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H

PUSKESMAS CIKEUSAL KIDUL


DESA SINDANGJAYA
TAHUN 2021
NO ALAMAT PHBS JML KK
1 DESA SINDANGJAYA RW 01 RT 01 A01 1
2 DESA SINDANGJAYA RW 01 RT 02 A02 1
3 DESA SINDANGJAYA RW 01 RT 03 A03 1
4 DESA SINDANGJAYA RW 01 RT 04 A04 1
5 DESA SINDANGJAYA RW 01 RT 05 A05 1
6 DESA SINDANGJAYA RW 02 RT 06 A06 1
7 DESA SINDANGJAYA RW 02 RT 07 A07 1
8 DESA SINDANGJAYA RW 02 RT 08 A08 1
9 DESA SINDANGJAYA RW 02 RT 09 A09 1
10 DESA SINDANGJAYA RW 02 RT 10 A10 1
11 DESA SINDANGJAYA RW 02 RT 11 A11 1
12 DESA SINDANGJAYA RW 02 RT 12 A12 1
13 DESA SINDANGJAYA RW 03 RT 13 A13 1
14 DESA SINDANGJAYA RW 03 RT 14 A14 1
15 DESA SINDANGJAYA RW 03 RT 15 A15 1
16 DESA SINDANGJAYA RW 03 RT 16 A16 1
17 DESA SINDANGJAYA RW 03 RT 17 A17 1
18 DESA SINDANGJAYA RW 04 RT 18 A18 1
19 DESA SINDANGJAYA RW 04 RT 19 A19 1
20 DESA SINDANGJAYA RW 04 RT 20 A20 1
21 DESA SINDANGJAYA RW 04 RT 21 A21 1
22 DESA SINDANGJAYA RW 05 RT 22 A22 1
23 DESA SINDANGJAYA RW 05 RT 23 A23 1
24 DESA SINDANGJAYA RW 05 RT 24 A24 1
NO DESA SINDANGJAYA DESA 24

Kepala Puskesmas Cikeusal Kidul

Sunarto,S.Kep.,Ners M.H (Kes)


NIP. 19720610 199203 1 003
KIDUL GRAFIK STRATA

YA GRAFIK INDIKATOR

PT MD UT PR
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 24

Pengelola PHBS

Arif Mustofa,S.KM
-
H
REKAPITULASI HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA
PUSKESMAS CIKEUSAL KIDUL TAHUN 2021

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Air Bersih
Seimbang
Eksklusif

Merokok
Timbang

Aktifitas

Narkoba
Sampah
Jamban

Jumlah
Parupirna
Tangan

Miras /
Rumah
Lantai

Gosok

Pratama
Nakes

Balita

Sehat

Tidak

Tidak
Salin

Fisik

Cuci

Madya

Utama
JPK

PSN
Gizi

Gigi
ASI
K4
No RT RW Desa

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 01 01 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
2 02 01 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
3 03 01 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
4 04 01 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
5 05 01 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
6 06 02 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
7 07 02 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
8 08 02 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
9 09 02 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
10 10 02 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
11 11 02 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
12 12 02 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
13 13 03 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
14 14 03 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
15 15 03 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
16 16 03 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
17 17 03 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
18 18 04 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
19 19 04 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
20 20 04 SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
21 21 04SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
22 22 05SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
23 23 05SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
24 24 05SINDANGJAYA 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1 1
JUMLAH 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 0 0 0 24 24
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 0 0 0 100 100
URUTAN MASALAH 5 6 3 7 11 16 10 1 9 13 2 14 12 15 4 8

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS


Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM
NIP. 19720610 199203 1 003 -
H
PUSKESMAS CIKEUSAL KIDUL
DESA SINDANGJAYA
TAHUN 2021
NO ALAMAT PHBS JML KK
1 RW 01 RT 01 A01 1
2 RW 01 RT 02 A02 1
3 RW 01 RT 03 A03 1
4 RW 01 RT 04 A04 1
5 RW 01 RT 05 A05 1
6 RW 02 RT 06 A06 1
7 RW 02 RT 07 A07 1
8 RW 02 RT 08 A08 1
9 RW 02 RT 09 A09 1
10 RW 02 RT 10 A10 1
11 RW 02 RT 11 A11 1
12 RW 02 RT 12 A12 1
13 RW 03 RT 13 A13 1
14 RW 03 RT 14 A14 1
15 RW 03 RT 15 A15 1
16 RW 03 RT 16 A16 1
17 RW 03 RT 17 A17 1
18 RW 04 RT 18 A18 1
19 RW 04 RT 19 A19 1
20 RW 04 RT 20 A20 1
21 RW 04 RT 21 A21 1
22 RW 05 RT 22 A22 1
23 RW 05 RT 23 A23 1
24 RW 05 RT 24 A24 1
NO DESA SINDANGJAYA DESA 24

