Data Offline Surveilans PTM berbasis FKTP

IDENTITAS

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

1 01 May 2019 5311052101000001 Mikhael Seto L

2 05 May 2019 5311052101000002 Stefanus Tali L
3 05 May 2019 5311052101000003 Musmuliadi Djafar L
4 06 May 2019 5311052101000004 Petrus Wonga L
5 06 May 2019 5311052101000005 Donata Sea P
6 08 May 2019 5311052101000006 Sofia Sa P
7 08 May 2019 5311052101000007 Melianus Mio L
8 08 May 2019 5311052101000008 Agata Deo P
9 09 May 2019 5311052101000009 Siprianus Mae L
10 11 May 2019 5311052101000010 Ambrosius Senda L
11 11 May 2019 5311052101000011 Seto Ignasius L
12 11 May 2019 5311052101000012 Magdalena Nata P
13 13 May 2019 5311052101000013 Mario F Baru L
14 13 May 2019 5311052101000014 Wihelmina Bella P
15 14 May 2019 5311052101000015 Idris Satu L
16 20 May 2019 5311052101000016 Damianus Bata L
17 23 May 2019 5311052101000017 Kristianus Y.S Lo L
18 27 May 2019 5311052101000018 Matilda A Wangge P
19 28 May 2019 5311052101000019 Agustina Londa P
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

Wolojita 12/31/1955 Wolojita

Wolojita 12/31/1949 Wolojita
Wologawi 12/31/1984 Wologawi
Wologawi 12/31/1972 Wologawi
Wolojita 12/31/1958 Wolojita
Wolojita 12/31/1959 Wolojita
Wolojita 12/31/1975 Wolojita
Wolojita 12/31/1963 Wolojita
Wolojita 12/31/1999 Wolojita
Wolojita 12/31/1976 Wolojita
Wolojita 12/31/1967 Wolojita
Wolojita 12/31/1959 Wolojita
Wolojita 12/31/1980 Wolojita
Wolojita 12/31/1951 Wolojita
Wolojita 12/31/1956 Wolojita
Wolojita 12/31/1963 Wolojita
Wolojita 12/31/1969 Wolojita
Wolojita 12/31/1999 Wolojita
Wolojita 12/31/1939 Wolojita
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 Golongan
No Telp. Rumah Status Suku Pekerjaan
Darah

Menikah Lio petani

Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
belum Lio Lainnya
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
belum Lio Lainnya
Janda/Duda Lio petani
xxx xxx xxx xxx xxx
 WAWANCARA IMT

Kurang Kurang Konsumsi Tinggi Berat Lingkar

Keterangan Merokok Aktivitas Makan Alkohol Badan Badan Perut
Fisik Sayur

ya 164 59
ya 160 49
ya ya 159 65
ya ya 164 60
ya ya 158 56
ya ya 160 52
ya ya 160 51
ya 158 50
ya ya 156 49
ya ya 165 49
ya ya 164 46
ya 159 56
ya ya 160 51
ya 164 46
ya ya 158 45
ya 160 59
ya ya 162 51
156 47
ya ya 159 43
xxx xxx xxx xxx xxx xxx xxx xxx
 Tekanan Darah Gula Darah Kolesterol

Arus
Gula Darah Gula Darah Kolesterol Puncak
Sistol Diastol Trigliserida LDL HDL
Sewaktu Puasa Total Ekspirasi
(APE)

150 90
170 100
110 70
120 80
150 90
140 90
110 70
160 100
110 80
120 70
140 70
150 100
190 90
160 100
110 70
150 100
130 90
110 70
200 120
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 DI

Kadar Tes Benjolan Hasil

Alkohol Amfetamin Abnormal Pap Smear Periksa Krioterapi Diagnosa 1
Pernafasan Urin Payudara IVA

