Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 HERI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
2 ISMAIL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
3 DEDE WITARSA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
4 SHOHIBUL H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
5 RIZKI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1
6 KOKOM K 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
7 DENI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
8 TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
9 DIKI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
10 YADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
11 NURZAENAL 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
12 WIWI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
13 HUSNUL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
14 KOMARUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
15 ACENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
16 ENDING 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
17 HUSNI T 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
18 DODI SOHIBUL 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0
19 TARNO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
20 U,KARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
21 HENDRI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
22 YAYAT.W 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
23 YANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
24 WATI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
25 ATIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
26 SUDIRMAN 1 1 0 0 2 0 2 2 1 1 1 1 1 1 0
27 ACEP SOLEH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
28 ASEP EMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
29 WIDIANSYAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
30 WIANTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
31 TIMBUL R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
32 EKO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
33 NUNUNG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
34 ENJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
35 WANAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
36 DARMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
37 JUJUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
38 SITI R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
39 DEDE HIDAYAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
40 SYARIF 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
41 LISDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
42 WILDAN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0
43 AHMAD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
44 SUTIAWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
45 DASMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
46 TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
47 ENTIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
48 DIAN 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0
49 IHIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
50 SUHERLAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
51 BENI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
52 DEDEN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
53 DIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
54 TATANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
55 M ILYAS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
56 ASEP H 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
57 ASEP G 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
58 ASEP S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
59 UTANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
60 AGUS M 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
61 TUTI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
62 ARDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
63 IWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
64 RUSLI 1 1 0 0 1 0 0 0 1 1 1 1 1 1 1
65 HASANUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
66 NOVA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
67 BUDIMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
68 DENI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
69 LUKMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
70 SURYA 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1
71 IJO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
72 WAWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
73 MAMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
74 SUJANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
75 ADJAT 1 1 0 1 0 0 0 0 1 1 1 1 1 1 0
76 SAHURI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
77 ACA.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
78 AGUS RIKI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
JUMLAH 7 7 2 2 5 2 30 30 78 78 78 78 78 78 21
N PHBS RUMAH TANGGA TINGKAT RW
HATAN DAN PEMBERDAYAAN MASYARAKAT
2019
21 22
0 1
0 1
0 1
0 1
1 0
1 0
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
1 0
0 1
1 0
0 1
1 0
0 1
1 0
0 1
0 1
0 1
0 1
1 0
1 0
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
1 0
1 0
0 1
0 1
0 1
1 0
1 0
1 0
1 0
0 1
0 1
0 1
0 1
1 0
21 57
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2018
RW : 2
DESA : Cipeundeuy
PKM : Cipeundeuy
rumah
rumah
sabun
Sehat
jumlah Bulin
Hari
hari
Ditmbang
3 4 5 6 ASI saja
7 8 9 10 11 12 13 14 15 16 17 18
1 U.SUKANDAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
2 AEP SAEPUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
3 POPONG ROHAYATI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
4 ENJANG ROSIDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
5 YUSI HENDRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
6 DEDE SUKANDA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
7 CUCU SUPARTIKA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
8 UJANG SUHENDAR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
9 IMAS KOMALA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
10 HJ.POPON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
11 TUTI RAHMAWATI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
CUCU SUPARTIKA 0
12 0 0 0 0 0 0 1 1 1 1 1 1 1 1
13 MAMAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
14 JUJU 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
15 UJANG RIZAL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
16 DEDE TURNASIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
17 AGUS SUHAELI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
18 SUYUD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
19 YUYUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
20 FALMI MUHAMAD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
21 IMAM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
22 JAJA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
23 M.SYAFI'I 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
24 ARIF SARIFUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
25 ANDI KURNIAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
26 AMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
27 SUPARMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
28 SUHERMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
29 WARDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
30 ANAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
31 DAAT DARYONO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
32 UJANG NANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
33 DADAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
34 DEDI SETIADI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
35 H.ASEP TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
36 JUARSAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
37 HALIMI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
38 RUDIYANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
39 EDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
40 CICAH SUPARTKA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
41 ENDANG SUTARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
42 H.OMOM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
43 H.SOLIHIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
44 M.IKHSAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
45 M ARSOWI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
46 PATIMAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
47 SURATIMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
48 CUCU DIANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
49 SAMSUL MAARIF 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
50 ENY H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
51 JA'A RAMDANI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
52 WOWON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
53 SUMIRAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
54 IKIR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
55 HM DASEMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
56 DEDI HERMAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
57 AYET 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
58 ISAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
59 DEDI SUPARDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
60 SURYATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
61 ENDANG SUTARYA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
62 DEDE LESMANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
63 SUKIRMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
JUMLAH 0 0 0 0 0 0 28 28 63 63 63 63 63 63 20
AAN PHBS RUMAH TANGGA TINGKAT RW
SEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2018
21 22
0 1
0 1
1 0
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
1
0
0 1
0 1
0 1
0 1
1 0
0 1
1 0
0 1
0 1
0 1
1 0
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
1 0
1 0
1 0
1 0
1 0
1 0
1 0
0 1
0 1
1 0
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
1 0
1 0
0 1
0 1
1 0
1 0
0 1
20 43
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 3
DESA : Cipeundeuy
PKM : Cipeundeuy
rumah
rumah
sabun
Sehat
jumlah Bulin
Hari
hari
Ditmbang
ASI saja
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 MAMAN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0
2 ASEP RUSMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
3 DALIM 1 1 1 1 0 0 2 2 1 1 1 1 1 1 0
4 IKIR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
5 ENDANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
6 UDIN.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
7 OON.E 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
8 YANWAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
9 SOLIHIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
10 DEDEH.R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
DUDI AHMAD
11 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
NURDIN 0 0 0 0 0 0 1 1 0
12 1 1 1 1 1 1
13 RENDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
14 NIA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
15 AGUS SAPUTRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
16 IWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
17 RONI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
18 ENCUM 1 1 0 0 1 0 1 1 1 1 1 1 1 1 1
19 DADANG KOSIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
20 SAMSU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
21 SARIPUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
22 ROSADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
23 ACA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
24 ENCEH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
25 WARSA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
26 D.HAPIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
27 RUDI HARLANTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
28 APANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
29 CECEP DARYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
30 ISOH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
31 BURHAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
32 ANDUT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
