SARANA PRASARANA

PELAYANAN TERPADU (PANDU) PENYAKIT TIDAK MENULAR DI FKTP

1. Provinsi : ................................................................................

2. Kota : ................................................................................

3. Puskesmas : ................................................................................

4. Jumlah Tenaga yang mengelola P2PTM : ................................................................................

5. Nama Petugas/Koordinator P2PTM : ................................................................................

A. Data Tenaga Kesehatan

PUSKESMAS KAWASAN PUSKESMAS

NO JENIS TENAGA
PERKOTAAN .......................

1 Dokter atau dokter layanan Primer 3

2 Dokter Gigi 2
3 Perawat 13
4 Bidan 11
5 Tenaga Kesehatan Masyarakat 4
6 Tenaga Kesehatan Lingkungan 2
7 Ahli Teknologi Laboratorium Medik 2
8 Tenaga Gizi 3
9 Tenaga Kefarmasian 3
10 Tenaga Administrasi 6
11 Pekarya 4

B. Data Alat Kesehatan Pelayanan Terpadu PTM di FKTP

Jumlah
No Jenis Alat Kesehatan
Ada Belum
1 Termometer
2 Stateskop
3 Tensimeter Air Raksa
4 Tensimeter Digital
5 Timbangan Berat Badan
6 Alat Ukur Tinggi Badan
7 Alat Ukur lingkar Perut
8 Peakflow meter
9 Glukometer
 10 Test Albumin Urine
11 Spacer Inhaler
12 Nebulazer
13 Pulse Oximeter
14 Alat Periksa Kolesterol
15 Lipidprofil
16 EKG
17 AED
18 Iva Kit
19 Rontgen Paru
20 Oftalmoskop
21 Optotip Snellen
22 Ear Kit
23 Garpu Tala
24 Test Mikro Albuminuria
25 CO Analyzer

C. Data Obat PTM

Jumlah
No Jenis Obat
Ada Belum
1 Aminofilin
2 Amoxicilin
3 Aspirin
4 Beclometasone Inhaler
5 Bisoprolol
6 Captopril
7 CCB (Nifedipine R, Amlodipine)
8 Cotrimoxalee
9 Cyclophospamide
10 Dextrose Infusion
11 Dexamethasone
12 Doksisilin
13 Diazepan
14 Erytromycin
15 Ephinephrine
16 Furosemide
17 Glukosa Injeksi
18 Glukose Injectable Solution
19 Heparin
20 Hydrocholorothiazide
21 Hydrocortisone (Injection)
 22 Ibuprofen
23 Insulin Basal (NPH, Detemi Glargine)
24 Ipratropium Bromide
25 Ipratropium Bromide + Salbutamol
26 Isosorbide Dinitrate
27 Metformin
28 Methilprednison
29 Metrodinazole
30 Paracetamol
31 Penicilin
32 Prednisolone
33 Povidon Iodine
34 Promethazine Injection
35 Salbutamol Inhaler
36 Salbutamol Tablet
37 Statin (Iovastin/Simvastatin)
38 Sulfonilurea (Glibenclamide, Glimepirid, Glikazid, Glikuidon)
39 Tamoxifen
40 Tiotropium
41 Morphine
42 Oksigen

D. Kelengkapan Pelayanan Terpadu PTM di FKTP

Jumlah
No Jenis Obat
Ada Belum
1 Carta Prediksi Faktor Risiko PJPD
2 Rekam Medis
3 SOP syok Anafilaktik
4 Alur Tatalaksana Asma Akut
5 Alur Tatalaksana Hipertensi
6 Alur Tatalaksana DM Terintegrasi
7 Media Penyuluhan PTM
8 Buku Pedoman tentang PTM

E. Rencana Tindak Lanjut

…………………………………………………………………………………….................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................