KOHORT IBU

DI WILAYAH UPTD PUSKESMAS MODO

TAHUN 2023

Desa

Bulan

No Kartu Keluarga Nik Ibu

No BPJS Ibu

No. HP Tanggal Lahir

RT/RW Umur Ibu (Tahun)

3
Bulan
4 Jenis Pemeriksaan
JANUARI FEBRUARI MARET APRIL MEI JUNI JULI
6 1 2 3
7 HPHT
8
9 TP
10 ###
7.205086803E+15 Ny. Rohana Muluk . Tn. Sahamin Salim .29/11/2000 22 S Potangoan
11 UK (Mgg) Ny. Ernawati S Husain .7205080809930000
Tn. Rusdin J Umar 10/9/2000 22 SMA Potangoan
Kesesuaian TFU dgn Usian
Kehamilan
GPA

Tanggal persalinan Terakhir

Jml Anak Hidup

Riwayat KB

Status Anemis

TD (mmHg)

TB (Cm)

BB (Kg)

Lila (Cm)

Palpasi

TFU

TBJ

LP

Presentasi

Hsil Kehamilan

hamil Sehat

Hamil Patologis

Hamil resiko stanting

DJJ

PMT

Fe 1

Fe 3
Imunisasi TT

Calon Pendonor

No.HP Calon Pendonor

Pemeriksaan Laboratorium

Goldar

HIV

Hepatitis

HB

Protein Urine

Kunjungan
K1

Kunj

USG

K2

K3

K4

Kunj

USG

K5

K6

Tatalaksana

Konseling
O

Nik Suami Alamat

Suami RT/RW

59
80/60 58.8
80/60 57.7
61.7
Keterangan
AGUSTUS SEPTEMBER OKTOBER ### NOVEMBER DESEMBER 120/80 58.9
4 5 ### 6 9 10 11 12
### 120/80 60
###
###
002/- 12/4/2022 9/11/2023 ### G 12/18/2021 Pil 100/70 156 47.6
1/25/2023 11/2/2023 ### G1P0A0 110/80 160 73.3
 23 81
24.5 20 83
24 89
91
78
13 14 15 16 17 18 19 20
29

23 Ball 71 30 A
29 Ball 81 30 3

dgdfg

QWEE2

FRTE
21 22 23 24 26 27 28 29 30 31 32 33 34 35

3/2/2023
3/20/2023 3/25/2023
36 37 38 39 40 43
Desa :
Bulan :
KO
DI WILAYAH UPT
TA

Nama

No No Kartu Keluarga No BPJS

Nik Ibu Ibu Nik Suami Suami

1 2 3
.7205080202110000 0 .7205086607870000 Ny. Juela P Jahur .7205081502840001 Tn. Ahmad A. Sindeo
.7205081209130001 1067866211 .7205034101930001 Ny.ira RS Ere .7205081203880002 Tn.Sudarmono
3 .7205081401080064 917731912 .7205084106820001 Ny.Ratna suleman .7205081605780003 Tn. Rusli G Kila
4 .7205031308190002 1570355807 .7205086005980004 Ny. Riana Harun .7205032307960002 Tn. Haris Harbi
5 .7205081901150001 1570359093 .7205085203950001 Ny. Masita S. Majid .7205080109790002 Tn. Amat Ismail
6 .7205080603180001 0 .7205084602010001 Ny. Marisa Alimin .7205081010960001 Tn. Yayan
7 .7205082711190001 3019883804 .7205056510910001 Ny. Musvita M Usman .72050 Tn. Ronal S Bandung
8 7205081201080038 .720508520680002 Ny. Irawati Hasani .72050 Tn. Samsudin D Kadiman
9 .7205084303020002 Ny. Puspita Ramli Tn. Zulpanur
10 2190950763 7205086802990001 Ny. Rohana Muluk .7205080203920000 Tn. Sahamin Salim
11 7205044910000001 Ny. Ernawati S Husain .7205080809930000 Tn. Rusdin J Umar
 KOHORT IBU
DI WILAYAH UPTD PUSKESMAS MODO
TAHUN 2023

Umur
Pendidik
Ibu UK
Tanggal Lahir an Alamat RT/RW No. HP HPHT TP
(Tahun (Mgg)
Terakhir
Suami )

