Anda di halaman 1dari 143

PROVINSI : Jawa Timur

KABUPATEN : Bojonegoro
KECAMATAN : Padangan
PUSKESMAS : Banjarjo Padangan
BULAN FEBRUARI2020

TOTAL KUNJUNGAN
0-4 5-9
NO. TEMPAT PELAYANAN

L P L P L P

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWOREJO 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0

III. POLINDES
1 KEBONAGUNG 0 0
2 KENDUNG 0 0
3 NGRADIN 230 318 16 14 4 12
4 KUNCEN 0 0
5 PADANGAN 0 0
6 CENDONO 0 0
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 230 318 16 14 4 12

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJO 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0
JUMLAH 230 318 16 14 4 12

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN

10-14 15-19 20-24 25-29 30-34

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

3 10 8 10 24 16 13 28 19 33

3 10 8 10 24 16 13 28 19 33
0 0 0 0 0 0 0 0 0 0
3 10 8 10 24 16 13 28 19 33
LAPORAN BULANAN PEMANFA
TAHUN

KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

8 24 9 24 15 23 23 40 39 34

8 24 9 24 15 23 23 40 39 34
0 0 0 0 0 0 0 0 0 0
8 24 9 24 15 23 23 40 39 34
NAN PEMANFAATAN PELAYANAN KESEHATAN
TAHUN : 2016

BAYAR
60-64 65-69 70-74 75+

CP HAJI
L P L P L P L P

0 0 0 0 0 0 0 0 0 0

6 28 32 12 5 9 6 1

6 28 32 12 5 9 6 1 0 0
0 0 0 0 0 0 0 0 0 0
6 28 32 12 5 9 6 1 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKE
NON PBI
SURAT TOTAL TOTAL
LAIN² PBI JAMSOST TNI/ KARTU
SEHAT BAYAR ASKES JKN
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 360 360
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 360 0 0 0 0 360 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 360 0 0 0 0 360 0
JENIS PELAYANAN
JAMKESDA
TOTAL BP GIGI KIA KB UGD LAB LINKES
KK/
SPM JAMKESD
KARTU
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
188 188 420 113 15
0
0
0
0
0
0
0
0
0
0
0
188 0 188 420 0 113 15 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
188 0 188 420 0 113 15 0 0 0

........................,................................. 2019
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
PERAWAT
LAIN² PELAYAN
AN
AN

0
0
0
0
0 0 0

0
0
548 230 230
0 318 318
0 548 188
0 128
0
0
0
0
0
0
0
0
0 0 548

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0
0 0 548

......
PROVINSI : Jawa Timur
KABUPATEN : Bojonegoro
KECAMATAN : Padangan
PUSKESMAS : Banjarjo Padangan
BULAN JANUARI 2020

TOTAL KUNJUNGAN
0-4 5-9
NO. TEMPAT PELAYANAN

L P L P L P

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWOREJO 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0

III. POLINDES
1 KEBONAGUNG 0 0
2 KENDUNG 0 0
3 NGRADIN 180 275 16 14 12 12
4 KUNCEN 0 0
5 PADANGAN 0 0
6 CENDONO 0 0
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 180 275 16 14 12 12

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJO 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0
JUMLAH 180 275 16 14 12 12

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN M

10-14 15-19 20-24 25-29 30-34

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

13 10 13 12 16 16 17 28 20 33

13 10 13 12 16 16 17 28 20 33
0 0 0 0 0 0 0 0 0 0
13 10 13 12 16 16 17 28 20 33
LAPORAN BULANAN PEMANFAA
TAHUN

KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

8 18 9 17 15 19 12 23 7 29

8 18 9 17 15 19 12 23 7 29
0 0 0 0 0 0 0 0 0 0
8 18 9 17 15 19 12 23 7 29
NAN PEMANFAATAN PELAYANAN KESEHATAN
TAHUN : 2016

