REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN TTV

NO NO RM NAMA UMUR ALAMAT NO JAM NO. BPJS /NO. BB

TB
LAHIR/ JAM HP IBU
DATANG PULANG U PBI N PER TD
DIRUJUK DA
PBI SAL

1 07/01/2023 07/01/2023 Maria Ulfa 23 th Pringgondani 2/4 120

PEMANTAUAN
18.00 20.00 Afri Yudiantio 22 th 76
2 07/01/2023 08/01/2023 09/01/2023 06.005.I.A1 Darmi 24 th Legoksayem 127
23.30 16.30 09.00 Khadirin 37 th 91
3 09/01/2023 10/01/2023 10/01/2023 04.099.V.A Nurlatifah 23 th Pecantelan 127
21.30 00.35 17.00 Harno 91
4 11/01/2023 11/01/2023 12/01/2023 05.086.IV.A Efa Ramawati 17 th Wotgalar 2/5 136
18.30 23.13 11.00 Eli Syaifulloh 23 th 96
5 14/01/2023 14/01/2023 14/01/2023 05.300.I.A Nurbiati Ngaro 32 th Jatilawang V 115
04.30 05.45 18.00 Kartono A 72
6 13/01/2023 13/01/2023 Turniah 24 th Mutisari V 121
22.00 23.30 Turah S 72
7 17/01/2023 17/01/2023 Uning Rohayati 32 th Pagondangan 2/1 V 110
14.30 15.55 Junanto 76
8 20/01/2023 23/01/2023 23/01/2023 08.012.III.A Slamet Yuniar 40 th Pesayangan 3/4 V 123
17.45 08.30 18.00 Arifiyanto 39 th 81
9 23/01/2023 23/01/2023 25/01/2023 04.043.III.A Khaltiati 23 th Kebodudu 2/3 V 127
14.45 16.45 16.00 Khusnul haji 25 th 79
10 24/01/2023 25/01/2023 25/01/2023 05.071.VI.A Nur Hotimah 28 th Jatilawang V 128
15.50 01.45 15.00 Basri 76
11 25/01/2023 26/01/2023 26/01/2023 08.013.I.A1 Mila H 20 th Penanggungan 1/1 V 121
17.50 04.40 17.00 Taufik 81
12 29/01/2023 29/01/2023 06.122.I.A2 Defi Irayu T 23 th Legoksayem 111
17.30 20.15 Aji P 25 th
PEMANTAUAN 68
13 29/01/2023 30/01/2023 09.012.A Septia 26 th Majatengah 3/11 112
22.00 12.00 Medi 34 th
PEMANTAUAN 82
14 29/01/2023 30/01/2023 Tantri 27 th Dawuhan 2/2 137
23.30 00.35 Samin 30 th 80

Total Kunj : 14
Rujuk :3
Bersalin :8
Pemantauan :3
 TTV

G/P/A
JK BB TEMPAT RUJUK ALASAN RUJUK KET
N S R DAN UK

82 36.3 20 Astri
29 Anifa
87 36.1 19 2/1/0 LK 2900 Astri
40-41 49
84 36.2 18 1/0/0 PR 2700 Nurh
36 - 37 47
89 36.5 18 1/0/0 LK 3000 Ani R
39-40 50
80 36.2 20 3/2/0 LK 3500 Astri
38 - 39 48 Harti
71 36.4 19 2/1/0 RSUD Halasko Inpartu dengan gemelly Astri
33-34 Harti
84 36.5 19 2/1/0 RSUD Halasko Inpartu dg PLR dan susp Ani R
40 Microchepal Ririn
79 36.2 19 3/2/0 PR 2700 Astri
39 - 40 47 Romi
80 36.4 19 2/1/0 PR 2940 Ani R
39-40 47 Ani F
82 36.2 19 2/1/0 PR 3200 Ria
41-42 49
78 36.2 19 1/0/0 LK 2900 Astri
38-39 48
77 36.2 20 1/0/0 Ani R
20-21 Ririn
81 36.4 18 3/2/0 Ani R
40-41 Ririn
78 36.4 19 2/1/0 PKU Bara Presbo, KPD BDP Ani R
40-41 Ririn
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN

UMU NO JAM JAM NO. BPJS /NO. HP BB

NO LAHIR/ NO RM NAMA ALAMAT
DATANG PULANG R U PBI N PERS IBU
DIRUJUK DA
PBI AL

1 2/1/2022 2/1/2022 2/1/2022 Nurhayati 31 th Karangmalan

g
02.30 02.40 15.00 Tofik 32 th
Pagondanga
2 2/1/2022 2/1/2022 Rusmiyati 33 th n 1/1
PEMANTAUAN
16.45 20.30
3 2/1/2022 2/1/2022 Elis P 20 th Legoksayem
1/1
19.45 06.30
4 2/3/2022 2/3/2022 05.100.VII.A Juwarti Karangmalan
g 2/6
05.30 16.30
5 2/9/2022 2/10/2022 2/11/2022 Titis Wulandari 29 th Pagondanga V
n
21.45 00.20 13.00
6 2/12/2022 2/12/2022 04.037.IV.A Sri Haryati 27 th Piasa 4/4
08.45 11.45
PEMANTAUAN
7 2/13/2022 2/13/2022 2/13/2022 05.059.VI.A Sugiarti 38 th Wadasputih
07.15 07.45 19.00
8 2/15/2022 2/16/2022 06.091.I.A2 Asri Nuroyni 24 th Legoksayem V
2/1
21.45 09.00
9 2/17/2022 2/18/2022 08.048.III.A2 Hatimah 20 th Penanggunga V
16.30 09.30 n 1/4
10 2/19/2022 2/19/2022 Robiati 23 th Piasa
10.00 14.30
PEMANTAUAN
11 2/20/2022 2/20/2022 2/21/2022 05.017.IV.A Emi Wahidah 28 th Wotgalar V
03.45 05.55 07.00
12 2/20/2022 2/20/2022 2/21/2022 Riska N 22 th Xderes V
09.00 20.45 13.00
13 2/20/2022 2/20/2022 2/21/2022 04.021.IV.A Robiati 23 th Piasa V
13.20 18.40 10.00
14 2/27/2022 2/27/2022 2/28/2022 08.040.III.A Khotimah 22 th PNG 1/4
06.15 07.10 08.00
15 2/28/2022 2/28/2022 2/1/2022 05.144.IV.A Darwati 28 th Wotglar V
12.00 14.58 08.00
16 2/28/2022 2/28/2022 3/1/2022 05.242.V.A2 Muslimah 19 th Xders
14.30 21.30 10.00

