Data Offline Surveilans PTM berbasis POSBINDU

Identitas Peserta Posbindu

No Tanggal Pemeriksaan
No KTP Nama Pasien Nama Panggilan

1 07 January 2019 7371046705670001 RATNA

2 07 January 2019 7308035601940006 ASMAWATI
3 07 January 2019 7371040901860001 SONI SANI
4 07 January 2019 7371044204020001 NURFADILLA
5 07 January 2019 7371044912020001 ZASISA
6 07 January 2019 7371042407730001 SUNARYO
7 07 January 2019 7371047112630004 MARYAM
8 07 January 2019 7371045601060001 FITRA
9 07 January 2019 7371044664620003 NURAENI
10 07 January 2019 7371045008920001 PUPUT
11 07 January 2019 7371044510920003 ADRI
12 07 January 2019 7371041406993331 RESKI
13 07 January 2019 7307052112900003 SAEFULLAH
14 07 January 2019 7307056612920005 FEMI E.
15 07 January 2019 7371046302770003 RASMIA
16 07 January 2019 7371046706790003 ASNI
17 07 January 2019 7371042809900001 ANDI
18 07 January 2019 7371040402630001 RAHMAN
19 07 January 2019 7371046510850001 NURINTAN
20 07 January 2019 7371042201040001 JUSRI
21 07 January 2019 7371042307800004 ASRUL
22 07 January 2019 7371044606880003 SUHARNISA
23 07 January 2019 7371046405920001 SINTA M
24 07 January 2019 7371132109730010 IRWAN S
25 07 January 2019 7371045608710001 SRI ASTUTI
26 07 January 2019 7371126303000009 DEVI NAWAY
27 07 January 2019 7309012903940002 JUMRIATY
28 07 January 2019 7371047064900001 YUYUN A
29 07 January 2019 7371043011810001 RADEN A
30 07 January 2019 7371046901810004 ELLA BUDI
31
32
33
34
35
36
37
38
39
40
41
 42
43
44
45
46
47
48
49
50
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 Jenis
Tanggal Lahir Agama Alamat No Telp/ HP
Kelamin

27 May 1967 P JL. WR SUPRATMAN

16 January 1994 P JL. WR SUPRATMAN
09 January 1980 P JL. WR SUPRATMAN
02 April 2000 P JL. WR SUPRATMAN
09 December 2002 P JL. WR SUPRATMAN
24 July 1973 L JL. WR SUPRATMAN
31 December 1963 P JL. WR SUPRATMAN
16 January 1986 P JL. WR SUPRATMAN
06 April 1962 P JL. WR SUPRATMAN
10 August 1992 P JL. WR SUPRATMAN
05 October 1990 L JL. WR SUPRATMAN
14 June 1996 L JL. WR SUPRATMAN
21 December 1990 L JL. WR SUPRATMAN
26 December 1992 P JL. WR SUPRATMAN
23 February 1977 P JL. WR SUPRATMAN
27 June 1979 P JL. WR SUPRATMAN
28 September 1996 L JL. WR SUPRATMAN
04 February 1983 L JL. WR SUPRATMAN
25 October 1985 P JL. WR SUPRATMAN
23 January 2004 L JL. WR SUPRATMAN
23 July 1980 L JL. WR SUPRATMAN
06 June 1988 P JL. WR SUPRATMAN
24 May 1992 P JL. WR SUPRATMAN
29 April 1972 L JL. WR SUPRATMAN
16 August 1971 P JL. WR SUPRATMAN
23 March 2000 P JL. WR SUPRATMAN
29 March 1994 P JL. WR SUPRATMAN
30 June 1994 P JL. WR SUPRATMAN
30 November 1981 L JL. WR SUPRATMAN
29 January 1981 P JL. WR SUPRATMAN
xxx xxx xxx xxx xxx
xxx xxx xxx xxx xxx
 Golongan
Pendidikan Terakhir Pekerjaan Status Darah

