LAPORAN BULANAN

REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA

PUSKESMAS MAUROLE BULAN JANUARI TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan : 5 2 1 3 2 1 1 0 0 0 0 0 1 16
Bulan ini 5 2 1 3 2 1 1 0 0 0 0 0 1 16
Kumulatif s/d bulan lalu -

II Asal Pasien Bulin :

1 Datang sendiri 5 2 1 3 2 1 1 0 0 0 0 0 1 16
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - - - - - - - - - - - -

III Bulin mendapat :

1 Fe 5 2 1 3 2 1 1 0 0 0 0 0 1 16
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 5 2 1 3 2 1 1 0 0 0 0 0 1 16
3 Bufas dapat Vit A 5 2 1 3 2 1 1 0 0 0 0 0 1 16

IV Deteksi Resiko Bulin :

1. Nakes 5 2 1 3 2 1 1 0 0 0 0 0 1 16
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 1 0 0 0 0 0 0 0 0 0 0 1 2
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 5 0 1 2 0 0 1 0 0 0 0 0 1 10
RSUD Ponek 0 2 0 1 2 1 0 0 0 0 0 0 0 6
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 5 0 1 3 0 1 1 0 0 0 0 0 1 12
2 Dokter 0 2 0 0 1 1 0 0 0 0 0 0 0 4
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 5 0 1 3 0 1 1 0 0 0 0 0 1 12
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 0 2 0 0 1 1 0 0 0 0 0 0 0 4

IX Kondisi Bulin
1 Sehat 5 2 1 3 2 1 1 0 0 0 0 0 1 16
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 0 0 0 0 0 1 0 0 0 0 0 0 0 1
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 1 0 0 0 0 0 0 0 1
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 5 2 1 3 2 0 1 0 0 0 0 0 1 15
2 Sakit 0 0 0 0 0 1 0 0 0 0 0 0 0 1
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 5 2 1 3 2 1 1 0 0 0 0 0 1 16
2 KF2 5 2 1 3 2 0 1 0 0 0 0 0 1 15
3 KF3 5 2 1 3 2 0 1 0 0 0 0 0 1 15

NEONATAL
I Inisiasi Menyusui Dini (IMD) 3 2 0 0 0 1 2 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 6 6

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 3 2 2 0 0 1 2 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 9 7
2 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 0 0 0 - -

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
2 BBL > 2500 gram 3 2 2 0 0 1 2 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 9 7 16

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 3 2 2 0 0 1 2 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 9 7 16
2 KN2 3 2 2 0 0 1 2 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 9 7 16
3 KN3 3 2 2 0 0 1 2 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 9 7 16

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 - -

PK.1 Ab
fase Kom
d. Kasus 0 0 0 aktif 0 0 0 0 0 0 0 0 0 0 0 0 0 plit+ 0 0 0 0 0 0 0 0
+ane Ane
mia mia

- -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 1
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
 Post
sc
- Lain - lain hari
ke 8
dg
syok
septi
k,
endo
metr
iosis,
ILO,
ARD
S,
hipo
albu
- - - - - - - - - - - min - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 0 1 0 2 0 1 0 0 0 2 0 1 0 1 0 0 0 3 0 0 0 0 0 1 0 1 - 13

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I -
- II -
- III
- IV
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - 1 - - -
* 45 - 60
* > 60
b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 28 Januari 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah
 LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS MAUROLE BULAN FEBRUARI TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan : 2 5 0 0 1 0 0 0 2 1 2 1 1 15
Bulan ini 10 4 2 6 4 2 2 0 0 0 0 0 2 32
Kumulatif s/d bulan lalu -

II Asal Pasien Bulin :

1 Datang sendiri 2 5 0 0 1 0 0 0 2 1 2 1 1 15
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - - - - - - - - - - - -

III Bulin mendapat :

1 Fe 2 5 0 0 1 0 0 0 2 1 2 1 1 15
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 2 5 0 0 1 0 0 0 2 1 2 1 1 15
3 Bufas dapat Vit A 2 5 0 0 1 0 0 0 2 1 2 1 1 15

IV Deteksi Resiko Bulin :

