswasta
24 5/2/2018 catn Randy Angga Kusuma 28 ampel mas swasta
25 5/2/2018 catn Abdul karim 26 nyamplunswasta
26 6/2/2018 catn Hikmah 34 nyamplung swasta
27 6/2/2018 catn Ika Purwati Devi 19 prabowo swasta
28 6/2/2018 catn Andri Purnomo 44 kedung taswasta
29 6/2/2018 catn Yeni Wahyuni 35 sidotopo lswasta
30 7/2/2018 catn Dwi Faisol Bahari 26 masanganswasta
31 6/2/2018 catn Farah Ihya Ul Haque 23 sukodonoswasta
32 2/7/2018 catn Abdullah Fitroni 50 sememi ba swasta
33 2/7/2018 catn Anik Widjayanti 47 sidotopo swasta
34 2/8/2018 catn M. Fauzi 23 ketapang swasta
35 2/8/2018 catn Izzatul Islamiyah 20 surtikanti swasta
36 2/10/2018 catn Luis Leoni 21 ds sumberswasta
37 2/10/2018 catn Novelia 19 sidotopo kswasta
38 2/10/2018 catn Dania Bt. Said Hayaza 27 ampel gubswasta
39 2/12/2018 catn Nadia 23 sidotopo swasta
40 2/12/2018 catn Maskur 20 surtikanti swasta
41 2/13/2018 catn Nur Azizah 23 nyamplunswasta
42 2/13/2018 catn Mochammad Agus Arifin 22 ampel ra swasta
43 2/17/2018 catn Arti Amalia 20 sidotopo swasta
44 2/17/2018 catn Bagus Setiabudi 29 krembanga swasta
45 2/17/2018 catn Rusmiyah 27 bolodewoswasta
46 2/17/2018 catn Silvi Lailatur Rohmah 28 sombo 3/ swasta
47 2/12/2018 catn Dwi Sutrisno 30 wonorejo swasta
48 2/17/2018 catn Yuliawati 23 komplek sswasta
49 2/17/2018 catn Hervinda Fiki A. 21 dapuan 2 swasta
50 2/19/2018 catn Rachmad Andriyanto 38 petukangaswasta
51 2/19/2018 catn Imron 43 danakaryaswasta
52 2/19/2018 catn M. Fatchur Rozi 24 nyamplunswasta
53 2/21/2018 catn Kemas Muhammad Zulfikar 23 ampel kejswasta
54 2/21/2018 catn Fausi 21 dsn sumbe swasta
55 2/21/2018 catn Fitriyah Sari 17 arimbi bunswasta
56 2/21/2018 catn Harifah 40 danakaryaswasta
57 2/22/2018 catn Madinatur Munawarah 26 nyamplung swasta
58 2/22/2018 catn Zaini 30 dsn labis swasta
59 2/22/2018 catn Naji Abdurahman Bawazier 27 KHM. Manswasta
60 2/23/2018 catn Fahmi Hadi 22 nyamplung swasta
61 2/24/2018 catn Nur Chumaidi 30 wedoro utswasta
62 2/24/2018 catn Nur Dini Cholidah 17 surtikanti swasta
ELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS PERNAH TEST HEP B
PUNYA
MASA PERKAWI KHAS
KERJA NAN GEJALA
(Tahun) (Kawin/T BELUM
1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH TEMPAT TES
(Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

belum men v pkm sidot

belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
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belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
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belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
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belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
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belum men v pkm sidot
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belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
belum men v pkm sidot
HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKSI DIN

HBsAg Anti HBs Anti HBC SGPT/ALT Anti HBe

WAKTU
WAKTU
MELAKUKAN TES TEMPAT TES MELAKUKAN
TES R NR (Titer IU/l) R NR (W : < 32) R

21 22 23 24 25 26 27 28 29 30

27-1-18
27-1-18
29-1-18
29-1-18
29-1-18
29-1-18
30-1-18
30-1-18
30-1-18
30-1-18
31-1-18
1/2/2018
1/2/2018
1/2/2018
1/2/2018
1/2/2018
3/2/2018
3/2/2018
3/2/2018
3/2/2018
3/2/2018
5/2/2018
5/2/2018
5/2/2018
5/2/2018
6/2/2018
6/2/2018
6/2/2018
6/2/2018
7/2/2018
6/2/2018
2/7/2018
2/7/2018
 2/8/2018
2/8/2018
2/10/2018
2/10/2018
2/10/2018
2/12/2018
2/12/2018
2/13/2018
2/13/2018
2/17/2018
2/17/2018
2/17/2018
2/17/2018
2/12/2018
2/17/2018
2/17/2018
2/19/2018
2/19/2018
2/19/2018
2/21/2018
2/21/2018
2/21/2018
2/21/2018
2/22/2018
2/22/2018
2/22/2018
2/23/2018
2/24/2018
2/24/2018
 PERNAH
MENGGU
SAAN SEBELUM DETEKSI DINI PERNAH PUNYA NAKAN
PERNAH MENJALA PASANGA NARKOB
TRANSFU NI N SEKS A/JARUM
Anti HBe HBeAg HBV DNA Anti HCV SI DARAH HEMODI LAIN SUNTIK
(Ya/Tdk) ALISA (Ya/Tdk) BERSAM
NR R NR (IU/ml) R NR (Ya/Tdk) A
31 32 33 34 35 36 37 38 39
(Ya/Tdk)
40

tdak tdak tdak tdak

tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
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tdak tdak tdak tdak
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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
 KELUARGA ADA
MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
ATAU C
YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R NR
Suami/Ist
41 42 43 44 45 46 47 48 49 50
LAH DETEKSI DINI REKOMENDASI DAN TINDAK LANJUT

HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif TGL IMUNISASI HEP B

Terapi 24-48 Terapi 48-72

R NR (IU/ml) R NR monitor Terapi mgg mgg 1

51 52 53 54 55 56 57 58 59 60
ASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

2 3 HEP B HEP C

61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR
PUSKESMAS : SIDOTOPO
BULAN : maret
TAHUN : 2018

UMUR (Th)
JENIS KODE SPESIMEN
KELOMP ALAMAT
NO TGL REGISTRASI NAMA
OK LENGKAP
RISIKO L P
HEP B HEP C
1 2 3 4 5 6 7 8 9
1 2/26/2018 catn Diana Puspita Sari 24 kedung bar
2 2/26/2018 catn Zakariyah 35 nyamplung
3 2/27/2018 catn Faizal Imam Basri 22 nyamplung
4 2/27/2018 catn Ummi Habibah 22 sidotopo ja
5 2/27/2018 catn M Nuris Shobach 32 nyamplung
6 2/27/2018 catn Fathiyah Assaidah 26 sidotopo ja
7 2/28/2018 catn Fatimah Azzahro 20 sukodono
8 2/28/2018 catn Kodratul Hasan 26 sidotopo s
9 2/28/2018 catn Vincentius Dimas Bagus 24 nyamplung
10 3/3/2018 catn Ainun Najib 24 nyamplung
11 3/3/2018 catn M. Miftahul Khoir 24 nyamplung
12 3/3/2018 catn Siti Aisyah 19 nyamplung
13 3/3/2018 catn Agus Hartanto 36 sidotopo 6
14 3/3/2018 catn Nurika Alfiana 22 sidotopo ja
15 5/3/2018 catn Herinen Taufik 28 sidotopo lo
16 5/3/2018 catn Iin Mutmainnah 19 sidorame b
17 5/3/2018 catn Wildan 23 sukodono
18 5/3/2018 catn Malasari 26 sidotopo k
19 5/3/2018 catn Wanda Fadilah 23 nyamplung
20 3/7/2018 catn Faizal Azmi A 23 petukanga
21 3/7/2018 catn Fidzah Bamahry 22 kalimas udi
22 3/7/2018 catn Achmad Musawir 19 dsn sari a
23 3/8/2018 catn Mochammad Yoyok Adianto 25 sidotopo ja
24 3/8/2018 catn Nena Amadasari 28 petukangan
25 3/8/2018 catn Moh Andik Surohudin 25 prayungan
26 3/12/2018 catn Johan Iskandar 30 petukangan
27 3/12/2018 catn Siti Solicha 46 petukangan
28 3/12/2018 catn Luluk Alaydrus 23 kebun dal
29 3/12/2018 catn Abd Syakur 24 pola'i
30 3/12/2018 catn Ida Umyana 22 sidotopo s
31 3/12/2018 catn Dendy Rizky Andrian 20 jl gedung n
32 3/12/2018 catn Karina Mauleiza 20 nyamplung
33 3/12/2018 catn Ratna Dwi Trisenda 25 sidotopo k
34 3/12/2018 catn Widodo 24 dsn krajan
35 3/14/2018 catn M Sholeh Umar 36 pragoto 63
36 3/14/2018 catn Ramzi 26 ketapang b
37 3/14/2018 catn Dina 24 perum perm
38 3/14/2018 catn Romadon 20 karangloh
39 3/15/2018 catn Talitha Nur Imansari 21 sidotopo s
40 3/15/2018 catn Mochammad Hasanudin 23 bogen 2/3
41 3/15/2018 catn Hayya Roh 22 pragoto 61
42 3/15/2018 catn Moch Imam 20 pragoto 63
43 3/19/2018 catn Beiheki 25 dsn buwaa
44 3/19/2018 catn Ausa Dhotul Ghofiroh 24 arimbi 3/16
45 3/19/2018 catn Moh Rosi Hidayat 34 petukanga
46 3/19/2018 catn Abdullah Asad Shahab 25 perum kebo
47 3/19/2018 catn Abdul Haris 25 nyamplung
48 3/19/2018 catn Yuliana Verdinasari 26 karangrejo
49 3/19/2018 catn Ni Wayan Ayu Sukawati 21 sidotopo j
50 3/19/2018 catn Rizky Ramadhan 23 tenggumun
51 3/19/2018 catn Ahmad Mahbub 31 petukanga
52 3/19/2018 catn Siti Anisah 29 sawah pulo
53 3/19/2018 catn Djonas Adi 39 Rusun Som
54 3/21/2018 catn Laga Kuncoro 24 petukangan
55 3/21/2018 catn Ramlan Nuril Huda 22 nyamplung
56 3/21/2018 catn Shintia Saputri 24 dsn pilang
57 3/21/2018 catn Shadiq Gees Ahmad 26 ampel guba
58 3/21/2018 catn Abd Malik 57 sukodono
59 3/21/2018 catn Jubaidi 44 nyamplung
60 22-3-18 catn hanah 27 banowati 3
61 22-3-18 catn Ahmad Al Jufri 27 dsn tlaban
62 22-3-18 catn Imam Syafi'i 25 kmp. Legu
63 22-3-18 catn Firmansyah 22 sidotopo s
64 22-3-18 catn Nita Triyastutik 19 irawati 2/1
65 24-3-18 catn Samsul Arifin 30 sidotopo j
DAN KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS
JENIS PUNYA
MASA PERKAWI
PEKERJA KERJA KHAS
NAN
AN/ GEJALA
(Tahun) (Kawin/T BELUM
PROFESI 1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH (Ya/Tdk)