BAYAR
60-64 65-69 70-74 75+

CP HAJI
L P L P L P L P

0 0 0 0 0 0 0 0 0 0

6 28 5 6 5 9 6 1

6 28 5 6 5 9 6 1 0 0
0 0 0 0 0 0 0 0 0 0
6 28 5 6 5 9 6 1 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESD
NON PBI
SURAT TOTAL TOTAL
LAIN² PBI JAMSOST TNI/ KARTU
SEHAT BAYAR ASKES JKN
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 224 270
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 224 0 0 0 0 270 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 224 0 0 0 0 270 0
JENIS PELAYANAN
JAMKESDA
TOTAL BP GIGI KIA KB UGD LAB LINKES
KK/
SPM JAMKESD
KARTU
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
185 185 360 83 12
0
0
0
0
0
0
0
0
0
0
0
185 0 185 360 0 83 12 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
185 0 185 360 0 83 12 0 0 0

........................,................................. 2019
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
PERAWA
LAIN² PELAYAN
TAN
AN

0
0
0
0
0 0 0

0
0
455 180 180
0 275 275
0 455
0
0
0
0
0
0
0
0
0
0 0 455

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0
0 0 455

.......
PROVINSI : Jawa Timur
KABUPATEN : Bojonegoro
KECAMATAN : Padangan
PUSKESMAS : Banjarjo Padangan
BULAN FEBRUARI 2020

TOTAL KUNJUNGAN
0-4 5-9
NO. TEMPAT PELAYANAN

L P L P L P

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWOREJO 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0

III. POLINDES
1 KEBONAGUNG 0 0
2 KENDUNG 0 0
3 NGRADIN 160 200 4 5 6 3
4 KUNCEN 0 0
5 PADANGAN 0 0
6 CENDONO 0 #NAME?
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 160 #NAME? 4 5 6 3

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJO 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0
JUMLAH 160 #NAME? 4 5 6 3

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN M

10-14 15-19 20-24 25-29 30-34

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

2 4 13 12 5 12 9 20 19 33

2 4 13 12 5 12 9 20 19 33
0 0 0 0 0 0 0 0 0 0
2 4 13 12 5 12 9 20 19 33
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

10 25 3 15 8 9 12 12 15 15

10 25 3 15 8 9 12 12 15 15
0 0 0 0 0 0 0 0 0 0
10 25 3 15 8 9 12 12 15 15
BAYAR
60-64 65-69 70-74 75+

CP HAJI
L P L P L P L P

0 0 0 0 0 0 0 0 0 0

9 16 16 10 15 8 12 1

#NAME?

9 16 16 10 15 #NAME? 12 1 0 0
0 0 0 0 0 0 0 0 0 0
9 16 16 10 15 #NAME? 12 1 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESD
NON PBI
SURAT TOTAL TOTAL
LAIN² PBI JAMSOST TNI/ KARTU
SEHAT BAYAR ASKES JKN
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 360 360
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 360 0 0 0 0 360 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 360 0 0 0 0 360 0
JENIS PELAYANAN
JAMKESDA
TOTAL BP GIGI KIA KB UGD LAB LINKES
KK/
SPM JAMKESD
KARTU
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 320 40
0
0
0
0
0
0
0
0
0
0
0
0 0 0 320 0 40 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 320 0 40 0 0 0 0

........................,................................. 2019
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
PERAWA
LAIN² PELAYAN
TAN
AN

0
0
0
0
0 0 0

0
0
360
0
0
0
0
0
0
0
0
0
0
0
0 0 360

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0
0 0 360

.......
PROVINSI : Jawa Timur
KABUPAT: Bojonegoro
KECAMAT: Padangan
PUSKESM: Banjarjo Padangan
BULAN FEBRUARI2020

TOTAL KUNJUNGAN
0-4 5-9 10-14
NO. TEMPAT PELAYANAN

L P L P L P L

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWORE 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0 0

III. POLINDES
1 KEBONAG 0 0
2 KENDUNG 0 0
3 NGRADIN 164 200 4 5 6 3 2
4 KUNCEN 0 0
5 PADANGA 0 0
6 CENDONO 0 #NAME?
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 164 #NAME? 4 5 6 3 2

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJ 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0 0
JUMLAH 164 #NAME? 4 5 6 3 2

