Laporan Penjaringan Puter

REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK
UPT PUSKESMAS PUTER

TAHUN 2012
Jumlah SD/ MI di wilayah kerja Puskesmas : 18
Jumlah SD/ MI di wilayah kerja Puskesmas yang melakukan penjaringan : 18
Jml peserta didik Status Gizi Tajam Tjm dengar Stat
Serumen Kum Gigi Gan
Yg dijaring KUM Penglihatan Kum KUM us
No Nama Sekolah Seru OM Luba g.
di Sek N G K KS GIZI TP N TN T.D Imun
Yg Dijaring L P Jml N TN ya tdk men ng ME
TL
1 SDN LANGEN SARI 1 25 72.0 12 6 18 15 0 3 0 18 17 1 18 11 7 18 0 18 0 18 18 0 1
2 SDN LANGEN SARI 5 21 95.2 12 8 20 18 0 2 0 20 19 1 20 14 6 20 0 20 0 20 18 0 0
3 SDN SENANG GALIH 34 88.2 12 18 30 20 4 6 0 30 30 0 30 12 18 30 0 30 0 30 18 0 2
4 SDN NEGLASARI 1 35 97.1 16 18 34 34 0 0 0 34 33 1 34 30 4 34 0 34 0 34 26 0 1
5 SDN NEGLASARI 3 37 91.9 17 17 34 32 1 1 0 34 34 0 34 16 18 34 0 34 0 34 29 0 0
6 SDN TILIL 1 38 92.1 16 19 35 28 2 5 0 35 35 0 35 11 24 35 0 35 0 35 25 0 0
7 SDN TILIL 2 36 88.9 19 13 32 30 1 1 0 32 32 0 32 29 3 32 0 32 0 32 29 0 0
8 SDN TILIL 3 32 84.4 16 11 27 23 3 1 0 27 27 0 27 18 9 27 0 27 0 27 25 0 0
9 SDN TILIL 4 36 97.2 16 19 35 26 3 6 0 35 34 1 35 19 16 35 0 35 0 35 30 0 0
10 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! ### ### ### ### ### ### ### ### ### ### ### ### ### ###
14 SDN TIKUKUR 5 40 80.0 16 16 32 23 1 7 1 32 32 0 32 17 15 32 0 32 0 32 24 0 0
15 SDN HAUR PANCUH 1 32 100.0 15 17 32 25 2 5 0 32 32 0 32 11 21 32 0 32 0 32 7 0 0
16 SDN HAUR PANCUH 2 31 93.5 9 20 29 21 2 6 0 29 29 0 29 10 19 29 0 29 0 29 6 0 0
17 SDN HAUR PANCUH 3 32 90.6 17 12 29 26 1 2 0 29 29 0 29 24 5 29 0 29 0 29 29 0 0
18 SDN MARGAHAYU BLOK I 28 96.4 14 13 27 21 3 3 0 27 25 2 27 24 3 27 0 27 0 27 24 0 0
TOTAL #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Status Gizi Status Gizi
No JML
Nama Sekolah
MURID N G K KS N G K KS
1 SDN LANGEN SARI 1 25 15 0 3 0 60.0 0.0 12.0 0.0

2 SDN LANGEN SARI 5 21 18 0 2 0 85.7 0.0 9.5 0.0
3 SDN SENANG GALIH 34 20 4 6 0 58.8 11.8 17.6 0.0
4 SDN NEGLASARI 1 35 34 0 0 0 97.1 0.0 0.0 0.0
5 SDN NEGLASARI 3 37 32 1 1 0 86.5 2.7 2.7 0.0
6 SDN TILIL 1 38 28 2 5 0 73.7 5.3 13.2 0.0
7 SDN TILIL 2 36 30 1 1 0 83.3 2.8 2.8 0.0
8 SDN TILIL 3 32 23 3 1 0 71.9 9.4 3.1 0.0
9 SDN TILIL 4 36 26 3 6 0 72.2 8.3 16.7 0.0
10 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
14 SDN TIKUKUR 5 40 23 1 7 1 57.5 2.5 17.5 2.5
15 SDN HAUR PANCUH 1 32 25 2 5 0 78.1 6.3 15.6 0.0
16 SDN HAUR PANCUH 2 31 21 2 6 0 67.7 6.5 19.4 0.0
17 SDN HAUR PANCUH 3 32 26 1 2 0 81.3 3.1 6.3 0.0
18 SDN MARGAHAYU BLOK I 28 21 3 3 0 75.0 10.7 10.7 0.0
TOTAL #REF! #REF! #REF! #REF! #REF!
PERSENTASE
Tajam TAJAM
TAJAM PENGLIHATAN JML
No Nama Sekolah Penglihatan PENGLIHATAN
MURID
NORMALTIDAK NORMAL N TN NORMAL
TIDAK NORMAL
1 SDN LANGEN SARI 1 68 4 25 17 1 68 4
2 SDN LANGEN SARI 5 90 5 21 19 1 90 5
3 SDN SENANG GALIH 88 0 34 30 0 88 0
4 SDN NEGLASARI 1 94 3 35 33 1 94 3
5 SDN NEGLASARI 3 92 0 37 34 0 92 0
6 SDN TILIL 1 92 0 38 35 0 92 0
7 SDN TILIL 2 89 0 36 32 0 89 0
8 SDN TILIL 3 84 0 32 27 0 84 0
9 SDN TILIL 4 94 3 36 34 1 94 3
10 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!
14 SDN TIKUKUR 5 80 0 40 32 0 80 0
15 SDN HAUR PANCUH 1 100 0 32 32 0 100 0
16 SDN HAUR PANCUH 2 94 0 31 29 0 94 0
17 SDN HAUR PANCUH 3 91 0 32 29 0 91 0
18 SDN MARGAHAYU BLOK I 89 7 28 25 2 89 7
TOTAL #REF! #REF! #REF! #REF! #REF! #REF! #REF!
TAJAM Tjm dengar Hsl Prks PenunjangKesegaran
TAJAM Statu
No PENDENG Gigi Mslh Ane- Keca Jasmani KUM
PENDENG GIGI Status Gang. Mslh KUM s Gang.
NAMA SEKOLAH ARAN Luban kespr
ARAN LUBANG Imun TL ME kespro N TN T.D Imun ME K.J
TIDAK g o
NORMAL TL
NORMAL mia cingan Segar Tdk s
1 SDN LANGEN SARI 1 72 0 72 18 0 18 18 0 1 0 8 0 18 0 18 25
2 SDN LANGEN SARI 5 95 0 86 20 0 20 18 0 0 0 8 0 19 1 20 21
3 SDN SENANG GALIH 88 0 53 30 0 30 18 0 2 0 12.67 0 30 0 30 34
4 SDN NEGLASARI 1 97 0 74 34 0 34 26 0 1 0 11.33 0 34 0 34 35
5 SDN NEGLASARI 3 92 0 78 34 0 34 29 0 0 0 11.67 0 34 0 34 37
6 SDN TILIL 1 92 0 66 35 0 35 25 0 0 0 14.33 0 35 0 35 38
7 SDN TILIL 2 89 0 81 32 0 32 29 0 0 0 11 0 32 0 32 36
8 SDN TILIL 3 84 0 78 27 0 27 25 0 0 0 8.667 0 27 0 27 32
9 SDN TILIL 4 97 0 83 35 0 35 30 0 0 0 14.67 0 35 0 35 36
10 #REF! #REF! #REF! #REF! #REF! #REF! ### ### ### ### ### ### ### ### ### ### ###
14 SDN TIKUKUR 5 80 0 60 32 0 32 24 0 0 0 15.67 0 32 0 32 40
15 SDN HAUR PANCUH 1 100 0 22 32 0 32 7 0 0 0 13.33 0 32 0 32 32
16 SDN HAUR PANCUH 2 94 0 19 29 0 29 6 0 0 0 13 0 29 0 29 31
17 SDN HAUR PANCUH 3 91 0 91 29 0 29 29 0 0 0 10.67 0 29 0 29 32
18 SDN MARGAHAYU BLOK I 96 0 86 27 0 27 24 0 0 0 10 0 27 0 27 28
TOTAL
Mslh
Gang.
Hsl Prks Penunjang Kesegaran kespr Kesegaran
ME
o
No Ane- Keca Jasmani HASIL PEMERIKSAAN PENUNJANG
Jasmani
JU
JUML Statu GAN ML
Status Imun Mslh AH s GGU KUM
TL
Gang. ME
kespro
KUM K.J
Imun AN
MAS
K.J AH
MURI ALAH
NAMA SEKOLAH TL MEN MU
D KESP
TAL RID
PERSENTASE
RO
EMO
SI SEG
mia cingan Segar Tdk sgr ANEMIA
KECACINGANTIDAK
AR SEGAR
1 SDN LANGEN SARI 1 0 1 0 8 0 18 0 18 25 0.0 4.0 0.0 32.0 0.0 72.0 0.0
2 SDN LANGEN SARI 5 0 0 0 8 0 19 1 20 21 0.0 0.0 0.0 38.1 0.0 90.5 4.8
3 SDN SENANG GALIH 0 2 0 12.6667 0 30 0 30 34 0.0 5.9 0.0 37.3 0.0 88.2 0.0
4 SDN NEGLASARI 1 0 1 0 11.3333 0 34 0 34 35 0.0 2.9 0.0 32.4 0.0 97.1 0.0
5 SDN NEGLASARI 3 0 0 0 11.6667 0 34 0 34 37 0.0 0.0 0.0 31.5 0.0 91.9 0.0
6 SDN TILIL 1 0 0 0 14.3333 0 35 0 35 38 0.0 0.0 0.0 37.7 0.0 92.1 0.0
7 SDN TILIL 2 0 0 0 11 0 32 0 32 36 0.0 0.0 0.0 30.6 0.0 88.9 0.0
8 SDN TILIL 3 0 0 0 8.66667 0 27 0 27 32 0.0 0.0 0.0 27.1 0.0 84.4 0.0
9 SDN TILIL 4 0 0 0 14.6667 0 35 0 35 36 0.0 0.0 0.0 40.7 0.0 97.2 0.0
10 #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! ### ### ### ### ### ### ###
14 SDN TIKUKUR 5 0 0 0 15.6667 0 32 0 32 40 0.0 0.0 0.0 39.2 0.0 80.0 0.0
15 SDN HAUR PANCUH 1 0 0 0 13.3333 0 32 0 32 32 0.0 0.0 0.0 41.7 0.0 ### 0.0
16 SDN HAUR PANCUH 2 0 0 0 13 0 29 0 29 31 0.0 0.0 0.0 41.9 0.0 93.5 0.0
17 SDN HAUR PANCUH 3 0 0 0 10.6667 0 29 0 29 32 0.0 0.0 0.0 33.3 0.0 90.6 0.0
18 SDN MARGAHAYU BLOK I 0 0 0 10 0 27 0 27 28 0.0 0.0 0.0 35.7 0.0 96.4 0.0
TOTAL #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF! ### ### ### ### ### ### ###
Lampiran
Hsl Prks Penunjang

Mslh Kesegaran
kesp Ane- Keca Seg Jasmani KUM
K.J
ro mia cingan ar Tdk s
0 8 0 18 0 18
0 8 0 19 1 20
0 13 0 30 0 30
0 11 0 34 0 34
0 12 0 34 0 34
0 14 0 35 0 35
0 11 0 32 0 32
0 9 0 27 0 27
0 15 0 35 0 35
### ### ### ### ### ###
### ### ### ### ### ###
### ### ### ### ### ###
### ### ### ### ### ###
0 16 0 32 0 32
0 13 0 32 0 32
0 13 0 29 0 29
0 11 0 29 0 29
0 10 0 27 0 27
### ### ### ### ### ###

GRAFIK HASIL PENJARINGAN KESEHATAN BERDASARKAN GANGGUAN MENTAL EMOSI, MASALAH KESPRO, ANEMIA,
GRAFIK HASIL PENJARINGAN KESEHATAN BERDASARKAN GANGGUAN MENTAL EMOSI, MASALAH KESPRO, ANEMIA,
KECACINGAN DAN KESEGARAN JASMANI
UPT PUSKESMAS PUTER
TAHUN 2012
PERSENTASE
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
SDN SDN SDN SDN SDN SDN SDN SDN SDN #REF! #REF! #REF! #REF! SDN SDN SDN SDN SDN TOTA
LANG LANG SENA NEGL NEGL TILIL TILIL TILIL TILIL TIKUK HAU HAU HAU MAR L
EN EN NG ASAR ASAR 1 2 3 4 UR 5 R R R GAH
SARI SARI GALI I1 I3 PANC PANC PANC AYU
1 5 H UH 1 UH 2 UH 3 BLOK
I
GRAFIK HASIL PENJARINGAN KESEHATAN SISWA SD
UPT PUSKESMAS PUTER
TAHUN 2012
100
Persentase
90
80
70
60
50
40
30
20
10
0 SDN SDN SDN SDN SDN SDN SDN SDN SDN #REF! #REF! #REF! #REF! SDN SDN SDN SDN SDN
LANGEN LANGEN SENANG NEGLAS NEGLAS TILIL 1 TILIL 2 TILIL 3 TILIL 4 TIKUKUR HAUR HAUR HAUR MARGA
SARI 1 SARI 5 GALIH ARI 1 ARI 3 5 PANCUH PANCUH PANCUH HAYU
1 2 3 BLOK I
SDN SDN SDN SDN SDN SDN SDN SDN SDN #REF! #REF! #REF! #REF! SDN SDN SDN SDN SDN
LANGEN LANGEN SENANG NEGLAS NEGLAS TILIL 1 TILIL 2 TILIL 3 TILIL 4 TIKUKUR HAUR HAUR HAUR MARGA
1 2 3 BLOK I
GRAFIK PENJARINGAN KESEHATAN SISWA SD BERDASARKAN STATUS GIZI