33 ADUNG 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0
34 AGUS MULYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
35 ADE MAMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
36 DANA ISMAIL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
37 DADANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
38 TUTI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
39 RAHMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
40 ABDUL MANAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
41 IYAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
42 DUDUY 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
43 ILEM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
44 WAWAN.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
45 GUGUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
46 DADANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
47 UU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
48 SUTIRAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
49 SALIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
50 OYON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
51 ENTIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
52 SUMITRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
53 ELON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
54 DEDE.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
55 KURNIA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
56 DARTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
57 SALMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
58 ITANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
59 DEDI SAMSUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
60 UUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
61 SUKAENAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
62 WAWAN.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
63 INDRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
64 IKA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
65 DIKI.S 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0
66 IYUS.G 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
67 BADRU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
68 ENDON 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
69 ADE.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
70 ADANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
71 ANAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
72 DODO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
73 YUKI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0
74 MUHIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
75 FERI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
76 NENG WITA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
77 MUSTAQIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
78 ENTIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
79 WIWI WIANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
80 ANI HERLINA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
81 INTAN RETNO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
JUMLAH 6 6 4 1 2 1 24 24 81 81 81 81 81 81 22
TAAN PHBS RUMAH TANGGA TINGKAT RW
ESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
21 22
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
1 0
1 0
0 1
0 1
1 0
0 1
0 1
0 1
0 1
1 0
0 1
0 1
1 0
0 1
0 1
1 0
0 1
0 1
1 0
1 0
0 1
0 1
0 1
1 0
0 1
1 0
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
1 0
1 0
0 1
0 1
1 0
0 1
1 0
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
1 0
0 1
1 0
1 0
0 1
0 1
22 59
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 4
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 DEDE.D 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
2 ASEP TARYAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
3 DIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
4 ABDUL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
5 THAMRIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
6 NINA.NIA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
7 ANENG.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
8 ANAN.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
9 WAHYUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 DADANG.S 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
11 WAWAN.M 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
12 UTANG.P 0 0 0 0 0 0 0 0 1 1 1 1 1 11 1
13 DIAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 JUJU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 TEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 HAERMAN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
17 INDRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
18 KOKO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
19 SEPTIAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
20 AGUS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
21 DJADJA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
22 HADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 WAHYU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 BUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 DUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
26 SUHENDAR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
27 DENI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1
28 AJA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
29 ODOS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
30 WAHID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
31 AGUS S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 DUDUY 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 RIDWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
34 HENDRA 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
35 DADUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
36 HJ.ENUNG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
37 H.TAMIMUL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 CECEP 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0 0
39 ODIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
40 MAMUR.R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
41 ACAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 NANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
43 MIFTAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
44 AHYAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
45 AGUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
46 MAESAROH 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
47 SARIF 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
48 ADE.R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
49 H.TATA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
50 DADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
51 SANDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
52 ENCANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 MAHMUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
54 GUNAWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
55 ABIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 BUBUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
57 RITA.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
58 AGUS.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
59 TAJUDIN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
60 ATEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
61 ROSITA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
62 RODIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
63 ENTIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
64 RIDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
65 U.SUPRIATNA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
66 CICAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
67 JUHAERNILAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
68 NANANG.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
69 SAHWI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
70 BENI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
71 KUSNADI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
72 ENCENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
73 AGUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
74 HERU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
75 DEDE.D 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
76 H.DEDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
77 YEYE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
78 DEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
79 KARMINI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
80 MURSAL 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
81 AYI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
82 DIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
83 K.ENTJUN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
84 PADLI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
85 DAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
86 ILAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
87 RIZKI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1
88 ENDAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
89 SARIF 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
90 H.KOMARIAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
91 ADE R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
92 YATI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
93 RAHMAN.T 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
94 GUMILAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
95 RIYAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
8 8 3 3 5 6 31 31 95 95 95 95 95 95 33 33
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
0
1
1
1
1
1
0
0
1
1
0
0
1
1
1
1
0
0
1
0
1
1
1
1
0
1
0
0
0
1
1
1
1
1
1
0
1
1
1
0
1
0
0
1
1
1
0
0
0
1
1
1
1
1
1
0
0
0
1
1
1
1
1
1
1
1
1
0
0
1
0
1
1
0
1
1
1
0
0
1
1
1
1
1
1
1
0
0
0
0
1
1
1
0
1
62
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 5
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 ENOK NINGSIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
2 DUCE 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
3 DIAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
4 SAEPUL 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
5 YAYAT R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
6 YUSUF 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
7 HASANUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
8 YUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 SURYADI 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
10 HOTIM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
11 WARSA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 HASRUL RUSLI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 ANDRI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 AHMAD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
15 DIDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 AHMAD NANDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
17 ANI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
18 ENTANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 ARIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 INAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
21 NINING 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
22 DION 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 DILAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 YAYAT.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
25 ANA.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 ROHIM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
27 ENGKOS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 PARDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
29 DEDEY 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
30 ATABF 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
31 AISYAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 AEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 DIDIN 1 1 0 0 1 1 2 2 1 1 1 1 1 1 0 0
34 HJ.IPAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
35 NENG IIS 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
36 ABAS HASAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
