LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR

PUSKESMAS KERANG KABUPATEN PASER

BULAN : JANUARI
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc

Jlh.
RL RL L P L P L P L P RL Pos
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : PEBRUARI
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : MARET
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : APRIL
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : MEI
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : JUNI
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : JULI
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : AGUSTUS
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : SEPTEMBER
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : OKTOBER
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : NOPEMBER
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR
PUSKESMAS KERANG KABUPATEN PASER
BULAN : DESEMBER
TAHUN : 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL Tingkat

Lab
Specimen Pemerksaan
Dehidrasi

Penderita Jlh. Jlh.

Tanpa Dehidrasi
Jumlah 0-<1Th 1-4Th > 5 Th Jumlah diberi Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Pemakaian
NO. Desa Pendu

Penderita

Sedang
Ringan
Oralit

Berat
duk

Zinc
P M P M P M P M RL

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL Pos

Jlh.
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Damai 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Desa Luar Wilayah Kerja
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
- 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2014
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare

Saudana Amd,Kep Thohiroh, Amd. Kep

NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
 REKAPITULASI LAPORAN PENEMUAN PENDERITA DIARE MENURUT GOLONGAN UMUR

PUSKESMAS KERANG KABUPATEN PASER

JANUARI S/D DESEMBER TAHUN 2014

PENDERITA DIARE YANG DITEMUKAN SARKES KADER TOTAL

0-<1Th 1-4Th > 5 Th Jumlah Penderita Jlh. Pemakaian 0-<1Th 1-4Th > 5 Th Jumlah Jlh.
Jumlah diberi Pemakaian

Penderita
NO. Desa Pendu
duk P M P M P M P M

Oralit

Oralit

Oralit
Zinc

Zinc

Zinc
RL RL L P L P L P L P RL
L P L P L P L P L P L P L P L P

1 Kerang 2,202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Kerang Dayo 862 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Tampakan 1,669 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Mengkudu 876 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Lomu 1,608 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Langgai 1,298 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Segendang 436 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Riwang 1,070 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Petangis 1,641 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bai Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Penggiuren Jaya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Teberu Paser Dam 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Saing Perupuk 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Puskesmas 11,662 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kerang, 2015
Mengetahui,
Kepala UPTD Puskesmas Kerang Pengelola Program Diare
 Saudana Amd,Kep Thohiroh, Amd. Kep
NIP. 19670529 198811 1 002 NIP. 19790607 200604 2 026
MUAN PENDERITA DIARE MENURUT GOLONGAN UMUR

MAS KERANG KABUPATEN PASER

RI S/D DESEMBER TAHUN 2014

TOTAL

Pemerik

Lab
saan
Oralit

Zinc
RL

Specimen
Pos

Jlh.
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 LAPORAN BULANAN PROGRAM P2 ISPA
PUSEKESMAS.................................
KABUPATEN PASER

BULAN : TAHUN : 2012

REALISASI PENEMUAN PENDERITA JUMLAH KEMATIAN

JML.PDDK.U ISPA > 5 TAHUN
SIA BALITA SASARAN PNEUMONIA JUMLAH BALITA
NO. PUSKESMAS JML.PDDK PNEUMONIA BATUK BUKAN PNEUMONIA KARENA PNEUMONIA
(10 % Balita) BERAT %
(10 % Pddk) BUKAN
< 1 Th 1-4 Th TOTAL PNEUMONIA
< 1 Th 1-4 Th < 1 Th 1 - 4 Th < 1 Th 1-4 Th JML < 1 Th 1-4 Th JML PNEUMONIA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Mengetahui, ........................., Januari 2007

Kepala UPTD Puskes ....... Contoh lap
 FORMULIR PENYARINGAN PENDERITA H
Provinsi : Kalimantan Timur
Kabupaten/Kota : Paser
Kecamatan :
Puskesmas :

JNS ALAMAT PEKERJAAN

UMUR KEL
NO NAMA
(THN)
KEL/DESA RW RT NO 1 2 3 4 5 6 7 8 9
L P
a b c d e f g
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Petunjuk Pelaksanaan
a,b,c,e :cukup jelas
d;g;j;k;l diberi tanda (√) pada kolom sesuai hasil yang didapat
f : isi dengan angka sesuai kolom mis RW : 4 RT : 7 No 6
i : isi kolom sesuai hasil pemeriksaan mis sistolik 120; diastolik 80 iss 120 /80

Pekerjaan : 1. Pekerjaan yang berhubungan dengan administrasi/kantoran : PNS/ BUMN/ karyawa