UPT PUSKESMAS PUTER
TAHUN 2012
PERSENTASE
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
SDN SDN SDN SDN SDN SDN TILIL SDN TILIL SDN TILIL SDN TILIL #REF! #REF! #REF! #REF! SDN SDN SDN SDN SDN
LANGEN LANGEN SENANG NEGLAS NEGLAS 1 2 3 4 TIKUKUR HAUR HAUR HAUR MARGA
1 2 3 BLOK I
GRAFIK HASIL PENJARINGAN KESEHATAN SISWA SD
BERDASARKAN TAJAM PENGLIHATAN
UPT PUSKESMAS PUTER
TAHUN 2012
100
90
80
70
60
50
40
30
20
10
0 SDN SDN SDN SDN SDN SDN TILIL SDN TILIL SDN TILIL SDN TILIL #REF! #REF! #REF! #REF! SDN SDN SDN SDN SDN TOTAL
LANGEN LANGEN SENANG NEGLAS NEGLAS 1 2 3 4 TIKUKUR HAUR HAUR HAUR MARGA
1 2 3 BLOK I
GRAFIK HASIL PENJARINGAN KESEHATAN BERDASARKAN
TAJAM PENDENGARAN DAN GIGI LUBANG
UPT PUSKESMAS PUTER
TAHUN 2012
100
90
PERSENTASE
80
70
60
50
40
30
20
10
0
SDN SDN SDN SDN SDN SDN TILIL SDN TILIL SDN TILIL SDN TILIL #REF! #REF! #REF! #REF! SDN SDN SDN SDN SDN
LANGEN LANGEN SENANG NEGLASA NEGLASA 1 2 3 4 TIKUKUR HAUR HAUR HAUR MARGA
SARI 1 SARI 5 GALIH RI 1 RI 3 5 PANCUH PANCUH PANCUH HAYU
1 2 3 BLOK I
PUSKESMAS SEKEJATI
NAMA SEKOLAH : SDN MARGAHAYU BLOK I

JUMLAH MURID SELURUHNYA :
JUMLAH MURID YANG DIJARING :
Jml peserta didik Status Gizi Tajam Tjm dengar Status Gang Ma- Hsl Prks Penunjan
Serumen Gigi
No NAMA MURID DI Yg dijaring Penglihatan OM Imuni- guan salah Ane-
N G K KS N TN Lubang
SEK L P Jml N TN ya tdk sasi TL ME Kespro mia
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 RIAN SAPUTRA 1 1 1 1 1 1 1 1 0
2 ACHMAD GALIH 1 1 1 1 1 1 1 1
3 ASRIL PERDIANSYAH 1 1 1 1 1 1 1 1 1
4 ASSIDKY ARIPIN 1 1 1 1 1 1 1 1 0
5 BAYU RAMADHAN 1 1 1 1 1 1 1 1 0
6 EKA SEPTIANA 1 1 1 1 1 1 1 0
7 EKA TITAN 1 1 1 1 1 1 1 1 0
8 FIRMANSYAH 1 1 1 1 1 1 1 1 0
9 HERNI NUSNAYAN 1 1 1 1 1 1 1 1 0
10 ISABELLA P 1 1 1 1 1 1 1 1 0
11 JUAN AL QIVARI 1 1 1 1 1 1 1 1 1
12 M FIKRI 1 1 1 1 1 1 1 1 0
13 M RIFA PRATAMA 1 1 1 1 1 1 1 0
14 NABIL ABDULLAH 1 1 1 1 1 1 1 1 0
15 NURLESTARI 1 1 1 1 1 1 1 1 0
16 NURUL SETIANINGSIH 1 1 1 1 1 1 1 1 0
17 RADITYA A 1 1 1 1 1 1 1 1 0
18 RAMDAN PERMANA 1 1 1 1 1 1 1 1 0
19 RIKA RISMAYANTI 1 0 0 0
20 RIMA RAHMAWATI 1 1 1 1 1 1 1 1 0
21 RIRIN AYUDIA 1 1 1 1 1 1 1 1 0
22 RIMA PUTRI PUSPITA 1 1 1 1 1 1 1 1 0
23 RIZKY MULADI 1 1 1 1 1 1 1 1 0
24 ROSA ROSITA 1 1 1 1 1 1 1 1 0
25 SELVI 1 1 1 1 1 1 1 1 0
26 SERINA R 1 1 1 1 1 1 1 1 0
27 SHELLA TRI 1 1 1 1 1 1 1 1 0
28 SYAHWAL M 1 1 1 1 1 1 1 1 0
28 TOTAL 28 14 13 27 21 3 3 0 25 2 24 3 0 27 0 24 0 0 0 10
Lampiran 3
Hsl Prks Penunjang Kesegaran

Keca Jasmani
cingan Segar Tdk sgr
23 24 25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
0 27 0
UPT PUSKESMAS PUTER
NAMA SEKOLAH : SDN HAUR PANCUH 3

JUMLAH MURID SELURUHNYA : 32
JUMLAH MURID YANG DIJARING : 29
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ABIZAR IBNU 1 1 1 1 1 1 1 1 0
2 ANJAR YULISTIANDI 1 0 0
3 ANISA NUR A 1 1 1 1 1 1 1 1 0
4 AZZRIFA URUL 1 1 1 1 1 1 1 1 0
5 CAKRA SUPRIATNA 1 1 1 1 1 1 1 1 0
6 DIMAS PUTRA 1 1 0
7 FATTIR PUTRA 1 1 0 1 1 1 1 1 0
8 GADIS AMELIA 1 1 1 1 1 1 1 1 0
9 KHABIR ABADI 1 1 1 1 1 1 1 1 0
10 IBNU HASAN M 1 1 1 1 1 1 1 1 0
11 IRFAN MAULANA 1 1 1 1 1 1 1 1 0
12 IRHAM AZKA 1 1 1 1 1 1 1 1 0
13 LESTARI JANUARI 1 1 1 1 1 1 1 1 0
14 MELANDRI 1 1 1 1 1 1 1 1 0
15 M RIFKI 1 1 1 1 1 1 1 1 1
16 M IQBAL 1 1 1 1 1 1 1 1 0
17 M RAFI 1 1 1 1 1 1 1 1 0
18 M RAFLI 1 1 1 1 1 1 1 1 1
19 M TRI AJI 1 1 1 1 1 1 1 1 0
20 RAJAK BRAJA 1 0
21 RATNA RAHMADANI 1 1 1 1 1 1 1 1 0
22 RIFKI SEPTIAN 1 1 1 1 1 1 1 1 0
23 SAEFUL FAJAR 1 1 1 1 1 1 1 1 0
24 SCHASA NUR R 1 1 1 1 1 1 1 1 0
25 SITI FADILLAH 1 1 1 1 1 1 1 1 0
26 STEPANYA 1 1 1 1 1 1 1 1 0
27 VERA NOVITA 1 1 1 1 1 1 1 1 0
28 VIVI AVITA 1 1 1 1 1 1 1 1 0
29 WAFI NUR AZIZAH 1 1 1 1 1 1 1 1 0
30 ABDUL RANDI 1 1 1 1 1 1 1 1 0
31 BAYU NUGRAHA 1 1 1 1 1 1 1 1 0
32 EDWAR ANDRIYANA 1 1 1 1 1 1 1 1 0
32 TOTAL 32 17 12 29 26 1 2 0 29 0 24 5 0 29 0 29 0 0 0 11
Lampiran 3

Keca Jasmani
23 24 25
1
0
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
0 29 0
UPT PUSKESMAS PUTER

Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 VIRLI NASYILA P 1 1 1 1 1 1 1 0
2 AJI MULYANA 1 1 1 1 1 1 1 1
3 BAGAS FEBRIAN 1 1 1 1 1 1 1 1
4 CITRA SHELLA 1 1 1 1 1 1 1 0
5 DELLA S 1 1 1 1 1 1 1 1 0
6 DIAN JULIANA 1 1 1 1 1 1 1 0
7 DILLA SR 1 1 1 1 1 1 1 0
8 DINAR N 1 1 1 1 1 1 1 0
9 FAJAR AGUNG 1 1 1 1 1 1 1 1 0
10 FHIKA YULIANTI 1 1 1 1 1 1 1 1 1
11 FEIKA N 1 1 1 1 1 1 1 0
12 IBNU AHMAD 1 1 1 1 1 1 1 0
13 IMAM ADUL 1 1 1 1 1 1 1 0
14 IMAMAH 1 1 1 1 1 1 1 0
15 M FAUZI N 1 0 0 0 0 0 0
16 MARWAH H 1 1 1 1 1 1 1 1
17 MARSHA NISWAH 1 1 1 1 1 1 1 1 0
18 MIKHA AULIA 1 1 1 1 1 1 1 0
19 M FAUZAN ALAMSYA 1 1 1 1 1 1 1 1
20 M NAJIB 1 1 1 1 1 1 1 0
21 M RIZKI AKBAR 1 1 1 1 1 1 1 0
22 NANDA WULAN 1 1 1 1 1 1 1 0
23 NAURA ABIDA 1 1 1 1 1 1 1 0
24 NURUL DIENIAH 1 1 1 1 1 1 1 0
25 AOLGA AULIA 1 1 1 1 1 1 1 1
26 PAJAR RAEHAN 1 0 0 0 0 0 0
27 PUTRI AL VARISA 1 1 1 1 1 1 1 0
28 RIDWAN KURNIAWAN 1 1 1 1 1 1 1 1 0
29 SAZKIA PUTRI F 1 1 1 1 1 1 1 0
30 SITI RIFA 1 1 1 1 1 1 1 1 0
31 TRIANY DWI NOV 1 1 1 1 1 1 1 0
31 TOTAL 31 9 20 29 21 2 6 0 29 0 10 19 0 29 0 6 0 0 0 13
Kepala Puskesmas
(………………………..)
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
0 29 0
Kepala Puskesmas
………………………..)
UPT PUSKESMAS PUTER

Jml peserta didik Status Gizi Tajam Tjm dengar Status Gang Ma- Hsl Prks Penunjang
Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 NABIH BURHARUDIN 1 1 1 1 1 1 1 0
2 AJI AKBAR 1 1 1 1 1 1 1 0
3 ARIFIN TRI PUTRA 1 1 1 1 1 1 1 0
4 DANNY SAEFUL 1 1 1 1 1 1 1 0
5 DWIKA AGUDIAS 1 1 1 1 1 1 1 1 0
6 FAUZIAH DARMA 1 1 1 1 1 1 1 0
7 M RAFA 1 1 1 1 1 1 1 0
8 IDHAR KHALID 1 1 1 1 1 1 1 0
9 M ABDUROHMAN R 1 1 1 1 1 1 1 1 1
10 MULFI SAPUTRA 1 1 1 1 1 1 1 1 0
11 ROVAN CANDRA 1 1 1 1 1 1 1 0
12 RINALDI PUTRA 1 1 1 1 1 1 1 0
13 M REYHAN PRATAMA 1 1 1 1 1 1 1 1
14 M IHSAN 1 1 1 1 1 1 1 0
15 M IQBAL 1 1 1 1 1 1 1 1 0
16 IKRIMAH SYIFA 1 1 1 1 1 1 1 0
17 LIESTY 1 1 1 1 1 1 1 1 0
18 NAYLA NESFA 1 1 1 1 1 1 1 0
19 NAZWA GINA 1 1 1 1 1 1 1 0
20 NIRMALA RIPHLUA 1 1 1 1 1 1 1 0
21 NOVA NURAZIZAH 1 1 1 1 1 1 1 0
22 SALSABILAH 1 1 1 1 1 1 1 1
23 SEPTAH DADVARA 1 1 1 1 1 1 1 0
24 SOFHIA HANA 1 1 1 1 1 1 1 0
25 AINA NUR 1 1 1 1 1 1 1 0
26 ANA YULIANA 1 1 1 1 1 1 1 1 0
27 ANSA NURHAYATI 1 1 1 1 1 1 1 1
28 ANISA AYU 1 1 1 1 1 1 1 1 0
29 HAFIZAH MAZAYA 1 1 1 1 1 1 1 0
30 DEVA PRAMITA 1 1 1 1 1 1 1 1
31 DIVA AULIA 1 1 1 1 1 1 1 0
32 ANAS 1 1 1 1 1 1 1 0
32 TOTAL 32 15 17 32 25 2 5 0 32 0 11 21 0 32 0 7 0 0 0 13
Lampiran 3

Keca Jasmani
23 24 25
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
0 32 0
UPT PUSKESMAS PUTER
NAMA SEKOLAH : SDN TIKUKUR 5

Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 1 1 1 1 1 1 1 0
2 1 1 1 1 1 1 1 1 0
3 1 1 1 1 1 1 1 0
4 1 1 1 1 1 1 1 1 0
5 1 1 1 1 1 1 1 1 1
6 1 1 1 1 1 1 1 0
7 1 1 1 1 1 1 1 1 0
8 1 1 1 1 1 1 1 0
9 1 1 1 1 1 1 1 1 1
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 0
12 1 1 1 1 1 1 1 1 0
13 1 1 1 1 1 1 1 1 0
14 1 1 1 1 1 1 1 0
15 1 1 1 1 1 1 1 1 1
16 1 1 1 1 1 1 1 1 0
17 1 1 1 1 1 1 1 1 0
18 1 1 1 1 1 1 1 1
19 1 1 1 1 1 1 1 1 0
20 1 1 1 1 1 1 1 1 0
21 1 1 1 1 1 1 1 0
22 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 0
24 1 1 1 1 1 1 1 1 0
25 1 1 1 1 1 1 1 1 0
26 1 1 1 1 1 1 1 1 0
27 1 1 1 1 1 1 1 1 0
28 1 1 1 1 1 1 1 1 1
29 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 0
Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
31 1 1 1 1 1 1 1 1 0
32 1 1 1 1 1 1 1 1 0
33 1 1 1 1 1 1 1 1 1
34 1 1 1 1 1 1 1 1
35 1 1 1 1 1 1 1 1 0
36 1 1 1 1 1 1 1 1 0
37 1 1 1 1 1 1 1 1 0
38 1 1 1 1 1 1 1 1 1
39 1 1 1 1 1 1 1 0
40 1 1 1 0
40 TOTAL 40 16 16 32 23 1 7 1 32 0 17 15 0 32 0 24 0 0 0 16
Lampiran 3