Jumlah Kunjungan : 16
Bersalin :9
Rujuk :4
Pemantauan :3
 TTV

G/P/A BB / TEMPAT
TB JK ALASAN RUJUK KET
TD N S R DAN UK PB RUJUK

117 90 36 20 3/3/0 LK 3000 Astri

82 41 49 Ine R
133 83 36.5 18 Ani R
AN
90 Harti
133 88 36.5 18 1/0/0 RSUD KPD BDP Ani R
98 37 HALASKO Harti
145 81 36.1 21 2/1/0 RSUD Inersia Uteri Astri
86 39 HALASKO Nesri
192 78 36.6 20 2/1/0 LK 2500 Astri
116 37-38 45
111 87 36.5 20 2/1/0 Ani R
UAN 76 36-37
148 84 36 20 3/2/0 LK 3000 Ine R
84 37-38 48 Antun
133 78 36 24 1/0/0 RSUD KPD Ria
86 39 HALASKO
139 81 36.1 21 3/0/2 RSUD KETUBAN PECAH Ani R
85 40-41 HALASKO DG MEKO Inay
131 81 36.2 21 2/1/0 Maelan
UAN 81 37-38 Inayah
122 83 36.2 20 3/2/0 LK 3600 Ani R
88 40-41 48.5 Ani F
128 81 36.5 20 2/1/0 LK 3200 Liska
83 38 50 Asih S
126 80 36.5 20 2/1/0 LK 2800 Harti
70 38-39 48 Astri
135 82 36.5 20 2/1/0 PR 3400 Asih
78 39 48.5 Harti
133 84 36.2 24 3/2/0 PR 2800 Nesri
97 38 47 Ririn
131 80 36.5 22 1/0/0 PR 3300 Astri
86 40-41 47 Linda
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN

NO. BPJS /NO. BB
NO LAHIR/ NO RM NAMA UMUR ALAMAT NON JAMD JAMP TB
DATANG PULANG U PBI HP IBU
DIRUJUK PBI A ERSAL

1 3/1/2021 3/1/2021 3/2/2021 05.026.II.A2 Ny. Afiatun M 19 th Krandegan V 537972748

02.00 10.52 13.00 3/3
2 3/5/2021 3/5/2021 3/6/2021 Ny. Anita 20 th Wanaraja
Rahayu
06.45 08.20 09.00 3/2
3 3/9/2021 3/10/2021 Ny. Yanti 17 th Ksp 9/3
19.00 06.00 Sriwati PEMANTAUAN
4 3/10/2021 3/10/2021 3/11/2021 Ny. Rani 24 th Krangmalan
08.00 08.25 10.00 g 2/6
5 3/11/2021 3/12/2021 3/13/2021 04.096.IV.A Ny. Utami 30 th Wnj 4/4
22.30 01.55 09.00
6 3/13/2021 3/13/2021 3/14/2021 06.130.I.A Ny. Saniyah 26 th Legok 2/1
05.45 08.30 09.00
7 3/13/2021 3/14/2021 4 Ny. Wiwit Elisa 21 th Piasa 3/4 V
20.00 17.00
8 3/14/2021 3/14/2021 3/15/2021 9 Ny. Ismayani 24 th
09.30 14.10 15.00 Genting 6/3
9 3/14/2021 3/14/2021 3/15/2021 05.238.I.A3 Ny.Fatimah A 26 th Jatilawang V
1/2
20.00 22.15 12.00
10 3/14/2021 3/14/2021 3/15/2021 04.130.II.A Ny. Misnah 27 th Pagondang
an
07.50 08.23 09.00
11 3/18/2021 3/19/2021 Ny. Giarti 40 th Grogol 2/1
23.00 00.15 PEMANTAUAN
12 3/21/2021 3/21/2021 3/23/2021 04.167.I.A Ny. Munasifa 28 th Wnj 1/2 V
18.30 19.30 09.00
13 3/26/2021 3/27/2021 Ny. Giarti 25 th Ksp 9/3 V
22.00 00.39
14 3/26/2021 3/27/2021 3/28/2021 07.001.I.A Ny. Linda S 21 th Ksp 11/3 V
23.00 16.50 17.00
15 3/27/2021 3/27/2021 3/28/2021 05.003.II.A Ny.Priyati 41 th Krandegan V
3/3
00.45 04.40 09.00
16 3/29/2021 3/29/2021 3/30/2021 04.008.II.A Ny. Dera N 23 th Wnj 3/1 V
06.30 10.55 11.00
17 3/29/2021 3/29/2021 05.239.I.A1 Ny. Anifa Kh 18 th Jtl 1/2 V
09.30 11.10
18 3/29/2021 3/29/2021 3/31/2021 Ny. Ma'rifatul 23 th Legok
21.45 23.30 08.00
19 3/30/2021 3/30/2021 Ny. Anisem 37 th Wanaraja
08.30 09.30

Total pasien : 19
Rujuk :5 (Post Asfiksia 1)
Bersalin : 13
Pantau :2
 TTV
G/P/A
BB / TEMPAT
DAN JK ALASAN RUJUK KET
TD N S R PB RUJUK
UK

137 81 36.4 19 1/0/0 LK 2300 Ririn

85 39 43 Linda
111 80 36.6 20 1/0/0 LK 2500
86 38-39 47
127 84 36.6 20 1/0/0 Nisa
78 10 Antun
136 80 36.5 22 3/2/0 LK 2900 Ria
86 36-37 49
133 96 36.2 20 3/1/1 Nesri
77 40-41
130 76 36 22 2/1/0 LK 3800 Nisa
89 39-40 49 Maelan
124 78 36.5 18 1/0/0 RSI Bara Kala I Fase aktif Ani R
85 39-40 memanjang Ine R
130 83 36.4 19 2/1/0 2300 Nur h
86 37-38
160 84 36.5 20 1/0/0 LK 2600 PKU Muh Post Asfiksia Ani R
100 39-40 Bara Berat Ine R
120 80 36 18 PR 3100 Astri
70 48
127 91 36.2 22 Nesri
74 Ririn
130 82 36.7 20 2/1/0 LK 3100 Nisa
88 38 - 39 48
128 81 36.5 18 2/1/0 PKU Muh KPD, BDP Ani R
Bara
72 37 - 38 Nesri
106 92 36.4 20 2/1/0 3400 Nisa
68 40-41 48 Antun
131 88 36.5 18 7/5/1 LK 3800 Ani R
91 38 50 Asih S
120 84 36.8 20 2/1/0 LK 3000 Ani R
72 40 49 Ria
130 88 36.5 18 1/0/0 RSUD PEB Ani R
90 31-32 Halasko Ria
121 82 36.4 23 2/1/0 PR 3500 Astri
72 38 - 39 51 Ririn
143 80 36.6 18 2/1/0 RSUD Inpartu dg Linda
97 36-37 Halasko Gemelly Inay
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN

