Data Dasar Inputan Laporan PWS KIA

Tahun Data : 2017

Bulan : Januari
Kab/ Kota : Aceh Besar
Provinsi : NAD

NO Kode Desa Puskesmas DESA Jumlah Penduduk

1 LHOKNGA Monikeun 1,218
2 Lamkruet 1,069
3 Weuraya 944
4 Lampaya 1,567
5 Mns mesjid lpk 408
6 Mns lambaro lpk 514
7 Mns Balee 556
8 Mns Blang lpk 216
9 Mns Cut Lpk 194
10 Mns Mesjid lhm 443
11 Mns Baro lhm 372
12 Mns Beutong 514
13 Mns Manyang 362
14 Mns Moncut 355
15 Mns Karieng 679
16 Mns Lamgirek 170
17 Naga Umbang 346
18 Lambaro Kueh 540
19 Aneuk Paya 640
20 Lam ateuk 516
21 Kueh 463
22 Lamgaboh 735
23 Tanjong 685
24 Nusa 1,039
25 Sebun Ketapang 394
26 Seubun Ayon 328
27 Lambaro Sebun 421
28 Lamcok 403
JUMLAH 16,091
Kab/KotaAceh Besar

Bulan : Januari

Tahun : 2017

Form 1 (ANC)

Status T Bumil DETEKSI RISIKO RUJUKAN KASUS R

Jumlah Buku
NO. NAMA DESA Bumil K1 % K4 % FE1 FE3
Penduduk KIA T1 T2 T3 T4 T5 T2+ NAKES % MASYARAKAT MATERNAL

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
1 Monikeun 1,218 33 2 2 6 1 3 0 1 1 0 0 2 2 1 0 0 0 0
2 Lamkruet 1,069 29 3 3 10 1 3 0 1 0 1 1 3 3 1 0 0 0 0
3 Weuraya 944 26 1 1 4 0 0 0 0 0 0 1 1 1 0 0 0 0 0
4 Lampaya 1,567 43 4 4 9 4 9 0 0 1 0 3 4 4 4 0 0 0 0
5 Mns mesjid lpk 408 11 2 2 18 2 18 0 0 0 1 1 2 2 2 1 50 0 0
6 Mns lambaro lpk 514 14 3 3 21 0 0 0 0 0 2 1 3 3 0 0 0 0 0
7 Mns Balee 556 15 1 1 7 1 7 0 0 0 1 0 1 1 1 0 0 0 0
8 Mns Blang lpk 216 6 3 3 50 0 0 0 0 1 0 2 3 3 0 0 0 0 0
9 Mns Cut Lpk 194 5 1 1 20 2 40 0 0 1 0 0 1 1 2 1 100 0 0
10 Mns Mesjid lhm 443 12 4 4 33 0 0 0 0 0 0 4 4 4 0 0 0 0 0
11 Mns Baro lhm 372 10 3 3 30 0 0 0 0 0 3 0 3 3 0 1 50 0 0
12 Mns Beutong 514 14 1 1 7 0 0 0 0 0 0 1 1 1 0 0 0 0 0
13 Mns Manyang 362 10 2 2 20 1 10 0 0 0 2 0 2 2 1 0 0 0 0
14 Mns Moncut 355 10 1 1 10 1 10 0 0 0 0 1 1 1 1 2 100 0 1
15 Mns Karieng 679 19 3 3 16 1 5 0 0 0 2 1 3 3 1 1 25 0 0
16 Mns Lamgirek 170 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Naga Umbang 346 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Lambaro Kueh 540 15 3 3 20 3 20 0 1 0 0 2 3 3 3 1 33.33 0 0
19 Aneuk Paya 640 18 0 0 0 0 0 0 0 0 0 0 0 0 0 1 25 0 0
20 Lam ateuk 516 14 2 2 14 3 21 0 0 0 0 2 2 2 3 0 0 0 0
21 Kueh 463 13 0 0 0 1 8 0 0 0 0 0 0 0 1 0 0 0 0
22 Lamgaboh 735 20 3 3 15 0 0 0 0 1 0 2 3 3 0 0 0 0 0
23 Tanjong 685 19 1 1 5 0 0 0 0 0 1 0 1 1 0 0 0 0 0
24 Nusa 1,039 29 0 0 0 4 14 0 0 0 0 0 0 0 4 0 0 0 0
25 Sebun Ketapang 394 11 1 1 9 0 0 0 0 0 0 1 1 1 0 0 0 0 0
26 Seubun Ayon 328 9 1 1 11 0 0 0 0 0 0 1 1 1 0 0 0 0 0
27 Lambaro Sebun 421 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Lamcok 403 11 1 1 9 0 0 0 0 0 0 1 1 1 0 0 0 0 0
Jumlah 16,091 443 46 46 10 25 6 0 3 5 13 25 46 46 25 8 8.989 0 1
UKAN KASUS RISTI PERIODE INPUT DATA

NEONATAL BULAN TAHUN

20 21 22
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
0 Januari 2017
Kab/ Kota : Aceh Besar

Bulan : Januari

Tahun : 2017
Form 2 (Persalinan Dan Nifas)

Persalinan Ditolong Nakes (PN) Kunjungan Nifas (KF)

Persalinan Komplikasi
NO. Nama Desa Sasaran Bulin Ditolong Non Maternal % VIT A NIFAS
PN DI PN DI NON Nakes Ditangani (PK)
PN % KF1 KF2 KF3
FASYANKES FASYANKES

1 2 3 4 5 6 7 8 9 10 11 12
1 Monikeun 32 0 0 0 0 0 0 0 0 0 0 2
2 Lamkruet 28 2 7 2 0 0 1 4 2 2 2 0
3 Weuraya 25 3 12 3 0 0 1 4 3 3 1 0
4 Lampaya 41 4 10 4 0 0 1 2 4 4 4 0
5 Mns mesjid lpk 11 2 18 2 0 0 0 0 2 2 2 1
6 Mns lambaro lpk 13 0 0 0 0 0 0 0 0 0 0 3
7 Mns Balee 15 0 0 0 0 0 0 0 0 0 0 0
8 Mns Blang lpk 6 0 0 0 0 0 0 0 0 0 0 0
9 Mns Cut Lpk 5 0 0 0 0 0 0 0 0 0 0 0
10 Mns Mesjid lhm 12 1 8 1 0 0 1 8 1 1 1 1
11 Mns Baro lhm 10 0 0 0 0 0 0 0 0 0 0 0
12 Mns Beutong 13 1 8 1 0 0 0 0 1 1 0 0
13 Mns Manyang 10 0 0 0 0 0 0 0 0 0 0 0
14 Mns Moncut 9 1 11 1 0 0 0 0 1 1 1 0
15 Mns Karieng 18 0 0 0 0 0 0 0 0 0 0 0
16 Mns Lamgirek 4 1 25 1 0 0 0 0 1 1 1 0
17 Naga Umbang 9 0 0 0 0 0 0 0 0 0 0 0
18 Lambaro Kueh 14 0 0 0 0 0 0 0 0 0 0 0
19 Aneuk Paya 17 3 18 1 0 0 2 12 3 3 3 0
20 Lam ateuk 14 0 0 0 0 0 0 0 0 0 0 0
21 Kueh 12 0 0 0 0 0 0 0 0 0 0 1
22 Lamgaboh 19 3 16 3 0 0 1 5 3 3 3 3
23 Tanjong 18 2 11 2 0 0 0 0 2 2 2 0
24 Nusa 27 2 7 2 0 0 1 4 2 2 2 2
25 Sebun Ketapang 10 0 0 0 0 0 0 0 0 0 0 0
26 Seubun Ayon 9 2 22 2 0 0 1 11 2 2 2 0
27 Lambaro Sebun 11 1 9 1 0 0 1 9 1 1 0 0
28 Lamcok 11 0 0 0 0 0 0 0 0 0 0 0
Puskesmas 423 28 7 28 0 0 10 2 28 28 24 13
 PERIODE INPUT DATA

