REGISTER KOHORT KB

Tanggal/Bulan/Tahun : Januari 2022

Pustu : Tepian
Jumla
h 4T ALKI
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin Pasca BB TD Ket No. HP
L P TT TM TR TB Anemia LILA Sakit Salin
1 Nurmila Andini 25 Dedi RT.001 1 Pil
2 Nuranira 37 Jumain RT.001 1 1 Pil
3 Ustaniah 36 Samrun RT.001 3 1 Tdk KB
4 Jainun 42 Arbain RT.001 2 2 Suntik
5 Rafiah 41 Umar RT. 001 2 1 Tdk kb
6 Diana 27 Sadri RT.001 2 1 Pil
7 Devi 36 Suhada RT.001 2 1 Pil
8 Armaniah 45 Sadli RT.001 2 1 Tdk KB
9 Dewi 29 Agus RT.001 2 Suntik
10 Jubaidah 34 Rahmat RT.001 2 2 Suntik
11 Maria.F 36 Syahrudin RT.001 1 1 Pil
12 Salsiah 31 Safari RT.001 2 pil
13 Nurhan 43 Ilham RT.001 4 suntik
14 Linda 41 Rais RT.001 6 1 MOW
15 Fatmawati 26 Robin RT.001 1 2 Suntik
16 Masniah 44 Masyudi RT.001 1 2 Tdk KB
17 Kurnia 43 Latif RT.001 1 2 pil
18 Wati 34 Jefri RT.001 3 Pil
19 Bariama 40 Hamid RT.001 2 1 Tdk KB
20 Murni 39 Johan RT.001 1 3 Suntik
21 Lidia 37 Johan RT.001 3 Suntik
 Jumla
h 4T ALKI
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin Pasca BB TD No. HP
L P TT TM TR TB Anemia LILA Sakit Salin
22 Erna 27 Sabran RT.001 3 PP
23 Nurlela 23 Acox RT.001 1 1 Suntik
24 Fitriana 20 Jupriadi RT.001 1 Suntik
25 Sunarti 20 M. Yasir RT.001 Tdk KB
26 Intan 25 Fredi RT.001 1 Pil
27 Irmayanti 23 Suhardi RT.001 1 IAS
28 Melati 40 Ramli RT.001 4 Tdk KB
29 Sariyah 25 Raden RT.001 Tdk KB
30 Sriwahyuni 34 Hamo RT.001 1 8 Suntik
31 Mirnawati 26 M.Zein RT.001 1 1 Tdk KB
32 Erni 30 M.Yamin RT.001 3 PP
33 Rubiah 25 Roni RT.001 1 1 Tdk KB
34 Siti Khatijah 25 Subari RT.001 1 Tdk KB
35 Megawati 47 H.Bekar RT.001 1 Tdk KB
36 Sulastri 29 Amril RT.001 2 Suntik
37 Fatmawati 28 Jakaria RT.001 Tdk KB
38 Juliah 26 M.Isju RT.001 2 Pil
39 Mardiana 20 Ibrahim RT.01 Tdk KB
40 Rosna 41 Sukran RT.001 5 Pil
41 Ani 46 Tahir RT.001 2 Tdk KB
42 Bahnur 43 JaparR RT.001 1 2 Tdk KB
43 Fatimah 36 Lukman RT.001 1 1 Suntik
44 Mega 35 Hamzah RT.001 2 3 Tdk KB
45 Rosa 43 Amran RT.001 1 3 Suntik
46 Sadariah 30 Bahrun RT.001 1 2 Tdk KB
47 Nurani 41 Slamet RT.001 1 2 Pil
 Jumla
h 4T ALKI
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin Pasca BB TD No. HP
L P TT TM TR TB Anemia LILA Sakit Salin
48 Marian 35 Sumarno RT.002 3 Pil
49 Tapiah 39 kasmadi RT.002 3 1 Suntik
50 Salmiah 30 Suryansyah RT. 002 1 1 Tdk KB
51 Juliati 40 Abdul rahman RT.002 2 Suntik
52 Rosnani 36 Abdul manaf RT.002 1 2 Pil
53 Mardiana 36 Arnold RT.002 1 3 Suntik
54 Hamdana 46 Nurdin RT.002 4 1 Tdk KB