10 11 12 13 14 15 16 17 18 19

swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
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swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
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swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
swasta v
DINI HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM D

HBsAg Anti HBs Anti HBC SGPT/ALT

WAKTU
WAKTU
TEMPAT TES TEMPAT TES MELAKUKAN
MELAKUKAN TES TES R NR (Titer IU/l) R NR (W : < 32)

20 21 22 23 24 25 26 27 28 29

pkm sidot 2/26/2018

pkm sidot 2/26/2018
pkm sidot 2/27/2018
pkm sidot 2/27/2018
pkm sidot 2/27/2018
pkm sidot 2/27/2018
pkm sidot 2/28/2018
pkm sidot 2/28/2018
pkm sidot 2/28/2018
pkm sidot 3/3/2018
pkm sidot 3/3/2018
pkm sidot 3/3/2018
pkm sidot 3/3/2018
pkm sidot 3/3/2018
pkm sidot 5/3/2018
pkm sidot 5/3/2018
pkm sidot 5/3/2018
pkm sidot 5/3/2018
pkm sidot 5/3/2018
pkm sidot 3/7/2018
pkm sidot 3/7/2018
pkm sidot 3/7/2018
pkm sidot 3/8/2018
pkm sidot 3/8/2018
pkm sidot 3/8/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/12/2018
pkm sidot 3/14/2018
pkm sidot 3/14/2018
pkm sidot 3/14/2018
pkm sidot 3/14/2018
pkm sidot 3/15/2018
pkm sidot 3/15/2018
pkm sidot 3/15/2018
pkm sidot 3/15/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/19/2018
pkm sidot 3/21/2018
pkm sidot 3/21/2018
pkm sidot 3/21/2018
pkm sidot 3/21/2018
pkm sidot 3/21/2018
pkm sidot 3/21/2018
pkm sidot 22-3-18
pkm sidot 22-3-18
pkm sidot 22-3-18
pkm sidot 22-3-18
pkm sidot 22-3-18
pkm sidot 24-3-18
PEMERIKSAAN SEBELUM DETEKSI DINI PERNAH PUNYA
PERNAH MENJALA PASANGA
TRANSFU NI
SI DARAH HEMODI NLAIN
Anti HBe HBeAg HBV DNA Anti HCV
SEKS
(Ya/Tdk) ALISA (Ya/Tdk)
R NR R NR (IU/ml) R NR (Ya/Tdk)
30 31 32 33 34 35 36 37 38 39

tdak tdak tdak

tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
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tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
tdak tdak tdak
 PERNAH
MENGGU KELUARGA ADA
NAKAN MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
NARKOB ATAU C
A/JARUM YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
SUNTIK
BERSAM TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R
A Suami/Ist
(Ya/Tdk)
40 41 42 43 44 45 46 47 48 49

tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
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tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
tdak
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SAAN SETELAH DETEKSI DINI REKOMENDASI DAN TINDAK LAN

Anti HBe HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif

Terapi 24-48 Terapi 48-72

NR R NR (IU/ml) R NR monitor Terapi mgg mgg

50 51 52 53 54 55 56 57 58 59
EKOMENDASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

1 2 3 HEP B HEP C

60 61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASY
PUSKESMAS : SIDOTOPO
BULAN : april
TAHUN : 2018

