LAPORAN BULANAN KEGIATAN DOKTER MASUK DESA

Kecamatan :................................................
Puskesmas :................................................
Bulan :................................................
Tahun :................................................

KELOMPOK UMUR / KUNJUNGAN JUMLAH

NO DESA/KEL KUNJUNGAN
0 - 5 THN 6 - 12 THN 13 -30 THN 31 - 49 THN 50 - 59 THN 60 THN >

1 .............Org .............Org .............Org .............Org .............Org .............Org

2 .............Org .............Org .............Org .............Org .............Org .............Org

3 .............Org .............Org .............Org .............Org .............Org .............Org

4 .............Org .............Org .............Org .............Org .............Org .............Org

5 .............Org .............Org .............Org .............Org .............Org .............Org

6 .............Org .............Org .............Org .............Org .............Org .............Org

7 .............Org .............Org .............Org .............Org .............Org .............Org

8 .............Org .............Org .............Org .............Org .............Org .............Org

9 .............Org .............Org .............Org .............Org .............Org .............Org

10 .............Org .............Org .............Org .............Org .............Org .............Org

11 .............Org .............Org .............Org .............Org .............Org .............Org

12 .............Org .............Org .............Org .............Org .............Org .............Org

13 .............Org .............Org .............Org .............Org .............Org .............Org

14 .............Org .............Org .............Org .............Org .............Org .............Org

15 .............Org .............Org .............Org .............Org .............Org .............Org

Mengetahui .............................Tgl................................2020
Kepala Puskesmas........................

.............................................. ..............................................
NIP. NIP.
 LAPORAN BULANAN KEGIATAN DOKTER MASUK DESA

Desa/Kecamatan :................................................
Puskesmas :................................................
Bulan dan Tahun :................................................

LAPORAN BULANAN MENURUT JENIS KEGIATAN

NO DESA/KEL Pemeriksaan Pelayanan Pemeriksaan
Pemeriksaan Pemeriksaan PERMASALAHAN
Pengobatan Intervensi PIS PK / Penyuluhan Gula Asam urat/Uric
IVA KB Kolestrerol
darah/Glukosa acid

Individu Klp Massal

1 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
2 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
3 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
4 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
5 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
6 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
7 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
8 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
9 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
10 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
11 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
12 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
13 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
14 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang
15 ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang

Jumlah ..............Orang ..............Orang ..........Klp ..............Kali ..............Orang ............Orang .............Orang .............Orang .............Orang

Mengetahui .............................Tgl................................2020
Kepala Puskesmas........................ Pengelola Kegiatan

.............................................. ..............................................
NIP. NIP.