1. Nakes 2 5 0 0 1 0 0 0 2 1 2 1 1 15
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 2 4 0 0 1 0 0 0 2 1 1 0 1 12
RSUD Ponek 0 1 0 0 0 0 0 0 0 0 1 1 0 3
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 2 5 0 0 1 0 0 0 2 1 1 0 1 13
2 Dokter 0 0 0 0 0 0 0 0 0 0 1 1 0 2
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 2 5 0 0 1 0 0 0 2 1 1 0 1 13
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 0 0 0 0 0 0 0 0 0 0 1 1 0 2

IX Kondisi Bulin
1 Sehat 2 5 0 0 1 0 0 0 2 1 2 1 1 15
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 0 0 0 0 0 1 0 0 0 0 0 0 0 1
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 1 0 0 0 0 0 0 0 1
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 2 5 0 0 1 0 0 0 2 1 2 1 1 15
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 2 5 0 0 1 0 0 0 2 1 2 1 1 15
2 KF2 2 5 0 0 1 0 0 0 2 1 2 1 1 15
3 KF3 2 5 0 0 1 0 0 0 2 1 2 1 1 15

NEONATAL
I Inisiasi Menyusui Dini (IMD) 0 2 4 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 1 6 7 13

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 0 2 4 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 1 7 8 15
2 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 0 0 0 - -

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1
2 BBL > 2500 gram 0 2 4 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 1 7 7 14

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 0 2 4 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 1 7 8 15
2 KN2 0 2 4 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 1 7 8 15
3 KN3 0 2 4 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 1 7 8 15

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 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. Kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 0 4 0 1 0 0 0 4 0 0 0 1 0 2 0 0 0 0 0 2 0 2 0 0 0 0 - 16

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I -
- II -
- III
- IV
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - - - - -
* 45 - 60
* > 60
 b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 28 Februari 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah
 LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS MAUROLE BULAN MARET TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan : 3 2 2 2 0 0 0 1 1 1 2 1 3 18
Bulan ini 12 9 2 6 5 2 2 0 2 1 2 1 3 47
Kumulatif s/d bulan lalu -

II Asal Pasien Bulin :

1 Datang sendiri 3 2 2 2 0 0 0 1 1 1 2 1 3 18
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - - - - - - - - - - - -

III Bulin mendapat :

1 Fe 3 2 2 2 0 0 0 1 1 1 2 1 3 18
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 3 2 2 2 0 0 0 1 1 1 2 1 3 18
3 Bufas dapat Vit A 3 2 2 2 0 0 0 1 1 1 2 1 3 18

IV Deteksi Resiko Bulin :

1. Nakes 3 2 2 2 0 0 0 1 1 1 2 1 3 18
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 2 2 2 2 0 0 0 1 1 0 1 1 3 15
RSUD Ponek 1 0 0 0 0 0 0 0 0 1 1 0 0 3
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 2 2 2 2 0 0 0 1 1 0 1 1 3 15
2 Dokter 1 0 0 0 0 0 0 0 0 1 1 0 0 3
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 2 2 2 2 0 0 0 1 1 0 1 1 3 15
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 1 0 0 0 0 0 0 0 0 1 1 0 0 3

IX Kondisi Bulin
1 Sehat 3 2 2 2 0 0 0 1 1 1 2 1 3 18
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 0 0 0 0 0 1 0 0 0 0 0 0 0 1
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 1 0 0 0 0 0 0 0 1
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 3 2 2 2 0 0 0 1 1 1 2 1 3 18
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 3 2 2 2 0 0 0 1 1 1 2 1 3 18
2 KF2 3 2 2 2 0 0 0 1 1 1 2 1 3 18
3 KF3 3 2 2 2 0 0 0 1 1 1 2 1 3 18

NEONATAL
I Inisiasi Menyusui Dini (IMD) 2 1 0 2 0 2 2 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 3 6 11 17

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 2 1 0 2 0 2 2 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 3 6 11 17
2 Lahir mati 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 - 1

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1
2 BBL > 2500 gram 2 1 0 2 0 2 2 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 3 6 11 17

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 2 1 0 2 0 2 2 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 3 6 11 17
2 KN2 2 1 0 2 0 2 2 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 3 6 11 17
3 KN3 2 1 0 2 0 2 2 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 3 6 11 17

