DAFTAR CHEKLIST

RUANG PERINATAL RSUD dr. DRAJAT PERWIRANEGARA

TAHUN 2014
BBLR HIPERTENSI
UMUR
GEMELI ANEMIA
PREEKLAMPSI
NO KEHA PARITAS
YA TDK YATDK
MILA
YA TD YA TDK YA TDK
N
K
1 32 mg G1P0A0 √ √ √ √ √
2 39 mg G1P0A0 √ √ √ √ √
3 38 mg G1P0A0 √ √ √ √ √
4 37 mg G4P3A0 √ √ √ √ √
5 40 mg G3P2A0 √ √ √ √ √
6 32 mg G1P0A0 √ √ √ √ √
7 32 mg G3P2A0 √ √ √ √ √
8 34 mg G3P2A0 √ √ √ √ √
9 39 mg G1P0A0 √ √ √ √ √
10 32 mg G4P3A0 √ √ √ √ √
11 20 mg G1P0A0 √ √ √ √ √
12 36 mg G2P1A0 √ √ √ √ √
13 36 mg G2P210 √ √ √ √ √
14 37 mg G2P1A0 √ √ √ √ √
15 36 mg G2P0A1 √ √ √ √ √
16 32 mg G4P3A0 √ √ √ √ √
17 38 mg G1P0A0 √ √ √ √ √
18 39 mg G2P1A0 √ √ √ √ √
19 35 mg G2P1A0 √ √ √ √ √
20 35 mg G2P1A0 √ √ √ √ √
21 40 mg G3P2A1 √ √ √ √ √
22 35 mg G3P2A0 √ √ √ √
23 38 mg G5P4A0 √ √ √ √
24 36 mg G1P0A0 √ √ √ √
25 34 mg G1P0A0 √ √ √ √
26 34 mg G1P0A0 √ √ √ √
27 34 mg G1P0A0 √ √ √ √
28 33 mg G4P3A0 √ √ √ √
29 40 mg G1P0A0 √ √ √ √
30 40 mg G1P0A0 √ √ √ √
31 36 mg G1P0A0 √ √ √ √
32 37 mg G2P1A0 √ √ √
33 36 mg G1P0A0 √ √ √ √
34 39 mg G1P0A0 √ √ √ √
35 40 mg G1P0A0 √ √ √ √
36 32 mg G2P1A0 √ √ √ √
37 34 mg G2P1A0 √ √ √ √
38 37 mg G2P1A0 √ √ √ √
39 40 mg G1P0A0 √ √ √ √
40 27 mg G5P4A0 √ √ √ √
41 38 mg G1P0A0 √ √ √ √
42 25 mg G1P0A0 √ √ √ √
43 37 mg G2P1A0 √ √ √ √
44 41 mg G2P1A0 √ √ √ √
45 32 mg G1P0A0 √ √ √ √
46 38 mg G1P0A0 √ √ √ √
47 38 mg G1P0A0 √ √ √ √
48 26 mg G1P0A0 √ √ √ √
49 36 mg G4P3A1 √ √ √ √
50 36 mg G4P3A1 √ √ √ √
51 38 mg G2P0A0 √ √ √ √
52 40 mg G3P2A0 √ √ √ √
53 38 mg G1P0A0 √ √ √ √
54 36 mg G1P0A0 √ √ √ √
55 37 mg G4P3A0 √ √ √ √

56 36 mg G5P4A0 √ √ √ √

57 36 mg G5P4A0 √ √ √ √
58 35 mg G2P1A0 √ √ √ √
59 37 mg G2P0A0 √ √ √ √
60 38 mg G3P1A1 √ √ √ √
61 36 mg G3P1A1 √ √ √ √
62 40 mg G2P1A0 √ √ √ √
63 36 mg G3P2A0 √ √ √ √
64 36 mg G1P0A0 √ √ √ √
65 36 mg G1P0A0 √ √ √ √
66 39 mg G2P1A0 √ √ √ √
67 37 mg G3P1A2 √ √ √ √
68 36 mg G1P0A0 √ √ √ √

69 36 mg G1P0A0 √ √ √ √
70 28 mg G6P4A1 √ √ √ √
71 29 mg G1P0A0 √ √ √ √
72 38 mg G1P0A0 √ √ √ √
73 38 mg G1P0A0 √ √ √ √
74 37 mg G4P2A1 √ √ √ √
75 38 mg G4P3A0 √ √ √ √
76 40 mg G3P2A1 √ √ √ √

