Plan Form Lap Kespro Puskesmas 2021

PESANGGRAHAN
1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 1

Peserta KB Baru Pasca Placenta Peserta KB Baru Pasca Salin Peserta KB Baru Murni Total Peserta KB Baru
No Kegiatan
Pemerintah Swasta Total Pemerintah Swasta Total Pemerintah Swasta Total Pemerintah Swasta Total
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Kepala Bidang Kesmas Pelapor
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................

Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................
btu 0
0
0
0
0
0
0
0
NGAGLIK
No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
Pemerintah Swasta Total Total Pemerintah Swasta Total Pemerintah Swasta Total
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................

Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................
bji 0
0
0
0
0
0
0
0
SUMBEREJO
No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................

Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
0 1 IUD 0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 MOP 0 0 0 0 0 0 0 0 0 0 0 0 0
0 3 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0
0 4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0 0
0 5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0 0
0 6 PIL 0 0 0 0 0 0 0 0 0 0 0 0 0
0 7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................
0
0
0
0
0
0
0
0
SONGGOKERTO
No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................

Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................
0
0
0
0
0
0
0
0
ORO ORO OMBO
No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................

Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0
7 KONDOM 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
0 1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
0 2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
0 3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
0 4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
0 5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
0 6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
0 7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................
0
0
0
0
0
0
0
0
PUSKESMAS BATU
1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) JANUARI 1
No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) FEBRUARI 2
No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) MARET 3
No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................

Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................

No Kegiatan
0 1 IUD 0 0 0 0 0 0 0 0 0 0 0 0
0 2 MOP 0 0 0 0 0 0 0 0 0 0 0 0
0 3 MOW 0 0 0 0 0 0 0 0 0 0 0 0
0 4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0
0 5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0
0 6 PIL 0 0 0 0 0 0 0 0 0 0 0 0
0 7 KONDOM 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
Mengetahui Batu,......................
Hayati, SST, MM .............................
NIP. ............................. NIP. .............................
0
PUSKESMAS
LAPORAN LB3 KUSUB KB JANUARI TAHUN 2021 KOTA BATU
No. METODE DROP OUT EFEK SAMPING KOMPLIKASI
KB KEG Pusin
KB KB Mual nyeri
PUS AKTIF Meno AGA g/ Infeks
BARU AKTIF
DIBINA Ingin
Medis paus Mati Cerai Pindah LAIN Jml LAN spooti Amen sakit / Perubah temp Neri Perda Flour Perfo Trans Hem
Erosi Jml rahan i/Abs albus rasi lokasi atom
Hamil ng orhoe munt an BB at perut
e kepal es
ah insisi
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, …....................

Kepala Puskesmas ................. Pelapor
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB FEBRUARI TAHUN 2021 KOTA BATU
K
No. METODE PUS KB KB KB E
BARU AKTIF AKTIF DROP OUT EFEK SAMPING KOMPLIKASI
G
DIBINA
A Pusin
G Mual Nyeri
Meno g/ Infeks
Ingin A spooti Amen / Perubah temp Neri Perda Flour Perfo Trans Hem
Medis paus Mati Cerai Pindah LAIN Jml sakit Erosi Jml i/Abs
Hamil
e L ng orhoe munt an BB at perut rahan
es
albus rasi lokasi atom
kepal
A ah insisi
a
N
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, 7 Maret 2021

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB MARET TAHUN 2021 KOTA BATU
No. METODE PUS KB KB KB

DIBINA
KEG Pusin
AGA Mual Nyeri
Meno g/ Infeks
Ingin
Medis paus Mati Cerai Pindah LAIN Jml LAN spooti Amen sakit / Perubah temp Neri
Erosi Jml
Perda
i/Abs
Flour Perfo Trans Hem
Hamil
e ng orhoe munt an BB at perut rahan
es
kepal
ah insisi
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB APRIL TAHUN 2021 KOTA BATU
DIBINA
KEG Pusin
AGA Mual nyeri
Meno g/ Infeks
Ingin
Medis paus Mati Cerai Pindah LAIN Jml LAN spooti Amen sakit / Perubah temp Neri
Erosi Jml
Perda
i/Abs
Hamil
e ng orhoe munt an BB at perut rahan
es
kepal
ah insisi
a
1 IUD 40123 0 2479 0 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 MOP 40123 0 70 0 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 MOW 40123 0 737 0 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 IMPLANT 40123 0 2814 0 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 SUNTIK 40123 0 17361 0 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 PIL 40123 0 2218 0 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 KONDOM 40123 0 460 0 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 40123 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB MEI TAHUN 2021 KOTA BATU
DIBINA
KEG Pusin
AGA Mual
Meno g/ Tensi Infeks
Ingin
Medis paus Mati Cerai Pindah LAIN Jml LAN spooti Amen sakit / Perubah
meni
Neri
Erosi Jml
Perda
i/Abs
Hamil
e ng orhoe munt an BB perut rahan
es
kepal ngkat
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB JUNI TAHUN 2021 KOTA BATU
DIBINA
KEG Pusin
AGA Mual
Ingin
meni
Neri
Erosi Jml
Perda
i/Abs
Hamil
es
kepal ngkat
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB JULI TAHUN 2021 KOTA BATU
DIBINA
KEG Pusin
AGA Mual
Ingin
meni
Neri
Erosi Jml
Perda
i/Abs
Hamil
es
kepal ngkat
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB AGUSTUS TAHUN 2021 KOTA BATU
DIBINA
KEG Pusin
AGA Mual
Ingin
meni
Neri
Erosi Jml
Perda
i/Abs
Hamil
es
kepal ngkat
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB SEPTEMBER TAHUN 2021 KOTA BATU
DIBINA
KEG Pusin
AGA Mual
Ingin
meni
Neri
Erosi Jml
Perda
i/Abs
Hamil
es
kepal ngkat
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB OKTOBER TAHUN 2021 KOTA BATU

DIBINA KEG Pusin
AGA Mual
Ingin
meni
Neri
Erosi Jml
Perda
i/Abs
Hamil ng orhoe munt an BB perut rahan albus rasi lokasi atom
e kepal ngkat es
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB NOFEMBER TAHUN 2021 KOTA BATU

DIBINA KEG Pusin
AGA Mual
Ingin
meni
Neri
Erosi Jml
Perda
i/Abs
e kepal ngkat es
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
LAPORAN LB3 KUSUB KB DESEMBER TAHUN 2021 KOTA BATU

DIBINA KEG Pusin
AGA Mual
Ingin
meni
Neri
Erosi Jml
Perda
i/Abs
e kepal ngkat es
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 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 MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2,218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
TAHUN 2021

DROP OUT EFEK SAMPING KOMPLIKASI
BARU AKTIF AKTIF
DIBINA KEG Pusin
AGA Mual
Ingin
meni
Neri Perda Flour Perfo Trans Hem
Hamil ng orhoe munt an BB perut
e kepal ngkat es
ah
a
1 IUD 35551 0 2479 0 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 MOP 35551 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MOW 35551 0 737 0 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 IMPLANT 35551 0 2814 0 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 SUNTIK 35551 0 17361 0 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 PIL 35551 0 2218 0 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 KONDOM 35551 0 460 0 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 35551 0 26139 0 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 Batu, ......................