3 4 5 6 9 10 11 12
Tn. Ahmad A. Sindeo 7/26/1987 35 SLTP Potangoan 007/004 7/10/2022 4/17/2023
Tn.Sudarmono 1/1/1993 30 SMA Potangoan 009/005 82296509206 10/26/2022 8/3/2023
Tn. Rusli G Kila 5/8/1982 40 SD Potangoan 001/001 ?/10/2022 ?/07/2023
Tn. Haris Harbi .20/05/1998 24 SLTA Potangoan 002/- 8/8/2022 5/15/2023
Tn. Amat Ismail .12/03/1995 27 Tdk sklh Potangoan 012/006 21-12-2022 28-09-2023 10
Tn. Yayan .06/02/2001 22 SD Potangoan 007/004 11-11-2022 18-08-2023 16
Tn. Ronal S Bandung .25/10/1991 33 SLTP Potangoan 010/005 15-11-2022 22-08-2023 15
Tn. Samsudin D Kadiman .12/06/1986 36 Potangoan 011/005 16-11-2022 23-08-2023 15
Tn. Zulpanur .03/07/2002 20 Potangoan 26-11-2022 03-09-2023 14
Tn. Sahamin Salim .29/11/2000 22 SMP Potangoan 002/- 04-12-2022 11-09-2023 12
Tn. Rusdin J Umar 10/9/2000 22 SMA Potangoan 25-01-2023 02-11-2023 10
 DATA JUMLAH IBU HAMIL
DI WILAYAH UPTD PUSKESMAS MODO
TAHUN 2023

Palpasi
Hsil Keha
Kesesuaian
Tanggal Jml
TFU dgn Riwaya Status TD TB BB Lila
GPA persalinan Anak Presenta
Usian t KB Anemis (mmHg) (Cm) (Kg) (Cm)
Terakhir Hidup TFU TBJ LP
Kehamilan si hamil
Sehat

13 14 15 16 17 18 19
G4 P3 A0 11/8/2016 3 pil 150/100 163 59 26.5 23 1550 81 kepala √
G3P2A0 1/18/2020 1 Suntik 80/60 157 58.8 24.5 20 83 √
G5 P3 A1 11/29/2015 3 pil 80/60 155 57.7 26 24 89 kepala
G2P1A0 9/15/2018 1 pil 90/70 150 61.7 26 22 1550 91 kepala
G3P4A0 2 Suntik 120/80 158 58.9 30 Ball Ball 78 Ball √
G2P1A0 11/21/2018 1 Pil 100/70 160 62.7 27 Ball Ball 78 Ball √
G4P2A1 2 Pil 120/80 150 60 29 Ball Ball Ball √
G7P5A1 Ball Ball Ball √
GIP0A0 Ball Ball Ball
G3P2A0 12/18/2021 Pil 100/70 156 47.6 23 Ball Ball 71 Ball
G1P0A0 110/80 160 73.3 29 Ball Ball 81 Ball √
 Pemeriksaan Laboratorium
Hsil Kehamilan
No.HP K1
Imunis Calon
DJJ PMT Fe 1 Fe 3 Calon Golda Hepatit Protein
asi TT Pendonor
Hamil Pendonor HIV HB GDS
Hamil r is Urine
Patologis
resiko Kunj
stanting

20 21 22 23 24 26 27 28 29 30 31

30 4 2/3/2023
30 3 2/3/2023
2/3/2023
2/3/2023
2/3/2023
√ 30 A 3/2/2023
30 3 3/20/2023
 Kunjungan

K1 K4
Tatalak Konseli
Ket
sana ng
K2 K3 K5 K6
USG Kunj USG

32 33 34 35 36 37 38 39 40 43
√
2/3/2023 √
2/3/2023 √
2/3/2023 √
√
√
√
√
√
√
3/25/2023 √
Desa :
Bulan :
KO
DI WILAYAH UPT
TA

Nama

No No Kartu Keluarga No BPJS

Nik Ibu Ibu Nik Suami Suami

1 2 3
1 .7205080202110000 0 .7205086607870000 Ny. Juela P Jahur .7205081502840001 Tn. Ahmad A. Sindeo
2 .7205081209130001 1067866211 .7205034101930001 Ny.ira RS Ere .7205081203880002 Tn.Sudarmono
3 .7205081401080064 917731912 .7205084106820001 Ny.Ratna suleman .7205081605780003 Tn. Rusli G Kila
4 .7205031308190002 1570355807 .7205086005980004 Ny. Riana Harun .7205032307960002 Tn. Haris Harbi
5 .7205081901150001 1570359093 .7205085203950001 Ny. Masita S. Majid .7205080109790002 Tn. Amat Ismail
6 .7205080603180001 0 .7205084602010001 Ny. Marisa Alimin .7205081010960001 Tn. Yayan
7 .7205082711190001 3019883804 .7205056510910001 Ny. Musvita M Usman .72050 Tn. Ronal S Bandung
8 7205081201080038 .720508520680002 Ny. Irawati Hasani .72050 Tn. Samsudin D Kadiman
9 .7205084303020002 Ny. Puspita Ramli Tn. Zulpanur
10 7205082112200001 2190950763 7205086802990001 Ny. Rohana Muluk .7205080203920000 Tn. Sahamin Salim
11 7205044910000001 Ny. Ernawati S Husain .7205080809930000 Tn. Rusdin J Umar
 KOHORT IBU
DI WILAYAH UPTD PUSKESMAS MODO
TAHUN 2023