AB
B
AB
O
O
O
AB
AB
AB
O
B
AB
AB
O
A
B
B
O
AB
B
B
B
A
A
B
A
AB
O
O
O
 xxx
xxx

xxx xxx xxx

 Riwayat Penyakit Tidak Menular Pada Keluarga

Penyakit Penyakit Penyakit Penyakit Penyakit Penyakit Kolesterol

eMail Diabetes Hipertensi Jantung Stroke Asma Kanker Tinggi
xxx xxx
xxx xxx xxx xxx xxx xxx xxx xxx
Riwayat Penyakit Tidak Menular Pada Diri Sendiri WAWANCARA

Kurang
Penyakit Penyakit Penyakit Penyakit Penyakit Penyakit Kolesterol Merokok Aktivitas
Diabetes Hipertensi Jantung Stroke Asma Kanker Tinggi
Fisik

Ya

Ya

Ya

Ya

Ya
Ya

Ya

Ya
Ya
xxx xxx xxx
xxx xxx xxx xxx xxx xxx xxx xxx xxx
WAWANCARA Tekanan Darah IMT Pemeriksaan La

Kurang Lingkar Pengukuran

Sayur dan Konsumsi Tinggi Berat Perut Fungsi Paru
Sistol Diastol Gula
Alkohol Badan Badan
Buah

12 80 152 74 95
110 60 150 65 97
120 80 155 70 99
110 70 160 75 98
100 60 158 60 95
160 90 162 85 103
150 90 160 68 93
120 80 159 75 98
160 100 160 75 106
100 70 155 60 80
120 80 162 75 102
110 80 159 80 106
120 70 159 60 98
100 70 15 43 71
120 80 159 65 95
120 86 162 80 111
110 70 158 73 95
130 80 155 60 97
130 90 159 65 99
100 70 155 62 85
120 90 162 73 99
130 80 156 54 73
120 80 160 73 99
130 80 159 70 95
120 80 155 45 70
100 70 152 45 70
120 80 159 60 80
110 80 160 53 85
130 80 162 73 95
130 80 161 80 102
xxx xxx xxx xxx xxx xxx xxx xxx xxx
xxx xxx xxx xxx xxx xxx xxx xxx xxx
 Pemeriksaan Lab. Penyuluhan
Kadar Tes
Benjolan IVA Alkohol Amfetamin Penyuluhan Penyuluhan
Kolesterol Trigliserida Pernafasan Urin
Payudara IVA & CBE Rokok
xxx xxx xxx xxx xxx xxx xxx xxx
xxx xxx xxx xxx xxx xxx xxx xxx
Penyuluhan

Penyuluhan
Potensi
Cedera
xxx
xxx
tanggal_pemeriksaanno_ktp nama_pasinama_pangtanggal_lah
jenis_kelaminagama alamat no_telp
2019-01-07 7371046705670001 RATNA 1967-05-27 P JL. WR SUPRATMAN

