JUMLAH POSYANDU MENURUT STRATA

KABUPATEN MUSI BANYUASIN

TAHUN 2019

POSYANDU
POSYANDU AKTIF
NO KAB / KOTA PUSKESMAS PRATAMA MADYA PURNAMA MANDIRI JUMLAH
JUMLAH % JUMLAH % JUMLAH % JUMLAH % JUMLAH % JUMLAH %
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1. MUSI BANYUASIN
JUMLAH ( KAB / KOTA )
RASIO POSYANDU PER 100 BALITA
 STRATA TINGKAT PERKEMBANGAN POSYANDU

PUSKESMAS :
KECAMATAN :
KAB/KOTA : MUSI BANYUASIN

INDIKATOR
RERATA CAKUPAN CAKUPAN CAKUPAN KESIMPULAN
NAMA POSYANDU FREK. RERATA PROGRAM CAK. DANA
CAKUPAN KUMULATIF KUMULATIF KUMULATIF (STRATA)
PENIMBANGAN KADER TAMBAHAN SEHAT
D/S KIA KB IMUNISASI
DAFTAR NAMA DAN ALAMAT POSYANDU
(BY NAME BY ADDRESS)

PUSKESMAS :
KAB/KOTA : MUSI BANYUASIN

SARANA
NO NAMA DESA / NAMA ALAMAT NAMA KADER Kader terlatih Kader tidak PRASARANA Posyandu KIT SUMBER DANA KET
KELURAHAN POSYANDU POSYANDU terlatih (Gedung ada/ (Ada/ Tidak)
Tidak)
 BIODATA KADER POSYANDU

Posyandu : ..................................................
Puskesmas : ..................................................
Kab/Kota : Musi Banyuasin

Nama : ........................................................................................................................
Tempat / Tanggal Lahi : ........................................................................................................................
Alamat : ........................................................................................................................
........................................................................................................................
Ukuran Baju : S M L XL XXL XXXL
(tandai √ yang sesuai)
No. Telpon / Hp : ........................................................................................................................
Agama : ........................................................................................................................
Status : ........................................................................................................................
Nama Posyandu : ........................................................................................................................
Alamat Posyandu : ........................................................................................................................
........................................................................................................................
Lama menjadi kader : dari tahun ................... Sampai dengan tahun .................
Peserta binaan : Balita orang ibu hamil orang Lansia
Pendidikan formal tera :
Pendidikan non formal : 1. ..................................................................................................................
yang pernah diikuti 2. ..................................................................................................................
3. ..................................................................................................................
4. ..................................................................................................................
Pengalaman organisas : 1. ..................................................................................................................
2. ..................................................................................................................
3. ..................................................................................................................
4. ..................................................................................................................
Alasan bersedia menja : ......................................................................................................................
kader posyandu ......................................................................................................................
......................................................................................................................

......................, ..........................2018

( .................................................)
 orang

...............2018
DATA POSYANDU
KABUPATEN MUSI BANYUASIN
PROVINSI SUMATERA SELATAN

JUMLAH
NO KECAMATAN PUSKESMAS NAMA PENGELOLA POSYANDU DI NO TLP / HP PENGELOLA
POSYANDU / POSYANDU / KADER / KADER / PUSKESMAS POSYANDU DI PUSKESMAS
KECAMATAN PUSKESMAS KECAMATAN PUSKESMAS