Kepala Puskesmas Cikeusal Kidul

Sunarto,S.Kep.,Ners M.H (Kes)


NIP. 19720610 199203 1 003
KIDUL PUSKESMAS CIKEU
YA DESA SINDANG
RW 02 RT
PT MD UT PR STRATA PRATAMA
- - - 1 #N/A
- - - 1
- - - 1
- - - 1
- - - 1 DESA BUAR
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 24

Pengelola PHBS

Arif Mustofa,S.KM
-
PUSKESMAS CIKEUSAL KIDUL
DESA SINDANGJAYA
RW 02 RT 01
STRATA MADYA STRATA UTAMA STRATA PARIPURNA
#N/A #N/A #N/A

DESA BUARA

RW 02 RT 01 STRATA PRATAMA

RW 02 RT 01 STRATA MADYA

RW 02 RT 01 STRATA UTAMA

RW 02 RT 01 STRATA PARIPURNA
H
REKAPITULASI HASIL PENGKAJIAN PHBS TATANAN
PUSKESMAS CIKEUSAL KIDUL TAHUN 2

Air Bersih
Seimbang
Eksklusif

Timbang

Sampah
Jamban

Rumah
Lantai
Nakes

Balita

Sehat
Salin

Gizi
ASI
K4
1 2 3 4 5 6 7 8 9
1 RW 01 RT 01 1 1 1 1 1 1 1 1 1
2 RW 01 RT 02 1 1 1 1 1 1 1 1 1
3 RW 01 RT 03 1 1 1 1 1 1 1 1 1
4 RW 01 RT 04 1 1 1 1 1 1 1 1 1
5 RW 01 RT 05 1 1 1 1 1 1 1 1 1
6 RW 02 RT 06 1 1 1 1 1 1 1 1 1
7 RW 02 RT 07 1 1 1 1 1 1 1 1 1
8 RW 02 RT 08 1 1 1 1 1 1 1 1 1
9 RW 02 RT 09 1 1 1 1 1 1 1 1 1
10 RW 02 RT 10 1 1 1 1 1 1 1 1 1
11 RW 02 RT 11 1 1 1 1 1 1 1 1 1
12 RW 02 RT 12 1 1 1 1 1 1 1 1 1
13 RW 03 RT 13 1 1 1 1 1 1 1 1 1
14 RW 03 RT 14 1 1 1 1 1 1 1 1 1
15 RW 03 RT 15 1 1 1 1 1 1 1 1 1
16 RW 03 RT 16 1 1 1 1 1 1 1 1 1
17 RW 03 RT 17 1 1 1 1 1 1 1 1 1
18 RW 04 RT 18 1 1 1 1 1 1 1 1 1
19 RW 04 RT 19 1 1 1 1 1 1 1 1 1
20 RW 04 RT 20 1 1 1 1 1 1 1 1 1
21 RW 04 RT 21 1 1 1 1 1 1 1 1 1
22 RW 05 RT 22 1 1 1 1 1 1 1 1 1
23 RW 05 RT 23 1 1 1 1 1 1 1 1 1
24 RW 05 RT 24 1 1 1 1 1 1 1 1 1
### DESA SINDANGJAY 24 24 24 24 24 24 24 24 24
S TATANAN RUMAH TANGGA REKAPITULASI HASIL PE
UL TAHUN 2021 PUSKESMAS

Eksklusif
Merokok
Aktifitas

Timbang
Narkoba
Tangan

Miras /
Gosok

Nakes

Balita
Tidak

Tidak

Salin
Fisik

Cuci

JPK
Gigi

PSN

ASI
K4
10 11 12 13 14 15 16 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1.2
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1
0.8
1 1 1 1 1 1 1
1 1 1 1 1 1 1
0.6
1 1 1 1 1 1 1
1 1 1 1 1 1 1 0.4
1 1 1 1 1 1 1
1 1 1 1 1 1 1 0.2
1 1 1 1 1 1 1
1 1 1 1 1 1 1 0

Timbang Balita
Salin Nakes

Gizi Seimbang
ASI Eksklusif
K4
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
24 24 24 24 24 24 24
ASI Eksklusif