55 Masjah 41 Jumaan RT.002 2 1 Tdk KB
56 Aidah 45 mustafa RT.002 1 2 Tdk KB
57 Fatimah 30 Ardi RT.002 1 1 Tdk KB
58 Rahimah 29 Sunaryo RT.002 1 Tdk KB
59 Herlina 36 Haryamurdi RT.002 1 1 Pil
60 Tutik Indiyah 41 Hadi Joko F RT.002 2 Tdk KB
61 Yuliani 46 Paidil RT.002 1 1 Pil
62 Irawati 41 Udin RT.002 2 Pil
63 Ernawati 41 Rustam RT.002 2 3 MOW
64 Kadariah 38 Lamri RT.002 1 2 Suntik
65 Fitriani 27 Hamid RT.002 2 1 Tdk KB
66 Bahriah 41 Hamdhani RT.002 2 1 Suntik
67 Yusni Yusuf Syamsudin RT.003 1 Tdk KB
68 Dayang 26 Kasmin RT 003 2 Suntik
69 Kurnia 31 Sabran RT 003 1 Suntik
70 Fatmawati 36 Kardiansah RT 003 1 1 Tdk KB
71 Hildania 28 Iwan RT 003 Tdk KB
72 Tari 24 mondi RT 003 Tdk KB
 Jumla
h 4T ALKI
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin Pasca BB TD No. HP
L P TT TM TR TB Anemia LILA Sakit Salin
73 Nilam 23 darmansyah RT 003 Suntik
74 Suryana 32 Pendi RT 003 1 1 Tdk KB
75 Umi Habibah 40 Junaidi RT 003 1 Tdk KB
76 Siti Nurfatimah 21 Untung RT 003 1 1 Tdk KB
77 Armawati 44 Musliadi RT 003 4 Tdk KB
78 Yunida 26 Karim RT 003 2 Tdk KB
79 Melani 45 Santrum RT 003 1 1 Tdk KB
80 Nurhayati 46 Johan RT 003 2 Tdk KB
81 Faridah 24 kamil RT 003 1 Suntik
82 Melati 38 Juliansyah RT 003 2 Tdk KB
83 Arabiah 22 sani RT 003 1 Pil
84 sabariah 44 Japar RT 003 2 3 Implan
85 Saimah 28 Rusdi RT 003 1 IUD
86 siti Aisyah 38 Umar RT 003 1 1 Suntik
87 Hapsah 44 Bastiar RT 003 2 3 MOW
88 Sofiati 39 abdul gani RT 003 1 Tdk KB
89 Marlina 40 sarifudin RT 003 2 3 Suntik
90 sabariah 48 Muksin RT 003 4 Suntik
91 Sahdia 25 Rojali RT 003 1 Tdk KB
92 Nurul 25 Kahar RT 003 1 1 Suntik
93 Riskita 22 Supardi RT 003 2 Suntik
94 Billah 21 Erwin RT 003 Tdk KB
95 Rismayanti 25 Aiwan RT 003 2 Suntik
96 Ainur 40 Rusli RT 003 3 1 Suntik
97 Rubiah 32 Sabri RT 003 2 Tdk KB
 Jumla
h 4T ALKI
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin Pasca BB TD No. HP
L P TT TM TR TB Anemia LILA Sakit Salin
98 Sahada 41 Sahdan RT 003 1 2 Pil
99 Rusmawati 21 Sahdan RT 003 Tdk KB
100 Rosita 35 Sulaiman RT 003 1 2 Tdk KB
101 Tinah 41 Ramli RT 003 2 1 Suntik
102 Nuraini 36 M. Iqbal RT 003 2 Suntik
103 Murni 28 Junaid RT 003 2 1 Suntik
104 Aida 39 Junaidi RT 003 1 2 Suntik
105 Juliana 23 NurAlam RT 003 1 Tdk KB
106 Karlia 35 Badrun RT 003 1 Suntik
107 Kartini 25 Asrul RT 003 1 1 PP
108 Desi 24 Saparudin RT 003 1 1 Tdk KB
109 Fatmawati 28 Hadi RT 003 1 1 Tdk KB
110 Habiba 47 Amirudin RT 003 3 Tdk KB
111 Nursaipah 21 Abu RT 003 1 Tdk KB
