LB3 + PWS KIA 2019 Untuk Di Print

LAPORAN PWS KIA (INDIKATOR KESEHATAN IBU 1)
PUSKESMAS :
BULAN/TAHUN: JANUARI 2019
SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN
NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

BUMIL RISTI BLN BLN R BLN BLN R BLN
JML % JML %
20% LALU INI LALU INI LALU
1 0 0 #DIV/0! 0 #DIV/0!
2 0 0 #DIV/0! 0 #DIV/0!
3 0 0 #DIV/0! 0 #DIV/0!
4 0 0 #DIV/0! 0 #DIV/0!
5 0 0 #DIV/0! 0 #DIV/0!
6 0 0 #DIV/0! 0 #DIV/0!
7 0 0 #DIV/0! 0 #DIV/0!
8 0 0 #DIV/0! 0 #DIV/0!
9 0 0 #DIV/0! 0 #DIV/0!
10 0 0 #DIV/0! 0 #DIV/0!
11 0 0 #DIV/0! 0 #DIV/0!
12 0 0 #DIV/0! 0 #DIV/0!
13 0 0 #DIV/0! 0 #DIV/0!
14 0 0 #DIV/0! 0 #DIV/0!
15 0 0 #DIV/0! 0 #DIV/0!
16 0 0 #DIV/0! 0 #DIV/0!
17 0 0 #DIV/0! 0 #DIV/0!
TOTAL PKM 0 0 0 0 #DIV/0! 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI
LUAR WIL PUSK.WIL.KAB
LUAR WIL PUSK.LUAR WIL.KAB
PUSKESMAS :
BULAN/TAHUN: FEBRUARI 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS :
BULAN/TAHUN: MARET 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS :
BULAN/TAHUN: APRIL 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS :
BULAN/TAHUN: MEI 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS :
BULAN/TAHUN: JUNI 2018

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: JULI 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: Agustus 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS :
BULAN/TAHUN: September 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS : ..........................
BULAN/TAHUN: Oktober 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS : ..........................
BULAN/TAHUN: November 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
PUSKESMAS : ..........................
BULAN/TAHUN: Desember 2019

JML % JML %
1 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
2 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
3 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
4 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
5 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
6 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
7 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
8 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
9 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
10 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
11 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
12 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
13 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
14 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
15 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
16 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
17 - 0 0 0 0 #DIV/0! 0 0 #DIV/0! 0
TOTAL PKM 0 0 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0
UNIT LAIN WIL PUSK
TOTAL BLN INI
KSI RISIKO TINGGI OLEH MASYARAKAT DETEKSI RISIKO TINGGI OLEH NAKES KOMPLIKASI KEBIDANAN YG DITANGANI
NC KUMUL PENC KUMUL PENC KUMUL

BLN R BLN BLN R BLN BLN R
JML % JML % JML %
INI LALU INI LALU INI
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
'………………..,………………..
Ka UPTD Puskesmas ................................
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NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
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NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
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NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
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NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
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NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
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NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
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'………………..,………………..
..................................................
NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
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'………………..,………………..
..................................................
NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
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0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
'………………..,………………..
..................................................
NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
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0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
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0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
'………………..,………………..
..................................................
NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
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0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
'………………..,………………..
..................................................
NIP. ............................................

JML % JML % JML %
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
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0 #DIV/0! 0 0 #DIV/0! 0 0 #DIV/0!
0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0!
'………………..,………………..
..................................................
NIP. ............................................
PUSKESMAS :
BULAN/TAHUN: JANUARI 2019
SASARAN
PERSALINAN OLEH NAKES PERSALINAN NAKES DI FASILITAS KESEHATAN
NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 0 #DIV/0! 0 #DIV/0!
2 0 #DIV/0! 0 #DIV/0!
3 0 #DIV/0! 0 #DIV/0!
4 0 #DIV/0! 0 #DIV/0!
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7 0 #DIV/0! 0 #DIV/0!
8 0 #DIV/0! 0 #DIV/0!
9 0 #DIV/0! 0 #DIV/0!
10 0 #DIV/0! 0 #DIV/0!
11 0 #DIV/0! 0 #DIV/0!
12 0 #DIV/0! 0 #DIV/0!
13 0 #DIV/0! 0 #DIV/0!
14 0 #DIV/0! 0 #DIV/0!
15 0 #DIV/0! 0 #DIV/0!
16 0 #DIV/0! 0 #DIV/0!
17 0 #DIV/0! 0 #DIV/0!
TOTAL PKM 0 0 0 #DIV/0! 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI
D/SUSRI/PWS-07 Ka UPTD Pus

