REK

Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 3 13
2 Kumulatif s.d. bulan lalu 0 0
II Peminta Tes Laboratorium : 3 13
1 Poli umum 3 1
2 KIA 0 12
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 2 15
801 Golongan darah : 2 5
1 A 0 1
2 O 0 1
3 B 0 0
4 AB 2 3
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 5
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 5
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 6 17
2 Kumulatif s.d. bulan lalu 3 13
II Peminta Tes Laboratorium : 6 17
1 Poli umum 6 6
2 KIA 0 11
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0 20
801 Golongan darah : 0 6
1 A 0 1
2 O 0 2
3 B 0 0
4 AB 0 3
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 8
a. 12 -17 gr /dl 0 1
b. 11 -16 gr /dl 0 7
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 4 9
2 Kumulatif s.d. bulan lalu 9 20
II Peminta Tes Laboratorium : 4 9
1 Poli umum 4 2
2 KIA 0 7
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 1 10
801 Golongan darah : 1 2
1 A 0 1
2 O 0 0
3 B 1 0
4 AB 0 1
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 3
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 3
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 1 17
2 Kumulatif s.d. bulan lalu 13 29
II Peminta Tes Laboratorium : 1 17
1 Poli umum 1 3
2 KIA 0 14
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 3 25
801 Golongan darah : 1 3
1 A 0 0
2 O 0 0
3 B 1 0
4 AB 0 3
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 7
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 7
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 0 5
2 Kumulatif s.d. bulan lalu 14 46
II Peminta Tes Laboratorium : 0 5
1 Poli umum 0 0
2 KIA 0 5
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0 7
801 Golongan darah : 0 0
1 A 0 0
2 O 0 0
3 B 0 0
4 AB 0 0
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 4
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 4
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 0 0
2 Kumulatif s.d. bulan lalu 14 51
II Peminta Tes Laboratorium : 0 0
1 Poli umum 0 0
2 KIA 0 0
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0 0
801 Golongan darah : 0 0
1 A 0 0
2 O 0 0
3 B 0 0
4 AB 0 0
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 0
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 0
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 0 7
2 Kumulatif s.d. bulan lalu 14 51
II Peminta Tes Laboratorium : 0 7
1 Poli umum 0 0
2 KIA 0 7
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0 7
801 Golongan darah : 0 0
1 A 0 0
2 O 0 0
3 B 0 0
4 AB 0 0
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 5
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 5
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 LAPORAN BULANAN
REKAPITULASI LABORATORIUM DI PUSKESMAS DAN JEJARINGNYA
KABUPATEN /PUSKESMAS HUEBUNIF

