INSTRUMEN SCRENING ABCDE PROGRAM LANSIA KAB.

PASER 2017
POSYANDU HARAPAN II PUSKESMAS BATU KAJANG
BULAN MEI 2017
No NAMA Umur Pendidikan IMT TD AKTIVITY Balanec Cognitive Disease Emotion Tindak Lanjut
(thn) IND.BARTHEL ROMBER MMSE/M SCORE GDS
G TES INI COG
L P Tmt Tdk N L K N T R N K.ring K.Sdg K.Brt N T N T R S B N Dep Dep. Dep BL BR BR
SD tmt sd an ringan sdg brt
1 Suriansyah 65
2 Suparyem 51
3 Masliyan 60
4 Lasminan N
5 Hartutik 48
6 Gusaini 55
7 Rosmilia 47
8 Yurmatatik 46
9 Riah 76
10 Nurhayati 57
11
12
13
14
15
16
17
18
19
2 8 6 4 6 4 0 4 11 0 9 1 0 9 1 10 0 5 5 0 9 1 0 0 10 0 0
Total 10 10 10 10 10 10 10 10 10 10

Batu kajang, 16 Mei 2017

Pelaksana

1.Ika Adiyanti Amd.Keb
Nip.1977080820031220
 INSTRUMEN SCRENING ABCDE PROGRAM LANSIA KAB.PASER 2017
POSYANDU HARAPAN III DESA PUSKESMAS BATU KAJANG
BULAN MEI 2017
NO Nama Umur Pendidikan IMT TD AKTIVITY BALANC COGNITIV DISEASE EMOTION TINDAK LANJUT
E E
IND.BARTHEL ROMBER MMSE/MIN SCORE GDS
G TES I COG
L P Tmt Tdk N L K N T R N K.ri K.Sd K.Brt N T N T R S B N D.rin D.sdg D.brt BL BE BR
SD tmt ngan g gan
sd
1 Salasiah 54
2 A. Gazali 58
3 Sunardi 63
4 Sumartini 59
5 H.Aripin 71
6 Ida rosita 50
7 Kartasiah 50
8 Siti Fatimah 52
9 Mardiati 51
10 Hanah 70
11 Bainah 53
12 Masnian 70
13 Halipah 60
14 Norsehan 60
15 Siang 55
16
17
18

Total 4 11 8 7 4 8 3 5 10 0 15 0 0 0 15 0 13 2 3 12 0 12 3 0 0 14 1 0
Total 15 15 15 15 15 15 15 15 15 15
Batu kajang, 23 Mei 2017
Pelaksana

1.Ika Adiyanti Amd.Keb
Nip.197708082003122006
 INSTRUMEN SCRENING ABCDE PROGRAM LANSIA KAB.PASER 2017
POSYANDU HARAPAN I PUSKESMAS BATU KAJANG
BULAN MEI 2017

NO NAMA UMUR Pendidika IMT AKTIVITY Balance Cognitive Disease Emotion Tindak Lanjut
(Thn) n TD IND.BARTHEL ROMBERG MMSE/Mini SCORE GDS
(mmhg) TES cog
L P Tm Tdk N L K N T R M K.rin K K.Brt N T N T R S B N D.rin D.sdg D.brt BL BR BR
t tmt gan Sdg gan
SD sd
1 Hamsah 65
2 Maseri 45
3 Simon Talukun 53
4 Rusman S 54
5 Muhamdsyah 53
6 Mastinah 52
7 Abdul Gafur 51
8 Rusna 47
9 Radiansyah 50
10 Muhayah 45
11 Ridan Suparjo 59
12 Sukandar 59
13 Suhardi 52
14 Aeni Inayat 50
15 Radiansyah 50
16 Muhayah 45
17 Sugeng 70
18 Suhardi 52
19 Rusiani 48
20 Jumansyah 48
12 8 17 3 12 7 1 11 9 0 20 20 19 1 1 14 5 15 5 0 0 18 2
Total 20 20 20 20 20 20 20 20 20 20
Batu Kajang, 13 Mei 2017
Pelaksana