Keca Jasmani
23 24 25
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
Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
0 32 0
UPT PUSKESMAS PUTER
NAMA SEKOLAH : SDN TILIL 4

Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 AIKA JINAN RS 1 1 1 1 1 1 0
2 ALIDA MIRANTIKA P 1 1 1 1 1 1 1 1 0
3 ALIFAH 1 1 1 1 1 1 1 0
4 ALIYA 1 1 1 1 1 1 1 1 0
5 AMELIA OKTAVIANI 1 1 1 1 1 1 1 1 0
6 ANISA MUTHOHAROH 1 1 1 1 1 1 1 1
7 ARIF RAHMAN 1 1 1 1 1 1 1 0
8 ASTRELLA 1 1 1 1 1 1 1 1 1
9 CANDRA JUNIA 1 1 1 1 1 1 1 1 1
10 CANDRA SAGI 1 1 1 1 1 1 1 1 0
11 DAVI ALBUCHORI 1 1 1 1 1 1 1 1 0
12 FARINKA R 1 1 1 1 1 1 1 0
13 GITA PURNA 1 1 1 1 1 1 0
14 KARMELIA 1 1 1 1 1 1 0
15 KHAIRIL A 1 1 1 1 1 1 1 1 0
16 LUTFIA 1 1 1 1 1 1 0
17 MARCELINA 1 1 1 1 1 1 1 0
18 M DAFFA 1 1 1 1 1 1 1 1 1
19 M YUAN 1 1 1 1 1 1 1 1 0
20 NABILA AMELIA SOLIHA 1 1 1 1 1 1 1 1 0
21 NABILA ANISA 1 1 1 1 1 1 1 1 1
22 NABILA PUTRI 1 1 1 1 1 1 1 1 0
23 NAUFAL H N 1 1 1 1 1 1 1 0
24 NOVA YULIANTI 1 1 1 1 1 1 0
25 NUR ANISA 1 1 1 1 1 1 1 1 0
26 NUR SYIFA 1 1 1 1 1 1 1 0
27 RAFAEL ABIDAL 1 1 1 1 1 1 1 0
Serumen Gigi
28 RAMA 1 1 1 1 1 1 1 0
29 RAMADHAN 1 1 1 1 1 1 1 1 0
30 RANGGA A 1 0 0 0
31 RISQI C A 1 1 1 1 1 1 1 0
32 SAEFUL R 1 1 1 1 1 1 1 1 0
33 SASKIA A 1 1 1 1 1 1 1 1 1
34 TEGAR H 1 1 1 1 1 1 1 1 0
35 TEGAR M SAPTA 1 1 1 1 1 1 1 1 0
36 BAGAS KARA 1 1 1 1 1 1 1 0
36 TOTAL 36 16 19 35 26 3 6 0 34 1 19 16 0 35 0 30 0 0 0 15
Kepala Puskesmas
(………………………..)
Lampiran 3

Keca Jasmani
23 24 25
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
Keca Jasmani
1
1
0
1
1
1
1
1
1
0 35 0
Kepala Puskesmas
………………………..)
UPT PUSKESMAS PUTER

Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ADE FIKRIANSYAH 1 1 1 1 1 1 1 1 0
2 AGUNG FIRMANSYAH 1 1 1 1 1 1 1 1 0
3 ALDI ALDIANSYAH 1 1 1 1 1 1 1 0
4 ALIKA PROBANDARI 1 1 1 1 1 1 1 1 0
5 ANBIYA DWIPA 1 1 1 1 1 1 1 1 0
6 AWLIYA DWIPA 1 1 1 1 1 1 1 1 0
7 AYUNDITA TRIBUANA 1 1 1 1 1 1 1 1 0
8 CALYA NABILA 1 1 1 1 1 1 1 1 0
9 DHEMA WINARKO 1 1 1 1 1 1 1 1 0
10 FACHRI ADITYA 1 1 1 1 1 1 1 1 0
11 GALIH M 1 1 1 1 1 1 1 1 0
12 HAFID SENTANA 1 0 0 0 0
13 ILHAM SEPTIANA 1 0 0 0 0
14 JESIKA RATU 1 1 1 1 1 1 1 1 0
15 KHUMAIRA 1 1 1 1 1 1 1 1 0
16 M ARIEF 1 1 1 1 1 1 1 0
17 MIFTAH M 1 0 0 0 0
18 M FACHRUL 1 1 1 1 1 1 1 1 0
19 M RAFLI 1 1 1 1 1 1 1 1 0
20 M ZAIDAN 1 1 1 1 1 1 1 1 0
21 M IKHSAN 1 1 1 1 1 1 1 1 0
22 RAISYA 1 1 1 1 1 1 1 1 0
23 RIJAL GUSMIRAN 1 1 1 1 1 1 1 1 1
24 RIZA GILANG 1 1 1 1 1 1 1 1 0
25 RIZKY HEPTA 1 1 1 1 1 1 1 1 0
26 SITI ANNISA 1 1 1 1 1 1 1 1 0
27 SUCI AGIANTI 1 0 0 0 0
28 SUCI FRANSISKA 1 1 1 1 1 1 1 1 0
29 VIRNA RIZKA 1 1 1 1 1 1 1 1 0
30 ZAHRA N 1 1 1 1 1 1 1 1 0
31 ZASKIA 1 0 0 0
32 FITRIA N 1 1 1 1 1 1 1 1 0
32 TOTAL 32 16 11 27 23 3 1 0 27 0 18 9 0 27 0 25 0 0 0 9
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
1
0
0
1
1
1
0
1
1
1
1
1
1
1
1
1
0
1
1
1
0
1
0 27 0
UPT PUSKESMAS PUTER

Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ABDUL RAHIM 1 1 1 1 1 1 1 1 0
2 ADINDA SEPTILA PUTRI 1 1 1 1 1 1 1 0
3 AGFAN DESDIRAH 1 1 1 1 1 1 1 1 0
4 AGUSTINA DWI N 1 0 0 0
5 ALDIN PUTRA ANANDA 1 1 1 1 1 1 1 1 0
6 ANISHA YUNIA PRADINI 1 1 1 1 1 1 1 0
7 ANGGY REINA LINTANG 1 1 1 1 1 1 1 1 0
8 AULIA PUTRI SYAH 1 1 1 1 1 1 1 1 0
9 CARLI ANGGARA 1 1 1 1 1 1 1 1 0
10 EGI PERMANA 1 1 1 1 1 1 1 1 0
11 HELMI FEBRIAN 1 1 1 1 1 1 1 1 1
12 M ADAM R 1 1 1 1 1 1 1 1 0
13 M AZMI JANZABILLA 1 1 1 1 1 1 1 1 0
14 M FIRMANSYAH 1 1 1 1 1 1 1 1 0
15 M RIZKY REINALDY 1 1 1 1 1 1 1 0
16 M SYAHRIZAL 1 1 1 1 1 1 1 1 0
17 NABILA DESWANI 1 1 1 1 1 1 1 1 0
18 NADIATUL AMANAH 1 1 1 1 1 1 1 1 0
19 NAUFAL HAFIDH 1 1 1 1 1 1 1 1 0
20 NURUL FADILAH 1 1 1 1 1 1 1 1 0
21 PUTRI MULYANI 1 1 1 1 1 1 1 1 0
22 RAI HANA ARDANIANTI 1 1 1 1 1 1 1 1 0
23 RICKY RAMADHAN 1 1 1 1 1 1 1 1 0
24 RYAN AZRIL 1 1 1 1 1 1 1 0
25 RIVA NUR FATHIYA 1 0 0 0
26 RYAN RUDANA SYAPUTRA 1 1 1 1 1 1 1 1 0
27 SATRIO GANTINA 1 1 1 1 1 1 1 1 0
Serumen Gigi
28 SEPTIANA TRI N 1 0 0 0
29 SUCHI OCTAVIANI 1 1 1 1 1 1 1 1 0
30 TRISYA AMALIA 1 1 1 1 1 1 1 0
31 VANDI 1 0 0 0
32 WAHYU RAMADANI 1 1 1 1 1 1 1 1 0
33 WISNU WIRANDA 1 1 1 1 1 1 1 1 0
34 KHAYLANY NIZARD R 1 1 1 1 1 1 1 1 0
35 ADINDA SAHFIRA AZAHRA 1 1 1 1 1 1 1 0
36 AQILA HAYA FAUZIAH 1 1 1 1 1 1 1 1 0
36 TOTAL 36 19 13 32 30 1 1 0 32 0 29 3 0 32 0 29 0 0 0 11
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
Keca Jasmani
0
1
1
0
1
1
1
1
1
0 32 0
UPT PUSKESMAS PUTER

Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 WINDA NUR FAUZIAH 1 1 1 1 1 1 1 1 0
2 ADAM INDIRA 1 1 1 1 1 1 1 1 0
3 AI BANY HASBALLAH 1 1 1 1 1 1 1 1
4 ALIFA ZAINATA NURUL 1 1 1 1 1 1 1 1 0
5 ALYSHA INSAN 1 1 1 1 1 1 1 1 1
6 AUDITA OKTAVIANI 1 1 1 1 1 1 1 1 0
7 CINTA ABDITIAS 1 1 1 1 1 1 1 1 0
8 DAFFA RAI PUTRA 1 1 1 1 1 1 1 1
9 DAVA MAFTAN PUTRA 1 1 1 1 1 1 1 1 1
10 DAVI MAULANA 1 1 1 1 1 1 1 1 0
11 DINI YULIA ASTUTI 1 1 1 1 1 1 1 1 0
12 DRI SYUJA NYLENDRA 1 1 1 1 1 1 1 1 0
13 ENZIE RAMADHANTI 1 1 1 1 1 1 1 1 0
14 LAURA RAMDA OCTAVIANI 1 1 1 1 1 1 1 1 0
15 MIKA RAIFATA 1 1 1 1 1 1 1 1 0
16 M ARVIN 1 1 1 1 1 1 1 1 0
17 M ANAUFAL 1 1 1 1 1 1 1 1 0
18 M RAFLY 1 1 1 1 1 1 1 1 0
19 NESYA RETNO DEWI 1 0 0
20 NOFAL M DHARMA 1 1 1 1 1 1 1 1 0
21 NUR AZIZAH 1 1 1 1 1 1 1 1 0
22 PRATAMA APRILYATNA 1 0 0
23 R RIZAL ADHITA 1 1 1 1 1 1 1 0
24 RAHMA NUR SANDI 1 1 1 1 1 1 1 0
25 RAKA RAMADHAN 1 1 1 1 1 1 1 1 0
26 RANGGA RIZKI 1 1 1 1 1 1 1 0
27 RANGGA YUDA 1 0 0
Serumen Gigi
28 SAFITRI JULIA 1 1 1 1 1 1 1 0
29 SALSABILA NUR 1 1 1 1 1 1 1 0
30 SHAFIYYAH 1 1 1 1 1 1 1 1 0
31 SITI NUR ANISA 1 1 1 1 1 1 1 1 0
32 TANTRIANA 1 1 1 1 1 1 1 1 0
33 WAFA SYAHIDAH 1 1 1 1 1 1 1 0
34 WAHYU MULYONO 1 1 1 1 1 1 1 1 1
35 WILDAN AHMAD 1 1 1 1 1 1 1 0
36 ZAHWA SALASADILA 1 1 1 1 1 1 1 1 0
37 AFINA ANGGITA 1 1 1 1 1 1 1 0
38 FATHIYA FATIHATUL 1 1 1 1 1 1 1 1 0
38 TOTAL 38 16 19 35 28 2 5 0 35 0 11 24 0 35 0 25 0 0 0 14
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Keca Jasmani
1
1
1
1
1
1
1
1
1
1
1
0 35 0
UPT PUSKESMAS PUTER
NAMA SEKOLAH : SDN NEGLASARI 3