112 Anita 32 Kacil RT 003 Tdk KB
113 Imelda 24 Ian RT 003 2 Suntik
114 Maisarah 47 Sunarto RT 003 1 1 Suntik
115 Sriwahyuni 23 Japriansyah RT 003 1 Suntik
116 Ika 26 Ahmad Dani RT 003 1 Tdk KB
117 Marlina 31 Ayub RT 003 1 Suntik
118 Nurdiah 26 Ariansyah RT 003 2 Suntik
119 Masturi 42 Nurdiansah RT 003 2 Tdk KB
120 Lita 32 Kamsah RT 003 1 1 Tdk KB
121 Amra 35 Johan RT 003 1 Suntik
122 Masni 41 Basri RT 003 1 2 Suntik
 Jumla
h 4T ALKI
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin Pasca BB TD No. HP
L P TT TM TR TB Anemia LILA Sakit Salin
123 Lailatul Qoiriah 30 M.Saini RT 003 1 Tdk KB
124 Soha 42 Sahdan RT.004 1 1 Tdk KB
125 Ratnawati 30 Jamil RT.004 1 2 Pil
126 Olivia 37 Marjuni RT.004 3 2 MOW
127 Lastrini 26 ahmad RT.004 1 suntik
128 Rena 29 Munir RT.004 2 1 suntik
129 Rusmiah 40 Ramli RT.004 2 2 suntik
130 Lina. S 37 Abdulah RT.004 1 2 Pil
131 Maimunah 30 Marjain RT.004 2 1 Pil
132 Saleha 35 Hamseh RT.004 3 Suntik
133 Berlian 41 Jumaan RT.004 1 Tdk KB
134 Baiduri 40 Jamhari RT.004 2 1 suntik
135 Irawati 33 Suhardi RT.004 4 suntik
136 Musdalipah 38 Selaker RT.004 2 2 suntik
137 Erma. Y 30 Umar RT.004 2 1 suntik
138 Saktiani 41 Jainal RT.004 1 2 MOW
139 Sahuda 36 Jainudin RT.004 4 Pil
140 Endang 34 Hamid RT.004 1 2 Tdk KB
141 Rika 29 Malik RT.004 3 suntik
142 Maryani 35 M.Aras RT.004 2 1 Pil
143 Jamilah 30 Nasir RT.004 3 suntik
144 Nurisah 37 Armansah RT.004 2 2 Pil
145 Nikmasari 25 Sabransah RT.004 1 1 Tdk KB
146 Faridah 36 Umar RT.004 1 2 Tdk KB
147 Suryaningsih 28 Japar RT.004 1 1 Tdk KB
 Jumla
h 4T ALKI
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin Pasca BB TD No. HP
L P TT TM TR TB Anemia LILA Sakit Salin
148 Apriani 31 Idris RT.004 1 1 suntik
149 Arbiah 41 Hasan RT.004 1 1 suntik
150 Salmiati 41 Basri RT.004 1 suntik
151 Sabtu riah 21 Saparudin RT.004 1 Tdk KB
152 Darmatasyah 29 Rusdar RT.004 2 Tdk KB
153 Kartini 45 Ridwansyah RT.004 2 2 Tdk KB
154 Karmila 23 Saparudin RT.004 1 1 suntik
155 Siti Maryam 42 Arbain RT.004 2 suntik
156 Nabila 20 Saleh RT.004 1 Tdk KB
157 Nurasiah 41 Bintoro RT.004 2 1 Tdk KB
158 Salmiah 46 Asnawi RT.004 Pil
159 Endang. S 34 Jaifudin RT.004 Tdk KB
160 Nurmawati 40 Hendracipta RT.004 3 Pil
161 Asnani 36 Alias RT.004 1 Tdk KB
162 Hasrina 22 Muhsin RT.004 1 Tdk KB
163 Rafiah 20 Madi RT.004 Tdk KB
164 Fitri 28 Faizal RT.004 2 suntik
165 Naning 32 Baco RT.OO3 Tdk KB
166 Sarah 35 Masran RT.001 Tdk KB
167 Kalsum 27 Ariansyah RT.001 1 Pil
168