37 H.AAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 HJ,ROMLAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 GINGIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
40 ASEP 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
41 SOPIAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
42 ALEX 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 ESIH 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
44 APE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
45 ADE R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 YUNUS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
47 H.ENGKOS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 ABDUL SALIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 ABDILAH HELMI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
50 DEDENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
51 AAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
52 SAEPUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 HELI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
54 KHOERUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
55 NISAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 NANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
57 YUSEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
58 ADIM 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
59 HAMDANI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
60 TEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
61 WENDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
62 OON 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0 0
63 UDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
64 IDOM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
65 ASEP SUTISNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
66 KARTINI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
67 ACEP IMAN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
68 ENGKAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
69 EDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
70 ADE MAULUD 1 1 0 0 1 1 2 2 1 1 1 1 1 1 0 0
71 HASANUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
72 ENDANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
73 IKIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
74 ADE YATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
75 ENTIS 1 1 0 0 1 1 2 2 1 1 1 1 1 1 0 0
76 H,CECENG 0 0 0 0 0 0 2 2 1 1 1 1 1 1 1 1
0
JUMLAH 7 7 2 2 5 4 30 30 76 76 76 76 76 76 12 12
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
0
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
0
1
1
1
1
1
1
0
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
0
0
1
0
1
1
0
1
1
1
1
0
64
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 6
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 RAZAMI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
2 RANI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
3 DENI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
4 SUTISNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
5 H.AANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
6 RUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
7 ASEP ROZA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
8 EUIS RATNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 TINTIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 SUWENDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
11 MARIAM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
12 ISMANTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 EUIS PARMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 IMAS NENGSIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 BAMBANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 YOYOH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 EUIS ETI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
18 A.ARIA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
19 ENDANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 ASUS M 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
21 JAJAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
22 DEDEH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 DADAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
24 NANANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 H.ODANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
26 ENCUM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
27 SARIF 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 KODIR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
29 RAFIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 ADI SUHERMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
31 MULYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 DENI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 KOMARA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
34 ALIK.M 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0
35 AHMAD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
36 EDE. SAMSURI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
37 EMAN S 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
38 UJANG SURYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 ADE SUMIATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
40 UCEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
41 EDY 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 ASEP DC 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 ACEP ANA 1 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0
44 SADILI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
45 ADBUL SOMAD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 HJ.SITI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
47 WAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 EPON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 DADAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
50 CITA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
51 HENDRI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
52 HERI.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
53 AMBAR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
54 DIKDIK 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
55 WAWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
56 HAMID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
57 JAJANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
58 ASEP SUDARNA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
59 ARIEF S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
60 AI.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
61 KUNRAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
62 PAUZI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
63 PANDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
64 SURYADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
65 RAIHARTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
66 HEMAS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
67 ALIT.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
68 UJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
69 AGUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
70 NURBUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
71 RUSNO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
72 AEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
73 WAWAN P 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
74 YADI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
75 KUSNO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
76 TK RATU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
77 H EDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
78 H AN AN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
79 H IWIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
80 H.ASENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
81 HJ. ENUNG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
82 H.AEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
83 JAJAT.R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
jumlah 3 3 1 0 2 2 23 23 83 83 83 83 83 83 16 16
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
1
1
1
1
1
0
1
1
1
1
1
0
1
1
1
0
1
1
1
1
1
0
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
0
1
1
1
1
1
0
1
1
1
0
1
1
0
1
1
1
1
1
1
1
0
0
0
67
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 7
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 TIAN SUTIANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
2 CACA YUSDANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
3 CECENG RIDWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
4 SAWITA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
5 ENTIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
6 NANDANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
7 MUMUN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
8 OMI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
9 DEDI LUKITA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
10 AGUS SOPIAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
11 ELAN DAHLAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
12 SOETARA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
13 WACIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
14 AMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
15 MAMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
16 IIS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
17 WAGINAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
18 ATA IS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
19 ACHMAD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
20 ADI PILHAQ 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
21 AGUS JABAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
22 SAMSUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
23 MUKSIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
24 TATA 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0
25 YUSUP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
26 UHA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
27 DADAN H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
28 H.ATIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
29 H.AA MULYADI 1 1 1 0 0 0 0 0 1 1 1 1 1 1 0
30 RAZAMI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
31 INDRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
32 INDRA.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
33 IWAN.S 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0
34 IMAS.J 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
35 AGUS N 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
36 LOSO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
37 MOCH RAMDAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
38 IGUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
39 NY.UTI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
40 ADE SUHERMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
41 SOROSA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
42 HERU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
43 SAEPUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
44 MARGIONO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
45 INA TARYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
46 TOTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
47 YAYAT.K 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
48 EMPUD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
49 SUHARI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
50 REZA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
51 ADING 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
52 SUSANDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
53 ENJANG' 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
54 PARMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
55 AJA SUTARJA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
56 SAEFUL ANWAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
57 SITI HERLINA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
58 AMRIZAL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
59 DENDEN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