BULAN TAHUN

13 14
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Kab/ Kota Aceh Besar

Bulan Januari

Tahun 2017
Form 3 : (Sumber Daya)

JUMLAH DESA JUMLAH PUSKESMAS Rumah Sakit

Jml RS
Rumah PKM Perawatan RS Swasta
Pemerintah
NO. Nama Desa Tunggu Jml PKM Jml PKM Jml PKM Jml PKM Jml RS
Jml Jml Jml Desa Kelahira Jml Jml PKM
JMLH Total Memiliki Dengan Melaks Melaks Mampu
Posyand Poskesde Melaksan n PKM Mampu
DESA PKM Dokter MAMPU Ruang Kelas Ibu Supervisi Jml Jml Jml Jml PONE
u s akan P4K JML PKRT PP-KtP
Umum PONED Bersalin Hamil Fasilitatif RSU RSIA RSU RSIA K

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

4 Monikeun 1 2 1 1 0 1 4 1 0 1 0 0 0 0 0 0 0 0 0

5 Lamkruet 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

6 Weuraya 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

7 Lampaya 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

8 Mns mesjid lpk 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 Mns lambaro lpk 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

10 Mns Balee 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

11 Mns Blang lpk 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12 Mns Cut Lpk 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Mns Mesjid lhm 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

14 Mns Baro lhm 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

15 Mns Beutong 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Mns Manyang 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Mns Moncut 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

18 Mns Karieng 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

19 Mns Lamgirek 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Naga Umbang 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

21 Lambaro Kueh 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

22 Aneuk Paya 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

23 Lam ateuk 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

24 Kueh 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

25 Lamgaboh 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

26 Tanjong 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

27 Nusa 1 2 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

28 Sebun Ketapang 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

29 Seubun Ayon 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

30 Lambaro Sebun 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

31 Lamcok 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas 28 29 16 28 0 1 4 1 0 1 0 14 0 0 0 0 0 0 0
 Jml Fasyankes Mampu Pelayanan KB Dokter Umum PERIODE INPUT
Dokter Spesialis Bidan Dukun Beranak
Sesuai Standar (DU) DATA

Jml RS Jml
Jml Jml Jml Jml
MEMIL RSU Jml Jml Jml BDD Jml
Poskes Jml Jml DU Jml SpA SpAn Bidan Bidan Di BDD Jml
IKI Pemeri PKM Pustu Total SpOG Total Punya Dukun BULAN TAHUN
des Total di PKM (Anak) (Anestes di Desa Tinggal Dukun
PPT/PK ntah DU (Obgin) Bidan Bidan Bermitra
i) PKM (BDD) di Desa
T Kit

22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

0 0 1 0 1 1 4 4 0 0 0 1 45 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 Januari 2017

0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 1 0 1 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 1 1 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 1 1 1 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017
0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 Januari 2017

0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 1 1 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 0 1 1 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 Januari 2017

0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 Januari 2017

0 0 1 3 14 18 4 4 0 0 0 28 45 28 17 23 0 0 Januari 2017
Kab/ Kota : Aceh Besar

Bulan : Januari

Tahun : 2017
Form 4 :(Kematian)

SEBAB KEMATIAN IBU

JML JML
JUMLAH JML KAB/KOTA
BAYI BAYI
NO. PUSKESMAS KEMATIAN
GGN SISTEM PEREDARAN GGN LAHIR LAHIR
MELAKSANAKAN
IBU HIPERTENSI DLM AMP
PERDARAHAN INFEKSI DARAH (JANTUNG, STROKE, METABOLIK LAIN2 HIDUP MATI
KEHAMILAN
DLL) (DM, DLL)
1 2 3 4 5 6 7 8 9 10 11 12

1 Monikeun 0 0 0 0 0 0 0 0 0 0
2 Lamkruet 0 0 0 0 0 0 0 2 0 0
3 Weuraya 0 0 0 0 0 0 0 3 0 0
4 Lampaya 0 0 0 0 0 0 0 4 0 0
5 Mns mesjid lpk 0 0 0 0 0 0 0 2 0 0
6 Mns lambaro lpk 0 0 0 0 0 0 0 0 0 0
7 Mns Balee 0 0 0 0 0 0 0 0 0 0
8 Mns Blang lpk 0 0 0 0 0 0 0 0 0 0
9 Mns Cut Lpk 0 0 0 0 0 0 0 0 0 0
10 Mns Mesjid lhm 0 0 0 0 0 0 0 1 0 0
11 Mns Baro lhm 0 0 0 0 0 0 0 0 0 0
12 Mns Beutong 0 0 0 0 0 0 0 1 0 0
13 Mns Manyang 0 0 0 0 0 0 0 0 0 0
14 Mns Moncut 0 0 0 0 0 0 0 1 0 0
15 Mns Karieng 0 0 0 0 0 0 0 0 0 0
16 Mns Lamgirek 0 0 0 0 0 0 0 1 0 0
17 Naga Umbang 0 0 0 0 0 0 0 0 0 0
18 Lambaro Kueh 0 0 0 0 0 0 0 0 0 0
19 Aneuk Paya 0 0 0 0 0 0 0 3 0 0
20 Lam ateuk 0 0 0 0 0 0 0 0 0 0
21 Kueh 0 0 0 0 0 0 0 0 0 0
22 Lamgaboh 0 0 0 0 0 0 0 3 0 0
23 Tanjong 0 0 0 0 0 0 0 2 0 0
24 Nusa 0 0 0 0 0 0 0 2 0 0
25 Sebun Ketapang 0 0 0 0 0 0 0 0 0 0
26 Seubun Ayon 0 0 0 0 0 0 0 2 0 0
27 Lambaro Sebun 0 0 0 0 0 0 0 1 0 0
28 Lamcok 0 0 0 0 0 0 0 0 0 0
Puskesmas 0 0 0 0 0 0 0 28 0 0
PERIODE INPUT
DATA

BULAN TAHUN

13 14

Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Januari 2017
Kab/ Kota : Aceh Besar

Bulan : Januari

Tahun : 2017
Form 5 (ANC Terpadu)

Integrasi Program
Hb KEK Protein urin Gula Darah (GD) Pencegahan Malaria Dalam Kehamilan
Pencegahan Penularan HIV dari Ibu ke Anak (PPIA) TB dalam Kehamilan
(PMDK)
Ibu Hamil HIV(+)

NO. PUSKESMAS
Ibu Hamil Ibu Hamil Ibu Hamil Ibu Hamil Ibu Ibu Hamil Ibu
Anemia Anemia KEK Ibu Hamil Ibu Hamil Persalina Persalina Ibu Hamil
Diperiks Diperiks Diperi Positif Diperik GD >140 Datang ditawarka Ibu Hamil mendapatk Diperiksa Hamil mendapatk Hamil
(8-11 (<8 (LiLA < Hasil Tes Mendapat n n Hasil Dahak Obat**
a Hb a LiLA ksa (+) sa g/dl dengan n Tes dites HIV an Mikroskop Malaria an Kina/ diperiksa
mg/dl) mg/dl) 23,5 cm) HIV (+) ART Pervagin Perabdom kelambu TB(+)
HIV(+) HIV is/RDT (+) ACT Dahak
am inam (SC)

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

1 Monikeun 2 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Lamkruet 3 3 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Weuraya 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Lampaya 4 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Mns mesjid lpk 2 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6 Mns lambaro lpk 3 3 0 3 0 0 0 0 0 0 0 0 0 0- 0 0 0 0 0 0 0 0 0