UMU NO. BPJS /NO.
NO LAHIR/ NO RM NAMA ALAMAT JAMPERS
DATANG PULANG R U PBI NON JAMDA HP
DIRUJUK PBI AL
1 4/2/2022 4/3/2022 Hartuti Pecawikan
PEMANTAUAN
19.15 07.45
2 4/4/2022 4/4/2022 4/5/2022 05.143.V.A Ma'rifatun N 19 Kalideres V
01.45 18.00 08.30
3 4/4/2022 4/4/2022 07.232.I.A2 Fifiati 19 Kasimpar
PEMANTAUAN
08.25 13.00
4 4/4/2022 4/4/2022 04.027.IV.A Naryati 31 Piasa 2/4 V
13.00 14.30
5 4/6/2022 4/6/2022 4/7/2022 Rita 28 Gumelem V
14.15 14.45 08.00
6 4/7/2022 4/7/2022 4/8/2022 08.118.I.A1 Heni Dewi U 23 Penanggungan
15.45 19.30 08.00
7 4/11/2022 4/11/2022 4/12/2022 08.030.III.A2 Rohmini 21 Pesayangan V
09.30 18.25 08.00
8 4/13/2022 4/13/2022 4/14/2022 09.017.A Arina Z 34 Grogol 4/2
05.15 09.55 10.00
9 4/13/2022 4/13/2022 4/14/2022 06.024.I.A1 Amelia R 21 Legoksayem
15.00 15.15 10.00
10 4/13/2022 4/13/2022 Susilowati Jatilawang
19.00 20.00
11 4/13/2022 4/13/2022 Arifah M 23 Pringgondani
18.30 19.30
12 4/15/2022 4/16/2022 4/16/2022 05.024.III.A Tursiyah 23 Pringwulung V
21.00 03.10 15.30
13 4/18/2022 4/18/2022 Nikmah S 23 Wotgalar
16.30 17.30
14 4/18/2022 4/18/2022 05.179.V.A Sueti 39 Kalideres V
19.15 22.00
15 4/19/2022 4/19/2022 4/20/2022 09.475.A2 Amiatun N 17 Grogol 1/1
14.30 21.35 10.00
16 4/20/2022 4/20/2022 06.085.I.A1 Ika Fitri H 22 Legoksayem V
15.45 16.45
17 4/20/2022 4/21/2022 4/21/2022 Lucky K Grogol 3/1
22.15 01.20 14.00
18 4/21/2022 4/21/2022 02.013.I.A1 Rustiyani 25 Dawuhan 1/3 V
21.00 22.00
19 4/22/2022 4/22/2022 4/23/2022 Riyan Wibi S Wanantara
16.10 17.10 09.00
20 4/22/2022 4/22/2022 04.027.IV.A Naryati 31 Piasa 2/4 V
16.15 18.30
21 4/25/2022 4/26/2011 4/27/2011 05.019.II.A2 Eka Nindia 20 Krandegan
11.00 07.22 08.00
22 4/27/2022 4/27/2022 4/28/2022 05.178.I.A Susiyati 28 Jatilawang V
02.30 06.00 09.10
23 4/28/2022 4/28/2022 4/29/2022 09.821.A1 Meilisa Utari 19 Genting V
02.00 07.25 09.30
24 4/29/2022 4/30/2022 05.179.V.A Sueti 39 Kalideres V
01.15 08.00
LS
25 4/29/2022 4/29/2022 4/30/2022 06.139.I.A1 Lina Kurniati 20 Legoksayem V
17.15 21.45 10.00
26 4/29/2022 4/30/2022 5/1/2022 08.062.II.A2 Sunarti 35 Silewok V
23.45 06.48 08.00

Total Kunjungan : 26
Rujuk : 6 (1 rujuk bayi BBLSR)
Bersalin : 18
Pemantauan :2
LS :1
 TTV
BB G/P/A BB / ALASAN
IBU TB JK TEMPAT RUJUK KET
TD N S R DAN UK PB RUJUK

107 81 36.6 19 3/1/1 Harti

71 35 Astri
120 81 36.6 19 1/0/0 2300 Nesri
78 37-38 45 Asih S
68 69 36.4 20 1/0/0 Ria
50 19-20 Inay
180 92 36.5 18 3/1/1 Maelan
120 29-30 RSUD Halasko PEB
132 82 36.5 18 2/1/0 PR 2900 Ani F
89 38-39 48
128 84 36.5 19 2/1/0 PR 2800 Astri
82 40-41 47 Ine R
105 78 36.5 20 1/0/0 PR 2400 Ani R
80 37-38 44 Ine R
130 78 36.6 18 4/3/0 PR 3500 Inay
97 39-40 49
132 84 36.6 18 1/0/0 3000 Asih S
82 39-40 47
133 84 37.7 20 Asih
73 Astri
120 84 36.5 20 2/0/1 RSUD Halasko Presbo Astri
86 41-42 Asih
130 81 36.6 20 2/1/0 PR 3300 Antun
82 39-40 48 Harti
113 82 36.5 18 1/0/0 Ani R
78 17-18 Ani F
138 84 36.5 18 2/1/0 RSUD BMS KPD BDP Ani R
78 27-28 Preterm Ani F
127 84 36.6 20 1/0/0 LK 3200 Ine R
86 38-39 48
130 85 36.3 18 1/0/0 RSUD Halasko Ketuban Ani R
80 39-40 Meko Linda
109 81 36.4 19 3/1/1 PR 3500 Astri
70 40 48
114 86 36.8 28 1/0/0 Ani R
78 38-39
117 85 36.5 20 2/1/0 LK 3700 Harti
65 39-40 50
194 86 36.4 20 3/1/1 RSUD Halasko Susp IUFD Nesri
138 32
110 78 36.7 20 1/0/0 PR 3000 Ririn
70 39-40 48 Astri
123 82 36.4 20 2/1/0 LK 3500 Astri
78 37-38 48
113 86 36.7 20 1/0/0 PR 3200 Asih S
64 39-40 50 Ani F
128 89 36.4 19 2/1/0 1400 RSUD Halasko BY rujuk Antun
84 30 44 BBLSR
126 78 36.6 19 1/0/0 LK 2400 Ani R
76 38-39 46 Antun
131 78 36.5 18 2/1/0 PR 3100 Ani R
86 39-40 49 Antun
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN TTV