............................. .............................
NIP. ............................. NIP. .............................
PUSKESMAS BATU
KOMPLIKASI
Kon Kon
Tensi Perub versi versi
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, …....................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, 7 Maret 2021

Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
Batu, ......................
Pelapor
.............................
NIP. .............................
PESANGG
LAPORAN LB3 KKUSUB KB JANUARI TAHUN 2021 KOTA BATU
No. DROP OUT EFEK SAMPING KOMPLIK
AKTIF BLN KB KB KEG Pusin

METODE PUS BAR KB AKTIF AKTIF AGA Mual Nyeri
LALU (DES Meno g/ Perub Infeks
2020) U DIBINA Ingin Medi paus Mati Cerai Pinda LAIN Jml LAN spooti Amen sakit /
ahan
temp Neri Perda Flour Perfo
Erosi Jml rahan i/Abs albus rasi
Hamil s h ng orhoe munt at perut
e kepal BB es
ah insisi
a
175 IUD 8486 0 175 0 0
10 MOP 8486 0 10 0 0
74 MOW 8486 0 74 0 0
409 IMPLANT 8486 0 409 0 0
4,667 SUNTIK 8486 0 4,667 0 0
797 PIL 8486 0 797 0 0
108 KONDOM 8486 0 108 0 0
6240 JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

K
No. METODE PUS KB KB AKTIF KB E
BAR AKTIF DROP OUT EFEK SAMPING KOMPLIK
G
U DIBINA
A Pusin
G Mual nyeri
Meno g/ Perub Infeks
Ingin Medi Pinda spooti Amen / temp Neri Perda Flour Perfo
paus Mati Cerai LAIN Jml A sakit ahan Erosi Jml i/Abs
Hamil s
e
h L ng orhoe munt at perut rahan
es
albus rasi
kepal BB
A ah insisi
a
N
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

No. METODE PUS KB KB AKTIF KB

U DIBINA
KEG Pusin
AGA Mual nyeri
Ingin Medi Pinda LAN spooti Amen / temp Neri Perda Flour Perfo
paus Mati Cerai LAIN Jml sakit ahan Erosi Jml i/Abs
Hamil s
e
h ng orhoe munt at perut rahan
es
albus rasi
kepal BB
ah insisi
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual nyeri
Hamil s
e
es
albus rasi
kepal BB
ah insisi
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi Infeks
Ingin Medi Pinda LAN spooti Amen / Neri Perda Flour Perfo
paus Mati Cerai LAIN Jml sakit ahan meni Erosi Jml i/Abs
Hamil s
e
h ng orhoe munt perut rahan
es
albus rasi
kepal BB ngkat
ah
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
albus rasi
kepal BB ngkat
ah
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
albus rasi
kepal BB ngkat
ah
a
1 IUD 8486 0 175 0 0 0
2 MOP 8486 0 10 0 0 0
3 MOW 8486 0 74 0 0 0
4 IMPLANT 8486 0 409 0 0 0
5 SUNTIK 8486 0 4,667 0 0 0
6 PIL 8486 0 797 0 0 0
7 KONDOM 8486 0 108 0 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
albus rasi
kepal BB ngkat
ah
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
albus rasi
kepal BB ngkat
ah
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U DIBINA KEG Pusin
AGA Mual
Hamil s h ng orhoe munt perut rahan albus rasi
e kepal BB ngkat es
ah
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U DIBINA KEG Pusin
AGA Mual
Hamil s h ng orhoe munt perut rahan albus rasi
e kepal BB ngkat es
ah
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g

U DIBINA KEG Pusin
AGA Mual nyeri
Hamil s h ng orhoe munt st perut rahan albus rasi
e kepal BB es
ah insisi
a
1 IUD 8486 0 175 0 0
2 MOP 8486 0 10 0 0
3 MOW 8486 0 74 0 0
4 IMPLANT 8486 0 409 0 0
5 SUNTIK 8486 0 4,667 0 0
6 PIL 8486 0 797 0 0
7 KONDOM 8486 0 108 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DROP OUT EFEK SAMPING KOMPLIK
BAR AKTIF
U DIBINA KEG Pusin
AGA Mual
Hamil s
paus Mati Cerai
h
LAIN Jml sakit ahan meni Erosi Jml rahan i/Abs albus rasi
e ng orhoe munt perut es
kepal BB ngkat
ah
a
1 IUD 8486 0 175 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 8486 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 8486 0 74 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 8486 0 409 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 8486 0 4,667 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 8486 0 797 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 8486 0 108 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PESANGGRAHAN
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Trans Hem Ekspu
lokasi atom meni ahan lsi
Jml in out
ngkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
NGAGLIK
No. KB AKTIF
METODE DROP OUT EFEK SAMPING KOMPLIKASI
KB
AKTIF BLN KB AKTI KEG Pusin
PUS BAR F AGA Mual Nyeri
LALU (DES Meno g/ Perub Infeks Tensi
U DIBI Ingin Medi paus Mati Cerai Pinda LAIN spooti Amen / temp Neri Perda Flour Perfo Trans Hem
2020) Jml LAN sakit ahan Erosi Jml rahan i/Abs albus rasi lokasi atom meni
NA Hamil s
e
h ng orhoe
kepal
munt
BB
at perut es ngkat
ah insisi
a
309 IUD 5307 0 309 0 0 0
12 MOP 5307 0 12 0 0 0
171 MOW 5307 0 171 0 0 0
158 IMPLANT 5307 0 158 0 0 0
2769 SUNTIK 5307 0 2,769 0 0 0
351 PIL 5307 0 351 0 0 0
15 KONDOM 5307 0 15 0 0 0
3785 JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

K
BAR AKTI DROP OUT EFEK SAMPING KOMPLIKASI
G
U F
A Pusin
DIBI G Mual nyeri
NA Ingin Medi Meno g/ Perub Infeks Tensi
Pinda spooti Amen / temp Neri Perda Flour Perfo Trans Hem
paus Mati Cerai LAIN Jml A sakit ahan Erosi Jml i/Abs meni
Hamil s
e
es
kepal BB ngkat
A ah insisi
a
N
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F
KEG Pusin
DIBI AGA Mual nyeri
Pinda LAN spooti Amen / temp Neri Perda Flour Perfo Trans Hem
paus Mati Cerai LAIN Jml sakit ahan Erosi Jml i/Abs meni
Hamil s
e
es
kepal BB ngkat
ah insisi
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual nyeri
Hamil s
e
es
kepal BB ngkat
ah insisi
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
NA Ingin Medi Meno g/ Perub Tensi Infeks Tensi
Pinda LAN spooti Amen / Neri Perda Flour Perfo Trans Hem
paus Mati Cerai LAIN Jml sakit ahan meni Erosi Jml i/Abs meni
Hamil s
e
es
kepal BB ngkat ngkat
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F KEG
DIBI Pusin
AGA Mual
Hamil s h ng orhoe munt perut rahan albus rasi lokasi atom
e kepal BB ngkat es ngkat
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F KEG
DIBI Pusin
AGA Mual
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F KEG
DIBI Pusin
AGA Mual
ah
a
1 IUD 5307 0 309 0 0
2 MOP 5307 0 12 0 0
3 MOW 5307 0 171 0 0
4 IMPLANT 5307 0 158 0 0
5 SUNTIK 5307 0 2,769 0 0
6 PIL 5307 0 351 0 0
7 KONDOM 5307 0 15 0 0
JUMLAH 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

bji

BAR AKTI
U F KEG
DIBI Pusin
AGA Mual
Hamil s
paus Mati Cerai
h
LAIN Jml sakit ahan meni Erosi Jml rahan i/Abs albus rasi lokasi atom meni
ah
a
1 IUD 0 309 0 0 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 MOP 0 12 0 0 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 MOW 0 171 0 0 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 IMPLANT 0 158 0 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 SUNTIK 0 2,769 0 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 PIL 0 351 0 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 KONDOM 0 15 0 0 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 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0 0

NGAGLIK
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0
0 0 0
0 0 0
0 0
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
SUMBEREJO
No. KB
AKTIF KB
PUS BAR F AGA Mual nyeri
2020) U DIBI Ingin Medi paus Mati Cerai Pinda LAIN Jml LAN spooti Amen sakit /
ahan
temp Neri Perda Flour Perfo Trans Hem
Erosi Jml rahan i/Abs albus rasi lokasi atom meni
NA Hamil s h ng orhoe munt at perut
e kepal BB es ngkat
ah insisi
a
898 IUD 10487 0 898 0 0
40 MOP 10487 0 40 0 0
190 MOW 10487 0 190 0 0
1492 IMPLANT 10487 0 1,492 0 0
4480 SUNTIK 10487 0 4,480 0 0
565 PIL 10487 0 565 0 0
181 KONDOM 10487 0 181 0 0
7846 JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

