FORM CHECKLIST KELENGKAPAN REKAM MEDIS

PUSKESMAS KALUMPANG
Keterangan:

1. (1) terisi

2. (0) tidak terisi

3. perhitungan = (jumlah terisi) ÷ 13 x 100 =

IDENTITAS PASIEN TNDKN / TTD TTD JAM/TGL JLH KLNGKPN

NO NO.RM NAMA TTL JK UMUR PEKERJAAN ALAMAT NO.JAMINAN ANAM DIAG PNGBTN DOKTER PERAWATKUNJUNGAN % %
1 020342 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
2 050221 1 0 0 1 1 1 1 1 1 1 1 1 1 11 84.62
3 080011 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
4 090331 1 1 0 1 0 1 1 0 1 1 1 0 1 9 69.23
5 010021 1 1 1 1 0 1 1 1 0 1 1 0 1 10 76.92
6 040112 1 0 1 1 1 1 0 1 1 1 1 0 1 10 76.92
7 070125 1 1 0 0 1 1 1 0 1 1 1 1 1 10 76.92
8 080023 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
9 070321 1 1 0 1 0 1 0 0 1 1 1 1 1 9 69.23
10 060231 1 1 1 0 1 1 1 1 1 1 1 1 1 12 92.31
11 010011 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
12 070165 1 1 1 1 1 1 0 1 1 1 1 1 1 12 92.31
13 050211 1 0 1 1 1 1 1 0 1 1 1 1 1 11 84.62
14 070112 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
15 030213 1 1 1 0 1 1 1 1 1 1 1 1 0 11 84.62
16 020331 1 1 1 1 1 1 1 1 1 0 1 1 1 12 92.31
17 030121 1 1 1 1 1 1 1 0 1 1 1 1 1 12 92.31
18 050211 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
19 060311 1 1 1 1 1 1 0 1 1 1 1 1 1 12 92.31
20 070275 1 1 1 0 1 1 1 1 1 1 1 1 1 12 92.31
21 020217 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
22 050043 1 1 1 0 1 1 1 1 1 1 1 1 1 12 92.31
23 020016 1 1 1 1 0 1 1 1 1 1 1 1 1 12 92.31
24 070119 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
25 030243 1 1 1 1 0 1 1 1 1 1 1 1 0 11 84.62
26 080099 1 0 1 1 1 1 1 1 1 1 1 1 0 11 84.62
27 050221 1 1 1 1 0 1 1 1 1 1 1 1 1 12 92.31
28 020222 1 1 1 1 1 1 1 1 1 1 1 1 0 12 92.31
29 090132 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
30 010001 1 1 1 1 1 1 1 1 1 1 1 0 1 12 92.31
31 080032 1 1 1 1 0 1 1 1 1 1 1 1 1 12 92.31
32 070044 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
33 080012 1 1 0 1 1 1 1 1 1 1 1 1 1 12 92.31
34 050043 1 1 1 1 1 1 1 1 1 1 1 1 0 12 92.31
35 070037 1 1 1 1 0 1 1 1 1 1 1 1 1 12 92.31
36 010039 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
37 030041 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
38 060031 1 1 1 1 1 1 1 1 1 1 1 1 0 12 92.31
39 040112 1 1 1 0 1 1 1 1 1 1 1 1 1 12 92.31
40 070211 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
41 080223 1 1 1 1 1 1 1 1 0 1 1 1 1 12 92.31
42 030213 1 1 1 0 1 1 1 1 1 1 0 1 0 10 76.92
43 050231 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
44 030112 1 1 1 0 0 1 1 1 1 1 1 1 1 11 84.62
45 060214 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
46 090238 1 1 1 1 0 1 1 1 0 1 0 1 1 10 76.92
47 010298 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
48 070331 1 1 1 0 1 1 1 1 1 0 1 1 1 11 84.62
49 020145 1 1 1 1 0 1 1 1 0 1 1 1 1 11 84.62
50 020541 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
51 060331 1 1 0 1 1 1 1 1 1 1 1 0 1 11 84.62
52 040156 1 1 1 1 1 1 0 0 1 1 1 1 1 11 84.62
53 050234 1 1 1 1 1 1 0 1 1 1 1 1 1 12 92.31
54 080297 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
55 070562 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
56 080641 1 1 1 1 0 1 1 1 1 1 0 1 1 11 84.62
57 080298 1 1 1 1 1 1 1 1 1 1 1 1 0 12 92.31