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN MENURUT K

10-14 15-19 20-24 25-29 30-34 35-39

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

4 13 12 7 12 10 20 19 33 11

4 13 12 7 12 10 20 19 33 11
0 0 0 0 0 0 0 0 0 0
4 13 12 7 12 10 20 19 33 11
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59 60-64

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

25 3 15 8 9 12 12 15 15 9

25 3 15 8 9 12 12 15 15 9
0 0 0 0 0 0 0 0 0 0
25 3 15 8 9 12 12 15 15 9
BAYAR
60-64 65-69 70-74 75+
SURAT
CP HAJI
P L P L P L P SEHAT

0 0 0 0 0 0 0 0 0 0

16 16 10 15 8 12 1

#NAME?

16 16 10 15 #NAME? 12 1 0 0 0
0 0 0 0 0 0 0 0 0 0
16 16 10 15 #NAME? 12 1 0 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESDA
NON PBI
TOTAL TOTAL KK/
LAIN² PBI JAMSOST TNI/ KARTU
BAYAR ASKES JKN KARTU
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 364 364
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 364 0 0 0 0 364 0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 364 0 0 0 0 364 0 0
JENIS PELAYANAN
JAMKESDA
TOTAL PERAWA
BP GIGI KIA KB UGD LAB LINKES
SPM JAMKESD TAN
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 324 40
0
0
0
0
0
0
0
0
0
0
0
0 0 324 0 40 0 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 324 0 40 0 0 0 0 0

........................,................................. 2019
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
LAIN² PELAYAN
AN

0
0
0
0
0 0

0
0
364
0
0
0
0
0
0
0
0
0
0
0
0 364

0
0
0
0
0
0
0
0
0
0
0
0
0 0
0 364
LAPORAN BULANAN PEMANFAATAN PELAYANAN KESEHATAN
TAHUN : 2016
PROVINSI : Jawa Timur
KABUPATEN : Bojonegoro
KECAMATAN : .....................
PUSKESMAS : .....................
BULAN : .....................

KUNJUNGAN MENURUT KELOMPOK UMUR STATUS KUNJUNGAN JENIS PELAYANAN


TOTAL BAYAR GRATIS / JKN JAMKESDA
KUNJUNGAN 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ TOT
NON PBI TOT PER AL
NO. TEMPAT PELAYANAN SUR TOTA TOT KK/ AL BP GIGI KIA LINK AW LAIN
AT LAIN L KAR KB UGD LAB PEL
CP HAJI PBI ASK MA JAM TNI/ AL KAR SPM JAM ES ATA ² AYA
L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P SEH ² BAYA TU N
AT R ES NDI SOS POL JKN TU KES NAN
RI TEK RI DA
I. PUSK. INDUK 0 0 0 0 0 0

II. PUSTU
1 PURWOREJO 0 0 0 0 0 0
2 DENGOK 0 0 0 0 0 0
3 0 0 0 0 0 0
4 0 0 0 0 0 0
TOTAL PUSTU 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

III. POLINDES
1 KEBONAGUNG 0 0 0 0 0 0
2 KENDUNG 0 0 0 0 0 0
3 NGRADIN 0 0 0 0 0 0
4 KUNCEN 0 0 0 0 0 0
5 PADANGAN 0 0 0 0 0 0
6 CENDONO 0 0 0 0 0 0
7 SIDOREJO 0 0 0 0 0 0
8 PRANGI 0 0 0 0 0 0
9 0 0 0 0 0 0
10 0 0 0 0 0 0
11 0 0 0 0 0 0
12 0 0 0 0 0 0
13 0 0 0 0 0 0
14 0 0 0 0 0 0
TOTAL POLINDES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

IV. PONKESDES
1 TEBON 0 0 0 0 0 0
2 NGEPER 0 0 0 0 0 0
3 NGASINAN 0 0 0 0 0 0
4 NGUKEN 0 0 0 0 0 0
5 SONOREJO 0 0 0 0 0 0
6 0 0 0 0 0 0
7 0 0 0 0 0 0
8 0 0 0 0 0 0
9 0 0 0 0 0 0
10 0 0 0 0 0 0
11 0 0 0 0 0 0
12 0 0 0 0 0 0
TOTAL PONKESDES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui ........................,................................. 2016


