FORMULIR LAPORAN KESEHATAN BAYI

Puskesmas : Cubadak Kecamat : Dua Koto

Kabupaten : Pasaman Propinsi : Sumatera Barat

Jumlah Sasaran cakupan Buku KIA Cakupan BBLR Cakupan MTBM Cakupan MTBS Cakupan DDTK Jml Kematian

jlh Bayi jml KN % KN di jml kunj. jlh Bayi jlh bayi % bayi jlh bayi jml bayi
No urut Nama Jorong Total Ket
L P Punya % buku
Bayi punya jlh BBLR jml BBLR jlh KN jlh KN di % KN di MTBM
KIA di BTBM MTBM
di
MTBM MTBM Bayi sakit di % Bayi
MTBS
sakit di MTBS MTBS DDTK
kontak
%bayi DDTK
kontak 1
DDTK % bayi DDTK
kontak kontak 4x/thn Asfiksia BBLR TN ISPA Diare Lain2
buku KIA dirujuk dirujuk sakit MTBS dirujuk dirujuk 1 4x/thn

1 Hulu Pasaman 6 5 11 25 227.272727273 0 0 1 1 9.09090909091 0 0 0 0 0 0 0 3 27.2727272727 0 0 0 0 0 0 0 0

2 Tanah Runtuh 5 5 10 10 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 Air Mancur 6 7 13 12 92.3076923077 1 1 2 2 15.3846153846 0 0 0 0 0 0 0 1 7.69230769231 2 15.3846153846 0 0 0 0 0 0

4 Tanah Putih 10 12 22 15 68.1818181818 0 0 2 2 0 0 0 0 0 0 0 0 0 0 2 9.09090909091 0 0 0 0 0 0

5 Harapan rakyat 8 9 17 20 117.647058824 0 0 0 0 0 0 0 0 0 0 0 0 1 5.88235294118 0 0 0 0 0 0 0 0

6 Banjar Luas 5 5 10 10 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7 Bandar Mas 7 8 15 15 100 0 0 2 2 13.3333333333 0 0 0 0 0 0 0 0 0 1 6.66666666667 0 0 0 0 0 0

8 Teluk Embun 8 7 15 15 100 0 0 0 0 0 0 0 0 0 0 0 0 2 13.3333333333 2 13.3333333333 0 0 0 0 0 0

9 Tiga Muara 10 14 24 24 100 0 0 2 2 8.33333333333 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 Sentosa 11 12 23 23 100 0 0 1 1 4.34782608696 0 0 0 0 0 0 0 2 8.69565217391 0 0 0 0 0 0 0 0

11 Pagaran 11 9 20 20 100 0 0 2 2 10 0 0 0 0 0 0 0 2 10 0 0 0 0 0 0 0 0

12 Koto Tuo 11 10 21 21 100 0 0 3 3 14.2857142857 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Kp. Pinang 9 8 17 17 100 0 0 0 0 0 0 0 1 1 5.88235294118 0 0 0 0 0 0 0 0 0 0 0 0

14 Kuraba 5 5 10 10 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Pembangunan 10 10 20 20 100 0 0 2 2 10 0 0 1 1 5 0 0 0 0 0 0 0 0 0 0 0 0

16 Mangkumang D 6 5 11 11 100 0 0 2 2 18.1818181818 0 0 2 2 18.1818181818 0 0 0 0 0 0 0 0 0 0 0 0

17 Lanai hilir 12 10 22 19 86.3636363636 0 0 0 0 0 0 0 2 2 9.09090909091 0 0 0 0 0 0 0 0 0 0 0 0

18 lanai Mudik 9 8 17 17 100 0 0 0 0 0 0 0 3 3 0 0 0 1 5.88235294118 0 0 0 0 0 0 0 0