60 AKOM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
61 HILMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
62 AGUS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
63 KARWITA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
64 TAUFIK. B 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
65 N.MIMIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
66 MUKHLIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
67 ENOK.AISAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
68 SUBARKAH 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0
69 MULYANTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
70 UDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
71 SARBINI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
72 RUHIMAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
73 DEWI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
74 RATNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
75 RUSTANDAR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
76 MIMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
77 TAUFIQ.B 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
78 EUIS 0 0 0 0 0 0 2 2 1 1 1 1 1 1 1
79 UCI SANUSI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
80 ENJANG' 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
81 BAMBANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
82 MAEMUNAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
83 RIKI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
84 ZABIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
85 YAYAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
86 SURYAMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
87 SAEFUL ANWAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
88 DARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
89 NASIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
90 YUYUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
91 SUPARTINI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
3 3 2 0 1 2 25 25 91 91 91 91 91 91 10
N PHBS RUMAH TANGGA TINGKAT RW
HATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
21 22
1 0
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
1 0
0 1
1 0
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
10 81
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 8
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
1 TEDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
2 EEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
3 CECENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
4 KUSWADIMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
5 IRWAN BUGIS 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0
6 YAYAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
7 AANG 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0
8 WIDODOWATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
9 OOH.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
10 RIDWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
11 DEDE.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
12 UU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
13 U.TARYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
14 ASEP SUHELI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
15 NINING 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
16 CECEN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
17 AJI.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
18 MOCH.JAJI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
19 UCI SANUSI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
20 ADE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
21 HASANAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
22 RUBIYO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
23 SAYID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
24 DIAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
25 ENGKRI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
26 INDRI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
27 WARSITO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
28 WAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
29 AGUS SALIM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
30 ALEX 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
31 YAYA.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
32 IMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
33 SURYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
34 EUIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
35 NINA.R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
36 ENTAM 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0
37 U.SUTISNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
38 MUKSIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
39 TARMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
40 U.KOHARUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
41 DADAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
42 E.DAHLI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
43 TIKA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
44 TINI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
45 SARMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
46 ONO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
47 DEDE RAHMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
48 IDIS MULYANI MAMAD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
49 SUHENDRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
50 AGUS GUNAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
51 RUDI B.S 1 1 1 0 0 0 0 0 1 1 1 1 1 1 0
52 GUGUM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
53 ENDUH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
54 EMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
55 DAIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
56 DEDI.K 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1
57 SOPANDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
58 UCU KURNIA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
59 BUDI RAHAYU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1
60 ADIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
61 KOMAR MUSTARI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
62 EUIS UKAEDAH 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1
63 ZAENAL 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
64 RIAN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1
65 ADINDA 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0
6 6 3 2 3 0 28 28 65 65 65 65 65 65 16
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
21 22
1 0
1 0
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
0 1
1 0
0 1
0 1
0 1
1 0
0 1
0 1
1 0
0 1
0 1
0 1
0 1
0 1
1 0
0 1
1 0
0 1
0 1
0 1
1 0
0 1
1 0
0 1
0 1
0 1
1 0
0 1
0 1
1 0
0 1
0 1
1 0
0 1
0 1
1 0
0 1
1 0
0 1
16 49 65
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 9
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 ASEP.R 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 YAHYA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
3 LAMRI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
4 UJE 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
5 USEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
6 ANGGI 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
7 DASEP 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
8 DODI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 AAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
10 MUSTOFA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
11 DAISAH 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0
12 DANI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
13 NANI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 AHUM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 NURDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
16 DOPI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 JUJU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
18 TAUFIQ 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 SIGIT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
21 DAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
22 PARMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
23 HINDUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
24 RATNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 ANBAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 DUDUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 EDAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
28 DEDE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
29 NANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 JUNJUNAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
31 DUDUY 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 ASEP.R 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
33 MAMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
34 EDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
35 CEPI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
36 YADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
37 YUNI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
38 SUMYATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 AAM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
40 KARNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 JUJUN 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
42 OSENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
43 ROHMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 EDI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
45 ROHANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 ADE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
47 INOK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 TARYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 RAKA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
50 RONO 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
51 RUKMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
52 WARSA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 TARSA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
54 DUDUNG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
55 TOTENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 TARSIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
57 NURLELA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
58 JAJA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
59 ENDANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
60 RUHIMAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
61 CACA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
62 KARYA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
63 DENI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
64 WAHYU 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
65 ACA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
66 MELI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
5 5 3 2 2 2 30 30 66 66 66 66 66 66 11 11
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
0
1
1
1
1
1
0
0
0
1
1
1
0
1
1
1
1
1
0
0
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
55
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 10
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 SULAEMI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 HJOOM 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1
3 A.SOMAD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
4 H.ACENG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
5 WARMA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
6 ENDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
7 ENGKOS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
8 IYUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
9 MIMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 YAYAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
11 DUDENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 DADANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 A.SOLEH 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0
14 ARIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 DEDIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 YATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 AMINAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