K
No. METODE PUS KB KB KB E
BAR AKTIF AKTI DROP OUT EFEK SAMPING KOMPLIKASI
G
U F
A Pusin
DIBI G Mual nyeri
Pinda spooti Amen / temp Nyeri Perda Flour Perfo Trans Hem
Hamil s
e
es
kepal BB ngkat
A ah insisi
a
N
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F
KEG Pusin
DIBI AGA Mual nyeri
Hamil s
e
es
kepal BB ngkat
ah insisi
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual nyeri
Hamil s
e
es
kepal BB ngkat
ah insisi
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Pinda LAN spooti Amen / Nyeri Neri Perda Flour Perfo Trans Hem
Hamil s
e
h ng orhoe munt insisi perut rahan
es
kepal BB ngkat
ah
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Pinda LAN spooti Amen / nyerii Neri Perda Flour Perfo Trans Hem
Hamil s
e
es
kepal BB ngkat
ah
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
kepal BB ngkat
ah
a
1 IUD 10487 0 898 0 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
kepal BB ngkat
ah
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
kepal BB ngkat
ah
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F KEG
DIBI Pusin
AGA Mual Nyeri
Pinda LAN spooti Amen / Temp Neri Perda Flour Perfo Trans Hem
Hamil s h ng orhoe munt at perut rahan albus rasi lokasi atom
e kepal BB es ngkat
ah Insisii
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F KEG
DIBI Pusin
AGA Mual
Pinda LAN spooti Amen / Nyeri Neri Perda Flour Perfo Trans Hem
Hamil s h ng orhoe munt insis perut rahan albus rasi lokasi atom
e kepal BB es ngkat
ah
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U F KEG
DIBI Pusin
AGA Mual
ah
a
1 IUD 10487 0 898 0 0
2 MOP 10487 0 40 0 0
3 MOW 10487 0 190 0 0
4 IMPLANT 10487 0 1,492 0 0
5 SUNTIK 10487 0 4,480 0 0
6 PIL 10487 0 565 0 0
7 KONDOM 10487 0 181 0 0
JUMLAH 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

BAR AKTIF AKTI
U F KEG
DIBI Pusin
AGA Mual
Hamil s
paus Mati Cerai
h
ah
a
1 IUD 0 898 0 0 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 MOP 0 40 0 0 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 MOW 0 190 0 0 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 IMPLANT 0 1,492 0 0 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 SUNTIK 0 4,480 0 0 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 PIL 0 565 0 0 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 KONDOM 0 181 0 0 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 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7846
SUMBEREJO
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
SONGGOKERTO
No. KB AKTIF
KB
PUS BAR F AGA Mual Nyeri
U DIBI Ingin Medi paus Mati Cerai Pinda LAIN spooti Amen / temp Neri Perda Flour Perfo Trans Hem
2020) Jml LAN sakit ahan Erosi Jml rahan i/Abs albus rasi lokasi atom meni
NA Hamil s
e
h ng orhoe
kepal
munt
BB
at perut es ngkat
ah insisi
a
238 IUD 3259 0 238 0 0
8 MOP 3259 0 8 0 0
102 MOW 3259 0 102 0 0
378 IMPLANT 3259 0 378 0 0
1455 SUNTIK 3259 0 1,455 0 0
169 PIL 3259 0 169 0 0
52 KONDOM 3259 0 52 0 0
2402 JUMLAH 3259 0 2,402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0
K
G
U F
A Pusin
DIBI G Mual
Pinda spooti Amen / Neri Perda Flour Perfo Trans Hem
paus Mati Cerai LAIN Jml A sakit ahan meni Erosi Jml i/Abs meni
Hamil s
e
h L ng orhoe munt perut rahan
es
A ah
a
N
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
JUMLAH 3259 0 2402 0 0 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 LB3 KUSUB KB MARET TAHUN 2021KOTA BATU

U F
KEG Pusin
DIBI AGA Mual
Pinda LAN spooti Amen / nyeri Neri Perda Flour Perfo Trans Hem
Hamil s
e
es
kepal BB ngkat
ah
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0 0
JUMLAH 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 iud 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
4465 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
IMPLANT 3259 0 2402 0 0 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 LB3 KUSUB KB JUNI TAHUN 2021
U F
KEG Pusin
DIBI AGA Mual
Pinda LAN spooti Amen / nyeri Neri Perda Flour Perfo Trans Hem
Hamil s
e
es
kepal BB ngkat
ah
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
U F
KEG Pusin
DIBI AGA Mual Nyeri
Hamil s
e
es
kepal BB ngkat
ah insisi
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
U F
KEG Pusin
DIBI AGA Mual
Hamil s
e
es
ah
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD
MOP
IMPLANT
U F KEG
DIBI Pusin
AGA Mual
ah
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD
MOP
IMPLANT
U F KEG
DIBI Pusin
AGA Mual
ah
a
1 IUD 3259 0 238 0 0
2 MOP 3259 0 8 0 0
3 MOW 3259 0 102 0 0
4 IMPLANT 3259 0 378 0 0
5 SUNTIK 3259 0 1,455 0 0
6 PIL 3259 0 169 0 0
7 KONDOM 3259 0 52 0 0
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD
MOP
IMPLANT
No. PUS KB KB AKTIF KB
U F KEG
DIBI Pusin
AGA Mual
ah
a
1 IUD 3259 0 238 0 0 0
2 MOP 3259 0 8 0 0 0
3 MOW 3259 0 102 0 0 0
4 IMPLANT 3259 0 378 0 0 0
5 SUNTIK 3259 0 1,455 0 0 0
6 PIL 3259 0 169 0 0 0
7 KONDOM 3259 0 52 0 0
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
IUD
MOP
No. PUS KB KB AKTIF KB

BAR AKTI
U F KEG
DIBI Pusin
AGA Mual
Hamil s
paus Mati Cerai
h
ah
a
1 IUD 0 238 0 0 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 MOP 0 8 0 0 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 MOW 0 102 0 0 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 IMPLANT 0 378 0 0 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 SUNTIK 0 1,455 0 0 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 PIL 0 169 0 0 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 KONDOM 0 52 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERTO
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
ORO ORO OMB
No. KB AKTIF
AKTIF BLN KB KB KEG Pusin

LALU (DES PUS BAR AKTIF AGA Mual Nyeri
Meno g/ Perub Infeks Tensi
2020) U DIBINA Ingin Medi paus Mati Cerai Pinda LAIN Jml LAN spooti Amen sakit /
ahan
Erosi Jml rahan i/Abs albus rasi lokasi atom meni
e kepal BB es ngkat
ah insisi
a
859 IUD 8012 0 859 0 0 0
0 MOP 8012 0 - 0 0 0
200 MOW 8012 0 200 0 0 0
377 IMPLANT 8012 0 377 0 0 0
3990 SUNTIK 8012 0 3,990 0 0 0
336 PIL 8012 0 336 0 0 0
104 KONDOM 8012 0 104 0 0 0
5866 JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

K
BAR AKTIF DROP OUT EFEK SAMPING KOMPLIKASI
G
U DIBINA
A Pusin
G Mual Nyeri
Ingin Medi Pinda spooti Amen / temp Neri Perda Flour Perfo Trans Hem
Hamil s
e
es
kepal BB ngkat
A ah insisi
a
N
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5,866

U DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi Infeks Tensi
Ingin Medi Pinda LAN spooti Amen / Neri Perda Flour Perfo Trans Hem
Hamil s
e
es
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 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 LB3 KUSUB KB APRIL TAHUN 2021KOTA BATU
U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 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 LB3 KUSUB KB MEI TAHUN KOT 2021A BATU
U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

U DIBINA
KEG Pusin
AGA Mual
Hamil s
e
es
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U DIBINA KEG Pusin
AGA Mual
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U DIBINA KEG Pusin
AGA Mual
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


U DIBINA KEG Pusin
AGA Mual
Ingin Medi Pinda LAN spooti Amen / Nyeri Neri Perda Flour Perfo Trans Hem
Hamil s h ng orhoe munt insisi perut rahan albus rasi lokasi atom
e kepal BB es ngkat
ah
a
1 IUD 8012 0 859 0 0
2 MOP 8012 0 - 0 0
3 MOW 8012 0 200 0 0
4 IMPLANT 8012 0 377 0 0
5 SUNTIK 8012 0 3,990 0 0
6 PIL 8012 0 336 0 0
7 KONDOM 8012 0 104 0 0
JUMLAH 8012 0 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

BAR AKTIF
U DIBINA KEG Pusin
AGA Mual
Hamil s
paus Mati Cerai
h
ah
a
1 IUD 0 859 0 0 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 MOP 0 - 0 0 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 MOW 0 200 0 0 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 IMPLANT 0 377 0 0 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 SUNTIK 0 3,990 0 0 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 PIL 0 336 0 0 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 KONDOM 0 104 0 0 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 5866 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO OMBO
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
KOMPLIKASI
Kon Kon
Perub versi versi
Ekspu
ahan
lsi
Jml in out
BB
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BARU AKTIF
DIBINA KEG Pusin
AGA Mual Nyeri
Ingin Medi
paus Mati Cerai
Pinda
LAIN Jml LAN spooti Amen sakit /
ahan
e kepal BB es
ah insisi
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

