LAPORAN PERSEDIAAN OBAT DAN ALAT KONTRASEPSI

BULAN : APRIL
UPT PUSKESMAS : TANJUNGSAMAK

DIKELUARKAN PENYESUAIAN SISA AKHIR BULAN BATAS

No. JENIS KONTRASEPSI NO. BATCH SISA AKHIR BULAN LALU DITERIMA BULAN INI BULAN INI (Hilang/ Rusak/ INI KEDALUWARSA
Kedaluwarsa) (bulan-tahun)

(1) (2) (3) (4) (5) (6) (7) (8)=(4+5)-(6+7) (9)

1 IUD DAR 2146 48 0 0 0 48

2 IMPLANT 9500127 2 40 2 0 40

3 SUNTIKAN 3 BULAN 0131007 10 500 429 0 81

4 PIL KOMBINASI 1193048 172 0 143 0 29

5 KONDOM 21105210078 18 0 2 0 16

6 MINI PIL 0146022 100 0 0 0 100

7 SPUIT 3 CC, IMPLANT 20200525 2 40 2 0 40

8 SPUIT 3 CC, SUNTIK KB 20200525 10 500 429 0 81

9 DERMAFIX 18101888 2 50 2 0 50

10 DOEK STERIL DISPOSABLE MT-TMAD-0320 0 65 2 0 63

11 POVIDON IODINE 23041988 3 0 0 3 0

12 MASKER 10022086 0 2 1 0 1

13 HANDSCOON 073455770 20 50 5 0 65

14 SAFETY BOX 2013/077 11 9 2 0 18

Mengetahui Pengelola Program KB
Kepala UPT Puskesmas Tanjungsamak
ERMINA,SST SANTI HOLYDINA HARIANDJA, A.Md.Keb
PEMBINA IV.a
NIP.19720413 199212 2 001 NIP. 19910313 202012 2 013
 LAPORAN PELAYANAN PESERT

BULAN : FEBRUARI 2023

UPT PUSKESMAS : TANJUNGSAMAK
NO TANGGAL PELAYANAN* NAMA SUAMI NAMA AKSEPTOR* NIK*
1 27/2/2023 KARYONO SITI MARYAM
2 27/2/2023 RAHMAT HAMIDAH 2171064212829009
3 27/2/2023 SAFRIZAL TATIK FARIKA 140307470435190
4 28/2/2023 IRWANTO KINGWA 1403076011820001
5 28/2/2023 MASROFIK LASIAH 1403074202920002
6 1/3/2023 LUKMAN DEWI
7 2/3/2023 ABROR SUSIANA 1403074709940002
8 2/3/2023 PRAPTO NURYANA
9 2/3/2023 SOLIHIN SRI WAHYUNI
10 2/3/2023 M. RIFA'I MAIZATUL MAIRO 1403076203942526
11 3/3/2023 SUWITO DARTI 1403076410861111
12 3/3/2023 LUTFIANA SITI LESTARI 1403075403850765
13 3/3/2023 TASRIB SUSAROH 1403074411860001
14 3/3/2023 BUKRI TUFI'AH
15 4/3/2023 LIZUL RUZITA
16 5/3/2023 IRFAN SITI ROHAYA 2102044605770007
17 5/3/2023 AMIN WASITOTUL ULFA 1403074208006161
18 6/3/2023 AHMAD MUKHOLIB HIMAYATUL ALIYAH
19 7/3/2023 HERI SRI WAHYUNI
20 7/3/2023 KHUSNUL
21 7/3/2023 SARIFUDDIN ASMAWATI 1403056206850002