Kepala Puskesmas ...................... Pengelola SP2TP

......................................................... .....................................................................................
NIP. NIP.
Compatibility Report for PEMANFAATAN PELY. KES. 2019
TERBARU_NGRADIN.xls
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Version

Excel 97-2003
PROVINSI : Jawa Timur
KABUPAT: Bojonegoro
KECAMAT: Padangan
PUSKESM: Banjarjo Padangan
BULAN MEI 2020

TOTAL KUNJUNGAN
0-4 5-9 10-14
NO. TEMPAT PELAYANAN

L P L P L P L

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWORE 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0 0

III. POLINDES
1 KEBONAG 0 0
2 KENDUNG 0 0
3 NGRADIN 160 200 3 5 5 3 2
4 KUNCEN 0 0
5 PADANGA 0 0
6 CENDONO 0 #NAME?
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 160 #NAME? 3 5 5 3 2

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJ 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0 0
JUMLAH 160 #NAME? 3 5 5 3 2

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN MENURUT K

10-14 15-19 20-24 25-29 30-34 35-39

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

4 12 12 7 12 10 20 19 33 11

4 12 12 7 12 10 20 19 33 11
0 0 0 0 0 0 0 0 0 0
4 12 12 7 12 10 20 19 33 11
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59 60-64

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

25 3 15 8 9 12 12 15 15 9

25 3 15 8 9 12 12 15 15 9
0 0 0 0 0 0 0 0 0 0
25 3 15 8 9 12 12 15 15 9
BAYAR
60-64 65-69 70-74 75+
SURAT
CP HAJI
P L P L P L P SEHAT

0 0 0 0 0 0 0 0 0 0

16 16 10 15 8 12 1

#NAME?

16 16 10 15 #NAME? 12 1 0 0 0
0 0 0 0 0 0 0 0 0 0
16 16 10 15 #NAME? 12 1 0 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESDA
NON PBI
TOTAL TOTAL KK/
LAIN² PBI JAMSOST TNI/ KARTU
BAYAR ASKES JKN KARTU
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 360 360
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 360 0 0 0 0 360 0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 360 0 0 0 0 360 0 0
JENIS PELAYANAN
JAMKESDA
TOTAL PERAWA
BP GIGI KIA KB UGD LAB LINKES
SPM JAMKESD TAN
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 320 40
0
0
0
0
0
0
0
0
0
0
0
0 0 320 0 40 0 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 320 0 40 0 0 0 0 0

........................,................................. 2020
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
LAIN² PELAYAN
AN

0
0
0
0
0 0

0
0
360
0
0
0
0
0
0
0
0
0
0
0
0 360

0
0
0
0
0
0
0
0
0
0
0
0
0 0
0 360
PROVINSI : Jawa Timur
KABUPAT: Bojonegoro
KECAMAT: Padangan
PUSKESM: Banjarjo Padangan
BULAN : JUNI 2020

TOTAL KUNJUNGAN
0-4 5-9 10-14
NO. TEMPAT PELAYANAN

L P L P L P L

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWORE 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0 0

III. POLINDES
1 KEBONAG 0 0
2 KENDUNG 0 0
3 NGRADIN 165 200 3 5 5 3 4
4 KUNCEN 0 0
5 PADANGA 0 0
6 CENDONO 0 0
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 165 200 3 5 5 3 4

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJ 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0 0
JUMLAH 165 200 3 5 5 3 4

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN MENURUT K

10-14 15-19 20-24 25-29 30-34 35-39

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

4 13 12 7 12 12 20 19 33 11

4 13 12 7 12 12 20 19 33 11
0 0 0 0 0 0 0 0 0 0
4 13 12 7 12 12 20 19 33 11
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59 60-64