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO REGISTRA NAMA
OK LENGKAP AN/
SI RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 26-3-18 catn Friyantoro 27 cepokolim swasta
2 26-3-18 catn Dewi Ratnasari 16 prabowo 1 swasta
3 26-3-18 catn Aliya 27 komplek siswasta
4 27-3-18 catn Happy Nurani 28 sidotopo loswasta
5 27-3-18 catn Fairul Rhosi 21 petukangan swasta
6 27-3-18 catn Moch Sofa Al Malik 21 prabowo 7 swasta
7 27-3-18 catn Moch Shofwan 27 petukangan swasta
8 27-3-18 catn Rumhana 17 pragoto 53swasta
9 27-3-18 catn Achmad Fauzan 24 komplek siswasta
10 28-3-18 catn Moch Faisol 28 sidotopo s swasta
11 28-3-18 catn Dwi Kartika 17 sidotopo s swasta
12 28-3-18 catn Yuliana 14 sidotopo s swasta
13 31-3-18 catn Moch Jupri 25 sukodono swasta
14 31-3-18 catn Lillananda Putri Mayangsari 27 sidotopo loswasta
15 31-3-18 catn Jaka 40 Graha Indi swasta
16 31-3-18 catn Amira Abdul Aziz 33 nyamplungswasta
17 4/2/2018 catn Dwi Rahayu Mustika Sari 27 sidodadi 1 swasta
18 4/2/2018 catn Lutfi Arif Rachman 25 gadukan utswasta
19 4/3/2018 catn Budiono 25 komplek siswasta
20 4/3/2018 catn Yuliana 22 komplek siswasta
21 4/3/2018 catn Amila Novel Mahri 24 ampel loncswasta
22 4/4/2018 catn Umar Faruk 25 bolodewo swasta
23 4/4/2018 catn Ainul Bashera 32 prabowo 8 swasta
24 4/4/2018 catn Umar Faruq 38 dsn paleh swasta
25 4/4/2018 catn Nur Hanifa 22 ampel masjswasta
26 4/4/2018 catn Nurul Firdaus 22 ampel masjswasta
27 4/4/2018 catn Muhammad Zainudin 25 tambak derswasta
28 4/4/2018 catn Ainul Yaqin 26 nyamplungswasta
29 4/4/2018 catn Zainia 24 sidotopo loswasta
30 4/7/2018 catn Lukman Hakim 36 nyamplungswasta
31 4/7/2018 catn Abdul Halim Hasan 23 nyamplungswasta
32 4/7/2018 catn Puji Indarti 22 dupak masiswasta
33 4/7/2018 catn Adnan 30 dsn dekok swasta
34 4/7/2018 catn Ananda Putra Hardian 25 jl urip sum swasta
35 4/7/2018 catn Dian Aristi 23 sidotopo s swasta
36 4/7/2018 catn Abdul Azizi 25 tanah meraswasta
37 4/7/2018 catn Safi'i 47 sukodono swasta
38 4/9/2018 catn M Umar Faruq 20 pragoto 6 swasta
39 4/9/2018 catn Revita Maya Sari 20 pragoto 6 swasta
40 4/9/2018 catn Zainab 25 sidotopo j swasta
41 4/9/2018 catn Al Aroek 24 dsn pancorswasta
42 4/9/2018 catn Siti Rohmah 21 bolodewo swasta
43 4/10/2018 catn Achmad Husaini 20 kalimas baswasta
44 4/10/2018 catn Ernawati 19 rusun somb swasta
45 4/10/2018 catn Radhiah 25 petukangan swasta
46 4/10/2018 catn M Azhar 25 danakarya swasta
47 4/10/2018 catn Ira Fatmawati 24 sombo 60 swasta
48 4/10/2018 catn Ainul Rifai 28 tanggun baswasta
49 4/10/2018 catn Firman 20 sidotopo s swasta
50 4/11/2018 catn Steven Gunawan 28 kertopatenswasta
51 4/11/2018 catn Florence 33 sidokare asswasta
52 4/12/2018 catn Abdul Kadir 23 sidorame 2swasta
53 4/12/2018 catn Diya Novayani 21 gadukan ti swasta
54 4/16/2018 catn Waris Sidi 23 dsn morson swasta
55 4/16/2018 catn Dewi Masitoh 23 kalirejo swasta
56 4/16/2018 catn Moch Iqbal 25 nyamplungswasta
57 4/16/2018 catn Fatimatus Zehro 19 jatipurwo 6swasta
58 4/16/2018 catn Agus Candra Kurniawan 42 sidotopo 4 swasta
59 4/16/2018 catn Bagus Santoso 29 panglima sswasta
60 4/16/2018 catn Sari Ayu Putri Wulandari 21 petukanga swasta
61 4/17/2018 catn Duwi Purnawan 24 luworo swasta
62 4/17/2018 catn Vira Yunita 21 nyamplungswasta
63 4/18/2018 catn Fakhrudin 25 pogot 7A/2swasta
64 4/18/2018 catn Widya Surya Romanthin 24 komplek siswasta
65 4/18/2018 catn Muhammad 42 nyamplungswasta
66 4/21/2018 catn Hatifah 24 dsn morto swasta
67 4/21/2018 catn Sholeh 21 kunti 8A swasta
68 4/21/2018 catn Homsatul Romlah 21 komplek siswasta
69 4/21/2018 catn Lutfiah 23 nyamplungswasta
70 4/21/2018 catn Hasan Saleh 27 ampel gadiswasta
71 4/23/2018 catn Lukman Hakim 23 sidodadi 1 swasta
72 4/23/2018 catn Arief Rachman 31 belakang pswasta
73 4/23/2018 catn Bustomi B. HJ Amin 33 lanji papa swasta
74 4/23/2018 catn Sujiono 28 sawah puloswasta
75 4/23/2018 catn Nurul Hikmatullah 24 nyamplungswasta
76 4/24/2018 catn Hafiluddin 23 nyamplungswasta
77 4/24/2018 catn Adi Toyib Ramadhan Putra 26 sidokapasaswasta
78 4/24/2018 catn Hikma Choirunnisa 18 dsn pancorswasta
79 24-4-18 catn Nur Alifa Okta Vianti 25 kunti 82 swasta
80 24-4-18 catn Usman Ali 27 buntaran nswasta
81 24-4-18 catn Siti Komariya 22 surtikanti 2swasta
82 24-4-18 catn Maulideh 23 sidotopo s swasta
83 24-4-18 catn M. Anas Abdillah 23 KP Serangswasta
84 25-4-18 catn MHD Vaeez Ryan Avino 23 ampel sawswasta
85 25-4-18 catn Abdul Rochman 26 srenggananswasta
86 25-4-18 catn Silvia Deviani Said Bachmid 45 ampel kes swasta
87 25-4-18 catn M. Syamsul Arifin 27 Sidodadi 1swasta
KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS PERNAH TEST HEP B
PUNYA
MASA PERKAWI KHAS
KERJA NAN GEJALA
(Tahun) (Kawin/T BELUM
1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH TEMPAT TES
(Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

v tdak pkm sidot

v tdak pkm sidot
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v tdak pkm sidot
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NI HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKS

HBsAg Anti HBs Anti HBC SGPT/ALT

WAKTU
WAKTU TEMPAT TES MELAKUKAN
MELAKUKAN TES TES R NR (Titer IU/l) R NR (W : < 32)

21 22 23 24 25 26 27 28 29

26-3-18
26-3-18
26-3-18
27-3-18
27-3-18
27-3-18
27-3-18
27-3-18
27-3-18
28-3-18
28-3-18
28-3-18
31-3-18
31-3-18
31-3-18
31-3-18
4/2/2018
4/2/2018
4/3/2018
4/3/2018
4/3/2018
4/4/2018
4/4/2018
4/4/2018
4/4/2018
4/4/2018
4/4/2018
4/4/2018
4/4/2018
4/7/2018
4/7/2018
4/7/2018
4/7/2018
4/7/2018
4/7/2018
4/7/2018
 4/7/2018
4/9/2018
4/9/2018
4/9/2018
4/9/2018
4/9/2018
4/10/2018
4/10/2018
4/10/2018
4/10/2018
4/10/2018
4/10/2018
4/10/2018
4/11/2018
4/11/2018
4/12/2018
4/12/2018
4/16/2018
4/16/2018
4/16/2018
4/16/2018
4/16/2018
4/16/2018
4/16/2018
4/17/2018
4/17/2018
4/18/2018
4/18/2018
4/18/2018
4/21/2018
4/21/2018
4/21/2018
4/21/2018
4/21/2018
4/23/2018
4/23/2018
4/23/2018
4/23/2018
4/23/2018
4/24/2018
4/24/2018
4/24/2018
24-4-18
24-4-18
24-4-18
24-4-18
24-4-18
25-4-18
25-4-18
25-4-18
25-4-18
PEMERIKSAAN SEBELUM DETEKSI DINI PERNAH PUNYA
PERNAH MENJALA PASANGA
TRANSFU NI
SI DARAH HEMODI NLAIN
Anti HBe HBeAg HBV DNA Anti HCV
SEKS
(Ya/Tdk) ALISA (Ya/Tdk)
R NR R NR (IU/ml) R NR (Ya/Tdk)
30 31 32 33 34 35 36 37 38 39

tdak tdak tdak

tdak tdak tdak
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 PERNAH
MENGGU KELUARGA ADA
NAKAN MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DIN
NARKOB ATAU C
A/JARUM YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
SUNTIK
BERSAM TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R
A Suami/Ist
(Ya/Tdk)
40 41 42 43 44 45 46 47 48 49

tdak
tdak
tdak
tdak
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tdak
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SAAN SETELAH DETEKSI DINI REKOMENDASI DAN TINDAK L

Anti HBe HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif

Terapi 24-48 Terapi 48-72

NR R NR (IU/ml) R NR monitor Terapi mgg mgg

50 51 52 53 54 55 56 57 58 59
EKOMENDASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

1 2 3 HEP B HEP C

60 61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR
PUSKESMAS : SIDOTOPO
BULAN : MEI
TAHUN : 2018