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 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. Kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 0 3 0 4 0 1 0 4 0 0 0 2 0 1 0 1 0 1 0 2 0 3 0 2 0 1 - 25

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I -
- II -
- III
- IV
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - - - - -
* 45 - 60
* > 60
 b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 31 Maret 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah
 LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS MAUROLE BULAN APRIL TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan :
Bulan ini 7 2 3 1 1 1 1 0 4 2 1 1 3 27
Kumulatif s/d bulan lalu 15 11 4 8 5 2 2 1 3 2 4 2 6 65

II Asal Pasien Bulin :

1 Datang sendiri 7 2 3 1 1 1 1 0 4 2 1 1 3 27
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - ### - - - - - - - - - -

III Bulin mendapat :

1 Fe 7 2 3 1 1 1 1 0 4 2 1 1 3 27
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 7 2 3 1 1 1 1 0 4 2 1 1 3 27
3 Bufas dapat Vit A 7 2 3 1 1 1 1 0 4 2 1 1 3 27

IV Deteksi Resiko Bulin :

1. Nakes 7 2 3 1 1 1 1 0 4 2 1 1 3 27
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 5 2 1 0 0 0 1 0 1 1 0 0 3 14
RSUD Ponek 2 0 2 1 1 1 0 0 3 1 1 1 0 13
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 5 2 3 1 0 1 1 0 3 1 0 0 3 20
2 Dokter 2 0 0 0 1 1 1 1 1 0 7
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 5 2 3 1 0 1 1 0 3 1 0 0 3 20
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 2 0 0 0 1 0 0 0 1 1 1 1 0 7

IX Kondisi Bulin
1 Sehat 7 2 3 1 1 1 1 0 4 2 1 1 3 27
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 7 2 3 1 1 1 1 0 4 2 1 1 3 27
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 7 2 3 1 1 1 1 0 4 2 1 1 3 27
2 KF2 7 2 3 1 1 1 1 0 4 2 1 1 3 27
3 KF3 7 2 3 1 1 1 1 0 4 2 1 1 3 27

NEONATAL
I Inisiasi Menyusui Dini (IMD) 4 1 2 0 0 3 1 0 0 0 1 0 1 0 0 0 2 1 1 0 0 0 0 0 1 2 13 7

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 5 2 2 0 0 3 0 1 0 1 1 0 1 0 0 0 2 2 2 0 1 0 1 0 1 2 16 11 27
2 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 0 0 0 - -

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 2 - 2
2 BBL > 2500 gram 5 2 2 0 0 3 0 1 0 1 1 0 1 0 0 0 2 1 2 0 0 0 1 0 1 2 15 10 25

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 5 2 2 0 0 3 0 1 0 1 1 0 1 0 0 0 2 2 2 0 1 0 1 0 1 2 16 11 27
2 KN2 5 2 2 0 0 3 0 1 0 1 1 0 1 0 0 0 2 2 2 0 1 0 1 0 1 2 16 11 27
3 KN3 5 2 2 0 0 3 0 1 0 1 1 0 1 0 0 0 2 2 2 0 1 0 1 0 1 2 16 11 27

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 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. Kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 0 2 0 5 0 1 0 3 0 2 0 1 0 0 0 0 0 0 0 0 0 2 0 1 0 0 - 17

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I -
- II -
- III
- IV
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - - - - -
* 45 - 60
* > 60
 b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 30 April 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah
 LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS MAUROLE BULAN MEI TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan :
Bulan ini 2 4 0 2 3 1 1 0 0 0 0 0 3 16
Kumulatif s/d bulan lalu 22 13 7 9 6 3 3 1 7 4 5 3 9 92

II Asal Pasien Bulin :

1 Datang sendiri 2 4 0 2 3 1 1 0 0 0 0 0 3 16
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - ### - - - - - - - - - -

III Bulin mendapat :

1 Fe 2 4 0 2 3 1 1 0 0 0 0 0 3 16
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 2 4 0 2 3 1 1 0 0 0 0 0 3 16
3 Bufas dapat Vit A 2 4 0 2 3 1 1 0 0 0 0 0 3 16

IV Deteksi Resiko Bulin :