7 Mns Balee 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Mns Blang lpk 3 1 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 Mns Cut Lpk 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Mns Mesjid lhm 4 2 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11 Mns Baro lhm 3 2 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12 Mns Beutong 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Mns Manyang 2 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Mns Moncut 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Mns Karieng 3 3 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Mns Lamgirek 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Naga Umbang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

18 Lambaro Kueh 3 2 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

19 Aneuk Paya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Lam ateuk 2 1 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Kueh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lamgaboh 3 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

23 Tanjong 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

24 Nusa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

25 Sebun Ketapang 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Seubun Ayon 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Lambaro Sebun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

28 Lamcok 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Puskesmas 46 26 0 46 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Pelaksanaan kelas ibu hamil
PERIODE INPUT
Pencegahan IMS dalam Pencegahan Hepatitis B dalam DATA
Kecacingan dalam Kehamilan
Kehamilan Kehamilan

Jumlah Jumlah
Desa yang Jumlah Jumlah Ibu
suami/kelua bidan
melaksan Kelas Ibu Hamil yang
Ibu Hamil Ibu Hamil Ibu Ibu Hamil rga yang yang
Ibu Ibu Hamil Ibu Ibu Hamil Ibu akan Hamil mengikuti
diperiksa Hasil Tes Hamil diperiksa mengikuti melakuka
Hamil Hasil Tes Hamil Hasil Tes Hamil kelas ibu yang kelas ibu
kelas ibu n kelas BULAN TAHUN
Ankylosto Ankylosto diperiksa Hepatitis hamil terbentuk hamil
diobati IMS (+) diobati Hep B (+) diobati hamil ibu hamil
ma ma (+) IMS B

26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

0 0 0 0 0 0 0 0 0 1 1 2 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 3 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 4 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 2 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 3 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 3 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 4 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 3 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 2 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 3 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 0 1 0 0 0 Januari 2017
0 0 0 0 0 0 0 0 0 0 1 0 0 0 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 3 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 0 1 0 0 0 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 2 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 0 0 0 0 0 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 3 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 0 1 0 0 0 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 0 1 0 0 0 Januari 2017
0 0 0 0 0 0 0 0 0 1 1 1 0 1 Januari 2017
0 0 0 0 0 0 0 0 0 22 14 46 0 22 Januari 2017
Kab/ Kota : Aceh Besar
Bulan : Januari
Tahun : 2017
Form 6 (KB)

Jml Peserta KB Pasca Persalinan Menurut M

Sasaran Pelayanan Keluarga Berencana Jml Peserta KB Aktif Menurut Metode Kontrasepsi Cara Modern
Modern

NO. PUSKESMAS
Jumlah Jumlah KB Pasca PUS 4T
KB Aktif Komplikasi Kegagalan Drop out Kondom Pil Suntik AKDR Implan MOW MOP Kondom Pil Suntik AKDR
PUS PUS 4T Persalinan Ber KB

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
1 Monikeun 227 24 170 2 6 0 0 0 10 114 35 5 2 6 0 0 0 0 0
2 Lamkruet 133 0 127 0 3 0 0 0 1 90 28 0 0 0 0 0 0 0 0
3 Weuraya 140 5 137 1 5 0 0 0 11 75 45 5 4 0 0 0 0 0 0
4 Lampaya 192 20 45 20 12 0 0 0 5 12 22 5 3 5 0 0 0 0 0
5 Mns mesjid lpk 71 5 45 2 4 0 0 2 5 15 28 0 1 1 0 0 0 0 0
6 Mns lambaro lpk 80 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0
7 Mns Balee 102 18 55 0 10 0 0 0 7 25 30 4 3 2 0 0 0 0 0
8 Mns Blang lpk 44 38 30 0 10 0 0 0 10 6 10 0 1 1 0 0 0 0 0
9 Mns Cut Lpk 42 0 25 0 0 0 0 0 5 11 6 0 0 0 0 0 0 0 0
10 Mns Mesjid lhm 38 0 31 1 0 0 0 0 2 2 3 2 0 0 0 0 0 0 0
11 Mns Baro lhm 47 0 35 0 0 0 0 0 7 12 8 2 6 0 0 0 0 0 0
12 Mns Beutong 51 0 43 0 0 0 0 5 4 20 20 2 1 0 0 0 0 0 0
13 Mns Manyang 54 0 36 0 0 0 0 0 7 10 11 5 2 1 0 0 0 0 0
14 Mns Moncut 41 0 33 2 0 0 0 0 1 10 17 1 4 0 0 0 0 0 0
15 Mns Karieng 105 5 72 1 5 0 0 0 3 40 25 1 1 0 0 0 0 0 0
16 Mns Lamgirek 32 0 27 1 0 0 0 3 3 4 4 0 0 0 0 0 0 0 0
17 Naga Umbang 60 10 50 2 10 0 0 8 20 27 2 0 1 0 0 0 0 0 0
18 Lambaro Kueh 60 30 49 0 10 0 0 0 5 25 15 1 1 2 0 0 0 0 0
19 Aneuk Paya 94 5 49 6 4 0 0 1 5 15 20 1 4 0 0 0 0 0 0
20 Lam ateuk 88 6 44 6 4 0 0 0 3 24 9 2 1 5 0 0 0 0 0
21 Kueh 73 17 59 0 15 0 0 0 3 8 40 1 7 0 0 0 0 0 0
22 Lamgaboh 90 0 40 1 0 0 0 50 3 17 17 2 0 1 0 0 0 0 0
23 Tanjong 136 42 102 0 38 0 0 0 2 50 78 4 5 1 0 0 0 0 0
24 Nusa 186 16 134 0 4 0 0 0 4 68 54 3 2 3 0 0 0 0 0
25 Sebun Ketapang 43 4 37 0 2 0 0 0 3 13 13 2 2 0 0 0 0 0 0
26 Seubun Ayon 48 48 16 0 0 0 0 1 1 6 8 0 0 0 0 0 0 0 0
27 Lambaro Sebun 40 0 30 0 0 0 0 0 2 10 15 0 0 3 0 0 0 0 0
28 Lamcok 60 2 35 0 1 0 0 0 0 5 30 0 1 1 1 0 0 0 0
Puskesmas 2,377 295 1,556 45 143 0 0 73 57 714 593 48 52 32 1 0 0 0 0

Mengetahui Lhoknga , 27 Januari 2017

Kepala Puskesmas Lhoknga Bikor

( dr. Firzalinda ) ( Muzaiyanah, S. ST )

Nip : 19790219 201001 2 014 Nip : 19770817 200701 2 031
an Menurut Metode Kontrasepsi Cara
PERIODE INPUT DATA
Modern

Implan MOW MOP Bulan TAHUN

22 23 24 25 26
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 2 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 1 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 0 0 Januari 2017
0 3 0 Januari 2017
LAPORAN ANTE NATAL CARE

PROPINSI NAD PUSKESMAS LHOKNGA

KABUPATEN Aceh Besar
BULAN Januari
TAHUN 2017

Kon
Kunj Ante Natal Care Ibu Bayi
Sasa- se
NO DESA ran Umur K1 K2 K3 Ibu K4 Ibu BB TB TD TFU LILA Status Reflek DJJ Kep thd TBJ Jml Pre- ling
Bumil Ibu Diknslng Diknslng (kg) (cm) (mmHg) (cm) (cm) Gizi Patella (x/m) PAP (gr) Janin sen- K1
Abs % Abs % Abs % Abs %
< 20 Thn > 35 Thn ASI ASI <145 >145 <140 >140 <23,5 >23,5 (N) (KEK) (+) (-) (M) (BM) (T) (G) tasi