Timbang Balita

Gizi
Gizi Seimbang Seimbang

1
Air Bersih Air Bersih

1
Jamban Sehat Jamban
Sehat

1
Sampah
Sampah
RW 01 RT 01

1
Lantai Rumah
Lantai
Rumah
1

Aktifitas Fisik
Aktifitas
RW 01 RT 01

Fisik
1

Tidak Merokok

Tidak
Cuci Tangan Merokok
1

Cuci
Gosok Gigi Tangan
1

Tidak Miras / Narkoba Gosok


Gigi
1
PUSKESMAS CIKEUSAL KIDUL TAHUN 2021

JPK Tidak
Miras /
Narkoba
1

PSN
JPK
1

PSN
Row 8
1
ASI HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA
Row 8
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
12 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
13 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
130 0 0 0 0 0
14 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
176 0 0 0 0 0
15 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

16 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
17 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
18 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
19 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
20 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

21 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 22 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0

Page 23 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
Page 24 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
Page 25 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1
Page 26 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 27 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 28 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama

Page 29 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 30 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 31 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

Page 32 of 278
Strata

lola PHBS

ustofa,S.KM
-

Page 33 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 34 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
Page 35 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 36 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 37 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 38 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 39 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 40 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 41 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 42 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 43 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 44 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 45 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 46 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 47 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 48 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 49 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 50 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 51 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 52 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 53 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 54 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 55 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 56 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 57 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 58 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 59 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 60 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 61 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 62 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 63 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 64 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 65 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 66 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 67 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 68 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 69 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 70 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 71 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 72 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 73 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 74 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
Page 75 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 76 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 77 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 78 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 79 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 80 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 81 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 82 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 83 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 84 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0

Page 85 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0

Page 86 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
129 0 0 0 0 0
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
Page 87 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
175 0 0 0 0 0
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 88 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 89 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama

Page 90 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama

Page 91 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 92 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 93 of 278
H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 94 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
Page 95 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 96 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 97 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 98 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 99 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 100 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 101 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 102 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 103 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 104 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 105 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 106 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 107 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 108 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 109 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 110 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 111 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 112 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 113 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 114 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 115 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 116 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 117 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 118 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 119 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 120 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 121 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 122 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 123 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 124 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 125 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 126 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 127 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 128 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 129 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 130 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 131 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 132 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 133 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 134 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
Page 135 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 136 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 137 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 138 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 139 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 140 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 141 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 142 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 143 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 144 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 145 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 146 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 147 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 148 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 149 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 150 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 151 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 152 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 153 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 154 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 155 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 156 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 157 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 158 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 159 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 160 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 161 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 162 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 163 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 164 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 165 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 166 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 167 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 168 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 169 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 170 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 171 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 172 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 173 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 174 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
Page 175 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 176 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 177 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 178 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 179 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 180 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 181 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 182 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 183 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 184 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
84 0 0 0 0 0
Page 185 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
130 0 0 0 0 0
Page 186 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 187 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 188 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 189 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 190 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 191 of 278
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Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 192 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 193 of 278