19 Sei Beremas 12 10 22 22 100 0 0 0 0 0 0 0 3 3 13.6363636364 0 0 0 0 0 0 0 0 0 0 0 0

20 Sigalabur 4 4 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

21 Sinuangon 2 1 3 6 200 0 0 0 0 0 0 0 0 0 0 0 0 1 33.3333333333 1 33.3333333333 0 0 0 0 0 0

22 Sei Jernih 1 1 2 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 Total 168 165 333 332 2191.77293295 1 1 19 19 102.957549697 0 0 12 12 51.7914438503 0 0 13 112.092059688 8 77.8088578089 0 0 0 0 0 0
Diketahui : Cubadak 02 Juni 2020
Kepala Puskesmas Cubadak Penanggung Jawab Program

MISRAYETI
Surya Saputra, SKM NIP.197609162014062003
NIP: 19890409 201503 1 002
 REKAPITULASI LAPORAN KESEHATAN ANAK BALITA

Puskesmas : Cubadak Kecamat : Dua koto

Kabupaten : Pasaman Propinsi : Sumatera Barat
BULAN : mei 2020

Jumlah Sasaran cakupan Buku KIA Cakupan Anak balita sakit di MTBS Cakupan DDTK Jml Kematian
jlh
No jlh jlh jlh anak % anak
Nama Jorong Total jlh Balita % Balita jlh kunj.Balit % Balita sakit jlh Balita %Balita A.Balita % A.Balita di A.Balita % A.Balita di balita di balita di
urut L P Punya punya buku kunj.Balit MTBS DDTK Kontak di DDTK DDTK Kontak ISPA DIARE Lain2
a sakit di di MTBS MTBS dirujuk di DDTK Kontak DDTK DDTK
buku KIA KIA a sakit dirujuk 1 2x/thn
MTBS Kontak 1 2x/thn dirujuk dirujuk

1 Hulu Pasaman 20 14 34 20 58.823529412 5 5 14.705882353 0 0 0 0 1 1 0 0 0 0 0

2 Tanah Runtuh 20 20 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Air Mancur 23 27 50 25 50 2 2 4 0 0 3 1 3 2 0 0 0 0 0
4 Tanah Putih 46 55 101 70 69.306930693 2 2 1.9801980198 0 0 2 1 7 4 0 0 0 0 0
5 Harapan rakyat 31 38 69 30 43.47826087 0 0 0 0 0 3 4.347826087 0 0 0 0 0 0 0
6 Banjar Luas 20 21 41 27 65.853658537 2 2 4.8780487805 0 0 0 0 0 0 0 0 0 0 0
7 Bandar Mas 27 25 52 47 90.384615385 4 4 7.6923076923 0 0 2 2 1 1.9230769231 0 0 0 0 0
8 Teluk Embun 34 34 68 40 58.823529412 3 3 4.4117647059 0 0 0 0 0 0 0 0 0 0 0
9 Tiga Muara 54 61 115 65 56.52173913 2 2 1.7391304348 0 0 0 0 1 0.8695652174 0 0 0 0 0
10 Sentosa 65 58 123 79 64.227642276 1 1 0.8130081301 0 0 0 0 0 0 0 0 0 0 0
11 Pagaran 47 41 88 40 45.454545455 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Koto Tuo 44 46 90 60 66.666666667 4 4 4.4444444444 0 0 0 0 0 0 0 0 0 0 0
13 Kp. Pinang 22 15 37 20 54.054054054 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Kuraba 21 21 42 25 59.523809524 1 1 2.380952381 0 0 2 4 2 6 0 0 0 0 0
15 Mangkumang D 40 40 80 39 48.75 3 3 3.75 0 0 0 0 0 0 0 0 0 0 0
16 Pembangunan 40 40 80 85 106.25 5 5 6.25 0 0 0 0 0 0 0 0 0 0 0
17 Lanai hilir 55 58 113 68 60.17699115 2 2 1.7699115044 0 0 0 0 0 0 0 0 0 0 0
18 lanai Mudik 24 25 49 38 77.551020408 5 5 10.204081633 0 0 2 4.0816326531 6 4 0 0 0 0 0
19 Sei Beremas 47 41 88 60 68.181818182 3 3 3.4090909091 0 0 0 3 0 0 0 0 0 0 0
20 Sigalabur 9 9 18 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sinuangon 10 6 16 20 125 0 0 0 0 0 3 3 0 1 0 0 0 0 0
22 Sei Jernih 10 7 17 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Jumlah Total 709 702 1411 858 1269.0288112 44 44 72.428820988 0 0 17 22.42945874 21 20.79264214 0 0 0 0 0
Diketahui : Cubadak, 02 JUNI 2020
Kepala UPT Puskesmas Cubadak Penanggung Jawab Program
 Surya Saputra,SKM MISRAYETI
NIP: 19890409 201503 1 002 NIP.197609162014062003
 REKAPITULASI LAPORAN KESEHATAN ANAK PRASEKOLAH

