LHK Bok Tahun 2023

No Kegiatan No
1 Pelacakan OVP 11
2 Pelacakan OVM 12
3 Pelacakan kronologis ke RS 13
4 Pelaporan kematian dan pelaksanaan otopsi verbal kematian

14 Ibu dan Bayi/balita
5 Rapat validasi dan evaluasi data Gikia Bersama lintas Sektor

15
6 Evaluasi E-Kohort dan PSG 16
7 Pelaksanaan edukasi bimbingan perkawinan/konseling pranikah

17 di KUA atau lembaga agama dan skrining calon pengantin
8 Pelaksanaan penyuluhan KB di Posyandu 18
9 Penyuluhan Kesehatan Reproduksi pada Remaja di Sekolah

19
10 Kelas Ibu Hamil 20

Kegiatan No Kegiatan
ANC Terpadu di Kelas Ibu Hamil 21 Penjaringan Siswa SD/MI
Kelas Ibu Balita 22 Penjaringan Siswa SMP/MTs
Rapat Koordinasi dengan OPD/perangkat desa dan23

Masyarakat
Deteksi dini/Skrining
terkait Perencanaan
faktor risiko
Persalinan
& PTM Prioritas
dan Pencegahan
di Posbindu
K
Pendampingan rujukan balita stunting /gizi buruk ( Komponen

24 SkriningPilihan
perilaku
) merokok dengan Monitoring KTR di Sekolah
Pembinaan Posyandu Balita 25 Kunjungan rumah u/ pemantauan Imunisasi pada bayi dg ibu
Pembinaan Pelayanan Kesehatan Ibu dan Anak di 26

Praktek
Penemuan
Mandiriaktif
Bidankasus PD3I
Kunjungan Pembinaan Pelayanan - Supervisi Supportif

27 Kunjungan rumah dan KIE Bumil HBsAg Reaktif
Kunjungan Lapangan Bumil Risti 28 Kunjungan Rumah Pasien Kusta
Kunjungan Lapangan Bufas Risti 29 Pendataan Sasaran POPM
Kunjungan Lapangan Neo/Bayi Risti 30 Pemberian Obat Pencegahan Massal (POPM)

No Kegiatan No
31 Pemantauan minum oralit dan zinc bagi diare balita41
di masyarakat
32 Pengambilan dan Pengiriman Spesimen TB Paru 42
33 Pemberdayaan kader masyarakat dalam pencegahan

43 Penyakit Menular Demam Berdarah

44 Penyakit Menular dengan Pembentukan dan pengaktifan

45 Penyakit Menular dalam rangka Monitoring dan evaluasi
36 Pemberdayaan kader masyarakat terlibat dalam pelaksanaan

46 deteksi dini Faktor Risiko Penyakit Tidak Menular
37 Pengiriman dan pemeriksaan Spesimen Penyakit Potensi

47 KLB/Wabah/Penyakit Infeksi Emerging ke Laboratoriu
38 Imunisasi Rutin 48
39 Investigasi kejadian kasus KIPI 49
40 Penyelidikan Epidemiologi Penyakit berpotensi KLB/Wabah

50 dan Penyakit Infeksi PD3i
Kegiatan
Survei vektor malaria, DBD dan reservoar Leptospirosis
Pelaksanaan gerakan kesehatan kerja di POS UKK
Pelaksanaan Skrining Masalah Kesehatan Jiwa di UKBM/ Lembaga (Lapas, Panti, Pesantren, sekolah)
Edukasi lansia dan lansia risiko tinggi di Posyandu Lansia
Deteksi Dini Bagi Lansia Risti dan pending lansia di Posyandu Lansia
Kunjungan rumah edukasi keluarga untuk perawatan dan berobat teratur pada orang dengan gangguan jiwa (ODGJ
Fasilitasi dan Pembinaan Kegiatan GP2SP
Pelaksanaan gerakan kesehatan kerja bersama institusi/perusahaan
DAFTAR HADIR
PEMERINTAH KABUPATEN MALANG
DINAS KESEHATAN
UPT PUSKESMAS PONCOKUSUMO
Jl. Kusnan Marzuki No. 101, Wonomulyo. Telp: (0341) 787792
Email: pkmponcokusumo@gmail.com
PONCOKUSUMO - 65157
LAPORAN KEGIATAN
1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