Umur
Pendidik
Ibu UK
Tanggal Lahir an Alamat RT/RW No. HP HPHT TP
(Tahun (Mgg)
Terakhir
Suami )

3 4 5 6 9 10 11 12
Tn. Ahmad A. Sindeo 7/26/1987 35 SLTP Potangoan 007/004 7/10/2022 4/17/2023
Tn.Sudarmono 1/1/1993 30 SMA Potangoan 009/005 82296509206 10/26/2022 8/3/2023
Tn. Rusli G Kila 5/8/1982 40 SD Potangoan 001/001 ?/10/2022 ?/07/2023
Tn. Haris Harbi .20/05/1998 24 SLTA Potangoan 002/- 8/8/2022 5/15/2023
Tn. Amat Ismail .12/03/1995 27 Tdk sklh Potangoan 012/006 21-12-2022 28-09-2023 10
Tn. Yayan .06/02/2001 22 SD Potangoan 007/004 11-11-2022 18-08-2023 16
Tn. Ronal S Bandung .25/10/1991 33 SLTP Potangoan 010/005 15-11-2022 22-08-2023 15
Tn. Samsudin D Kadiman .12/06/1986 36 Potangoan 011/005 16-11-2022 23-08-2023 15
Tn. Zulpanur .03/07/2002 20 Potangoan 26-11-2022 03-09-2023 14
Tn. Sahamin Salim .29/11/2000 22 SMP Potangoan 002/- 04-12-2022 11-09-2023 12
Tn. Rusdin J Umar 10/9/2000 22 SMA Potangoan 25-01-2023 02-11-2023 10
 DATA JUMLAH IBU HAMIL
DI WILAYAH UPTD PUSKESMAS MODO
TAHUN 2023

Palpasi
Hsil Keha
Kesesuaian
Tanggal Jml
TFU dgn Riwaya Status TD TB BB Lila
GPA persalinan Anak Presenta
Usian t KB Anemis (mmHg) (Cm) (Kg) (Cm)
Terakhir Hidup TFU TBJ LP
Kehamilan si hamil
Sehat

13 14 15 16 17 18 19
G4 P3 A0 11/8/2016 3 pil 150/100 163 59 26.5 23 1705 81 kepala √
G3P2A0 1/18/2020 1 Suntik 80/60 157 58.8 24.5 20 1240 83 √
G5 P3 A1 11/29/2015 3 pil 80/60 155 57.7 26 24 1860 89 kepala
G2P1A0 9/15/2018 1 pil 90/70 150 61.7 26 22 1550 91 kepala
G3P4A0 2 Suntik 120/80 158 58.9 30 Ball Ball 78 Ball √
G2P1A0 11/21/2018 1 Pil 100/70 160 62.7 27 Ball Ball 78 Ball √
G4P2A1 2 Pil 120/80 150 60 29 Ball Ball 78 Ball √
G7P5A1 26 Ball Ball 78 Ball √
GIP0A0 Ball Ball Ball
G3P2A0 12/18/2021 Pil 100/70 156 47.6 23 Ball Ball 71 Ball
G1P0A0 110/80 160 73.3 29 Ball Ball 81 Ball √
 Pemeriksaan Laboratorium
Hsil Kehamilan
No.HP K1
Imunis Calon
DJJ PMT Fe 1 Fe 3 Calon Golda Hepatit Protein
asi TT Pendonor
Hamil Pendonor HIV HB GDS
Hamil r is Urine
Patologis
resiko Kunj
stanting

20 21 22 23 24 26 27 28 29 30 31

30 4 2/3/2023
30 3 2/3/2023
2/3/2023
2/3/2023
2/3/2023
√ 30 A 3/2/2023
30 3 3/20/2023
 Kunjungan

K1 K4
Tatalak Konseli
Ket
sana ng
K2 K3 K5 K6
USG Kunj USG

32 33 34 35 36 37 38 39 40 43
√
2/3/2023 √
2/3/2023 √
2/3/2023 √
√
√
√
√
√
√
3/25/2023 √
NO KEGIATAN JAN FEB
1 Jmlh Catin yg di dampingi 1 0
2 Jmlh Ibu Hamil yg di dampingi 7 9
3 Jmlh Ibu Paska Salin yg di dampingi 4 2
4 Jmlh Baduta/ Balita yg di dampingi 113 102
5 Jmlh penyuluhan / KIE 125 113
6 Jmlh Fasilitas Layanan Rujukan 2 2
7 Jmlh Fasilitas Bantuan Sosial

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