Puskesmas : Cubadak
Kabupaten : Pasaman Bulan : MEI 2020

Jumlah Sasaran Cakupan DDTK

No jlh Anak % Anak jlh Anak % Anak Jml anak % anak
urut Nama Jorong Total
L P prasekolah prasekolah prasekolah prasekolah prasekolah prasekolah
DDTK Kontak 1 DDTK Kontak 1 DDTK 2x/thn DDTK 2x/thn DDTK dirujuk DDTK dirujuk
1 Harapan rakyat 8 7 15 0 0 0 0 0 0
2 Tanah Runtuh 8 7 15 0 0 0 0 0 0
3 Air Mancur 9 11 20 1 5 3 15 0 0
4 Tanah Putih 19 22 31 4 12.90322580645 0 0 0 0
5 Harapan rakyat 12 5 28 2 7.142857142857 0 0 0 0
6 Banjar Luas 8 8 16 0 0 0 0 0 0
7 Bandar Mas 10 10 20 0 0 0 0 0 0
8 Teluk Embun 13 13 26 0 0 0 0 0 0
9 Tiga Muara 21 24 46 0 0 0 0 0 0
10 Sentosa 26 23 49 0 0 0 0 0 0
11 Pagaran 19 16 35 0 0 0 0 0 0
12 Koto Tuo 17 18 35 0 0 0 0 0 0
13 Kp. Pinang 14 14 28 0 0 0 0 0 0
14 Kuraba 8 8 16 1 6.25 0 0 0 0
15 Mangkumang Datar 10 9 19 0 0 0 0 0 0
16 Pembangunan 16 0 32 0 0 0 0 0 0
17 Lanai hilir 5 5 10 0 0 0 0 0 0
18 lanai Mudik 5 2 7 0 0 0 0 0 0
19 Sei Barameh 19 16 35 0 0 0 0 0 0
20 Sigalabur 6 7 13 0 0 0 0 0 0
21 Sinuangon 2 2 4 0 0 0 0 0 0
22 Sei Jernih 4 3 7 0 0 0 0 0 0
Jumlah Total 259 230 507 8 31.29608294931 3 15 0 0

Diketahui : Cubadak, 02 JUNI 2020

Kepala UPT Puskesmas Cubadak Penanggung Jawab Program

Surya Saputra MISRAYETI

NIP: 19890409 201503 1 002 NIP.197609162014062003
 LAPORAN LB3 ANAK

PUSKESMAS : CUBADAK
BULAN : MEI 2020
JUMLAH SELURUH SASARAN BAYI DALAM SATU TAHUN : 333

JORONG

NO DATA B.MAS SENTOSA B.TUHUR B.P.PEMBANGUNAN

MANGKUM
H.PASAMA TANAH AIR BANJAR TIGA PEMBANG SIGALABU SINUANG
T. PUTIH H.RAKYAT ANG S.BEREMAS S.JERNIH TOTAL
N RUNTUH MANCUR LUAS MUARA KOTO KP. UNAN R ON
T.EMBUN B.MAS SENTOSA PAGARAN KURABA DATAR L.HILIR L.MUDIK
TUO PINANG

