LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP

INSTALASI GIZI RSUD KUDUNGGA

TAHUN 2021
Bulan : Januari
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 1-Jan-21 Ny. Ika 0 143186 55 165 20.20 Normal Diet Lunak 1.1
2 Ny. Asmia 1 141915 53 155 22.06 Normal Diet Lunak 1.2
3 Ny. Tasini 1 143385 57 157 23.12 Normal Diet Lunak Diet Lambung 1.4
4 3-Jan-21 Ny. Hasna 0 143816 60 168 21.25 Normal Diet Lunak TKTP 1.3
5 Ny. Sugiatri 2 289255 54 156 22.18 Normal Diet Lunak 1.4
6 4-Jan-21 Tn. Adi Kusuma 0 289249 65 158 26.03 Overweight Diet Lunak DM 1.3
7 Ny. Nurbely 0 289632 60 150 26.66 Overweight Diet Lunak TKTP Rendah Energi 1.5
8 Nn. Rezky Pati 1 289795 54 166 19.59 Normal Diet LunakTKTP 1.4
9 Tn. Taslim 0 289824 67 162 25.52 Normal Diet Lunak TKTP 1.3
10 5-Jan-21 Tn. Waluyo 1 290037 59 171 20.17 Normal Diet Lunak 1.5
11 Tn. Subiyantoro 0 231229 65 170 22.49 Normal Diet Biasa+Diet Jantung 1.1
12 Tn. Amiruddin 2 232451 68 169 23.8 Normal Diet Biasa+DM 1.2
13 10-Jan-21 Ny. Evi Hidayah 1 232593 58 150 25.77 Overweight Diet Biasa+RG 1.3
14 Ny. Agustina 0 233231 66 165 24.24 Normal Diet Bubur Saring 1.4 3X50 cc
15 Ny. Nursami 2 235529 70 165 25.71 Overweight Diet Biasa+DM+RP 1.5
16 Tn. Yudi 0 239687 74 169 25.9 Overweight Diet Lunak+Diet Jantung 1.1
17 11-Jan-21 Ny. Melky 0 241291 72 155 29.96 Obesitas Diet Lunak+RG+R.Energi 1.2
18 Tn. Fajar 2 245455 65 165 23.87 Normal Diet Lunak+Diet Jantung 1.4
19 Tn. Edy 0 246686 67 170 23.18 Normal Diet Lunak+Diet Jantung 1.3
20 13-Jan-21 Tn. Anwar 1 246751 65 160 25.39 Overweight Diet Lunak+RG+Diet Jantung 1.5
21 Tn. Fadil 0 140568 51 150 22.67 Normal Diet Lunak RG TKTP 1 2.25
22 14-Jan-21 Ny. Suci 0 028162 46 152 19.91 Normal Diet Lunak RG TKTP 2 2.3104
23 Ny. Fatima 0 281754 53 155 22.06 Normal Diet Lunak RG TKTP 3 2.4025
24 Tn. Suripto 1 281915 58 160 22.66 Normal Diet Lunak DJ 4 2.56
25 Ny. Nur yanti 1 280889 57 157 23.12 Normal Diet Lunak DJ 5 2.4649
26 17-Jan-21 Ny. Marlina 1 280888 53 160 20.70 Normal Diet Lunak DJ DM 2 2.56
27 Ny. Muli 1 280882 52 156 21.37 Normal Diet Lunak RG DJ 1 2.4336
28 Tn. Nur hidayat 1 281478 55 161 21.22 Normal Diet Lunak DJ 3 2.5921
29 Tn. Maryanto 1 281433 58 159 22.94 Normal Diet Lunak DJ 4 2.5281
30 25-Jan-21 Tn. Sugianto 1 140603 55 160 21.48 Normal Diet Lunak DJ 5 2.56
TB2 BB/TB
2.7225 20.20202
2.4025 22.06035
2.4649 23.12467
2.8224 21.2585
2.4336 22.18935
2.4964 26.03749
2.25 26.66667
2.7556 19.59646
2.6244 25.52964
2.9241 20.17715
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Februari
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 1-Feb-21 Ny. Desya D B 1 290187 70 155 29.13 Obesitas Diet Biasa 1.1 Makanan untuk Keluarga
2 Tn. Nulyanus K 0 290771 95 179 29.64 Obesitas Diet Lunak 1.3
3 2-Feb-21 Ny. Siti Samsiah 0 292652 47 155 19.56 Normal Diet Lunak DM 1.5
4 Tn. Abdul R 0 144544 65.2 165 23.94 Normal Diet Lunak RG DJ 1.2
5 Ny. Yuyun 0 144591 79 167 28.32 Obesitas Diet Lunak RG TKTP 1.4 Alergi Ikan Tongkol
6 Tn. Tawi 0 121583 55 155 22.89 Normal Diet Lunak DJ 1.1
7 5-Feb-21 Ny. Ramlah 1 144750 65 150 28.88 Obesitas Diet Lunak DM RG RP 1.3 Alergi Telur
8 Tn. Ardian 1 102675 50 160 19.53 Normal Diet Lunak DJ 1.5
9 Tn. Ikhsan 1 144870 60 158 24.03 Normal Diet Lunak DJ RG 1.4
10 6-Feb-21 Tn. Adrianto 1 141016 60 155 24.97 Normal Diet Lunak DJ RG 1.1
11 Ny. Antonella 0 272605 55 150 24.44 Normal Diet Lunak TKTP RG 1
12 Ny. Sinar 0 125470 80 165 29.38 Obesitas Diet Lunak RG DJ 2