2. Tujuan Kunjungan : Maksud Tujuan : Pelacakan OVP
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
3. Hasil Kunjungan :
a. Proses Pelaksanaan
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b. Permasalahan yang ditemui pada waktu melakukan kegiatan

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4. Kesimpulan/ Rencana Tindak Lanjut

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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pelacakan OVM
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pemantauan minum oralit dan zinc bagi diare balita
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pelaporan kematian dan pelaksanaan
otopsi verbal kematian Ibu dan Bayi/balita
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Rapat validasi dan evaluasi data
Gikia Bersama lintas Sektor
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Evaluasi E-Kohort dan PSG
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pelaksanaan edukasi bimbingan
perkawinan/konseling pranikah di KUA
atau lembaga agama dan skrining calon
pengantin
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …............................... 6. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pelaksanaan penyuluhan KB di Posyandu
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Penyuluhan Kesehatan Reproduksi pada
Remaja di Sekolah
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kelas Ibu Hamil
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : ANC Terpadu di Kelas Ibu Hamil
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …............................... 6. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kelas Ibu Balita
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Rapat Koordinasi dengan OPD/perangkat
desa dan Masyarakat terkait Perencanaan
Persalinan dan Pencegahan Komplikasi
(P4K), termasuk pemantauan ibu hamil
risiko tinggi
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 3. …...............................
2. …............................... 4. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pendampingan rujukan balita stunting
/gizi buruk ( Komponen Pilihan )
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pembinaan Posyandu Balita
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pembinaan Pelayanan Kesehatan Ibu
dan Anak di Praktek Mandiri Bidan
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 3. …...............................
2. …............................... 4. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan Pembinaan Pelayanan -
Supervisi Supportif
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan Lapangan Bumil Risti
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
IDENTITAS
Nama Ibu : …................................................................
Umur Ibu : …................................................................
Nama suami : …................................................................
Alamat : …................................................................
Pekerjaan : …................................................................
Tanggal Haid terakhir : …................................................................
Diagnosa : …................................................................
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HASIL PEMERIKSAAN
T : …............... Keadaan ibu : …...............................................................
N : …............... …...............................................................
R : …............... Gizi : …...............................................................
S : …............... …...............................................................
b. Permasalahan yang ditemui pada waktu melakukan kunjungan

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Poncokusumo, …..............................2023
Yang Dikunjungi Pelapor
…..................................................... ….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan Lapangan Bufas Risti
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
IDENTITAS
Nama Ibu : …................................................................
Umur Ibu : …................................................................
Nama suami : …................................................................
Alamat : …................................................................
Pekerjaan : …................................................................
Tanggal Haid terakhir : …................................................................
Diagnosa : …................................................................
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HASIL PEMERIKSAAN
T : …............... Keadaan ibu : …...............................................................
N : …............... …...............................................................
R : …............... …...............................................................
S : …............... …...............................................................

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Poncokusumo, …..............................2023
…..................................................... ….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan Lapangan Neo/Bayi Risti
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
IDENTITAS
Nama Ibu : ….................................................................................................
Umur Ibu : ….................................................................................................
Nama suami : ….................................................................................................
Anak Ke : ….................................................................................................
Nama Bayi : ….................................................................................................
Jenis Kelamin : ….................................................................................................
Tanggal Lahir : ….................................................................................................
Alamat : ….................................................................................................
Pekerjaan : ….................................................................................................
Diagnosa : ….................................................................................................
HASIL PEMERIKSAAN
Keadaan Umum Suhu : …..........................................................
Nadi : …..........................................................
Respirasi : …..........................................................
Denyut Nadi Jantung : …..........................................................

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Poncokusumo, …..............................2023
…..................................................... ….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Penjaringan Siswa SD/MI
SD / MI : …............….............…………………..
Tanggal : …............….............…………………..
Jumlah Peserta Didik di Mata / Telinga /
Penilaian Status Gizi
Imunisasi
sekolah Penglihatan Pendengaran

Gigi dan Gusi
Jml
Yang di jaring Tidak Tidak
sasaran N Kurus Gemuk Sehat Sehat
Sehat Sehat
L P L P Jml Sehat Karies
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Poncokusumo, …..............................2023
Mengetahui, Pelapor
Kepala Sekolah ..............................
1. …...............................
2. …...............................
( .................................................... )
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Penjaringan Siswa SMP/MTs
SMP / MTs : …............….............…………………..
Tanggal : …............….............…………………..
Jumlah Peserta Didik di Mata / Telinga /
Penilaian Status Gizi
Imunisasi
sekolah Penglihatan Pendengaran