K
BARU AKTIF DROP OUT EFEK SAMPING KOMPLIKASI
G
DIBINA
A Pusin
G Mual
Ingin Medi Pinda A spooti Amen / Neri Perda Flour Perfo Trans Hem
Hamil s
e
h L ng orhoe munt perut rahan
es
kepal BB ngkat
A ah
a
N
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


DIBINA
KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
Hamil s
e
es
kepal BB ngkat
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DIBINA
KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
Hamil s
e
es
kepal BB ngkat
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DIBINA
KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
Hamil s
e
es
kepal BB ngkat
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0

DIBINA
KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
Hamil s
e
es
kepal BB ngkat
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DIBINA
KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
Hamil s
e
es
kepal BB ngkat
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DIBINA
KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
Hamil s
e
es
kepal BB ngkat
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DIBINA
KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
Hamil s
e
es
kepal BB ngkat
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


DIBINA KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
e kepal BB ngkat es
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


DIBINA KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
e kepal BB ngkat es
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


DIBINA KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
i/Abs
e kepal BB ngkat es
ah
a
1 Batu 8486 0 6240 0 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 Beji 5307 0 3785 0 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 Bumiaji 10487 0 7846 0 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 Junrejo 3259 0 2402 0 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 Sisir 8012 0 5866 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

BARU AKTIF
DIBINA KEG Pusin
AGA Mual
Ingin Medi
paus Mati Cerai
Pinda
ahan meni
Neri Perda Flour Perfo Trans Hem
Hamil s h ng orhoe munt perut
e kepal BB ngkat es
ah
a
1 Batu 8486 0 6240 0 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 Beji 0 0 3785 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 Bumiaji 0 0 7846 0 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 Junrejo 0 0 2402 0 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 Sisir 0 0 5866 0 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 8486 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0 0 0 0 0 0

KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
KOMPLIKASI
Kon Kon
Ekspu
meni ahan
lsi
Jml in out
ngkat BB
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
PUSKESMAS BATU
LAPORAN KB 4T JANUARI TAHUN 2021
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO ORO ORO OMBO TOTA

No Kegiatan
PASCA SALIN 4T Total PASCA SALIN 4T Total PASCA SALIN 4T Total PASCA SALIN 4T Total PASCA SALIN 4T Total PASCA SALIN
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui Batu, …...................
Kepala Puskesmas ................. Kepala Puskesmas .................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN KB 4 T FEBRUARI 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
Kepala Puskesmas .................
.............................
NIP. .............................
LAPORAN KB 4 T MARET 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00
.............................
NIP. .............................
LAPORAN KB 4 T APRIL 2021
No Kegiatan
PASCA SALIN 4T Total PASCA SALIN 4T 0 PASCA SALIN 4T Total PASCA SALIN 4T Total PASCA SALIN 4T Total PASCA SALIN
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T MEI 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T JUNI 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00
.............................
NIP. .............................
LAPORAN KB 4 T JULI 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T AGUSTUS 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T SEPTEMBER 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T OKTOBER 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T NOPEMBER 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T DESEMBER 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
LAPORAN KB 4 T TAHUN 2021
No Kegiatan
6734 4215 8324 2586 6360
1 IUD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 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
Cakupan 0.00 0.00 0.00 0.00 0.00

Mengetahui
.............................
NIP. .............................
PKP

URAIAN SASARAN SASARAN SASARAN SASARAN SASARAN SASARAN
CAPAIAN CAKUPAN CAPAIAN CAKUPAN CAPAIAN CAKUPAN CAPAIAN CAKUPAN CAPAIAN CAKUPAN
4T 4T 4T 4T 4T 4T
TB I 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
TB II 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
TB III 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
TB IV 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
2021 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
Capaian dihitung PERBULAN
0 0 0 0 0 0
SASARAN SASARAN SASARAN SASARAN SASARAN SASARAN
4T 4T 4T 4T 4T 4T
JAN 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
FEB 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
MAR 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
APR 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
MAY 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
JUN 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
JUL 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
AUG 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
SEP 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
OCT 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
NOV 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
DEC 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
2021 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
Capaian dihitung komulatif

SASARAN SASARAN SASARAN SASARAN SASARAN SASARAN
4T 4T 4T 4T 4T 4T
JAN 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
FEB 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
MAR 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
APR 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
MAY 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
JUN 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
JUL 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
AUG 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
SEP 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
OCT 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
NOV 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
DEC 6734 0 0.00 4215 0 0.00 8324 0 0.00 2586 0 0.00 6360 0 0.00 28219
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0.00
TOTAL
4T Total
28219
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0.00
TOTAL
CAPAIAN CAKUPAN
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
CAPAIAN CAKUPAN
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
TOTAL
CAPAIAN CAKUPAN
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
0 0.00
PENCATATAN HA
BULAN …..........................
TAHUN …..........................
PUSKESMAS …..........................
NAMA CATIN
NO alamat CPW alamat CPL
CPW CPL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
PENCATATAN HASIL LAYANAN DASAR KESPRO CATIN
HASIL
Fe CPW (tablet)
UMUR GOLONGAN PEMER LILA
pemeriksaan IMT CPW
(TAHUN) DARAH IKSAA CPW
N Hb
(BB/TB2)
CPW (gr
IMT
%)
CPW CPL CPW CPL hasil TB (M) BB(Kg)
10 24 150 56 24.88889
18 150 45 20
25 155 48 19.97919
24 150 76 33.77778
26 157 54 21.90758
30 153 52 22.21368
24 152 40 17.31302
25 150 67 29.77778
25 150 48 21.33333
26 160 65 25.39063
26 155 60 24.97399
21 154 44 18.55288
20 155 40 16.64932
23 150 55 24.44444
22 145 41 19.50059
24 157 55 22.31328
23 154 55 23.19109
24 150 54 24
20 165 45 16.52893
24 153 51 21.78649
26 155 68 28.30385
24 155 54 22.47659
23 150 55 24.44444
24 155 54 22.47659
26 150 53 23.55556
26 150 61 27.11111
25 145 48 22.82996
24 146 49 22.98743
30 155 80 33.29865
26 156 65 26.7094
24 155 53 22.06035
25 150 48 21.33333
24 150 52 23.11111
25 154 51 21.50447
STATUS TT
HIV HbsAg
CPW CPL CPW CPL

FORMAT LAPORAN KEGIATAN KESPRO CALON PENGANTIN
PUSK :
BULAN :
Tahun : 2021
Catin Terdaftar di Catin Dilayani Kespro

KUA + Lembaga
Agama Lain
DESA / CPW CPL

NO
KELURAHAN
CPW CPL N % N %
1 0 0 0 #DIV/0! 0 #DIV/0!
2 0 0 0 #DIV/0! 0 #DIV/0!
3 0 0 0 #DIV/0! 0 #DIV/0!
4 0 0 0 #DIV/0! 0 #DIV/0!
5 0 0 0 #DIV/0! 0 #DIV/0!
6 0 0 0 #DIV/0! 0 #DIV/0!
7 0 0 0 #DIV/0! 0 #DIV/0!
8 0 0 0 #DIV/0! 0 #DIV/0!
9 0 0 0 #DIV/0! 0 #DIV/0!
0 0 0 #DIV/0! 0 #DIV/0!
Hasil Pemeriksaan CPW Pemeriksaan Laborat
Anemia Kekurangan Gizi Kekurangan Gizi Golongan Darah HIV

(IMT) (LILA <23,5 cm)
Abs % Abs % Abs % CPW CPL CPW
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0

0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0
0 #DIV/0! 0 #DIV/0! #DIV/0! 0 0 0

emeriksaan Laborat
HIV HbsAg
CPL CPW CPL
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Lampiran 5
LAPORAN PELAYANAN KOR
DI PUSKESMAS /
PUSKESMAS/ RUMAH SAKIT ……………………………………………..