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK LK
PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR
A. PERINATAL DAN BAYI

Jumlah Bayi lahir hidup

2 0 0 0 1 0 0 1 2 1 0 1 0 0 0 0 0 0 1 0 0 0 9
1.
0 0 2 2 0 0 0 1 0 0 2 2 0 0 1 1 1 1 0 0 1 0 14
Jumlah Bayi lahir Mati
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Bayi lahir prematur kurang dari
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3.
37 minggu (259) hari 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 2
Jumlah Bayi lahir hidup yang
1 0 0 0 0 0 0 1 2 1 0 1 0 0 0 0 0 0 0 0 0 0 6
4
mempunyai buku KIA 0 0 2 2 0 0 0 1 0 0 2 2 0 0 1 1 1 1 1 0 1 0 15
Jumlah Bayi dapat vitamin K1
1 0 0 0 0 0 0 1 2 1 0 1 0 0 0 0 0 0 0 0 0 0 6
5
0 0 2 1 0 0 0 1 0 0 2 2 0 0 1 1 1 1 1 0 1 0 14
Jumlah Bayi melaksanakan inisiasi dini
0 0 0 0 0 0 0 1 2 1 0 1 0 0 0 0 0 0 0 0 0 0 5
6
0 0 2 2 0 0 0 1 0 0 2 2 0 0 1 1 1 1 1 0 1 0 15
Jumlah Kunjungan neonatal pertama
1 0 0 0 0 0 0 1 2 1 0 1 0 0 0 0 0 0 0 0 0 0 6
7
(KN1,6 - 48 jam) sesuai standar 0 0 2 2 0 0 0 1 0 0 2 2 0 0 1 1 1 1 1 0 1 0 15
Jumlah kunjungan neonatal kedua
1 0 0 0 0 0 0 1 2 1 0 1 0 0 0 0 0 0 0 0 0 0 6
8
(KN2(3 - 7 hari )sesuai standar 0 0 2 2 0 0 0 1 0 0 2 2 0 0 1 1 1 1 1 0 1 0 15
Jumlah kunjungan neonatal lengkap
0 0 0 0 0 0 0 1 2 1 0 1 0 0 0 0 2 0 1 0 0 0 8
9
sesuai standar 5 0 2 1 0 0 0 1 0 0 2 2 0 0 1 1 2 1 0 0 1 0 19
Jumlah neonatus (0 - 28 )hari dengan
0 0 1 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 4
10
komplikasi yang ada 0 0 1 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 4
Jumlah neonatus (0 - 28 )hari dengan
0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
11
komplikasi yang ditangani 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah neonatus (0 - 28 hari) dengan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12
komplikasi yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Jumlah kunjungan bayi
0 0 0 0 0 0 0 0 0 3 0 0 0 0 1 0 2 0 0 0 0 0 6
13
0 0 0 2 0 0 0 1 0 4 0 0 0 0 1 0 0 0 0 0 0 0 8
Jumlah Bayi mendapatkan ASI Eksklusif
1 0 1 0 0 1 0 0 5 0 0 1 0 0 0 0 2 0 0 0 1 0 12
14
1 0 0 0 0 0 0 0 2 0 0 1 0 0 1 0 0 0 0 0 2 0 7
Jumlah Bayi dengan KPSDDp
0 0 4 2 0 0 0 2 0 0 0 0 0 0 0 0 4 0 0 0 1 0 13
15
(Penyimpangan ) 0 0 4 5 0 0 0 1 0 0 0 0 0 0 0 0 2 0 0 0 2 0 14
Jumlah kasus tetanus neonatorum
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Kelahiran dgn BBLR(<2500gr)
0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 2
17
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah BBLR yang ditangani
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah BBLR yang dirujuk
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kematian neonatal 0 - 7 hari,Penyebab
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Trauma lahir
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Asfiksia
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. BBLR(<2500gr)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Prematur <37 minggu (259 hari)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Infeksi
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
f. Tetanus neonatorum
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. Ikterus / kelainan darah
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. Kelainan bawaan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
i. Lain -lain (KJDK)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kematian neonatal 8 - 28 hari,
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21
penyebab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Uma lahir
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Asfiksia
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. BBLR ( < 2500gr )
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Prematur <37 minggu (259 hari)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Infeksi
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
f. Tetanus neonatorum
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. Ikterus / kelainan darah
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. Kelainan bawaan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
i. IUFD
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. Lain -lain (sebutkan........................)
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kematian neonatal 29 hari - 11 bln,
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22
Penyebab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Diare
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Pnemoni
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Meningitis /Sepalitis
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Sepsis
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Kelainan Jantung
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
f. Kelainan Pencernaan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. Ikterus / Kelainan darah
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. Kelainan bawaan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
i. Demam berdarah Dengue
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. Infeksi Paru
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. Tetanus
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. Lain - lain
sebutkan ................................. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 kasus kematian neonatus yang
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23
diotopsi verbal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ANAK BALITA DAN APRAS
B