Hipertensi
Hipertensi
Asma Bronchiale
Asma Bronchiale
Hipertensi
Hipertensi
Cedera Akibat Jatuh
Hipertensi
Cedera Akibat Jatuh
Asma Bronchiale
Hipertensi
Hipertensi
Hipertensi
Hipertensi
Hipertropi Prostat
Hipertensi
Cedera Akibat Jatuh
Cedera Akibat Terbakar
Hipertensi
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 DIAGNOSA Pemeriksaan Penunjang

Diagnosa 2 Diagnosa 3 Diagnosa 4 Diagnosa 5 EKG

xxx xxx xxx xxx xxx
Pemeriksaan Penunjang

Urin Rutin
Darah &
Radiologi Dirujuk
Lengkap Mikroskop
ik
xxx xxx xxx xxx
 tgl_periksa rekam_medis nik nama tgl_lahir alamat
2019-05-01 5311052101000001 Mikhael Seto #REF! Wolojita
2019-05-05 5311052101000002 Stefanus Tali 1949-12-31 Wolojita
2019-05-05 5311052101000003 Musmuliadi Djafar 1984-12-31 Wologawi
2019-05-06 5311052101000004 Petrus Wonga 1972-12-31 Wologawi
2019-05-06 5311052101000005 Donata Sea 1958-12-31 Wolojita
2019-05-08 5311052101000006 Sofia Sa 1959-12-31 Wolojita
2019-05-08 h Melianus Mio 1975-12-31 Wolojita
2019-05-08 5311052101000008 Agata Deo 1963-12-31 Wolojita
2019-05-09 5311052101000009 Siprianus Mae 1999-12-31 Wolojita
2019-05-11 5311052101000010 Ambrosius Senda 1976-12-31 Wolojita
2019-05-11 5311052101000011 Seto Ignasius 1967-12-31 Wolojita
2019-05-11 5311052101000012 Magdalena Nata 1959-12-31 Wolojita
2019-05-13 5311052101000013 Mario F Baru 1980-12-31 Wolojita
2019-05-13 5311052101000014 Wihelmina Bella 1951-12-31 Wolojita
2019-05-14 5311052101000015 Idris Satu 1956-12-31 Wolojita
2019-05-20 5311052101000016 Damianus Bata 1963-12-31 Wolojita
2019-05-23 5311052101000017 Kristianus Y.S Lo 1969-12-31 Wolojita
2019-05-27 5311052101000018 Matilda A Wangge 1999-12-31 Wolojita
2019-05-28 5311052101000019 Agustina Londa 1955-12-31 Wolojita
 gender telp diagnosa1 diagnosa2 diagnosa3 diagnosa4 diagnosa5 merokok kurang_aktifitas
L 4 1
L 4 1
L 3 1
L 3 1
P 4 1
P 4 1
L 20 1
P 4
L 20 1
L 3 1
L 4 1 1
P 4
L 4 1
P 4
L 26 1
L 4
L 20 1
P 27
P 4 1
kurang_sayur
konsumsi_alkohol tb bb lp sistol diastol gds
164 59 150 90
160 49 170 100
1 159 65 110 70
1 164 60 120 80
1 158 56 150 90
1 160 52 140 90
1 160 51 110 70
1 158 50 160 100
1 156 49 110 80
1 165 49 120 70
164 46 140 70
1 159 56 150 100
1 160 51 190 90
1 164 46 160 100
1 158 45 110 70
1 160 59 150 100
1 162 51 130 90
156 47 110 70
1 159 43 200 120
gdp apebenjolan_payudara
positif_iva krioterapi papsmear tempat_lahir no_telprum
Wolojita
Wolojita
Wologawi
Wologawi
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
golongan_d status suku pekerjaan keterangan kolesterol_totrigliserida ldl
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
belum Lio Lainnya
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
belum Lio Lainnya
Janda/Duda Lio petani
hdl kadar_alko tesamfetamekg radiologi darah_lengurin_rutin dirujuk
2 fktp