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO NAMA
REGISTRASI OK LENGKAP AN/
RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 4/26/2018 catn Muhammad Rizal A R 24 nyamplungswasta
2 26-4-20018 catn H. Aziz 37 petukangan swasta
3 4/26/2018 catn Fatchur Rozi 23 sukodono 9swasta
4 4/30/2018 catn M. Alfan Hadinor R. 23 Banowati 2swasta
5 9/30/2018 catn Nurhasanah 23 jatipurwo 9swasta
6 4/30/2018 catn Yulianto 18 dusun remswasta
7 4/30/2018 catn Fatimatus Zehro 17 Banowati 2swasta
8 4/30/2018 catn Nariman Amari 24 sukodono swasta
9 4/30/2018 catn Husnul hotimah 27 sidotopo j swasta
10 4/30/2018 catn Arifin 20 dusun Bet swasta
11 4/30/2018 catn ilma Indah Sari 21 arimbi bun swasta
12 4/30/2018 catn Nur Aisah 20 sidotopo s swasta
13 4/30/2018 catn Sulismawati 32 petukangan swasta
14 4/30/2018 catn Rosi 29 batu nudu swasta
15 30-*04-2018 catn Abdus Salam 35 taman haraswasta
16 4/30/2018 catn Fikri 26 nyamplungswasta
17 5/2/2018 catn Joko Susilo 31 bulusidokaswasta
18 5/2/2018 catn Riska Zakiya 24 sidotopo kiswasta
19 5/2/2018 catn susanti 25 kunti 1/39 swasta
20 5/2/2018 catn Amalia H. 20 sidotopo s swasta
21 5/2/2018 catn Ahmad Zulfikar 22 donokerto swasta
22 5/2/2018 catn Mila yuyun 21 sidotopo jaswasta
23 5/2/2018 catn Rudy Ashariyanto 30 jl jatisron swasta
24 5/2/2018 catn Diana silfiah 24 ampel rac swasta
25 5/2/2018 catn Asmad murtado 24 kemayoranswasta
26 5/3/2018 catn lutfillah 26 dusun Buwswasta
27 5/3/2018 catn Ulfia 23 kebondale swasta
28 5/3/2018 catn Shohbus Samal 28 laeran swasta
29 5/3/2018 catn Sentot Suseno 50 simolawanswasta
30 5/3/2018 catn Umar Hasni 27 nyamplungswasta
31 5/3/2018 catn Kamalul Qomar 29 simolawanswasta
32 5/3/2018 catn Emil Fuaida 22 sidodadi 1 swasta
33 5/3/2018 catn Agus Andrianto 38 rusun somb swasta
34 5/3/2018 catn M Zakaria 25 nyamplungswasta
35 5/5/2018 catn Fahriyah Bagar 35 ampel guba swasta
36 5/5/2018 catn Umik Habibah 39 turi swasta
37 5/7/2018 catn Bakri Azhari 24 prabowo 7 swasta
38 5/7/2018 catn Nahdiyah Laili Muslim 20 petukanga swasta
39 5/7/2018 catn Luluk 18 kunti 1/25 swasta
40 5/7/2018 catn Raudatul Jannah 20 surtikanti swasta
41 5/7/2018 catn Fathur Rosi 20 bolodewo swasta
42 5/7/2018 catn Farizal 27 nyamplungswasta
43 5/9/2018 catn Iis 30 sidodadi loswasta
44 5/9/2018 catn Zainal Abidin 37 nyamplungswasta
45 5/14/2018 catn Dewi Akmalia 16 irawati 2/1 swasta
46 5/14/2018 catn Abud Bahasoan 33 sukodono swasta
47 5/14/2018 catn Ernawati 20 sidotopo jaswasta
48 14/052018 catn Bayu Triyono 24 sidotopo s swasta
49 5/14/2018 catn Ali 20 Nyamplungswasta
50 5/14/2018 catn Abdul Majid Hamzah 28 Nyamplungswasta
51 5/14/2018 catn Choir Makia Fairus 24 Danakaryaswasta
52 5/14/2018 catn Rofik 26 Petukangaswasta
53 5/14/2018 catn Fitria 20 Srengganaswasta
54 5/14/2018 catn Mohammad Baqir 28 Dsn Kebonswasta
55 5/15/2018 catn Reza Herdiyanto 30 Jangkungaswasta
56 5/15/2018 catn Zulfa Alawiyah 18 Sukodono swasta
57 5/15/2018 catn Mochammad Nasrun 31 Nyamplungswasta
58 5/16/2018 catn Fausi 24 Dsn.Lobukswasta
59 5/16/2018 catn Ahmad wahab Benge 24 sidotopo loswasta
60 5/15/2018 catn Abdul malik 30 Nyamplungswasta
61 5/15/2018 catn Muhammad Syamsul 27 Nyamplungswasta
62 5/17/2018 catn Fatimah Al Muchdar 43 nyamplungswasta
63 5/19/2018 catn Purnomo 30 Rangkah Bswasta
64 5/19/2018 catn Laili Theana Firdaus 21 danakarya swasta
65 5/19/2018 catn Salma B Abu Bakar Balbed 24 ampel cemswasta
66 5/19/2018 catn Dian Kresnawati 32 sidotopo s swasta
67 5/19/2018 catn Februry Wiloso 42 gemah barswasta
68 5/21/2018 catn Mohammad Arif 28 sukodono swasta
69 5/21/2018 catn Muhammad 26 ampel melaswasta
70 5/22/2018 catn Anis Baqaar 42 ampel rac swasta
71 5/22/2018 catn Achmad Zaenal Abidin 25 dsn ponco swasta
72 5/22/2018 catn A'riva 23 nyamplungswasta
73 5/22/2018 catn Moh Romli 32 bolodewo swasta
74 5/23/2018 catn Ardilla 27 abimanyu uswasta
75 5/23/2018 catn Alex Setiono 31 sidodadi b swasta
76 5/23/2018 catn Umaimah Bajuber 22 kalimas maswasta
77 5/23/2018 catn Zaid Abd Azis 26 penanggunswasta
78 5/24/2018 catn Siti Hosiyeh 30 surtikanti swasta
KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS PERNAH TEST HEP B
PUNYA
MASA PERKAWI KHAS
KERJA NAN GEJALA
(Tahun) (Kawin/T BELUM
1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH TEMPAT TES
(Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

v tdak pkm sidot

v tdak pkm sidot
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HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKSI DIN

HBsAg Anti HBs Anti HBC SGPT/ALT Anti HBe

WAKTU
WAKTU TEMPAT TES MELAKUKAN
MELAKUKAN TES TES R NR (Titer IU/l) R NR (W : < 32) R

21 22 23 24 25 26 27 28 29 30

4/26/2018
26-4-20018
4/26/2018
4/30/2018
9/30/2018
4/30/2018
4/30/2018
4/30/2018
4/30/2018
4/30/2018
4/30/2018
4/30/2018
4/30/2018
4/30/2018
30-*04-2018
4/30/2018
5/2/2018
5/2/2018
5/2/2018
5/2/2018
5/2/2018
5/2/2018
5/2/2018
5/2/2018
5/2/2018
5/3/2018
5/3/2018
5/3/2018
5/3/2018
5/3/2018
5/3/2018
5/3/2018
5/3/2018
 5/3/2018
5/5/2018
5/5/2018
5/7/2018
5/7/2018
5/7/2018
5/7/2018
5/7/2018
5/7/2018
5/9/2018
5/9/2018
5/14/2018
5/14/2018
5/14/2018
14/052018
5/14/2018
5/14/2018
5/14/2018
5/14/2018
5/14/2018
5/14/2018
5/15/2018
5/15/2018
5/15/2018
5/16/2018
5/16/2018
5/15/2018
5/15/2018
5/17/2018
5/19/2018
5/19/2018
5/19/2018
5/19/2018
5/19/2018
5/21/2018
5/21/2018
5/22/2018
5/22/2018
5/22/2018
5/22/2018
5/23/2018
5/23/2018
5/23/2018
5/23/2018
5/24/2018
 PERNAH
MENGGU
SAAN SEBELUM DETEKSI DINI PERNAH PUNYA NAKAN
PERNAH MENJALA PASANGA NARKOB
TRANSFU NI N SEKS A/JARUM
Anti HBe HBeAg HBV DNA Anti HCV SI DARAH HEMODI LAIN SUNTIK
(Ya/Tdk) ALISA (Ya/Tdk) BERSAM
NR R NR (IU/ml) R NR (Ya/Tdk) A
31 32 33 34 35 36 37 38 39
(Ya/Tdk)
40

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 KELUARGA ADA
MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
ATAU C
YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R NR
Suami/Ist
41 42 43 44 45 46 47 48 49 50
LAH DETEKSI DINI REKOMENDASI DAN TINDAK LANJUT

HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif TGL IMUNISASI HEP B

Terapi 24-48 Terapi 48-72

R NR (IU/ml) R NR monitor Terapi mgg mgg 1

51 52 53 54 55 56 57 58 59 60
ASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

2 3 HEP B HEP C

61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR
PUSKESMAS : SIDOTOPO
BULAN : juni
TAHUN : 2018