NO.
JAMP BPJS /NO. BB
NO LAHIR/ NO RM NAMA UMUR ALAMAT NON JAM IBU TB
DATANG PULANG U PBI PBI ERSA HP TD
DIRUJUK DA
L
1 5/1/2022 5/1/2022 5/1/2022 04.069.I.A Fitriyanti 21 th 128
Wanaraja
03.45 04.10 19.00 4/2 75
2 5/1/2022 5/1/2022 5/2/2022 05.088.IV.A3 Fitriyah 26 th V 133
Wotgalar
22.15 23.55 12.00 2/5 91
3 5/2/2022 5/2/2022 04.181.II.A Khalimah 38 th 131
Wanaraja
04.15 10.00 1/1 91
4 5/2/2022 5/2/2022 5/2/2022 Siti Khaniyah 31 th Grogol 5/3 V 124
05.25 05.35 18.30 82
5 5/4/2022 5/4/2022 5/5/2022 Fifin Fania 19 th Pesayangan 128
05.45 17.15 15.30 2/4 77
6 5/6/2022 5/6/2022 5/7/2022 Kurniasih 28 th Kasimpar V 127
19.00 22.25 09.00 81
7 5/7/2022 5/7/2022 5/8/2022 Karsinah 31 th Pringgonda V 133
03.00 03.30 17.00 ni 1/4 79
8 5/7/2022 5/7/2022 5/8/2022 05.064.IV.A Manisem 28 th Wotgalar V 133
09.00 12.15 09.00 1/5 85
9 5/8/2022 5/9/2022 5/10/2022 Farah 22 th 130
Handayani Pagondang
20.45 01.45 09.58 an 1/1 81
10 5/11/2022 5/11/2022 5/12/2022 06.117.I.A Nurkhomimah 29 th Legoksaye V 129
19.30 22.35 14.30 m 5/1 93
11 5/13/2022 5/13/2022 5/14/2022 Rohimah 24 th Gumelem V 114
13.30 18.30 09.00 1/1 78
12 5/14/2022 5/14/2022 5/15/2022 05.021.IV.A Bartiah 26 th Jatilawang V 115
1/5
10.20 13.15 13.15 72
13 17-05-2022 18-05-2022 04.048.I.A Siti Barokah 26 th 105
15.00 15.30
Wanaraja
4/2
PEMANTAUAN 75
14 20-05-2022 20-05-2022 21-05-2022 04.048.I.A Siti Barokah 26 th Wanaraja V 127
19.00 20.29 10.00 4/2 71
15 23-05-2022 24-05-2022 Evi Sa'bana 31 th Kebodudu V 86
1/3
22.40 01.05 75
16 24-05-2022 25-05-2022 25-05-2022 05.085.V.A1 Ismi K 27 th Kalideres 132
19.00 00.30 13.00 2/8 84
17 26-05-2022 26-05-2022 26-05-2022 09.056.A1 Nisa Ayu 20 th Grogol 4/1 V 122
01.30 03.04 15.00 76
18 28-05-2022 29-05-2022 29-05-2022 05.045.V.A Susiyati 17 th Kalideres 131
18.30 03.20 16.00 2/8 91
19 29-05-2022 31-05-2022 04.132.II.A Ratu Dinda 21 th V 128
Wanaraja
20.15 03.05 2/1 91
20 31-05-2022 31-05-2022 05.086.IV.A Mustika 22 th Wotgalar V 128
13.00 14.00 1/5 84

TOTAL KUNJUNGAN : 20
Bersalin : 15
Rujuk :4
Pemantauan :1
 TTV
G/P/A BB /
DAN UK JK PB TEMPAT RUJUK ALASAN RUJUK KET
N S R

80 36.4 22 3/1/1 LK 2900 Ria

37 47
84 36.3 19 2/1/0 PR 2800 Linda
39-40 47 Asih
82 36.4 20 3/2/0 RSUD Halsko Ria
34-35
80 36.4 22 3/1/1 PR 3000 Antun
38-39 49
82 36.2 24 1/0/0 PR 2800 Ani R
40-41 46 Ririn
92 36.5 18 2/1/0 PR 2900 Ririn
40-41 48
81 36.5 20 3/2/0 PR 3100 Ani F
40-41 49
80 36.7 22 2/1/0 LK 3100 Romi
38-39 49 Asih
82 36.6 20 1/0/0 LK 2400 Ani F
41-42 46
82 36.4 22 2/2/0 LK 3100 Astriyani
37-38 48
82 36.4 19 2/1/0 LK 2500 Ria
39-40 47
84 36.2 20 2/1/0 PR 3650 Ria
40-41 50 Nesri
76 36.5 20 2/1/0 Ani R
39 Inayah
78 36.5 18 2/1/0 3000 Ani R
39 47 Liska
185 38.1 18 P3A0 RSUD Halasko Asites Astri
3hr Antun
90 36.4 20 2/1/0 LK 3000 Astri
40-41 48 Ria
86 36.5 18 1/0/0 PR 2100 Ani R
39-40 45 Asih S
78 36.6 20 1/0/0 2800 Nisa K
40 46
78 36.5 18 1/0/0 RSUD Halasko Kala II lama Astri
40-41 Harti
92 36.5 18 2/1/0 RSU Bms B20, KPD, BDP, Ani R
39-40 Anemia Inayah
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN

NO.
BB
NO LAHIR/ NO RM NAMA UMUR ALAMAT NON JAMD JAMP BPJS /NO. IBU TB
DATANG PULANG U PBI HP
DIRUJUK PBI A ERSAL

1 1/6/2022 1/6/2022 2/6/2022 08.033.II.A Tuti Listiowati 26 th Silewok V

04.30 04.30 08.00
2 03/06/2022 04/06/2022 05/06/2022 09 Vety Pohan 22 th Tieng
19.00 05.53 16.45
3 05/06/2022 05/06/2022 06/06/2022 05.039.III.A Rusiyati 24 th Pringgondani V
18.00 19.18 15.00
4 07/06/2022 07/06/2022 07/06/2022 04.014.IV.A1 Homsatun 39 th Piasa V
01.45 02.30 16.00
5 08/06/2022 08/06/2022 10/06/2022 08.015.III.A Tumyati 24 th Pesayangan V
17.45 18.20 10.00
6 09/06/2022 09/06/2022 11/06/2022 Sumini 32 th Wotgalar V
22.30 23.10 06.30
7 15/06/2022 15/06/2022 16/06/2022 Rizka Fidia 22 th Kalideres V
10.55 11.15 12.00
8 17/06/2022 17/06/2022 17/06/2022 09.412.A Tuti 40 th Majatengah V
04.50 04.53 17.00
9 17/06/2022 18/06/2022 19/06/2022 09.198.A Elni Slamet 20 th Genting V
21.45 09.10 09.00
10 20/06/2022 20/06/2022 21/06/2022 Diah Puji P 28 th Pagondangan V
05.25 13.20 13.30
11 24/06/2022 24/06/2022 By. Ny. Arina 1 hr Pesayangan V
00.40 10.30
12 24/06/2022 24/06/2022 25/06/2022 05.081.I.A Nurondiyah 32 th Jatilawang V
03.05 03.10 08.00
13 24/06/2022 24/06/2022 25/06/2022 08.044.III.A1 Ani Haryati 28 th Pesayangan
14.30 23.15 14.00

TOTAL KUNJUNGAN : 13
BERSALIN : 11
RUJUK :2
PEMANTAUAN :0
 TTV
G/P/A
BB /
DAN JK PB TEMPAT RUJUK ALASAN RUJUK KET
TD N S R UK

118 74 36.5 18 3/1/1 PR 3200 Astri

68 39-40 47 Ine R
128 82 36.2 20 1/0/0 LK 2600 Ani R
98 39-40 47
125 97 36.4 19 2/1/0 PR 2900 Astri
87 40-41 48 Ria
132 80 36.2 20 2/1/0 LK 2200 Ririn
89 38-39 46 Maelan
137 96 36.2 19 2/1/0 PR 3400 Ani R
89 42-43 49 Liska
128 83 36 18 3/2/0 PR 3000 Ani R
82 39-40 49.5 Nisa
103 80 36.2 20 1/0/0 PR 2800 Harti
71 40-41 48
138 86 2/1/0 PR 2000 RSUD Halasko BBLR Ani R
86 35-36 42
132 78 36.2 16 1/0/0 PR 3200 Ani R
84 40 49
129 84 36.3 18 2/1/0 PR 3200 RSUD Halasko Laserasi Grade 4 Liska
85 40 48 Romi
125 41 LK 3200 Astri
Antun
150 78 36.4 21 4/3/0 PR 3100 Astri
80 39-40 47.5 Antun
133 81 36.5 19 3/1/1 LK 2800 Astri
94 38-39 47.5 Liska
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN

NO.
UMU JAM BPJS /NO. BB
NO LAHIR/ NO RM NAMA ALAMAT JAM
DATANG PULANG R U PBI NON
PBI DA PERS HP
IBU
DIRUJUK
AL
1 1/7/2022 1/7/2022 2/7/2022 04.077.V.A Purwati 28 th Pecantelan 1/5
23.10 23.20 13.30
2 5/7/2022 5/7/2022 6/7/2022 04.047.III.A Runtiyah 29 th Kebodudu V
21.30 23.43 14.00 Aredi 27 th
3 9/7/2022 9/7/2022 10/7/2022 05.008.V.A1 Lisa Haryanti 23 th Wotgalar 4/5
08.30 09.30 09.00 M.Khadis
4 10/7/2022 10/7/2022 11/7/2022 04.164.I.A1 Nur Mela 20 th Wanaraja 3/2 V
01.00 08.12 09.00 Ari Setianto
5 10/7/2022 10/7/2022 11/7/2022 08.065.III.A Hatimah 27 th Pesayangan 1/4
02.00 04.32 08.00 Turmono
6 10/7/2022 10/7/2022 11/7/2022 05.078.I.A Yuliana 26 th Jatilawang 2/3
13.10 15.15 15.00 Yudianto
7 11/7/2022 11/7/2022 11/7/2022 04.017.V.A Khotimah 26 th Peacntelan 2/5
09.30 10.28 10.30 Cipto 31 th
8 17/07/2022 17/07/2022 18/07/2022 08.009.III.A Manisem 26 th Pesayangan V
18.35 21.45 10.00 Alwanto 31 th
9 18/07/2022 19/07/2022 09.186.A1 Sri Barokah 19 th Grogol
PEMANTAUAN
07.45 15.00 Fani Adam
10 19/07/2022 20/07/2022 Rusmiyati Wanaraja 1/1
PEMANTAUAN
20.20 08.00 Kasrin
11 19/07/2022 20/07/2022 21/07/2022 Suwiyah 31 th Dawuhan 1/2
23.15 00.45 13.00 Satimah 37 th
12 20/07/2022 20/07/2022 21/07/2022 09.186.A1 Sri Barokah 19 th Grogol 3/1 V
18.45 21.58 17.00 Fani Adam 21 th
13 20/07/2022 21/07/2022 22/07/2022 Nurul khotimah 16 th Grogol 3/1
19.00 16.14 15.00 Ari S 17 th
14 23/07/2022 23/07/2022 24/07/2022 09.290.A1 Ernawati 18 th Grogol 7/1 V
02.30 10.40 13.00 Hasim R 18 th
15 23/07/2022 23/07/2022 24/07/2022 03.269.I.A Nur Chalimah 23 th Jomblang V
06.30 12.15 12.00 Nur Fauzi 32 th
16 24/07/2022 24/07/2022 25/07/2022 Sumirah 27 th Grogol 6/3 V
11.30 13.40 12.00 Pawitro 37 th
17 24/07/2022 25/07/2022 26/07/2022 Rondiah 23 th Grogol 2/1
18.05 03.45 Santo 36 th
18 25/07/2022 25/07/2022 26/07/2022 08.105.I.A2 Hatimah 19 th Penanggungan V
08.00 18.33 17.00 Irman 22 th 4/1
19 27/07/2022 27/07/2022 28/07/2022 07.144.I.A2 Intan Berliyani 21 th Kasimpar 6/2
05.45 15.30 15.30 Rizqi Setiawan
20 27/07/2022 28/07/2022 Anarisya Mulya 21 th Genting 7/3 V
12.15 04.40 Kholidun 25 th
21 29/07/2022 30/07/2022 Susiati 23 th Pesayangan 1/4
00.00 00.30 Zaenal 24 th
22 29/07/2022 29/07/2022 Rasiti 37 th Jatilawang 1/2
17.30 18.30 Fuad

TOTAL KUNJUNGAN : 22
BERSALIN : 17
RUJUK :3
PEMANTAUAN :2
 TTV
G/P/A BB /
TB DAN UK JK PB TEMPAT RUJUK ALASAN RUJUK KET
TD N S R

128 80 36.3 20 2/1/0 LK 3200 Antun

72 38 49
123 82 36 21 2/1/0 3000 Astriyani
78 38-39 47.5
132 92 36.4 20 2/1/0 PR 3300 Astri
91 38-39 49 Harti
126 85 36.5 18 1/0/0 PR 3400 Ani R
84 40-41 49 Asih S
141 92 36.5 18 2/1/0 PR 2700 Ani R
90 38 47 Asih S
134 84 36.2 20 3/1/1 PR 3100 Astri
79 38-39 46 Ririn
151 89 36.5 20 2/1/0 PR 3400 Ani R
90 40 48
131 81 36.6 20 2/1/0 LK 3100 Astri
88 39-40 48
127 82 36.3 20 1/0/0 Astri
72 39-40 Linda
124 89 36.2 16 3/1/1 Ani f
74 36
127 81 36.4 20 2/1/0 PR 3000 Ani f
83 39-40 49
116 69 36.7 20 1/0/0 LK 2800 Ani R
79 39-40 46.5 Asih S
126 96 36.5 19 1/0/0 2900 Harti
86 37-38 47
136 82 36.5 18 1/0/0 2900 Ani R
84 37 - 38 46 Linda
131 99 36.4 19 2/1/0 PR 3000 Ani R
90 38-39 47 Linda
156 83 36.2 20 3/1/1 LK 3500 Nurhajiati
100 40-41 48.5
131 80 37.8 20 2/1/0 3100 Astriyani
85 40 - 41 49
117 80 36.4 19 1/0/0 LK 2600 Ani R
70 39 - 40 47 Ririn
117 90 36.2 19 1/0/0 PR 3400 Ani R
80 41 50 Ririn
138 98 36.4 19 1/0/0 KU Anugrah Kala I Fase Ani R
88 41 aktif memanjang Ririn
140 86 36.4 19 1/0/0 KU Anugrah kala I Fase laten Astri
89 38-39 memanjang Maelan
139 83 36.4 20 3/2/0 RSUD Halasko Ketuban pecah Astri
90 38-39 keruh Maelan
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN

NO.
JAMP BPJS /NO. BB
NO LAHIR/ NO RM NAMA UMUR ALAMAT JAM TB
DATANG PULANG U PBI NON
PBI DA ERSA HP
IBU
DIRUJUK
L
1 3/8/2022 3/8/2022 4/8/2022 04.001.II.A1 Ny. Shierly M Pagondanga V
09.00 17.30 17.00 Tn. Hendri n 2/1
2 6/8/2022 7/8/2022 7/8/2022 Vina Oktaviana 19 th Legoksayem
12.30 01.30 17.00 Darmaji 22 th 2/1
3 9/8/2022 9/8/2020 10/8/2022 05.059.I.A Sumini 33 th Jatilawang V
07.30 08.37 06.00 Khomsatun 1/3
4 14/08/2022 14/08/2022 15/08/2022 05.167.I.A2 Chusnul Kh 21 th Jatilawang V
14.50 17.13 17.00 Habibul Umam 22 th 2/3
5 15/08/2022 15/08/2022 16/08/2022 Nur Afiyah 21 th Grogol 4/3
02.50 02.45 08.00 Ahmad B 27 th
6 15/08/2022 15/08/2022 16/08/2022 Sri Hastuti 24 th Gumelem V
05.30 07.23 08.00 Warsono 30 th 1/1
7 19/08/2022 19/08/2022 05.044.VI.A1 Usfifah 18 th Wadasputih V
21.50 22.15 Saryadi 26 th 2/7
8 23/08/2022 24/08/2022 24/08/2022 04.146.I.A Daryati 27 th Wanaraja V
23.30 02.35 15.00 Junaidi 37 th 2/2
9 25/08/2022 26/08/2022 Efi I 17 th Tlaga Abang
Wawan H
PEMANTAUAN
16.00 08.00
10 28/08/2022 28/08/2022 29/08/2022 Ningrum 29 th Wanaraja V
05.40 06.30 07.00 Gono 32 th 1/4
11 29/08/2022 29/08/2022 30/08/2022 Lustia M 25 th Piasa 2/4 V
19.00 20.25 08.00 Wiwit A 29 th
12 29/08/2022 29/08/2022 Samiatut 31 th Dawuhan V
22.15 23.30 Toseri
13 30/08/2022 31/08/2022 1/9/2022 07.232.I.A2 Fifiati 19 th
20.30 15.05 14.00 Ainur R 23 th Kasimpar 4/2

TOTAL KUNJUNGAN : 13
BERSALIN : 10
RUJUK :2
PEMANTAUAN :1
 TTV
G/P/A
BB / TEMPAT
DAN JK PB RUJUK ALASAN RUJUK KET
TD N S R UK

120 88 36.6 22 2/1/0 4000 Antun

80 41-42 51
113 89 36.4 20 2/0/1 PR 3100 Ani f
77 40-41 48
134 78 36.7 19 4/3/0 2600 Harti
79 36 47
115 98 36.4 19 1/0/0 PR 2800 Harti
82 40-41 49 Ani R
LK 2500 Ani R
46 Harti
126 83 36.1 18 2/1/0 LK 3000 Ani R
73 38-39 49 Harti
137 87 36.2 18 1/0/0 RSUD Presbo Ani R
79 39 Halasko Antun
102 77 36.5 19 3/2/0 2650 Nisa
70 39-40 46 ani F
117 78 36.7 18 1/0/0 Astri
70 26- 27 Ine R
128 84 36.5 18 2/1/0 LK 3300 Nur H
78 40-41 50 Ria
130 87 36.1 18 4/1/2 PR 2600 Astri
80 40-41 48
129 78 36.2 19 2/1/0 RSUD Fase laten dg Astri
79 39 Halasko riw SC Liska
139 83 36.3 20 1/0/0 LK 3300 Nisa
90 40-41 50 Ria
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN

NO.
JAMP BPJS /NO. BB
NO LAHIR/ NO RM NAMA UMUR ALAMAT NON JAMD TB
DATANG PULANG U PBI IBU
DIRUJUK PBI A ERSA HP
L
1 2/9/2022 2/9/2022 Hatini 28 th Legoksayem
20.30 21.30 Sayun
2 5/9/2022 5/9/2022 7/9/2022 04.123.IV.A Rini S 31 th Piasa 3/4 V
21.40 23.45 08.00 Hadno
3 6/9/2022 6/9/2022 Parwati 23 th Wanaraja 2/2
02.30 03.30 Irwanto
4 7/9/2022 7/9/2022 08.201.I.A1 Khusnul Kh 24 th Png 4/1 V
03.30 07.45 Anwar
5 10/9/2022 10/9/2022 10/9/2022 04.135.I.A Huswatun Kh 30 th Wnj 3/2 V
07.45 09.25 18.30 Hatijo 38 th
6 10/9/2022 11/9/2022 12/9/2022 09.059.A Elly Fitriani 20 th Grogol 4/1
19.30 07.18 08.00 Ade Gunawan 22 th
7 11/9/2022 13/09/2022 05.028.IV.A1 Nur Fatma 26 th Wotgalar
22.30 09.00 Okto S
8 15/09/2022 15/09/2022 16/09/2022 Diah Sartika 23 th Pecantelan V
22.30 23.57 13.00 Dasmin 33 th
9 17/09/2022 17/09/2022 18/09/2022 04.031.IV.A1 Suprapti 29 th Piasa 4/4
15.13 15.30 15.30 Supendi
10 26/09/2022 26/09/2022 27/09/2022 09.297.A Ribut Suinah 27 th Grogol 6/3 V
10.30 12.03 12.00 Mujir 32 th
11 30/09/2022 17/09/2022 06.098.I.A Kustirah 27 th Legoksayem
PEMANTAUAN
16.30 07.30 Sidik

TOTAL KUNJUNGAN : 11
BERSALIN :6
RUJUK :4
PEMANTAUAN :1
 TTV
G/P/A
BB / TEMPAT
DAN JK ALASAN RUJUK KET
TD N S R PB RUJUK
UK

137 85 36.2 20 RSI Bara KPD BDP Harti

91
132 79 36.4 19 2/1/0 LK 3200 Asih S
79 39-40 49 Ria K
125 82 36.2 18 2/1/0 RSUD Inpartu dengan Ria K
86 39-40 Halasko presbo Asih S
133 89 36.7 18 2/1/0 RSUD Inpartu kala I fase Astri
78 40-41 Halasko laten dengan KPD Nur H
146 79 36.5 19 3/2/0 LK 3000 Astri
72 39-40 49
128 83 36.4 18 1/0/0 LK 2900 Astri
78 38-39 48
154 89 36.5 18 2/0/1 RSI Bara Kala II lama Astri
101 40 Ria K
139 79 36.4 20 3/1/1 LK 3400 Astri
84 37-38 47
135 84 36.3 19 3/1/1 LK 2500 Ria K
94 34 46
102 84 36.4 20 3/1/1 PR 2900 Liska
74 40-41 46
125 93 37.9 18 2/1/0 Ani R
69 37 Antun
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM JAMINAN TTV