Serumen Gigi
No NAMA MURID di Yg dijaring Penglihatan OM Imuni- guan salah Ane-
sek L P Jml N TN ya tdk sasi TL ME Kespro mia
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ADINDA MAULIDINA 1 0 0
2 AGI 1 1 1 1 1 1 1 0
3 AL ACKZSYA 1 1 1 1 1 1 1 1 0
4 ALINDA NUR 1 1 1 1 1 1 1 0
5 ANDIAN RAHMADI 1 1 1 1 1 1 1 0
6 ANDIKA RAMDANI 1 1 1 1 1 1 1 1 0
7 CINDUS AGUSTINA 1 1 1 1 1 1 1 0
8 CITRA NOVAYANTI 1 1 1 1 1 1 1 1 0
9 DHE MELANI PUTRI 1 0 0 0
10 DZUBYAN FALLAH 1 1 1 1 1 1 1 1 0
11 EKANANDA 1 1 1 1 1 1 1 0
12 EPRIL LIYANTI 1 1 1 1 1 1 1 1 0
13 FABIAN AZKA RISMAWAN 1 1 1 1 1 1 1 0
14 GESYA CANTIKA PRATIWI 1 1 1 1 1 1 1 0
15 JULKIFLI AKBAR 1 1 1 1 1 1 1 0
16 KELVIN ANDIKA 1 1 1 1 1 1 1 1
17 LULU NUR AGNIA 1 1 1 1 1 1 1 1 0
18 M IDFI RENAR 1 1 1 1 1 1 1 1 0
19 RAHMAWATI 1 1 1 1 1 1 1 1 0
20 RAISSA ANINDYA 1 1 1 1 1 1 1 0
21 RAMADHANI YULIA PUTRI 1 1 1 1 1 1 1 0
22 RAMADITA PRASETIO 1 1 1 1 1 1 1 0
23 RIAN RAMADHAN 1 1 1 1 1 1 1 0
24 RICKY BACHTIAR 1 1 1 1 1 1 1 1 0
25 RIFQI RAMADHAN 1 1 1 1 1 1 1 1 0
26 RIO DWI IRAWAN 1 1 1 1 1 1 1 0
27 SALWA AULIA 1 1 1 1 1 1 1 0
Serumen Gigi
No NAMA MURID di Yg dijaring Penglihatan OM Imuni- guan salah Ane-
sek L P Jml N TN ya tdk sasi TL ME Kespro mia
28 SANDI 1 1 1 1 1 1 1 1 0
29 SHOPIA YULI 1 1 1 1 1 1 0
30 SRI NURYANI 1 1 1 1 1 1 1 0
31 SUCI AMELIA 1 1 1 1 1 1 1 0
32 SULTAN HAKIM 1 1 1 1 1 1 1 0
33 TRISYA 1 0 0 0
34 WINDI ALYA AURELIA 1 1 1 1 1 1 0
35 WULANDARI 1 1 1 1 1 1 1 1 0
36 YUDHI LEMANA PUTRA 1 1 1 1 1 1 1 0
37 ZAKI ZULKIFLI 1 1 1 1 1 1 1 1 0
37 TOTAL 37 17 17 34 32 1 1 0 34 0 16 18 0 34 0 29 0 0 0 12
Lampiran 3

Keca Jasmani
23 24 25
0
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Keca Jasmani
1
1
1
1
1
1
1
1
1
0 34 0
REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK Lampiran
UPT PUSKESMAS PUTER

Serumen Gigi
No NAMA MURID di Yg dijaring Penglihatan OM Imuni- guan salah Ane- Keca
sek L P Jml N TN ya tdk sasi TL ME Kespro mia cingan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
1 IKBAL HARI 1 1 1 1 1 1 1 0
2 AKMAL AMALI 1 1 1 1 1 1 1 1 0
3 DETTY RIZQIYA 1 1 1 1 1 1 1 1 0
4 GANIA 1 1 1 1 1 1 1 0
5 GUNTUR ALAMSYAH 1 1 1 1 1 1 1 1 0
6 ILHAM NUROHMAN 1 1 1 1 1 1 1 0
7 IMELSA DESTAVIA 1 1 1 1 1 1 1 0
8 IRHAM KHALIN 1 1 1 1 1 1 1 0
9 IRVAN ABDUL HALIM 1 1 1 1 1 1 1 0
10 MAULANA AKBAR 1 1 1 1 1 1 1 0
11 M HABIBURROHMAN 1 1 1 1 1 1 1 1 0
12 NAISYA SABILA 1 1 1 1 1 1 1 0
13 NAUFAL A 1 1 1 1 1 1 1 0
14 NAZWA F 1 1 1 1 1 1 1 0
15 NENG RAHMI 1 1 1 1 1 1 1 1 0
16 NIRRA N 1 1 1 1 1 1 1 1 0
17 NUR INDAH 1 1 1 1 1 1 1 1 0
18 RAMZI SALIM 1 1 1 1 1 1 1 1 0
19 REIHAN FAUZI 1 1 1 1 1 1 1 0
20 RESKA AJEUNG 1 1 1 1 1 1 1 1 0
21 RIYANTI AYU 1 1 1 1 1 1 1 1 0
22 RIZKI MAULANA 1 1 1 1 1 1 1 1 0
23 SALMA AQUILA 1 1 1 1 1 1 1 1 0
24 SANDI ADITYA 1 1 1 1 1 1 1 1 0
25 SARAH DIANDRA 1 1 1 1 1 1 1 1 0
26 SUCI ILMI RAHMA 1 1 1 1 1 1 1 1 0
27 SYAHARA P 1 1 1 1 1 1 1 1 0
28 SILPIA N 1 1 1 1 1 1 1 1 0
29 TIARA S 1 1 1 1 1 1 1 1 0
30 TESSA DWI 1 1 1 1 1 1 1 1 0
31 TRISTAN NALENDRA 1 1 1 1 1 1 1 1 0
32 VARISA NISRINA 1 1 1 1 1 1 1 1 0
33 WAHYU NUGRAHA 1 1 1 1 1 1 1 1 0
34 WESA ANGGARA 1 1 1 1 1 1 1 1 0
35 JAKA 1 0 0
35 TOTAL 35 16 18 34 34 0 0 0 33 1 30 4 0 34 0 26 0 1 0 11 0
Kepala Puskesmas
(………………………..)
Lampiran 3
Kesegaran
Jasmani
Segar Tdk sgr
24 25
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
0
34 0
REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK Lampiran
UPT PUSKESMAS PUTER
NAMA SEKOLAH : SDN SENANG GALIH

Serumen Gigi
sek L P Jml N TN ya tdk sasi TL ME Kespro mia cingan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
1 ALYA NUR HASANAH 1 1 1 1 1 1 1 0
2 AZKA NURFADILAH 1 1 1 1 1 1 1 0
3 ANDITA DESIANA 1 1 1 1 1 1 1 1
4 ADRIANO JULIANSYAH 1 1 1 1 1 1 1 0
5 AISYAH NUR ABIDIN 1 1 1 1 1 1 1 1 0
6 AKMAL ARYANTO 1 1 1 1 1 1 1 1 0
7 ALFIRA KHAIRUNNISA 1 1 1 1 1 1 0
8 ANA EKA LESTARI 1 0 0 0
9 ASEP SENDI 1 1 1 1 1 1 1 1 0
10 DELVAN 1 1 1 1 1 1 1 0
11 DEN YUDI 1 1 1 1 1 1 1 1
12 DESI NABILAH 1 1 1 1 1 1 0
13 DZIKRI SYAWALI 1 0 0 0
14 FATIR MUTAQIR 1 0 0 0
15 FENINDA NOFIANTI 1 1 1 1 1 1 1 1 1
16 HANIA NURHASANAH 1 1 1 1 1 1 1 0
17 HANIFA RIZKY 1 1 1 1 1 1 1 0
18 M ILHAM NUGRAHA 1 1 1 1 1 1 1 1 1 0
19 M RIZKY D 1 1 1 1 1 1 1
20 MERIL ANZANI 1 1 1 1 1 1 0
21 NAZWA NOVIANTI 1 1 1 1 1 1 1 0
22 NIKI SAPUTRA 1 1 1 1 1 1 0
23 NIRA SRI RAHAYU 1 1 1 1 1 1 1 0
24 PURI YANTI 1 1 1 1 1 1 0
25 RANGGA DWI SAPUTRA 1 1 1 1 1 1 1 1 0
26 RADIKA GEMA 1 1 1 1 1 1 1 1 0
27 RENDY ADITIA 1 1 1 1 1 1 1 1
28 RESHA NATALI 1 1 1 1 1 1 1 0
29 RIDWAN SAMBAS 1 1 1 1 1 1 1 1 0
30 SHAKIRA SALWA 1 1 1 1 1 1 1 1 1
31 SITI NURAENI 1 1 1 1 1 1 1 0
32 WULAN ANGGITA 1 0 0 0
33 ZAHRA AFIFF 1 1 1 1 1 1 0
34 M TOPIK 1 1 1 1 1 1 0
34 TOTAL 34 12 18 30 20 4 6 0 30 0 12 18 0 30 0 18 0 2 0 13 0
Kepala Puskesmas
(………………………..)
Lampiran 3
Kesegaran
Jasmani
Segar Tdk sgr
24 25
1
1
1
1
1
1
1
0
1
1
1
1
0
0
1
1
1
1 CACAT BAWAAN
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
30 0
REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK Lampiran 3
UPT PUSKESMAS PUTER
NAMA SEKOLAH : SDN LANGEN SARI 5

Serumen Gigi
Sek L P Jml N TN ya tdk sasi TL ME Kespro mia cingan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
1 ABDURRAHMAN 1 1 1 1 1 1 1 1
2 AMELIA TITIN 1 1 1 1 1 1 1 1 0
3 ANANDA PUTRI 1 1 1 1 1 1 1 1 0
4 ANDIKA FADLI 1 1 1 1 1 1 1 1 0
5 ARYA PUTRA 1 1 1 1 1 1 1 1 0
6 HAFIZH REPALDI 1 1 1 1 1 1 1 1 0
7 IKHSAN DWI S 1 1 1 1 1 1 1 1 0
8 M RIDWAN 1 1 1 1 1 1 1 1 0
9 M RIZKY 1 1 1 1 1 1 1 1 0
10 M FAZA 1 1 1 1 1 1 1 1 0
11 NANDA LUBAY 1 1 1 1 1 1 1 1 0
12 NENG IQLIMA 1 1 1 1 1 1 1 0
13 NUR AISYAH 1 0 0
14 NABILA 1 1 1 1 1 1 1 1 0
15 ROBBY RAKA 1 1 1 1 1 1 1 1 0
16 RATIH DESYANA 1 1 1 1 1 1 1 1 0
17 RENDI ANDI 1 1 1 1 1 1 1 1 0
18 REVINA 1 1 1 1 1 1 1 1 0
19 RIRI NURHASANAH 1 1 1 1 1 1 1 1 0
20 SETIADJI 1 1 1 1 1 1 1 1 1
21 SHIFA SEPTIANI 1 1 1 1 1 1 1 1 0
21 TOTAL 21 12 8 20 18 0 2 0 19 1 14 6 0 20 0 18 0 0 0 8 0
Lampiran 3
Kesegaran
Jasmani
Segar Tdk sgr
24 25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
19 1
UPT PUSKESMAS PUTER
TAHUN 2012
Jml peserta didik Status Gizi Tajam Tjm dengar Status Gang Ma- Hsl Prks Pen
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 A. SOFANDI 1 0
2 ARMI ANGGUN P 1 1 1 1 1 1 1 1 1 0
3 ASEP N 1 1 1 1 1 1 1 1 0
4 DIAS P 1 1 1 1 1 1 1 1 0
5 FAREL FAUZI 1 1 1 1 1 1 1 1 0
6 MARDIAN SYAH 1 1 1 1 1 1 1 1 0
7 MIDA NURAENI 1 1 1 1 1 1 1 1 0
8 M REKSA 1 1 1 1 1 1 1 1 0
9 M SILPAN FARID 1 1 1 1 1 1 1 1 0
10 M FAISAL YASIN 1 1 1 1 1 1 1 1 1
11 NARUMI ELLYA 1 1 1 1 1 1 1 1 1
12 RIZKIA MUTA 1 1 1 1 1 1 1 1 0
13 REVALINA R 1 0 0
14 SINTA 1 0 0
15 SANDI 1 1 1 1 1 1 1 1 0
16 SHERLI 1 0 0
17 SIDQI NAUFAL 1 1 1 1 1 1 1 1 0
18 SALWA DWI 1 1 1 1 1 1 1 1 0
19 SARAH MEYLISA 1 0 0
20 SUPRAYOGI 1 1 1 1 1 1 1 1 0
21 TEDI SUTISNA 1 1 1 1 1 1 1 1 0
22 TASYA AULIA 1 0 0
23 VIKA FEBRIANTI 1 1 1 1 1 1 1 1 0
24 VASYA ARNETA 1 1 1 1 1 1 1 1 1
25 VARIO SFORSA 1 0 0
25 TOTAL 25 12 6 18 15 0 3 0 17 1 11 7 0 18 0 18 0 1 0 8
Lampiran 3

Keca Jasmani
23 24 25
1
1 `
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
18 0
UPT PUSKESMAS PUTER

Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 A. SOFANDI 1 0
2 ARMI ANGGUN P 1 1 1 1 1 1 1 1 1
3 ASEP N 1 1 1 1 1 1 1 1
4 DIAS P 1 1 1 1 1 1 1 1
5 FAREL FAUZI 1 1 1 1 1 1 1 1
6 MARDIAN SYAH 1 1 1 1 1 1 1 1
7 MIDA NURAENI 1 1 1 1 1 1 1
8 M REKSA 1 1 1 1 1 1 1
9 M SILPAN FARID 1 1 1 1 1 1 1
10 M FAISAL YASIN 1 1 1 1 1 1 1 1
11 NARUMI ELLYA 1 1 1 1 1 1 1
12 RIZKIA MUTA 1 1 1 1 1 1 1 1
13 REVALINA R 1 0
14 SINTA 1 0
15 SANDI 1 1 1 1 1 1 1 1
16 SHERLI 1 0
17 SIDQI NAUFAL 1 1 1 1 1 1 1
18 SALWA DWI 1 1 1 1 1 1 1
19 SARAH MEYLISA 1 0
20 SUPRAYOGI 1 1 1 1 1 1 1
21 TEDI SUTISNA 1 1 1 1 1 1 1 1
22 TASYA AULIA 1 0
23 VIKA FEBRIANTI 1 1 1 1 1 1 1 1
24 VASYA ARNETA 1 1 1 1 1 1 1 1
25 VARIO SFORSA 1 0
25 TOTAL 25 12 6 18 17 1 11 14 0 18 0 18 0 1 0 0
Mengetahui,
Kepala UPT Puskesmas Puter Penanggung Jawa
dr. Sylfie Virgianti Sylva Lestari,