18 NANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 IWA.K 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
20 UMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
21 A.DAFIS 1 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0
22 DENI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 HERI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 IIK.A 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 MAS EKO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 DEDIK J 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 DENI CASMANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 ENDANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
29 DEDE KURNIA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 ASEP RUSLI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
31 DUDUNG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 YUYU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 JEJEN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
34 TEGUH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
35 TAPSIR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
36 H.SAPARI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
37 DEDI H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 RUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 AJAT JAELANI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
40 EMIN AMINAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 NANA S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 FENDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 UUS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 H.OYEH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
45 DEDE.TARGUNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 AGUS. 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
47 ERIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 WAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 SUWARI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
50 M.SIDIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
51 NANANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
52 KOKO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 SUPYANI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
54 SUNARDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
55 HARYATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 IDAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
57 ADE M 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
58 IBNU 1 1 0 0 1 0 1 1 1 1 1 1 1 1 1 1
59 DEDE R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
60 BARNAS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
4 4 3 2 1 0 6 7 60 60 60 60 60 60 10 10
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
1
1
1
1
0
0
1
1
1
1
1
1
1
1
1
1
1
1
1
0
0
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
0
1
1
1
1
0
1
1
50
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 11
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 IMAN.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 KURNIAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
3 ENGGUH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
4 ROMLAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
5 AAH 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
6 SUANDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
7 UYUN.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
8 RULI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
9 SAEFUL A 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 ODIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
11 DEDE.R 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1
12 iip 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
13 TITIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 DIJAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 H.IYAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 ROHANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
17 HJ.UWIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
18 AHMAD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
19 UDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
20 WAHIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
21 IRMA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
22 DRS.AGUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
23 ARIF.G 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 SOSE 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
25 SUNJAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
26 H.TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 HJ.DEDE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 M.SOFWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
29 H.AGUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
30 EEM.R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
31 ARIF HILMAN 1 1 1 0 0 0 2 2 1 1 1 1 1 1 0 0
32 H.ADE 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
33 H.IGIT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
34 H.DEDE TITO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
35 HJ.DEUIS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
36 DIDIN S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
37 GUNGUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
38 YAYAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
39 AGUS DAMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
40 TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 AHMAD.K 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
42 IIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
43 ADJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 NENGSIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
45 AMINUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 IRMANSYAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
47 NENEH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 ROSTIA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
49 GAGAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
50 ADE ROCHAETI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
51 IDA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
52 HJ.II 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 YANTI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
54 OMAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
55 YUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 RACHMAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
57 DIDIN S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
58 HOMSAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
59 KHODIJAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
jumlah 3 3 3 2 0 0 24 24 59 59 59 59 59 59 22 22
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
0
0
1
1
1
0
0
0
1
1
0
1
1
0
0
1
1
0
0
0
1
1
1
1
1
0
0
0
0
1
1
0
1
1
1
1
1
0
1
1
0
1
1
0
1
1
1
1
1
37
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 12
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 KRISNA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 A.SUPRIATNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
3 IRFAN HILMI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
4 ENCE 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
5 IDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
6 DADENG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
7 ADE.DARMANSYAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
8 DEDE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 U KOMARUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 A.SUPRIADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
11 CEMEH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 CECEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 OMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 NANANG 1 1 1 1 0 0 0 0 1 1 1 1 1 1 0 0
15 ENDNG DANI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 TATAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 FAKHRUL 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
18 ELIN C 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 EPI SOPIAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 ASEP SAEPUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
21 UMAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
22 ATEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 SUPRAPTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 DEDE SUARDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 ENDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 IWAN S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 CACA RUHIMAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
28 IYA S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
29 ENTIS TEJA 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 1
30 WINDU 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
31 OO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 CECEP SLAMET 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
33 IKA SITI 0 0 0 0 0 0 1 1 1 1 1 1 0 0
34 MAMAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
35 A.SAEHU 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
36 JAJA JAENUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
37 ADANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 DURIAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 MIMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
40 DEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 ITA J 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 SUHERMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
43 HERMAN 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 BUBUN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
45 AROM 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 USEP DANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
47 CICIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
48 IJAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 SUHARNA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
50 APANDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
51 ACENG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
52 PURWONO 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 TASMO 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
54 RACIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
55 WAHYUDIN 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 ENTIS TEJA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
57 EPON 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
58 AYEP 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
59 ARIS 1 1 0 1 0 1 1 1 1 1 1 1 1 0 0
60 SULASTRI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1
61 DADAN 0 0 0 0 0 0 1 1 1 1 1 1 0 0
62 ASEP RIDWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
63 IDIN 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0 0
64 OKI 0 0 0 0 0 0 1 1 1 1 1 1 0 0
65 CACA SUDIRO 0 0 0 0 0 0 1 1 1 1 1 1 0 0
66 CHAERUDIN 0 0 0 0 0 0 1 1 1 1 1 1 0 0
67 EULIS SOLIHAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
68 SUTIANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
69 RUSMANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
70 RUSTANDI 0 0 0 0 0 0 1 1 1 1 1 1 0 0
71 ENUNG 0 0 0 0 0 0 1 1 1 1 1 1 1 1
72 SETIAWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
73 ACEP 0 0 0 0 0 0 1 1 1 1 1 1 0 0
74 ADE HADIAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
75 YAYAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
76 YAYAH 0 0 0 0 0 0 1 1 1 1 1 1 0 0
77 IWAN SUMIRAT 0 0 0 0 0 0 1 1 1 1 1 1 0 0
78 ARI TRIYANA 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
79 NENEG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
80 PEPEP 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
81 SUBITA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
82 APENDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
83 WARSONO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
84 ACEP SOPIAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
85 ENGKOS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
86 SUPIATI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
87 BUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