H
HASIL PENGKAJIAN PHBS TATANAN RUMAH TANGGA TAHUN 2021
PUSKESMAS : CIKEUSAL KIDUL RT : 01
DESA : SINDANGJAYA RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 0 0 0 0 0
2 0 0 0 0 0
3 0 0 0 0 0
4 0 0 0 0 0
5 0 0 0 0 0
6 0 0 0 0 0
7 0 0 0 0 0
8 0 0 0 0 0
9 0 0 0 0 0
10 0 0 0 0 0
11 0 0 0 0 0
12 0 0 0 0 0
13 0 0 0 0 0
14 0 0 0 0 0
15 0 0 0 0 0
16 0 0 0 0 0
17 0 0 0 0 0
18 0 0 0 0 0
19 0 0 0 0 0
20 0 0 0 0 0
21 0 0 0 0 0
22 0 0 0 0 0
23 0 0 0 0 0
24 0 0 0 0 0
25 0 0 0 0 0
26 0 0 0 0 0
27 0 0 0 0 0
28 0 0 0 0 0
29 0 0 0 0 0
30 0 0 0 0 0
31 0 0 0 0 0
32 0 0 0 0 0
33 0 0 0 0 0
34 0 0 0 0 0
35 0 0 0 0 0
36 0 0 0 0 0
37 0 0 0 0 0
38 0 0 0 0 0
Page 194 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
39 0 0 0 0 0
40 0 0 0 0 0
41 0 0 0 0 0
42 0 0 0 0 0
43 0 0 0 0 0
44 0 0 0 0 0
45 0 0 0 0 0
46 0 0 0 0 0
47 0 0 0 0 0
48 0 0 0 0 0
49 0 0 0 0 0
50 0 0 0 0 0
51 0 0 0 0 0
52 0 0 0 0 0
53 0 0 0 0 0
54 0 0 0 0 0
55 0 0 0 0 0
56 0 0 0 0 0
57 0 0 0 0 0
58 0 0 0 0 0
59 0 0 0 0 0
60 0 0 0 0 0
61 0 0 0 0 0
62 0 0 0 0 0
63 0 0 0 0 0
64 0 0 0 0 0
65 0 0 0 0 0
66 0 0 0 0 0
67 0 0 0 0 0
68 0 0 0 0 0
69 0 0 0 0 0
70 0 0 0 0 0
71 0 0 0 0 0
72 0 0 0 0 0
73 0 0 0 0 0
74 0 0 0 0 0
75 0 0 0 0 0
76 0 0 0 0 0
77 0 0 0 0 0
78 0 0 0 0 0
79 0 0 0 0 0
80 0 0 0 0 0
81 0 0 0 0 0
82 0 0 0 0 0
83 0 0 0 0 0
Page 195 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
84 0 0 0 0 0
85 0 0 0 0 0
86 0 0 0 0 0
87 0 0 0 0 0
88 0 0 0 0 0
89 0 0 0 0 0
90 0 0 0 0 0
91 0 0 0 0 0
92 0 0 0 0 0
93 0 0 0 0 0
94 0 0 0 0 0
95 0 0 0 0 0
96 0 0 0 0 0
97 0 0 0 0 0
98 0 0 0 0 0
99 0 0 0 0 0
100 0 0 0 0 0
101 0 0 0 0 0
102 0 0 0 0 0
103 0 0 0 0 0
104 0 0 0 0 0
105 0 0 0 0 0
106 0 0 0 0 0
107 0 0 0 0 0
108 0 0 0 0 0
109 0 0 0 0 0
110 0 0 0 0 0
111 0 0 0 0 0
112 0 0 0 0 0
113 0 0 0 0 0
114 0 0 0 0 0
115 0 0 0 0 0
116 0 0 0 0 0
117 0 0 0 0 0
118 0 0 0 0 0
119 0 0 0 0 0
120 0 0 0 0 0
121 0 0 0 0 0
122 0 0 0 0 0
123 0 0 0 0 0
124 0 0 0 0 0
125 0 0 0 0 0
126 0 0 0 0 0
127 0 0 0 0 0
128 0 0 0 0 0
129 0 0 0 0 0
Page 196 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
130 0 0 0 0 0
131 0 0 0 0 0
132 0 0 0 0 0
133 0 0 0 0 0
134 0 0 0 0 0
135 0 0 0 0 0
136 0 0 0 0 0
137 0 0 0 0 0
138 0 0 0 0 0
139 0 0 0 0 0
140 0 0 0 0 0
141 0 0 0 0 0
142 0 0 0 0 0
143 0 0 0 0 0
144 0 0 0 0 0
145 0 0 0 0 0
146 0 0 0 0 0
147 0 0 0 0 0
148 0 0 0 0 0
149 0 0 0 0 0
150 0 0 0 0 0
151 0 0 0 0 0
152 0 0 0 0 0
153 0 0 0 0 0
154 0 0 0 0 0
155 0 0 0 0 0
156 0 0 0 0 0
157 0 0 0 0 0
158 0 0 0 0 0
159 0 0 0 0 0
160 0 0 0 0 0
161 0 0 0 0 0
162 0 0 0 0 0
163 0 0 0 0 0
164 0 0 0 0 0
165 0 0 0 0 0
166 0 0 0 0 0
167 0 0 0 0 0
168 0 0 0 0 0
169 0 0 0 0 0
170 0 0 0 0 0
171 0 0 0 0 0
172 0 0 0 0 0
173 0 0 0 0 0
174 0 0 0 0 0
175 0 0 0 0 0
Page 197 of 278
Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Timbang Balita