KABUPATEN/KOTA …………………………… PROVINSI : ……………………..
KODE PUSKESMAS/RUMAH SAKIT : …………….
Bulan : ………………………… Tahun ……………………….
Nama Kasus
Tanggal Lengkap/ Alamat kronologi Tanggal
No Kunjungan Inisial Lengkap (Baru/Lam kasus lahir Jenis Disabilitas Pendidikan
nama a/Rujukan) (tgl/bln/th Kelamin (ya/tidak)
n)
(1) (2) (4) (5) (6) (7) (8) (9) (10) (11)
ORAN PELAYANAN KORBAN TINDAK KEKERASAN TERHADAP PEREMPUAN, ANAK
DI PUSKESMAS /RUMAH SAKIT ……………………………………………….
KORBAN TERLAP
Tindak
Kekerasan Waktu
(Fisik/Psikis Kejadian Tanggal
Status Pelayanan Jenis
Pekerjaan Perkawina /Seksual/P TKP (lokasi (tgl, bln, yang Rujuk Ke Kebangsaa lahir Kelamin
n enelantara kejadian) tahun, diberikan n (tgl/bln/th (L/P)
n, TPPO, waktu n)
Eksploitasi, kejadian)
dll)
(12) (13) (14) (16) (17) (18) (20) (21) (22) (23)
TERLAPOR
Hubungan Kebangsaa Keteranga

Pendidikan Pekerjaan dengan n
korban n
(24) (25) (26) (27) (28)
…………….., …………………..
Kepala Puskesmas ………………………
Nama …………………………………
NIP …………………………………….
LAPORAN PWS KB KOTA BATU BULAN JANUARI 2021
PESERTA BARU PESERTA KB AKTIF PST KB AKTIF DIBINA EFEK SAMPING KEGAGALAN KOMPLIKASI DROP OUT
JUML SASA
NO DESA AH RAN Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah
bln bln bln bln bln bln bln bln bln
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
lalu ini lalu ini lalu
bln ini
lalu
bln ini
Kom Kom
Koml % Koml % Koml % % % Koml %
l l
1 IUD 35551 3296 0 0 0 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3296 0 0 0 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3296 0 0 0 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3296 0 0 0 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3296 0 0 0 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3296 0 0 0 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3296 0 0 0 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN FEBRUARI 2021
JUML SASA
PUSKES
NO AH RAN Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah
MAS bln bln bln bln bln bln bln bln bln
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
lalu ini lalu ini lalu
bln ini
lalu
bln ini
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN MARET 2021
JUML SASA
PUSKES Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah
NO AH RAN bula bula bula
MAS bula bulan bulan bulan bulan bula bula bulan bulan bulan bulan
PUS BULIN n n ini lalu ini lalu ini
n
n ini
n
n ini lalu ini lalu ini
lalu lalu lalu
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN APRIL 2021
JUML SASA
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 40123 3403 0 0 0 0 2479 2479 2479 6.179 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 40123 3403 0 0 0 0 70 70 70 0.174 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 40123 3403 0 0 0 0 737 737 737 1.837 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 40123 3403 0 0 0 0 2814 2814 2814 7.013 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 40123 3403 0 0 0 0 17361 17361 17361 43.27 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 40123 3403 0 0 0 0 2218 2218 2218 5.528 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 40123 3403 0 0 0 0 460 460 460 1.146 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 40123 3403 0 0 0 0 26139 26139 26139 65.15 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN MEI 2021
JUML SASA
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN JUNI 2021
JUML SASA
n
n ini
n
lalu lalu Kom lalu Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN JULI 2021
JUML SASA
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN AGUSTUS 2021
JUML SASA
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN SEPTEMBER 2021
JUML SASA
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN OKTOBER 2021
JUML SASA
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN NOFEMBER 2021
JUML SASA
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 35551 3403 0 0 0 0 2479 2479 2479 6.973 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 35551 3403 0 0 0 0 70 70 70 0.197 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 35551 3403 0 0 0 0 737 737 737 2.073 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 35551 3403 0 0 0 0 2814 2814 2814 7.915 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 35551 3403 0 0 0 0 17361 17361 17361 48.83 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 35551 3403 0 0 0 0 2218 2218 2218 6.239 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 35551 3403 0 0 0 0 460 460 460 1.294 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35551 3403 0 0 0 0 26139 26139 26139 73.53 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................
LAPORAN PWS KB KOTA BATU BULAN DESEMBER 2021
JUML SASA
PUSKES
NO AH RAN bula Jumlah Jumlah Jumlah bula Jumlah bula Jumlah Jumlah
n
n ini
n
lalu lalu lalu
Kom Kom
l l
1 IUD 34984 3296 0 0 0 0 2479 2479 2479 7.086 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 MOP 34984 3296 0 0 0 0 70 70 70 0.2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 MOW 34984 3296 0 0 0 0 737 737 737 2.107 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 IMPLANT 34984 3296 0 0 0 0 2814 2814 2814 8.044 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 SUNTIK 34984 3296 0 0 0 0 17361 17361 17361 49.63 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 PIL 34984 3296 0 0 0 0 2218 2218 2218 6.34 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 KONDOM 34984 3296 0 0 0 0 460 460 460 1.315 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 34984 3296 0 0 0 0 26139 26139 26139 74.72 0 0 0 0 0 0 0 0 0 0 0 0.000 0 0 0 0 0 0
Mengetahui Batu,…..........................
............................. .............................
NIP. ............................. NIP. .............................

DROP OUT PST KB PASCA SALIN BARU AKTIF AKTIF
DROP OUT EFEK SAMPING KOMPL
DIBINA KEG Pusin
AGA Mual
Meno g/ Perub Tensi Infeksi
Jumlah Jumlah
Ingin
Medis paus Mati Cerai
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
bln bln Hamil h ng orhoe munt perut rahan albus asi
e kepal BB ngkat s
lalu ini ah
a
Koml % Koml %
0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................
K
DROP OUT E EFEK SAMPING KOMPL
G
DIBINA
A Pusin
G Mual
Ingin Pinda spooti Amen / Neri Perda Flour Perfor
Jumlah Jumlah Medis paus Mati Cerai LAIN Jml A sakit ahan meni Erosi Jml /Abse
bln bln Hamil h L ng orhoe munt perut rahan albus asi
e kepal BB ngkat s
lalu ini A ah
a
N
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Jumlah Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
bula Hamil h ng orhoe munt perut rahan albus asi
bula e kepal BB ngkat s
n ah
n ini a
lalu
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Jumlah Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
n ah
n ini a
lalu
Koml % Koml %
0 0 0 0 0 0 1 IUD 40123 0 2479 0 0 0 0 0 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 MOP 40123 0 70 0 0 0 0 0 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 MOW 40123 0 737 0 0 0 0 0 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 IMPLANT 40123 0 2814 0 0 0 0 0 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 SUNTIK 40123 0 17361 0 0 0 0 0 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 PIL 40123 0 2218 0 0 0 0 0 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 KONDOM 40123 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Jumlah Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
n ah
n ini a
lalu
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA KEG Pusin
AGA Mual
Jumlah Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
n ah
n ini a
lalu
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Jumlah Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
n ah
n ini a
lalu
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Ingin Pinda LAN spooti Amen / Neri Perda Flour Perfor
Jumlah bula Jumlah Hamil
h
LAIN Jml sakit ahan meni Erosi Jml /Abse
bula e ng orhoe munt perut rahan
s
albus asi
n kepal BB ngkat
n ini ah
lalu a
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Jumlah Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
n ah
n ini a
lalu
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Ingin Pinda LAN spooti Amen / Neri Perda Flour Perfor
Jumlah bula Jumlah Hamil
h
LAIN Jml sakit ahan meni Erosi Jml /Abse
bula e ng orhoe munt perut rahan
s
albus asi
n kepal BB ngkat
n ini ah
lalu a
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Jumlah Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
n ah
n ini a
lalu
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................