Puskesmas Pustu Tanini Pustu Hueknutu Pustu Oelnaineno Poskesdes Nefoneke Pustu Kauniki Pustu O
No Elemen Data Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah
L P L P L P L P L P L P L P L P L P L P L P L P L
I Total Kunjungan Laboratorium :
1 Bulan ini 1 0 0 0 0 4 0 0 0 3 0 0 0 6 0 0 0 1 0 0 0 3 0 0 0
2 Kumulatif s.d. bulan lalu 14 58 0 0 0 16 0 0 0 8 0 0 0 4 0 0 0 4 0 0 0 24 0 0 0
II Peminta Tes Laboratorium : 1 0 0 0 0 4 0 0 0 3 0 0 0 6 0 0 0 1 0 0 0 3 0 0 0
1 Poli umum 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 KIA 0 0 0 0 0 4 0 0 0 3 0 0 0 6 0 0 0 1 0 0 0 3 0 0 0
3 Rawat inap 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
4 Unit gawat darurat 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
5 Lain-lain (sebutkan) 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
III Jumlah Pemeriksaan Laboratorium : 1 0 0 0 0 4 0 0 0 3 0 0 0 6 0 0 0 1 0 0 0 3 0 0 0
801 Golongan darah : 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
1 A 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
2 O 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
3 B 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
4 AB 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
5 Rhesus + 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 Rhesus - 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
802 Hb : 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
a. 12 -17 gr /dl 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
b. 11 -16 gr /dl 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
803 Leukosit : 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
a. 4,0 - 6,2 103/μl 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
b. 6,0 - 17,5 103/μl 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
804 Eritrosit : 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
a. 4,0 - 6,2 106/μl 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
b. < 4,0 106/μl 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
c. > 6,2 106/μl 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
805 Trombosit : 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
a. 150 - 450 103/μl 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
b. < 150 103/μl 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
c. > 450 103/μl 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
806 Hematokrit / Hct : 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
a. 31 - 47 % 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
b. < 31 % 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
c. > 47 % 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
807 LED : 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 - 20 mm/jam 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
808 Hitung jenis leukosit : 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
a. Eosinofil : 1 - 4 % 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
b. Basofil : 0 -1 % 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
c. Stab :1 - 5 % 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
d. Segmen : 38 - 71 % 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
e. Monosit : 2 - 10 % 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
f. Limposit : 25 - 50 % 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
809 Ureum : 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
a.10 - 50 mg/dl 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
b. < 10 mg/dl 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
c. > 50 mg/dl 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
810 Kreatinin : 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
a. 0,6 - 1,3 mg/dl 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
b. < 0,6 mg/dl 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
c. > 1,3 mg/dl 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
811 Asam urat : 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
a. 2,4 - 7,0 mg/dl 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
b. < 2,4 mg/dl 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
c. > 7,0 mg/dl 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
812 Cholesterol : 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
a. < 200 mg/dl 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
b. > 200 mg/dl 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
813 Trigliserida : 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
a. < 200 mg/dl 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
b. > 200 mg/dl 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
814 HDL : 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
 a. ≥ 45 mg/dl 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
b. < 45 mg/dl 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
815 LDL : 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
a. ≤ 130 mg/dl 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
b. > 130 mg/dl 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
816 SGOT : 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
a. < 38 U/L 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
b. < 32 U/L 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
817 SGPT : 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
a. < 38 U/L 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
b. < 32 U/L 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
818 Gula Darah : 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
a. Gula Darah Puasa : 70 - 140 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
b. Gula darah 2 j PP : < 126 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
c. Gula Darah Sewaktu : < 140 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
819 Widal : 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
a. Salmonela typhi O 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
b. Salmonela typhi H : ≤ 1/80 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
c. Salmonela para typhi AO : ≥ 1/160 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
d. Salmonela para typhi BO 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
820 HBsAg : 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
nilai rujukan : non reaktif 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
821 Malaria : 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
a. P. Vivax 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
b. P. Falcifarum 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
c. P. Malariae 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
d. P. Ovale 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
e. P. Mix 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
822 Sputum BTA : 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
a. Positif 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
b. Negatif 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
823 Urine lengkap : 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
a. Berat jenis 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
b. pH 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
c. Protein 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
d. Glukosa 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
e. Keton 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
f. Bilirubin 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
g. Urobilinogen 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
h. Nitrit 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
i. Eritrosit 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
j. Lekosit 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
k. Sedimen : Lekosit 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
Eritrosit 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
Epitel 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
Kristal 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
Bakteri 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
Lain - lain 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
824 Faeces lengkap : 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
a. Makroskopis : Warna 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
Konsistensi 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
Darah 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
Lendir 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
b. Mikroskopis : Lekosit 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
Epitel 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
Bakteri 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
Sisa Makanan 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
Telur Cacing 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
Amoeba 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
HCG 0 0 0 0 0 4 0 0 0 3 0 0 0 6 0 0 0 1 0 0 0 3 0 0 0

Mengetahui Huebunif, 03 Septem

Kepala Puskesmas Huebunif Yang Melapor

Antonius Naisumu, SKM Paskalis S. Jemarut,

Nip. 19680715 199103 1 013 Nip. 19810325 2006
AN BULANAN
M DI PUSKESMAS DAN JEJARINGNYA
USKESMAS HUEBUNIF

Pustu Oekolo TOTAL

Jumlah Hasil Jumlah Hasil
P L P L P L P

2 0 0 1 19 0 0
6 0 0 14 120 0 0
2 0 0 1 19 0 0
0 0 0 1 0 0 0
2 0 0 0 19 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
2 0 0 1 19 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 0 0
0 0 0 0 0 0 0
0 0 0 1 0 0 0
0 0 0 1 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 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 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 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 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 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 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 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 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 0 0 0
0 0 0 0 0 0 0
2 0 0 0 19 0 0

Huebunif, 03 September 2018

Yang Melapor

Paskalis S. Jemarut, S.Kep

Nip. 19810325 200604 1 012
 LAPORAN BULANAN
REKAPITULASI LABORATORIUM DI PUSKESMAS DAN JEJARINGNYA
KABUPATEN /PUSKESMAS HUEBUNIF