77 38 mg G1P0A0 √ √ √ √
78 32 mg G1P0A0 √ √ √ √
79 40 mg G5P4A0 √ √ √ √
80 40 mg G5P4A0 √ √ √ √
81 38 mg G1P0A0 √ √ √ √
82 40 mg G3P2A0 √ √ √ √
83 37 mg G2P1A0 √ √ √ √
84 41 mg G2P1A0 √ √ √ √
85 28 mg G2P1A0 √ √ √ √
86 34 mg G2P1A0 √ √ √ √
87 34 mg G2P1A0 √ √ √ √
88 38 mg G1P0A0 √ √ √ √
89 38 mg G2P0A1 √ √ √ √
90 39 mg G5P1A3 √ √ √ √
91 39 mg G3P2A0 √ √ √ √
92 39 mg G3P2A0 √ √ √ √
93 32 mg G1P0A0 √ √ √ √
94 37 mg G1P0A0 √ √ √ √
95 40 mg G7P5A1 √ √ √ √

96 40 mg G7P5A1 √ √ √ √

97 40 mg G1P0A0 √ √ √ √
98 39 mg G3P2A0 √ √ √
99 40 mg G1P0A0 √ √ √ √
100 38 mg G3P1A1 √ √ √ √
101 36 mg G4P3A1 √ √ √ √
102 32 mg G1P0A0 √ √ √ √
103 42 mg G5P3A1 √ √ √ √
104 38 mg G2P1A0 √ √ √ √
105 40 mg G2P1A0 √ √ √ √
106 31 mg G1P0A0 √ √ √ √
107 34 mg G6P4A1 √ √ √ √
108 34 mg G1P0A0 √ √ √ √

109 33 mg G1P0A0 √ √ √ √
110 38 mg G1P0A0 √ √ √ √
111 40 mg G2P1A0 √ √ √ √
112 39 mg G3P2A0 √ √ √ √
113 36 mg G1P0A0 √ √ √ √
114 39 mg G4P2A1 √ √ √ √
115 40 mg G2P1A0 √ √ √ √
116 39 mg G3P2A1 √ √ √ √

117 38 mg G1P0A0 √ √ √ √
118 37 mg G2P1A0 √ √ √ √
119 38 mg G1P0A0 √ √ √ √
120 36 mg G1P0A0 √ √ √ √
121 38 mg G1P0A0 √ √ √ √
122 37 mg G4P3A0 √ √ √ √
123 34 mg G1P0A0 √ √ √ √
124 41 mg G2P1A0 √ √ √ √
125 36 mg G1P0A0 √ √ √ √
126 39 mg G3P2A1 √ √ √ √
127 37 mg G4P3A0 √ √ √ √
128 37 mg G4P3A0 √ √ √ √
129 39 mg G2P0A1 √ √ √ √
130 30 mg G2P1A0 √ √ √ √
131 36 mg G1P0A0 √ √ √ √
132 38 mg G3P2A0 √ √ √ √
133 33 mg G1P0A0 √ √ √ √
134 36 mg G5P4A0 √ √ √ √
135 36 mg G5P4A0 √ √ √ √

136 28 mg G2P0A1 √ √ √ √

137 39 mg G3P2A0 √ √ √ √
138 30 mg G4P3A0 √ √ √ √
139 30 mg G1P0A0 √ √ √ √
140 30 mg G1P0A0 √ √ √ √
141 30 mg G1P0A0 √ √ √ √
142 39 mg G2P1A0 √ √ √ √
143 42 mg G5P3A1 √ √ √ √
144 36 mg G1P0A0 √ √ √ √
145 39 mg G2P1A0 √ √ √ √
146 38 mg G2P1A0 √ √ √ √
147 40 mg G3P1A2 √ √ √ √
148 34 mg G1P0A0 √ √ √ √

149 35 mg G1P0A0 √ √ √ √
150 39 mg G1P0A0 √ √ √ √
151 38 mg G1P0A0 √ √ √ √
152 35 mg G1P0A0 √ √ √ √
153 38 mg G2P1A0 √ √ √ √
154 37 mg G2P1A1 √ √ √ √
155 38 mg G3P2A0 √ √ √ √
156 40 mg G3P2A1 √ √ √ √

157 39 mg G1P0A0 √ √ √ √
158 39 mg G1P0A0 √ √ √ √
159 38 mg G1P0A0 √ √ √ √
160 35 mg G1P0A0 √ √ √ √
161 32 mg G1P0A0 √ √ √ √
162 34 mg G2P1A0 √ √ √ √
163 38 mg G2P1A0 √ √ √ √
164 41 mg G2P1A0 √ √ √ √
165 40 mg G1P0A0 √ √ √ √
166 38 mg G1P0A0 √ √ √ √
167 38 mg G2P1A0 √ √ √ √
168 38 mg G2P1A0 √ √ √ √
169 37 mg G2P0A1 √ √ √ √
170 36 mg G3P2A0 √ √ √ √
171 39 mg G2P2A0 √ √ √ √
172 39 mg G4P3A0 √ √ √ √
173 28 mg G2P1A0 √ √ √ √
174 38 mg G1P0A0 √ √ √ √
175 34 mg G2P1A0 √ √ √ √

