REGESTER ANC

NOVEMBER TAHUN 2018

NAMA IBU HASIL PEMERIKSAAN JARAK KE- K1 K2 K3 K4 RESTI

NO TGL UMUR ALAMAT DIAGNOSA
NAMA SUAMI HPTP TP TD N BB TB LILA GD HB HAMILAN B B L B L B L B L YA TIDAK

1 1/3/2019 Ny.Yohana / Tn.Jaleng 22 th Atu-Atu 8/6/2018 5/13/2019 120/70 89 75 G1P0A0 H.21 mgg ✔

2 1/3/2019 Ny.Fini / Tn. Arif 18 th Tampang 9/12/2018 6/19/2019 100/70 90 46 11.4 G1P0A0 H. 17 mgg ✔

3 1/3/2019 Ny. Muniroh/ Tn. M.Fajar 22 th Sarang Halang 11/21/2018 6/28/2019 110/80 90 56 G2P1A0 H. 23 mgg

4 1/4/2019 Ny.Suci Arta/ Tn. Ahmad 26 th Bumi Jaya 9/20/2018 6/28/2019 110/80 89 62 G2P1A0 H,23 mgg 2 th ✔

5 1/5/2019 Ny.Nurul Khoiriyah/ Tn. Siswoyo 26 th Atu-Atu 9/16/2018 6/23/2019 110/80 90 54 G2P1A0 H,11 mgg 4 th ✔

6 1/8/2019 Ny.Reni/ Tn. Budiyanto 41 th Sarang Halang 10/5/2018 7/12/2019 120/80 85 75 G2P1A0 H.12 mgg 8 th ✔

7 1/11/2019 Ny.Muzalatifah/ Tn. Nurul Zain 35 th Sarang Halang 6/23/2018 3/30/2019 100/60 93 52 G3P2A0 H.25 mgg ✔ ✔

8 1/17/2019 Ny. Hamisah/ Tn. Asrani 32 th Sarang Halang 8/12/2018 5/19/2019 110/80 90 56 G4P1A2 H.22 mgg

Pelaihari, ......,........................20........
BPM/RS/RS SWASTA...........................

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 REGESTER PNC
TAHUN 20........

NAMA IBU HASIL PEMERIKSAAN

NO TGL UMUR ALAMAT IBU BAYI
NAMA SUAMI
TD N TFU LOCHEA JK BB PB LK LD IMUN

1 12/30/2018 Ny. Marfuah/ Tn. M.Nor 30 th Sarang Halang 120/70 90 2 jr ↓ pstt Rubra ♂ 3900 53 33 33 HBO POL.I

2 1/19/2019 Ny.Nana Yuliana/ Tn. A.Maulana 23 th Sarang Halang 120/70 86 2 jr ↓ pstt Rubra ♀ 3100 48 33 33 HBO POL.I

3 1/24/2019 Ny.Nur Hikmah/ Tn. Hilmi 21 th Sarang Halang 120/80 88 2 jr ↓ pstt Rubra ♂ 2900 49 31 31 HBO POL.I

4 1/24/2019 Ny. Dian Fitria/ Tn. Sujono 27 th Bumi Jaya 130/90 89 2 jr ↓ pstt Rubra ♀ 3400 51 33 33 HBO POL.I

♂ HBO POL.I
5 1/25/2019 Ny. Septia Hairina/ Tn. Mashur 30 th Atu-Atu 4000 52 32 32

♀ HBO POL.I
6 1/28/2019 Ny. Dewi Ratna/ Tn. M.Taufiq 23 th Bumi Jaya 2400 47 29 30

♂ HBO POL.I
7 1/31/2019 Ny. Fusani/ Tn. Muderi 23 th Angsau 3200 50 33 32

NB : TGL DIISI TANGGAL PARTUS SAJA

Pelaihari, ......,........................20.......
BPM/RS/RS SWASTA....................

...........................................................
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 DX RESTI

YA TIDAK

P3A0 POST PARTUM HR.I ✔

P1A0 POST PARTUM

P1A0 POST PARTUM

P3A0 POST PARTUM

P1A0 POST SC HR.II ✔

P3A0 POST PARTUM HR.I ✔

i, ......,........................20........
S/RS SWASTA...........................

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 REGESTER KB
TAHUN 20........

NAMA IBU JENIS KONTRASEPSI KB PASCAKEGAGALAN

NO TGL UMUR ALAMAT PIL SUNTIK IMPLANT IUD MOP/MOW KONDOM SALIN KB
NAMA SUAMI
B L B L B L B L B L B L
1 1/3/2019 Ny. Hairiyah/Tn.Sigit 48 th Agsau ✔

2 1/3/2019 Ny.Husnul Khotimah/ Tn.Andre 30 th Sarang Halang ✔

3 1/3/2019 Ny. Munawarah /Tn. Arpian 30 th Tampang ✔

4 1/5/2019 Ny. Diah/ Tn. Muhartoyo 33 th Sarang Halang ✔

5 1/5/2019 Ny. Antik/ Tn. Sigit 41 th Atu-Atu ✔

6 1/7/2019 Ny. Uway/ Tn. Ridho 21 th Sarang Halang ✔

7 1/10/2019 Ny. Rohamah/ Tn. Marzuki 28 th Sarang Halang ✔

8 1/10/2019 Ny.Lulu / Tn. Gianto 28 th Sarang Halang ✔

9 1/12/2019 Ny.Soniah/ Tn. Ahmadi 32 th Angsau ✔

Pelaihari, ......,........................20......
BPM/RS/RS SWASTA...................

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...........................................................
 DO KET

......,........................20........
RS SWASTA...........................

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 REGESTER MTBS
TAHUN 20........

NAMA ANAK HASIL PEMERIKSAAN

NO TGL UMUR ALAMAT DIAGNOSA KET
NAMA ORTU TB BB SUHU RESP

Pelaihari, ......,........................20........
BPM/RS/RS SWASTA...........................

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