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO NAMA
REGISTRASI OK LENGKAP AN/
RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 1/8/2017 catn Agus Sugianto 21 dsn balon swasta
2 1/8/2017 catn Zaynal Abdillah Putra 21 botoputih swasta
3 1/8/2017 catn Ayu Wandira 20 komplek siswasta
4 2/8/2017 catn Mawardi 28 dsn barat sswasta
5 2/8/2017 catn Amalia Karimah 19 kebon daleswasta
6 2/8/2017 catn Ismali 32 ampel madswasta
7 2/8/2017 catn Fitria 19 arimbi bun swasta
8 3/8/2017 catn Rohani 20 kunti 63 swasta
9 3/8/2017 catn Agus Setiawan 20 wonosari t swasta
10 5/8/2017 catn Saifulloh 22 sidotopo s swasta
11 5/8/2017 catn Rifki Fauzi Sungkar 30 jl cempakaswasta
12 5/8/2017 catn Adilah Basyarewan 23 lingkunganswasta
13 7/8/2017 catn Chusnul Amrullah 22 perum wahy swasta
14 7/8/2017 catn Fenny Novitasari 24 sidotopo s swasta
15 7/8/2017 catn Novia Nurhasanah 20 sidotopo s swasta
16 8/8/2017 catn Mustofa 20 sidotopo j swasta
17 8/8/2017 catn Mahally 25 nyamplungswasta
18 9/8/2017 catn Linda Dewi Utami 23 nyamplungswasta
19 9/8/2017 catn Supaatun 46 sidotopo jaswasta
20 9/8/2017 catn Badrus Sholeh 23 komplek siswasta
21 10/8/2017 catn Siti Maisaroh 18 arimbi 1/17swasta
22 10/8/2017 catn Mayang Sari 18 arimbi 2/1 swasta
23 10/8/2017 catn Amar Maruf 21 nyamplungswasta
24 10/8/2017 catn Prima Rizky Syahputra 24 sidotopo jaswasta
25 10/8/2107 catn Marjui 41 pegirian 2 swasta
26 12/8/2017 catn Mila Riskiya 28 irawati 2/7 swasta
27 12/8/2017 catn M mahrus Ali 28 nyamplungswasta
28 12/8/2017 catn Irfan 23 lembung swasta
29 14/8/2017 catn Nurul Wahyuni 19 sidorame 6swasta
30 14/8/2017 catn Abd Rohim 24 dsn laske swasta
31 15/8/2017 catn Farhat Attamimi 33 nyamplungswasta
32 15/8/2017 catn Anggi Kurniawan Dwi Arta 21 kalianak baswasta
33 15/8/2017 catn Krisdianti 21 kunti 27 swasta
34 15/8/2017 catn Eka Widiyanti 21 sidotopo k swasta
35 19/8/2017 catn Vildza Sisilia 25 petukangan swasta
36 16/8/2017 catn Dini Yuliati 35 nyamplungswasta
37 22/8/2017 catn Purnami Shidiky 24 sidotopo s swasta
38 22/8/2017 catn Pungki Sugiarto 33 kupang barswasta
39 22/8/2017 catn Yessica Injil Tina 33 sencaki 4/ swasta
40 22/8/2017 catn Anas Ibnu Safaruddin 30 kmp banyuswasta
41 22/8/2017 catn Arif Rachmandika Hudyana 24 bronggala swasta
42 22/8/2017 catn Idatul Hasanah 24 arimbi 3/8 swasta
43 22/8/2017 catn Abd Wahid 23 dsn legok swasta
44 23/8/2017 catn Mohammad Ilmiyanto 21 dsn lantek swasta
45 23/8/2017 catn Ainun Ayu M 19 sidorame bswasta
46 24/8/2017 catn Saiful Bahar 26 dsn durbukswasta
47 24/8/2017 catn Musarofah 19 sidotopo s swasta
KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS PERNAH TEST HEP B
PUNYA
MASA PERKAWI KHAS
KERJA NAN GEJALA
(Tahun) (Kawin/T BELUM
1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH TEMPAT TES
(Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

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HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKSI DINI

HBsAg Anti HBs Anti HBC SGPT/ALT Anti HBe

WAKTU WAKTU
MELAKUKAN TEMPAT TES MELAKUKAN
TES TES R NR (Titer IU/l) R NR (W : < 32) R

21 22 23 24 25 26 27 28 29 30

1/8/2017
1/8/2017
1/8/2017
2/8/2017
2/8/2017
2/8/2017
2/8/2017
3/8/2017
3/8/2017
5/8/2017
5/8/2017
5/8/2017
7/8/2017
7/8/2017
7/8/2017
8/8/2017
8/8/2017
9/8/2017
9/8/2017
9/8/2017
10/8/2017
10/8/2017
10/8/2017
10/8/2017
10/8/2107
12/8/2017
12/8/2017
12/8/2017
14/8/2017
14/8/2017
15/8/2017
15/8/2017
15/8/2017
15/8/2017
19/8/2017
16/8/2017
22/8/2017
22/8/2017
22/8/2017
22/8/2017
22/8/2017
22/8/2017
22/8/2017
23/8/2017
23/8/2017
24/8/2017
24/8/2017
 PERNAH
MENGGU
SAAN SEBELUM DETEKSI DINI PERNAH PUNYA NAKAN
PERNAH MENJALA PASANGA NARKOB
TRANSFU NI N SEKS A/JARUM
Anti HBe HBeAg HBV DNA Anti HCV SI DARAH HEMODI LAIN SUNTIK
(Ya/Tdk) ALISA (Ya/Tdk) BERSAM
NR R NR (IU/ml) R NR (Ya/Tdk) A
31 32 33 34 35 36 37 38 39
(Ya/Tdk)
40

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 KELUARGA ADA
MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
ATAU C
YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R NR
Suami/Ist
41 42 43 44 45 46 47 48 49 50
LAH DETEKSI DINI REKOMENDASI DAN TINDAK LANJUT

HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif TGL IMUNISASI HEP B

Terapi 24-48 Terapi 48-72

R NR (IU/ml) R NR monitor Terapi mgg mgg 1

51 52 53 54 55 56 57 58 59 60
ASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

2 3 HEP B HEP C

61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR
PUSKESMAS : SIDOTOPO
BULAN : juli
TAHUN : 2018