13 7-Feb-21 Ny. Sutimah 125529 58 154 24.45 Normal Diet Lunak RG 1
14 Ny. Santi 0 125639 60 160 23.43 Normal Diet Lunak TKTP RG 3
15 Ny. Kaseti 1 099662 68 154 28.67 Obesitas Diet Lunak DM RP 4
16 10-Feb-21 Ny. Hasnah 0 067802 59 164 21.93 Normal Diet Lunak DM RG 5
17 Ny. Meriana 1 071813 48 157 19.47 Normal Diet Lunak 1
18 Ny. Siti Nurjanah 1 126706 55 150 24.44 Normal Diet Lunak TKTP RG 2
19 Tn. Purwanto 1 977980 65 168 23.03 Normal Diet Lunak RG 3
20 18-Feb-21 Ny. Oktavia 0 784581 67 169 23.45 Normal Diet Lunak RG 4
21 Ny. Andi F 0 140568 48 150 21.33 Normal Diet Lunak RG TKTP 1 2.25
22 Ny. Ling S 0 028162 47 152 20.34 Normal Diet Lunak RG TKTP 2 2.3104
23 20-Feb-21 Ny. Sasa 0 281754 52 155 21.64 Normal Diet Lunak RG TKTP 3 2.4025
24 Tn. Sucipto 1 281915 60 160 23.44 Normal Diet Lunak DJ 4 2.56
25 Ny. Nurlina 1 280889 55 157 22.31 Normal Diet Lunak DJ 5 2.4649
26 Ny. Yustian 1 280888 48 149 21.62 Normal Diet Lunak DJ DM 2 2.2201
27 22-Feb-21 Ny. Daliati 1 280882 49 156 20.13 Normal Diet Lunak RG DJ 1 2.4336
28 Tn. Alif 1 281478 59 161 22.76 Normal Diet Lunak DJ 3 2.5921
29 Tn. Zainuddin 1 281433 57 159 22.55 Normal Diet Lunak DJ 4 2.5281
30 23-Feb-21 Tn. Chandra S 1 140603 55 160 21.48 Normal Diet Lunak DJ 5 2.56
TB2 BB/TB
2.4025 29.13632
3.2041 29.64951
2.4025 19.56296
2.7225 23.94858
2.7889 28.32658
2.4025 22.89282
2.25 28.88889
2.56 19.53125
2.4964 24.03461
2.4025 24.97399
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Maret
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan TB2
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 2-Mar-21 Ny. Mita 1 142963 60 162 22.86 Normal Diet Lunak RG TKTP 1.2 2.6244
2 Tn. Didik 1 107531 56 163 21.07 Normal Diet Biasa DJ 1.5 2.6569
3 Tn. Bulihar 1 295768 65 170 22.49 Normal Diet Biasa DJ 1.3 2.89
4 3-Mar-21 Tn. Ramadhan 1 295982 53 150 23.55 Normal Diet Cair 6 x 200 cc 1.1 2.25
5 Ny. Masriah 1 296045 52.5 169 18.38 Normal Diet Lunak DM DJ 1.4 2.8561
6 Ny. Farida 1 296439 57 164 21.19 Normal Diet Biasa 1.3 Makanan untuk Keluarga 2.6896
7 4-Mar-21 Tn. Teguh 1 294976 48 152 20.77 Normal Diet Lunak DJ 1.5 2.3104
8 Ny. Salatia 0 283364 52 155 21.64 Normal Diet Lunak RG TKTP 2 2.4025
9 Tn Umar F 1 283383 49 157 19.88 Normal Diet Lunak DJ 3 2.4649
10 6-Mar-21 Tn. Sukarman 1 283358 50 152 21.64 Normal Diet Cair 3 x 100 cc 1 2.3104
11 Ny. Yuliana 0 283799 55 154 23.19 Normal Diet Lunak RG TKTP 4 2.3716
12 Tn. Iwan 1 284194 48 160 18.75 Normal Diet Lunak DJ 5 2.56
13 Tn. Nasruddin 1 284759 61 159 24.13 Normal Diet Biasa 1 Makanan untuk Keluarga 2.5281
14 7-Mar-21 Tn. Dirman 1 285352 56 158 22.43 Normal Diet Lunak 2 2.4964
15 Tn. M Ramal 1 285588 52 161 20.06 Normal Diet Lunak DJ 3 2.5921
16 8-Mar-21 Tn. Subki A 1 141864 57 157 23.12 Normal Diet Lunak DJ 4 2.4649
17 Tn. Johan S 1 141917 54 159 21.36 Normal Diet Lunak DJ 5 2.5281
18 Ny. Siti F 0 141995 49 160 19.14 Normal Diet Lunak RG TKTP 2 2.56
19 Tn. Wawan 0 127439 58 170 20.06 Normal Diet Lunak 1
20 12-Mar-21 Tn. Tarsius 1 273083 49 168 17.36 Undeweight Diet Lunak DM 2
21 Ny. Najwa 2 273439 57 159 22.54 Normal Diet Lunak 4
22 Ny. Hashol 1 274398 52 159 20.56 Normal Diet Lunak 5
23 Tn. Madrus 0 278298 58 170 20.06 Normal Diet Biasa 3 Makanan untuk keluarga
24 16-Mar-21 Ny. Misrukiyah 0 278977 48 160 18.75 Normal Diet Bubur Saring RG 1
25 Ny. Nur Asiah 1 278844 58 155 24.14 Normal Diet Lunak RG 2
26 Tn. Deny 1 279790 65 168 23.03 Normal Diet Lunak DM RG 3
27 18-Mar-21 Tn. Bahtiar 1 279838 58 177 18.51 Normal Diet Lunak DM DJ 4