1 Mon Ikeun 33 0 0 2 6 2 6 2 6 2 1 3 20 2 0 2 2 0 2 0 2 2 0 2 0 2 0 2 2 2 0 2 2

2 Lamkruet 29 0 0 3 10 4 14 1 3 3 1 3 1 3 0 3 3 0 1 0 3 3 0 3 0 1 0 3 1 1 0 1 3

3 weuraya 26 0 0 1 4 1 4 1 4 12 0 0 0 1 0 1 1 0 1 0 1 1 0 1 0 1 1 3 1 1 0 1 1

4 Lampaya 43 0 0 4 9 2 5 0 0 4 4 9 4 4 0 4 4 0 0 0 4 4 0 4 0 0 5 4 0 0 0 0 4

5 Mns mesjid lpk 11 0 1 2 18 2 18 3 27 2 2 18 2 2 0 2 2 0 3 0 2 2 0 2 0 3 0 2 3 3 0 3 2

6 Mns lambaro lpk 14 0 0 3 21 2 14 2 14 3 0 0 0 3 0 3 3 0 2 0 3 3 0 3 0 2 0 3 2 2 0 2 3

7 Mns Bale 15 0 0 1 7 0 0 0 0 1 1 7 1 1 0 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 1

8 Mns blang 6 0 0 3 50 3 50 3 50 3 0 0 0 3 0 3 3 0 3 0 3 3 0 3 0 3 2 4 3 3 0 3 3

9 Mns cut 5 0 0 1 20 2 40 0 0 1 2 40 2 1 0 1 1 0 0 0 1 1 0 1 0 0 1 3 0 0 0 0 1

10 Mns mesjid llm 12 0 0 4 33 0 0 1 8 4 0 0 0 4 0 4 4 0 1 0 4 4 0 4 0 1 0 4 1 1 0 1 4

11 Mns. Baro 10 0 0 3 30 2 20 1 10 3 0 0 0 3 0 3 3 0 1 0 3 3 0 3 0 1 0 3 1 1 0 1 3

12 Mns Beutong 14 0 0 1 7 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 1

13 Mns Manyang 10 0 0 2 20 0 0 0 0 2 1 10 1 2 0 2 2 0 0 0 2 2 0 2 0 0 0 2 0 0 0 0 2

14 Mns Moncut 10 0 0 1 10 1 10 0 0 1 1 10 1 1 0 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 1

15 Mns Karieng 19 0 0 3 16 2 11 1 5 3 1 5 1 3 0 3 3 0 1 1 2 2 1 3 0 1 0 3 1 1 0 1 3

16 Lamgirek 5 0 0 0 - 1 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Naga Umbang 10 0 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Lambaro Kueh 15 0 0 3 20 0 0 0 0 3 3 20 3 3 0 3 3 0 0 0 3 3 0 3 0 0 0 0 0 0 0 0 3

19 Aneuk Paya 18 0 0 0 - 0 0 2 11 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 2 0 0 2 2 0 2 0

20 Lam Ateuk 14 0 0 2 14 0 0 1 7 2 3 21 3 2 0 2 2 0 1 0 2 2 0 2 0 1 2 2 1 1 0 1 2

21 Kueh 13 0 0 0 - 2 15 4 31 0 1 8 1 0 1 0 0 0 4 0 0 0 0 0 0 4 2 0 4 4 0 4 0

22 Lamgaboh 20 0 0 3 15 1 5 1 5 3 0 0 0 3 0 3 3 0 1 0 3 3 0 3 0 1 0 3 1 1 0 1 3

23 Tanjong 19 0 0 1 5 3 16 1 5 1 0 0 0 1 0 1 1 0 1 0 1 1 0 1 0 1 0 1 1 1 0 1 1

24 Nusa 29 0 0 0 - 4 14 1 3 0 4 14 4 0 0 0 0 0 1 0 0 0 0 0 0 1 4 0 1 1 0 1 0

25 Seubun Ketapang 11 0 0 1 9 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 1

26 Seubun Ayon 9 0 0 1 11 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 1

27 Lambaro Seubun 12 0 0 0 - 1 8 1 8 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0

28 Lamcok 11 0 0 1 9 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 1

JUMLAH 443 5 1 46 10 35 8 26 6 46 25 6 25 46 0 46 46 0 26 1 45 45 1 46 0 26 17 49 26 26 0 26 46
 1
Status Imunisasi TT
Pelayanan
Saat Kunjungan
Injeksi Catat di FE
T1 T2 T3 T4 T5 TT Buku (tab/ botol)
KIA Fe1 Fe2 Fe3
0 1 1 0 0 0 2 2 2 1

0 1 0 1 1 0 3 3 1 1

0 0 0 0 1 0 1 1 1 0

0 0 1 0 3 0 4 4 0 4

0 0 0 1 1 0 2 2 3 2

0 0 0 2 1 0 3 3 2 0

0 0 0 1 0 0 1 1 0 1

0 0 1 0 2 0 3 3 3 0

0 0 1 0 0 0 1 1 0 2

0 0 0 0 4 0 4 4 1 0

0 0 0 3 0 0 3 3 1 0

0 0 0 0 1 0 1 1 0 0

0 0 0 2 0 0 2 2 0 1

0 0 0 0 1 1 1 1 0 1

0 0 0 2 1 3 3 3 1 1

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0
0 1 0 0 2 0 3 3 0 3

0 0 0 0 0 0 0 0 2 0

0 0 0 0 2 0 2 2 1 3

0 0 0 0 0 0 0 0 4 1

0 0 1 0 2 0 3 3 1 0

0 0 0 1 0 0 1 1 1 0

0 0 0 0 0 0 0 0 1 4

0 0 0 0 1 0 1 1 0 0

0 0 0 0 1 0 1 1 0 0

0 0 0 0 0 0 0 0 1 0

0 0 0 0 1 0 1 1 0 0

0 3 5 13 25 4 46 46 26 25
 Integrasi Program Resiko
Laboratorium Komplikasi
PMTCT Malaria TB terdeteksi oleh
DESA Hb (gr/dl Anemia) Protein Gula Gula Keca- Sero- ARV Mala- Obat Kelambu Na Non Abor- Perda- In-
Sifilis HBsAg TB
Ri Se Be Urin Darah Urin cingan VCT logi Profi- ria yg di Berintek- Obat kes Nakes HDK tus rahan feksi KPD lain2
10-11 8-9 <8 (+) (-) (+) (-) (+) (-) (+) (-) (+) (-) (+) (-) (+) (-) falksis (+) (-) berikan sida (+) (-)
Mon Ikeun 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Lamkruet 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

weuraya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Lampaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mns mesjid lpk 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

Mns lambaro lpk 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0

Mns Bale 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mns blang 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mns cut 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

Mns mesjid llm 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mns. Baro 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

Mns Beutong 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mns Manyang 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mns Moncut 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0

Mns Karieng 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

Lamgirek 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Naga Umbang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lambaro Kueh 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

Aneuk Paya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0

Lam Ateuk 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kueh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Lamgaboh 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Tanjong 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Nusa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Seubun Ketapang 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Seubun Ayon 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Lambaro Seubun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Lamcok 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JUMLAH 36 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 1 0 0 0 0
 2
Kegiatan Rujukan
Fasilitas Kesehatan Keadaan
RSIA Tiba Pulang
Pusk. RB / RS lain2
(H) (M) (H) (M)
RSB
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 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 PERSALINAN
PROPINSI NAD
KABUPATEN Aceh Besar
BULAN Januari
TAHUN 2017

Pn Cara Persalinan Presentasi Penolong Tempat Persalinan

Sasar- Nor- Va- For- Puncak Blkng Lin- Bo- Dok- Per-
NO DESA an mal cum ceps Kepala Kepala tang kong ter awat
Abs % SC Dahi Muka Kaki SPOG Bidan Dukun Lain2 Fasilitas
Bulin