1. Nakes 2 4 0 2 3 1 1 0 0 0 0 0 3 16
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 1 2 0 1 0 1 0 0 0 0 0 0 2 7
RSUD Ponek 1 2 0 1 3 0 1 0 0 0 0 0 1 9
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 2 3 0 1 2 1 1 0 0 0 0 0 2 12
2 Dokter 0 1 0 1 1 0 0 0 0 0 0 0 1 4
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 2 3 0 1 2 1 1 0 0 0 0 0 2 12
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 0 1 0 1 1 0 0 0 0 0 0 0 1 4

IX Kondisi Bulin
1 Sehat 2 4 0 2 3 1 1 0 0 0 0 0 3 16
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 2 4 0 2 3 1 1 0 0 0 0 0 3 16
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 2 4 0 2 3 1 1 0 0 0 0 0 3 16
2 KF2 2 4 0 2 3 1 1 0 0 0 0 0 3 16
3 KF3 2 4 0 2 3 1 1 0 0 0 0 0 3 16

NEONATAL
I Inisiasi Menyusui Dini (IMD) 1 1 2 2 0 0 1 1 2 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 2 1 9 7

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 1 1 2 2 0 0 1 1 2 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 2 1 9 7 16
2 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 0 0 0 - -

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 1 0 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 1
2 BBL > 2500 gram 1 0 2 2 0 0 1 1 2 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 2 1 9 6 15

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 1 1 2 2 0 0 1 1 2 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 2 1 9 7 16
2 KN2 1 1 2 2 0 0 1 1 2 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 2 1 9 7 16
3 KN3 1 1 2 2 0 0 1 1 2 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 2 1 9 7 16

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 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. Kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 0 1 0 4 0 2 0 1 0 2 0 0 0 0 0 1 0 1 0 2 0 0 0 0 0 0 - 14

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I -
- II -
- III
- IV
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - - - - -
* 45 - 60
* > 60
 b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 31 Mei 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah
 LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS MAUROLE BULAN JUNI TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan :
Bulan ini 1 1 1 1 3 0 0 1 2 2 1 1 1 15
Kumulatif s/d bulan lalu 19 15 6 8 7 3 3 1 7 4 5 3 11 92

II Asal Pasien Bulin :

1 Datang sendiri 1 1 1 1 3 0 0 1 2 2 1 1 1 15
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - ### - - - - - - - - - -

III Bulin mendapat :

1 Fe 1 1 1 1 3 0 0 1 2 2 1 1 1 15
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 1 1 1 1 3 0 0 1 2 2 1 1 1 15
3 Bufas dapat Vit A 1 1 1 1 3 0 0 1 2 2 1 1 1 15

IV Deteksi Resiko Bulin :

1. Nakes 1 1 1 1 3 0 0 1 2 2 1 1 1 15
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 0 1 1 1 2 0 0 0 1 1 0 0 1 8
RSUD Ponek 1 0 0 0 1 0 0 1 1 1 1 1 0 7
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 0 1 1 1 2 0 0 1 2 2 1 0 1 12
2 Dokter 1 0 0 0 1 0 0 0 0 0 0 1 0 3
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 0 1 1 1 2 0 0 1 2 2 1 0 1 12
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 1 0 0 0 1 0 0 0 0 0 0 1 0 3

IX Kondisi Bulin
1 Sehat 1 1 1 1 3 0 0 1 2 2 1 1 1 15
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 1 1 1 1 3 0 0 1 2 2 1 1 1 15
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 1 1 1 1 3 0 0 1 2 2 1 1 1 15
2 KF2 1 1 1 1 3 0 0 1 2 2 1 1 1 15
3 KF3 1 1 1 1 3 0 0 1 2 2 1 1 1 15

NEONATAL
I Inisiasi Menyusui Dini (IMD) 0 0 1 0 1 0 1 0 0 2 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1 0 6 5 11

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 0 1 1 0 1 0 1 0 1 2 0 0 0 0 0 1 1 1 1 1 0 0 1 0 1 0 8 6 14
2 Lahir mati 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 1 - IUFD

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 BBL > 2500 gram 0 1 1 0 1 0 1 0 1 2 0 0 0 0 0 1 1 1 1 1 0 0 1 0 1 0 8 6 14