1. Ika Adiyanti
Nip 197708082003122006
 INSTRUMEN SCRENING ABCDE PROGRAM LANSIA KAB.PASER 2017
PUSKESMAS BATU KAJANG
BULAN AGUSTUS 2017
No NAMA Umur Pendidikan IMT TD AKTIVITY Balance Cognitive Disease Emotion Tindak Lanjut
(thn) IND.BARTHEL ROMBER MMSE/M SCORE GDS
60 G TES INI COG
L P Tmt Tdk N L K N T R N K.ring K.Sdg K.Brt N P N T R S B N Dep Dep. Dep BL BE BR
SD tmt sd an ringan sdg brt
1 Posyandu Harapan I 4 2 4 2 4 2 0 5 1 0 5 1 0 0 5 1 5 1 1 5 0 2 4 0 0 2 4 0
2 Pydu Harapan II 5 1 4 2 3 3 0 4 2 0 6 0 0 0 6 0 4 2 0 4 2 4 2 0 0 2 4 0
3 Pydu Harapan III 2 1 0 3 1 2 0 3 0 0 3 0 0 0 3 0 3 0 0 3 0 1 2 0 0 1 2 0
4 Kasungai 2 1 0 3 2 1 0 0 3 0 2 1 0 0 2 1 0 3 0 3 0 0 3 0 0 0 3 0
5 Legai 0 0 0 0 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 Samurangau 2 0 2 0 2 0 0 2 0 0 2 0 0 0 2 0 2 0 2 0 0 2 0 0 0 2 0 0
7 Resdes 2 0 0 2 2 0 0 0 2 0 2 0 0 0 2 0 2 0 2 0 0 2 0 0 0 2 0 0
8 Sei Terik 1 2 2 1 3 0 0 1 2 0 3 0 0 0 3 0 3 0 1 2 0 2 1 0 0 2 1 0
9 Busui 1 0 1 0 1 0 0 1 0 0 1 0 0 0 1 0 1 0 1 0 0 1 0 0 0 1 0 0
10 Songka 0 1 0 1 1 0 0 1 0 0 1 0 0 0 1 0 1 0 1 0 0 0 1 0 0 1 0 0
11 Rantau Buta 1 1 0 2 2 0 0 2 0 0 2 0 0 0 2 0 2 0 2 0 0 2 0 0 0 2 0 0
12 Rantau Layung 1 3 0 4 4 0 0 4 0 0 4 0 0 0 4 0 4 0 4 0 0 4 0 0 0 4 0 0

Jumlah 21 12 13 20 25 8 0 23 10 0 31 2 0 0 31 2 27 6 14 17 2 20 13 0 0 19 14 0
33 33 33 33 33 33 33 33 33 33

Mengetahui Batu Kajang, 04 September 2017

Pimpinan Puskesmas Pelaksana

Wijanarko SKM.MPH 1.Ika Adiyanti Amd.Keb
NIP 1969110219991021002 Nip.1977080820031220
 INSTRUMEN SCRENING ABCDE PROGRAM LANSIA KAB.PASER 2017
PUSKESMAS BATU KAJANG
BULAN JUNI 2017
No NAMA Umur Pendidikan IMT TD AKTIVITY Balance Cognitiv Disease Emotion Tindak Lanjut
(thn) e
45-70 IND.BARTHEL ROMBERG MMSE/ SCORE GD7
TES MINI
COG
L P Tmt Tdk N L K N T R N K.ring K.Sdg K.Brt N P N T R S B N Dep Dep. Dep BL BR BR
SD tmt sd an ringan sdg brt
1 Posyandu Harapan I 7 8 13 2 8 7 0 8 7 0 13 2 0 0 14 1 14 1 4 5 6 12 3 0 0 12 3 0
2 Pydu Harapan II 7 8 9 6 5 10 0 4 11 0 14 0 0 1 14 1 12 3 4 8 3 13 2 0 0 14 0 1
3 Pydu Harapan III 1 14 1 14 9 4 2 9 6 0 15 0 0 0 15 0 13 2 3 12 0 12 3 0 0 14 1 0
4 Kasungai 0 5 1 4 5 0 0 2 3 0 5 0 0 0 3 2 5 0 2 3 0 1 5 0 0 4 1 0
5 Legai 3 7 4 6 4 2 4 8 1 1 9 0 0 1 8 2 3 7 3 3 4 6 3 1 0 10 0 0
6 Samurangau 5 4 4 5 5 4 0 7 2 0 9 0 0 0 9 0 8 1 7 2 0 9 0 0 0 9 0 0
7 Resdes 8 2 5 5 10 0 0 7 3 0 9 1 0 0 10 0 9 1 7 3 0 10 0 0 0 10 0 0
8 Sei Terik 0 0 0 0 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 Busui 3 2 3 2 5 0 0 3 2 0 3 2 0 0 5 0 5 0 2 3 0 5 0 0 0 5 0 0
10 Songka 1 4 5 0 3 1 1 7 3 0 4 1 0 0 5 0 5 0 2 3 0 5 0 0 0 5 0 0
11 Rantau Layung 3 6 1 8 9 0 0 8 1 0 9 0 0 0 9 0 9 0 9 0 0 9 0 0 0 9 0 0
12 Rantau Buta 3 2 3 2 5 0 0 1 4 0 5 0 0 0 5 0 5 0 0 5 0 5 0 0 0 5 0 0

Total 39 53 42 50 53 32 7 57 35 0 90 0 1 1 84 8 78 14 29 46 17 72 19 1 0 84 5 3
Total 92 92 92 92 92 92 92 92 92 92

Batu Kajang, 06 JUNI 2017

Pelaksana

1.Ika Adiyanti Amd.Keb
Nip.1977080820031220