1 Mon Ikeun 32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Lamkruet 28 2 7 1 0 0 1 0 2 0 0 0 0 0 1 0 1 0 0 0 2
3 weuraya 25 3 12 2 0 0 1 0 3 0 0 0 0 0 1 0 2 0 0 0 3
4 Lampaya 41 4 10 3 0 0 1 0 4 0 0 0 0 0 1 0 3 0 0 0 4
5 Mns mesjid lpk 11 2 18 2 0 0 0 0 2 0 0 0 0 0 0 0 2 0 0 0 2
6 Mns lambaro lpk 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Mns Bale 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Mns blang 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Mns cut 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Mns mesjid llm 12 1 8 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1
11 Mns. Baro 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Mns Beutong 13 1 8 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1
13 Mns Manyang 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Mns Moncut 9 1 11 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1
15 Mns Karieng 18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Lamgirek 4 1 25 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1
17 Naga Umbang 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Lambaro Kueh 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Aneuk Paya 17 3 18 1 0 0 2 0 3 0 0 0 0 0 2 0 1 0 0 0 3
20 Lam Ateuk 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Kueh 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Lamgaboh 19 3 16 2 0 0 1 0 3 0 0 0 0 0 1 0 2 0 0 0 3
23 Tanjong 18 2 11 2 0 0 0 0 2 0 0 0 0 0 0 0 2 0 0 0 2
24 Nusa 27 2 7 1 0 0 1 0 2 0 0 0 0 0 1 0 1 0 0 0 2
25 Seubun Ketapang 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Seubun Ayon 9 2 22 1 0 0 1 0 2 0 0 0 0 0 1 0 1 0 0 0 2
27 Lambaro Seubun 11 1 9 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1
28 Lamcok 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 423 28 7 18 0 0 10 0 28 0 0 0 0 0 10 0 18 0 0 0 28
 3
mpat Persalinan Usia

Non Kehamilan

Fasilitas < 36 > 36

minggu minggu

0 0 0
0 0 2
0 0 3
0 0 4
0 0 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 1
0 0 0
0 0 1
0 0 0
0 0 1
0 0 0
0 0 1
0 0 0
0 0 0
0 0 3
0 0 0
0 0 0
0 0 3
0 0 2
0 0 2
0 0 0
0 0 2
0 0 1
0 0 0
0 0 28
 Manajemen Aktif Kala III Pelayanan Keadaan Integrasi Program Komplikasi

Injeksi Pere- Masase Menggu- Catat IMD* Ibu Bayi ARV Mala- Anti Kelambu Anti Dis- In- Fasi
Desa Oksi- gangan Fundus nakan di Buku Profi- ria+ Mala- Berin- TB+ tok- fek-
HIV+ TB+ HDK PPP lain2
toksin Tali Uteri Parto- KIA <1 Jam >1 Jam (H) (M) (H) (M) laksis ria sekti- sia si Pusk.

Pusat graf sida

Monikeun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamkruet 1 1 1 2 2 1 1 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Weuraya 2 2 2 3 3 2 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lampaya 3 3 3 4 4 3 0 4 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns mesjid lpk 2 2 2 2 2 2 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns Lbr lpk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns balee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns Blang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns Cut lpk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns mesjid lhm 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mons Baro 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
mns Beutong 1 1 1 1 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
mns manyang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns Moncut 1 1 1 1 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0
mns karieng 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
lamgirek 1 1 1 1 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Naga umbang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lambaro Kueh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Aneuk Paya 1 1 1 3 3 1 0 3 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamateuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kueh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamgaboh 2 2 2 3 3 2 1 3 0 3 0 0 0 0 0 0 0 0 0 0 0 0 1 0
Tanjong 2 2 2 2 2 2 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Nusa 1 1 1 2 2 1 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Seubun ketapang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
sebun Ayon 1 1 1 2 2 1 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lbr Sebun 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamcok 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 18 18 18 28 28 18 10 28 0 28 0 0 0 0 0 0 0 0 0 0 0 0 2 0
 4
Kegiatan Rujukan
Fasilitas Kesehatan Keadaan

R.Bersa- RSIA/ Tiba Pulang

lin RSB RS lain2

(H) (M) (H) (M)

0 0 0 0 0 0 0 0
0 0 1 0 1 0 1 0
0 0 1 0 1 0 1 0
0 0 1 0 1 0 1 0
0 0 2 0 2 0 2 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 1 0 1 0 1 0
0 0 0 0 0 0 0 0
0 0 1 0 1 0 1 0
0 0 0 0 0 0 0 0
0 0 1 0 1 0 1 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 4 0 4 0 4 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 1 0 1 0 1 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 1 0 1 0 1 0
0 0 0 0 0 0 0 0
0 0 14 0 14 0 14 0
LAPORAN NIFAS
PROPINSI NAD PUSKESMAS LHOKNGA
KABUPATEN Aceh Besar
BULAN Januari
TAHUN 2017

NO PUSKESMAS KF Pelayanan Integrasi Program Pelayanan KB

Sasa- KF 1 KF 2 Konse KF 3 Konse Catat Vit.A PMCT Malaria TB

ran ling ling di Buku Ibu Peme- Mala- Anti Kelambu Foto Thorax Obat Kon- Sun-
Bufas Abs % Abs % ASI Abs % ASI KIA riksaan ria+ Mala- Berinsek- Diperik- TB+ Anti MAL dom PIL tik IUD
ke I ke II DC4 ria tisida sa TB
Mon Ikeun
1 33 0 - 0 - 0 2 6 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamkruet
2 23 2 9 2 9 2 0 - 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0
weuraya
3 19 3 16 1 5 3 0 - 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0
Lampaya
4 36 4 11 4 11 4 0 - 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0
Mns mesjid lpk
5 5 2 40 2 40 2 1 20 10 2 2 0 0 0 0 0 0 0 0 0 0 0 0
Mns lambaro lpk
6 13 0 - 0 - 0 3 23 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns Bale
7 11 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns blang
8 4 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns cut
9 3 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns mesjid llm
10 10 1 10 1 10 1 1 10 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0
Mns. Baro
11 7 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns Beutong
12 15 1 7 0 - 1 0 - 0 1 1 0 0 0 0 0 0 0 5 0 0 0 0
Mns Manyang
13 9 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mns. Moncut
14 8 1 13 1 13 1 0 - 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0
Mns Karieng
15 13 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Lamgirek
16 4 1 25 1 25 1 0 - 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0
Naga Umbang 7
17 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lambaro Kueh
18 12 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Aneuk Paya
19 15 3 20 3 20 3 0 - 0 3 3 0 0 0 0 0 0 0 2 0 0 0 0
Lam Ateuk
20 11 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kueh
21 12 0 - 0 - 0 1 8 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Lamgaboh
22 16 3 19 3 19 3 3 19 3 3 3 0 0 0 0 0 0 0 0 0 0 0 0
Tanjong
23 17 2 12 2 12 2 0 - 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0
Nusa
24 27 2 7 2 7 2 2 7 2 2 2 0 0 0 0 0 0 0 0 0 0 0 0
Seubun Ketapang
25 9 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Seubun Ayon
26 8 2 25 2 25 2 0 - 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0
Lambaro Seubun
27 9 1 11 0 - 1 0 - 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0
Lamcok
28 8 0 - 0 - 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 364 28 224 24 195 28 13 94 22 28 28 0 0 0 0 0 0 0 7 0 0 0 0
Mengetahui
Kepala Puskesmas Lhoknga

dr. Firzalinda
Nip : 19790219201001 2 014
 5
Keadaan
Komplikasi Pelayanan Rujukan
Tiba Pulang