BB/TB
22.86237
21.0772
22.49135
23.55556
18.38171
21.19274
20.77562
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : April
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan TB2
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 1-Apr-21 Tn. Ruslan 0 296931 48 160 18.75 Normal Diet Lunak DJ 1.3 2.56
2 Ny. Mardiana 1 297332 45 156 18.49 Normal Diet Lunak RG DJ 1.5 2.4336
3 Ny. Saminah 0 298220 55 158 22.03 Normal Diet Biasa 1.2 Makanan untuk Keluarga 2.4964
4 2-Apr-21 Tn. Piara B 1 297975 56 164 20.82 Normal Diet Lunak Dj 1.4 2.6896
5 Ny. Anita 0 145262 68 161 26.23 Overweight Diet Lunak RG TKTP 1.1 2.5921
6 Ny. Masriah 1 145397 56 152 24.23 Normal Diet Lunak DM RG 1.3 2.3104
7 4-Apr-21 Tn. Andi F 0 145405 60 155 24.97 Normal Diet Lunak TKTP 1.2 2.4025
8 Ny. Siti Kamara 0 145512 63 159 24.91 Normal Diet Biasa RG TKTP 1.4 2.5281
9 Tn. Arbani 1 286244 75 152 32.46 Obesitas Diet Lunak DJ RG 1
10 6-Apr-21 Ny. Ellyana 1 287017 80 160 31.25 Obesitas Diet Lunak DJ 2
11 Ny. Siti Fatimah 0 287176 65 155 27.05 Obesitas Diet Lunak RG TKTP 2
12 Ny. Bauna 1 287229 58 165 21.3 Normal Diet Bubur Saring 3 x 3 Susu 3 x 100 cc
13 Tn. Kusnadi 1 287464 64 155 26.63 Overweight Diet Lunak DJ 4
14 10-Apr-21 An. Yudanta 0 287036 60 172 20.28 Normal Diet Lunak TKTP 3
15 Ny. Hamidah 0 287552 70 158 28.04 Obesitas Diet Biasa 2
16 Ny. Sihmiati 2 287695 50 160 19.53 Normal Diet Cair 4 x 100 cc 5
17 Tn. Sabahuddin 1 288083 50 155 20.81 Normal Diet Lunak DM DJ RG 3
18 12-Apr-21 Tn. Muh. Tang 1 288497 62 159 24.52 Normal Diet Lunak RG DJ 4
19 Tn. Tantri 1 130007 48 153 20.50 Normal Diet Lunak DJ 1 2.3409
20 Tn. Muharram 1 142034 51 158 20.43 Normal Diet Lunak DJ 2 2.4964
21 22-Apr-21 Ny. Sutini 1 140560 55 155 22.89 Normal Diet Biasa 3 Makanan untuk Keluarga 2.4025
22 NY. Aminatun 1 795750 49 157 19.88 Normal Diet Biasa 4 Makanan untuk Keluarga 2.4649
23 Ny. Yasinta 0 142258 52 152 22.51 Normal Diet Lunak RG 5 2.3104
24 Ny. Rubina 1 142273 50 154 21.08 Normal Diet Lunak DJ 1 2.3716
25 25-Apr-21 Tn. Jumri 1 142332 58 160 22.66 Normal Diet Lunak DJ 2 2.56
26 Tn. Supri 1 285620 60 164 22.31 Normal Diet Lunak DJ 3 2.6896
27 Ny. Sri W 0 285830 48 150 21.33 Normal Diet Lunak RG TKTP 4 2.25
28 27-Apr-21 Ny. Angela 0 286037 53 149 23.87 Normal Diet Lunak RG TKTP 5 2.2201
29 Ny. Fransiska 0 314238 56 157 22.72 Normal Diet Lunak RG TKTP 3 2.4649
BB/TB
18.75
18.49112
22.03173
20.82094
26.23356
24.23823
24.97399
24.9199
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Mei
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 1-May-21 Ny. Tatik S 0 038983 53 153 22.64 Normal Diet Lunak DJ 1.1
2 Tn. Usman 0 126756 50 157 20.28 Normal Diet Lunak DJ 1.4
3 Tn. Galis 2 145819 43 160 16.79 Underweight Diet Bubur Saring 3 x 50 cc 1.3 Jus Buah 2 x 50 cc
4 Tn. Hendrikus 0 142087 65 165 23.87 Normal Diet Biasa 1.2 Makanan untuk Keluarga
5 3-May-21 Tn. Basuki W 1 298576 55 155 22.89 Normal Diet Lunak DM DJ 1.5
6 Tn. Ruswanto 1 299258 55 152 23.80 Normal Diet Lunak TKTP 1.1
7 Ny. I Mati 1 299361 50 170 17.30 Normal Diet Lunak DM DJ 1.3
8 Tn. Wahyudin 0 299792 49 169 17.15 Normal Diet Lunak DM 1.2
9 5-May-21 Tn. Basuki 1 300878 60 152 25.96 Normal Diet Lunak DM 1.5
10 Ny. Yuliana 1 301091 54 164 20.07 Normal Diet Lunak 1.4
11 Ny. Lensi Quito 0 288316 50 158 20.02 Normal Diet Lunak 1
12 Ny. Chadijah 0 128533 48 155 19.97 Normal Diet Lunak 2
13 Tn. Faisal 0 129115 65 168 23.03 Normal Diet Lunak RG 3
