Laporan Imunisasi Hep B Nadis & Nakes

REGISTER I
NAMA PUSK/FASKES : UPT BLUD Puskemas Wanasaba

ALAMAT FASKES : Jln. TGH Zainudin Arsyad Desa Wanasaba Kec.Wanasaba
PENANGGUNGJAWAB WILAYAH LAYANAN : Zalzali, A.Md.Kep
KABUPATEN/KOTA : Lombok Timur
PROVINSI : NTB
JENIS KELAMIN
NO NAMA TANGGAL LAHIR
L P
1 Aria Zamzari Putrawan L 13/01/1992
2 Rudi Sukrisman L 5/9/1988

3 susilawati P 1/11/1983
4 SITI MAELANA P 20-05-1994
5 Mery Rosa Sagita P 21/11/1985
6 MUPRIHATUN P 12/6/1989
7 sri hasmawati P 6/9/1989
8 BQ. Rini Widya Kiswari P 8/10/1986
9 Zurriatun Toibah P 29/7/1992
10 dr. WAHYUNI YAHYA P 13/9/1978
11 Rizki kurniawati P 21/09/1991
12 SUKMAWATI P 15/02/1994
13 Rizkiatul fitri P 31-12-1990
14 Muh. Efan bahrul ahari L 15-07-1993
15 Puspa Nia P 5/5/1999
16 BQ. Febri Korawati P 17/2/1989
17 salmiaton P 11/5/1995
18 Solatiah P 12/11/1982
19 Ely asriani P 17-08-1983
20 Rabiatul Adawiyah P 24/06/ 1994
21 Nova Hermawati P 7/11/1996
22 L. Syahid Abdul Fatah L 14 /12/ 1993
23 Erna Yuliana P 15/03/1978
24 Ardian Fahmi Hidayat L 4/7/1998
25 Ayu Karlina P 9/7/2000
26 Ririn Ariani P 28/11/1995
27 Kartika kiala Putri P 20/04/1996
28 Bq. Ade Erma Suryani P 27/09/1977
29 Eri Rishatil Aini,A.Md.Kep P 29/5/1994
30 Dwi Puji Susilawati, S.Kep.,Ns P 7/10/1994
31 Yuyun sri Wahyuni P 18/11/1987
32 Karunia Utami Rasyid, A.Md.bid P 10/12/1991
33 Artha Nurhidayah P 2/3/1992
34 muliyati P 2/4/1987
35 Mega Rosoda P 31-12-198
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REGISTER IMUNISASI HEPATITIS B UNTUK TENAGA MEDIS DAN TENAGA KESEHATAN
aba Kec.Wanasaba
NIK DESA/KELUARAHAN KECAMATAN
5203141301920005 Wanasaba Wanasaba
5203170509880001 Korleko Labuhan Haji

5207024111830003 Aikmel timur Aikmel
5203084107941424 Batumas Desa Batuyang Pringgabaya
5203086111850002 Gubuk timuk Desa Pohgading Pringgabaya
5203135206890002 suralaga suralaga
5203144609890003 beririjarak Wanasaba
5203144810860006 Wanasaba Lauk Wanasaba
5203146907920004 Bebidas Wanasaba
5203075309780002 Wansaba lauk Wanasaba
5203146109910001 Mamben Lauk Wanasaba
5203147112900027 wanasaba lauk Wanasaba

5203084505900005 Pohgading Pringgabaya
5203115702890002 Kembang Kerang Daya Aikmel
5203147112930016 Mamben Daya Wanasaba
5203145211820001 Tembeng Putik Wanasaba
5203145708830002 bagik nyaka santri Aikmel
5203144711960005 Mamben Lauk Wanasaba
5203145503780002 mamben daya Wanasaba
5203090407980003 Kalijaga Aikmel
5203134907000002 Lajut Praya Tengah
5203086811950002 Batuyang Pringgabaya
5203086004960003 Mantun Maluk
5203146905940002 wanasaba lauk Wanasaba
5201084710940001 BTN BHP labuapi Mataram
5203085811870004 pohhading Pringgabaya
5203085012910001 Kembang Kerang Daya Aikmel
520307074203920001 Apitaik Pringgabaya
5203144204870002 wanasaba wanasaba
5203097112890376 Mamben Baru wanasaba
S DAN TENAGA KESEHATAN
TANGGAL IMUNISASI HEPATITIS B

