SDN I Kutorejo

NAMA SEKOLAH KEGIATAN SCREENING : PUSKESMAS BAGOR
TANGGAL PEMERIKSAAN KELAS : I (SATU)
KELAMIN TGL LAHIR NAMA ORTU HASIL RUJUK KUKU =SEHAT 1

NO NAMA ALAMAT BB TB KET
L P TGL BULAN TAHUN BAPAK IBU MATA BT WRN GIGI TELINGA KULIT KUKU RAMBUT YA TIDAK KULIT
1 AISHA AQILA HUMAIRA 1 Ds. Kutorejo 24 04 2014 SUNOTO LAMINEM RAMBUT =SEHAT 1
2 ARDILA CITRA CALISTA 1 Ds. Kutorejo 04 07 2014 PURWANTO NUR AZLIN MATA =SEHAT 0
3 CHYNTIA YUNIA PUTRI HERLIANA 1 Ds. Sugihwaras 12 06 2014 HERWANTO EKA NARLIANA BT WAENA =SEHAT 0
4 DIMAS RANGGA YUDHISTIRA 1 Ds. Kutorejo 22 02 2014 YATIM SUDARTI KARIES 1
5 FEBBY KHOIROTUL AZIZAH 1 Ds. Sugihwaras 18 02 2014 PURNOMO SANTI ANA VERAWATI TELINGA = SERUMEN 2
6 KENZIE JIRHAM MAULANA 1 Ds. Gemenggeng 06 05 2014 JOKO PRASETIO TUTIK SUSANTI
7 MAR'ATUS SHOFIA 1 Ds. Kutorejo 18 10 2014 MAT DELI HOLIYEH
8 MOH. HELMYYAQDAN 1 Ds. Kutorejo 07 02 2015 EDI SUSANTO PUTRIANA SUSIANTI
9 NABILA OKTA ADELLIA 1 Ds. Kutorejo 04 10 2014 AGUS HIDAYAT NANIN SUGIHARTI
10 NUR LINTANG KHALIFAH 1 Ds. Kutorejo 22 09 2014 MOHAMMAD SYA'RONI TITIN SUMARNI
11 SANDI SAMAHITA 1 Ds. Sugihwaras 29 04 2014 ANDI ARIFIN NURUL HIDAYATI
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JENIS KELAMIN DI ISI : 1

NAMA SEKOLAH : KEGIATAN SCREENING :
TANGGAL PEMERIKSAAN : KELAS :
KELAMIN TGL LAHIR NAMA ORTU HASIL RUJUK

NO NAMA BB TB
L P TANGGAL
BULAN TAHUN BAPAK IBU MATA BT WRN GIGI TELINGA KULIT YA TIDAK
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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16
17
18
19
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22
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KUKU =SEHAT 1
0
RAMBUT =SEHAT 1
MATA =SEHAT 0
BT WAENA =SEHAT 0
TELINGA = SERUMEN 2 SEHAT 0 INFEKSI 1

NAMA SEKOLAH : SD NEGERI SELOREJO
TANGGAL PEMERIKSAAN : 10 MARET 2020
KELAMIN TGL LAHIR

NO NAMA ALAMAT
L P TGL BULAN TAHUN
1
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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27
28
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32
NAMA SEKOLAH :
TANGGAL PEMERIKSAAN :
KELAMIN TGL LAHIR

NO NAMA
L P TANGGAL
BULAN TAHUN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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26
KEGIATAN SCREENING : PUSKESMAS BAGOR
KELAS : II (DUA)
NAMA ORTU HASIL

BB TB
BAPAK IBU MATA BT WRN GIGI TELINGA KUKU KULIT RAMBUT
KEGIATAN SCREENING :
KELAS :
NAMA ORTU HASIL

BB TB
BAPAK IBU MATA BT WRN GIGI TELINGA KULIT
RUJUK
KET
YA TIDAK KUKU =SEHAT 1
KULIT
RAMBUT =SEHAT 1
MATA =SEHAT 0
BT WAENA =SEHAT 0
KARIES 1
TELINGA = SERUMEN 2
RUJUK
YA TIDAK
PENENTUAN STATUS GIZI ANAK USIA 0 - 60 BULAN DAN 5 - 18 TAHUN
BERDASARKAN NILAI Z_SCORE BAKU RUJUKAN WHO 2005
Sex Tg.Timbang Tgl.Lahir Umur BB TB IMT 5 - 18 TH

NO NAMA
L=1,P=2 Tg Bln Thn Tg Bln Thn ( Bln ) ( Kg ) ( Cm ) Nilai Status
#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
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#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
1 2 3 4 1 2 3 4
BB / U TB / U
KETERANGAN :
1. USIA 0 - 60 BULAN BISA MENGGUNAKAN BB/U, TB/U DAN IMT/U KHUSUS 0 - 60 BULAN
2. USIA 61 BULAN (5 TAHUN 1 BULAN) S/D 228 BULAN (19 TAHUN 0 BULAN) HANYA BISA MENGGUNAKAN IMT/U UNTUK 5 - 18 TAHUN
PENENTUAN STATUS GIZI ANAK USIA 0 - 60 BULAN DAN 5 - 18 TAHUN
BERDASARKAN NILAI Z_SCORE BAKU RUJUKAN WHO 2005
Sex Tg.Timbang Tgl.Lahir Umur BB TB IMT 5 - 18 TH

NO NAMA
L=1,P=2 Tg Bln Thn Tg Bln Thn ( Bln ) ( Kg ) ( Cm ) Nilai Status
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1 2 3 4 1 2 3 4
BB / U TB / U
KETERANGAN :
1. USIA 0 - 60 BULAN BISA MENGGUNAKAN BB/U, TB/U DAN IMT/U KHUSUS 0 - 60 BULAN
2. USIA 61 BULAN (5 TAHUN 1 BULAN) S/D 228 BULAN (19 TAHUN 0 BULAN) HANYA BISA MENGGUNAKAN IMT/U UNTUK 5 - 18 TAHUN

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NAMA SEKOLAH KEGIATAN SCREENING : PUSKESMAS BAGOR

TANGGAL PEMERIKSAAN KELAS : I (SATU)

KELAMIN TGL LAHIR NAMA ORTU HASIL RUJUK KUKU =SEHAT 1

JENIS KELAMIN DI ISI : 1

KELAMIN TGL LAHIR NAMA ORTU HASIL RUJUK

TELINGA = SERUMEN 2 SEHAT 0 INFEKSI 1

KELAMIN TGL LAHIR

KELAMIN TGL LAHIR

NAMA ORTU HASIL

NAMA ORTU HASIL

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