NIP.19640902 198903 2 006 NIP. 19870910 2
dr. Sylfie Virgianti Sylva Lestari,
NIP.19640902 198903 2 006 NIP. 19870910 2

UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
No NAMA MURID Yg dijaring Penglihatan OM Imuni- guan salah Ane-
di Sek N G K KS N TN Lubang
L P Jml N TN ya tdk sasi TL ME Kespro mia
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ABDURRAHMAN 1 1 1 1 1 1 1
2 AMELIA TITIN 1 1 1 1 1 1 1 1
3 ANANDA PUTRI 1 1 1 1 1 1 1 1
4 ANDIKA FADLI 1 1 1 1 1 1 1 1
5 ARYA PUTRA 1 1 1 1 1 1 1 1
6 HAFIZH REPALDI 1 1 1 1 1 1 1 1
7 IKHSAN DWI S 1 1 1 1 1 1 1 1
8 M RIDWAN 1 1 1 1 1 1 1 1
9 M RIZKY 1 1 1 1 1 1 1 1
10 M FAZA 1 1 1 1 1 1 1 1
11 NANDA LUBAY 1 1 1 1 1 1 1 1
12 NENG IQLIMA 1 1 1 1 1 1 1
13 NUR AISYAH 1 0
14 NABILA 1 1 1 1 1 1 1 1
15 ROBBY RAKA 1 1 1 1 1 1 1 1
16 RATIH DESYANA 1 1 1 1 1 1 1 1
17 RENDI ANDI 1 1 1 1 1 1 1 1
18 REVINA 1 1 1 1 1 1 1 1
19 RIRI NURHASANAH 1 1 1 1 1 1 1 1
20 SETIADJI 1 1 1 1 1 1 1 1
21 SHIFA SEPTIANI 1 1 1 1 1 1 1 1
21 TOTAL 21 12 8 20 18 0 2 0 19 1 14 6 0 20 0 18 0 0 0 0
Mengetahui, Penanggung Jawab P

Kepala UPT Puskesmas Puter
Sylva Lestari, Am
dr. Sylfie Virgianti NIP. 19870910 200
NIP.19640902 198903 2 006
Sylva Lestari, Am
NIP.19640902 198903 2 006

UPT PUSKESMAS PUTER
TAHUN 2012
NAMA SEKOLAH : SDN SENANG GALIH
Serumen Gigi
di sek N G K KS N TN Lubang
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ALYA NUR HASANAH 1 1 1 1 1 1 1
2 AZKA NURFADILAH 1 1 1 1 1 1 1
3 ANDITA DESIANA 1 1 1 1 1 1 1
4 ADRIANO JULIANSYAH 1 1 1 1 1 1 1
5 AISYAH NUR ABIDIN 1 1 1 1 1 1 1 1
6 AKMAL ARYANTO 1 1 1 1 1 1 1 1
7 ALFIRA KHAIRUNNISA 1 1 1 1 1 1
8 ANA EKA LESTARI 1 0 0
9 ASEP SENDI 1 1 1 1 1 1 1 1
10 DELVAN 1 1 1 1 1 1 1
11 DEN YUDI 1 1 1 1 1 1 1
12 DESI NABILAH 1 1 1 1 1 1
13 DZIKRI SYAWALI 1 0 0
14 FATIR MUTAQIR 1 0 0
15 FENINDA NOFIANTI 1 1 1 1 1 1 1 1
16 HANIA NURHASANAH 1 1 1 1 1 1 1
17 HANIFA RIZKY 1 1 1 1 1 1 1
18 M ILHAM NUGRAHA 1 1 1 1 1 1 1 1 1
19 M RIZKY D 1 1 1 1 1 1
20 MERIL ANZANI 1 1 1 1 1 1
21 NAZWA NOVIANTI 1 1 1 1 1 1 1
22 NIKI SAPUTRA 1 1 1 1 1 1
23 NIRA SRI RAHAYU 1 1 1 1 1 1 1
24 PURI YANTI 1 1 1 1 1 1
25 RANGGA DWI SAPUTRA 1 1 1 1 1 1 1 1
26 RADIKA GEMA 1 1 1 1 1 1 1 1
27 RENDY ADITIA 1 1 1 1 1 1 1
28 RESHA NATALI 1 1 1 1 1 1 1
29 RIDWAN SAMBAS 1 1 1 1 1 1 1 1
30 SHAKIRA SALWA 1 1 1 1 1 1 1 1
31 SITI NURAENI 1 1 1 1 1 1 1
32 WULAN ANGGITA 1 0 0
33 ZAHRA AFIFF 1 1 1 1 1 1
34 M TOPIK 1 1 1 1 1 1
34 TOTAL 34 12 18 30 20 4 6 0 30 0 12 18 0 30 0 18 0 2 0 0
Mengetahui, Penanggung Jawab Program

Sylva Lestari, Amd.Keb

dr. Sylfie Virgianti NIP. 19870910 200902 2 00
NIP.19640902 198903 2 006
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 IKBAL HARI 1 1 1 1 1 1
2 AKMAL AMALI 1 1 1 1 1 1 1
3 DETTY RIZQIYA 1 1 1 1 1 1 1
4 GANIA 1 1 1 1 1 1
5 GUNTUR ALAMSYAH 1 1 1 1 1 1 1
6 ILHAM NUROHMAN 1 1 1 1 1 1
7 IMELSA DESTAVIA 1 1 1 1 1 1
8 IRHAM KHALIN 1 1 1 1 1 1
9 IRVAN ABDUL HALIM 1 1 1 1 1 1
10 MAULANA AKBAR 1 1 1 1 1 1
11 M HABIBURROHMAN 1 1 1 1 1 1 1
12 NAISYA SABILA 1 1 1 1 1 1
13 NAUFAL A 1 1 1 1 1 1
14 NAZWA F 1 1 1 1 1 1
15 NENG RAHMI 1 1 1 1 1 1 1
16 NIRRA N 1 1 1 1 1 1 1
17 NUR INDAH 1 1 1 1 1 1 1
18 RAMZI SALIM 1 1 1 1 1 1 1
19 REIHAN FAUZI 1 1 1 1 1 1
20 RESKA AJEUNG 1 1 1 1 1 1 1
21 RIYANTI AYU 1 1 1 1 1 1 1
22 RIZKI MAULANA 1 1 1 1 1 1 1
23 SALMA AQUILA 1 1 1 1 1 1 1
24 SANDI ADITYA 1 1 1 1 1 1 1
25 SARAH DIANDRA 1 1 1 1 1 1 1
26 SUCI ILMI RAHMA 1 1 1 1 1 1 1
27 SYAHARA P 1 1 1 1 1 1 1
28 SILPIA N 1 1 1 1 1 1 1
29 TIARA S 1 1 1 1 1 1 1
30 TESSA DWI 1 1 1 1 1 1 1
31 TRISTAN NALENDRA 1 1 1 1 1 1 1
32 VARISA NISRINA 1 1 1 1 1 1 1
33 WAHYU NUGRAHA 1 1 1 1 1 1 1
34 WESA ANGGARA 1 1 1 1 1 1 1
35 JAKA 1 0
35 TOTAL 35 16 18 34 0 0 0 0 33 1 30 4 0 34 0 26 0 1 0 0
Mengetahui, Penanggung Jawab P

Sylva Lestari, Am
NIP.19640902 198903 2 006
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ADINDA MAULIDINA 1 0 0
2 AGI 1 1 1 1 1 1 1
3 AL ACKZSYA 1 1 1 1 1 1 1 1
4 ALINDA NUR 1 1 1 1 1 1 1
5 ANDIAN RAHMADI 1 1 1 1 1 1 1
6 ANDIKA RAMDANI 1 1 1 1 1 1 1 1
7 CINDUS AGUSTINA 1 1 1 1 1 1 1
8 CITRA NOVAYANTI 1 1 1 1 1 1 1 1
9 DHE MELANI PUTRI 1 0 0
10 DZUBYAN FALLAH 1 1 1 1 1 1 1 1
11 EKANANDA 1 1 1 1 1 1 1
12 EPRIL LIYANTI 1 1 1 1 1 1 1 1
13 FABIAN AZKA RISMAWA 1 1 1 1 1 1 1
14 GESYA CANTIKA PRATIW 1 1 1 1 1 1 1
15 JULKIFLI AKBAR 1 1 1 1 1 1 1
16 KELVIN ANDIKA 1 1 1 1 1 1 1
17 LULU NUR AGNIA 1 1 1 1 1 1 1 1
18 M IDFI RENAR 1 1 1 1 1 1 1 1
19 RAHMAWATI 1 1 1 1 1 1 1 1
20 RAISSA ANINDYA 1 1 1 1 1 1 1
21 RAMADHANI YULIA PUTR 1 1 1 1 1 1 1
22 RAMADITA PRASETIO 1 1 1 1 1 1 1
23 RIAN RAMADHAN 1 1 1 1 1 1 1
24 RICKY BACHTIAR 1 1 1 1 1 1 1 1
25 RIFQI RAMADHAN 1 1 1 1 1 1 1 1
26 RIO DWI IRAWAN 1 1 1 1 1 1 1
27 SALWA AULIA 1 1 1 1 1 1 1
28 SANDI 1 1 1 1 1 1 1 1
29 SHOPIA YULI 1 1 1 1 1 1
30 SRI NURYANI 1 1 1 1 1 1 1
31 SUCI AMELIA 1 1 1 1 1 1 1
32 SULTAN HAKIM 1 1 1 1 1 1 1
33 TRISYA 1 0 0
34 WINDI ALYA AURELIA 1 1 1 1 1 1
35 WULANDARI 1 1 1 1 1 1 1 1
36 YUDHI LEMANA PUTRA 1 1 1 1 1 1 1
37 ZAKI ZULKIFLI 1 1 1 1 1 1 1 1
37 TOTAL 37 17 17 34 32 1 1 0 34 0 16 18 0 34 0 29 0 0 0 0
Mengetahui,
Kepala UPT Puskesmas Puter Penanggung Jawab Program
dr. Sylfie Virgianti Sylva Lestari, Amd.Keb

NIP.19640902 198903 2 006 NIP. 19870910 200902 2 00
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 WINDA NUR FAUZIAH 1 1 1 1 1 1 1
2 ADAM INDIRA 1 1 1 1 1 1 1
3 AI BANY HASBALLAH 1 1 1 1 1 1
4 ALIFA ZAINATA NURUL 1 1 1 1 1 1 1
5 ALYSHA INSAN 1 1 1 1 1 1 1
6 AUDITA OKTAVIANI 1 1 1 1 1 1 1
7 CINTA ABDITIAS 1 1 1 1 1 1 1
8 DAFFA RAI PUTRA 1 1 1 1 1 1
9 DAVA MAFTAN PUTRA 1 1 1 1 1 1 1
10 DAVI MAULANA 1 1 1 1 1 1 1
11 DINI YULIA ASTUTI 1 1 1 1 1 1 1
12 DRI SYUJA NYLENDRA 1 1 1 1 1 1 1
13 ENZIE RAMADHANTI 1 1 1 1 1 1 1
14 LAURA RAMDA OCTAVIA 1 1 1 1 1 1 1
15 MIKA RAIFATA 1 1 1 1 1 1 1
16 M ARVIN 1 1 1 1 1 1 1
17 M ANAUFAL 1 1 1 1 1 1 1
18 M RAFLY 1 1 1 1 1 1 1
19 NESYA RETNO DEWI 1 0 1
20 NOFAL M DHARMA 1 1 1 1 1 1 1
21 NUR AZIZAH 1 1 1 1 1 1 1
22 PRATAMA APRILYATNA 1 0 1
23 R RIZAL ADHITA 1 1 1 1 1 1
24 RAHMA NUR SANDI 1 1 1 1 1 1
25 RAKA RAMADHAN 1 1 1 1 1 1 1
26 RANGGA RIZKI 1 1 1 1 1 1
27 RANGGA YUDA 1 0 1
28 SAFITRI JULIA 1 1 1 1 1 1
29 SALSABILA NUR 1 1 1 1 1 1
30 SHAFIYYAH 1 1 1 1 1 1 1
31 SITI NUR ANISA 1 1 1 1 1 1 1
32 TANTRIANA 1 1 1 1 1 1 1
33 WAFA SYAHIDAH 1 1 1 1 1 1
34 WAHYU MULYONO 1 1 1 1 1 1 1
35 WILDAN AHMAD 1 1 1 1 1 1
36 ZAHWA SALASADILA 1 1 1 1 1 1 1
37 AFINA ANGGITA 1 1 1 1 1 1
38 FATHIYA FATIHATUL 1 1 1 1 1 1 1
38 TOTAL 38 16 19 35 0 0 0 0 35 0 11 24 0 38 0 25 0 0 0 0
Mengetahui,
Kepala UPT Puskesmas Puter Penanggung Jawab P
dr. Sylfie Virgianti Sylva Lestari, Am