PUSKESMAS :
BULAN/TAHUN: FEBRUARI 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: MARET 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: APRIL 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: MEI 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: JUNI 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
3 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: JULI 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
3 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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17 - 0 0 0 #DIV/0! 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI


PUSKESMAS :
BULAN/TAHUN: Agustus 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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17 - 0 0 0 #DIV/0! 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS :
BULAN/TAHUN: September 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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14 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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17 - 0 0 0 #DIV/0! 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS : ...................
BULAN/TAHUN: Oktober 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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11 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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13 - 0 0 0 #DIV/0! 0 0 #DIV/0!
14 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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17 - 0 0 0 #DIV/0! 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS : ...................
BULAN/TAHUN: November 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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14 - 0 0 0 #DIV/0! 0 0 #DIV/0!
15 - 0 0 0 #DIV/0! 0 0 #DIV/0!
16 - 0 0 0 #DIV/0! 0 0 #DIV/0!
17 - 0 0 0 #DIV/0! 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PUSKESMAS : ...................
BULAN/TAHUN: Desember 2019
SASARAN

BLN BLN R BLN BLN R
JML % JML %
LALU INI LALU INI
1 - 0 0 0 #DIV/0! 0 0 #DIV/0!
2 - 0 0 0 #DIV/0! 0 0 #DIV/0!
3 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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10 - 0 0 0 #DIV/0! 0 0 #DIV/0!
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14 - 0 0 0 #DIV/0! 0 0 #DIV/0!
15 - 0 0 0 #DIV/0! 0 0 #DIV/0!
16 - 0 0 0 #DIV/0! 0 0 #DIV/0!
17 - 0 0 0 #DIV/0! 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 #DIV/0! 0 0 0 #DIV/0!
UNIT LAIN WIL PUSK
TOTAL BLN INI