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

25 3 15 8 9 12 12 15 15 9

25 3 15 8 9 12 12 15 15 9
0 0 0 0 0 0 0 0 0 0
25 3 15 8 9 12 12 15 15 9
BAYAR
60-64 65-69 70-74 75+
SURAT
CP HAJI
P L P L P L P SEHAT

0 0 0 0 0 0 0 0 0 0

16 16 10 15 8 12 1

16 16 10 15 8 12 1 0 0 0
0 0 0 0 0 0 0 0 0 0
16 16 10 15 8 12 1 0 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESDA
NON PBI
TOTAL TOTAL KK/
LAIN² PBI JAMSOST TNI/ KARTU
BAYAR ASKES JKN KARTU
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 365 365
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 365 0 0 0 0 365 0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 365 0 0 0 0 365 0 0
JENIS PELAYANAN
JAMKESDA
TOTAL PERAWA
BP GIGI KIA KB UGD LAB LINKES
SPM JAMKESD TAN
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 325 40
0
0
0
0
0
0
0
0
0
0
0
0 0 325 0 40 0 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 325 0 40 0 0 0 0 0

........................,................................. 2020
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
LAIN² PELAYAN
AN

0
0
0
0
0 0

0
0
365
0
0
0
0
0
0
0
0
0
0
0
0 365

0
0
0
0
0
0
0
0
0
0
0
0
0 0
0 365
PROVINSI : Jawa Timur
KABUPATEN : Bojonegoro
KECAMATAN : Padangan
PUSKESMAS : Banjarjo Padangan
BULAN : JULI 2020

TOTAL KUNJUNGAN
0-4 5-9
NO. TEMPAT PELAYANAN

L P L P L P

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWOREJO 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0

III. POLINDES
1 KEBONAGUNG 0 0
2 KENDUNG 0 0
3 NGRADIN 170 200 4 5 6 3
4 KUNCEN 0 0
5 PADANGAN 0 0
6 CENDONO 0 0
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 170 200 4 5 6 3

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJO 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0
JUMLAH 170 200 4 5 6 3

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN

10-14 15-19 20-24 25-29 30-34

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

5 4 14 12 8 12 12 20 19 33

5 4 14 12 8 12 12 20 19 33
0 0 0 0 0 0 0 0 0 0
5 4 14 12 8 12 12 20 19 33
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

11 25 3 15 8 9 12 12 15 15

11 25 3 15 8 9 12 12 15 15
0 0 0 0 0 0 0 0 0 0
11 25 3 15 8 9 12 12 15 15
BAYAR
60-64 65-69 70-74 75+

CP HAJI
L P L P L P L P

0 0 0 0 0 0 0 0 0 0

9 16 16 10 15 8 12 1

9 16 16 10 15 8 12 1 0 0
0 0 0 0 0 0 0 0 0 0
9 16 16 10 15 8 12 1 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKE
NON PBI
SURAT TOTAL TOTAL
LAIN² PBI JAMSOST TNI/ KARTU
SEHAT BAYAR ASKES JKN
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 370 370
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 370 0 0 0 0 370 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 370 0 0 0 0 370 0
JENIS PELAYANAN
JAMKESDA
TOTAL BP GIGI KIA KB UGD LAB LINKES
KK/
SPM JAMKESD
KARTU
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 330 40
0
0
0
0
0
0
0
0
0
0
0
0 0 0 330 0 40 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 330 0 40 0 0 0 0

........................,................................. 2020
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
PERAWAT
LAIN² PELAYAN
AN
AN

0
0
0
0
0 0 0

0
0
370
0
0
0
0
0
0
0
0
0
0
0
0 0 370

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0
0 0 370

......
PROVINSI : Jawa Timur
KABUPAT: Bojonegoro
KECAMAT: Padangan
PUSKESM: Banjarjo Padangan
BULAN Agustus 2020

TOTAL KUNJUNGAN
0-4 5-9 10-14
NO. TEMPAT PELAYANAN

L P L P L P L

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWORE 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0 0

III. POLINDES
1 KEBONAG 0 0
2 KENDUNG 0 0
3 NGRADIN 165 200 3 5 5 3 4
4 KUNCEN 0 0
5 PADANGA 0 0
6 CENDONO 0 0
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 165 200 3 5 5 3 4