A : Tanggal Kunjungan
B : Diisi dengan kode :
 B : Peserta Baru (hanya satu kali dihitung)
L : Peserta Lama (hanya satu kali dihitung, bulan berikutnya tidak dihitung lagi)
GC : Ganti Cara
DO : Drop Out
G : Gagal
K : Komplikasi
ES : Efek Samping
C: Diisi dengan metode kontrasepsi : Pil (P), Suntik (S), IUD, Implant (I), MOW, MOP
HORT KB

Bulan
No. NIK Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
6405035407970001
6405035907840000
6405037105840001 31 L P
6405036010730002 20 L P
6405036301810001
6405034603890001
6473045811860001
6404134306770001
6405025602950001 11 L P
6405035109830002
6405035812820001
6405035205900002
6405036103780001
6405036808830001
6405035402890001 8L S
6405035305760001
6405035704750001 4L P
6405035005880002
6405034106810002
6405034708840002
6405034205840001
 Bulan
No. NIK Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
6405037112880001 20 BPP P
6473024911950009

640503410100001
6405034611020001
740110670696001 14 L S
6405031409990001
6405034901830001
6405025701920001
6473014404487001
6405035708940000
6405034311900002
6405035408960001
6571025703960001
7401104707750005
6571012603910001
7308164107940003

6405034812900002
6405034906020001
6405035010780001
6410014904740001
6405034104760002
6405034407820002 7 GC S
6405034305800001
6405034206760002
6405034703870001
6405035507810001
 Bulan
No. NIK Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
6405036501840001 18 L P
6405035103780001
6405036804920001
6405034301750001 10 L S
6405036109800001 11 L P
6405034301830001
6405035203760001
6405034903820001
6405034210730001
6405036106910001
6405036903920001
6405035208850001
6405034507810001
6405034207750002 15 L P 5L P
640503550281**** 17 L P
6473045606770002
6410024703810002
6405084107900032
6405036402810001 20 GC P
7204085204940001
6405036604930003 3L S
6405034701800001
6405036712840001
1271215908900003
6405034610990001
 Bulan
No. NIK Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
6473024210960006

6405035001880001
6405036111830001
6405035010970001

6405035202780001

6405034103750002
6405034204750003
6405034303960002
6405036207820001
6405025312000001 19 L P
6405024612780001

6405035010840002
6405034710750001
6473021505830017
6405034304820001
6405035005680003
6405034207940001
6405045110930001 9L S
6405035306980001 10 L S
6405035506030001

6405034506980001
6405036511810001
6405036004880002
 Bulan
No. NIK Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
6405034205760002
6405034102000000
6405036512840001
6405036307800001
6405035805860000 11 L S
6405036507930001
6405035606780001 3L S

6503036503860001 3L S
6405085303950001
64733024212960007
6405034809930002
6405035712720002
6405034102990001
6405014501900000
6405035002950002
6405035510720001
6405036508980001 12 L S
5202074605000002

6405025203960002

6405036712750001
6105065708890008

7204090107******
6405035207820001 21 L S
 Bulan
No. NIK Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
6405036805920001
6405035507800003
6405035605890001
6405034803850001
6405036504940001
6405034107920008 1L S
6405037010820002 25 L S
6405035007900002 5L P
6405034211880001
6405034101860004 12 L S
6405034110810003 12 L S
6405034107800004
6405034808880001
6405035904830001
6405035402910001 12 L S
6405034110810004
6405035006850001 6L P
6405035106850001
6405034606920001
6405034106860001 22 L P
6405034304870003
6405035509850001
6405034112960001
6405035205840001
6405036104920001
 Bulan
No. NIK Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
6405035505960001
6405036501800002
6405034400580002
6405034112010002
6405035108930002
6405035201760001
6405035209990001
6473015312790003 7L S
6405035112020001
6405035704760001
6405036005750001
6405035805488002
6405034110820001
6405015003860005

6410034211940001
7204084707870006

6405036312930001 13 L P

Kriteria KB Baru : 1. Pertama Ber-KB

2. KB Pasca Salin
3. KB Pasca Abortus
 4. KB Pasca DO (dikatakan DO jika tidak datang sampai 3 kali)

IAS: : Ingin Anak Segera

 REGISTER KOHORT KB

Tanggal/Bulan/Tahun :
Pustu :
Jumla
h 4T ALKI Pasc
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin a BB TD No. HP No. NIK
L P TT TM TR TB Anemia LILA Sakit Salin
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
 Jumla
h 4T ALKI Pasc
No. No. Reg. Nama Ibu Umur Nama Ayah Alamat Anak Gakin a BB TD No. HP No. NIK
L P TT TM TR TB Anemia LILA Sakit Salin
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
 Bulan
Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C
 Bulan
Jan Feb Mar Apr Mei Jun Jul Agst Sep Okt Nov Des
A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C A B C