14 10-May-21 Tn. Asmuron 1 128281 59 158 23.63 Normal Diet Lunak RG 4
15 Tn. Nurhanus 0 129505 47 170 16.26 Underweight Diet Cair 4 x 100 cc 5
16 Ny. Jarti 1 127345 70 169 24.5 Normal Diet Lunak 2
17 Tn. M. Subuh 1 129797 65 177 20.74 Normal Diet Biasa 3 Makanan untuk Keluarga
18 Tn. Muh Basri 1 129854 59 165 21.67 Normal Diet lunak DJ 1
19 Ny. Desya Dani 2 129855 55 167 19.72 Normal Diet Lunak RG TKTP 2
20 Ny. Siti Samsia 0 129902 49 158 19.62 Normal Diet Lunak DM 4
21 15-May-21 Tn. Supri K 1 286221 49 155 20.40 Normal Diet Lunak DJ 2
22 Tn. Arianto 1 286264 52 158 20.83 Normal Diet Lunak DJ 4
23 Tn. Sudarman 1 286395 54 161 20.83 Normal Diet Lunak DJ 5
24 Tn. Daniel T 1 286842 60 159 23.73 Normal Diet Lunak DJ 1
25 Ny. Rinda 0 287059 48 151 21.05 Normal Diet lunak RG TKTP 3
26 20-May-21 Ny. Lisa 0 287136 50 150 22.22 Normal Diet lunak RG TKTP 4
27 Tn. Sukardi 1 287348 56 162 21.34 Normal Diet Lunak DJ 5
28 Tn. Barsani 1 142448 59 158 23.63 Normal Diet Lunak DJ 1
TB2 BB/TB
2.3409 22.64086
2.4649 20.2848
2.56 16.79688
2.7225 23.87511
2.4025 22.89282
2.3104 23.8054
2.89 17.30104
2.8561 17.15626
2.3104 25.96953
2.6896 20.07733

2.4025
2.4964
2.5921
2.5281
2.2801
2.25
2.6244
2.4964
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Juni
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 2-Jun-21 Tn. Andre Caesar 1 301134 55 175.5 17.85 Normal Diet Biasa 1.3 Makanan untuk Keluarga
2 Tn. Hengki 0 301140 70 170 24.22 Normal Diet Biasa 1.4 Makanan untuk Keluarga
3 Ny. Christiana 1 146094 54 156 22.18 Normal Diet Lunak 1.1
4 Tn. Idrus 2 146296 64 162 24.38 Normal Diet Bubur Saring 3 x 200 cc 1.5
5 4-Jun-21 Ny. Tri wulan 0 090168 45 154 18.97 Normal Diet Lunak DM 1.2
6 Tn. Keneng 0 146658 48 150 21.33 Normal Diet Lunak TKTP 1.3
7 Tn. Ong Pangka 0 146815 50 153 21.35 Normal Diet Lunak TKTP 1.2
8 5-Jun-21 Tn. Saltu 0 144730 49 157 19.87 Normal Diet Lunak TKTP 1.5
9 Tn. Yacob 0 130007 62 154 26.14 Overweight Diet lunak 1.1
10 Ny. Azrah 0 302465 61 162 23.24 Normal Diet lunak 1.3
11 Ny. Rusmiah 0 303259 46 156 18.9 Normal Diet Lunak DM DJ 1.2
12 6-Jun-21 Tn. Rustam 0 303435 58 169 20.30 Normal Diet biasa DJ 1.5
13 Tn. Abdul R 0 129912 65.2 165 23.94 Normal Diet Lunak RG 1
14 Ny. Yuyun 0 127488 79 167 28.32 Obesitas Diet Lunak RG TKTP 2
15 Tn. Tawi 0 129959 55 155 22.89 Normal Diet Lunak DJ 3
16 8-Jun-21 Ny. Bariah 1 130007 45 156 18.49 Normal Diet Cair 6 x 100 cc 1
17 Tn. Bayu S 1 130205 55 167 19.72 Normal Diet Biasa 2
18 Ny. Maria 0 293065 50 157 20.28 Normal Diet Lunak RG TKTP 4
19 10-Jun-21 Ny. Silvanita 0 293315 79.5 150 35.33 Obesitas Diet Lunak RG TKTP 5
20 Ny. Chang 1 293507 40 157 16.22 Undeweight Diet Cair 6 x 100 cc 3
21 Ny. Dau Ilung 2 294452 57 156 23.42 Normal Diet Lunak RG DJ RP 1
22 11-Jun-21 Tn. Muh Siri 0 130272 60 160 23.43 Normal Diet Cair 2 x 100 cc 2
23 Ny. Viktoria 0 142507 52 154 21.93 Normal Diet Lunak TKTP 1
24 Ny. Jusmiati 0 142517 48 150 21.33 Normal Diet Lunak TKTP 3
25 14-Jun-21 Ny. Ana 0 142600 50 154 21.08 Normal Diet Lunak TKTP 2
26 Ny. Retno 0 142657 52 157 21.10 Normal Diet Lunak TKTP 4
27 Ny. Minarti 0 141016 55 156 22.60 Normal Diet Lunak TKTP 5
28 16-Jun-21 Tn. Abu Bakar 1 142829 56 161 21.60 Normal Diet Lunak DJ 3
29 Ny. Karionawati 0 142866 49 158 19.63 Normal Diet Lunak RG TKTP 2
 TB2 BB/TB
3.080025 17.857
2.89 24.22145
2.4336 22.18935
2.6244 24.38653
2.3716 18.97453
2.25 21.33333
2.3409 21.35931
2.4649 19.8791
2.3716 26.14269
2.6244 23.24341