Jumlah Kunjungan anak balita yang

4 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 4 4 0 0 0 0 13
24
sesuai dengan standar( 1 - 5 ) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 2 0 0 0 0 5
Jumlah anak balita dgn kelainan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25
tumbuh kembang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah anak balita dgn kelainan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26
tumbuh kembang yang ditangani 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah anak balita dgn tumbuh
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27
kembang yang dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah kunjungan APRAS
0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 4
28
0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 6
Jumlah APRAS deteksi /stimulasi
0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2
29
tumbuh kembang ( Kontak 1 ) 0 0 0 4 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 7
Jumlah APRAS dengan kelainan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30
tumbuh kembang 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah APRAS dengan kelainan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
31
tumbuh kembang yg ditangani 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah APRAS dengan tumbuh
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
32
kembang yg dirujuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah kunjungan balita ditangani dgn
0 0 0 0 0 0 0 1 0 0 0 4 0 0 0 0 1 0 2 0 0 0 8
33
MTBS 0 0 0 0 0 0 0 3 0 0 0 1 0 0 0 0 1 0 4 0 0 0 9
Jumlah anak balita mempunyai buku
11 0 15 40 15 0 10 0 0 0 0 0 0 14 0 0 30 23 0 0 12 0 170
34
KIA 9 0 20 30 15 0 12 0 0 0 0 0 0 10 0 0 38 29 0 0 14 0 177
Jumlah anak balita yg mendapat
0 0 1 0 0 0 0 1 0 0 0 0 2 0 0 0 0 0 0 0 0 0 4
35 pemantauan pertumbuhan min 4x /
tahun 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2
Jumlah anak balita yg mendapat
0 0 2 0 0 0 0 1 0 0 0 0 0 1 0 0 0 4 0 0 0 0 8
36 pemantauan pertumbuhan min 2x /
tahun 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 2 0 0 0 0 5
Jumlah kematian anak balita penyebab
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 a. Infeksi saluran nafas ( Pneumonia )
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Asfeksia
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Diare
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Malaria
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Campak
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
f. DBD
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. Meningitis/Nophalitis
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. Kelainan bawaan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
i. Sepsis
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. Gizi Buruk
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. Dll............. Tifus
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 Kematian Balita diaudit 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL
37 0 68 95 31 1 28 25 21 14 22 28 3 29 10 8 99 71 14 0 42 0 646
Diketahui : Cubadak, 02 JUNI 2020

Pimpinan Puskesmas Cubadak Penanggung Jawab Program

SURYA SAPUTRA MISRAYETI

NIP: 198904O9 201503 1 002 NIP.197609162014062003
 REKAP LAPORAN PWS-KIA (INDIKATOR KESEHATAN ANAK)
BULAN MEI TAHUN 2020
PUSKESMAS CUBADAK