DIBINA
KEG Pusin
AGA Mual
Jumlah bula Jumlah
Ingin
Pinda
ahan meni
Neri
Erosi Jml
Perda
/Abse
Flour Perfor
n e kepal BB ngkat s
n ini ah
lalu a
Koml % Koml %
0 0 0 0 0 0 1 IUD 35551 0 2479 0 0 0 0 0 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 MOP 35551 0 70 0 0 0 0 0 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 MOW 35551 0 737 0 0 0 0 0 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 IMPLANT 35551 0 2814 0 0 0 0 0 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 SUNTIK 35551 0 17361 0 0 0 0 0 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 PIL 35551 0 2218 0 0 0 0 0 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 KONDOM 35551 0 460 0 0 0 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,......................
............................. .............................
NIP. ............................. NIP. .............................
KOMPLIKASI
Konv Konv
Tensi Perub ersi ersi
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
Transl Hemat Ekspul
okasi om
menin ahan
si
Jml in out
gkat BB
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Batu,......................
Pelapor
.............................
NIP. .............................
JUML SASA
bln bln bln bln bln bln bln bln bln bln bln
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
lalu ini lalu ini Kom lalu ini Ko lalu ini
Koml % Koml % Koml % Koml % % %
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0
SUMBEREJ
3 O 10405 966 0 0 0 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
lalu ini lalu ini lalu ini lalu ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
PESANGGR
1 AHAN 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 NGAGLIK 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SUMBEREJ
3 O 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKE
4 RTO 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
5 OMBO 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,............................
............................. .............................
NIP. ............................. NIP. .............................
DROP OUT PST KB PASCA SALIN No. METODE KB DROP OUT KEG Pusin EFEK SAMPING
KB KB Mual
PUS AKTIF Meno AGA g/ Perub Tensi
BARU AKTIF
Jumlah Jumlah DIBINA Ingin Medi paus Mati Cerai Pinda LAIN Jml LAN spooti Amen sakit /
ahan meni
Neri
Erosi Jml
Perda
bln bln Hamil s h ng orhoe munt perut rahan
e kepal BB ngkat
lalu ini ah
Koml % Koml % a
PESANGGRAH
0 0 0 0 0 1
AN
8486 0 6240 0 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 NGAGLIK 5307 0 3785 0 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 SUMBEREJO 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 4
O
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 5
OMBO
8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....
K
DROP OUT PST KB PASCA SALIN No. METODE DROP OUT E EFEK SAMPING
G
KB A Pusin
KB KB Mual
PUS AKTIF Meno G g/ Perub Tensi
BARU AKTIF spooti Amen / Neri
Jumlah Jumlah DIBINA Ingin Medi paus Mati Cerai Pinda LAIN Jml A sakit ahan meni Erosi Jml
Perda
bln bln Hamil s h L ng orhoe munt perut rahan
e kepal BB ngkat
lalu ini A ah
a
N
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1
AN
8486 0 6240 0 0 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 NGAGLIK 5307 0 3785 0 0 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 SUMBEREJO 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4
O
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5
OMBO
8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....
DROP OUT PST KB PASCA SALIN No. METODE DROP OUT EFEK SAMPING
KB KEG Pusin
KB KB Mual
PUS AKTIF Meno AGA g/ Perub Tensi
BARU AKTIF
Jumlah Jumlah DIBINA Ingin Medi paus Mati Cerai Pinda LAIN Jml LAN spooti Amen sakit /
ahan meni
Neri
Erosi Jml
Perda
bln bln Hamil s
e
kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1
AN
8486 0 6240 0 0 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 NGAGLIK 5307 0 3785 0 0 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 SUMBEREJO 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4
O
3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5
OMBO
8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DROP OUT EFEK SAMPING
DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
Ingin Medi Pinda spooti Amen / Neri Perda
Jumlah Jumlah paus Mati Cerai LAIN Jml LAN sakit ahan meni Erosi Jml
bln bln Hamil s h ng orhoe munt perut rahan
e kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
NGAGLIK
0 0 0 0 0 0 2 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SUMBEREJO
0 0 0 0 0 0 3 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
Ingin Medi Pinda LAN spooti Amen / Neri Perda
Jumlah Jumlah Hamil s
paus Mati Cerai
h
LAIN Jml sakit ahan meni Erosi Jml rahan
bln bln e ng orhoe munt perut
kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 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 NGAGLIK 5307 0 3785 0 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 SUMBEREJO 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ### 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA KEG Pusin
AGA Mual
Meno g/ Perub Tensi
Jumlah Jumlah paus Mati Cerai LAIN Jml LAN sakit ahan meni Erosi Jml rahan
bln bln Hamil s h ng orhoe munt perut
e kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
NGAGLIK
0 0 0 0 0 0 2 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SUMBEREJO
0 0 0 0 0 0 3 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
e kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 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 NGAGLIK 5307 0 3785 0 0 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 SUMBEREJO 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
Jumlah Jumlah paus Mati Cerai LAIN Jml sakit ahan meni Erosi Jml
bln bln Hamil s
e
kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 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 NGAGLIK 5307 0 3785 0 0 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 SUMBEREJO 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
e kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
NGAGLIK
0 0 0 0 0 0 2 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SUMBEREJO
0 0 0 0 0 0 3 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
Jumlah Jumlah paus Mati Cerai LAIN Jml sakit ahan meni Erosi Jml rahan
bln bln Hamil s
e
h ng orhoe munt perut
kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 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 NGAGLIK 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 SUMBEREJO
3 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
e kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 NGAGLIK
2 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 SUMBEREJO
3 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....

DIBINA
KEG Pusin
AGA Mual
Meno g/ Perub Tensi
e kepal BB ngkat
lalu ini ah
a
Koml % Koml %
PESANGGRAH
0 0 0 0 0 0 1 AN 8486 0 6240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
NGAGLIK
0 0 0 0 0 0 2 5307 0 3785 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SUMBEREJO
0 0 0 0 0 0 3 10487 0 7846 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SONGGOKERT
0 0 0 0 0 0 4 O 3259 0 2402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ORO ORO
0 0 0 0 0 0 5 OMBO 8012 0 5866 0 0 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 35551 0 26139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,...
............................. ........
NIP. ............................. NIP. ....
KOMPLIKASI Konv Konv
Infeksi Tensi Perub ersi ersi
Flour Perfor Transl Hemat Ekspul
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om menin ahan si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
KOMPLIKASI
Konv Konv
/Abse
albus asi okasi om
menin ahan
si
Jml in out
s gkat BB
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
Batu,............................
Pelapor
.............................
NIP. .............................
HITUNGAN CAPAIAN PKP ( PER TRIBU
PESERTA BARU PESERTA KB AKTIF EFEK SAMPING

URAIAN
KB
PUS CAPAIAN CAKUPAN PUS CAPAIAN CAKUPAN CAPAIAN
AKTIF
TB I 35274 0 0.00% 35274 26139 74.10% 26139 0
TB II 35274 0 0.00% 35274 26139 74.10% 26139 0
TB III 35274 0 0.00% 35274 26139 74.10% 26139 0
TB IV 35274 0 0.00% 35274 26139 74.10% 26139 0
2021 35274 0 0.00% 35274 26139 74.10% 26139 0
CAPAIAN PKP ( sesuai DO Dinkes Prop )
URAIAN PESERTA PESERTA PST KB

EFEK DROP
KOMPLIKASI PASCA 4T
BARU KB AKTIF SAMPING OUT
SALIN
TB I 0.00% 75% 100% 100% 100% 0.00% 0.00%
TB II 0.00% 75% 100% 100% 100% 0.00% 0.00%
TB III 0.00% 75% 100% 100% 100% 0.00% 0.00%
TB IV 0.00% 75% 100% 100% 100% 0.00% 0.00%
2021 0.00% 75% 100% 100% 100% 0.00% 0.00%
HITUNGAN CAPAIAN PKP ( KOMULA
PESERTA BARU PESERTA KB AKTIF EFEK SAMPING

URAIAN KB
PUS CAPAIAN CAKUPAN PUS CAPAIAN CAKUPAN CAPAIAN
AKTIF
TB I 35274 0 0.00% 35274 26139 74.10% 26139 0
TB II 35274 0 0.00% 35274 26139 74.10% 26139 0
TB III 35274 0 0.00% 35274 26139 74.10% 26139 0
TB IV 35274 0 0.00% 35274 26139 74.10% 26139 0
2021 35274 0 0.00% 35274 26139 74.10% 26139 0
CAPAIAN PKP ( sesuai DO Dinkes Prop )
URAIAN PESERTA PESERTA PST KB