88 DARMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
89 SUHENDRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
jumlah 6 6 3 3 3 1 39 39 89 89 89 89 89 89 10 10
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
0
1
1
1
1
1
1
0
1
0
1
0
1
1
1
0
1
1
1
1
1
1
0
1
0
1
0
1
1
1
79 89
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 13
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 DEDI N 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 LISNAWATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
3 ERDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
4 PIA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
5 TAOFIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
6 M HASAN A 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
7 WILDAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
8 IDHAM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 TATAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 ENDIN R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
11 DODO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 USMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
13 AAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 CHADIVAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 AKBAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 YUSUP 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0 0
17 SUWITO 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
18 NIRAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1
19 ADE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 AAS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
21 ADING 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
22 DINA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
23 IMAS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
24 SURAHMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 ELIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 RISIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 KUNDANG S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 DANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
29 AJAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 MAMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
31 APIT EMONG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 ROJAK 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
33 RASMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
34 YOSANDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
35 ROHAETI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
36 SUMARNA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
37 ASESP HADIAN 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
38 NONO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
39 AMO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
40 RAHMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 SOLEHUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1
42 IMAN S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 BUDIONO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 ENCA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
45 HERI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 ANENG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
47 TATAN 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
48 ENTIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 KOHAR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
50 CUCUM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
51 ENOK 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
52 SUGANDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 AJIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
54 RAHMAT A 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
55 KUSNANDAR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
56 YAN YAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
57 ETI R 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
58 PEBBY 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0
jumlah 4 4 1 1 3 2 20 20 58 58 58 58 58 58 6 10
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
1
1
1
0
1
1
0
0
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
0
1
1
1
1
1
1
1
1
0
1
1
1
0
0
1
1
1
48
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 14
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 DARJA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
2 EMPUR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
3 YANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
4 TATANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
5 ADANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
6 ASEP HARUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
7 TAYUM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
8 AMUD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
9 USUP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
10 AGUS S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
11 ODIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 SAPAAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 AAM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 AHEN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 SAMANHUDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
16 MASUD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 DASEMAN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
18 SAKUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 AGUS S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 TARYATI 1 1 0 1 1 1 1 1 1 1 1 1 1 0 0
21 AYAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
22 NANAG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
23 IYUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
24 IMAS SRI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 ASEP ADAY 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 ABDUL KOSIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 AZIBY 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
28 SUGIANTO 1 1 1 1 1 1 1 1 1 1 1 1 0 0
29 HENDRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 DEDE HERI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
31 CACA SOPANDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
32 AJAT.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 POPON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
34 DENI JUHENDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
35 UDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
36 ODING 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
37 CICI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 SUPARMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
39 EMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
40 DEDE.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 SUTARNO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 AAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 IWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 DIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
45 ROKIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 AAN.K 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
47 IYAN.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 INAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 TEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
50 EMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
51 RUMINTA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
52 UJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 SOLEH 1 1 1 1 1 1 1 1 1 1 1 1 0 0
54 ROHANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
55 WAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 IRWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
57 USEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
58 TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
59 TARJO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
60 ELAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
61 ERUS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
62 AJA CANDRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
63 SUKMI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
64 SASEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
65 NANANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
66 NANTA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
67 AJAT K 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
68 IMAS.K 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
69 CADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
70 ENDANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
71 DENI W 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
72 RUDI.H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
73 TUMIRAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
74 SRI WAHYUNI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
75 SRI WAHYUNI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
76 AEP SAEPUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
77 HOLISAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
78 TATAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
79 ANGGA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
JUMLAH 4 4 1 1 3 3 23 23 79 79 79 79 79 79 14 14
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
0
1
1
0
1
1
1
0
0
1
1
1
0
1
1
1
0
1
1
0
1
1
65
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 15
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 WARSIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
2 PURKON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
3 KARNIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
4 NUNUNG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
5 DIDIN ROJIDIN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
6 UKUN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
7 WACIH 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1
8 DEDE S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
9 AJID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 ROSID 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
11 KANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 ASEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 DAYAT 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0 0
14 JAJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 KASMIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
16 RASTA 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1
17 JAJAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
18 NANO 1 1 0 1 1 0 1 1 1 1 1 1 1 1 0 0
19 OTEN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 OTA 1 1 0 0 1 0 1 1 1 1 1 1 1 1 1 1
21 KIWIT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
22 IYAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 JUNO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 IDAS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 WARSIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
26 NYAI JUA 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0
27 DANIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 ROSADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
29 TATA BAHTIAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 BUDI IRAWAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
31 CASTAM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 WATI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
33 WAHYUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
34 NUNUNG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
35 MITRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
36 ILAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
37 RUDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
38 SUMINAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 IKHSAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
40 DINDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 UJANG CUCUN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
42 MARWAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 HERMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 DARSA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
45 ROHAETIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