2.4336 18.90204
2.8561 20.30741

2.3716
2.25
2.3716
2.4649
2.4336
2.5921
2.4964
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Juli
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan TB2
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 1-Jul-21 Nn. Juwita 1 304573 52 158 20.83 Normal Diet Lunak Diet Lambung 1.1 2.4964
2 Tn. Ignasius 1 305336 38 155 15.81 Underweight Diet Lunak TKTP Diet Lambu 1.2 2.4025
3 Tn. Yosep 1 305380 44 155 18.31 Normal Diet Lunak DJ 1.3 2.4025
4 5-Jul-21 Tn. Darwin 0 305897 50 154 21.08 Normal Diet Lunak TKTP 1.5 2.3716
5 Tn. Muh Junaedi 0 147107 47 164 17.47 Normal Diet Lunak Diet Lambung 1.4 2.6896
6 Tn. Kardain 0 140560 57 157 23.12 Normal Diet Lunak TKTP 1.2 2.4649
7 7-Jul-21 Tn. Abd Hasan 0 130007 60 162 22.86 Normal Diet Lunak DM DJ 1.1 2.6244
8 Tn. Dirham 0 143648 42 163 15.80 Underweight Diet Lunak 1.3 2.6569
9 Ny. Anik 0 147356 63 152 27.26 Obesitas Diet Lunak DM RG 1.4 2.3104
10 10-Jul-21 Ny. Siti Hajar 0 140560 58 154 24.45 Normal Diet Lunak DM RP 1.2 2.3716
11 Ny. Bau Ifung 1 130324 95 150 42.22 Obesitas Diet Lunak DM 1
12 Ny. Rahmatia 1 127488 60 158 24.03 Normal Diet Lunak RG TKTP 2
13 11-Jul-21 Tn. Rofinus 1 130689 85 174 28.07 Obesitas Diet Lunak RG DJ 4
14 Tn. Syamsudin 2 130746 75 160 29.29 Obesitas Diet Lunak RG DJ 3
15 Ny. Hayya 0 125270 37 145 17.59 Normal Diet Lunak RG DJ 5
16 15-Jul-21 An. Dilla 0 130882 38 135 +1SD Normal Diet Biasa 1 Makanan untuk Keluarga
17 Ny. Ria 1 130938 67 160 26.17 Overweight Diet Lunak RG TKTP 3
18 Tn. Marlan 1 078458 40 154 16.86 Underweight Diet Lunak DJ 4
19 17-Jul-21 Tn. Ding lung 1 131102 60 166 21.77 Normal Diet Biasa 2 Makanan untuk Keluarga
20 Ny. Sri Mulyanti 0 131225 71 155 29.55 Obesitas Diet Lunak RG TKTP 3
21 Ny. Suti 0 142854 48 152 20.78 Normal Diet Biasa 1 Makanan untuk Keluarga 2.3104
22 18-Jul-21 Ny. Nurbaiti 0 142873 50 154 21.08 Normal Diet Biasa TKTP 2 2.3716
23 Ny. Elkana 0 287736 47 158 18.83 Normal Diet Biasa TKTP 3 2.4964
24 Ny. Mawar 0 287768 55 155 22.89 Normal Diet Biasa TKTP 4 2.4025
25 20-Jul-21 Ny. Maria 0 288253 56 157 22.72 Normal Diet Lunak RG TKTP 5 2.4649
26 Ny. Christin 0 288509 49 154 20.66 Normal Diet Lunak TKTP 1 2.3716
BB/TB
20.83
15.81686
18.31426
21.08281
17.47472
23.12467
22.86237
15.8079
27.26801
24.45606
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Agustus
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 5-Aug-21 NY. Sutimah 0 306575 50 162 19.05 Normal Diet Lunak 1.4
2 Tn. Mufid 0 306700 46 161 17.74 Normal Diet Cair 3 x 100 cc 1.3
3 Tn. Sukardi 0 307067 55 167 19.72 Normal Diet Lunak RG Diet Stroke 1.2
4 11-Aug-21 Ny. Rehati 1 307583 62 150 27.55 Obesitas Diet Lunak RG 1.1
5 Ny. Rubingah 1 307784 52.5 162 20.01 Normal Diet Lunak DJ 1.2
6 Ny. Mutmainah 1 307953 58 154 24.45 Normal Diet Lunak Diet Lambung RP 1.5
7 15-Aug-21 Tn. Hendrikus 0 122779 50 153 21.35 Normal Diet Lunak TKTP 1.3
8 Tn. Aminuddin 0 147440 46 168 16.29 UnderweightDiet Lunak Diet Lambung 1.1
9 Tn. Marzuki 1 147469 67 172 22.64 Normal Diet Lunak DJ 1.4
10 17-Aug-21 Tn. Marlan 0 131242 58 160 22.65 Normal Diet Lunak RG 1
11 Tn. M. Galuh 0 294747 65 166 23.58 Normal Diet Lunak DJ 2
12 Ny. Rusmini 0 294983 60 170 20.76 Normal Diet Cair 3 x 100 3
13 19-Aug-21 Ny. Rodiah 1 295628 48 155 19.94 Normal Diet Lunak RG 5
14 Ny. Fitri 1 296756 57 172 19.26 Normal Diet Lunak RG 3
15 Ny. Rensi 2 297122 67 165 24.6 Normal Diet Lunak RG 4
16 22-Aug-21 Tn. Malarangen 2 297365 55 158 22.03 Normal Diet Lunak RG 1