ASAL INSTANSI JENIS NAKES
DOSIS 1
UPT BLUD Puskesmas Wanasaba Perawat
UPT BLUD Puskesmas Wanasaba Bidan
UPT BLUD Puskesmas Wanasaba Dokter
UPT BLUD Puskesmas Wanasaba Kesmas
UPT BLUD Puskesmas Wanasaba Laboratorium
UPT BLUD Puskesmas Wanasaba
TANGGAL IMUNISASI HEPATITIS B
DOSIS 2 DOSIS 3
LAPORAN HARIAN IMUNISASI HEPATITIS B UNTU
TANGGAL/BULAN/TAHUN :
NAMA FASYANKES :
ALAMAT FASYANKES :
PENANGGUNGJAWAB WILAYAH LAYANAN :
KABUPATEN/KOTA :
PROVINSI :
Isilah pada kolom yang berwarna
JUMLAH SASARAN
NO DESA/KELURAHAN CAPAIAN DOSIS 1
L P TOTAL
L %
1 0 0%
2 0 0%
3 0 0%
4 0 0%
5 0 0%
6 0 0%
7 0 0%
8 0 0%
9 0 0%
10 0 0%
11 0 0%
12 0 0%
13 0 0%
14 0 0%
15 0 0%
16 0 0%
17 0 0%
18 0 0%
19 0 0%
20 0 0%
JUMLAH 0 0 0 0 0%
NISASI HEPATITIS B UNTUK TENAGA MEDIS DAN TENAGA KESEHATAN TINGKAT FASYANKES
CAKUPAN IMUNISASI HEPATITIS B

CAPAIAN DOSIS 1 CAPAIAN DOSIS 2
P % TOTAL % L % P % TOTAL %
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0 0% 0 0% 0 0% 0 0% 0 0%
ASYANKES
CAPAIAN DOSIS 3
L % P % TOTAL %
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
0 0% 0 0% 0 0%
………, ………………………. 202…..

Kepala Fasyankes
(…………………………………..)
LAPORAN IMUNISASI HEPATITIS B UNTUK
DINAS KESEHATAN KAB/KOTA :
ALAMAT DINKES :
PROVINSI :
JUMLAH SASARAN
NO PUSKESMAS/FASYANKES CAPAIAN DOSIS 1

L P TOTAL
L % P
1 3 3 6 1 33% 2
2 0 0%
3 0 0%
4 0 0%
5 0 0%
6 0 0%
7 0 0%
8 0 0%
9 0 0%
10 0 0%
JUMLAH 3 3 6 1 33% 2
EPATITIS B UNTUK TENAGA MEDIS DAN TENAGA KESEHATAN TINGKAT KABUPATEN/KOTA
% TOTAL % L % P % TOTAL %
67% 3 50% 1 33% 1 33% 2 33%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
67% 3 50% 1 33% 1 33% 2 33%
EN/KOTA
CAPAIAN DOSIS 3
L % P % TOTAL %
1 33% 1 33% 2 33%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
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 33% 1 33% 2 33%
………, ………………………. 202…..

Kepala Bidang …………….
Dinas Kesehatan Kabupaten/Kota …………….
(…………………………………..)
LAPORAN IMUNISASI HEPATITIS B UNTU
DINAS KESEHATAN PROVINSI :
ALAMAT DINKES :
JUMLAH SASARAN
NO KABUPATEN/KOTA CAPAIAN DOSIS

L P TOTAL
L %
1 3 3 6 1 33%
2 0 0%
3 0 0%
4 0 0%
5 0 0%
6 0 0%
7 0 0%
8 0 0%
9 0 0%
10 0 0%
JUMLAH 3 3 6 1 33%
SASI HEPATITIS B UNTUK TENAGA MEDIS DAN TENAGA KESEHATAN TINGKAT PROVINSI
P % TOTAL % L % P % TOTAL %
2 67% 3 50% 1 33% 1 33% 2 33%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 0% 0 0%
0% 0 0% 0% 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 67% 3 50% 1 33% 1 33% 2 33%
NSI
CAPAIAN DOSIS 3
L % P % TOTAL %
1 33% 1 33% 2 33%
0% 0% 0 0%
0% 0% 0 0%
0% 0% 0 0%
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 33% 1 33% 2 33%
………, ………………………. 202…..

Kepala Bidang …………….
Dinas Kesehatan Provinsi …………….
(…………………………………..)

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REGISTER I

NAMA PUSK/FASKES : UPT BLUD Puskemas Wanasaba

2 Rudi Sukrisman L 5/9/1988

NIK DESA/KELUARAHAN KECAMATAN

5203141301920005 Wanasaba Wanasaba

5203170509880001 Korleko Labuhan Haji

5203144810860006 Wanasaba Lauk Wanasaba

5203146907920004 Bebidas Wanasaba

5203075309780002 Wansaba lauk Wanasaba

5203146109910001 Mamben Lauk Wanasaba

5203135502940004 Wanasaba Wanasaba

5203147112900027 wanasaba lauk Wanasaba

5203141507930007 Wanasaba Wanasaba

TANGGAL IMUNISASI HEPATITIS B

CAKUPAN IMUNISASI HEPATITIS B

………, ………………………. 202…..

NO PUSKESMAS/FASYANKES CAPAIAN DOSIS 1

CAKUPAN IMUNISASI HEPATITIS B

CAPAIAN DOSIS 1 CAPAIAN DOSIS 2

………, ………………………. 202…..

NO KABUPATEN/KOTA CAPAIAN DOSIS

CAKUPAN IMUNISASI HEPATITIS B

CAPAIAN DOSIS 1 CAPAIAN DOSIS 2

………, ………………………. 202…..

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