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  • Lampiran UP Alex

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    Alexander Mukti
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    This document contains information from a study on basal body temperature and fertility, including tables of basal temperature measurements over multiple menstrual cycles and demographic data from participants. It outlines the proposal, ethics committee submission, sample collection and data processing timeline for the study from 2013 to 2014. It also includes forms with fields for a participant's identification number, consent documentation, medical history, height, weight, hormone levels, cervical mucus scores, and total study scores.

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    contoh lampiran UP

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    This document contains information from a study on basal body temperature and fertility, including tables of basal temperature measurements over multiple menstrual cycles and demographic data from participants. It outlines the proposal, ethics committee submission, sample collection and data processing timeline for the study from 2013 to 2014. It also includes forms with fields for a participant's identification number, consent documentation, medical history, height, weight, hormone levels, cervical mucus scores, and total study scores.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views12 pages

    Lampiran UP Alex

    Uploaded by

    Alexander Mukti
    This document contains information from a study on basal body temperature and fertility, including tables of basal temperature measurements over multiple menstrual cycles and demographic data from participants. It outlines the proposal, ethics committee submission, sample collection and data processing timeline for the study from 2013 to 2014. It also includes forms with fields for a participant's identification number, consent documentation, medical history, height, weight, hormone levels, cervical mucus scores, and total study scores.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 12

    3-6

    Proposal
    Pengajuan komite etik
    Pengambilan sampel dan data
    Pengolahan/analisis data
    Penulisan laporan
    Presentasi hasil
    Publikasi

    2013
    7-9

    2014
    10-12

    1-3

    2014
    4-6

    7-9

    Suhu Basal Tub


    3 Siklus terakhir
    Siklus haid hari ke
    Tanggal
    Jam waktu pengukuran
    Suhu bangun tidur

    Paling pendek

    Paling panjang

    10

    11

    12

    13

    14

    15

    16

    17

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    Hari Perkiraan Ovulasi


    Umur
    Panjang siklus bulan ini

    Suhu Basal Tubuh


    Bulan

    Tahun

    18

    19

    20

    21

    22

    23

    24

    25

    26

    27

    28

    29

    30

    31

    32

    33

    34

    35

    36

    37

    38

    39

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10
    10

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
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    40
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    30
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    5
    36

    40

    10
    5
    37
    95
    90
    85
    80
    75
    70
    65
    60
    55
    50
    45
    40
    35
    30
    25
    20
    15
    10
    5
    36

    Nomor penelitian :

    Data Pasien
    -

    Nomor Subyek :

    Inisial

    Tanggal datang :
    Tanggal

    Bulan

    Tahun

    Informed Consent
    Tanggal penandatanganan :
    Tanggal

    Bulan

    Tahun

    Data Demograf
    Tanggal lahir :
    Tanggal

    Bulan

    Tahun

    Umur saat datang :

    tahun

    Umur saat menikah :

    tahun

    Umur menarche :

    tahun

    Jenis Kelamin :

    WANITA

    Pengukuran berat dan tinggi badan


    BB
    IMT

    .
    .

    kg

    TB

    kg/m2

    Kadar FSH, LH, Progesteron dan Prolaktin


    Kadar FSH :

    mIU/mL

    Kadar LH :

    mIU/mL

    Kadar Progsteron :

    ng/mL

    Kadar Prolaktin :

    ng/mL

    Skor Insler Lendir Serviks H-2


    Kuantitas caran :
    Derajat pembukaan serviks :
    Ferning :
    Spinnbarkeit
    Total Skor

    Skor Insler Lendir Serviks H


    Kuantitas caran :
    Derajat pembukaan serviks :
    Ferning :

    cm

    Spinnbarkeit
    Total Skor

    Skor Insler Lendir Serviks H+2


    Kuantitas caran :
    Derajat pembukaan serviks :
    Ferning :
    Spinnbarkeit
    Total Skor

    Data Pasien

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