PELAYANAN IBU NIFAS TEMPAT PERSALINAN DI FASILITAS KESEHATAN KUMULATIF TEMPAT PERS
PENC KUMUL
BPM BPM
PKM POLIND PKM
BLN BLN R RS PKM PUSTU WILAYA SWAST RUMAH JUMLAH RS PKM
JML % PONED ES PONED
H A
LALU INI
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
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0 0 #DIV/0! 0 0 0 0
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0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 52.00 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PENC KUMUL
BPM BPM
PKM POLIND PKM
H A
LALU INI
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 #DIV/0! 0 0 0 0
0 0 0 #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0
………………..,………………..
a UPTD Puskesmas ................................
..................................................
NIP. ................................
PAT PERSALINAN DI FASILITAS KESEHATAN
BPM BPM
POLIND
PUSTU WILAYA SWAST RUMAH JUMLAH
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
BPM BPM
POLIND
ES
H A
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
LAPORAN PWS KIA (INDIKATOR KESEHATAN ANAK 1)
PUSKESMAS :
BULAN/TAHUN : JANUARI 2019
SASARAN RIIL BULAN INI RIIL
NO DESA
BAYI LAHIR HIDUP LINAK LIN JUMLAH BAYI LAHIR HIDUP BAYILAHIRMATI LIN
GEMELI LINAKES GEMELI
ES DUKUN BAYI DUKUN
L P L+ P L P L+ P L P L+P
1 - - - 0 0 0 0 - - -
2 - - - 0 0 - - -
3 - - - 0 0 - - -
4 - - - 0 0 - - -
5 - - - 0 0 - - -
6 - - - 0 0 - - -
7 - - - 0 0 - - -
8 - - - 0 0 - - -
9 - - - 0 0 - - -
10 - - - 0 0 - - -
11 - - - 0 0 - - -
12 - - - 0 0 - - -
13 - - - 0 0 - - -
14 - - - 0 0 - - -
15 - - - 0 0 - - -
16 - - - 0 0 - - -
17 - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
LUAR WIL PUSK.WIL.KAB/KOTA
TOTAL BULAN INI
LUAR WIL PUSK LUAR.WIL.KAB
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : PEBRUARI 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : MARET 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : APRIL 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : MEI 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : JUNI 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : JULI 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : AGUSTUS 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : SEPTEMBER 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : OKTOBER 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : NOVEMBER 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PUSKESMA - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
BULAN/TAHUN : DESEMBER 2019
NO DESA
ES DUKUN BAYI DUKUN
1 - - - - - - 0 0 - - -
2 - - - - - - 0 0 - - -
3 - - - - - - 0 0 - - -
4 - - - - - - 0 0 - - -
5 - - - - - - 0 0 - - -
6 - - - - - - 0 0 - - -
7 - - - - - - 0 0 - - -
8 - - - - - - 0 0 - - -
9 - - - - - - 0 0 - - -
10 - - - - - - 0 0 - - -
11 - - - - - - 0 0 - - -
12 - - - - - - 0 0 - - -
13 - - - - - - 0 0 - - -
14 - - - - - - 0 0 - - -
15 - - - - - - 0 0 - - -
16 - - - - - - 0 0 - - -
17 - - - - - - 0 0 - - -
TOTAL PKM - - - - - - - - - - - - - - - -
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
NEONATUS
RIIL KUMULATIF
KN 1MURNI
PENCAPAIAN KUMULATIF
JUMLAH BAYI LAHIR HIDUP BAYILAHIRMATI
BLN LALU BLN INI JML R
BAYI
L P L+ P L P L+P L P L+ P L P L+ P L % P % L+P %
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
NEONATUS
RIIL KUMULATIF
KN 1MURNI
BAYI
- - - - - - - 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 ###
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
EONATUS
KN LENGKAP
L P L+ P L P L+ P L % P % L+P %
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 ###
'………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :
SASARAN NEONATAL KOMPLIKASI YANG DITANGANI
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
BLN LALU BLN INI JML
L P L+ P L P L+P L P L+ P L P L+ P L %
1 0 0 0 0 #DIV/0!
2 0 0 0 0 #DIV/0!
3 0 0 0 0 #DIV/0!
4 0 0 0 0 #DIV/0!
5 0 0 0 0 #DIV/0!
6 0 0 0 0 #DIV/0!
7 0 0 0 0 #DIV/0!
8 0 0 0 0 #DIV/0!
9 0 0 0 0 #DIV/0!
10 0 0 0 0 #DIV/0!
11 0 0 0 0 #DIV/0!
12 0 0 0 0 #DIV/0!
13 0 0 0 0 #DIV/0!
14 0 0 0 0 #DIV/0!
15 0 0 0 0 #DIV/0!
16 0 0 0 0 #DIV/0!
17 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC KUMUL

BAYI NEO RISTI 15 %
1 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
2 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
3 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
4 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
5 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
6 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
7 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
8 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
9 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
10 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
11 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
12 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
13 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
14 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
15 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
16 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
17 - 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 #DIV/0!
UNIT LAIN WIL PKM
TOTAL BULAN INI
D/SUSRI/PWS-07
NGANI CAKUPAN KUNJUNGAN BAYI (PARIPURNA)
KUMUL PENC KUMUL

JML R BLN LALU BLN INI JML R
P % L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

0 #DIV/0! 0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
KUMUL PENC KUMUL

………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :
SASARAN CAKUPAN ANAK BA
NO DESA PENC
ANAK BALITA BALITA ANAK PRA SEKOLAH
BLN LALU BLN INI
L P L+ P L P L+ P L P L+P L P L+ P L P
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PKM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PUSKESMAS :
NO DESA PENC
BLN LALU BLN INI
1 - 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PUSKESM 0 0 0 0 0 0 0 0 0 0 0 0 0 0
UNIT LAIN WIL KAB
TOTAL BULAN INI
D/SUSRI/PWS-07
PAN ANAK BALITA ( PARIPURNA ) CAKUPAN BALITA ( PARIPURNA )
KUMUL PENC KUMUL

NI JML R BLN LALU BLN INI JML
L+ P L % P % L+P % L P L+ P L P L+ P L % P %
0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0 0 #DIV/0! 0 #DIV/0!
KUMUL PENC KUMUL

0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0!
KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