2. Pekerjaan yang berhubungan dengan kekuatan fisik : ABRI ; Polisi ; Olahragawan
3. Pekerjaan yang beresiko tinggi penularaan : dokter ; perawat, petugas RS/Puskesm
4. Buruh Kasar : Kuli Bangunan ; Pekerja Pabrik, Tukang Ojek ; Supir Angkutan Umum
5. Pekerjaan dengan kemampuan ekonomi menengah keatas; Pengusaha; Artis; Peja
6. Pekerjaan dengan kemampuan ekonomi menengah kebawah : pengusaha warteg;
7. Pelajar / Mahasiswa, ibu rumah tangga
NGAN PENDERITA HEPATITIS TAHAP AWAL

PEMERIKSAAAN
ANAMNESE PEMERIKSAAN PHYSIK DIAGNOSA LAB
R.KEL R.PASIEN TD ICTERIK PEMBESARAN HATI KLINIS HBsAg
HEPATITIS HEPATITIS DM MOIDIAL mmHg (+) (-) (+) (-) (+) (-) (+)
h i j k l

120 /80

an : PNS/ BUMN/ karyawan swasta, dll

RI ; Polisi ; Olahragawan
wat, petugas RS/Puskesmas
ek ; Supir Angkutan Umum ; Supir Bajaj
s; Pengusaha; Artis; Pejabat; Direktur; dll
wah : pengusaha warteg; pembantu rumah tangga, dll
 LAB
HBsAg
(-)
l
 FORMULIR PENYARINGAN PENDERITA HEPATITIS TAHAP LANJU
DIAGNOSA KLINIS HEPATITIS & HBsAG POSITIF

PROVINSI :
KOTA :
KECAMATAN :
PUSKESMAS :

PEMERIKSAAN LAN
UMUR JENIS ALAMAT
NO NAMA KELAMIN HNeAG anti Hbe
(THN) KELURAHAN/
RW RT NO
L P DESA (+) (-) (+)
a b c d e f g
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Petunjuk Pelaksanaaan :
a,b,c,e : cukup jelas
d;g & i diberi tanda (Ö) pada kolom sesuai hasil
f : isi dengan angka sesuai kolom misalkan RW 4 ; RT 7 No 6
h: isi kolom sesuai hasil pemeriksaan
j: isi sesuai hasil akhir lab
EPATITIS TAHAP LANJUTAN
& HBsAG POSITIF

Form 2A

PEMERIKSAAN LANJUTAN
LFT
anti Hbe HBV DNA KESIMPULAN
SGOT SGPT
(-) (+) (-)
g h i j
 FORMULIR PENYARINGAN PENDERITA HEPATITIS TA
DIAGNOSA KLINIS HEPATITIS & HBsAG PO

PROVINSI :
KOTA :
KECAMATAN :
PUSKESMAS :

JENIS
ALAMAT
UMUR KELAMIN
NO NAMA
(THN) KELURAHAN/
L P RW RT
DESA
a b c d e f
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Petunjuk Pelaksanaaan :
a,b,c,e : cukup jelas
d;g & i diberi tanda (Ö) pada kolom sesuai hasil
f : isi dengan angka sesuai kolom misalkan RW 4 ; RT 7 No 6
h: isi kolom sesuai hasil pemeriksaan
j: isi sesuai hasil akhir lab
 ENDERITA HEPATITIS TAHAP LANJUTAN
S HEPATITIS & HBsAG POSITIF

Form 2B

PEMERIKSAAN LANJUTAN
T
LFT
HNeAG anti Hbe HBV DNA KESIMPULAN
SGOT SGPT
NO
(+) (-) (-) (-) (+) (-)
f g h i j
 FORMULIR PEMANTAUAN PENGOBATAN PEND

PROVINSI :
KOTA :
KECAMATAN :
PUSKESMAS :

JENIS
ALAMAT TELP
UMUR KELAMIN
NO NAMA
(THN) KELURAHAN/
L P RW RT NO RMH
DESA
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TAUAN PENGOBATAN PENDERITA HEPATITIS

Form 3

PENGOBATAN EVALUASI
TELP
BULAN ke- LAB
KET
HBsAG
HP 1 2 3 4 5 6 7 8 9 10 11 12
(+) (-)
 FORMULIR PEMANTAUAN HEPATITIS

PROVINSI :
KOTA :
KECAMATAN :
PUSKESMAS :

JENIS
HEPATITIS
KELAMIN
UMUR
NO NAMA JUM
(THN) LABORATORIUM
L P A B C
HBsAG
LAH
a b c d e f
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
JUMLAH
ATITIS

Form 4

PENGOBATAN
KETERANGAN
TIDAK
LENGKAP
LENGKAP
g h i