2019-01-07 7308035601940006 ASMAWATI 1994-01-16 P JL. WR SUPRATMAN

2019-01-07 7371040901860001 SONI SANI 1980-01-09 P JL. WR SUPRATMAN

2019-01-07 7371044204020001 NURFADILLA 2000-04-02 P JL. WR SUPRATMAN

2019-01-07 7371044912020001 ZASISA 2002-12-09 P JL. WR SUPRATMAN

2019-01-07 7371042407730001 SUNARYO 1973-07-24 L JL. WR SUPRATMAN

2019-01-07 7371047112630004 MARYAM 1963-12-31 P JL. WR SUPRATMAN

2019-01-07 7371045601060001 FITRA 1986-01-16 P JL. WR SUPRATMAN

2019-01-07 7371044664620003 NURAENI 1962-04-06 P JL. WR SUPRATMAN

2019-01-07 7371045008920001 PUPUT 1992-08-10 P JL. WR SUPRATMAN

2019-01-07 7371044510920003 ADRI 1990-10-05 L JL. WR SUPRATMAN

2019-01-07 7371041406993331 RESKI 1996-06-14 L JL. WR SUPRATMAN

2019-01-07 7307052112900003 SAEFULLAH 1990-12-21 L JL. WR SUPRATMAN

2019-01-07 7307056612920005 FEMI E. 1992-12-26 P JL. WR SUPRATMAN

2019-01-07 7371046302770003 RASMIA 1977-02-23 P JL. WR SUPRATMAN

2019-01-07 7371046706790003 ASNI 1979-06-27 P JL. WR SUPRATMAN

2019-01-07 7371042809900001 ANDI 1996-09-28 L JL. WR SUPRATMAN

2019-01-07 7371040402630001 RAHMAN 1983-02-04 L JL. WR SUPRATMAN

2019-01-07 7371046510850001 NURINTAN 1985-10-25 P JL. WR SUPRATMAN

2019-01-07 7371042201040001 JUSRI 2004-01-23 L JL. WR SUPRATMAN

2019-01-07 7371042307800004 ASRUL 1980-07-23 L JL. WR SUPRATMAN

2019-01-07 7371044606880003 SUHARNISA 1988-06-06 P JL. WR SUPRATMAN

2019-01-07 7371046405920001 SINTA M 1992-05-24 P JL. WR SUPRATMAN

2019-01-07 7371132109730010 IRWAN S 1972-04-29 L JL. WR SUPRATMAN

2019-01-07 7371045608710001 SRI ASTUTI 1971-08-16 P JL. WR SUPRATMAN

2019-01-07 7371126303000009 DEVI NAWAY 2000-03-23 P JL. WR SUPRATMAN

2019-01-07 7309012903940002 JUMRIATY 1994-03-29 P JL. WR SUPRATMAN

2019-01-07 7371047064900001 YUYUN A 1994-06-30 P JL. WR SUPRATMAN

2019-01-07 7371043011810001 RADEN A 1981-11-30 L JL. WR SUPRATMAN

2019-01-07 7371046901810004 ELLA BUDI 1981-01-29 P JL. WR SUPRATMAN

pendidikan_terakhir
pekerjaan statusgolongan_darah emailpenyakit_diabetes
penyakit_hipertensi
penyakit_jantung
penyakit_stroke
AB
B
AB
O
O
O
AB
AB
AB
O
B
AB
AB
O
A
B
B
O
AB
B
B
B
A
A
B
A
AB
O
O
O
penyakit_asma
penyakit_kanker
kolesterol_tinggi
penyakit_diabetes
penyakit_hipertensi
penyakit_jantung
penyakit_stroke
penyakit_asma
penyakit_kanker
kolesterol_tinggi
merokok
kurang_aktivitas
kurang_sayur
konsumsi_alkoholsistol diastol tinggi_badberat_bad lingkar_pepengukura
12 80 152 74 95
110 60 150 65 97
1 120 80 155 70 99
110 70 160 75 98
100 60 158 60 95
160 90 162 85 103
150 90 160 68 93
1 120 80 159 75 98
160 100 160 75 106
100 70 155 60 80
1 120 80 162 75 102
110 80 159 80 106
1 120 70 159 60 98
100 70 15 43 71
120 80 159 65 95
120 86 162 80 111
1 110 70 158 73 95
1 130 80 155 60 97
130 90 159 65 99
100 70 155 62 85
1 120 90 162 73 99
130 80 156 54 73
120 80 160 73 99
130 80 159 70 95
120 80 155 45 70
1 100 70 152 45 70
1 120 80 159 60 80
110 80 160 53 85
130 80 162 73 95
130 80 161 80 102
gula kolesterol trigliseridabenjolan_ iva kadar_alkotes_amfet penyuluhapenyuluhapenyuluhan_cedera
penyuluhan_cedera
1 posbindu