KUMUL PENC KUMUL

CAKUPAN ANAK PRA SEKOLAH ( PARIPURNA )
PENC KUMUL
R BLN LALU BLN INI JML R
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
PENC KUMUL
L+P % L P L+ P L P L+ P L % P % L+P %
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 0 0 0 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!
………………..,………………..
..................................................
NIP. ................................
FORMAT LAPORAN MATERNAL 1 (LB3KIA)
PUSKESMAS :
BULAN / TAHUN : JANUARI 2019
HB KEK Protein Urin Gula Darah KASU

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
NO DESA K1 a (8- mia Dipe Diperi eklams Perdaraha
Diperik A Diperi Diperi >14 ere Abo ahan Perdarah Partus Infeks Diper
11 (< 8 riksa ksa ia/ n
sa HB <23 ksa ksa 0 mes rtus Keham an Nifas Lama i iksa
mg/dl mg/d LILA (+) Eklams persalinan
,5c g/dl is ilan PITC
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 -
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : PEBRUARI 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : MAR 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : APRIL 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : MEI 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : JUNI 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : JULI 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : AGUSTUS 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : SEPTEMBER 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : OKTOBER 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : NOVEMBER 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
BULAN / TAHUN : DESEMBER 2019

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -
7 - -
8 - -
9 - -
10 - -
11 - -
12 - -
13 - -
14 - -
15 - -
16 - -
17 - -
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS :
TAHUN : 2018

AIDS
KEK
Anemi Ane Pre
(LIL GD Hip Perdar
) l) ia
m)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
KASUS MATERNAL YANG DITEMUKAN
AIDS HEPATITIS B Kasus Lain-Lain
Ancam
Malari Diperik IMS Ketuban Kehamil an
TB Partus Infeksi Jumlah
Reakt a sa + Kelainan Persalin
Positif Pecah an lebih macet / Gemelli pada kasus
if letak an
HBsAg Dini bulan distocia Nifas lain-lain
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
………………..,………………..
..................................................
NIP. ................................
Ancam
if letak an
Premat
ur
22 23 24 25 26 27 28 29 30 31 32 33 34 35
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
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
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :
JUMLAH PERSALINAN JENIS PERSALINAN

Tindakan
NO DESA TOTAL
LINAKES DUKUN LINAKES + Normal SC
DUKUN Drip Vakum/ Forcep Curetage
1 2 3 4 5 6 7 8 9 10
1 0 0 0
2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
9 0 0 0
10 0 0 0
11 0 0 0
12 0 0 0
13 0 0 0
14 0 0 0
15 0 0 0
16 0 0 0
17 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0
2 - 0 0 0
3 - 0 0 0
4 - 0 0 0
5 - 0 0 0
6 - 0 0 0
7 - 0 0 0
8 - 0 0 0
9 - 0 0 0
10 - 0 0 0
11 - 0 0 0
12 - 0 0 0
13 - 0 0 0
14 - 0 0 0
15 - 0 0 0
16 - 0 0 0
17 - 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
PUSKESMAS :
TAHUN : 2018

Tindakan
NO DESA TOTAL
1 2 3 4 5 6 7 8 9 10
1 - 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0
3 - 0 0 0 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0
PUSKESMAS 0 0 0 0 0 0 0 0
………………..,………………..
..................................................
NIP. ................................
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
0 0 0 0
…………..
.........................
..................
............
Jumlah Persalinan
Persalinan Dukun
Plasenta
JUMLAH Nakes
Manual
11 12 13 14
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
…………..
.........................
..................
............
FORMAT LAPORAN NEONATAL (LB3KIA)
PUSKESMAS :
KASUS NEONATAL YANG DITEMUK