Tidak Merokok
Buang Sampah
Nomor Rumah

Gizi Seimabng

Aktifitas Fisik
Jamban Sehat

Lantai Rumah
ASI Eksklusif

Cuci Tangan

dan Narkoba
Tidak Miras
Salin Nakes

Gosok Gigi
Air Bersih

Jumlah

Paripurna
Pratama

Madya

Utama
JPK

PSN
K4
No Nama KK NIK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
176 0 0 0 0 0
177 0 0 0 0 0
178 0 0 0 0 0
179 0 0 0 0 0
180 0 0 0 0 0
181 0 0 0 0 0
182 0 0 0 0 0
183 0 0 0 0 0
184 0 0 0 0 0
185 0 0 0 0 0
186 0 0 0 0 0
187 0 0 0 0 0
188 0 0 0 0 0
189 0 0 0 0 0
190 0 0 0 0 0
191 0 0 0 0 0
192 0 0 0 0 0
193 0 0 0 0 0
194 0 0 0 0 0
195 0 0 0 0 0
196 0 0 0 0 0
197 0 0 0 0 0
198 0 0 0 0 0
199 0 0 0 0 0
200 126 SURTIJAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 16 0 0 0 1
JUMLAH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 1
PROSENTASE 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
URUTAN MASALAH 1

Kepala Puskesmas Cikeusal Kidul Pengelola PHBS

Sunarto,S.Kep.,Ners M.H (Kes) Arif Mustofa,S.KM


NIP. 19720610 199203 1 003 -

Page 198 of 278


Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 199 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 200 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 201 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Page 202 of 278
Strata

Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Pratama
Paripurna

lola PHBS

ustofa,S.KM
-

Page 203 of 278


H
HASIL PENGKAJIAN PHBS TATAN
PUSKESMAS : CIKEUSAL KIDUL
DESA : SINDANGJAYA

Indikator PHBS T

Timbang Balita
Nomor Rumah

Gizi Seimabng
ASI Eksklusif
Salin Nakes

Air Bersih
K4
No Nama KK NIK

1 2 3 4 5 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200 126 SURTIJAH 1 1 1 1 1 1
JUMLAH 1 1 1 1 1 1
PROSENTASE 100 100 100 100 100 100
URUTAN MASALAH

Kepala Puskesmas Cikeusal Kidul

Sunarto,S.Kep.,Ners M.H (Kes)


NIP. 19720610 199203 1 003
PHBS TATANAN RUMAH TANGGA TAHUN 2021
RT : 01
RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Tidak Merokok
Buang Sampah

Aktifitas Fisik
Jamban Sehat

Lantai Rumah

Cuci Tangan

dan Narkoba
Tidak Miras
Gosok Gigi

Jumlah

Pratama

Madya
JPK

PSN
7 8 9 10 11 12 13 14 15 16
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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 1 1 1 1 1 1 1 1 1 16 0 0
1 1 1 1 1 1 1 1 1 1 0 0
100 100 100 100 100 100 100 100 100 100

Pengelola PHB

Arif Mustofa,S.
-
Strata Rumah Tangga
Paripurna
Utama

Strata

0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 1 Paripurna
0 1

Pengelola PHBS

Arif Mustofa,S.KM
-
H
HASIL PENGKAJIAN PHBS TATAN
PUSKESMAS : CIKEUSAL KIDUL
DESA : SINDANGJAYA

Indikator PHBS T

Timbang Balita
Nomor Rumah

Gizi Seimabng
ASI Eksklusif
Salin Nakes

Air Bersih
K4
No Nama KK NIK

1 2 3 4 5 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200 126 SURTIJAH 1 1 1 1 1 1
JUMLAH 1 1 1 1 1 1
PROSENTASE 100 100 100 100 100 100
URUTAN MASALAH

Kepala Puskesmas Cikeusal Kidul

Sunarto,S.Kep.,Ners M.H (Kes)


NIP. 19720610 199203 1 003
PHBS TATANAN RUMAH TANGGA TAHUN 2021
RT : 01
RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Tidak Merokok
Buang Sampah

Aktifitas Fisik
Jamban Sehat

Lantai Rumah

Cuci Tangan

dan Narkoba
Tidak Miras
Gosok Gigi

Jumlah

Pratama

Madya
JPK

PSN
7 8 9 10 11 12 13 14 15 16
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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 1 1 1 1 1 1 1 1 1 16 0 0
1 1 1 1 1 1 1 1 1 1 0 0
100 100 100 100 100 100 100 100 100 100

Pengelola PHB

Arif Mustofa,S.
-
Strata Rumah Tangga
Paripurna
Utama

Strata

0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 1 Paripurna
0 1

Pengelola PHBS

Arif Mustofa,S.KM
-
H
HASIL PENGKAJIAN PHBS TATAN
PUSKESMAS : CIKEUSAL KIDUL
DESA : SINDANGJAYA

Indikator PHBS T

Timbang Balita
Nomor Rumah

Gizi Seimabng
ASI Eksklusif
Salin Nakes

Air Bersih
K4
No Nama KK NIK

1 2 3 4 5 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200 126 SURTIJAH 1 1 1 1 1 1
JUMLAH 1 1 1 1 1 1
PROSENTASE 100 100 100 100 100 100
URUTAN MASALAH