NO.
UMU BB
NO LAHIR/ NO RM NAMA ALAMAT JAM JAMP BPJS /NO. IBU TB
DATANG PULANG R U PBI NON HP TD
DIRUJUK PBI DA ERSAL

1 01/10/2022 01/10/2022 02/10/2022 04.054.IV.A2 Laila Rizqah 20 th Piasa 1/4 V 110

03.30 18.15 16.00 Lutfi A 23 th 72
2 02/10/2022 02/10/2022 05.085.I.A Nur Khanifah 30 th Jatilawang 2/2 V 121
22.30 23.50 Eko Lustiana 82
3 04/10/22 05/10/2022 06/10/2022 05.039.V.A Haryanti 25 th Kalideres 1/9 125
15.15 06.45 07.00 Wagiono 28 th 87
4 04/10/2022 04/10/2022 Susanti 33 th Gumelem V 132
18.30 21.00 Tulani 50 th 89
5 04/10/2022 04/10/2022 Turinah 33 th Tempuran 2/2 V 124
18.45 21.30 Ahmad N 76
6 05/10/2022 05/10/2022 Ristiana 32 th Kasimpar V 106
09.45 11/15 69
7 08/10/2022 09/10/2022 09/10/2022 05.047.III.A Tumirah 24 th Pringgondani 2/4 V 131
23.50 01.55 14.00 Tugio 29 th 89
8 09/10/2022 09/10/2022 10/10/2022 05.185.V.A1 Silviana 17 th Kalideres 2/9 V 133
20.00 22.30 13.00 Dwi Setiawan 21 th 84
9 12/10/2022 12/10/2022 13/10/2022 Isronah 23 th Genting 5/3 V 124
10.00 11.30 12.00 Harsono 93
10 17/10/2022 17/10/2022 Runti 31 th Gumelem 2/1 131
01.30 03.30 Ritno 35 th 90
11 19/10/2022 20/20/2022 06.098.I.A Kustirah 27 th Legoksayem V 125
17.15 Sidik 82
12 19/10/2022 20/10/2022 20/10/2022 Widiarti 27 th Genting V 134
19.45 01.48 19.00 Teguh 32 th 74
13 20/10/2022 20/10/2022 04.146.IV.A1 Diah Tri W 17 th Piasa 3/4 104
PEMANTAUAN
10.00 20.00 Jumhan S 22 th 60
14 21/10/2022 21/10/2022 07.099.I.A4 Yayang A 26 th Kasimpar 6/2 V 114
07.30 17.00 Ganang 26 th 81
15 22/10/2022 23/10/2022 07.203.I.A2 Wiranti 18 th Kasimpar V 110
19.15 Salman 23 th 72
16 26/10/2022 26/10/2022 27/10/2022 Wiwin R Legoksayem 98
09.00 11.40 11.00 Ahmal 67
17 29/10/2022 29/10/2022 30/10/2022 05.008.VI.A Susilowati 26 th Wadasputih V 143
09.35 11.35 12.00 Rendi 36 th 88
 TTV
G/P/A BB /
JK TEMPAT RUJUK ALASAN RUJUK KET
N S R DAN UK PB

82 36.4 20 1/0/0 PR 3200 Ani R

40 48 Nisa
84 36.5 19 4/2/1 RSUD Halasko Riw SC Liska
40-41 Ririn
82 36.5 18 2/1/0 LK 3200 Astriyani
39-40 49
78 36.4 19 2/1/0 RSUD Halasko Susp. CPD Astriyani
40-41
102 37.1 37 3/1/1 RS Emanuel Dipneu Astri
37-38 Anifa
90 37.8 20 3/2/0 RSUD Halasko Harti
16
81 36.5 19 2/1/0 PR 3050 Antun
39-40 49
76 36.2 19 1/0/0 PR 3200 Astriyani
36-37 48 Nisa K
76 36.6 20 2/1/0 3400 Ine R
40-41 48 Romi
86 36.4 20 3/2/0 RSUD Halasko Ab Inkomplit Astriyani
20 - 21 Antun
72 36.1 18 2/1/0 LK 3000 Ani R
39-40 47 Ririn
76 36.2 19 3/1/1 LK 2900 Ani R
39 - 40 47 Ririn
120 38 20 1/0/0 Ria
30 - 31 Liska
84 36.4 18 1/0/0 RSUD Halasko KPD BDP Astri
38 - 39 Harti
70 36.2 19 1/0/0 RSUD HaLasko Inpartu Kala I Fase Liska
39 - 40 Aktif memanjang
92 36.1 18 2/1/0 LK 3200 Inayah
40-41 49 Ine R
77 36.4 20 2/1/0 LK 3750 Nisa K
40 47 Ria
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM

UMU
NO LAHIR/ NO RM NAMA
DATANG PULANG R
DIRUJUK

1 03/11/2022 03/11/2022 04.043.V.A Sukenti 34 th

00.45 01.30 Mukadi 37 th
2 03/11/2022 03/11/2022 04/11/2022 08.094.III.A1 Neni Widia 28 th
06.15 12.00 10.00 Tofik 32 th
3 03/11/2022 03/11/2022 04/11/2022 04.048.I.A1 Iswatun Khasanah 24 th
20.00 21.35 11.00 Burham
4 04/11/2022 04/11/2022 05/11/2022 05.201.V.A1 Sunarti 24 th
14.20 17.30 10.00 Ngadiono
5 07/11/2022 07/11/2022 08/11/2022 Fila Sifah 24 th
10.30 10.40 11.00 Ahmad R 28 th
6 11/11/2022 11/11/2022 12/11/2022 04.002.II.A Holyatun 23 th
07.45 08.19 08.30 Basuki 32 th
7 11/11/2022 11/11/2022 Khotimah 26 th
08.50 17.45 Asror 42 th
8 12/11/2022 12/11/2022 Siti Rohmah 19 th
18.30 19.30 Agus S 23 th
9 16/11/2022 16/11/2022 16/11/2022 04.034.V.A Miskem 31 th
03.00 04.18 16.30 Kotim
10 17/11/2022 17/11/2022 18/11/2022 05.275.V.A3 Lika Milasari 17 th
02.30 12.10 12.00 Fajar Anang 23 th
11 23/11/2022 23/11/2022 Karyanti 33 th
10.00 14.00 Sarwono
12 25/11/2022 25/11/2022 04.044.II.A Tri Wiasti 19 th
02.30 10.45 Andri R 27 th
13 25/11/2022 25/11/2022 26/11/2022 04.238.IV.A Eli Murtiyanah 29 th
10.45 10.58 12.00 Slamet