Jumlah Bayi
Jumlah Bayi di SHK Tetanus
Prematur Trauma Lahir Asfiksia BBLR <2500 gram Infeksi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - 0 0 0 0 0 0
2 - 0 0 0 0 0 0
3 - 0 0 0 0 0 0
4 - 0 0 0 0 0 0
5 - 0 0 0 0 0 0
6 - 0 0 0 0 0 0
7 - 0 0 0 0 0 0
8 - 0 0 0 0 0 0
9 - 0 0 0 0 0 0
10 - 0 0 0 0 0 0
11 - 0 0 0 0 0 0
12 - 0 0 0 0 0 0
13 - 0 0 0 0 0 0
14 - 0 0 0 0 0 0
15 - 0 0 0 0 0 0
16 - 0 0 0 0 0 0
17 - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - - 0 0 0 0 0 0
2 - - 0 0 0 0 0 0
3 - - 0 0 0 0 0 0
4 - - 0 0 0 0 0 0
5 - - 0 0 0 0 0 0
6 - - 0 0 0 0 0 0
7 - - 0 0 0 0 0 0
8 - - 0 0 0 0 0 0
9 - - 0 0 0 0 0 0
10 - - 0 0 0 0 0 0
11 - - 0 0 0 0 0 0
12 - - 0 0 0 0 0 0
13 - - 0 0 0 0 0 0
14 - - 0 0 0 0 0 0
15 - - 0 0 0 0 0 0
16 - - 0 0 0 0 0 0
17 - - 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
PUSKESMAS :
TAHUN : 2018

Jumlah Bayi
Neonatorum
SASARA
NO DESA N LAHIR
HIDUP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 - 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0
4 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS - - - - - - - - - - - - - - - - - - - -
NG DITEMUKAN
Tetanus
Kelainan Bawaan HK (+) Lain-Lain
Neonatorum
P L+P L P L+P L P L+P L P L+P
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
NG DITEMUKAN
Tetanus
Neonatorum
23 24 25 26 27 28 29 30 31 32 33
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 0 0 0 0 0
- - - - - - - - - - -
………………..,………………..
..................................................
NIP. ................................
FORMAT LAPORAN (LB3-KIA) HASIL PELAYANAN SDIDTK BAYI
Puskesmas :
Bulan / Tahun : JANUARI 2019
Jumlah Jumlah Penyimpangan SDIDTK

Jumlah Bayi (0-12 bulan) KPSP Penyimpangan /Gangguan Perkembangan
Jumlah
Desa/ Bayi di mendapatkan
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
(0-12 bulan) Sosialisasi,
(Pertama kali) SDIDTK 4 x LKA tidak Motorik Motorik Bicara, Gangguan
% % % % Kemandiria %
setahun normal Kasar Halus Bahasa TDL
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 0 - #DIV/0! - #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Jumlah - - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! -
…………………….., Tangga
Mengetahu
Kepala Puskesmas………
Puskesmas :
Bulan / Tahun : PEBRUARI 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : MARET 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : APRIL 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : MEI 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : JUNI 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : JULI 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : AGUSTUS 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : SEPTEMBER 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : OKTOBER 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : NOVEMBER 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Bulan / Tahun : DESEMBER 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Tahun : 2019

Jumlah
NO. Kelurahan
Sasaran Bayi
SDIDTK
%
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 0 - - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! -
…………………….., Tangga
Mengetahu
Kumulaatif Jumlah
Jumlah yang Dirujuk Bayi di SDIDTK
(Pertama kali)
MME
Gangguan
% TDD % mungkin ada % % Absolut %
gangguan
N
19 20 21 22 23 24 25 26 27
#DIV/0! #DIV/0! #DIV/0! #DIV/0! - #DIV/0!
#DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0!
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
Kumulaatif Jumlah
(Pertama kali)
MME
Gangguan
gangguan
N
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
FORMAT LAPORAN (LB3-KIA) HASIL PELAYANAN SDIDTK ANAK BALITA
Puskesmas :
Jumlah Anak Jumlah Penyimpangan SDIDTK

Balita (12-59
Jumlah Jumlah KPSP Penyimpangan /Gangguan Perkembangan
bulan)
Desa/ Sasaran Anak Anak Balita di
NO. Kelurahan Balita (12-59 SDIDTK
% mendapatkan %
pelayanan Sosialisasi,
bulan) (Pertama kali) LKA tidak Motorik Motorik Bicara, Gangguan
SDIDTK 4 x % % % % Kemandiria %
setahun
normal Kasar Halus Bahasa TDL
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Tahun : 2019

Balita (12-59
bulan)
% mendapatkan %
setahun
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Jumlah yang Dirujuk Kumulaatif Jumlah
Anak Balita di SDIDTK
(Pertama kali)
MME N %
Gangguan
% TDD % mungkin ada % Absolut %
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali)
MME N %
Gangguan
gangguan
19 20 21 22 23 24 25 26 27
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
FORMAT LAPORAN (LB3-KIA) HASIL PELAYANAN SDIDTK APRAS
Puskesmas :
Jumlah Apras (60- Jumlah Penyimpangan SDIDTK