NIP.19640902 198903 2 006 NIP. 19870910 200
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ABDUL RAHIM 1 1 1 1 1 1 1 1
2 ADINDA SEPTILA PUTRI 1 1 1 1 1 1 1
3 AGFAN DESDIRAH 1 1 1 1 1 1 1 1
4 AGUSTINA DWI N 1 0 0
5 ALDIN PUTRA ANANDA 1 1 1 1 1 1 1 1
6 ANISHA YUNIA PRADINI 1 1 1 1 1 1 1
7 ANGGY REINA LINTANG 1 1 1 1 1 1 1 1
8 AULIA PUTRI SYAH 1 1 1 1 1 1 1 1
9 CARLI ANGGARA 1 1 1 1 1 1 1 1
10 EGI PERMANA 1 1 1 1 1 1 1 1
11 HELMI FEBRIAN 1 1 1 1 1 1 1 1
12 M ADAM R 1 1 1 1 1 1 1 1
13 M AZMI JANZABILLA 1 1 1 1 1 1 1 1
14 M FIRMANSYAH 1 1 1 1 1 1 1 1
15 M RIZKY REINALDY 1 1 1 1 1 1 1
16 M SYAHRIZAL 1 1 1 1 1 1 1 1
17 NABILA DESWANI 1 1 1 1 1 1 1 1
18 NADIATUL AMANAH 1 1 1 1 1 1 1 1
19 NAUFAL HAFIDH 1 1 1 1 1 1 1 1
20 NURUL FADILAH 1 1 1 1 1 1 1 1
21 PUTRI MULYANI 1 1 1 1 1 1 1 1
22 RAI HANA ARDANIANTI 1 1 1 1 1 1 1 1
23 RICKY RAMADHAN 1 1 1 1 1 1 1 1
24 RYAN AZRIL 1 1 1 1 1 1 1
25 RIVA NUR FATHIYA 1 0 0
26 RYAN RUDANA SYAPUT 1 1 1 1 1 1 1 1
27 SATRIO GANTINA 1 1 1 1 1 1 1 1
28 SEPTIANA TRI N 1 0 0
29 SUCHI OCTAVIANI 1 1 1 1 1 1 1 1
30 TRISYA AMALIA 1 1 1 1 1 1 1
31 VANDI 1 0 0
32 WAHYU RAMADANI 1 1 1 1 1 1 1 1
33 WISNU WIRANDA 1 1 1 1 1 1 1 1
34 KHAYLANY NIZARD R 1 1 1 1 1 1 1 1
35 ADINDA SAHFIRA AZAH 1 1 1 1 1 1 1
36 AQILA HAYA FAUZIAH 1 1 1 1 1 1 1 1
36 TOTAL 36 19 13 32 30 1 1 0 32 0 29 3 0 32 0 29 0 0 0 0
Penanggung Jawab Program
Mengetahui,
NIP. 19870910 200902 2 00
dr. Sylfie Virgianti

NIP.19640902 198903 2 006
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ADE FIKRIANSYAH 1 1 1 1 1 1 1 1
2 AGUNG FIRMANSYAH 1 1 1 1 1 1 1 1
3 ALDI ALDIANSYAH 1 1 1 1 1 1 1
4 ALIKA PROBANDARI 1 1 1 1 1 1 1 1
5 ANBIYA DWIPA 1 1 1 1 1 1 1 1
6 AWLIYA DWIPA 1 1 1 1 1 1 1 1
7 AYUNDITA TRIBUANA 1 1 1 1 1 1 1 1
8 CALYA NABILA 1 1 1 1 1 1 1 1
9 DHEMA WINARKO 1 1 1 1 1 1 1 1
10 FACHRI ADITYA 1 1 1 1 1 1 1 1
11 GALIH M 1 1 1 1 1 1 1 1
12 HAFID SENTANA 1 0 0 0
13 ILHAM SEPTIANA 1 0 0 0
14 JESIKA RATU 1 1 1 1 1 1 1 1
15 KHUMAIRA 1 1 1 1 1 1 1 1
16 M ARIEF 1 1 1 1 1 1 1
17 MIFTAH M 1 0 0 0
18 M FACHRUL 1 1 1 1 1 1 1 1
19 M RAFLI 1 1 1 1 1 1 1 1
20 M ZAIDAN 1 1 1 1 1 1 1 1
21 M IKHSAN 1 1 1 1 1 1 1 1
22 RAISYA 1 1 1 1 1 1 1 1
23 RIJAL GUSMIRAN 1 1 1 1 1 1 1 1
24 RIZA GILANG 1 1 1 1 1 1 1 1
25 RIZKY HEPTA 1 1 1 1 1 1 1 1
26 SITI ANNISA 1 1 1 1 1 1 1 1
27 SUCI AGIANTI 1 0 0 0
28 SUCI FRANSISKA 1 1 1 1 1 1 1 1
29 VIRNA RIZKA 1 1 1 1 1 1 1 1
30 ZAHRA N 1 1 1 1 1 1 1 1
31 ZASKIA 1 0 0
32 FITRIA N 1 1 1 1 1 1 1 1
32 TOTAL 32 16 11 27 23 3 1 0 27 0 18 9 0 27 0 25 0 0 0 0
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 AIKA JINAN RS 1 1 1 1 1 1
2 ALIDA MIRANTIKA P 1 1 1 1 1 1 1 1
3 ALIFAH 1 1 1 1 1 1 1
4 ALIYA 1 1 1 1 1 1 1 1
5 AMELIA OKTAVIANI 1 1 1 1 1 1 1 1
6 ANISA MUTHOHAROH 1 1 1 1 1 1 1
7 ARIF RAHMAN 1 1 1 1 1 1 1
8 ASTRELLA 1 1 1 1 1 1 1 1
9 CANDRA JUNIA 1 1 1 1 1 1 1 1
10 CANDRA SAGI 1 1 1 1 1 1 1 1
11 DAVI ALBUCHORI 1 1 1 1 1 1 1 1
12 FARINKA R 1 1 1 1 1 1 1
13 GITA PURNA 1 1 1 1 1 1
14 KARMELIA 1 1 1 1 1 1
15 KHAIRIL A 1 1 1 1 1 1 1 1
16 LUTFIA 1 1 1 1 1 1
17 MARCELINA 1 1 1 1 1 1 1
18 M DAFFA 1 1 1 1 1 1 1 1
19 M YUAN 1 1 1 1 1 1 1 1
20 NABILA AMELIA SOLIHA 1 1 1 1 1 1 1 1
21 NABILA ANISA 1 1 1 1 1 1 1 1
22 NABILA PUTRI 1 1 1 1 1 1 1 1
23 NAUFAL H N 1 1 1 1 1 1 1
24 NOVA YULIANTI 1 1 1 1 1
25 NUR ANISA 1 1 1 1 1 1 1 1
26 NUR SYIFA 1 1 1 1 1 1 1
27 RAFAEL ABIDAL 1 1 1 1 1 1 1
28 RAMA 1 1 1 1 1 1 1
29 RAMADHAN 1 1 1 1 1 1 1
30 RANGGA A 1 0 0
31 RISQI C A 1 1 1 1 1 1 1
32 SAEFUL R 1 1 1 1 1 1 1 1
33 SASKIA A 1 1 1 1 1 1 1 1
34 TEGAR H 1 1 1 1 1 1 1 1
35 TEGAR M SAPTA 1 1 1 1 1 1 1 1
36 BAGAS KARA 1 1 1 1 1 1 1
36 TOTAL 36 16 19 35 24 3 6 0 34 1 19 16 0 35 0 30 0 0 0 0


NIP.19640902 198903 2 006
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 IHSAN AINUR BADJA 1 1 1 1 1 1 1 1 0
2 ADAM SALMANDJAYA 1 1 1 1 1 1 1 0
3 AHMAD SYARIFUDIN 1 1 1 1 1 1 1 1 0
4 ARIA FERDIANSYAH 1 1 1 1 1 1 1 1 1
5 AULIA ANGGUN 1 1 1 1 1 1 1 1 1
6 AZKA PUTRA M 1 1 1 1 1 1 1 1 1
7 BAYU PUTRA P 1 1 1 1 1 1 1 1 1
8 CHESA PATAKA 1 1 1 1 1 1 1 1 0
9 DELYANI PUTRI 1 1 1 1 1 1 1 1 1
10 ELSA FATIMAH 1 1 1 1 1 1 1 1 0
11 FIKRI ALI RAMADHAN 1 1 1 1 1 1 1 1 1
12 HASBILLAH HAMMAM 1 1 1 1 1 1 1 1 1
13 IMAM SANTOSO 1 1 1 1 1 1 1 1 1
14 KHAILAH RAHIMAH 1 1 1 1 1 1 1 1 1
15 KHALISA TRUSTYALIZA 1 1 1 1 1 1 1 1 0
16 MAITARA LUQMAN 1 1 1 1 1 1 1 1 1
17 MEIRA HERDIANI 1 1 1 1 1 1 1 1 1
18 MEISYA DWISY N 1 1 1 1 1 1 1 1 0
19 M GILANG PUTRA P 1 1 1 1 1 1 1 1 0
20 M RAZZAN DHIAYUL 1 1 1 1 1 1 1 1 0
21 M RIZQI SABIL 1 1 1 1 1 1 1 1 0
22 NABILA EKA 1 1 1 1 1 1 1 1 1
23 NADZALLA DIVA 1 1 1 1 1 1 1 0
24 NAZRIEL NURPRATAMA 1 1 1 1 1 1 1 1 0
25 RAFI PUTRA 1 1 1 1 1 1 1 1 0
26 REVINA ALINY 1 1 1 1 1 1 1 1 0
27 RIFAISAL VINO A 1 1 1 1 1 1 1 1 0
28 ROHADI 1 1 1 1 1 1 1 1 1
29 RYANE TRI M 1 1 1 1 1 1 1 1 1
30 SALVA ALIYA JATI 1 1 1 1 1 1 1 1 0
31 SELVI AULIA 1 1 1 1 1 1 1 1 1
32 SHAFIRA NURHALIZA 1 1 1 1 1 1 1 0
33 TERA FAUZI 1 1 1 1 1 1 1 1 0
34 WATIK AYUNINGTYAS 1 1 1 1 1 1 1 1 1
35 M RADIYA F 1 1 1 1 1 1 1 1 0
36 ZALFA RIFQI 1 1 1 1 1 1 1 1
37 ZAIDAIN RAFIF 1 1 1 1 1 1 1 1
38 DANI W SAPUTRA 1 1 1 1 1 1 1 1 1
38 38 22 16 38 17 2 14 5 38 0 21 17 0 38 0 33 0 0 0 25