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO NAMA
REGISTRASI OK LENGKAP AN/
RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 26-6-18 catn Nadhir Heykal 30 sukodono swasta
2 26-6-18 catn Iqlima 24 sukodono swasta
3 26-6-18 catn Rizky Firmansyah 21 petukangan swasta
4 26-6-18 catn Muhammad 23 ampel loncswasta
5 26-6-18 catn Deny Dwi Cahyana 24 kaliwaron swasta
6 26-6-18 catn Zulianah 22 sidotopo s swasta
7 28-6-18 catn Faradiba 25 sukodono swasta
8 28-6-18 catn Sukma Mulya Cahyaning Galuh 27 sidotopo kiswasta
9 28-6-18 catn Ferry Irawan 25 sidotopo s swasta
10 28-6-18 catn Amir Hamzah 32 sasak 27 swasta
11 30-6-18 catn Sutrisno 26 nyamplungswasta
12 30-6-18 catn Abdul Rahman 26 nyamplungswasta
13 30-6-18 catn Moh Mahrus Saleh 46 danakarya swasta
14 30-6-18 catn Rumiyati 46 danakarya swasta
15 30-6-18 catn Ali Hasan 36 sidotopo s swasta
16 6/30/2018 catn Achmad Ismail 24 Sidotopo sswasta
17 6/30/2018 catn Acmad Zaini 22 dsn kopok swasta
18 6/30/2018 catn Erina Safitri 19 sencaki 10swasta
19 6/30/2018 catn Muhammad Burhanudin 21 danakarya swasta
20 6/30/2018 catn Agustina 23 sidotopo s swasta
21 7/2/2018 catn Ayyub Novel Baya'syut 33 ampel guba swasta
22 7/2/2018 catn Muhammad Nurush Shobah 26 kalimas udswasta
23 7/2/2018 catn Andi 26 dsn palam swasta
24 7/2/2018 catn Nur Faradilah Isfu Aida 25 pragoto 25swasta
25 7/3/2018 catn Marsuni 28 kmp jurek swasta
26 7/3/2018 catn Sulis Kusmiati 20 sidotopo j swasta
27 7/3/2018 catn Isnin Dwi Irianti 23 sidotopo loswasta
28 7/3/2018 catn Yazid 28 jl rw mongiswasta
29 7/3/2018 catn Rahardjo Kerijono 45 komplek siswasta
30 7/3/2018 catn Henny Purwanti 36 komplek siswasta
31 7/3/2018 catn Hermanto 27 komplek siswasta
32 7/4/2018 catn Andri Soesanto 25 petukangan swasta
33 7/4/2018 catn Bahrudin 34 pembantai swasta
34 7/4/2018 catn Miftahul Farid 24 sidotopo kiswasta
35 7/4/2018 catn Zainal Abidin Baharun 26 nyamplungswasta
36 7/4/2018 catn Muhammad Rasit 28 nyamplungswasta
37 7/4/2018 catn Arif Bagus Priantoro 26 nyamplungswasta
38 7/4/2018 catn Gandi Mustofa 24 dsn karangswasta
39 7/4/2018 catn Muhammad Safiq 25 ampel gadiswasta
40 7/4/2018 catn Afia Atika 29 ampel magswasta
41 7/5/2018 catn Aisyah 22 khm mansyswasta
42 7/5/2018 catn Zainun Aprilia Arifin 26 petukanga swasta
43 7/5/2018 catn Muhartono 36 kleco swasta
44 7/5/2018 catn Masrifah 41 irawati 2/5 swasta
45 7/5/2018 catn Ainur Rofiq 35 sidodadi 1 swasta
46 7/5/2018 catn M Nasir 24 ampel muliswasta
47 7/5/2018 catn Silvi Yuli Lestari 20 abimanyu uswasta
48 7/5/2018 catn Ahmida Nur Indah Sari 23 sidotopo s swasta
49 7/5/2018 catn M Renaldi Al Fatoh 24 surtikanti swasta
50 7/5/2018 catn Resdiansyah Dwi Widiyanto 33 kemlaten swasta
51 7/5/2018 catn Yunita Fitrotul Islamiyah 20 sidotopo 4 swasta
52 7/5/2018 catn Oki Alvionita 25 sidotopo s swasta
53 7/7/2018 catn Fitri Nur Cahyani 18 kunti 41 swasta
54 7/7/2018 catn Siti Alvia 19 danakarya swasta
55 7/9/2018 catn Isma Kamilia 22 sukodono swasta
56 7/9/2018 catn Kartika Agustina 27 petukangan swasta
57 7/9/2018 catn Usman Ali 27 sidotopo s swasta
58 7/9/2018 catn Mahrus 33 nyamplungswasta
59 7/9/2018 catn Marhati 25 sidorame bswasta
60 7/9/2018 catn Yohan Kurniawan 25 sebayi swasta
61 7/9/2018 catn Ria Farichah 26 ampel suciswasta
62 7/9/2018 catn Muhammad Sahri 24 nyamplungswasta
63 7/10/2018 catn Hosen 24 dsn sargadswasta
64 7/10/2018 catn Silvia Mufidatul A 24 komplek siswasta
65 7/11/2018 catn Ach Fadli 28 sidodadi loswasta
66 7/11/2018 catn Yunita Kurnia Sari 30 sidotopo j swasta
67 7/11/2018 catn M Rosid 32 nyamplungswasta
68 7/11/2018 catn Elis Setiawati 23 nyamplungswasta
69 7/11/2018 catn Suminem 46 sidotopo s swasta
70 7/11/2018 catn Nariman 24 ampel cemswasta
71 7/11/2018 catn Sarmin 52 talun swasta
72 7/11/2018 catn Ade Erwan Sugiarto 27 nginden koswasta
73 7/11/2018 catn Wulansari 24 sidotopo j swasta
74 7/12/2018 catn Siti Aisyah 25 kunti 45 swasta
75 7/12/2018 catn Moch Ichwan Rizki 28 nyamplungswasta
76 7/12/2018 catn soim 27 nyamplungswasta
77 7/12/2018 catn Moch Rachmad 29 petukangan swasta
78 7/14/2018 catn Faisin 27 dsn dumaj swasta
 79 7/14/2018 catn Nurul Qomariah 26 sidotopo s swasta
80 7/14/2018 catn Awaludin Nur Fitro 25 bulubrangsswasta
81 7/14/2018 catn Putri Megawati 22 sidotopo kiswasta
82 7/14/2018 catn Indah Permatasari 24 petukanga swasta
83 7/14/2018 catn Agra Aulia Oka Ayubian 22 nyamplungswasta
84 7/14/2018 catn Izzatul Hikmah 23 irawati 3/6 swasta
85 7/14/2018 catn Syafiudin 23 petukanga swasta
86 7/16/2018 catn Holilur Rohman 24 dsn rabaja swasta
87 7/16/2018 catn Ida Kurnia 17 kunti 80B swasta
88 7/16/2018 catn Cici Handriani Desy 22 sidotopo s swasta
89 7/16/2018 catn Munif Ali Moch Martak 58 sukodono swasta
90 7/16/2018 catn Siti Fatimah 20 abimanyu lswasta
91 7/16/2018 catn Samsul 22 dsn bajete swasta
92 7/16/2018 catn Usama 26 sidotopo kiswasta
93 7/17/2018 catn Moch Holil 36 nyamplunga swasta
94 7/17/2018 catn Nur Lukita Sari 24 sidotopo s swasta
95 7/17/2018 catn Riska Dewi S 24 sidotopo s swasta
96 7/17/2018 catn Nur Isnaini 28 sidorame nswasta
97 7/17/2018 catn Ana Lailatul Fitriya 23 sidotopo kiswasta
98 7/18/2018 catn Sayeroh 22 kunti 67 swasta
99 7/18/2018 catn Arifin Hidayat 24 dsn banmoswasta
100 7/18/2018 catn Ludia Anggraini 21 sencaki 51swasta
101 7/18/2018 catn Ririn Pratiwi 19 sencaki 51swasta
102 7/18/2018 catn Koimah 18 kunti 67B swasta
103 7/18/2018 catn Maisyaroh 25 sidotopo s swasta
104 7/18/2018 catn Adnan 28 dsn baktokswasta
105 7/18/2018 catn Rohani Amalia Agustin 22 nyamplungswasta
106 7/19/2018 catn Novia Rizky Faradiba 22 taman irawswasta
107 7/19/2018 catn Fathul Arifin 28 danakarya swasta
108 7/21/2018 catn A Rizal 20 danakarya swasta
109 7/21/2018 catn Nurul Syamsiyah 28 nyamplungswasta
110 7/21/2018 catn Azizah 23 sidotopo kiswasta
111 7/23/2018 catn Latifa 23 prabowo 8 swasta
112 7/23/2018 catn Erni Anggraini 21 sidotopo s swasta
113 7/23/2018 catn Ahmadi 34 ampel suciswasta
114 7/23/2018 catn Nurul Iswanto 28 jl teuku umswasta
115 7/24/2018 catn Mochamad Faris Amin 27 ampel menswasta
116 7/24/2018 catn Achmad Fadeli 23 arimbi 1/9 swasta
117 7/24/2018 catn Mariyah 21 sombo 76-swasta
118 7/24/2018 catn Wildah Rosdiana 23 bolodewo swasta
119 7/24/2018 catn Herlinda 27 sencaki 10swasta
120 7/24/2018 catn Moch Mahfud 28 nyamplungswasta
121 7/24/2018 catn Fauziah Bin Cholid Bagar 28 ampel rac swasta
122 7/25/2018 catn Mahendra Puji S 30 perum pesswasta
123 7/25/2018 catn Nardi Wiyono 40 buthohrejoswasta
124 7/25/2018 catn Susi Mulyati 45 sidotopo j swasta
125 7/25/2018 catn Ika Purnama Sari 25 pasi swasta
126 7/25/2018 catn Salman Anshari 25 arimbi 21 swasta
127 7/25/2018 catn Lutfiati 22 sidotopo s swasta
KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS PERNAH TEST HEP B
PUNYA
MASA PERKAWI KHAS
KERJA NAN GEJALA
(Tahun) (Kawin/T BELUM
1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH TEMPAT TES
(Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

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HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKSI DINI

HBsAg Anti HBs Anti HBC SGPT/ALT Anti HBe

WAKTU
WAKTU
MELAKUKAN TES TEMPAT TES MELAKUKAN
TES R NR (Titer IU/l) R NR (W : < 32) R

21 22 23 24 25 26 27 28 29 30

26-6-18
26-6-18
26-6-18
26-6-18
26-6-18
26-6-18
28-6-18
28-6-18
28-6-18
28-6-18
30-6-18
30-6-18
30-6-18
30-6-18
30-6-18
6/30/2018
6/30/2018
6/30/2018
6/30/2018
6/30/2018
7/2/2018
7/2/2018
7/2/2018
7/2/2018
7/3/2018
7/3/2018
7/3/2018
7/3/2018
7/3/2018
7/3/2018
7/3/2018
7/4/2018
7/4/2018
 7/4/2018
7/4/2018
7/4/2018
7/4/2018
7/4/2018
7/4/2018
7/4/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/5/2018
7/7/2018
7/7/2018
7/9/2018
7/9/2018
7/9/2018
7/9/2018
7/9/2018
7/9/2018
7/10/2018
7/11/2018
7/12/2018
7/13/2018
7/14/2018
7/15/2018
7/16/2018
7/17/2018
7/18/2018
7/19/2018
7/20/2018
7/21/2018
7/22/2018
7/23/2018
7/24/2018
7/25/2018
7/26/2018
7/27/2018
7/28/2018
7/29/2018
7/30/2018
7/31/2018
8/1/2018
8/2/2018
8/3/2018
8/4/2018
8/5/2018
8/6/2018
8/7/2018
8/8/2018
8/9/2018
8/10/2018
8/11/2018
8/12/2018
8/13/2018
8/14/2018
8/15/2018
8/16/2018
8/17/2018
8/18/2018
8/19/2018
8/20/2018
8/21/2018
8/22/2018
8/23/2018
8/24/2018
8/25/2018
8/26/2018
8/27/2018
8/28/2018
8/29/2018
8/30/2018
8/31/2018
9/1/2018
9/2/2018
9/3/2018
9/4/2018
9/5/2018
9/6/2018
9/7/2018
9/8/2018
9/9/2018
9/10/2018
9/11/2018
9/12/2018
9/13/2018
9/14/2018
 PERNAH
MENGGU
SAAN SEBELUM DETEKSI DINI PERNAH PUNYA NAKAN
PERNAH MENJALA PASANGA NARKOB
TRANSFU NI N SEKS A/JARUM
Anti HBe HBeAg HBV DNA Anti HCV SI DARAH HEMODI LAIN SUNTIK
(Ya/Tdk) ALISA (Ya/Tdk) BERSAM
NR R NR (IU/ml) R NR (Ya/Tdk) A
31 32 33 34 35 36 37 38 39
(Ya/Tdk)
40