Kepala Puskesmas Cikeusal Kidul

Sunarto,S.Kep.,Ners M.H (Kes)


NIP. 19720610 199203 1 003
PHBS TATANAN RUMAH TANGGA TAHUN 2021
RT : 01
RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Tidak Merokok
Buang Sampah

Aktifitas Fisik
Jamban Sehat

Lantai Rumah

Cuci Tangan

dan Narkoba
Tidak Miras
Gosok Gigi

Jumlah

Pratama

Madya
JPK

PSN
7 8 9 10 11 12 13 14 15 16
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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 1 1 1 1 1 1 1 1 1 16 0 0
1 1 1 1 1 1 1 1 1 1 0 0
100 100 100 100 100 100 100 100 100 100

Pengelola PHB

Arif Mustofa,S.
-
Strata Rumah Tangga
Paripurna
Utama

Strata

0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 1 Paripurna
0 1

Pengelola PHBS

Arif Mustofa,S.KM
-
H
HASIL PENGKAJIAN PHBS TATAN
PUSKESMAS : CIKEUSAL KIDUL
DESA : SINDANGJAYA

Indikator PHBS T

Timbang Balita
Nomor Rumah

Gizi Seimabng
ASI Eksklusif
Salin Nakes

Air Bersih
K4
No Nama KK NIK

1 2 3 4 5 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200 126 SURTIJAH 1 1 1 1 1 1
JUMLAH 1 1 1 1 1 1
PROSENTASE 100 100 100 100 100 100
URUTAN MASALAH

Kepala Puskesmas Cikeusal Kidul

Sunarto,S.Kep.,Ners M.H (Kes)


NIP. 19720610 199203 1 003
PHBS TATANAN RUMAH TANGGA TAHUN 2021
RT : 01
RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Tidak Merokok
Buang Sampah

Aktifitas Fisik
Jamban Sehat

Lantai Rumah

Cuci Tangan

dan Narkoba
Tidak Miras
Gosok Gigi

Jumlah

Pratama

Madya
JPK

PSN
7 8 9 10 11 12 13 14 15 16
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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 1 1 1 1 1 1 1 1 1 16 0 0
1 1 1 1 1 1 1 1 1 1 0 0
100 100 100 100 100 100 100 100 100 100

Pengelola PHB

Arif Mustofa,S.
-
Strata Rumah Tangga
Paripurna
Utama

Strata

0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 1 Paripurna
0 1

Pengelola PHBS

Arif Mustofa,S.KM
-
H
HASIL PENGKAJIAN PHBS TATAN
PUSKESMAS : CIKEUSAL KIDUL
DESA : SINDANGJAYA

Indikator PHBS T

Timbang Balita
Nomor Rumah

Gizi Seimabng
ASI Eksklusif
Salin Nakes

Air Bersih
K4
No Nama KK NIK

1 2 3 4 5 6
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200 126 SURTIJAH 1 1 1 1 1 1
JUMLAH 1 1 1 1 1 1
PROSENTASE 100 100 100 100 100 100
URUTAN MASALAH

Kepala Puskesmas Cikeusal Kidul

Sunarto,S.Kep.,Ners M.H (Kes)


NIP. 19720610 199203 1 003
PHBS TATANAN RUMAH TANGGA TAHUN 2021
RT : 01
RW : 01

Indikator PHBS Tatanan Rumah Tangga Strata Rumah Tangga

Tidak Merokok
Buang Sampah

Aktifitas Fisik
Jamban Sehat

Lantai Rumah

Cuci Tangan

dan Narkoba
Tidak Miras
Gosok Gigi

Jumlah

Pratama

Madya
JPK

PSN
7 8 9 10 11 12 13 14 15 16
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
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 1 1 1 1 1 1 1 1 1 16 0 0
1 1 1 1 1 1 1 1 1 1 0 0
100 100 100 100 100 100 100 100 100 100

Pengelola PHB

Arif Mustofa,S.
-
Strata Rumah Tangga
Paripurna
Utama

Strata

0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 0 Pratama
0 1 Paripurna
0 1

Pengelola PHBS

Arif Mustofa,S.KM
-

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