22 7/3/2023 ISMAIL WINDI 3522056110900001
23 8/3/2023 SUPRI SUSILAWATI 1403075008873290
24 8/3/2023 ANDI SUMIATI 1403076502860002
25 8/3/2023 M. SYAFI'I AINUN
26 8/3/2023 SANIMEN ASIAH
27 8/3/2023 MISWANDI TUGIRAH
28 8/3/2023 NURHAYATI
29 9/3/2023 ARI SUSANTO FITRIANI 1403075204925813
30 10/3/2023 GUNAWAN ELVI LIA
31 10/3/2023 SUPRIYADI JULIANI
32 10/3/2023 SURYANA
33 11/3/2023 ARIYANTO RITA HASTUTI
34 11/3/2023 MASRUHAN HADI AISMAHFIROH 1403074412840001
35 13/3/2023 IBNU SANI MAHFUDO
36 13/3/2023 BUDI RUBY 1403075303800749
37 13/3/2023 RIDWAN FIKOH 1403075008795648
38 13/3/2023 BAHAK FITRI
39 13/3/2023 IDRIS INTAN
40 13/3/2023 TAUFIK NUR ANISA
41 14/3/2023 TUGIMAN SITI NURMAH 1403076612834288
42 14/3/2023 SODIK UMUL ROHMAH
43 14/3/2023 NUROKIB RUZIANA
44 14/3/2023 OMA YUYUN
45 14/3/2023 KHOIRUL MISWANA
46 15/3/2023 MANAN TATIK 1403074905730001
47 16/3/2023 PAWIT
48 16/3/2023 YATNO NELI
49 16/3/2023 HARIYANTO NARTI 1403075705919531
50 16/3/2023 INDRA SITI MARFUATUN 1403056801811638
51 16/3/2023 SULIDIN ENDANG 1403077006890001
52 17/3/2023 DARMA NI'AM UNZILA 1403077105003902
53 17/3/2023 M. YUSUF NURVADILA 1403076909958267
54 17/3/2023 BUYATIN SULASTRI 1403074607760494
 55 17/3/2023 SUJARNO ASIAH
56 18/3/2023 NUR
57 19/3/2023 ROHAIDIN SALMIAH
58 19/3/2023 IZULIN NUR AINI
59 19/3/2023 SITI HALIMAH
60 19/3/2023 MUSTA'IN MEGAWATI
61 19/3/2023 FITRI SARI
62 19/3/2023 RUSTINA
63 19/3/2023 SARI
64 20/3/2023 SURATNO ROSMINAR 1403074611825043
65 20/3/2023 ASIM MARYANI 14030774312870001
66 21/3/2023 ARIF NURMIATI
67 21/3/2023 DAIM RINI AGUSTINA
68 21/3/2023 FENDI NANI
69 23/3/2023 YATI
70 23/3/2023 HAKIM NURUL INAYAH
71 26/3/2023 HERMANTO RUSTINA
72 26/3/2023 KHAIRUL ASMARITA 1410034205960005
73 27/3/2023 IWAN NURUL
74 28/3/2023 DEDI KHUSNUL
75 29/3/2023 SIMA
76 31/3/2023 RAHMAT HAMIDAH 2171064212829009
77 31/3/2023 SAHRUL AMIR MUTOMIMAH
78 31/3/2023 MA'SUN HANDAYANI
79 31/3/2023 TASRIB SUSAROH
80 31/3/2023 KARYONO SITI MARYAM