72 bulan) KPSP Penyimpangan /Gangguan Perkembangan
Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
Sasaran Apras di SDIDTK %
pelayanan
%
(60-72 bulan) (Pertama kali) Sosialisasi,
SDIDTK 4 x LKA tidak Motorik Motorik Bicara, Gangguan
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Puskesmas :
Tahun : 2019

Jumlah Jumlah Apras
Desa/ mendapatkan
NO. Kelurahan
pelayanan
%
n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
…………………….., Tangga
Mengetahu
Kumulaatif Jumlah MTBS
Jumlah yang Dirujuk Apras di SDIDTK
(Pertama kali) Jumlah Balita
di MTBS
Jumlah
MME Balita
Gangguan
% TDD % mungkin ada % N % Absolut % Sakit N %
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
#DIV/0! #DIV/0! #DIV/0! #DIV/0! - #DIV/0! #DIV/0!
#DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! 0 0 #DIV/0!
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
di MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
di MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
di MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
di MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
(Pertama kali) Jumlah Balita di
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
MTBS
Jumlah
MME Balita
Gangguan
gangguan
19 20 21 22 23 24 25 26 27 28 29 30
#DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - #DIV/0! - - #DIV/0!
….., Tanggal, …………………..2019

Mengetahui,
esmas……………………….
________________)
NIP.
LAPORAN LAHIR MATI TAHUN 2018
PUSKESMAS ...........................
NAMA UMUR GRAVIDA / PENYEBAB KEMATIAN PENGAKHIRAN KEH

BULAN ALAMAT ANC
IBU AYAH IBU PARA TGL TEMPAT
JAN
PEB
MAR
APR
MEI
JUN
JUL
AGT
SEPT
OKT
NOP
DES
AHIR MATI TAHUN 2018
MAS ...........................
JENIS
PENGAKHIRAN KEHAMILAN JENIS
KELAMIN SKOR KET
UMUR BB PB PENOLONG L P PERS
………………..,………………..
..................................................
NIP. ................................
DATA PERSALINAN GEMELI TAHUN 2018
PUSKESMAS .............................
NAMA UMUR PERSALINAN BB / PB / JENIS KELAMIN

BULAN
ISTRI SUAMI ISTRI TGL TEMPAT PENOLONG JENIS UK ANAK I ANAK II ANAK III
JAN
PEB
MAR
APR
MEI
JUN
JUL
AGT
SEPT
OKT
NOP
DES
………………..,………………
Ka UPTD Puskesmas ...................
..............................................
NIP. ................................
LINAN GEMELI TAHUN 2018
MAS .............................
KEADAAN BAYI
ALAMAT
LH / LM
………………..,………………..
..................................................
NIP. ................................
LAPORAN PERSALINAN
BULAN JANUARI 2018
PUSKESMAS ..........................
NAMA KEADAAN BAYI RUJUKAN

PERSALINAN TUNGGAL GEMELI / TRIPLE
NO ISTRI SUAMI ALAMAT TGL TEMPAT PENOLONG JENIS UK LH/LM/BB LH/LM/BB LH/LM/BB LH/LM/BB DIAGNOSA RS .... KETERANGAN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN PEBRUARI 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN MARET 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN APRIL 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN MEI 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN JUNI 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN JULI 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN AGUSTUS 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN SEPTEMBER 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN OKTOBER 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN NOVEMBER 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
LAPORAN PERSALINAN
BULAN DESEMBER 2018
PUSKESMAS ..........................

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

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LAPORAN PWS KIA (INDIKATOR KESEHATAN IBU 1)

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

LUAR WIL PUSK.LUAR WIL.KAB

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

LUAR WIL PUSK.WIL.KAB

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

SASARAN K1 (IBU HAMIL ) K4 (IBU HAMIL ) DETEKSI RISIKO TIN

NO DESA BUMIL PENC KUMUL PENC KUMUL PENC

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NC KUMUL PENC KUMUL PENC KUMUL

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

LUAR WIL PUSK.LUAR WIL.KAB

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

LUAR WIL PUSK.WIL.KAB

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus

NO DESA BULIN / BUFAS PENC KUMUL PENC KUMUL

D/SUSRI/PWS-07 Ka UPTD Pus