NIP.19640902 198903 2 006
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 RADEN SURYO 1 1 1 1 1 1 1 0
2 ADE HALIMATU SADIAH 1 1 1 1 1 1 1 1 0
3 AHMAD FADIL R 1 1 1 1 1 1 1 0
4 ALVIO FITRAH 1 1 1 1 1 1 1 1 0
5 ARI ARIYANTO 1 1 1 1 1 1 1 1 1
6 ANANDA F P 1 1 1 1 1 1 1 0
7 ARDIANSYAH PRAWIRA 1 1 1 1 1 1 1 1 0
8 ARIN OKTAVIA 1 1 1 1 1 1 1 0
9 DIANA FEBRIANTI 1 1 1 1 1 1 1 1 1
10 DIMAS ROSYADI P 1 1 1 1 1 1 1 1 1
11 DIVA APRILIA 1 1 1 1 1 1 1 1 0
12 EKA ERLIKA A 1 1 1 1 1 1 1 1 0
13 FADILA PERMATA 1 1 1 1 1 1 1 1 0
14 SILABAN AGNES E 1 1 1 1 1 1 1 0
15 DINE DWI MULYA 1 1 1 1 1 1 1 1 1
16 M FADHLAN APRIANTO 1 1 1 1 1 1 1 1 0
17 GINA DWI W 1 1 1 1 1 1 1 1 0
18 ILHAM NURFAUZAN 1 1 1 1 1 1 1 1
19 LIVIA APRILIANI 1 1 1 1 1 1 1 1 0
20 MICHELLE LAVIERA 1 1 1 1 1 1 1 1 0
21 M RADITYA R 1 1 1 1 1 1 1 0
22 M RIZQIKAN 1 1 1 1 1 1 1 1
23 NAZWA PUTRI 1 1 1 1 1 1 1 1 0
24 RAIHAN ZAKI 1 1 1 1 1 1 1 1 0
25 RAMONA PUTRI 1 1 1 1 1 1 1 1 0
26 SIRVANG ALESANI A 1 1 1 1 1 1 1 1 0
27 TRIA MUKTI R 1 1 1 1 1 1 1 1 0
28 TSARA SYUSAYA F 1 1 1 1 1 1 1 1 1
29 UMI KULSUM 1 1 1 1 1 1 1 1 1
30 VITO NADIEF R 1 1 1 1 1 1 1 1 0
31 ARDHIKA WATI S 1 1 1 1 1 1 1 1 0
32 AWFA INDAH 1 1 1 1 1 1 1 1 0
33 BAGAS SUSANTO 1 1 1 1 1 1 1 1 1
34 SHAHAYA AURA 1 1 1 1 1 1 1 0
34 TOTAL 40 15 19 34 23 2 8 1 34 0 15 19 0 34 0 25 0 0 0 17
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 NALWA 1 1 1 1 1 1 1 0
2 SHAFA 1 1 1 1 1 1 1 1 0
3 AKHMAD K F 1 1 1 1 1 1 1 0
4 ALIFIA SAFITRI 1 1 1 1 1 1 1 1 0
5 ALIFIO RIANSYA 1 1 1 1 1 1 1 1 1
6 AMALIA SITI N H 1 1 1 1 1 1 1 0
7 ANGGUN YUNDA E 1 1 1 1 1 1 1 1 0
8 ANNISA NURIZKI 1 1 1 1 1 1 1 0
9 BAGUS PRASONGKO 1 1 1 1 1 1 1 1 1
10 DANISH YASLAM 1 1 1 1 1 1 1 1 1
11 DEANLOVA F A 1 1 1 1 1 1 1 1 0
12 DEVINA K A 1 1 1 1 1 1 1 1 0
13 DHIANINGTYAS T Z 1 1 1 1 1 1 1 1 0
14 DZAKIR MARZUQ 1 1 1 1 1 1 1 0
15 EVANYA I N 1 1 1 1 1 1 1 1 1
16 GHAFIQI K A 1 1 1 1 1 1 1 1 0
17 HILMI FABIAN P 1 1 1 1 1 1 1 1 0
18 IQBAL M F 1 1 1 1 1 1 1 1
19 MALIKA C S 1 1 1 1 1 1 1 1 0
20 M FAHRIEL O 1 1 1 1 1 1 1 1 0
21 M FATUROHMAN 1 1 1 1 1 1 1 0
22 M JAKA S 1 1 1 1 1 1 1 1
23 M ZIDAN A 1 1 1 1 1 1 1 1 0
24 M SAYYID 1 1 1 1 1 1 1 1 0
25 MUTRIA F S 1 1 1 1 1 1 1 1 0
26 NAZWA NADIA A 1 1 1 1 1 1 1 1 0
27 NURUL KAMILA 1 1 1 1 1 1 1 1 0
28 PRISLY SHAFA 1 1 1 1 1 1 1 1 1
29 RADEN NAJWA N R 1 1 1 1 1 1 1 1 1
30 RAKA F W 1 1 1 1 1 1 1 1 0
31 SALSABILA D P 1 1 1 1 1 1 1 1 0
32 SARAH Z A 1 1 1 1 1 1 1 1 0
33 SYAMSYAM 1 1 1 1 1 1 1 1 1
34 WAFA A S 1 1 1 1 1 1 1 1
35 ZIDAN MULYADI 1 1 1 1 1 1 1 1 0
36 AURELIA S M 1 1 1 1 1 1 1 1 0
37 ARISTIA D A 1 1 1 1 1 1 1 1 0
38 GHINA N N 1 1 1 1 1 1 1 1 1
39 DELVIN A R 1 1 1 1 1 1 1 0
40 DWIKA H P 1 1 1 0
39 TOTAL 40 15 14 29 20 1 7 1 29 0 14 15 0 29 0 21 0 0 0 15
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ADHAN JANVAZA N 1 1 1 1 1 1 1 0
2 AGHNI ZAHIDA R 1 1 1 1 1 1 1 1 0
3 ALIYA NUR FATIHA 1 1 1 1 1 1 1 0
4 AURA AULIA MEDINA 1 1 1 1 1 1 1 1 0
5 AZRIEL PUTRA RULIANT 1 1 1 1 1 1 1 1 1
6 DEVAN WAHYU W 1 1 1 1 1 1 1 0
7 FAHMI FADLU R 1 1 1 1 1 1 1 1 0
8 FIRMAN ADTYA R 1 1 1 1 1 1 1 0
9 GADIS SHAYLIKA P 1 1 1 1 1 1 1 1 1
10 GISELLA ELVIA 1 1 1 1 1 1 1 1 1
11 JASMINE NAORA Z 1 1 1 1 1 1 1 1 0
12 JEANE WIDYANTARI A 1 1 1 1 1 1 1 1 0
13 LISTIA ANGGRAENI 1 1 1 1 1 1 1 1 0
14 M ALFI N 1 1 1 1 1 1 1 0
15 M RAESYA 1 1 1 1 1 1 1 1 1
16 M RIZKI 1 1 1 1 1 1 1 1 0
17 M ALFA 1 1 1 1 1 1 1 1 0
18 M GAZA R 1 1 1 1 1 1 1 1
19 M AKMAL 1 1 1 1 1 1 1 1 0
20 M DZAKI 1 1 1 1 1 1 1 1 0
21 NABEEL MUHAMAD 1 1 1 1 1 1 1 0
22 NADHIF TSAQIF P 1 1 1 1 1 1 1 1
23 NADIRA ZALFA F 1 1 1 1 1 1 1 1 0
24 NAUFALLINA DZULFILA 1 1 1 1 1 1 1 1 0
25 PRADHIKA ILHAM D 1 1 1 1 1 1 1 1 0
26 RAFFI MUHAIRAMA 1 1 1 1 1 1 1 1 0
27 RADEN BALUH A 1 1 1 1 1 1 1 1 0
28 RIZKI FATAH A 1 1 1 1 1 1 1 1 1
29 SALSA BILLA I 1 1 1 1 1 1 1 1 1
30 SHABRINA NAJLA A 1 1 1 1 1 1 1 1 0
31 SHALMA NURFITRIA 1 1 1 1 1 1 1 1 0
32 SHAVITA ZAHRA 1 1 1 1 1 1 1 1 0
33 SHOFIYYAH N 1 1 1 1 1 1 1 1 1
34 TAMAYA WIANDRA 1 1 1 1 1 1 1 1
35 TISYA AJRILLIA P 1 1 1 1 1 1 1 1 0
36 VAGIA NURFEBRIAN 1 1 1 1 1 1 1 1 0
37 BILAAL DAFFAH I 1 1 1 1 1 1 1 1 0
38 SYAHFATIH A S 1 1 1 1 1 1 1 1 1
39 M NABI AMJAD 1 1 1 1 1 1 1 0
40 CECEP JAELANI 1 1 1 0
40 TOTAL 40 14 12 26 19 1 5 1 26 0 13 13 0 26 0 18 0 0 0 6
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200
UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 1 1 1 1 1 1 1 0
2 1 1 1 1 1 1 1 1 0
3 1 1 1 1 1 1 1 0
4 1 1 1 1 1 1 1 1 0
5 1 1 1 1 1 1 1 1 1
6 1 1 1 1 1 1 1 0
7 1 1 1 1 1 1 1 1 0
8 1 1 1 1 1 1 1 0
9 1 1 1 1 1 1 1 1 1
10 1 1 1 1 1 1 1 1 1
11 1 1 1 1 1 1 1 1 0
12 1 1 1 1 1 1 1 1 0
13 1 1 1 1 1 1 1 1 0
14 1 1 1 1 1 1 1 0
15 1 1 1 1 1 1 1 1 1
16 1 1 1 1 1 1 1 1 0
17 1 1 1 1 1 1 1 1 0
18 1 1 1 1 1 1 1 1
19 1 1 1 1 1 1 1 1 0
20 1 1 1 1 1 1 1 1 0
21 1 1 1 1 1 1 1 0
22 1 1 1 1 1 1 1 1
23 1 1 1 1 1 1 1 1 0
24 1 1 1 1 1 1 1 1 0
25 1 1 1 1 1 1 1 1 0
26 1 1 1 1 1 1 1 1 0
27 1 1 1 1 1 1 1 1 0
28 1 1 1 1 1 1 1 1 1
29 1 1 1 1 1 1 1 1 1
30 1 1 1 1 1 1 1 1 0
31 1 1 1 1 1 1 1 1 0
32 1 1 1 1 1 1 1 1 0
33 1 1 1 1 1 1 1 1 1
34 1 1 1 1 1 1 1 1
35 1 1 1 1 1 1 1 1 0
36 1 1 1 1 1 1 1 1 0
37 1 1 1 1 1 1 1 1 0
38 1 1 1 1 1 1 1 1 1
39 1 1 1 1 1 1 1 0
40 1 1 1 0
40 TOTAL 40 16 16 32 23 1 7 1 32 0 17 15 0 32 0 24 0 0 0 16
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200
Sylva Lestari, Am
NIP. 19870910 200

UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 NABIH BURHARUDIN 1 1 1 1 1 1 1 0
2 AJI AKBAR 1 1 1 1 1 1 1 0
3 ARIFIN TRI PUTRA 1 1 1 1 1 1 1 0
4 DANNY SAEFUL 1 1 1 1 1 1 1 0
5 DWIKA AGUDIAS 1 1 1 1 1 1 1 1 0
6 FAUZIAH DARMA 1 1 1 1 1 1 1 0
7 M RAFA 1 1 1 1 1 1 1 0
8 IDHAR KHALID 1 1 1 1 1 1 1 0
9 M ABDUROHMAN R 1 1 1 1 1 1 1 1 1
10 MULFI SAPUTRA 1 1 1 1 1 1 1 1 0
11 ROVAN CANDRA 1 1 1 1 1 1 1 0
12 RINALDI PUTRA 1 1 1 1 1 1 1 0
13 M REYHAN PRATAMA 1 1 1 1 1 1 1 1
14 M IHSAN 1 1 1 1 1 1 1 0
15 M IQBAL 1 1 1 1 1 1 1 1 0
16 IKRIMAH SYIFA 1 1 1 1 1 1 1 0
17 LIESTY 1 1 1 1 1 1 1 1 0
18 NAYLA NESFA 1 1 1 1 1 1 1 0
19 NAZWA GINA 1 1 1 1 1 1 1 0
20 NIRMALA RIPHLUA 1 1 1 1 1 1 1 0
21 NOVA NURAZIZAH 1 1 1 1 1 1 1 0
22 SALSABILAH 1 1 1 1 1 1 1 1
23 SEPTAH DADVARA 1 1 1 1 1 1 1 0
24 SOFHIA HANA 1 1 1 1 1 1 1 0
25 AINA NUR 1 1 1 1 1 1 1 0
26 ANA YULIANA 1 1 1 1 1 1 1 1 0
27 ANSA NURHAYATI 1 1 1 1 1 1 1 1
28 ANISA AYU 1 1 1 1 1 1 1 1 0
29 HAFIZAH MAZAYA 1 1 1 1 1 1 1 0
30 DEVA PRAMITA 1 1 1 1 1 1 1 1
31 DIVA AULIA 1 1 1 1 1 1 1 0
32 ANAS 1 1 1 1 1 1 1 0
32 TOTAL 32 15 17 32 25 2 5 0 32 0 11 21 0 32 0 7 0 0 0 13
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200
Sylva Lestari, Am
NIP. 19870910 200

UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 VIRLI NASYILA P 1 1 1 1 1 1 1 0
2 AJI MULYANA 1 1 1 1 1 1 1 1
3 BAGAS FEBRIAN 1 1 1 1 1 1 1 1
4 CITRA SHELLA 1 1 1 1 1 1 1 0
5 DELLA S 1 1 1 1 1 1 1 1 0
6 DIAN JULIANA 1 1 1 1 1 1 1 0
7 DILLA SR 1 1 1 1 1 1 1 0
8 DINAR N 1 1 1 1 1 1 1 0
9 FAJAR AGUNG 1 1 1 1 1 1 1 1 0
10 FHIKA YULIANTI 1 1 1 1 1 1 1 1 1
11 FEIKA N 1 1 1 1 1 1 1 0
12 IBNU AHMAD 1 1 1 1 1 1 1 0
13 IMAM ADUL 1 1 1 1 1 1 1 0
14 IMAMAH 1 1 1 1 1 1 1 0
15 M FAUZI N 1 0 0 0 0 0 0
16 MARWAH H 1 1 1 1 1 1 1 1
17 MARSHA NISWAH 1 1 1 1 1 1 1 1 0
18 MIKHA AULIA 1 1 1 1 1 1 1 0
19 M FAUZAN ALAMSYA 1 1 1 1 1 1 1 1
20 M NAJIB 1 1 1 1 1 1 1 0
21 M RIZKI AKBAR 1 1 1 1 1 1 1 0
22 NANDA WULAN 1 1 1 1 1 1 1 0
23 NAURA ABIDA 1 1 1 1 1 1 1 0
24 NURUL DIENIAH 1 1 1 1 1 1 1 0
25 AOLGA AULIA 1 1 1 1 1 1 1 1
26 PAJAR RAEHAN 1 0 0 0 0 0 0
27 PUTRI AL VARISA 1 1 1 1 1 1 1 0
28 RIDWAN KURNIAWAN 1 1 1 1 1 1 1 1 0
29 SAZKIA PUTRI F 1 1 1 1 1 1 1 0
30 SITI RIFA 1 1 1 1 1 1 1 1 0
31 TRIANY DWI NOV 1 1 1 1 1 1 1 0
31 TOTAL 31 9 20 29 21 2 6 0 29 0 10 19 0 29 0 6 0 0 0 13
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200
Sylva Lestari, Am
NIP. 19870910 200

UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 ABIZAR IBNU 1 1 1 1 1 1 1 1 0
2 ANJAR YULISTIANDI 1 0 0
3 ANISA NUR A 1 1 1 1 1 1 1 1 0
4 AZZRIFA URUL 1 1 1 1 1 1 1 1 0
5 CAKRA SUPRIATNA 1 1 1 1 1 1 1 1 0
6 DIMAS PUTRA 1 1 0
7 FATTIR PUTRA 1 1 0 1 1 1 1 1 0
8 GADIS AMELIA 1 1 1 1 1 1 1 1 0
9 KHABIR ABADI 1 1 1 1 1 1 1 1 0
10 IBNU HASAN M 1 1 1 1 1 1 1 1 0
11 IRFAN MAULANA 1 1 1 1 1 1 1 1 0
12 IRHAM AZKA 1 1 1 1 1 1 1 1 0
13 LESTARI JANUARI 1 1 1 1 1 1 1 1 0
14 MELANDRI 1 1 1 1 1 1 1 1 0
15 M RIFKI 1 1 1 1 1 1 1 1 1
16 M IQBAL 1 1 1 1 1 1 1 1 0
17 M RAFI 1 1 1 1 1 1 1 1 0
18 M RAFLI 1 1 1 1 1 1 1 1 1
19 M TRI AJI 1 1 1 1 1 1 1 1 0
20 RAJAK BRAJA 1 0
21 RATNA RAHMADANI 1 1 1 1 1 1 1 1 0
22 RIFKI SEPTIAN 1 1 1 1 1 1 1 1 0
23 SAEFUL FAJAR 1 1 1 1 1 1 1 1 0
24 SCHASA NUR R 1 1 1 1 1 1 1 1 0
25 SITI FADILLAH 1 1 1 1 1 1 1 1 0
26 STEPANYA 1 1 1 1 1 1 1 1 0
27 VERA NOVITA 1 1 1 1 1 1 1 1 0
28 VIVI AVITA 1 1 1 1 1 1 1 1 0
29 WAFI NUR AZIZAH 1 1 1 1 1 1 1 1 0
30 ABDUL RANDI 1 1 1 1 1 1 1 1 0
31 BAYU NUGRAHA 1 1 1 1 1 1 1 1 0
32 EDWAR ANDRIYANA 1 1 1 1 1 1 1 1 0
32 TOTAL 32 17 12 29 26 1 2 0 29 0 24 5 0 29 0 29 0 0 0 11
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200