46 AMIR ABO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
47 DEDE SURYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 SOBANA 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
49 IMAS MASITOH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
50 KARMIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
51 MISTA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
52 SUPENDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
53 YAYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
54 M SAEPUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
55 ENIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 SUGANDA 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
57 M.ADE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
58 HODIJAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
59 YAYAT.H 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
60 OTA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
61 TEJO 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
62 AMANAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
63 USUP 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
64 AMIR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
65 MAMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
66 TETI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
67 DIDING 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
68 MULYANTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
69 LAMID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
70 EFENDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
71 ATOM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
72 CICI.S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
73 UJANG WARKIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
74 UDEN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
10 10 6 5 4 1 32 32 74 74 74 74 74 74 12 12
PHBS RUMAH TANGGA TINGKAT RW
TAN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
1
0
1
1
1
0
0
1
1
1
1
1
1
1
1
1
1
0
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
0
1
1
1
1
1
1
1
0
1
1
1
1
1
62
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2018
RW : 16
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 RUSMANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 JAJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
3 TATANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
4 EDI S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
5 H. KANA 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
15 TITI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
16 ENTAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 CUCU SUTISNA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
18 ENGKAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 HERU DIHASAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
20 UYUN 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
21 CUCU SETIAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
22 ROSITA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 NANA RUSYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 AHMAD H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 M. IHSAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 AGUS SALIM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
27 ELIS LISNAWATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
28 M. IHSAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
29 H. KUNDANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 H. RAMIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
31 ROHMALIAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 DAHLAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 YAYAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
34 ADJAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
35 EMIN 0 0 0 0 0 0 3 3 1 1 1 1 1 1 0 1
36 U. SUKALNA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
37 WARMA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 H. KOSIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 INDRA LUKMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
40 IROD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
41 WATI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
42 AGUS HAMDAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
43 DEDE ROHMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 UKI JUMIATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
45 IKIN SODIKIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
46 AYI TERI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
47 M. SHOLEH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
48 DAHLAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 SONA SURYANI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
50 M HASAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
51 RAHMAT DEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
52 ABAS BASRI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
53 ADE KARDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
54 ASEP ENDANG S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
55 DOPI SUHENDI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
56 SYARIP H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
57 ASEP HIDAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
58 ASEP SURAHMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
59 DRS. UTA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
60 ASEP SURAHMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
61 CACA S 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
62 ODON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
63 EUIS MINTARSIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
64 YANI 1 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1
65 H. HADA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
66 SOPIAN. M 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
67 IYAR KARMINI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
68 OCAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
69 RUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
70 JUMSA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
71 RASNAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
72 SUDARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
73 DEDE 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
74 MURSID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
75 YUSUP 1 1 1 1 0 0 2 2 1 1 1 1 1 1 0 0
76 H. HILMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
77 MAMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
78 ASIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
79 DAMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
80 TINI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
81 SONA SANTOSA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
82 AEP SAEPUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
83 HASAN 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0
84 SANDI 1 1 0 0 1 0 1 1 1 1 1 1 1 1 1 0
85 DARMAN 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0
86 EKO 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0
87 DEDE 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
88 WAHYU 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0
89 AGUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
90 UJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0
91 KUNDANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0
92 KANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 0
JUMLAH 8 8 3 3 5 3 43 43 92 92 92 92 92 92 12 16
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2018
RUMAH TANGGA
Status Rumah
Tangga
22
1
1
1
1
1
0
1
1
1
1
1
1
1
0
1
###
0
###
###
###
###
0
1
###
###
###
0
###
###
###
###
0
0
0
###
###
###
0
###
###
###
###
###
###
###
###
0
###
###
###
0
0
0
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
76 92
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 17
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 DIDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 ENTUN P 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
3 WARIYEM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
4 M. SOLEH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
5 PURI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
6 H. ADE. M 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
7 H. LILI 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1
8 UDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 JUNED 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
10 H. NATIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
11 ASMARA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 A. SAEFUL B 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
13 AMUNG K 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
14 DADANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 TATANG R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
16 M. BISNI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
17 H. YAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
18 RIAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
19 H. ENTIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
20 KARDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
21 SUGIH M 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
22 SUANGSIH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
23 ASEP.M 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
24 DADANG 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
25 ASON 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
26 CUCU 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
27 H.ACA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
28 H.ELI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
29 SOFYAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
30 KAJA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
31 KARTO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
32 YEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 MAHDAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
34 ANGGA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
35 SUBANDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
36 H.UCU 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
37 MAMAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
38 ANANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
39 REGI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
40 SALMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 N.MARYATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 DASA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
43 AJUM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 SUMARNI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
45 IHAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
46 IKAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
47 JAJAT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
48 ONO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 ANIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
50 DEDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
51 AGUS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
52 MAMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 RUSMANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
54 H. MAJID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
55 AGUS R 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
56 Dr. LILI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
JUMLAH 1 1 1 1 0 0 21 21 56 56 56 56 56 56 27 27
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
1
0
29
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 18
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 DEDE S 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
2 DAVIT 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
3 DATI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
4 EDIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
5 ETI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
6 YAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
7 DARIAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
8 ASEP S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 ITANG 0 0 0 0 0 0 2 2 1 1 1 1 1 1 0 0
