LAPORAN AKHIR PENDAMPINGAN POSKESTREN

PONPES MINAUS SHOLIKIN

IDENTITAS KADER PENDAMPING

Nama :
Nomor HP :
Alamat :

I. KONDISI SEBELUM PENDAMPINGAN

1. Tingkat Kemandirian Poskestren : …………………... dengan jumlah nilai .............
2. Masalah Utama Kesehatan Perorangan :
a. …………………………………………...
b. …………………………………………...
c. …………………………………………...
3. Masalah Utama Fisik/Lingkungan Pondok Pesantren :
a. …………………………………………………………..
b. …………………………………………………………..
c. …………………………………………………………..
4. Klasifikasi PHBS Ponpes : ……………………………… dengan jumlah nilai ……..
5. Rencana Intervensi Berdasarkan Hasil Musyawarah Masyarakat Pondok
Pesantren
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………

II. HASIL SETELAH PENDAMPINGAN

1. Tingkat Kemandirian Poskestren : …………………... dengan jumlah nilai .............
2. Masalah Utama Kesehatan Perorangan :
a. …………………………………………...
b. …………………………………………...
c. …………………………………………...
3. Masalah Utama Fisik/Lingkungan Pondok Pesantren :
a. …………………………………………………………..
b. …………………………………………………………..
c. …………………………………………………………..
4. Klasifikasi PHBS Ponpes : ……………………………… dengan jumlah nilai ……..

III. PERMASALAHAN YANG DIHADAPI

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IV. KENDALA YANG DIHADAPI
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