58 080089 1 1 1 1 1 1 0 1 1 1 1 0 1 11 84.62
59 060287 1 0 1 1 1 1 1 1 1 1 0 1 1 11 84.62
60 070065 1 1 1 1 0 1 1 1 1 1 1 1 1 12 92.31
61 020241 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
62 070029 1 0 1 1 1 0 1 1 1 1 1 0 0 9 69.23
63 090086 1 1 1 1 1 1 1 1 0 1 1 1 1 12 92.31
64 050321 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
65 020231 1 1 1 1 0 1 1 1 1 0 1 1 1 11 84.62
66 030185 1 1 0 1 1 1 0 1 1 1 1 0 0 9 69.23
67 030128 1 1 1 1 1 0 1 1 1 1 1 1 1 12 92.31
68 080026 1 1 1 1 0 1 1 1 0 1 1 1 1 11 84.62
69 030213 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
70 070231 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
71 090152 1 1 1 1 1 1 0 1 1 1 1 1 1 12 92.31
72 050213 1 1 0 1 1 1 1 1 1 1 1 1 1 12 92.31
73 070312 1 1 1 0 1 1 1 1 1 1 1 1 1 12 92.31
74 020132 1 1 1 1 0 1 1 1 1 1 1 1 1 12 92.31
75 010110 1 1 1 1 1 0 1 1 1 1 1 1 1 12 92.31
76 020210 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
77 070280 1 1 1 1 1 1 1 1 1 0 1 1 1 12 92.31
78 060055 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
79 040021 1 0 1 1 1 1 0 1 1 1 0 0 1 9 69.23
80 050076 1 1 1 0 1 1 1 1 1 1 1 1 1 12 92.31
81 060023 1 1 0 1 1 1 1 1 1 1 1 0 1 11 84.62
82 020012 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
83 060012 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
84 040321 1 1 0 1 1 0 1 1 1 1 1 1 1 11 84.62
85 050112 1 1 1 1 1 1 1 0 1 1 1 1 1 12 92.31
86 060221 1 1 1 1 1 1 1 1 1 1 1 0 1 12 92.31
 87 040221 1 1 1 0 1 1 1 1 1 1 1 1 1 12 92.31
88 020112 1 1 0 1 1 1 0 1 1 0 1 1 1 10 76.92
89 060012 1 1 1 1 0 1 1 1 1 1 1 1 0 11 84.62
90 070229 1 1 1 1 1 0 1 0 1 1 1 1 1 11 84.62
91 090213 1 1 1 1 1 1 0 1 1 1 1 0 1 11 84.62
92 020123 1 1 1 1 1 1 1 1 1 1 0 1 1 12 92.31
93 050143 1 1 1 1 0 1 1 1 1 1 1 1 0 11 84.62
94 030176 1 1 0 1 1 1 1 1 1 0 1 1 1 11 84.62
95 020831 1 1 1 1 1 1 1 1 1 1 1 0 1 12 92.31
96 090228 1 1 1 1 1 1 0 1 0 1 1 1 1 11 84.62
97 030213 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
98 050327 1 1 1 1 1 0 1 1 1 1 1 1 0 11 84.62
99 020116 1 1 0 1 0 1 1 1 1 1 0 1 1 10 76.92
100 030351 1 1 1 1 1 1 1 0 1 1 1 1 1 12 92.31
101 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
102 1 0 1 1 1 1 1 1 1 1 1 1 1 12 92.31
103 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
104 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
105 1 1 1 1 1 1 1 1 1 1 1 1 0 12 92.31
106 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
107 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
108 1 1 1 1 1 1 1 1 1 1 1 1 0 12 92.31
109 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
110 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
111 1 1 1 1 1 1 1 0 1 1 0 1 1 11 84.62
112 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
113 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
114 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
115 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
116 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
117 1 1 1 1 0 1 1 1 1 1 1 1 1 12 92.31
118 1 1 1 1 1 1 1 1 1 1 0 1 1 12 92.31
119 1 1 1 1 1 1 1 1 1 1 1 0 1 12 92.31
120 1 1 1 1 1 1 1 1 1 1 1 1 0 12 92.31
121 1 1 1 1 1 1 0 1 1 1 1 1 1 12 92.31
122 1 1 1 1 1 1 1 1 1 1 1 1 1 13 100.00
123 1 1 1 1 1 1 0 1 1 1 1 1 1 12 92.31