Puskesmas Pustu Tanini Pustu Hueknutu Pustu Oelnaineno Poskesdes Nefoneke Pustu Kauniki Pustu O
No Elemen Data Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah Hasil Jumlah
L P L P L P L P L P L P L P L P L P L P L P L P L
I Total Kunjungan Laboratorium :
1 Bulan ini 0 6 0 0 0 2 0 0 0 0 0 0 0 5 0 0 0 2 0 0 0 2 0 0 0
2 Kumulatif s.d. bulan lalu 15 58 0 0 0 20 0 0 0 11 0 0 0 10 0 0 0 5 0 0 0 27 0 0 0
II Peminta Tes Laboratorium : 0 6 0 0 0 2 0 0 0 0 0 0 0 5 0 0 0 2 0 0 0 2 0 0 0
1 Poli umum 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
2 KIA 0 6 0 0 0 2 0 0 0 0 0 0 0 5 0 0 0 2 0 0 0 2 0 0 0
3 Rawat inap 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
4 Unit gawat darurat 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
5 Lain-lain (sebutkan) 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
III Jumlah Pemeriksaan Laboratorium : 0 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
801 Golongan darah : 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 A 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
2 O 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
3 B 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 AB 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Rhesus + 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Rhesus - 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
802 Hb : 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. 12 -17 gr /dl 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
b. 11 -16 gr /dl 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
803 Leukosit : 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
a. 4,0 - 6,2 103/μl 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
b. 6,0 - 17,5 103/μl 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
804 Eritrosit : 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
a. 4,0 - 6,2 106/μl 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
b. < 4,0 106/μl 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
c. > 6,2 106/μl 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
805 Trombosit : 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
 a. 150 - 450 103/μl 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
b. < 150 103/μl 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
c. > 450 103/μl 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
806 Hematokrit / Hct : 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
a. 31 - 47 % 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
b. < 31 % 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
c. > 47 % 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
807 LED : 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 - 20 mm/jam 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
808 Hitung jenis leukosit : 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
a. Eosinofil : 1 - 4 % 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
b. Basofil : 0 -1 % 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
c. Stab :1 - 5 % 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
d. Segmen : 38 - 71 % 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
e. Monosit : 2 - 10 % 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
f. Limposit : 25 - 50 % 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
809 Ureum : 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
a.10 - 50 mg/dl 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
b. < 10 mg/dl 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
c. > 50 mg/dl 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

810 Kreatinin : 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
a. 0,6 - 1,3 mg/dl 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
b. < 0,6 mg/dl 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
c. > 1,3 mg/dl 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
811 Asam urat : 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
a. 2,4 - 7,0 mg/dl 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
b. < 2,4 mg/dl 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
c. > 7,0 mg/dl 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
812 Cholesterol : 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
a. < 200 mg/dl 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
b. > 200 mg/dl 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
813 Trigliserida : 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
a. < 200 mg/dl 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
b. > 200 mg/dl 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
814 HDL : 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
a. ≥ 45 mg/dl 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
b. < 45 mg/dl 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
815 LDL : 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
a. ≤ 130 mg/dl 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
b. > 130 mg/dl 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
816 SGOT : 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
a. < 38 U/L 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
b. < 32 U/L 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
817 SGPT : 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
a. < 38 U/L 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
b. < 32 U/L 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
818 Gula Darah : 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
a. Gula Darah Puasa : 70 - 140 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
b. Gula darah 2 j PP : < 126 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
c. Gula Darah Sewaktu : < 140 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
819 Widal : 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
a. Salmonela typhi O 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
b. Salmonela typhi H : ≤ 1/80 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
c. Salmonela para typhi AO : ≥ 1/160 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
d. Salmonela para typhi BO 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
820 HBsAg : 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
nilai rujukan : non reaktif 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
821 Malaria : 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
a. P. Vivax 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
b. P. Falcifarum 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
c. P. Malariae 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
d. P. Ovale 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
e. P. Mix 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
822 Sputum BTA : 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
a. Positif 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
b. Negatif 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
823 Urine lengkap : 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
a. Berat jenis 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
 b. pH 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
c. Protein 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d. Glukosa 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
e. Keton 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
f. Bilirubin 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
g. Urobilinogen 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
h. Nitrit 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
i. Eritrosit 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
j. Lekosit 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
k. Sedimen : Lekosit 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