1. Yang Kode (*) wajib diisi

2. jenis pelayanan KB (Pasca Persalinan / Pasca Keguguran)
3. Status Peserta KB (Baru / Ulangan / Ganti Cara )

Mengetahui
Kepala UPT Puskesmas Tanjungsamak

ERMINA,SST
PEMBINA IV.a
NIP.19720413 199212 2 001
PORAN PELAYANAN PESERTA KB

T.T.L* ALAMAT (DESA, DUSUN, RT)* JENIS PELAYANAN KB* *STATUS

39 TH P. SIDOMULYO SUNTIK 1 BLN LAMA
40 TH P. TENGAH SUNTIK 1 BLN LAMA
30 TH P. LAJAR CITRA DAMAI SUNTIK 3 BLN BARU
39 TH PASAR SUNTIK 1 BLN LAMA
31 TH WONOSARI SUNTIK 1 BLN LAMA
42 TH P. LAPIS SUNTIK 3 BLN BARU
26 TH P. TENGAH SUNTIK 3 BLN LAMA
27 TH P. DOKOL SUNTIK 1 BLN LAMA
36 TH P. TENGAH SUNTIK 3 BLN LAMA
28 TH P. LAJAR TG. SAMAK SUNTIK 1 BLN LAMA
34 TH P. LAJAR SUNTIK 1 BLN LAMA
34 TH P. SIDOMULYO SUNTIK 1 BLN LAMA
36 TH P. SARWI SUNTIK 1 BLN LAMA
36 TH P. LAJAR TG. SAMAK SUNTIK 3 BLN LAMA
31 TH TEGALSARI SUNTIK 1 BLN LAMA
42 TH TG. GEMUK SUNTIK 3 BLN LAMA
22 TH P. MASJID SUNTIK 1 BLN LAMA
30 TH P. MASJID SUNTIK 1 BLN LAMA
40 TH P. MASJID SUNTIK 3 BLN LAMA
28 TH P. TENGAH SUNTIK 1 BLN LAMA
38 TH S. GAYUNG KIRI SUNTIK 1 BLN LAMA
31 TH P. MASJID SUNTIK 1 BLN LAMA
34 TH P. TENGAH SUNTIK 1 BLN LAMA
35 TH P. TENGAH SUNTIK 3 BLN LAMA
43 TH PASAR SUNTIK 3 BLN LAMA
43 TH GEMALASARI SUNTIK 3 BLN LAMA
45 TH GEMALASARI SUNTIK 3 BLN LAMA
28 TH P. LAJAR TG. SAMAK SUNTIK 1 BLN LAMA
30 TH P. DOKOL SUNTIK 3 BLN LAMA
31 TH P. SIDOMULYO SUNTIK 3 BLN LAMA
32 TH KP. TENGAH SUNTIK 1 BLN BARU
40 TH GEMALASARI IMPLAN LAMA
32 TH P. LAPIS SUNTIK 1 BLN LAMA
37 TH P. LAJAR TG. SAMAK SUNTIK 1 BLN LAMA
30 TH P. LAJAR CITRA DAMAI SUNTIK 1 BLN BARU
33 TH P. TENGAH TG. SAMAK SUNTIK 1 BLN LAMA
42 TH P. TENGAH TG. SAMAK SUNTIK 1 BLN LAMA
30 TH S. GAYUNG KIRI SUNTIK 1 BLN LAMA
16 TH GEMALASARI SUNTIK 3 BLN BARU
25 TH GEMALASARI SUNTIK 1 BLN LAMA
39 TH P. TENGAH CITRA DAMAI SUNTIK 3 BLN BARU
42 TH P. SIDOMULYO SUNTIK 1 BLN LAMA
32 TH P. MASJID SUNTIK 1 BLN LAMA
38 TH P. MASJID SUNTIK 3 BLN LAMA
29 TH MEKAR SARI SUNTIK 1 BLN LAMA
48 TH PASAR SUNTIK 1 BLN LAMA
52 TH P. SARWI SUNTIK 3 BLN BARU
41 TH TELUK SAMAK SUNTIK 3 BLN BARU
29 TH P. GANTUNG SUNTIK 1 BLN LAMA
42 TH P. MASJID SUNTIK 1 BLN BARU
33 TH P. TENGAH SUNTIK 3 BLN LAMA
23 TH P. MASJID SUNTIK 3 BLN LAMA
28 TH P. LAPIS SUNTIK 3 BLN LAMA
44 TH P. TENGAH SUNTIK 3 BLN LAMA
33 TH P. SARWI SUNTIK 3 BLN LAMA
31 TH P. TENGAH SUNTIK 1 BLN LAMA
26 TH TELUK SAMAK SUNTIK 3 BLN LAMA
52 TH P. SIDOMULYO SUNTIK 1 BLN LAMA
28 TH TG. GEMUK SUNTIK 1 BLN LAMA
30 TH P. TENGAH SUNTIK 1 BLN LAMA
SUNTIK 1 BLN BARU
41 TH BALAK ALU SUNTIK 1 BLN LAMA
37 TH P. LAJAR TG. SAMAK SUNTIK 1 BLN LAMA
39 TH P. TENGAH CITRA DAMAI SUNTIK 3 BLN LAMA
34 TH TOPANG SUNTIK 3 BLN LAMA
37 TH P. SIDOMULYO SUNTIK 1 BLN LAMA
29 TH MEKAR SARI SUNTIK 1 BLN LAMA
35 TH P. TENGAH SUNTIK 1 BLN LAMA
42 TH TOPANG SUNTIK 1 BLN LAMA
38 TH P. MASJID SUNTIK 1 BLN BARU
27 TH MAYAU SUNTIK 3 BLN BARU
25 TH P. LAJAR CITRA DAMAI SUNTIK 1 BLN LAMA
32 TH PASAR SUNTIK 1 BLN LAMA
21 TH P. TENGAH SUNTIK 3 BLN LAMA
33 TH P. LAJAR SUNTIK 1 BLN LAMA
40 TH P. TENGAH SUNTIK 1 BLN LAMA
22 TH P. LAJAR CITRA DAMAI SUNTIK 1 BLN BARU
42 TH P. LAPIS SUNTIK 3 BLN LAMA
36 TH P. SARWI SUNTIK 1 BLN LAMA
39 TH P. SIDOMULYO SUNTIK 3 BLN LAMA

Pengelola
Program KB

SANTI HOLYDINA HARIANDJA, A.Md.Keb

NIP. 19910313 202012 2 013

JENIS ALOKON* NO HP BPJS* NON BPJS*
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HOLYDINA HARIANDJA, A.Md.Keb

910313 202012 2 013