176 37 mg G1P0A0 √ √ √ √

177 36 mg G3P2A0 √ √ √ √
178 34 mg G2P1A0 √ √ √ √
179 39 mg G1P0A0 √ √ √ √
180 40 mg G3P1A1 √ √ √ √
181 37 mg G1P0A0 √ √ √ √
182 24 mg G1P0A0 √ √ √ √
183 42 mg G5P3A1 √ √ √ √
184 31 mg G4P3A0 √ √ √ √
185 34 mg G4P3A0 √ √ √ √
186 37 mg G2P1A0 √ √ √ √
187 39 mg G3P1A2 √ √ √ √
188 31 mg G5P4A0 √ √ √ √

189 38 mg G1P0A0 √ √ √ √
190 33 mg G1P0A0 √ √ √ √
191 37 mg G2P1A0 √ √ √ √

192 40 mg G2P1A0 √ √ √ √
193 37 mg G2P1A0 √ √ √ √
194 37 mg G4P2A1 √ √ √ √
195 36 mg G4P3A0 √ √ √ √
196 39 mg G3P2A1 √ √ √ √

197 33 mg G1P0A0 √ √ √ √
198 40 mg G2P1A0 √ √ √ √
199 40 mg G2P1A0 √ √ √ √
200 38 mg G5P4A0 √ √ √ √
201 38 mg G1P0A0 √ √ √ √
202 33 mg G2P1A0 √ √ √ √
203 34 mg G1P0A0 √ √ √ √
204 41 mg G2P1A0 √ √ √ √
205 27 mg G3P2A0 √ √ √ √
206 34 mg G4P3A1 √ √ √ √
207 40 mg G2P1A0 √ √ √ √
208 37 mg G2P1A0 √ √ √ √
209 38 mg G2P0A1 √ √ √ √
210 40 mg G1P0A0 √ √ √ √
211 27 mg G3P2A0 √ √ √ √
212 42 mg G3P2A0 √ √ √ √
213 32 mg G2P1A0 √ √ √ √
214 41 mg G7P6A0 √ √ √ √
215 35 mg G4P3A0 √ √ √ √

216 34 mg G4P3A0 √ √ √ √

217 40 mg G3P2A0 √ √ √ √
218 42 mg G8P7A1 √ √ √ √
219 31 mg G4P3A0 √ √ √ √
220 40 mg G3P1A1 √ √ √ √
221 40 mg G2P0A1 √ √ √ √
222 39 mg G1P0A0 √ √ √ √
223 39 mg G1P0A0 √ √ √ √
224 33 mg G1P0A0 √ √ √ √
225 40 mg G2P1A0 √ √ √ √
226 38 mg G2P1A0 √ √ √ √
227 38 mg G3P1A2 √ √ √ √
228 38 mg G4P3A0 √ √ √ √

229 32 mg G2P1A0 √ √ √ √
230 36 mg G5P4A0 √ √ √ √
231 40 mg G2P1A0 √ √ √ √
232 38 mg G3P2A0 √ √ √ √
233 31mg G1P0A0 √ √ √ √
234 36 mg G2P1A1 √ √ √ √
235 38 mg G3P2A0 √ √ √ √
236 33 mg G1P0A0 √ √ √ √

237 33 mg G1P0A0 √ √ √ √
238 40 mg G2P1A0 √ √ √ √
239 33 mg G2P1A0 √ √ √ √
240 38 mg G5P4A0 √ √ √ √
241 37 mg G1P0A0 √ √ √ √
242 35 mg G1P0A0 √ √ √ √
243 41 mg G1P0A0 √ √ √ √
244 41 mg G2P1A0 √ √ √ √
245 39 mg G5P4A0 √ √ √ √
246 27 mg G1P1A0 √ √ √ √
247 32 mg G3P2A0 √ √ √ √
248 38 mg G2P1A0 √ √ √ √
249 37 mg G2P0A1 √ √ √ √
250 39 mg G5P1A3 √ √ √ √
251 39 mg G1P0A0 √ √ √ √
252 39 mg G3P2A0 √ √ √ √
253 24 mg G1P0A0 √ √ √ √
254 32 mg G1P0A0 √ √ √ √
255 37 mg G4P3A0 √ √ √ √