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJ 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0 0
JUMLAH 165 200 3 5 5 3 4

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN MENURUT K

10-14 15-19 20-24 25-29 30-34 35-39

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

4 12 12 8 12 12 20 19 33 11

4 12 12 8 12 12 20 19 33 11
0 0 0 0 0 0 0 0 0 0
4 12 12 8 12 12 20 19 33 11
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59 60-64

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

25 3 15 8 9 12 12 15 15 9

25 3 15 8 9 12 12 15 15 9
0 0 0 0 0 0 0 0 0 0
25 3 15 8 9 12 12 15 15 9
BAYAR
60-64 65-69 70-74 75+
SURAT
CP HAJI
P L P L P L P SEHAT

0 0 0 0 0 0 0 0 0 0

16 16 10 15 8 12 1

16 16 10 15 8 12 1 0 0 0
0 0 0 0 0 0 0 0 0 0
16 16 10 15 8 12 1 0 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESDA
NON PBI
TOTAL TOTAL KK/
LAIN² PBI JAMSOST TNI/ KARTU
BAYAR ASKES JKN KARTU
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 365 365
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 365 0 0 0 0 365 0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 365 0 0 0 0 365 0 0
JENIS PELAYANAN
JAMKESDA
TOTAL PERAWA
BP GIGI KIA KB UGD LAB LINKES
SPM JAMKESD TAN
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 330 40
0
0
0
0
0
0
0
0
0
0
0
0 0 330 0 40 0 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 330 0 40 0 0 0 0 0

........................,................................. 2020
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
LAIN² PELAYAN
AN

0
0
0
0
0 0

0
0
365
0
0
0
0
0
0
0
0
0
0
0
0 365

0
0
0
0
0
0
0
0
0
0
0
0
0 0
0 365
PROVINSI : Jawa Timur
KABUPATEN : Bojonegoro
KECAMATAN : Padangan
PUSKESMAS : Banjarjo Padangan
BULAN September 2020

TOTAL KUNJUNGAN
0-4 5-9
NO. TEMPAT PELAYANAN

L P L P L P

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWOREJO 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0

III. POLINDES
1 KEBONAGUNG 0 0
2 KENDUNG 0 0
3 NGRADIN 366 200 3 5 5 3
4 KUNCEN 0 0
5 PADANGAN 0 0
6 CENDONO 0 0
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 366 200 3 5 5 3

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJO 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0
JUMLAH 366 200 3 5 5 3

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN M

10-14 15-19 20-24 25-29 30-34

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

4 4 12 12 8 12 13 20 19 33

4 4 12 12 8 12 13 20 19 33
0 0 0 0 0 0 0 0 0 0
4 4 12 12 8 12 13 20 19 33
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59

L P L P L P L P L P

0 0 0 0 0 0 0 0 0 0

11 25 3 15 8 9 12 12 15 15

11 25 3 15 8 9 12 12 15 15
0 0 0 0 0 0 0 0 0 0
11 25 3 15 8 9 12 12 15 15
BAYAR
60-64 65-69 70-74 75+

CP HAJI
L P L P L P L P

0 0 0 0 0 0 0 0 0 0

9 16 16 10 15 8 12 1

9 16 16 10 15 8 12 1 0 0
0 0 0 0 0 0 0 0 0 0
9 16 16 10 15 8 12 1 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESD
NON PBI
SURAT TOTAL TOTAL
LAIN² PBI JAMSOST TNI/ KARTU
SEHAT BAYAR ASKES JKN
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 366 366
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 366 0 0 0 0 366 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 366 0 0 0 0 366 0
JENIS PELAYANAN
JAMKESDA
TOTAL BP GIGI KIA KB UGD LAB LINKES
KK/
SPM JAMKESD
KARTU
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 331 40
0
0
0
0
0
0
0
0
0
0
0
0 0 0 331 0 40 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 0 331 0 40 0 0 0 0

........................,................................. 2020
Pengelola SP2TP

.....................................................................................
NIP.
PERAWA TOTAL
LAIN² PELAYAN
TAN
AN

