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DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : JANUARI
TAHUN : 2018
JUMLAH IBU BERSALIN USIA IBU
NO DESA
NAKES DUKUN TOTAL ≤ 19 th 20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
1 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0 0
10 0 0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 0 0 0
12 0 0 0 0 0 0 0 0 0 0 0
13 0 0 0 0 0 0 0 0 0 0 0
14 0 0 0 0 0 0 0 0 0 0 0
15 0 0 0 0 0 0 0 0 0 0 0
16 0 0 0 0 0 0 0 0 0 0 0
17 0 0 0 0 0 0 0 0 0 0 0
PUSKESMAS…………… 0 0 0 0 0 0 0 0 0 0 0
Mengetahui
Kepala UPT Puskesmas………….. Pengelola Kesbu Puskesmas
………………………………………….. ………………………………………………………….
Nip. ………………………………………. Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : FEBRUARI
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : MARET
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : APRIL
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : MEI
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : JUNI
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : JULI
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : AGUSTUS
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : SEPTEMBER
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : OKTOBER
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : NOVEMBER
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : DESEMBER
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
DATA JUMLAH IBU BERSALIN
PUSKESMAS……………………………….
BULAN : JANUARI - DESEMBER
TAHUN : 2018
JUMLAH IBU BERSALIN
NO DESA
NAKES DUKUN TOTAL ≤ 19 th
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
PUSKESMAS…………… 0 0 0 0
Mengetahui
Kepala UPT Puskesmas…………..
…………………………………………..
Nip. ……………………………………….
LAH IBU BERSALIN
S……………………………….
USIA IBU
20-24 th 25-29 Th 30-34 Th 35-39 Th 40-45 Th > 45 Th TOTAL
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
Pengelola Kesbu Puskesmas
………………………………………………………….
Nip. …………………………………………………….
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