17 Ny. Andi F L 0 297620 50 160 19.53 Normal Diet Lunak DM RG DJ 3
18 Ny. Tri Ponia 0 297865 60 166 21.77 Normal Diet Lunak RG TKTP 2
19 28-Aug-21 Ny. Siti Rahmah 1 298054 49 159 19.38 Normal Diet Lunak RG DJ 5
20 Tn. Balis S 0 142854 54 153 23.07 Normal Diet Biasa 1 Makanan untuk Keluarga
21 Tn Anang 1 142873 55 150 24.44 Normal Diet Lunak DJ 2
22 29-Aug-21 Ny. Rinda 1 287736 48 156 19.72 Normal Diet Lunak DJ 3
23 Ny. Asnidar 1 287768 50 155 20.81 Normal Diet Lunak DJ 4
24 Ny. Rista 1 288253 55 149 24.77 Normal Diet Lunak DJ 5
TB2 BB/TB
2.6244 19.05197
2.5921 17.74623
2.7889 19.72104
2.25 27.55556
2.6244 20.00457
2.3716 24.45606
2.3409 21.35931
2.8224 16.29819
2.9584 22.64738

2.3409
2.25
2.4336
2.4025
2.2201
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : September
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan TB2
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 4-Sep-21 Ny. Aminatun 1 147645 48 156 19.72 Normal Diet Cair 6 x 100 cc 1.2 2.4336
2 Tn. Sudarman 1 147646 50 171 17.09 Normal Diet Lunak DJ 1.5 2.9241
3 8-Sep-21 Tn. Daniel 0 147688 53 168 18.77 Normal Diet Lunak DJ 1.3 2.8224
4 Tn. Syarifudin 0 147694 55 153 23.49 Normal Diet Biasa 1.2 2.3409
5 10-Sep-21 Tn. Ahmadi 1 307976 53 156 21.77 Normal Diet Biasa 1.4 2.4336
6 Tn. Bony 1 308172 60 162 22.86 Normal Diet Biasa 1.1 2.6244
7 12-Sep-21 Tn. M Rody 1 308314 67 167 24.02 Normal Diet Biasa 1.3 2.7889
8 Ny. Elsa 1 309148 61 159 24.12 Normal Diet Biasa 1.5 2.5281
9 Ny. Suminah 0 298769 56 158 22.43 Normal Diet Cair 3 x 200 cc 1
10 Tn. Hadi 0 299468 58 160 22.65 Normal Diet Biasa DJ 3
11 15-Sep-21 Tn. Asnan 0 299505 56 157 22.71 Normal Diet Cair 3 x 150 cc 4
12 Ny. Ita Maryam 1 131113 60 150 26.66 Overweight Diet Lunak RG DJ 2
13 Ny. Aulia Dewi 0 126086 66 153 28.19 Obesitas Diet Lunak RG TKTP 1
14 Ny. Salma 2 127488 59 155 24.55 Normal Diet Lunak DJ 3
15 17-Sep-21 Ny. Marlina 1 131457 48 159 18.98 Normal Diet lunak 5
16 Ny. Maria Y 2 131437 55 157 22.31 Normal Diet Lunak RG TKTP 4
17 Tn. Abidin 1 131496 50 150 22.22 Normal Diet Cair 6 x 200 cc 2
18 18-Sep-21 Ny. Nuraini 2 131241 67 155 27.88 Obesitas Diet Biasa 3 Makanan untuk Keluarga
19 Tn Galis 0 143074 48 154 20.24 Normal Diet Biasa 1 Makanan untuk Keluarga 2.3716
20 Tn. Sabar 1 036855 49 156 20.13 Normal Diet Lunak DJ 2 2.4336
21 22-Sep-21 Ny. Nurlia 0 112069 55 158 22.03 Normal Diet Lunak RG TKTP 3 Alergi Ikan Tongkol 2.4964
22 Ny. Ahmad 1 143186 58 153 24.78 Normal Diet Lunak DJ 4 2.3409
23 Tn. Herwanto 1 141915 62 167 22.23 Normal Diet Lunak DJ 5 2.7889
24 25-Sep-21 Tn. Bustami 1 143385 54 157 21.91 Normal Diet Lunak DJ 1 2.4649
25 Tn. Rustam 1 143816 54 156 22.19 Normal Diet Lunak DJ 2 2.4336
26 Tn. Baharuddin 1 289255 60 157 24.34 Normal Diet Lunak DJ 3 2.4649
BB/TB
19.72387
17.09928
18.77834
23.49524
21.77844
22.86237
24.02381
24.12879
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Oktober
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan TB2
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 1-Oct-21 Tn. Febry 0 309149 52 161 20.06 Normal Diet Biasa 1.1 2.5921
2 Tn. Anas 0 309379 61 156 25.06 Normal Diet Biasa 1.2 2.4336
3 Tn. M Iqbal 1 309410 57 163 21.45 Normal Diet Biasa 1.3 2.6569
4 Ny. Rusilawati 0 147738 53 157 21.50 Normal Diet Lunak 1.4 2.4649
5 Ny. Wahidah 0 041494 62 166 22.49 Normal Diet Biasa 1.5 2.7556
6 5-Oct-21 Tn. Roni 0 144730 50 157 20.28 Normal Diet Biasa 1.2 2.4649