0
0
0
0
0 0 0

0
0
366
0
0
0
0
0
0
0
0
0
0
0
0 0 366

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0
0 0 366

.......
PROVINSI : Jawa Timur
KABUPAT: Bojonegoro
KECAMAT: Padangan
PUSKESM: Banjarjo Padangan
BULAN Oktober 2020

TOTAL KUNJUNGAN
0-4 5-9 10-14
NO. TEMPAT PELAYANAN

L P L P L P L

I. PUSK. INDUK 0 0

II. PUSTU
1 PURWORE 0 0
2 DENGOK 0 0
3 0 0
4 0 0
TOTAL PUSTU 0 0 0 0 0 0 0

III. POLINDES
1 KEBONAG 0 0
2 KENDUNG 0 0
3 NGRADIN 165 200 5 5 5 3 2
4 KUNCEN 0 0
5 PADANGA 0 0
6 CENDONO 0 0
7 SIDOREJO 0 0
8 PRANGI 0 0
9 0 0
10 0 0
11 0 0
12 0 0
13 0 0
14 0 0
TOTAL POLINDES 165 200 5 5 5 3 2

IV. PONKESDES
1 TEBON 0 0
2 NGEPER 0 0
3 NGASINAN 0 0
4 NGUKEN 0 0
5 SONOREJ 0 0
6 0 0
7 0 0
8 0 0
9 0 0
10 0 0
11 0 0
12 0 0
TOTAL PONKESDES 0 0 0 0 0 0 0
JUMLAH 165 200 5 5 5 3 2

Mengetahui
Kepala Puskesmas ......................

.........................................................
NIP.
KUNJUNGAN MENURUT K

10-14 15-19 20-24 25-29 30-34 35-39

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

4 12 12 7 12 12 20 20 33 11

4 12 12 7 12 12 20 20 33 11
0 0 0 0 0 0 0 0 0 0
4 12 12 7 12 12 20 20 33 11
KUNJUNGAN MENURUT KELOMPOK UMUR

35-39 40-44 45-49 50-54 55-59 60-64

P L P L P L P L P L

0 0 0 0 0 0 0 0 0 0

25 3 15 8 9 12 12 15 15 9

25 3 15 8 9 12 12 15 15 9
0 0 0 0 0 0 0 0 0 0
25 3 15 8 9 12 12 15 15 9
BAYAR
60-64 65-69 70-74 75+
SURAT
CP HAJI
P L P L P L P SEHAT

0 0 0 0 0 0 0 0 0 0

16 16 10 15 8 12 1

16 16 10 15 8 12 1 0 0 0
0 0 0 0 0 0 0 0 0 0
16 16 10 15 8 12 1 0 0 0
STATUS KUNJUNGAN
BAYAR GRATIS / JKN JAMKESDA
NON PBI
TOTAL TOTAL KK/
LAIN² PBI JAMSOST TNI/ KARTU
BAYAR ASKES JKN KARTU
MANDIRI EK POLRI
0 0

0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0

0 0
0 0
0 365 365
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 365 0 0 0 0 365 0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0 0 0
0 0 365 0 0 0 0 365 0 0
JENIS PELAYANAN
JAMKESDA
TOTAL PERAWA
BP GIGI KIA KB UGD LAB LINKES
SPM JAMKESD TAN
A
0

0
0
0
0
0 0 0 0 0 0 0 0 0 0

0
0
0 320 45
0
0
0
0
0
0
0
0
0
0
0
0 0 320 0 45 0 0 0 0 0

0
0
0
0
0
0
0
0
0
0
0
0
0 0 0 0 0 0 0 0 0 0
0 0 320 0 45 0 0 0 0 0

........................,................................. 2020
Pengelola SP2TP

.....................................................................................
NIP.
TOTAL
LAIN² PELAYAN
AN

0
0
0
0
0 0

0
0
365
0
0
0
0
0
0
0
0
0
0
0
0 365

0
0
0
0
0
0
0
0
0
0
0
0
0 0
0 365

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