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 0 1 1 0 1 0 1 0 1 2 0 0 0 0 0 1 1 1 1 1 0 0 1 0 1 0 8 6 15
2 KN2 0 1 1 0 1 0 1 0 1 2 0 0 0 0 0 1 1 1 1 1 0 0 1 0 1 0 8 6 15
3 KN3 0 1 1 0 1 0 1 0 1 2 0 0 0 0 0 1 1 1 1 1 0 0 1 0 1 0 8 6 15

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 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. Kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 0 2 0 2 0 2 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 4 - 13

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I -
- II -
- III
- IV
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - - - - -
* 45 - 60
* > 60
 b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 30 Juni 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah
 LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS MAUROLE BULAN JULI TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan :
Bulan ini 2 1 1 2 0 0 0 0 1 0 0 0 0 7
Kumulatif s/d bulan lalu 20 16 7 8 10 3 3 2 9 6 6 4 12 106

II Asal Pasien Bulin :

1 Datang sendiri 2 1 1 2 0 0 0 0 1 0 0 0 0 7
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - ### - - - - - - - - - -

III Bulin mendapat :

1 Fe 2 1 1 2 0 0 0 0 1 0 0 0 0 7
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 2 1 1 2 0 0 0 0 1 0 0 0 0 7
3 Bufas dapat Vit A 2 1 1 2 0 0 0 0 1 0 0 0 0 7

IV Deteksi Resiko Bulin :

1. Nakes 2 1 1 2 0 0 0 0 1 0 0 0 0 7
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 1 0 1 1 0 0 0 0 1 0 0 0 0 4
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 1 1 1 0 0 0 0 0 0 0 0 0 0 3
RSUD Ponek 1 0 0 1 0 0 0 1 1 0 0 0 0 4
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 1 1 1 0 0 0 0 0 0 0 0 0 0 3
2 Dokter 1 0 0 1 0 0 0 1 1 0 0 0 0 4
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 1 1 1 0 0 0 0 0 0 0 0 0 0 3
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 1 0 0 1 0 0 0 1 1 0 0 0 0 4

IX Kondisi Bulin
1 Sehat 2 1 1 2 0 0 0 0 1 0 0 0 0 7
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 2 1 1 2 0 0 0 0 1 0 0 0 0 7
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 2 1 1 2 0 0 0 0 1 0 0 0 0 7
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 2 1 1 2 0 0 0 0 1 0 0 0 0 7
2 KF2 2 1 1 2 0 0 0 0 1 0 0 0 0 7
3 KF3 2 1 1 2 0 0 0 0 1 0 0 0 0 7

NEONATAL -
I Inisiasi Menyusui Dini (IMD) 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 1 1 0 1 1 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 4
2 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 0 0 0 - IUFD

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 BBL > 2500 gram 1 1 0 1 1 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 4

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 1 1 0 1 1 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 4 -
2 KN2 1 1 0 1 1 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 4 -
3 KN3 1 1 0 1 1 0 0 2 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 3 4 -

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 - -
d. Kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 2 1 1 2 0 0 0 0 1 0 0 0 0 7

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I 2 1 1 2 0 0 0 0 1 0 0 0 0 7
- II 2 1 1 2 0 0 0 0 1 0 0 0 0 7
- III 2 1 1 2 0 0 0 0 1 0 0 0 0 7
- IV 2 1 1 2 0 0 0 0 1 0 0 0 0 7
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - - - - -
* 45 - 60
* > 60
 b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 30 Juli 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah
 LAPORAN BULANAN
REKAPITULASI BULIN DAN NIFAS DI PUSKESMAS DAN JEJARINGNYA
PUSKESMAS MAUROLE BULAN AGUSTUS TAHUN 2023

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Total
No Elemen Data
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
A Ibu Bersalin
I Total Persalinan :
Bulan ini 4 1 0 4 0 2 1 0 0 0 1 1 0 14
Kumulatif s/d bulan lalu 20 16 7 8 10 3 3 2 9 6 6 4 12 106

II Asal Pasien Bulin :