Gigi dan Gusi
Jml
Yang di jaring Tidak Tidak
sasaran N Kurus Gemuk Sehat Sehat
Sehat Sehat
L P L P Jml Sehat Karies
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................................................................................................................................................
Poncokusumo, …..............................2023
Mengetahui, Pelapor
Kepala Sekolah ..............................
1. …...............................
2. …...............................
( .................................................... )
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Deteksi dini/Skrining faktor risiko &
PTM Prioritas di Posbindu PTM
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
1 Jumlah Sasaran : .........................orang
2 Jumlah Yang Hadir : .........................orang
3 Hasil Pemeriksaan
a. Tensi
● Hipertensi : .........................orang
● Normal : .........................orang
● Hipotensi : .........................orang
b. Nadi
● Takikardi : .........................orang
● Normal : .........................orang
● Brakikardi : .........................orang
c. IMT
● Underweight : .........................orang
● Normal : .........................orang
● Overweight : .........................orang
d. Pemeriksaan Lab Sederhana :
● Cek Gula Darah : .........................orang
● Cek Kolesterol : .........................orang
● Cek Asam Urat : .........................orang
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................................................................................................................................................
Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Skrining perilaku merokok dengan
Monitoring KTR di Sekolah
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan rumah u/ pemantauan
Imunisasi pada bayi dg ibu HBsAg R
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Penemuan aktif kasus PD3I
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan rumah dan KIE Bumil
HBsAg Reaktif
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan Rumah Pasien Kusta
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pendataan Sasaran POPM
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
No Posyandu / Sekolah Jumlah Bayi / Siswa

1
2
3
4
5
6
7
8
9
10
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pemberian Obat Pencegahan Massal
(POPM)
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
Jumlah Total Jumlah Total Sasaran yang Mendapat Obat Cacing
Sasaran yg
No Posyandu / Sekolah 12 - 23 Bulan 2 - 6 Tahun 7 - 12 Tahun
Dapat Obat
Cacing L P Total L P Total L P Total
1
2
3
4
5
6
7
8
9
10 …......................................................................................................................................
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Jumlah

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................................................................................................................................................
Poncokusumo, …..............................2023
Mengetahui, Pelapor
Kepala Sekolah ..............................
( ................................................ ) ….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pemantauan minum oralit dan zinc bagi
diare balita di masyarakat
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pengambilan dan Pengiriman Spesimen
TB Paru
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
Jumlah Spesimen Dahak Hasil
Keterangan
Yg Dikirim (+) (-)
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pemberdayaan kader masyarakat dalam
pencegahan Penyakit Menular Demam
Berdarah
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

pencegahan Penyakit Menular dengan
Pembentukan dan pengaktifan kader
TB Paru
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