Eritrosit 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
Epitel 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
Kristal 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
Bakteri 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
Lain - lain 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
824 Faeces lengkap : 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
a. Makroskopis : Warna 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
Konsistensi 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
Darah 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
Lendir 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
b. Mikroskopis : Lekosit 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
Epitel 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
Bakteri 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
Sisa Makanan 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
Telur Cacing 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
Amoeba 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
HCG 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

Mengetahui Huebunif, 04 Oktob

a/n. Kepala Puskesmas Huebunif Yang Melapor
 Bidan Koordinator

Martha A.W. Kononis, Amd.Keb Paskalis S. Jemarut,

19770412 200501 2 016 Nip. 19810325 2006
 ORAN BULANAN
RIUM DI PUSKESMAS DAN JEJARINGNYA
/PUSKESMAS HUEBUNIF

Pustu Oekolo TOTAL

Jumlah Hasil Jumlah Hasil
P L P L P L P

3 0 0 0 20 0 0
8 0 0 15 139 0 0
3 0 0 0 20 0 0
0 0 0 0 0 0 0
3 0 0 0 20 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 12 0 0
0 0 0 0 6 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 2 0 0
0 0 0 0 1 0 0
0 0 0 0 2 0 0
0 0 0 0 1 0 0
0 0 0 0 3 0 0
0 0 0 0 0 0 0
0 0 0 0 3 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 3 0 0
0 0 0 0 0 0 0
 0 0 0 0 0 0 0
0 0 0 0 3 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 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 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 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 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 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 0 0
0 0 0 0 0 0 0

Huebunif, 04 Oktober 2018

Yang Melapor
Paskalis S. Jemarut, S.Kep
Nip. 19810325 200604 1 012
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 0 0
2 Kumulatif s.d. bulan lalu 0 0
II Peminta Tes Laboratorium : 0 0
1 Poli umum 0 0
2 KIA 0 0
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0 0
801 Golongan darah : 0 0
1 A 0 0
2 O 0 0
3 B 0 0
4 AB 0 0
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 0
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 0
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 0 0
2 Kumulatif s.d. bulan lalu 0 0
II Peminta Tes Laboratorium : 0 0
1 Poli umum 0 0
2 KIA 0 0
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0 0
801 Golongan darah : 0 0
1 A 0 0
2 O 0 0
3 B 0 0
4 AB 0 0
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 0
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 0
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Puskesmas
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 0 0
2 Kumulatif s.d. bulan lalu 0 0
II Peminta Tes Laboratorium : 0 0
1 Poli umum 0 0
2 KIA 0 0
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 0 0
801 Golongan darah : 0 0
1 A 0 0
2 O 0 0
3 B 0 0
4 AB 0 0
5 Rhesus + 0 0
6 Rhesus - 0 0
802 Hb : 0 0
a. 12 -17 gr /dl 0 0
b. 11 -16 gr /dl 0 0
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0
 Pusk/Desa……….
No Elemen Data Jumlah
L P
I Total Kunjungan Laboratorium :
1 Bulan ini 15 74
2 Kumulatif s.d. bulan lalu 0 0
II Peminta Tes Laboratorium : 15 74
1 Poli umum 15 12
2 KIA 0 62
3 Rawat inap 0 0
4 Unit gawat darurat 0 0
5 Lain-lain (sebutkan) 0 0
III Jumlah Pemeriksaan Laboratorium : 7 96
801 Golongan darah : 4 22
1 A 0 3
2 O 0 3
3 B 2 2
4 AB 2 11
5 Rhesus + 0 2
6 Rhesus - 0 1
802 Hb : 0 35
a. 12 -17 gr /dl 0 1
b. 11 -16 gr /dl 0 34
803 Leukosit : 0 0
a. 4,0 - 6,2 103/μl 0 0
b. 6,0 - 17,5 103/μl 0 0
804 Eritrosit : 0 0
a. 4,0 - 6,2 106/μl 0 0
b. < 4,0 106/μl 0 0
c. > 6,2 106/μl 0 0
805 Trombosit : 0 0
a. 150 - 450 103/μl 0 0
b. < 150 103/μl 0 0
c. > 450 103/μl 0 0
806 Hematokrit / Hct : 0 0
a. 31 - 47 % 0 0