LAPORAN PEMERIKSAAN

PERTUMBUHAN DAN PERKEMBANGAN ANAK

DENGAN KPSP & DENVER II

A. Identitas Pasien :
Nama Pasien : An.
Jenis kelamin :
Nama Ibu :
Tanggal lahir pasien :
Tanggal pemeriksaan :
Riwayat kelahiran dan perhitungan usia bayi :

Berikut adalah hasil perhitungan usia An. saat dilakukan pemeriksaan :

Tanggal pemeriksaan :
Tanggal lahir :

Maka, usia An. saat diperiksa adalah tahun bulan atau sama dengan bulan.

B. Perlengkapan yang digunakan :

1. Pensil
2. Format Denver II
3. Kertas
4. Penggaris
5. Kubus 7 buah
6. Gambar-gambar hewan dan manusia
7. Bola

C. Data Hasil Pertumbuhan Pasien

a) Hasil pengkajian antropometri An. :
 Berat badan : kg
 Tinggi badan : cm
 Lingkar kepala : cm
 Lingkar lengan atas : cm
 Status gizi :
b) Interpretasi hasil pengkajian antropometri An. :
 Pemeriksaan berat badan berdasarkan usia
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................

 Pemeriksaan panjang badan berdasarkan usia

..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
 Pemeriksaan berat badan berdasarkan panjang badan
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

 Pemeriksaan IMT berdasarkan usia

..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................

 Pemeriksaan lingkar lengan atas berdasarkan usia

........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................

 Pemeriksaan lingkar kepala berdasarkan usia

........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
D. Laporan Perkembangan An. dengan KPSP (Kuesioner Pra-Skrining
Perkembangan)
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................

E. Laporan Perkembangan An. dengan Denver II

 Perkembangan Personal Sosial
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
Kesimpulan :
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
 Perkembangan Adaptif-Motorik Halus
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
Kesimpulan :
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
 Perkembangan Bahasa
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
 Kesimpulan :
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
 Perkembangan Motorik Kasar
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
Kesimpulan :
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
 Kesimpulan Pemeriksaan Denver II :
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................

F. Intervensi kepada Ibu

Berdasarkan hasil pengkajian yang diperoleh pada KPSP maupun Denver II
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................