pencegahan Penyakit Menular dalam
rangka Monitoring dan evaluasi kader
TB Oleh Petugas Puskesmas
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pemberdayaan kader masyarakat terlibat
dalam pelaksanaan deteksi dini Faktor
Risiko Penyakit Tidak Menular
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 3. …...............................
2. …............................... 4. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pengiriman dan pemeriksaan Spesimen
Penyakit Potensi KLB/Wabah/Penyakit
Infeksi Emerging ke Laboratorium Rujukan
serta Pengembalian Spesimen Carrier
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Imunisasi Rutin
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
S : ............................... HB uniject : ...............................
K : ............................... BCG, OPV1 : ...............................
D : ............................... DPT-HB-Hib 1 OPV2 : ...............................
N : ............................... DPT-HB-Hib 2 OPV3 : ...............................
T : ............................... DPT-HB-Hib 3 OPV4, IPV : ...............................
O : ............................... Campak (MR) : ...............................
B : ............................... DPT-HB-Hib Ulangan : ...............................
MR Ulangan (Boster) : ...............................
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Poncokusumo, …..............................2023
Kader Pelapor
…..................................................... ….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Investigasi kejadian kasus KIPI
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Penyelidikan Epidemiologi Penyakit
berpotensi KLB/Wabah dan Penyakit
Infeksi PD3i
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Survei vektor malaria, DBD dan
reservoar Leptospirosis
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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................................................................................................................................................
Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pelaksanaan gerakan kesehatan kerja
di POS UKK
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 4. …...............................
2. …............................... 5. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pelaksanaan Skrining Masalah Kesehatan
Jiwa di UKBM/ Lembaga (Lapas, Panti,
Pesantren, sekolah)
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Edukasi lansia dan lansia risiko tinggi
di Posyandu Lansia
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Deteksi Dini Bagi Lansia Risti dan
pending lansia di Posyandu Lansia
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
1 Jumlah Sasaran : .........................orang
2 Jumlah Yang Hadir : .........................orang
3 Hasil Pemeriksaan
a. Tensi
● Hipertensi : .........................orang
● Normal : .........................orang
● Hipotensi : .........................orang
b. Nadi
● Takikardi : .........................orang
● Normal : .........................orang
● Brakikardi : .........................orang
c. IMT
● Underweight : .........................orang
● Normal : .........................orang
● Overweight : .........................orang
d. Pemeriksaan Lab Sederhana :
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Poncokusumo, …..............................2023
Kader Pelapor
…..................................................... ….....................................................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Kunjungan rumah edukasi keluarga
untuk perawatan dan berobat teratur
pada orang dengan gangguan jiwa (ODGJ)
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Fasilitasi dan Pembinaan Kegiatan GP2SP
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …............................... 3. …...............................
2. …............................... 4. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
LAPORAN KEGIATAN

2. Tujuan Kunjungan : Maksud Tujuan : Pelaksanaan gerakan kesehatan kerja
bersama institusi/perusahaan
Tempat : …............….............…………………..
Tanggal : …............….............…………………..
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Poncokusumo, …..............................2023
Pelapor
1. …...............................
2. …...............................
3. …...............................
DINAS KESEHATAN
PONCOKUSUMO - 65157
Daftar Hadir
Kegiatan …......................................................................
Tempat : …..............................
Tanggal : …...........................
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4 Pelaporan kematian dan pelaksanaan otopsi verbal kematian

5 Rapat validasi dan evaluasi data Gikia Bersama lintas Sektor

6 Evaluasi E-Kohort dan PSG 16

7 Pelaksanaan edukasi bimbingan perkawinan/konseling pranikah

8 Pelaksanaan penyuluhan KB di Posyandu 18

9 Penyuluhan Kesehatan Reproduksi pada Remaja di Sekolah

10 Kelas Ibu Hamil 20

Kelas Ibu Balita 22 Penjaringan Siswa SMP/MTs

Rapat Koordinasi dengan OPD/perangkat desa dan23

Pendampingan rujukan balita stunting /gizi buruk ( Komponen

Pembinaan Pelayanan Kesehatan Ibu dan Anak di 26

Kunjungan Pembinaan Pelayanan - Supervisi Supportif

Kunjungan Lapangan Bumil Risti 28 Kunjungan Rumah Pasien Kusta

Kunjungan Lapangan Bufas Risti 29 Pendataan Sasaran POPM

Kunjungan Lapangan Neo/Bayi Risti 30 Pemberian Obat Pencegahan Massal (POPM)

32 Pengambilan dan Pengiriman Spesimen TB Paru 42

33 Pemberdayaan kader masyarakat dalam pencegahan

34 Pemberdayaan kader masyarakat dalam pencegahan

35 Pemberdayaan kader masyarakat dalam pencegahan

36 Pemberdayaan kader masyarakat terlibat dalam pelaksanaan

37 Pengiriman dan pemeriksaan Spesimen Penyakit Potensi

39 Investigasi kejadian kasus KIPI 49

40 Penyelidikan Epidemiologi Penyakit berpotensi KLB/Wabah

Pelaksanaan gerakan kesehatan kerja di POS UKK

Edukasi lansia dan lansia risiko tinggi di Posyandu Lansia

Fasilitasi dan Pembinaan Kegiatan GP2SP

Pelaksanaan gerakan kesehatan kerja bersama institusi/perusahaan

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan

4. Kesimpulan/ Rencana Tindak Lanjut

1. Dasar : Surat Tugas Nomor : 094/ /35.07.103.133/2023

b. Permasalahan yang ditemui pada waktu melakukan kegiatan