7 Tn. Hamdan 0 078458 55 150 24.44 Normal Diet Lunak 1.4 2.25
8 Ny. Sutiti 0 147958 59 160 23.04 Normal Diet Lunak 1.5 2.56
9 Ny. Kalsum 2 147985 63 158 25.23 Normal Diet Lunak 1.1 2.4964
10 7-Oct-21 Tn. Kube Y 1 147986 67 154 28.25 Obesitas Diet Lunak 1.3 2.3716
11 Tn. Hadi P 0 097885 51 162 19.43 Normal Diet Lunak DJ 1.2 2.6244
12 Tn. Hermansyah 0 309622 49 173 16.37 Underweight Diet Lunak DM DJ 1.4 2.9929
13 9-Oct-21 Tn. Tenjun 0 129502 58 158 23.23 Normal Diet Lunak DM RG 1
14 Tn. Sape 0 102341 55 160 21.48 Normal Diet Lunak RG DJ 2
15 Ny. Nur Asiani 0 131430 50 166 18.14 Normal Diet Lunak RG TK 4
16 10-Oct-21 Tn. Kudus 1 131772 65 172 21.97 Normal Diet Lunak DJ 5
17 Ny. Nur Ulfa 1 131903 58 169 20.30 Normal Diet Biasa 2 Makanan untuk Keluarga
18 Tn. Sudirman 0 131967 55 172 18.59 Normal Diet Cair 6 x 200 c 1
19 Tn. Supriyanto 1 299644 65 158 26.03 Overweight Diet Lunak 3
20 12-Oct-21 Ny. Florentina 0 299653 60 165 22.03 Normal Diet Lunak RG TK 2
21 Tn. Irvan O 1 300694 64 170 22.14 Normal Diet Lunak 5
22 Tn. Asmaun 2 300735 57 175 18.61 Normal Diet Lunak RG DJ 4
23 Ny. Pariyah 0 290037 52 155 21.64 Normal Diet Lunak RG TK 1 2.4025
24 15-Oct-21 Ny. Martina 0 290187 54 156 22.19 Normal Diet Lunak TKTP 2 2.4336
25 Ny. Sumani 0 190771 49 158 19.63 Normal Diet Lunak TKTP 3 2.4964
26 Ny. Hajriah 0 292652 47 149 21.17 Normal Diet Lunak TKTP 4 2.2201
27 Ny. Fatimah 0 144544 53 155 22.06 Normal Diet Biasa RG TKT 5 2.4025
28 18-Oct-21 Ny. Novianti 1 144591 55 157 22.31 Normal Diet Lunak DJ 1 2.4649
29 Ny. Vera 1 121583 58 153 24.78 Normal Diet Lunak DJ 2 2.3409
30 Ny. Yustina 0 144750 49 158 19.63 Normal Diet Lunak RG TK 3 2.4964
31 19-Oct-21 Ny. Nurkolbi 1 102675 47 154 19.82 Normal Diet Lunak DJ DM 4 2.3716
32 Ny. Sukiyem 0 144870 51 150 22.67 Normal Diet Lunak RG TK 5 2.25
BB/TB
20.06095
25.06575
21.45357
21.50189
22.49964
20.2848
24.44444
23.04688
25.23634
28.25097
19.43301
16.37208
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : November
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 2-Nov-21 Tn. Daniel 1 309627 49 156 20.13 Normal Diet Lunak 1.1
2 Tn. Sudarman 1 310386 46 157 18.66 Normal Diet Lunak 1.2
3 Tn. Abu Bakar 1 310582 58 160 22.65 Normal Diet Lunak 1.3
4 Ny. Aminatun 0 310579 55 155 22.89 Normal Diet Cair 4 x 100 cc 1.4
5 5-Nov-21 Ny. Ferlang 0 310747 52 171 17.78 Normal Diet Biasa 1.5
6 Ny. Halimah 1 311404 49 168 17.36 Normal Diet Lunak Diet lambung Rendah Lemak 1.4
7 Tn. Ngerang 1 311023 51 160 19.92 Normal Diet Lunak TKTP 1.3
8 7-Nov-21 Ny. Yanti 1 148036 61 162 23.24 Normal Diet Lunak TKTP 1.2
9 Tn. Jian P 0 086961 60 157 24.34 Normal Diet Lunak TKTP 1.5
10 Tn. Dirham 0 147986 58 161 22.37 Normal Diet Lunak 1.1
11 8-Nov-21 Ny. Qomariah 1 300661 60 160 23.43 Normal Diet Lunak RG TKTP 2
12 Ny. Farida 1 300891 60 158 24.03 Normal Diet Lunak 1
13 An. Mutiara 0 301172 35 135 0 SD Normal Diet Biasa 3 Makanan untuk Keluarga
14 Ny. Ratna 0 301539 55 168 19.48 Normal Diet Biasa RG TKTP 4
15 10-Nov-21 Ny. Ketut 0 301929 57 166 20.68 Normal Diet Lunak DJ 5
16 Tn. Arwin 1 300541 59 165 21.67 Normal Diet Lunak DJ 2
17 An. Siska A 0 302381 23 117 1 SD Normal Diet Bubur Saring 3 x 50 cc 4
18 15-Nov-21 Ny. Nurima 1 303051 58 164 21.56 Normal Diet Lunak RG TKTP 3
19 Tn. Soekasno 1 303419 60 162 22.86 Normal Diet Biasa 2 Makanan untuk Keluarga
20 Ny. Puji Lestari 1 132847 56 157 22.71 Normal Diet Lunak RG TKTP 1
21 20-Nov-21 Tn. Fitriansyah 1 141016 48 151 21.05 Normal Diet Lunak RG DJ 1