256 31 mg G1P0A0 √ √ √ √

257 40 mg G3P2A0 √ √ √ √
258 39 mg G2P1A0 √ √ √
259 32 mg G1P0A0 √ √ √ √
260 40 mg G3P1A1 √ √ √ √
261 36 mg G3P1A1 √ √ √ √
262 22 mg G2P1A0 √ √ √ √
263 42 mg G5P3A1 √ √ √ √
264 33 mg G2P1A0 √ √ √ √
265 38 mg G2P1A0 √ √ √ √
266 40 mg G2P1A0 √ √ √ √
267 28 mg G3P1A2 √ √ √ √
268 20 mg G1P0A0 √ √ √ √

269 38 mg G5P3A1 √ √ √ √
270 31 mg G5P4A0 √ √ √ √
271 32 mg G4P3A0 √ √ √ √
272 35 mg G6P5A0 √ √ √ √
273 39 mg G2P1A0 √ √ √ √
274 33 mg G7P6A0 √ √ √ √
275 34 mg G2P1A0 √ √ √ √
276 38 mg G3P2A1 √ √ √ √

277 38 mg G1P0A0 √ √ √ √
278 35 mg G2P1A0 √ √ √ √
279 32 mg G4P3A0 √ √ √ √
280 32 mg G5P4A0 √ √ √ √
281 38 mg G1P0A0 √ √ √ √
282 40 mg G4P3A0 √ √ √ √
283 37 mg G2P1A0 √ √ √ √
284 41 mg G1P0A0 √ √ √ √
285 40 mg G5P4A0 √ √ √ √
286 40 mg G4P3A1 √ √ √ √
287 34 mg G4P3A0 √ √ √ √
288 39 mg G2P1A0 √ √ √ √
289 39 mg G2P0A1 √ √ √ √
290 32 mg G1P0A0 √ √ √ √
291 34 mg G2P1A0 √ √ √ √
292 38 mg G3P2A0 √ √ √ √
293 40 mg G8P7A0 √ √ √ √
294 31 mg G2P1A0 √ √ √ √
295 31 mg G2P1A0 √ √ √ √

296 34 mg G5P4A0 √ √ √ √

297 33 mg G3P2A0 √ √ √ √
298 33 mg G3P2A0 √ √ √ √
299 37 mg G1P0A0 √ √ √ √
300 40 mg G3P1A1 √ √ √ √
301 34 mg G3P1A1 √ √ √ √
302 38 mg G2P1A0 √ √ √ √
303 42 mg G5P3A1 √ √ √ √
304 33 mg G1P0A0 √ √ √ √
305 39 mg G2P1A0 √ √ √ √
306 38 mg G2P1A0 √ √ √ √
307 42 mg G2P1A0 √ √ √ √
308 42 mg G2P1A0 √ √ √ √

309 39 mg G5P3A1 √ √ √ √
310 34 mg G5P4A0 √ √ √ √
311 40 mg G1P0A0 √ √ √ √
312 34 mg G1P0A0 √ √ √ √
313 37 mg G2P1A0 √ √ √ √
314 38 mg G4P2A1 √ √ √ √
315 37 mg G1P0A0 √ √ √ √
316 37 mg G1P0A0 √ √ √ √

317 34 mg G1P0A0 √ √ √ √
318 37 mg G2P1A0 √ √ √ √
319 41 mg G10P8A1 √ √ √ √
320 37 mg G6P5A0 √ √ √ √
321 42 mg G1P0A0 √ √ √ √
322 25 mg G1P0A0 √ √ √ √
324 36 mg G2P1A0 √ √ √ √
325 41 mg G2P1A0 √ √ √ √
326 30 mg G6P5A0 √ √ √ √
327 37 mg G3P2A1 √ √ √ √
328 33 mg G1P0A0 √ √ √ √
329 33 mg G1P0A0 √ √ √ √
330 40 mg G1P0A0 √ √ √ √
331 39 mg G1P0A0 √ √ √ √
332 42 mg G1P0A0 √ √ √ √
333 38 mg G3P2A0 √ √ √ √
334 32 mg G2P1A0 √ √ √ √
335 29 mg G6P5A0 √ √ √ √
336 37 mg G6P5A0 √ √ √ √

337 42 mg G1P0A0 √ √ √ √

338 38 mg G3P2A0 √ √ √ √
339 38 mg G3P2A0 √ √ √ √
340 32 mg G2P1A0 √ √ √ √
341 42 mg G3P1A1 √ √ √ √
342 41 mg G1P0A0 √ √ √ √
343 31 mg G1P0A0 √ √ √ √
344 42 mg G4P3A0 √ √ √ √
345 32 mg G4P3A0 √ √ √ √
346 38 mg G2P1A0 √ √ √ √
347 30 mg G6P5A0 √ √ √ √
348 31 mg G1P0A0 √ √ √ √