In- R.Ber RSIA

MOP MOW PPP feksi HDK lain2 Pusk. salin / RS Lain2 (H) (M) (H) (M)

RSB

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 11 0 11 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 1` 0 0 1 0 1 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 1 0 1 0 1 0

0 0 0 0 0 0 0 0 0 0 0 5 0 5 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 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 1 0 18 0 18 0
Lhoknga , 27 Januari 2017
Koordinator KIA

Muzaiyanah.S.ST
Nip : 19770817 200701 2 031
LAPORAN BAYI
PROPINSI NAD
KABUPATEN Aceh Besar
BULAN Januari
TAHUN 2017

Kelpk Umur / menurt Masa Neonatal Hasil Penimbangan Pemantauan

Sasar- Jenis Kelamin Punya Berat Dan Status Gizi Tumbuh ASI Ekslusif
Saat lahir s/d 5 jam Kunj Neonatal 0-28 hr Pemeriks
an 0-5 bln 29 hr 6-11 bln 29 hr Buku lahir (gr) aan Kembang
NO Nama Desa Menggun
BAYI KIA IMD I II III SDIDTK
akan
Salep MTBM
L P L P > 2500 < 2500 Vit K N T O B 2T BGM A0 A1 A2 A3 A4 A5
mata L P Kunj 1 Kunj 2
6 s/d 3-7 8-28
48 jam hari hari
Mon Ikeun 30 4 11 8 11 34 0 0 0 0 0 0 0 0 0 0 34 2 0 0 0 0 0 0 0 1 4 4 3 1
1
Lamkruet 27 1 2 4 4 11 2 0 2 2 0 2 2 2 2 0 10 1 0 1 1 0 0 0 2 0 0 0 0 0
2
weuraya 24 7 8 6 5 26 3 0 3 3 1 1 3 1 0 2 12 6 0 1 0 0 10 9 2 2 3 0 1 4
3
Lampaya 39 2 2 0 0 4 4 0 4 4 1 2 4 4 2 0 0 0 0 0 0 0 0 0 4 2 1 1 1 1
4
Mns mesjid lpk 10 4 0 2 3 9 2 0 2 2 2 0 2 2 2 0 3 0 0 0 0 0 0 0 2 0 0 0 0 2
5
Mns lambaro lpk 13 2 3 1 2 8 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 3 0 0 2 0
6
Mns Bale 14 3 2 3 5 13 0 0 0 0 0 0 0 0 0 8 8 2 0 0 0 0 0 0 0 0 2 3 0 0
7
Mns blang 5 1 3 1 1 6 0 0 0 0 0 0 0 0 0 0 5 0 0 1 0 0 0 0 0 0 1 0 1 1
8
Mns cut 5 0 0 12 13 25 0 0 0 0 0 0 0 0 0 0 3 3 0 0 3 0 0 0 0 0 0 0 0 0
9
Mns mesjid llm 11 0 1 4 2 7 1 0 1 1 0 0 1 1 1 0 3 2 0 1 0 0 0 0 1 0 0 0 0 0
10
Mns. Baro 9 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 1 0
11
Mns Beutong 13 1 2 1 2 6 1 0 1 1 0 1 1 0 0 0 3 0 0 0 0 0 0 0 1 0 0 1 0 1
12
Mns Manyang 9 0 3 3 1 7 0 0 0 0 0 0 0 0 0 0 4 1 0 0 0 0 0 0 0 0 0 2 1 1
13
Mns Moncut 9 0 1 0 0 1 0 1 1 1 0 0 1 1 1 0 7 0 0 3 0 0 0 0 1 0 0 0 0 0
14
 Mns Karieng 17 2 2 3 2 9 0 0 0 0 0 0 0 0 0 0 5 3 1 0 0 0 0 0 0 1 0 1 0 0
15
Lamgirek 4 1 1 0 0 2 1 0 1 1 0 1 1 1 1 0 1 0 0 1 0 0 0 0 1 1 0 0 0 0
16
17 Naga Umbang 9 3 4 0 3 10 0 0 0 0 0 0 0 0 0 0 5 0 0 2 0 0 0 0 0 0 2 3 0 0

Lambaro Kueh 14 3 1 1 2 7 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0
18
Aneuk Paya 16 1 4 2 2 9 3 0 3 3 0 1 3 3 3 0 10 1 0 0 0 0 0 0 3 0 0 0 0 0
19
Lam Ateuk 13 0 1 3 2 6 0 0 0 0 0 0 0 0 0 0 4 1 0 0 0 0 2 0 0 0 0 0 0 0
20
Kueh 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 0 0 0 0 0 0 0 0 0 0 0 0
21
Lamgaboh 18 2 2 5 3 12 3 0 3 3 1 2 3 3 3 0 9 2 0 2 0 0 5 0 3 0 0 0 0 0
22
Tanjong 17 5 4 4 6 19 2 0 2 2 1 1 2 2 2 2 11 4 1 0 0 0 1 0 2 3 0 0 1 1
23
Nusa 26 6 1 7 6 20 2 0 2 2 0 1 2 2 2 0 20 0 0 0 0 0 0 0 2 0 0 0 0 0
24
Seubun Ketapang 10 1 1 1 1 4 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 2
25
Seubun Ayon 8 2 4 2 0 8 2 0 2 2 1 0 2 2 2 0 1 0 0 1 0 0 0 0 2 2 0 1 0 1
26
Lambaro Seubun 11 3 0 1 2 6 1 0 1 1 0 0 1 1 0 0 5 0 1 1 0 0 0 0 1 0 0 0 0 0
27
Lamcok 10 3 2 6 2 13 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 1 0 0 2
28
Puskesmas 403 57 65 80 80 282 27 1 28 28 7 12 28 25 21 12 185 31 4 14 4 0 18 9 27 15 14 16 11 17
 6
Imunisasi
Malaria
HB 0-7 hari
Sebab
Vit. A 6 Kematia

pak
Ket

3
1

Kelambu
1

3
BCG

Bln n Post
HB1

HB2

HB3
Polio

Polio

Polio

Polio
DPT

DPT

DPT

C am
RDT Natal
(Ya) (Tdk)

0 0 0 5 5 2 2 2 5 5 5 3 3 3 5 0 0 0 0

0 2 0 1 1 2 2 2 0 0 0 0 0 0 0 0 0 0 0

0 2 0 2 2 3 3 3 2 2 2 2 2 2 0 0 0 0 0

0 4 0 3 3 2 2 2 1 1 1 1 1 1 3 0 0 0 0

0 2 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0

0 0 0 2 2 1 1 1 0 0 1 0 0 0 1 0 0 0 0

0 0 0 1 1 0 2 0 2 0 2 0 0 0 1 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0

0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0

0 0 0 0 0 2 2 2 1 1 2 1 1 1 1 0 0 0 0

0 1 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 1 1 1 2 2 2 0 0 0 0 0 0 0 0

0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
0 0 0 1 1 3 3 3 1 1 1 0 0 2 2 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 1 1 1 1 5 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 3 0 2 2 0 0 0 0 0 0 0 0 2 2 0 0 0 0

0 2 0 2 2 0 0 0 1 1 1 0 0 0 4 0 0 0 0

0 2 0 0 0 0 0 0 0 0 3 3 3 3 0 0 0 0 0

0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 2 0 3 3 2 2 2 0 0 0 0 0 0 0 0 0 0 0

0 1 0 0 0 0 0 0 0 0 2 0 0 0 1 0 0 0 0

0 0 0 0 0 0 0 0 1 1 1 2 2 2 1 0 0 0 0

0 27 0 26 26 18 20 18 17 15 27 15 15 17 27 0 0 0 0
LAPORAN BALITA DAN PRASEKOLAH
PROPINSI NAD
KABUPATEN Aceh Besar
BULAN Januari
TAHUN 2017