10 HALIR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
11 HENDRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
12 UUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 SULAEMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
14 ACAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 DARIA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
16 ADE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 UUS 1 1 0 0 1 0 2 2 1 1 1 1 1 1 0 0
18 ONI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 NANANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 HANAPI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
21 RICARDO 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
22 EKA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
23 NANDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 DAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
25 WAWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 ASEP R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 DENI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 OO PUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
29 ADE F 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 UNAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
31 ENO.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
32 ASEP G 1 1 0 0 1 0 1 1 1 1 1 1 1 1 0 0
33 WARNI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
34 ANGGA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
35 DIDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
36 DARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
37 DADANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 MITRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
39 H.UNANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
40 ASEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
41 UJANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 RASIKA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 TARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 SANA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
45 IBIT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 ASEP SURYA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
47 KARIM 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 ASIKIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
49 H.SUGENG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
50 EKO BAYU 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
51 HASANAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
52 CARMA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
53 WAWAN R 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
54 IWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
55 AHMAD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
56 HJ.UMINAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
57 EUIS IDA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
58 H.EDDY 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
59 H,DASUKI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
60 DINI 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0
61 ASEP HENDRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
62 ENDANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
63 KOMAR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
64 ADE WIWI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
65 IWAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
66 ADE K 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
67 M,JALALUDIN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
68 NANDAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
69 AYI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
70 ADE.F 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
71 DENI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
72 ARI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
73 IDIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
74 ROSYID 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
75 GUGUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
76 ADE.S 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
77 RUKMANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
78 ENOK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
79 RUBI 1 1 1 1 0 0 2 2 1 1 1 1 1 1 1 1
80 SALIM 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
81 SUTISNA 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0
82 ROHMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
83 ROYANI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
84 DEDIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
85 ENGKOS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
86 OTANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
87 JUJUN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
88 SULAEMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
89 UCU ROSADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
90 KAMAL 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
5 5 3 1 2 0 34 34 90 90 90 90 90 90 15 15
HBS RUMAH TANGGA TINGKAT RW
AN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
RUMAH TANGGA
Status Rumah
Tangga
22
0
1
0
1
0
1
1
1
1
1
1
0
1
1
1
1
1
0
1
1
0
1
1
1
1
1
1
1
1
0
1
1
1
1
1
0
1
0
1
0 S
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
0
1
1
1
0
1
1
1
1
1
1
1
75 90
1
FORMULIR PENDATAAN PHBS RUMAH TANGGA TINGKAT RW
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
RW : 19
DESA : Cipeundeuy
PKM : Cipeundeuy
INDIKATOR PHBS RUMAH TANGGA
Memberantas Jentk di
Menggunakan Jamban
Persalinan Memberi ASI Ekslusif Menimbang
setap Hari
Jml Bayi 6-12 bln
o Rumah Tangga
& sabun
rumah
rumah
Ada bayi dan
jumlah Bulin
Sehat
Ditmbang
hari
Ber- PHBS
ASI saja
Balita
bln
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 21
1 NANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
2 DR.WAHYUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
3 HASAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
4 UUS 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
5 YADI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
6 ATANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
7 KUNDANG 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0
8 MAE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
9 IGUN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1
10 ANDRI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
11 EDIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
12 U RIANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
13 ITANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
14 RAIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
15 MMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
16 ENGKOS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
17 HJ.EUIS 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
18 ASEP H 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
19 MAMD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
20 RADIANA 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
21 IYON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
22 SAEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
23 HANDRA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
24 HANDI 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 0
25 ANGGA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
26 SUNARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
27 TANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
28 DEDE 1 1 1 1 0 0 2 2 1 1 1 1 1 1 0 0
29 SANANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
30 NURDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
31 SAEFUL 1 1 0 0 1 1 1 1 1 1 1 1 1 1 0 0
32 AHMAD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
33 DIDIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
34 PUPUD 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
35 TARYA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
36 AMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
37 RUDI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
38 DAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
39 GANJAR 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1
40 ARON 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
41 HRTMAN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
42 CACIH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
43 DIKDIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
44 AES 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
45 U.ALIYUDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
46 ASEP.K 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
47 SAHIDIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
48 YAYAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
49 TETI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
50 CICAH 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
51 ADE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
52 ROKI 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1
53 ICAH 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
54 NURJAMAN 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
55 SURYANA 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
56 AANG 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
57 ANE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
58 MULYA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
59 AMAT 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
60 ODANG 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
61 ADIN 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
62 CECEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
63 ISUR 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
64 DEDE 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1
65 ASEP 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
66 TOPIK 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1
67 TITI 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
68 UHUD 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
69 ECE 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0
70 INDRA 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0
5 5 3 2 2 2 18 18 70 70 70 70 70 70 10 10
PHBS RUMAH TANGGA TINGKAT RW
TAN DAN PEMBERDAYAAN MASYARAKAT
AHUN 2019
S RUMAH TANGGA
Status Rumah
Tangga
22
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
0
1
1
1
1
1
1
0
1
0
1
1
1
1
60
REKAPITULASI PENDATAAN
PROGRAM PROMOSI KES
PUSKESMAS : Cipeundeuy
KECAMATAN : Cipeundeuy
KABUPATEN : BANDUNG BARAT
INDIKATOR PHBS
Persalinan Memberi ASI Ekslusif Menimbang
Nama
N
Jumlah Bayi
Jumlah < 6
o
Linakes
Jumlah
RW
Balita
6 bln
A.E
bln
1 2 3 4 5 6 7 8 9 10
1 Cipeundeuy 1 7 7 2 2 5 2 30
2 Cipeundeuy 2 0 0 0 0 0 0 28
3 Cipeundeuy 3 6 6 4 1 2 1 24
4 Cipeundeuy 4 8 8 3 3 5 6 31
5 Cipeundeuy 5 7 7 2 2 5 4 30
6 Cipeundeuy 6 7 7 2 2 5 4 30
7 Cipeundeuy 7 3 3 2 0 1 2 25
8 Cipeundeuy 8 6 6 3 2 3 0 28
9 Cipeundeuy 9 5 5 3 2 2 2 30
10 Cipeundeuy 10 4 4 3 2 1 0 7
11 Cipeundey 11 3 3 3 2 0 0 24
12 Cipeundeuy 12 6 6 3 3 3 1 39
13 Cipeundeuy 13 4 4 1 1 3 2 20
14 Cipeundeuy 14 4 4 1 1 3 3 23
15 Cipeundeuy 15 10 10 6 5 4 1 32
16 Cipeundeuy 16 8 8 3 3 5 3 43
17 Cipeundeuy 17 1 1 1 1 0 0 21
18 Cipeundeuy 18 5 5 3 1 2 0 34
19 Cipeundeuy 19 5 5 3 2 2 2 18
JUMLAH 99 99 48 35 51 33 517
REKAPITULASI PENDATAAN PHBS RUMAH TANGGA TINGKAT PUSKESMAS
PROGRAM PROMOSI KESEHATAN DAN PEMBERDAYAAN MASYARAKAT
TAHUN 2019
Tidak Merokok di
Status Rumah Tangga
Mencuci Tangan
dgn Air & sabun
Melkkn aktftas
Fisik setap Hari
Jentk di rumah
Memberantas
Jamban Sehat
dlm rumah
Ditmbang
bersih
Tidak Ber-
Ber- PHBS
PHBS
11 12 13 14 15 16 17 18 21 22
30 78 78 78 78 78 78 21 21 57
28 63 63 63 63 63 63 20 20 43
24 81 81 81 81 81 81 22 22 59
31 95 95 95 95 95 95 33 33 62
30 76 76 76 76 76 76 12 12 64
30 76 76 76 76 76 76 12 12 64
25 91 91 91 91 91 91 10 10 81
28 65 65 65 65 65 65 16 16 49
30 66 66 66 66 66 66 11 11 55
7 60 60 60 60 60 60 10 10 50
24 59 59 59 59 59 59 22 22 37
39 89 89 89 89 89 89 10 10 79
20 58 58 58 58 58 58 10 10 48
23 79 79 79 79 79 79 14 14 65
32 74 74 74 74 74 74 12 12 62
43 92 92 92 92 92 92 16 16 76
21 56 56 56 56 56 56 27 27 29
34 90 90 90 90 90 90 15 15 75
18 70 70 70 70 70 70 10 10 60
517 1418 1418 1418 1418 1418 1418 303 303 1115