22 Ny. Sri N 1 142963 55 157 22.31 Normal Diet Lunak DJ 2
23 Ny. Nirwanti 1 107531 62 159 24.52 Normal Diet Lunak DJ 3
24 22-Nov-21 Tn. Lawai 1 295768 57 155 23.73 Normal Diet Lunak DJ 4
25 Ny. Dzuwariyah 0 295982 60 156 24.65 Normal Diet Biasa RG TKTP 5
26 Tn. Andra 1 296045 50 149 22.52 Normal Diet Lunak DJ 1
27 NY. Winda 0 296439 57 152 24.67 Normal Diet Lunak RG TKTP 2
28 25-Nov-21 Ny. Linda 0 294976 50 154 21.08 Normal Diet Lunak RG TKTP 3
29 Ny. Sumiani 2 296931 65 149 29.28 Obesitas Diet Lunak Rendah Energi DJ 4
30 Ny. Wanti 0 297332 48 151 21.05 Normal Diet Lunak RG TKTP 5
TB2 BB/TB
2.4336 20.13478
2.4649 18.66201
2.56 22.65625
2.4025 22.89282
2.9241 17.78325
2.8224 17.36111
2.56 19.92188
2.6244 23.24341
2.4649 24.34176
2.5921 22.37568

2.2801
2.4649
2.5281
2.4025
2.4336
2.2201
2.3104
2.3716
2.2201
2.2801
 LAPORAN SKRINING DAN ASUHAN GIZI RAWAT INAP
INSTALASI GIZI RSUD KUDUNGGA
TAHUN 2021
Bulan : Desember
Ruang : ICU
Skor Asuhan Gizi
No. Tanggal Nama Pasien Diet Pasien Bed Keterangan
Skrining RM BB TB/PB IMT/BB/PB/TB Status Gizi
1 4-Dec-21 Tn. Abu Hasan 0 147105 55 158 22.03 Normal Diet Lunak DM DJ 1.4
2 Tn. Jumiadi 0 148424 57 159 22.54 Normal Diet Lunak Rendah Lemak 1.2
3 Ny. Nova 0 145558 60 152 25.96 Normal Diet Lunak DM RG 1.1
4 5-Dec-21 Tn. Anjar 0 148627 49 160 19.14 Normal Diet lunak Diet Lambung RP 1.3
5 Ny. Kanisem 0 311069 45 154 18.97 Normal Diet lunak 1.5
6 Ny. Sri W 0 311103 56 152 24.23 Normal Diet Biasa 1.3
7 Tn. Modeali 0 311405 62 161 23.91 Normal Diet Lunak DM Diet Lambung 1.2
8 8-Dec-21 Tn. Bangsawan 0 311965 59 158 23.63 Normal Diet Lunak 1.1
9 Tn. Adrianus 0 312855 60 168 21.25 Normal Diet Lunak TKTP 1.4
10 Ny. Salsabiah 1 313555 51 158 20.42 Normal Diet Lunak DM 1.5
11 Ny. Muliani 0 130467 57.6 165 21.15 Normal Diet Lunak RG TKTP 1
12 15-Dec-21 Ny. Ika N 0 127014 55 170 19.03 Normal Diet Lunak DJ 2
13 Tn. Halim 0 133065 60 155 24.97 Normal Diet Lunak DJ 3
14 Tn. Sultan 1 133058 66 158 26.43 Overweight Diet Biasa DJ 4
15 17-Dec-21 Tn. Ahmad S 0 132112 63 160 24.6 Normal Diet Lunak Dm DJ 5
16 Tn. Musa 1 65953 58.5 165 21.48 Normal Diet Biasa DJ 2
17 Ny. Maria 0 133143 54 160 21.09 Normal Diet Biasa RG TKTP 1
18 Ny. Apari 1 130007 50 172 16.9 UnderweightDiet Lunak 3
19 19-Dec-21 Ny. Mursita 0 125139 48 165 17.63 Normal Diet Lunak 4
20 Tn. Balan 1 923720 55 155 22.89 Normal Diet Biasa 5 Makanan untuk Keluarga
21 Tn. Andri 1 297975 48 155 48.00 Normal Diet Biasa DJ 1
22 22-Dec-21 Ny. Yunita 1 145262 49 153 20.40 Normal Diet Lunak DJ 2
23 Tn. Hendrianus 0 145397 55 154 23.50 Normal Diet Lunak TKTP 3 Susu 2 x 200 cc
24 Tn. Andi Wijaya 0 145405 58 152 24.46 Normal Diet Biasa TKTP 4
25 Ny. Tatik 0 145512 62 159 24.52 Normal Diet Lunak RG TKTP 5
26 25-Dec-21 Ny. Hilda 0 038983 54 155 22.48 Normal Diet Lunak RG TKTP 1
27 Ny. Hajeriani 1 126756 64 149 28.83 Obesitas Diet Lunak DJ Rendah Energi 2
28 Tn. Usman 1 145819 52 158 20.83 Normal Diet Bubur saring 3 x 50 cc 3
29 28-Dec-21 Tn. Hendrikus 1 142087 57 154 24.03 Normal Diet Lunak 4
30 Ny. Rosmini 1 298576 55 156 22.60 Normal Diet Cair 3 x 100 cc 5
31 Ny. Kristina L 0 140509 53 150 23.56 Normal Diet Biasa TKTP 1
32 Ny. Fajrin 0 140591 53 155 22.06 Normal Diet Biasa RG TKTP 3
TB2 BB/TB
2.4964 22.03173
2.5281 22.54658
2.3104 25.96953
2.56 19.14063
2.3716 18.97453
2.3104 24.23823
2.5921 23.91883
2.4964 23.63403
2.8224 21.2585
2.4964 20.42942

2.4025
2.3409
2.3716
2.5281
2.4025
2.2201
2.4964
2.3716
2.4336
2.25
2.4025