1 Datang sendiri 4 1 0 4 0 2 1 0 0 0 1 1 0 14
2 Rujukan - - - - - - - - - - - - - -
3 Kiriman kader/dukun - - - ### - - - - - - - - - -

III Bulin mendapat :

1 Fe 4 1 0 4 0 2 1 0 0 0 1 1 0 14
2 Vit. A 2 kali (Umur 0 hr - 30 hr) 4 1 0 4 0 2 1 0 0 0 1 1 0 14
3 Bufas dapat Vit A 4 1 0 4 0 2 1 0 0 0 1 1 0 14

IV Deteksi Resiko Bulin :

1. Nakes 4 1 0 4 0 2 1 0 0 0 1 1 0 14
2. Mayarakat

V Ibu Bersalin dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 RSUD Ponek 0 0 0 1 0 0 0 0 1 0 0 0 0 2
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 0
VI Tempat Persalinan :
1 Non Faskes
2 Faskes : -
Puskesmas RI
Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Puskesmas Poned 1 0 0 3 0 1 0 0 0 0 1 0 0 6
RSUD Ponek 3 1 0 1 0 1 1 0 0 0 0 1 0 8
RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VII Penolong Persalinan :

1 Bidan 4 1 0 3 0 2 1 0 0 0 1 0 0 12
2 Dokter 0 0 0 1 0 0 0 0 0 0 0 1 0 2
 3 Nakes lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Dukun 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Keluarga/Lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VIII Cara Persalinan :

1 Normal/spontan 4 1 0 3 0 2 1 0 0 0 1 0 0 12
2 Ekstraksi Vakum/Forcet 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Sectio Caesaria 0 0 0 1 0 0 0 0 1 0 0 0 0 2

IX Kondisi Bulin
1 Sehat 4 1 0 4 0 2 1 0 1 0 1 0 0 14
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bulin usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulin usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0

X Sebab Kematian Bulin :

1 Ketuban Pecah Dini (KPD) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Partus Lama 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -

B Ibu Nifas
I
Deteksi Resti Bufas yang ditemukan dan ditangani :
1 Nakes 0 0 0 1 0 0 0 0 0 0 0 0 0 1
2 Masyarakat 0 0 0 0 0 0 0 0 0 0 0 0 0 -

II Ibu Bufas dirujuk

1 Puskesmas RI 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Puskesmas Memadai 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Puskesmas Poned 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 RSUD Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 RSUD Non Ponek 0 0 0 0 0 0 0 0 0 0 0 0 0 -
6 RS SWASTA 0 0 0 0 0 0 0 0 0 0 0 0 0 -
7 RSIA/RSB 0 0 0 0 0 0 0 0 0 0 0 0 0 -
8 Fasilitas Keseh. Lainnya (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

III Bufas Komplikasi :

1 Perdarahan Paska Persalinan (PPP) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
2 Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
4 Pre Eklamsia 0 0 0 0 0 0 0 0 0 0 0 0 0 -
5 Lain-lain (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -
IV Kondisi Bufas/Nifas
1 Sehat 4 1 0 4 0 2 1 0 0 0 1 1 0 14
2 Sakit 0 0 0 0 0 0 0 0 0 0 0 0 0 -
3 Meninggal -
Bufas usia < 20 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas usia 20 - 34 tahn 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Bufas Usia ≥35 Thn 0 0 0 0 0 0 0 0 0 0 0 0 0 -

V Penyebab Kematian
Perdarahan 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Infeksi 0 0 0 0 0 0 0 0 0 0 0 0 0 -
Dll (sebutkan) 0 0 0 0 0 0 0 0 0 0 0 0 0 -

VI Kunjungan Bufas :
1 KF1 4 1 0 4 0 2 1 0 0 0 1 1 0 14
2 KF2 4 1 0 4 0 2 1 0 0 0 1 1 0 14
3 KF3 4 1 0 4 0 2 1 0 0 0 1 1 0 14

NEONATAL -
I Inisiasi Menyusui Dini (IMD) 1 3 0 1 0 0 1 2 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 4 9

II Lahir Kembar : 0 0 0 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 Kondisi Neonatal Paska Persalinan

1 Lahir Hidup 1 3 0 1 0 0 2 2 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 5 9
2 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 0 0 0 - IUFD