EFEK DROP
KOMPLIKASI PASCA 4T
BARU KB AKTIF SAMPING OUT
SALIN
TB I 0.00% 75% 100% 100% 100% 0.00% 0.00%
TB II 0.00% 75% 100% 100% 100% 0.00% 0.00%
TB III 0.00% 75% 100% 100% 100% 0.00% 0.00%
TB IV 0.00% 75% 100% 100% 100% 0.00% 0.00%
2021 0.00% 75% 100% 100% 100% 0.00% 0.00%
GAN CAPAIAN PKP ( PER TRIBULAN)
EK SAMPING KOMPLIKASI DROP OUT PST KB PASCA SALIN

KB KB
CAKUPAN CAPAIAN CAKUPAN CAPAIAN CAKUPAN BULIN CAPAIAN CAKUPAN
AKTIF AKTIF
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
NGAN CAPAIAN PKP ( KOMULATIF)
EK SAMPING KOMPLIKASI DROP OUT PST KB PASCA SALIN

KB KB
CAKUPAN CAPAIAN CAKUPAN CAPAIAN CAKUPAN BULIN CAPAIAN CAKUPAN
AKTIF AKTIF
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
0.00% 26139 0 0.00% 26139 0 0.00% 3275 0 0.00%
4T
4T CAPAIAN CAKUPAN
28219 0 0.00%
28219 0 0.00%
28219 0 0.00%
28219 0 0.00%
28219 0 0.00%
PST KB PASCA SALIN
BULIN CAPAIAN CAKUPAN

28219 0 0.00%
28219 0 0.00%
28219 0 0.00%
28219 0 0.00%
28219 0 0.00%
PEMANTAUAN WILAYAH SETEMPAT
P W S - K B
PUSKESMAS BATU JANUARI - DESEMBER 2021

PESERTA BARU SEMUA METODE (KOMULATIF)
PUSK 1 2 3 4 5 6 7 8
PESANGGRAHAN 0 0 0 0 0 0 0 0
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
SONGGOKERTO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0
TOTAL PUSKESMAS 0 0 0 0 0 0 0 0

P W S - K B
PESERTA AKTIF SEMUA METODE (KOMULATIF)
`
PUSK 1 2 3 4 5 6 7 8
PESANGGRAHAN 74.1269 74.127 74.127 74.12687 74.12687 74.12687 74.12687 74.12687
NGAGLIK 71.8353 71.835 71.835 71.83526 71.83526 71.83526 71.83526 71.83526
SUMBEREJO 75.4061 75.406 75.406 75.40605 75.40605 75.40605 75.40605 75.40605
SONGGOKERTO 74.3193 74.319 74.319 74.31931 74.31931 74.31931 74.31931 74.31931
ORO ORO OMBO 73.7862 73.786 73.786 73.78616 73.78616 73.78616 73.78616 73.78616
TOTAL PUSKESMAS 74.1027 74.103 74.103 74.10274 74.10274 74.10274 74.10274 74.10274

P W S - K B
PESERTA AKTIF DIBINA SEMUA METODE (KOMULATIF)
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA EFEK SAMPING SEMUA METODE ( KOMULATIF )
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA KEGAGALAN SEMUA METODE (KOMULATIF)
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0
P W S - K B
PESERTA KOMPLIKASI SEMUA METODE (KOMULATIF)
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA DROP OUT SEMUA METODE (KOMULATIF)
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA KB PASCA SALIN SEMUA METODE (KOMULATIF)
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA KB 4T SEMUA METODE (KOMULATIF )
PUSK 1 2 3 4 5 6 7 8
PESANGGRAHAN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NGAGLIK 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SUMBEREJO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SONGGOKERTO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
ORO ORO OMBO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TOTAL PUSKESMAS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MPAT
KB BARU ( KOMULA
10.0
EMBER 2021
9.2
OMULATIF)
8.3
9 10 11 12 7.5
0 0 0 0
0 0 0 0 6.7
0 0 0 0
5.8
0 0 0 0
0 0 0 0 5.0
0 0 0 0
4.2
3.3
2.5
1.7
0.8
0.0
1 2 3 4 5 6 7
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO
MPAT
EMBER 2021 KB AKTIF ( KOMULATIF)

70.0
OMULATIF)
64.2
9 10 11 12 58.3
74.12687 74.12687 74.12687 74.12687 52.5
46.7
71.83526 71.83526 71.83526 71.83526
40.8
75.40605 75.40605 75.40605 75.40605
35.0
74.31931 74.31931 74.31931 74.31931
29.2
73.78616 73.78616 73.78616 73.78616
23.3
17.5
11.7
5.8
35.0
29.2
23.3
74.10274 74.10274 74.10274 74.10274 17.5
11.7
5.8
0.0
1 2 3 4 5 6 7
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO OR
MPAT AKTIF DIBINA ( KOMUL

70.0
EMBER 2021 64.2
E (KOMULATIF)
58.3
52.5
9 10 11 12
46.7
0 0 0 0
40.8
0 0 0 0
35.0
0 0 0 0 29.2
0 0 0 0 23.3
17.5
0 0 0 0
11.7
0 0 0 0
5.8
0.0
1 2 3 4 5 6 7
EFEK SAMPING (KOMULATIF)

MPAT
11.5
EMBER 2021 10.4
9.4
8.3
11.5
10.4
DE ( KOMULATIF ) 9.4
9 10 11 12 8.3
0 0 0 0 7.3
0 0 0 0 6.3
5.2
0 0 0 0
4.2
0 0 0 0
3.1
0 0 0 0
2.1
0 0 0 0
1.0
0.0
1 2 3 4 5 6 7 8 9 10
PESANGGRAHAN NGAGLIK SUMBEREJO
SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
KEGAGALAN (KOMULATIF)
0.2
0.2
0.2
MPAT
0.1
EMBER 2021 0.1
E (KOMULATIF) 0.1
0.1
9 10 11 12 0.1
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
1 2 3 4 5 6 7 8 9
SONGGOKERTO ORO ORO OMBO TOTAL PUSKESM
KOMPLIKASI ( KOMULATIF)
3.2
2.9
MPAT
2.6
EMBER 2021 2.3
E (KOMULATIF) 2.0
1.8
9 10 11 12
0 0 0 0 1.5
0 0 0 0
0 0 0 0 1.2
0 0 0 0
0.9
0 0 0 0
0 0 0 0 0.6
0.3
0.0
1 2 3 4 5 6 7 8
SONGGOKERTO ORO ORO OMBO TOTAL PUSK
MPAT DROP OUT (KOMULATIF)

10.0
EMBER 2021 9.2
(KOMULATIF) 8.3
7.5
9 10 11 12
0 0 0 0 6.7
0 0 0 0
5.8
5.0
4.2
7.5
6.7
5.8
0 0 0 0
0 0 0 0 5.0
0 0 0 0
4.2
0 0 0 0
3.3
2.5
1.7
0.8
0.0
1 2 3 4 5 6 7 8
SONGGOKERTO ORO ORO OMBO TOTAL PUSKE
MPAT
EMBER 2021
ODE (KOMULATIF) PASCA SALIN (KOMULATIF
60.0
55.0
9 10 11 12
0 0 0 0 50.0
0 0 0 0
45.0
0 0 0 0
0 0 0 0 40.0
0 0 0 0 35.0
0 0 0 0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
1 2 3 4 5 6 7 8
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO ORO
4T
MPAT 60
55
50
45
4T
60
55
EMBER 2021
50
OMULATIF )
45
9 10 11 12 40
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 35
0.00 0.00 0.00 0.00 30

0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 25
0.00 0.00 0.00 0.00 20
15
10
0
1 2 3 4 5 6 7 8
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO ORO OR
KB BARU ( KOMULATIF)
5 6 7 8 9 10 11 12
UMBEREJO SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
AKTIF ( KOMULATIF)
5 6 7 8 9 10 11 12
REJO SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
TIF DIBINA ( KOMULATIF)
5 6 7 8 9 10 11 12
MBEREJO SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
KOMULATIF)
7 8 9 10 11 12
SUMBEREJO
MBO TOTAL PUSKESMAS
AN (KOMULATIF)
6 7 8 9 10 11 12
AGLIK SUMBEREJO
O ORO OMBO TOTAL PUSKESMAS
KASI ( KOMULATIF)
6 7 8 9 10 11 12
NGAGLIK SUMBEREJO
ORO ORO OMBO TOTAL PUSKESMAS
OUT (KOMULATIF)
6 7 8 9 10 11 12
GAGLIK SUMBEREJO
RO ORO OMBO TOTAL PUSKESMAS
CA SALIN (KOMULATIF)
5 6 7 8 9 10 11 12
4T
4T
6 7 8 9 10 11 12
JO SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
P W S - K B