Sasaran KN 1 KN Lengkap Neonatal Kompl Yg Ditangani kunjungan Bayi Yang Mendapatkan SHK Kunjungan Bayi Pel. Kesehatan Anak Balita Pelayanan Kesehatan Apras
Kumulatif Kumulatif Kumulatif Kumulatif Kumulatif Kumulatif Kumulatif
Neo
NO JORONG Bln Bln Bln Bln Bln Bln
Bayi A. Balita Resti Apras Bln ini R Bln ini R Bln ini R Bln Bln ABS % R Bln ini R Bln ini R Bln ini R
Lalu ABS % Lalu ABS % Lalu ABS % Lalu ABS % Lalu ABS % Lalu ABS %
Lalu Ini

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
1 Hulu Pasaman 12 51 2 20 7 1 5 41.7 0 2 5 7 58.3 0 0 0 0 0.0 0 0 0 0 0 0 1 0 2 16.7 0 0 2 14 27.5 0 2 0 5 25.0 0

2 Tanah Runtuh 10 40 1 16 0 0 3 30.0 0 0 0 5 50.0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 0 0.0 0 0 0 6 15.0 0 0 0 2 12.5 0

3 Air Mancur 12 50 2 20 0 2 5 41.7 0 0 1 3 25.0 0 0 0 0 0.0 0 0 0 0 0 0 1 2 8 66.7 0 2 2 14 28.0 0 1 1 3 15.0 0

4 Tanah Putih 25 101 4 40 2 2 7 28.0 0 1 2 6 24.0 0 0 0 1 0.0 0 0 0 0 0 0 3 0 2 8.0 0 4 7 17 16.8 0 0 4 6 15.0 0

5 Harapan Rakyat 17 70 2 28 0 0 4 23.5 0 0 0 2 11.8 0 0 0 0 0.0 0 0 0 0 0 0 0 0 1 5.9 0 0 0 6 8.6 0 0 2 2 7.1 0

6 Banjar Luas 10 41 1 16 1 0 2 20.0 0 1 0 2 20.0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 4 40.0 0 0 0 7 17.1 0 0 0 2 12.5 0

