PEMERINTAH KABUPATEN CIREBON

DINAS KESEHATAN
UPT PUSKESMAS PANGURAGAN
Jl. Nyi Mas Gandasari No. 85 Ds. Panguragan Kulon Kec. Panguragan
Kabupaten Cirebon, Telp.(0231) 8830109
Email: pkm_panguragan@yahoo.com, kode pos 45152

SURVEY PERBAIKAN KINERJA UKM

UPT PUSKESMAS PANGURAGAN

1. KIA DAN KB
a. bagaimana pendapat saudara tentang pelayanan KIA dan KB di
Puskesmas Panguragan?
..............................................................................................................
................................................................................................................
b. Apakah saudara mengetahui tentang resiko tinggi pada kehamilan?
................................................................................................................
................................................................................................................
c. Apa saran saudara tentang kegiatan KIA dan KB
................................................................................................................
................................................................................................................
2. PROMKES
a. Apakah Pendapat saudara tentang PHBS ?
................................................................................................................
................................................................................................................
b. Apakah menurut saudara perlu untuk meningkatkan pelayanan di
posyandu?
................................................................................................................
................................................................................................................
c. Apa saran saudara tentang kegiatan PHBS?
................................................................................................................
...............................................................................................................
3. KESLING
a. Apakah saudara memiliki jamban dan menggunakanya ?
................................................................................................................
................................................................................................................
b. Apakah saudara mengerti tentang sanitasi ?
................................................................................................................
................................................................................................................
c. Apa saran saudara tentang kegiatan Kesling
................................................................................................................
..............................................................................................................
4. GIZI
 a. Apakah saudara mengetahui tentang gizi seimbang ?
................................................................................................................
................................................................................................................
b. Apakah ada balita Gizi Buruk di daerah saudara ?
................................................................................................................
................................................................................................................
c. Apakah saran saudara tentang kegiatan Gizi ?
................................................................................................................
................................................................................................................
5. TB PARU
a. Apakah saudara mengerti tentang penyakit TBC
................................................................................................................
................................................................................................................
b. Aapakah ada yang menderita batuk - batuk selama 2 minggu atau lebih
di lingkungan saudara ?
................................................................................................................
................................................................................................................
c. Apa saran Saudara tentang kegiatan TB paru
................................................................................................................
................................................................................................................
6. DBD DAN SURVEYLANS
a. Apakah saudara mengetahui tentang penyakit Demam Berdarah
................................................................................................................
................................................................................................................
b. Apakah saudara mengerti dan melaksanakan 3M di lingkungan
saudara?
................................................................................................................
................................................................................................................
c. Apa saran saudara tentang kegiatan DBD dan surveylans
...............................................................................................................
................................................................................................................
7. IMUNISASI
a. Apakah saudara mengerti tentang imunisasi?
................................................................................................................
................................................................................................................
b. Apakah anda mengerti tentang MMR ?
................................................................................................................
................................................................................................................
c. Apa saran saudara tentang kegiatan imunisasi ?
................................................................................................................
................................................................................................................
8. KEPERKOM
a. Apakah menurut saudara perlu kunjungan rumah ?
................................................................................................................
................................................................................................................
 b. Apakah saudara mengerti tentang masalah kesehatan dan cara
menangani masalah kesehatan yang saudara alami ?
................................................................................................................
................................................................................................................
c. Apa saran saudara tentang kegiatan keperkom ?
................................................................................................................
................................................................................................................
9. DIARE DAN ISPA
a. Apakah menurut saudara perlu kunjungan rumah bagi penderita Diare
dan ISPA ?
................................................................................................................
................................................................................................................
b. Apa saran saudara tentang kegiatan Diare dan ISPA
10.JIWA
a. Apakah saudara mengerti tentang tanda awal penyakit jiwa ?
................................................................................................................
................................................................................................................
b. Apa saran saudara tentang kegiatan jiwa ?
................................................................................................................
................................................................................................................
11.UKS
a. Apakah menurut saudara perlu pemeriksaan kesehatan di sekolah ?
................................................................................................................
................................................................................................................
b. Apa saran saudara tentang kegiatan UKS ?
................................................................................................................
................................................................................................................
12.KESORGA
a. Apakah di Desa saudara perlu di bentuk kelompok olah raga ?
................................................................................................................
................................................................................................................
b. Apa saran saudara tentang kegiatan Kesehatan Olah raga ?
................................................................................................................
................................................................................................................
13.UKGS
a. Apakah menurut saudara perlu pemeriksaan kesehatan Gigi dan Mulut
di Posyandu ?
................................................................................................................
................................................................................................................
b. Apa saran saudara tentang kegiatan UKGS ?
................................................................................................................
................................................................................................................
14.UKK
a. Apakah ada pos UKK di Desa saudara ?
................................................................................................................
 Panguragan, Mei 2018

Kepala UPT Puskesmas

Panguragan

H.JAMIAT, SKM MM
NIP 196405161984121001