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 KELUARGA ADA
MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
ATAU C
YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R NR
Suami/Ist
41 42 43 44 45 46 47 48 49 50
LAH DETEKSI DINI REKOMENDASI DAN TINDAK LANJUT

HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif TGL IMUNISASI HEP B

Terapi 24-48 Terapi 48-72

R NR (IU/ml) R NR monitor Terapi mgg mgg 1

51 52 53 54 55 56 57 58 59 60
ASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

2 3 HEP B HEP C

61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR
PUSKESMAS : SIDOTOPO
BULAN : MEI
TAHUN : 2017

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO NAMA
REGISTRASI OK LENGKAP AN/
RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 7/26/2018 catn Lailatul Mukarromah 22 arimbi bun swasta
2 7/26/2018 catn Fauzen 23 dsn jennuhswasta
3 7/26/2018 catn Sirotul Rizky 20 wonoplintaswasta
4 7/26/2018 catn Faisal 21 prabowo 1 swasta
5 7/26/2018 catn Nabil Lutfi 35 ampel muliswasta
6 7/26/2018 catn Qonita Usman 23 ampel masjswasta
7 7/28/2018 catn Farhan 30 dsn dalem swasta
8 7/28/2018 catn Siti Soleha 19 sidorame bswasta
9 7/28/2018 catn Mohammad Zaini 22 sidotopo jaswasta
10 7/30/2018 catn M Chusen Ali Zainal Abidin 27 pakal madyswasta
11 7/30/2018 catn Atiyah 28 sultan isk swasta
12 7/30/2018 catn Syukriyah 26 petukangan swasta
13 7/30/2018 catn Jamilah 33 ampel suciswasta
14 7/31/2018 catn Abdul Syakur 30 dsn masar swasta
15 7/31/2018 catn Rafika 25 arimbi 3/1 swasta
16 8/1/2018 catn Retno Puspitasari 24 sidotopo kiswasta
17 8/1/2018 catn Masriyah 39 kunti 41 swasta
18 8/1/2018 catn Ach Zulfikar 33 sidotopo k swasta
19 8/2/2018 catn Nur Zeni 30 jagir swasta
20 8/2/2018 catn Ansori 28 semalang swasta
21 8/2/2018 catn Maria Ulfa 29 kunti 1/10 swasta
22 8/4/2018 catn Achmad Bin Agil 32 petukangan swasta
23 8/4/2018 catn Syifa 33 sumbersukswasta
24 8/4/2018 catn Firda Zainiyah Anwar 21 nyamplungswasta
25 8/4/2018 catn Hadiri 28 dsn buwaaswasta
26 8/4/2018 catn Dailatun Nadifa 24 petukangan swasta
27 8/4/2018 catn Moch Ali Hasan 24 pragoto 45swasta
28 8/4/2018 catn Sabrina 23 nyamplungswasta
29 8/4/2018 catn Miftahul Husna 23 nyamplungswasta
30 8/6/2018 catn Marensy Sesilia 31 komplek siswasta
31 8/6/2018 catn Nasir 31 dsn paleh swasta
32 8/6/2018 catn Titin Suaida 23 irawati 1/3 swasta
33 8/6/2018 catn Tejo Waryono 37 sidotopo s swasta
34 8/7/2018 catn Reza Novalia Ariski 18 dsn dukuh swasta
35 8/7/2018 catn Abu Bakar 23 petukangan swasta
36 8/7/2018 catn Agus Sholihin 20 prabowo n swasta
37 8/7/2018 catn Al Deleymi 23 ampel loncswasta
38 8/9/2018 catn Fatmawati 23 sidotopo j swasta
39 8/9/2018 catn Jauharul Musthofa 29 tunggul swasta
40 8/9/2018 catn Mirna Megawati 24 kunti 1/9A swasta
41 8/9/2018 catn Sri Melina 18 kunti 51A swasta
42 8/9/2018 catn Arifin 23 dsn rabes swasta
43 8/9/2018 catn Aliyah Agustin 22 nyamplungswasta
44 8/9/2018 catn Eva Ariyani 20 sidotopo s swasta
45 8/11/2018 catn Raguan 25 nyamplungswasta
46 8/11/2018 catn Moh Lutfi 28 sukodono swasta
47 8/13/2018 catn Santi Maimuna 20 komplek siswasta
48 8/13/2018 catn Himami Maulidiyah 18 bolodewo swasta
49 8/13/2018 catn Moh Aziz 21 dsn manduswasta
50 8/13/2018 catn Ahmad Febriyanto 23 dsn nganj swasta
51 8/13/2018 catn Frienka Tama Jelang Happy 21 jl panti da swasta
52 8/13/2018 catn Khanna Kumala 22 sidotopo s swasta
53 8/13/2018 catn Mia Wati 26 sidotopo s swasta
54 8/14/2018 catn Anugerah Tri Bagus Wicaksono 20 sidotopo k swasta
55 8/14/2018 catn Imam 25 dsn kacoduswasta
56 8/14/2018 catn Munali 38 dsn gung swasta
57 8/14/2018 catn Fatimah 38 bulak banteswasta
58 8/15/2018 catn Nur Komaria 20 sencaki 4/ swasta
59 8/15/2018 catn Marsodo 33 nyamplungswasta
60 8/15/2018 catn Ali Fadli 27 abimanyu swasta
61 8/15/2018 catn Rani Fadillah 26 danakarya swasta
62 8/18/2018 catn Prayitno Rachman 57 sukodono swasta
63 8/20/2018 catn Syaiful Anam 34 sidotopo loswasta
64 8/20/2018 catn Sulimah 31 sidotopo loswasta
65 8/20/2018 catn Husnul Chotimah 25 nyamplungswasta
66 8/20/2018 catn Moch Syaiful Bahri 27 sencaki 3/ swasta
67 8/20/2018 catn Dewi Rasdiana 25 perum swaswasta
68 8/21/2018 catn Fernandah Safbrin 22 nyamplungswasta
69 8/25/2018 catn Kurniawan 30 sidotopo j swasta
70 8/25/2018 catn Siti Hotijah Welas Indah Sari 22 sidotopo s swasta
KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS PERNAH TEST HEP B
PUNYA
MASA PERKAWI KHAS
KERJA NAN GEJALA
(Tahun) (Kawin/T BELUM
1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH TEMPAT TES
(Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

v pkm sidot
v pkm sidot
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v pkm sidot
v pkm sidot
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v pkm sidot
v pkm sidot
v pkm sidot
v pkm sidot
v pkm sidot
v pkm sidot
v pkm sidot
HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKSI DINI

HBsAg Anti HBs Anti HBC SGPT/ALT Anti HBe

WAKTU
WAKTU
MELAKUKAN TES TEMPAT TES MELAKUKAN
TES R NR (Titer IU/l) R NR (W : < 32) R

21 22 23 24 25 26 27 28 29 30

7/26/2018
7/26/2018
7/26/2018
7/26/2018
7/26/2018
7/26/2018
7/28/2018
7/28/2018
7/28/2018
7/30/2018
7/30/2018
7/30/2018
7/30/2018
7/31/2018
7/31/2018
8/1/2018
8/1/2018
8/1/2018
8/2/2018
8/2/2018
8/2/2018
8/4/2018
8/4/2018
8/4/2018
8/4/2018
8/4/2018
8/4/2018
8/4/2018
8/4/2018
8/6/2018
8/6/2018
8/6/2018
8/6/2018
 8/7/2018
8/7/2018
8/7/2018
8/7/2018
8/9/2018
8/9/2018
8/9/2018
8/9/2018
8/9/2018
8/9/2018
8/9/2018
8/11/2018
8/11/2018
8/13/2018
8/13/2018
8/13/2018
8/13/2018
8/13/2018
8/13/2018
8/13/2018
8/14/2018
8/14/2018
8/14/2018
8/14/2018
8/15/2018
8/15/2018
8/15/2018
8/15/2018
8/18/2018
8/20/2018
8/20/2018
8/20/2018
8/20/2018
8/20/2018
8/21/2018
8/25/2018
8/25/2018
 PERNAH
MENGGU
SAAN SEBELUM DETEKSI DINI PERNAH PUNYA NAKAN
PERNAH MENJALA PASANGA NARKOB
TRANSFU NI N SEKS A/JARUM
Anti HBe HBeAg HBV DNA Anti HCV SI DARAH HEMODI LAIN SUNTIK
(Ya/Tdk) ALISA (Ya/Tdk) BERSAM
NR R NR (IU/ml) R NR (Ya/Tdk) A
31 32 33 34 35 36 37 38 39
(Ya/Tdk)
40

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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
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tdak tdak tdak tdak
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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
 KELUARGA ADA
MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
ATAU C
YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R NR
Suami/Ist
41 42 43 44 45 46 47 48 49 50
LAH DETEKSI DINI REKOMENDASI DAN TINDAK LANJUT

HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif TGL IMUNISASI HEP B

Terapi 24-48 Terapi 48-72

R NR (IU/ml) R NR monitor Terapi mgg mgg 1

51 52 53 54 55 56 57 58 59 60
ASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

2 3 HEP B HEP C

61 62 63 64 65
BY NAME LAPORAN BULANAN REKAPITULASI TENAGA KESEHATAN DAN KELOMPOK MASYAR
PUSKESMAS : SIDOTOPO
BULAN : MEI
TAHUN : 2017

UMUR (Th)
JENIS KODE SPESIMEN JENIS
TGL KELOMP ALAMAT PEKERJA
NO NAMA
REGISTRASI OK LENGKAP AN/
RISIKO L P PROFESI
HEP B HEP C
1 2 3 4 5 6 7 8 9 10
1 8/27/2018 catn Ali Umar 22 sumbo 1/4 swasta
2 8/27/2018 catn Isnaini Arfilia 22 bolodewo swasta
3 8/28/2018 catn Indra Maulana Basir 21 sidotopo s swasta
4 8/28/2018 catn Sugalih Prioadi 37 rungkut maswasta
5 8/28/2018 catn Fitriawati 30 sidotopo s swasta
6 8/28/2018 catn Nurul Afifah 17 sidotopo loswasta
7 8/29/2018 catn Roldy Rahmat 28 dsn betengswasta
8 8/29/2018 catn Savira Rugaiyah 24 sidotopo 4 swasta
9 9/3/2018 catn Santi Apsari Nurbaya 38 sidotopo 3 swasta
10 9/4/2018 catn Noval 24 dsn baktokswasta
11 9/4/2018 catn Masita 17 nyamplungswasta
12 9/4/2018 catn Sudi 38 dsn dekok swasta
13 9/4/2018 catn Bunimah 24 surtikanti swasta
14 9/4/2018 catn Ahmad Romzi 27 petukangan swasta
15 9/4/2018 catn M. Rifqi Anfar 22 taman irawswasta
16 9/4/2018 catn Ziyad Baja'sut 24 ampel magh swasta
17 9/5/2018 catn Wahyu Dwi Kurniawan 23 sidotopo kiswasta
18 9/5/2018 catn Ahmad Baihaqi 21 sukodono swasta
19 9/5/2018 catn Berliani Isfiani Ashila 19 sidotopo j swasta
20 9/6/2018 catn Yusfika Maulidia 24 sombo 1/1 swasta
21 9/6/2018 catn Isro'atul Amilia 26 nyamplungswasta
22 9/6/2018 catn Mohamad Ali B. Ma'roef 35 sombo 76-swasta
23 8/6/2018 catn Tito Hari Sasmito 24 komplek siswasta
24 9/8/2018 catn Ach Sirojuddin 25 taman irawswasta
25 9/8/2018 catn Arikatul Ummah 19 surtikanti swasta
26 9/8/2018 catn Arifin 21 sidotopo j swasta
27 9/12/2018 catn Tiyara Verima Putri 23 petukanga swasta
28 9/8/2018 catn Syaiful Ashar 22 sidotopo k swasta
29 9/12/2018 catn Saniri 58 dsn jambu swasta
30 9/12/2018 catn Nuryati 45 nyamplungswasta
31 9/12/2018 catn Ach Gusti 26 danakarya swasta
32 9/12/2018 catn Hendra Tirta Saputra 28 semeru 35swasta
33 9/12/2018 catn Dian Puspa Rani 23 sidotopo s swasta
34 9/13/2018 catn Viki Januar 26 nyamplungswasta
35 9/15/2018 catn Rajif Bachmid 31 ketapang pswasta
36 9/15/2018 catn Fathi B. H. Abdullah Ali 31 ampel madswasta
37 9/18/2018 catn Nur Fadhilah 24 sidotopo j swasta
38 9/18/2018 catn Muchammad Soleh 19 danakarya swasta
39 9/18/2018 catn Nida' Durrotul Hikmah 21 kalikobok swasta
40 9/18/2018 catn Ahmad Rifa'i 21 kunti 41 swasta
41 9/18/2018 catn Nurul Faizah 26 petukangan swasta
42 9/18/2018 catn Al Amin Ibnu Fajar 24 pogot palmswasta
43 9/20/2018 catn Amir Mahmud 34 nyamplungswasta
44 9/20/2018 catn M. Randy Fiqri Hakim 27 ampel madswasta
45 9/20/2018 catn Novitasari 26 sidotopo kiswasta
46 9/24/2018 catn Ria Febriyani 27 sidotopo kiswasta
47 9/24/2018 catn Achmad Masykur 25 nyamplungswasta
48 9/24/2018 catn Sakinah 28 petukangan swasta
49 9/24/2018 catn Milatul Islamiyah 18 sombo 5/8 swasta
50 9/25/2018 catn Nurul Qudrotin 25 nyamplungswasta
51 9/25/2018 catn Bianca Wahdini Hariyadi 19 sidotopo loswasta
KELOMPOK MASYARAKAT BERISIKO TINGGI LAIN YANG MELAKUKAN DETEKSI DINI HEPATITIS B DAN C

STATUS IMUNISASI HEP. B PERNAH GEJALA

STATUS PERNAH TEST HEP B
PUNYA
MASA PERKAWI KHAS
KERJA NAN GEJALA
(Tahun) (Kawin/T BELUM
1X 2X 3X HEPATITIS URINE GELAP IKTERIK
dk Kawin) PERNAH TEMPAT TES
(Ya/Tdk)
11 12 13 14 15 16 17 18 19 20

v tdak pkm sidot

v tdak pkm sidot
v tdak pkm sidot
v tdak pkm sidot
v tdak pkm sidot
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v tdak pkm sidot
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v tdak pkm sidot
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HEPATITIS B DAN C

PERNAH TEST HEP B PERNAH TEST HEP C HASIL PEMERIKSAAN SEBELUM DETEKSI DIN

HBsAg Anti HBs Anti HBC SGPT/ALT Anti HBe

WAKTU
WAKTU
MELAKUKAN TES TEMPAT TES MELAKUKAN
TES R NR (Titer IU/l) R NR (W : < 32) R

21 22 23 24 25 26 27 28 29 30

8/27/2018
8/27/2018
8/28/2018
8/28/2018
8/28/2018
8/28/2018
8/29/2018
8/29/2018
9/3/2018
9/4/2018
9/4/2018
9/4/2018
9/4/2018
9/4/2018
9/4/2018
9/4/2018
9/5/2018
9/5/2018
9/5/2018
9/6/2018
9/6/2018
9/6/2018
8/6/2018
9/8/2018
9/8/2018
9/8/2018
9/12/2018
9/8/2018
9/12/2018
9/12/2018
9/12/2018
9/12/2018
9/12/2018
9/13/2018
9/15/2018
9/15/2018
9/18/2018
9/18/2018
9/18/2018
9/18/2018
9/18/2018
9/18/2018
9/20/2018
9/20/2018
9/20/2018
9/24/2018
9/24/2018
9/24/2018
9/24/2018
9/25/2018
9/25/2018
 PERNAH
MENGGU
SAAN SEBELUM DETEKSI DINI PERNAH PUNYA NAKAN
PERNAH MENJALA PASANGA NARKOB
TRANSFU NI N SEKS A/JARUM
Anti HBe HBeAg HBV DNA Anti HCV SI DARAH HEMODI LAIN SUNTIK
(Ya/Tdk) ALISA (Ya/Tdk) BERSAM
NR R NR (IU/ml) R NR (Ya/Tdk) A
31 32 33 34 35 36 37 38 39
(Ya/Tdk)
40

tdak tdak tdak tdak

tdak tdak tdak tdak
tdak tdak tdak tdak
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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
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tdak tdak tdak tdak
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tdak tdak tdak tdak
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tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
tdak tdak tdak tdak
 KELUARGA ADA
MENDERITA HEP B & HASIL PEMERIKSAAN SETELAH DETEKSI DINI
ATAU C
YA HBsAg HBsAg Konfirmasi Anti HBs SGPT/ALT Anti HBe
TIDAK
1. R NR R NR (Titer IU/l) (W : < 32) R NR
Suami/Ist
41 42 43 44 45 46 47 48 49 50
LAH DETEKSI DINI REKOMENDASI DAN TINDAK LANJUT

HBeAg HBV DNA Anti HCV HBsAg Reaktif HCV Reaktif TGL IMUNISASI HEP B

Terapi 24-48 Terapi 48-72

R NR (IU/ml) R NR monitor Terapi mgg mgg 1

51 52 53 54 55 56 57 58 59 60
ASI DAN TINDAK LANJUT
KETERAN
TGL IMUNISASI HEP B KONSELING GAN

2 3 HEP B HEP C

61 62 63 64 65