7 Bandar Mas 17 45 2 24 2 2 4 23.5 0 2 2 4 23.5 0 0 0 0 0.0 0 0 0 0 0 0 2 1 3 17.6 0 2 3 8 17.8 0 0 0 3 0.0 0

8 Teluk Embun 17 68 1 27 1 0 3 17.6 0 1 0 4 23.5 0 0 0 0 0.0 0 0 0 0 0 0 0 0 2 11.8 0 0 0 9 13.2 0 0 0 4 0.0 0

9 Tiga Muara 18 48 1 27 2 2 10 55.6 0 5 2 6 33.3 0 0 0 0 0.0 0 0 0 0 0 0 0 0 3 16.7 0 1 1 9 18.8 0 0 0 6 22.2 0

10 Sentosa 30 122 4 49 4 1 5 16.7 0 4 1 7 23.3 0 0 0 0 0.0 0 0 0 0 0 0 0 7 8 26.7 0 0 0 18 14.8 0 0 0 5 10.2 0

11 Pagaran 22 88 2 35 0 2 7 31.8 0 0 2 4 18.2 0 0 0 0 0.0 0 0 0 0 0 0 0 6 8 36.4 0 0 0 4 4.5 0 0 0 3 8.6 0

12 Koto Tuo 27 89 3 35 2 3 5 18.5 0 3 3 7 25.9 0 0 0 0 0.0 0 0 0 0 0 0 0 0 2 7.4 0 0 0 4 4.5 0 0 0 2 0.0 0

13 Kampung Pinang 22 89 3 35 2 0 2 9.1 0 2 0 1 4.5 0 0 0 0 0.0 0 0 0 0 0 0 0 0 6 27.3 0 0 0 6 6.7 0 0 0 0 0.0 0

14 Kuraba 10 42 1 16 0 0 0 0.0 0 0 0 0 0.0 0 0 0 0 0.0 0 0 0 0 0 0 3 0 2 20.0 0 6 2 10 23.8 0 0 1 2 12.5 0

15 Pembangunan 20 80 5 35 1 2 9 45.0 0 1 2 3 15.0 0 0 0 0 0.0 0 0 0 0 0 0 3 0 5 25.0 0 0 0 25 31.3 0 0 0 9 25.7 0

16 Mangkumang Datar 12 48 2 19 1 2 2 16.7 0 1 2 0 0.0 0 0 0 0 0.0 0 0 0 0 0 0 0 4 10 83.3 0 0 0 14 29.2 0 0 0 7 36.8 0

17 Lanai Hilir 22 53 3 32 5 0 4 18.2 0 3 0 2 9.1 0 0 0 0 0.0 0 0 0 0 0 0 8 0 5 22.7 0 0 2 25 47.2 0 0 0 14 43.8 0

18 Lanai Mudik 16 66 2 38 0 1 5 0.0 0 0 0 2 12.5 0 0 0 0 0.0 0 0 0 0 0 0 1 0 5 0.0 0 4 6 16 24.2 0 0 0 11 28.9 0

19 Sei Beremas 23 75 2 26 1 1 5 21.7 0 2 0 3 13.0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 4 17.4 0 0 0 4 5.3 0 0 0 3 11.5 0

20 Sigalabur 9 30 4 35 0 0 0 0.0 0 0 0 0 0.0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 1 0.0 0 0 0 1 3.3 0 0 0 1 2.9 0

21 Sinuangon 4 15 1 6 0 0 1 0.0 0 0 0 3 0.0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 2 0.0 0 0 3 7 46.7 0 0 0 0 0.0 0

22 Sei Jernih 4 17 1 7 0 0 0 0.0 0 0 0 0 0.0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 0 0.0 0 0 0 0 0.0 0 0 0 0 0.0

Total 359 1,328 49 586 31 21 88 459 0 28 22 71 391 0 0 0 1 0 0 0 0 0 0 0 22 20 83 449 0 19 28 224 404 0 3 8 90 15.4 0

Diketahui : Cubadak,02 JUNI 2020

Pimpinan Puskesmas Cubadak Penanggung Jawab Program

SURYA SAPUTRA,SKM MISRAYETI

NIP: 198904O9 201503 1 002 NIP.197609162014062003
LAPORAN KEMATIAN ANAK PUSKESMAS CUBADAK BULAN MARET

BULAN : MEI 2020

JORONG
NO DATA
AIR MANBUR H. RAKYAT BANJAR LUAS TANAH RUNTUH TANAH PUTIH HULU PASAMAN TIGA MUARA BANDAR MAS TELIK EMBUN SENTASO PAGARAN KOTO TUO Kp. PINANG
3 4 5 6 7 8 9 10 11 12 13 14 15
1 2
LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK
JUMLAH KEMATIAN ANAK 7-18 TAHUN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. kecelakaan transfortasi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b.Akibat Kehamilan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c.NAFZA 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. HIV/AIDS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
e. Penyakit Menular 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
f. penyakit Tidak Menular 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. Bunuh Diri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. Lain-Lain 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Diketahui CUBADAK, 02 JUNI 2020

Kepala Puskesmas Cubadak

SURYA SAPUTRA MISRAYETI

NIP: 198904O9 201503 1 002 NIP.197609162014062003
Kp. PINANG KURABA LANAI HILIR LANAI MUDIK PEMBANGUNAN MANGKUMANG DATAR Sei. BERMAS SIGALABOR SINUANGON Sei. JERNIH TOTAL
15 16 17 18 19 20 21 22 23 24 25
PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR LK PR
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0