Data Offline Surveilans PTM berbasis FKTP

IDENTITA
S
Tanggal
No No Rekam Jenis
Pemeriksaan * No KTP * Nama Pasien
Medis Kelamin

1 25 February 2016 0641 3512130202680002 TRISNO L

2 0640 3512134064500001 SAHJO L
3 26 February 2016 0649 3512132164830002 HASAN L
4 0054 3512130904510001 SOEMINDAR L
5 27 February 2016 0664 3512134707540063 SUMYAMI P
6 0561 3512131706450002 SIYATUN P
7 0429 PARIYEM L
8 0641 TRISNO L
9 0286 3512137807000001 SAIYAH P
10 0511 3512130107480015 MUNTAHE L
11 29 February 2016 0370 3512130305650001 MATRAWI L
12 0359 3512134107780076 YOYOK L
13 0481 3512133006520008 LITO
14 0525 3512130209600003 HERRY L
15 0145 3512130107600135 AHMAD L
16 0267 3512135907580002 NURTIMAH P
17 0679 3512132405650001 MUH. SULAM L
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
 42
43
44
45
46
47
48
49
50
xxx xxx xxx xxx xxx xxx
Tempat Lahir Tanggal Lahir Alamat Lengkap No HP

05 March 1900 PERANTE

11 March 1900 AWAR-AWAR
20 March 1900 TRIGONCO
04 March 1900 MOJOSARI
02 March 1900 MOJOSARI
19 January 1900 ASEMBAGUS
03 March 1900 GUDANG
15 February 1900 PERANTE
26 February 1900 AWAR-AWAR
07 March 1900 MOJOSARI
18 February 1900 AWAR-AWAR
17 February 1900 GUDANG
04 March 1900 AWAR-AWAR
22 February 1900 MOJOSARI
23 February 1900 TRIGONCO
26 February 1900 MOJOSARI
28 February 1900 ASEMBAGUS
xxx xxx xxx xxx
 Golongan
No Telp. Rumah Status Suku Pekerjaan
Darah
xxx xxx xxx xxx xxx
 WAWANCARA IMT Tekanan Darah

Kurang Kurang Konsumsi Tinggi Berat Lingkar

Keterangan Merokok Aktivitas Makan Sistol
Alkohol Badan Badan Perut
Fisik Sayur
xxx xxx xxx xxx xxx xxx xxx xxx xxx
Tekanan Darah Gula Darah Kolesterol

Arus Kadar
Gula Darah Gula Darah Kolesterol Puncak
Diastol Trigliserida LDL HDL Alkohol
Sewaktu Puasa Total Ekspirasi Pernafasan
(APE)
xxx xxx xxx xxx xxx xxx xxx xxx xxx
 DIAGNOSA

Tes Benjolan Hasil

Amfetamin Abnormal Pap Smear Periksa Krioterapi Diagnosa 1 Diagnosa 2
Urin Payudara IVA
xxx xxx xxx xxx xxx xxx xxx
DIAGNOSA Pemeriksaan Penunjang

Urin Rutin
Darah &
Diagnosa 3 Diagnosa 4 Diagnosa 5 EKG Radiologi Lengkap Mikroskop
ik
xxx xxx xxx xxx xxx xxx xxx
Dirujuk
xxx
 tgl_periksa rekam_medis nik nama tgl_lahir alamat gender
2016-02-25 0641 3512130202680002 TRISNO 1900-03-05 PERANTE L
0640 3512134064500001 SAHJO 1900-03-11 AWAR-AWAR L
2016-02-26 0649 3512132164830002 HASAN 1900-03-20 TRIGONCO L
0054 3512130904510001 SOEMINDAR 1900-03-04 MOJOSARI L
2016-02-27 0664 3512134707540063 SUMYAMI 1900-03-02 MOJOSARI P
0561 3512131706450002 SIYATUN 1900-01-19 ASEMBAGUS P
0429 PARIYEM 1900-03-03 GUDANG L
0641 TRISNO 1900-02-15 PERANTE L
0286 3512137807000001 SAIYAH 1900-02-26 AWAR-AWAR P
0511 3512130107480015 MUNTAHE 1900-03-07 MOJOSARI L
2016-02-29 0370 3512130305650001 MATRAWI 1900-02-18 AWAR-AWAR L
0359 3512134107780076 YOYOK 1900-02-17 GUDANG L
0481 3512133006520008 LITO 1900-03-04 AWAR-AWAR
0525 3512130209600003 HERRY 1900-02-22 MOJOSARI L
0145 3512130107600135 AHMAD 1900-02-23 TRIGONCO L
0267 3512135907580002 NURTIMAH 1900-02-26 MOJOSARI P
0679 3512132405650001 MUH. SULAM 1900-02-28 ASEMBAGUS L

Err:509 Err:509
telp diagnosa1 diagnosa2 diagnosa3 diagnosa4 diagnosa5 merokok kurang_aktifitas
kurang_sayur
konsumsi_alkohol tb bb lp sistol diastol gds gdp
apebenjolan_payudara
positif_iva krioterapi papsmear tempat_lahirno_telprum golongan_dastatus
suku pekerjaan keterangan kolesterol_totrigliserida ldl hdl kadar_alko
tesamfetamekg radiologi darah_lengurin_rutin dirujuk
2 fktp