IV Sebab Kematian Neonatus (Dilaporkan pada

Surveilan Kematian)
1 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
2 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
3 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 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
5 Kelainan Kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Ickterus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Hipotermis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 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
9 Infeksi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Lain-lain (sebutkan)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

V Berat Badan Lahir :

1 BBL < 2500 gram - 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 BBL > 2500 gram 1 3 0 1 0 0 1 2 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 4 9

VI Alasan Neonatus Dirujuk :

1 Prematur 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
2 BBLR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
3 Kelainan kongenital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -
 4 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 - -
5 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 - -

VII Kunjungan Neonatus :

1 KN1 1 3 0 1 0 0 2 2 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 5 9 -
2 KN2 1 3 0 1 0 0 2 2 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 5 9 -
3 KN3 1 3 0 1 0 0 2 2 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 0 5 9 -

TAMBAHAN
FORM KEMATIAN

Maurole Aewora Watukamba Mausambi Keliwumbu Ranokolo Ransel Otogedu Detuwulu Ngalukoja Niranusa Uludala Woloau Total Luar Wilayah
No Elemen Data
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
I Komplikasi Kehamilan
a. Jml Ditangani 0 0 0 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. Kasus 0 0 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. Jml Dirujuk 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 - -
d. Kasus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - -

II KEMATIAN IBU
a. Lokasi Kejadian Kematian
- RS Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- RS Nom Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Pusk Non Ponek - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Rumah - - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Penyebab Kematian
- Pendarahan - - - - - - - - - - - - - - - - - - - - - - - - - -
- HDK - - - - - - - - - - - - - - - - - - - - - - - - - -
- Infeksi - - - - - - - - - - - - - - - - - - - - - - - - - -
- Abortus - - - - - - - - - - - - - - - - - - - - - - - - - -
- Distosia - - - - - - - - - - - - - - - - - - - - - - - - - -
- Lain - lain - - - - - - - - - - - - - - - - - - - - - - - - - -

P4K KELAS IBU HAMIL

I Jumlah Penempelan Stiker P4k di rmh bumil 6 1 0 1 2 3 1 0 1 2 0 1 0 18

II Pelaksanaan Kelas Ibu hamil
a. Jml Bumil Peserta Pertemuan Ke
-I 6 1 0 1 2 3 1 0 1 2 0 1 0 18
- II 6 1 0 1 2 3 1 0 1 2 0 1 0 18
- III 6 1 0 1 2 3 1 0 1 2 0 1 0 18
- IV 6 1 0 1 2 3 1 0 1 2 0 1 0 18
III Jenis Kekerasan Terhadap Perempuan
a. Mental
* 15 - 44 - - - - - - - - - - - - - -
* 45 - 60
* > 60
 b. Fisik
* 15 - 44
* 45 - 60
* > 60
c. Emosional
* 15 - 44
* 45 - 60
* > 60
d. Pelantaran
* 15 - 44
* 45 - 60
* > 60

SARANA DAN TENAGA PELKES (F6)

I SDM Kesehatan
a. Jml Dokter
- Dokter PNS
- Dokter PTT/NS 0 1
b. Jml Perawat
- Perawat PNS 0 0 0 0 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Perawat (Tenaga Penunjang)
c. Jml Bidan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PNS 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan PTT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan (Tenaga Penunjang) 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bikor 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- Bidan di Pusk 9
- Bidan di Desa 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tinggal 0 0 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Tidak Tinggal 0
- Mendapat Pelatihan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* APN 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* PPGDON 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* Mampu Poned 6
d. Dukun
- Jml Yg Ada 0 2 0 2 0 1 0 2 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 -
- Bermitra 2 2 1 2 1 1 1 1 1 1 1 1 1
e. Kader
- Jml Yg Ada 5 5 5 5 5 5 5 5 5 0 5 5 5 5
- Aktif 5 5 5 5 5 5 5 5 5 5 5 5 5

Maurole 30 Agustus 2023

Mengetahui
Kepala Puskesmas Maurole Yang Melapor

Maria Kristina Londa,A.Md.Keb Sarsance Agnesta Tani, AMD Keb

NIP.19751106 200212 2 008 NIP.19870214 201705 2 001
Luar Wilayah