Jenis Kelamin Tahun I

Punya Status
Sasaran
NO Nama Desa L P Buku Gizi
Anak Balita
KIA Vit Obat
(N) (T) (O) (B) (2T) (BGM)
0 - 11 bln 12-24 bln 25-60 bln jumlah 0 - 11 bln 12-24 bln 25-60 bln A Cacing

1 Monikeun 108 12 10 30 117 20 13 32 117 38 14 10 3 0 0 0 0

2 Lamkruet 94 3 10 28 80 7 5 27 80 22 7 2 0 0 0 0 0

3 Weuraya 83 12 13 27 91 9 6 24 91 32 18 7 0 0 0 0 0

4 Lampaya 139 19 17 40 147 20 16 35 147 105 12 0 5 0 0 0 0

5 Mns mesjid lpk 36 4 7 13 47 1 8 14 47 25 5 0 0 0 3 0 0

6 Mns. Lambaro,Lpk 45 3 2 20 47 3 4 15 47 22 11 1 0 1 1 0 0

7 Mns Balee 49 6 3 24 61 7 5 16 61 51 10 0 0 0 0 0 0

8 Mns Blang 19 3 5 8 34 7 4 7 34 17 7 0 0 0 0 0 0

9 Mns Cut 17 4 2 10 43 3 4 20 43 29 5 1 0 2 0 0 0

10 Mns Mesjid lhm 39 4 5 11 39 2 8 9 39 21 8 2 1 0 0 0 0

11 Mns Baro 33 1 2 9 24 1 2 9 24 6 6 7 0 0 0 0 0

12 Mns Beutong 45 2 7 12 33 4 1 7 33 25 2 0 0 0 0 0 0

13 Mns Manyang 32 3 3 9 30 4 2 9 30 7 11 0 1 1 1 0 0

14 Mns moncut 31 6 3 13 43 6 2 13 43 30 10 0 0 0 0 0 0

15 Mns Karieng 60 5 7 6 36 3 3 12 36 29 6 0 0 1 0 0 0

16 Lamgirek 15 2 1 6 16 2 2 3 16 10 2 1 1 0 0 0 0

17 Naga umbang 31 3 7 7 41 7 8 9 41 23 7 1 2 0 0 0 0
18 Lambaro Kueh 48 4 5 6 31 3 2 11 31 13 4 8 0 0 0 0 0
19 Aneuk paya 57 3 4 10 45 8 7 13 45 36 7 0 0 0 0 0 0
20 Lam Ateuk 46 3 13 15 47 3 4 9 47 24 11 0 1 1 0 0 0
21 Kueh 41 4 2 10 42 3 4 19 42 27 7 1 0 2 0 0 0
22 lamgaboh 65 6 8 23 67 3 12 15 67 19 1 2 0 0 0 0 0
23 Tanjong 61 9 6 24 69 10 5 15 69 36 11 7 2 0 0 0 0
24 Nusa 92 13 7 28 87 7 10 22 87 58 2 0 0 0 0 0 0
25 Seubun Ketapang 35 2 5 8 31 2 5 9 31 19 2 1 0 0 0 0 0
26 Seubun Ayon 29 2 8 6 28 4 0 8 28 4 4 0 0 0 0 0 0
27 Lambaro Seubun 37 4 0 6 28 2 4 12 28 11 8 2 0 0 0 0 0

28 Lamcok 36 7 6 8 33 3 2 7 33 30 3 0 0 0 0 0 0

JUMLAH 1423 149 168 417 1437 154 148 401 1437 769 201 53 16 8 5 0 0

Mengetahui Lhoknga , 27 Januari 2017

Kepala Puskesmas Lhoknga Bikor

( dr. Firzalinda ) ( Maulidia, S. ST )

Nip : 19790219 201001 2 014 Nip : 19680719 199003 2 007
 7
Pemantauan
MENINGGAL
Tumbuh
Kembang Tgl dan Ket

SDIDTK penyebab
Kunj 1 Kunj 2 kematian
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 2 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 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 0 0 0
0 0 0 0 0
1 5 0 0 0
0 0 0 0 0
2 0 0 0 0
1 1 0 0 0
0 0 0 0 0
6 1 0 0 0
0 0 0 0 0
0 0 0 0 0

0 0 0 0 0

12 15 0 0 0
 DATA IBU HAMIL RESTI TAHUN 2017
BULAN Januari DIKECAMATAN LHOKNGA
Resume SMS Kadinkes : Tgl : Bumil: org, Calon Partus: , Bumil Resti: org, Bumil Baru: org, Lahir Hdp:
GRAVIDA TD HB LILA JARAK BERAT BADAN BUMIL
NO NAMA BUMIL / SUAMI ALAMAT NO HP UMUR USIA HPHT TTP KELAH SBLM SAAT PENAM
G P A MMHG GRAM % CM
(MINGGU) IRAN HAMIL HAMIL BAHAN
1 3 4 5 6 7 8 9 10 11 12 13

1 Dewi Fayani 2 1 0 13 08/09/2016 15/06/2017 120/80 13,7 26 5 th 60 60

Mns. Moncut
2 Eva rosita 3 2 0 12 23/10/2016 30/07/2017 90/60 27 2 th 50 51 1

3 Darlina Lambaro Kueh 33 4 3 0 13-14 10/10/2016 15/07/207 90/60 25 9 th 0

4 Mawardah Mns. Baro, LLm 085260354217 42 2 0 1 12 06/10/2016 10/07/2017 120/60 11 30 0 55 57 2

5 Nurmi Mns. Mesjid, LPK 40 2 1 0 16 20/08/2016 27/05/2017 120/80 3 63 64 1

6 Darwati Mns. Cut 4 3 0 36 ?/ 02/ 2017 110/70 13 28 3 bln 0

7 Yusniar/ bahagia Mns. Karieng 085373815361 32 1 0 0 9 18/11/2016 21/08/2017 90/70 10,5 21 0 43 43 0

8 Rusi Erina Aneuk paya 085361345993 29 2 1 0 15 04/10/2016 11/07/2017 21 1 th

9
org, Lahir Hdp: KI: , KB: , GB: ,JML Bumil Malaria: ,Jml Bumil TB:
TANDA INTERVEVSI PENANGGUNG JAWAB ( NAMA/NO HB)
RESIKO YG SUDAH KETERANGAN
BIKOR PKM/ NO HP BIDES HP
LAINNYA DILAKUKAN
15 16 17 18 19 20

bsc 1x Konseling
Laida Hanum 08126901171
bsc 1x Konseling

Rw. Abortus 2x Konseling Nurdiana 085260092728

Glukoma Konseling Nina ariani 085270574051

Muzaiyanah,
Terlalu Tua Konseling S.ST Wan Asni 085296726001

Perdarahan Pervaginam + Konseling Ftriani, DJ 085260740179

Terlalu dekat

KEK Konseling Nurul Hasanah 082160786864

KEK Konseling Yanti, A. Md. Keb 085275284999

Mengetahui
Kepala Puskesmas Lhoknga

( dr. Firzalinda )
Nip : 19790219 201001 2 014
 LAPORAN ANAK
BULAN Januari
DESA : DATA CAKUPAN PROGRAM
CAKUPAN KUNJUNGAN NEONATAL CAK. PENANGANAN NEONATAL CAK. KUNJUNGAN BAYI CAK. KUNJUNGAN BALITA ∑ LAHIR MATI
KOMPLIKASI
KN 1 KN LENGKAP
∑ KELAHIRAN
NO Desa HIDUP
∑ LK-LK ∑ PR ∑ LK+PR CAK.% ∑ LK-LK ∑ PR ∑ LK+PR CAK.% ∑ LK-LK ∑ PR ∑ LK+PR CAK.% ∑ LK-LK ∑ PR ∑ LK+PR CAK.% ∑ LK-LK ∑ PR ∑ LK+PR CAK.% ∑ LK-LK ∑ PR ∑ LK+PR