TOTAL KUNJUNGAN : 13
BERSALIN :8
RUJUK :4
PEMANTAUAN :1
 JAMINAN TTV
NO.
ALAMAT JAMP BPJS /NO. BB IBU TB
NON JAMD
U PBI ERSA HP TD N S R
PBI A
L
Pecantelan 2/5 V 128 80 36.6 18
82
Pesayangan 2/4 V 140 89 36.2 19
87
Wanaraja 4/2 V 129 83 36.4 19
76
Kalideres 1/8 V 112 74 36.2 19
78
Genting 3/3 V 149 89 36.2 20
91
Pagondangan V 122 81 36.5 18
88
Dawuhan 3/1 105 81 36.5 18
PEMANTAUAN
69
Piasa V 131 84 36.5 18
85
Pecantelan 2/5 V 118 65 36.7 20
75
Kalideres 3/9 V 132 66 36.5 18
87
Jatilawang 1/2 V 134 80 36.4 20
86
Pecantelan V 120 87 36.3 18
86
Piasa 3/4 V 138 81 36.5 19
88
 G/P/A BB /
JK TEMPAT RUJUK ALASAN RUJUK KET
DAN UK PB

3/2/0 RSUD Halasko Riw SC Astri

36 - 37 Nisa K
2/1/0 3100 Antun
41 - 42 49 Ririn
2/1/0 LK 3700 Astri
39-40 51.5
2/1/0 LK 3100 Ria K
39-40 48 Ani F
2/1/0 PR 3300 Ani F
40-41 48 Harti
2/1/0 LK 3900 Ria K
38-39 49
2/1/0 Nisa K
32-33
1/0/0 RSUD Halasko KPD preterm Astri
34
2/1/0 PR 3000 Ani R
40-41 47.5 Antun
1/0/0 LK 3200 Nur H
40-41 47.5 Ria K
3/2/0 RSUD Halasko KPD BDP Astri
38-39 Harti
1/0/0 RSUD Halasko KPD Asih S
39-40 Ani F
2/1/0 PR 2700 Asih S
38 48 Ani F
REKAPAN BULANAN

A. KUNJUNGAN PERSALINAN

TANGGAL DAN JAM

UMU
NO LAHIR/ NO RM NAMA
DATANG PULANG R
DIRUJUK

1 03/12/2022 04/12/2022 04/12/2022 08.085.III.A Tutur Asrimah 23 th

22.30 02.30 14.30 Tunut Soehan 28 th
2 06/12/2022 07/12/2022 07/12/2022 05.015.IV.A Elly Nurjanah 33 th
19.00 00.35 15.39 Subagyo 40 th
3 07/12/2022 08/12/2022 05.118.I.A1 Istiqomah 30 th
05.30 01.00 Singgih 31 th
4 09/12/2022 09/12/2022 10/12/2022 08.070.I.A Villa Anggraeni 24 th
12.30 17.53 16.00 Nyana 26 th
5 09/12/2022 09/12/2022 10/12/2022 09.827.A1 Umi Rofiatul 22 th
14.00 20.15 10.00 Jamil 31 th
6 09/12/2022 09/12/2022 10/12/2022 05.050.I.K Kartini 23 th
23.10 23.40 12.30 Andi R 31 th
7 12/12/2022 12/12/2022 05.391.I.A1 Amanah Febrian 25 th
01.10 22.10 M. Khoerul Amin
8 13/12/2022 13/12/2022 Elly Ernawati 23 th
11.00 15.00 Jono
9 14/12/2022 14/12/2022 15/12/2022 Lilik Harliningsih 22 th
03.30 03.50 16.00 Mustakir 28 th
10 14/12/2022 14/12/2022 15/12/2022 Rundiowati 35 th
06.00 06.57 19.00 Lukman
11 14/12/2022 15/12/2022 15/12/2022 Kartika 22 th
18.30 02.30 15.00 Dandi 23 th
12 16/12/2022 17/12/2022 17/12/2022 Suci Hardiyanti 25 th
17.30 01.46 15.00 Khadri 29 th
13 17/12/2022 17/12/2022 Yuniar Indri 22 th
07.30 09.10 Wiwit H
14 18/12/2022 18/12/2022 04.010.III.A Sumiyati 36 th
05.00 20.25 Tuhat
15 20/12/2022 20/12/2022 21/1/2022 02.163.I.A Cholimah 34 th
18.30 19.40 11.00 Sumar 46 th
16 21/12/2022 21/12/2022 21/12/2022 09.739.A Siti Sukhaebah 30 th
00.50 01.00 13.00 Slamet Wibowo 31 th
17 25/12/2022 25/12/2022 26/12/2022 04.146.IV.A1 Diah Tri 17 th
02.30 14.45 09.00 Jumhan Saputra 22 th
18 29/12/2022 29/12/2022 08.013.I.A1 Mila Hidayatul T 19 th
13.00 17.25 Taufik 21 th

TOTAL KUNJUNGAN : 18
BERSALIN : 12
RUJUK :4
PEMANTAUAN :2
 JAMINAN TTV
NO. G/P/A
ALAMAT JAMP BPJS /NO. BB TB DAN JK
JAM
U PBI NON
PBI DA ERSA HP
IBU TD N S R UK
L
Pesayangan V 133 72 36.4 20 2/1/0 LK
2/4 78 40-41
Wotgalar 1/5 123 83 36.3 20 3/2/0 LK
88 38-39
V 120 82 36.5 19 2/1/0
Jatilawang 1/1 88 39-40
Png 1/1 V 120 92 36.4 21 2/1/0 LK
76 39-40
Grogol 8/3 V 101 85 36.2 19 1/0/0
69 41-42
V 136 94 36.2 18 2/1/0
Jatilawang 1/3 98 37-38
V 130 87 36.5 20 1/0/0
Jatilawang 1/2 80 38-39
Karangmalang 96 101 37.5 20 2/1/0
PEMANTAUAN
46
Kasimpar 3/1 V 112 82 36.4 18 2/1/0 LK
76 37-38
Jatilawang 2/2 V 120 86 36.4 19 5/3/1 LK
78 40
Kasimpar 6/2 V 137 80 36.4 19 1/0/0 LK
87 38-39
Pesayangan 1/4 V 110 81 36.5 18 2/1/0 PR
75 39-40
Legoksayem V 122 80 36.5 22 2/0/1
78 39-40
Kebodudu 1/3 V 126 90 36.5 19 2/1/0
85 41-42
Dawuhan 3/3 V 119 80 36.4 19 3/2/0 LK
72 37-38
Genting 7/3 V 120 79 36.4 19 2/1/0 LK
70 38-39
Piasa 3/4 V 112 84 36.2 18 1/0/0 LK
76 39-40
Penanggungan 115 85 36.7 18 1/0/0
PEMANTAUAN
1/1 75 34-35
 BB / TEMPAT
ALASAN RUJUK KET
PB RUJUK

3000 Astri
49
3300 Harti
49
Kala I fase aktif Astri
PKU Bara memanjang Linda
3000 Ani R
48
3500 Ria K
49
2800 Ani R
48.5 Liska
RSUD Bara Kala I fase aktif Ani R
memanjang Ririn
Maelan
Inayah
3000 Liska
48.5
3000 Liska
48
3200 Astri
50
2500 Maelan
47 Nur H
RSUD Bara Susp. IUFD Ririn
Ria K
RSUD Bara Kala I fase aktif Ani R
memanjang Linda
3100 Astri
48.5 Harti
3400 Astri
50 Harti
2700 Ine R
47
Ani R