PESERTA BARU SEMUA METODE
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA AKTIF SEMUA METODE
`
PUSK 1 2 3 4 5 6 7 8
PESANGGRAHAN 74.1269 74.127 74.127 74.12687 74.12687 74.12687 74.12687 74.12687
NGAGLIK 71.8353 71.835 71.835 71.83526 71.83526 71.83526 71.83526 71.83526
SUMBEREJO 75.4061 75.406 75.406 75.40605 75.40605 75.40605 75.40605 75.40605
SONGGOKERTO 74.3193 74.319 74.319 74.31931 74.31931 74.31931 74.31931 74.31931
ORO ORO OMBO 73.7862 73.786 73.786 73.78616 73.78616 73.78616 73.78616 73.78616
TOTAL PUSKESMAS 74.1027 74.103 74.103 74.10274 74.10274 74.10274 74.10274 74.10274

P W S - K B
PESERTA AKTIF DIBINA SEMUA METODE
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA EFEK SAMPING SEMUA METODE ( KOMULATIF )
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA KEGAGALAN SEMUA METODE
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0
P W S - K B
PESERTA KOMPLIKASI SEMUA METODE
PUSK 1 2 3 4 5 6 7 8
PESANGGRAHAN 0 0 0 0 0 0 0.00 0.00
NGAGLIK 0 0 0 0 0 0 0.00 0.00
SUMBEREJO 0 0 0 0 0 0 0.00 0.00
SONGGOKERTO 0 0 0 0 0 0 0.00 0.00
ORO ORO OMBO 0 0 0 0 0 0 0.00 0.00
TOTAL PUSKESMAS 0 0 0 0 0 0 0.00 0.00

P W S - K B
PESERTA DROP OUT SEMUA METODE
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA KB PASCA SALIN SEMUA METODE
PUSK 1 2 3 4 5 6 7 8
NGAGLIK 0 0 0 0 0 0 0 0
SUMBEREJO 0 0 0 0 0 0 0 0
ORO ORO OMBO 0 0 0 0 0 0 0 0

P W S - K B
PESERTA KB 4T SEMUA METODE
PUSK 1 2 3 4 5 6 7 8
PESANGGRAHAN 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
NGAGLIK 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SUMBEREJO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
SONGGOKERTO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
ORO ORO OMBO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TOTAL PUSKESMAS 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
MPAT
KB BARU
EMBER 2021
ODE
9 10 11 12 2.5
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1.7
0 0 0 0
0 0 0 0
0.8
0.0
1 2 3 4 5 6 7
MPAT
EMBER 2021 KB AKTIF ( KOMULATIF)

70.0
ODE
64.2
9 10 11 12 58.3
74.12687 74.12687 74.12687 74.12687 52.5
46.7
71.83526 71.83526 71.83526 71.83526
40.8
75.40605 75.40605 75.40605 75.40605
35.0
74.31931 74.31931 74.31931 74.31931
29.2
73.78616 73.78616 73.78616 73.78616
23.3
17.5
11.7
35.0
29.2
23.3
74.10274 74.10274 74.10274 74.10274 17.5
11.7
5.8
0.0
1 2 3 4 5 6 7
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO OR
MPAT AKTIF DIBINA

11.7
EMBER 2021
METODE
9 10 11 12
0 0 0 0
0 0 0 0
5.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0.0
1 2 3 4 5 6 7
EFEK SAMPING
2.08
MPAT
EMBER 2021
2.08
DE ( KOMULATIF )
9 10 11 12
0 0 0 0
0 0 0 0 1.04
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0.00
1 2 3 4 5 6 7 8 9 10
SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
KEGAGALAN
MPAT
0.033
EMBER 2021
METODE
9 10 11 12 0.017
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0 0.000
1 2 3 4 5 6 7 8 9
SONGGOKERTO ORO ORO OMBO TOTAL PUSKESM
KOMPLIKASI
MPAT
EMBER 2021 0.6
METODE
9 10 11 12
0.00 0 0 0
0.00 0 0 0
0.00 0 0 0 0.3
0.00 0 0 0
0.00 0 0 0
0.00 0 0 0
0.0
1 2 3 4 5 6 7 8
SONGGOKERTO ORO ORO OMBO TOTAL PUSK
MPAT DROP OUT

2.5
EMBER 2021
ETODE
9 10 11 12
0 0 0 0 1.7
0 0 0 0
1.7
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0.8
0.0
1 2 3 4 5 6 7 8
SONGGOKERTO ORO ORO OMBO TOTAL PUSKE
MPAT
EMBER 2021
A METODE PASCA SALIN
15.0
9 10 11 12
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0 10.0
0 0 0 0
0 0 0 0
5.0
0.0
1 2 3 4 5 6 7 8
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO ORO
4T
MPAT 10
4T
10
EMBER 2021
ODE
9 10 11 12
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 5
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0
1 2 3 4 5 6 7 8
PESANGGRAHAN NGAGLIK SUMBEREJO SONGGOKERTO ORO OR
KB BARU
5 6 7 8 9 10 11 12
SUMBEREJO SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
AKTIF ( KOMULATIF)
5 6 7 8 9 10 11 12
AKTIF DIBINA
5 6 7 8 9 10 11 12
MBEREJO SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
MPING
7 8 9 10 11 12
SUMBEREJO
MBO TOTAL PUSKESMAS
GAGALAN
6 7 8 9 10 11 12
AGLIK SUMBEREJO
O ORO OMBO TOTAL PUSKESMAS
KOMPLIKASI
6 7 8 9 10 11 12
NGAGLIK SUMBEREJO
ORO ORO OMBO TOTAL PUSKESMAS
DROP OUT
6 7 8 9 10 11 12
GAGLIK SUMBEREJO
RO ORO OMBO TOTAL PUSKESMAS
PASCA SALIN
5 6 7 8 9 10 11 12
4T
4T
6 7 8 9 10 11 12
JO SONGGOKERTO ORO ORO OMBO TOTAL PUSKESMAS
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
lalu ini lalu ini Kom lalu ini Ko lalu ini
l ml
1 Batu 8418 781 0 0 0 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui Batu,9 Februari 2021

Kepala Bidang Kesmas Kepala Seksi KGM
Hayati, SST, MM Emi Kusrilowati, STr.Keb

NIP. 19650528 198502 2 001 NIP. 19710324 199102 2 001
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 0 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


NIP. 19650528 198502 2 001 NIP. 19710324 199102 2 001
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


NIP. 19650528 198502 2 001 NIP. 19710324 199102 2 001
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JUML SASA
PUS BULIN lalu ini
bln lalu bln ini
lalu
bln ini
Kom Ko
l ml
1 Batu 8418 781 0 0 0 0 6240 6240 6240 74.13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Beji 5269 488 0 0 0 0 3785 3785 3785 71.84 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Bumiaji 10405 966 0 0 0 0 7846 7846 7846 75.41 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Junrejo 3232 301 0 0 0 0 2402 2402 2402 74.32 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Sisir 7950 739 0 0 0 0 5866 5866 5866 73.79 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 35274 3275 0 0 0 0 26139 26139 26139 74.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DROP OUT PST KB PASCA SALIN
Jumlah Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0
0 0 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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0
0 0 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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0
0 0 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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0
0 0 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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0
0 0 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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0 0
0 0 0 0 0 0
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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0 0
0 0 0 0 0 0
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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0 0
0 0 0 0 0 0
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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0 0
0 0 0 0 0 0
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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0 0
0 0 0 0 0 0
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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0 0
0 0 0 0 0 0
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 Jumlah
bln bln
lalu ini
Koml % Koml %
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

Plan Form Lap Kespro Puskesmas 2021

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Plan Form Lap Kespro Puskesmas 2021

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PESANGGRAHAN

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 1

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 5

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 6

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 7

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 8

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 9

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 10

Kepala Bidang Kesmas Pelapor

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 11

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 12

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................

NIP. ............................. NIP. .............................

1. Hasil Kegiatan Pelayanan KB ( Peserta KB Baru) 5

Kepala Bidang Kesmas Pelapor

Hayati, SST, MM .............................