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
1 Monikeun 134 0 0 0 0 0 0 0 0 0 0 0 0 3 2 5 16.667 3 3 6 4.4776 0 0 0

2 Lamkruet 118 0 2 2 6.6667 0 2 2 6.6667 0 0 0 0 0 2 2 7.4074 2 5 7 5.9322 0 0 0

3 Weuraya 104 1 2 3 10 1 0 1 3.3333 0 1 1 0.9615 0 0 0 0 0 0 0 0 0 0 0

4 Lampaya 172 2 2 4 13.333 1 1 2 6.6667 0 0 0 0 2 2 4 10.256 2 2 4 2.3256 0 0 0

5 Mns Mesjid Lpk 45 2 0 2 6.6667 2 0 2 6.6667 0 0 0 0 0 0 0 0 2 0 2 4.4444 0 0 0

6 Mns lambaro lpk 57 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 7.6923 2 1 3 5.2632 0 0 0

7 Mns Balee 61 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 7.1429 1 1 2 3.2787 0 0 0

8 Mns Blang 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 Mns. Cut 21 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Mns. Mesjid Llm 49 0 1 1 3.3333 0 1 1 3.3333 0 0 0 0 2 2 4 36.364 0 4 4 8.1633 0 0 0

11 Mns. Baro 41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 7.3171 0 0 0

12 Mns Beutong 57 0 1 1 3.3333 0 0 0 0 0 0 0 0 0 0 0 0 6 0 6 10.526 0 0 0

13 Mns Manyang 40 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 11.111 1 1 2 5 0 0 0

14 Mns Moncut 39 0 1 1 3.3333 0 0 0 0 0 1 1 2.5641 0 0 0 0 1 3 4 10.256 0 0 0

15 Mns Karieng 75 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 2.6667 0 0 0

16 Lamgirek 19 0 1 1 3.3333 0 1 1 3.3333 0 0 0 0 0 3 3 75 1 2 3 15.789 0 0 0

17 Naga umbang 38 0 0 0 0 0 0 0 0 0 0 0 0 2 1 3 33.333 2 2 4 10.526 0 0 0

18 L. Kueh 59 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1.6949 0 0 0
19 Aneuk Paya 70 1 2 3 10 1 2 3 10 0 0 0 0 3 0 3 18.75 1 2 3 4.2857 0 0 0

20 Lam Ateuk 57 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 15.385 4 1 5 8.7719 0 0 0

21 Kueh 51 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lamgaboh 81 1 2 3 10 1 2 3 10 0 0 0 0 2 0 2 11.111 2 0 2 2.4691 0 0 0

23 Tanjong 75 1 1 2 6.6667 1 1 2 6.6667 0 0 0 0 1 0 1 5.8824 1 1 2 2.6667 0 0 0

24 Nusa 114 1 1 2 6.6667 1 1 2 6.6667 1 0 1 0.8772 0 0 0 0 4 3 7 6.1404 0 0 0

25 Seubun Ktp 43 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Seubun ayon 36 1 1 2 6.6667 1 1 2 6.6667 0 0 0 0 2 0 2 25 1 0 1 2.7778 0 0 0

27 Lambaro Sebun 46 1 0 1 3.3333 0 0 0 0 0 0 0 0 0 1 1 9.0909 0 1 1 2.1739 0 0 0

28 lamcok 44 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 10 1 1 2 4.5455 0 0 0

Jumlah 1770 11 17 28 6.9479 9 12 21 5.2109 1 2 3 0.1695 22 14 36 8.933 39 37 76 4.2938 0 0 0

 BAYI (0-11 BULAN)
∑ LAHIR HIDUP
KEMATIAN NEONATAL
∑ KEMATIAN 0-6 HARI ∑ KEMATIAN 7-28 HARI JUMLAH
∑ LK-LK ∑ PR ∑ LK+PR KEMATIAN
∑ LK-LK ∑ PR ∑ LK+PR ∑ LK-LK ∑ PR ∑ LK+PR
NEONATAL
27 28 29 30 31 32 33 34 35 36
0 0 0 0 0 0 0 0 0 0

0 2 2 0 0 0 0 0 0 0

1 2 3 0 0 0 0 0 0 0

2 2 4 0 0 0 0 0 0 0

2 0 2 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 1 1 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 1 1 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 1 1 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 1 1 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0
1 2 3 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

1 2 3 0 0 0 0 0 0 0

1 1 2 0 0 0 0 0 0 0

1 1 2 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

1 1 2 0 0 0 0 0 0 0

1 0 1 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

11 17 28 0 0 0 0 0 0 0
 KEMATIAN DAN PENYEBABNYA
BAYI (0-11 BULAN) KEMATIAN ANAK BALITA ( 12- 59 BLN ) KEM
SEBAB KEMATIAN NEONATAL ∑ KEMAT.POST NEO SEBAB KEMATIAN POST NEONATAL BAYI (0-11 BL) SEBAB KEMATIAN ANAK BALITA A
KEMAT. A. BALITA (12-59)
ASF TET. SE KELAI. LAIN (29 HR- 11 BLN ) DI KELAI. TE KELAI ( NEO + POST NEONATAL ) DI DIF LAIN (7-1
NO Desa PNEM A NAN MALA PNEMO MALAR CAMPA DBD
BBLR IKS NEO P BAW LAIN SAL. TA A TE LAIN
∑ LK-LK ∑ PR ∑ LK+PR ONIA RIA ∑ LK-LK ∑ PR ∑ LK+PR ∑ LK-LK ∑ PR ∑ LK+PR NIA IA K ∑ LK-LK
IA NATUR SIS AAN RE CER NUS SYARAF RE RI
37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
1 Monikeun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Lamkruet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Weuraya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Lampaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Mns Mesjid Lpk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6 Mns lambaro lpk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7 Mns Balee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Mns Blang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 Mns. Cut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Mns. Mesjid Llm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11 Mns. Baro 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12 Mns Beutong 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Mns Manyang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Mns Moncut 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Mns Karieng 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

16 Lamgirek 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

17 Naga umbang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

18 L. Kueh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Aneuk Paya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20 Lam Ateuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Kueh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

22 Lamgaboh 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

23 Tanjong 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

24 Nusa 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

25 Seubun Ktp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

26 Seubun ayon 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27 Lambaro Sebun 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

28 lamcok 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui Lhoknga , 27 Jan

Kepala Puskesmas Biko

( dr. Firzalinda ) (
19790219 201001 2 014 197
EMATIAN SEBAB KEMATIAN ANAK 7-18 TH
ANAK
KECELA AKIBAT PENYAK PENY.TI
-18THN) KAAN KEHAM NAPZA HIV/AI IT DAK BUNUH LAIN-
TRNSP ILAN DS MENUL MENUL DIRI LAIN
∑ PR ∑ LK+PR ORTASI AR AR

66 67 68 69 70 71 72 73 74 75
0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

anuari 2017
or Puskesmas Lhoknga

(Muzaiyanah,S.ST)
770817 200701 2 031
 FORMAT BBLR 2017

JENIS BB LAHIR
KELAMIN
NO BULAN NAMA BAYI NAMA ORANG TUA TANGGAL LAHIR ALAMAT KETERANGAN
L P GRAM

1 Januari Aska Syabilla Mawarna / Baihaqi 06/01/2017 1 2200 Mns. Moncut

2 Aisya riskiya putri Zahraturrahmi / Mkhsaini 05/01/2017 1 2250 Mns. Mesjid, LLM

10

11

12

13

14

15
16