UPT PUSKESMAS PUTER
TAHUN 2012
Serumen Gigi
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 RIAN SAPUTRA 1 1 1 1 1 1 1 1 0
2 ACHMAD GALIH 1 1 1 1 1 1 1 1
3 ASRIL PERDIANSYAH 1 1 1 1 1 1 1 1 1
4 ASSIDKY ARIPIN 1 1 1 1 1 1 1 1 0
5 BAYU RAMADHAN 1 1 1 1 1 1 1 1 0
6 EKA SEPTIANA 1 1 1 1 1 1 1 0
7 EKA TITAN 1 1 1 1 1 1 1 1 0
8 FIRMANSYAH 1 1 1 1 1 1 1 1 0
9 HERNI NUSNAYAN 1 1 1 1 1 1 1 1 0
10 ISABELLA P 1 1 1 1 1 1 1 1 0
11 JUAN AL QIVARI 1 1 1 1 1 1 1 1 1
12 M FIKRI 1 1 1 1 1 1 1 1 0
13 M RIFA PRATAMA 1 1 1 1 1 1 1 0
14 NABIL ABDULLAH 1 1 1 1 1 1 1 1 0
15 NURLESTARI 1 1 1 1 1 1 1 1 0
16 NURUL SETIANINGSIH 1 1 1 1 1 1 1 1 0
17 RADITYA A 1 1 1 1 1 1 1 1 0
18 RAMDAN PERMANA 1 1 1 1 1 1 1 1 0
19 RIKA RISMAYANTI 1 0 0 0
20 RIMA RAHMAWATI 1 1 1 1 1 1 1 1 0
21 RIRIN AYUDIA 1 1 1 1 1 1 1 1 0
22 RIMA PUTRI PUSPITA 1 1 1 1 1 1 1 1 0
23 RIZKY MULADI 1 1 1 1 1 1 1 1 0
24 ROSA ROSITA 1 1 1 1 1 1 1 1 0
25 SELVI 1 1 1 1 1 1 1 1 0
26 SERINA R 1 1 1 1 1 1 1 1 0
27 SHELLA TRI 1 1 1 1 1 1 1 1 0
28 SYAHWAL M 1 1 1 1 1 1 1 1 0
28 TOTAL 28 14 13 27 21 3 3 0 25 2 24 3 0 27 0 24 0 0 0 10
Mengetahui,
Mengetahui,

NIP.19640902 198903 2 006 NIP. 19870910 200
Lampiran 3

Keca Jasmani
23 24 25
1
1 `
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0 18 0
ggung Jawab Program UKS
ylva Lestari, Amd.Keb

19870910 200902 2 002
ylva Lestari, Amd.Keb
19870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0 19 1
ung Jawab Program UKS
a Lestari, Amd.Keb
870910 200902 2 002
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
0
1
1
1
1
0
0
1
1
1
1 CACAT BAWAAN
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
0 30 0
ab Program UKS
, Amd.Keb
200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0
0 34 0
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
0
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0 30 0
ab Program UKS
, Amd.Keb
200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0 32 0
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
0
1
1
0
1
1
1
1
1
0 32 0
ab Program UKS
, Amd.Keb
200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
1
0
0
1
1
1
0
1
1
1
1
1
1
1
1
1
0
1
1
1
0
1
0 27 0
Lampiran 3

Keca Jasmani
23 24 25
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
0
1
1
1
1
1
1
0 35 0
ab Program UKS
, Amd.Keb
200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0 36 0
ab Program UKS
, Amd.Keb
200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0 34 0
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0
0 29 0
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0
0 26 0
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0 32 0
a Lestari, Amd.Keb
870910 200902 2 002
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
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
0 32 0
a Lestari, Amd.Keb
870910 200902 2 002
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
0 29 0
a Lestari, Amd.Keb
870910 200902 2 002
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
1
0
1
1
0 29 0
a Lestari, Amd.Keb
870910 200902 2 002
Lampiran 3

Keca Jasmani
23 24 25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
1
1
1
1
1
1
1
1
1
0 27 0

a Lestari, Amd.Keb
870910 200902 2 002
UPT PUSKESMAS PUTER
TAHUN 2012
Jumlah SD/ MI di wilayah kerja Puskesmas : 18
Jumlah SD/ MI di wilayah kerja Puskesmas yang melakukan penjaringan : 18
Jml peserta didik Status Gizi Tajam Kum Tjm dengar Gigi Status Mslh Hsl Prks Penunjang
KUM Kum Serumen KUM Gang.
No di Yg dijaring Penglihatan Serum OM Luban Imun kespr Ane-
N G K KS GIZI TP N TN T.D ME
Nama Sekolah Sek L P Jml N TN ya tdk en g TL o mia
1 SDN LANGEN SARI 1 25 12 6 18 15 0 3 0 18 17 1 18 11 7 18 0 18 0 18 18 0 1 0 8
2 SDN LANGEN SARI 5 21 12 8 20 18 0 2 0 20 19 1 20 14 6 20 0 20 0 20 18 0 0 0 8
3 SDN SENANG GALIH 34 12 18 30 20 4 6 0 30 30 0 30 12 18 30 0 30 0 30 18 0 2 0 13
4 SDN NEGLASARI 1 35 16 18 34 34 0 0 0 34 33 1 34 30 4 34 0 34 0 34 26 0 1 0 11
5 SDN NEGLASARI 3 37 17 17 34 32 1 1 0 34 34 0 34 16 18 34 0 34 0 34 29 0 0 0 12
6 SDN TILIL 1 38 16 19 35 28 2 5 0 35 35 0 35 11 24 35 0 35 0 35 25 0 0 0 14
7 SDN TILIL 2 36 19 13 32 30 1 1 0 32 32 0 32 29 3 32 0 32 0 32 29 0 0 0 11
8 SDN TILIL 3 32 16 11 27 23 3 1 0 27 27 0 27 18 9 27 0 27 0 27 25 0 0 0 9
9 SDN TILIL 4 36 16 19 35 26 3 6 0 35 34 1 35 19 16 35 0 35 0 35 30 0 0 0 15
10 #REF! ### ### ### ### ### ### ### ### ### ### ### #REF! ### ### #REF! ### ### ### #REF! #REF! #REF! #REF! #REF! #REF!
14 SDN TIKUKUR 5 40 16 16 32 23 1 7 1 32 32 0 32 17 15 32 0 32 0 32 24 0 0 0 16
15 SDN HAUR PANCUH 1 32 15 17 32 25 2 5 0 32 32 0 32 11 21 32 0 32 0 32 7 0 0 0 13
16 SDN HAUR PANCUH 2 31 9 20 29 21 2 6 0 29 29 0 29 10 19 29 0 29 0 29 6 0 0 0 13
17 SDN HAUR PANCUH 3 32 17 12 29 26 1 2 0 29 29 0 29 24 5 29 0 29 0 29 29 0 0 0 11
18 SDN MARGAHAYU BLOK I 28 14 13 27 21 3 3 0 27 25 2 27 24 3 27 0 27 0 27 24 0 0 0 10
TOTAL ### ### ### ### ### ### ### ### ### ### ### ### ### ### #REF! ### ### ### #REF! #REF! #REF! ### ### #REF!
Lampiran 3
Penunjang Kesegaran
Keca Jasmani KUM
K.J
0 18 0 18
0 19 1 20
0 30 0 30
0 34 0 34
0 34 0 34
0 35 0 35
0 32 0 32
0 27 0 27
0 35 0 35
#REF! #REF! #REF! #REF!
0 32 0 32
0 32 0 32
0 29 0 29
0 29 0 29
0 27 0 27

KABUPATEN / KOTA ……………………………
Jml Puskesmas :
Jml Puskesmas yg melakukan penjaringan kesehatan :
Sekolah (SMP/SMA) Jumlah peserta di dik Status Gi zi

No Nama Puskesmas Jml Yg lakukan di Yang di jaring N G K KS
penjaringan sek L P Jml
1 2 3 4 5 6 7 8 9 10 11 12
1
2
3
4
5
6
7
8
9
dst
TOTAL
Lampiran 4
Tajam Se OM Tjm de ngar Gigi Status Gang Ma- Hsl Prks Penunjang Kesegaran Jasmasni
Penglihatan ru N TN Imuni- guan salah Ane- Keca
N TN men Lubang sasi TL ME Kespro mia cingan Segar Tdk sgr
13 14 15 16 17 18 19 20 21 22 23 24 25 26
PROVINSI: ……………………………………………..
Jumlah Kabupaten/Kota :
Jumlah Kabupaten/Kota yang melakukan penjaringan kesehatan :
Sekolah (SMP/SMA) Jumlah peserta di dik Status Gi zi Tajam Se OM Tjm de ngar Gigi Status
No Kabupaten/Kota Jml Yg lakukan di Yang di jaring N G K KS Penglihatan ru N TN Imuni-
penjaringan sek L P Jml N TN men Lubang sasi TL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1
2
3
4
5
6
7
8
9
dst
TOTAL
Lampiran 4
Gang Ma- Hsl Prks Penunjang Kesegaran Jasmasni

guan salah Ane- Keca
ME Kespro mia cingan Segar Tdk sgr
21 22 23 24 25 26

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REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK

UPT PUSKESMAS PUTER

2 SDN LANGEN SARI 5 21 95.2 12 8 20 18 0 2 0 20 19 1 20 14 6 20 0 20 0 20 18 0 0

3 SDN SENANG GALIH 34 88.2 12 18 30 20 4 6 0 30 30 0 30 12 18 30 0 30 0 30 18 0 2

4 SDN NEGLASARI 1 35 97.1 16 18 34 34 0 0 0 34 33 1 34 30 4 34 0 34 0 34 26 0 1

5 SDN NEGLASARI 3 37 91.9 17 17 34 32 1 1 0 34 34 0 34 16 18 34 0 34 0 34 29 0 0

6 SDN TILIL 1 38 92.1 16 19 35 28 2 5 0 35 35 0 35 11 24 35 0 35 0 35 25 0 0

7 SDN TILIL 2 36 88.9 19 13 32 30 1 1 0 32 32 0 32 29 3 32 0 32 0 32 29 0 0

8 SDN TILIL 3 32 84.4 16 11 27 23 3 1 0 27 27 0 27 18 9 27 0 27 0 27 25 0 0

9 SDN TILIL 4 36 97.2 16 19 35 26 3 6 0 35 34 1 35 19 16 35 0 35 0 35 30 0 0

14 SDN TIKUKUR 5 40 80.0 16 16 32 23 1 7 1 32 32 0 32 17 15 32 0 32 0 32 24 0 0

15 SDN HAUR PANCUH 1 32 100.0 15 17 32 25 2 5 0 32 32 0 32 11 21 32 0 32 0 32 7 0 0

16 SDN HAUR PANCUH 2 31 93.5 9 20 29 21 2 6 0 29 29 0 29 10 19 29 0 29 0 29 6 0 0

17 SDN HAUR PANCUH 3 32 90.6 17 12 29 26 1 2 0 29 29 0 29 24 5 29 0 29 0 29 29 0 0

18 SDN MARGAHAYU BLOK I 28 96.4 14 13 27 21 3 3 0 27 25 2 27 24 3 27 0 27 0 27 24 0 0

1 SDN LANGEN SARI 1 25 15 0 3 0 60.0 0.0 12.0 0.0

Hsl Prks Penunjang

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GRAFIK PENJARINGAN KESEHATAN SISWA SD BERDASARKAN STATUS GIZI

NAMA SEKOLAH : SDN MARGAHAYU BLOK I

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN HAUR PANCUH 3

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN HAUR PANCUH 2

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN HAUR PANCUH 1

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN TIKUKUR 5

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN TILIL 4

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN TILIL 3

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN TILIL 2

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN TILIL 1

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN NEGLASARI 3

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN NEGLASARI 1

NAMA SEKOLAH : SDN SENANG GALIH

NAMA SEKOLAH : SDN LANGEN SARI 5

Hsl Prks Penunjang Kesegaran

NAMA SEKOLAH : SDN LANGEN SARI 1

dr. Sylfie Virgianti Sylva Lestari,

REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK

Mengetahui, Penanggung Jawab P

REKAPITULASI HASIL PENJARINGAN KESEHATAN PESERTA DIDIK

Mengetahui, Penanggung Jawab Program

Sylva Lestari, Amd.Keb

Mengetahui, Penanggung Jawab P

dr. Sylfie Virgianti Sylva Lestari, Amd.Keb

dr. Sylfie Virgianti Sylva Lestari, Am

Penanggung Jawab Program

dr. Sylfie Virgianti

Mengetahui, Penanggung Jawab Program

Sylva Lestari, Amd.Keb

Mengetahui, Penanggung Jawab Program

Sylva Lestari, Amd.Keb