Professional Documents
Culture Documents
R1KB20 9
R1KB20 9
Petugas Entri
Data
REGISTER PELAYANAN KB R/I/KB/20
Lembar 1
1 2 3 4 5 V
6 3 0 6 0 0 6 Bulan : 2023
NAMA FASKES/ Puskesmas Padang Batung 7 8 9 10 11 12
:
JARINGAN/JEJARING Kode Provinsi Kode No. Register Faskes No. Jaringan/
Kabupaten/ Jejaring Faskes
Kota
PELAYANAN BERGERAK
STATUS PESERTA KB
INFORMED CONSENT
PASCA KEGUGURAN
PASCA PERSALINAN
ISTRI
BPJS KESEHATAN
NO. TANGGAL ALAMAT NO. HANDPHONE
PEMASANGAN
PENCABUTAN
PENCABUTAN
KEGAGALAN
PEMBERIAN/
KOMPLIKASI
NAMA SUAMI
OPERATIF/
LAINNYA
TANGGAL
MANDIRI
NIK (NOMOR INDUK KEPENDUDUKAN) NAMA
BERAT
LAHIR
(Kode)
TIDAK
APBN
APBD
DAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
IRHAMNI FEBTIANTO
11 01-Jun-2023 6 3 0 6 0 2 4 2 0 9 0 0 0 0 0 3 RABIATUL ADAWIAH 02-Sep-2000 BATU BINI 3 0 0 0 4 1 0 0 1 0 0 1
R
JL BREGJEND H HASAN BASERY
12 01-Jun-2023 ABDUL MUTI 6 3 0 6 0 2 5 3 0 8 8 6 0 0 0 5 MASLIANI 13-Aug-1986 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
AHMAD IMANOL
18 01-Jun-2023 6 3 0 6 0 2 6 7 1 2 9 4 0 0 0 1 SAIDAH 27-Dec-1994 BATU BINI 1 0 1 0 3 1 0 0 1 0 0 0
YAQIN
JL BREGJEND H HASAN BASERY
19 01-Jun-2023 AKHMAD ROYANI 6 3 0 6 0 2 6 7 1 2 7 4 0 0 0 2 SALMIAH 27-Dec-1974 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
DESA PADANG BATUNG KEC
20 01-Jun-2023 SAMSUN 6 3 0 8 0 5 5 6 0 5 7 5 0 0 0 2 MAISARAH 16-May-1975 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
JL BREGJEND H HASAN BASERY
21 01-Jun-2023 YAHDI FAKHRIANI 6 3 0 6 0 2 4 8 1 2 8 1 0 0 0 1 GINA ARIYANTI 08-Dec-1981 3 0 0 0 3 1 0 0 1 0 0 0
PADANG BATUNG
DESA MALILINGIN
23 01-Jun-2023 AHMAD BASAIBAN 6 3 0 6 0 2 4 2 0 8 8 1 0 0 0 1 MAIMANAH 02-Aug-1979 3 1 0 0 0 0 1 1 0 0 1
JL MUHAMMAD NOR
29 01-Jun-2023 RAMMADI 6 3 0 6 0 2 4 1 0 7 8 6 0 1 1 0 MILDAWATI 01-Jul-1986 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
JL BREGJEND H HASAN BASERY
30 01-Jun-2023 ZULKIPLI 6 3 0 6 0 2 5 9 1 0 8 3 0 0 0 1 HALIMATUS SAIDIAH 19-Oct-1983 3 0 0 0 3 1 0 0 1 0 0 0
PADANG BATUNG
JL BREGJEND H HASAN BASERY
31 01-Jun-2023 MARHANI 6 3 0 6 0 2 6 1 0 6 9 0 0 0 0 1 MASLIANA 21-Jun-1990 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
JL BREGJEND H HASAN BASERY
32 01-Jun-2023 ROMI MAHRA 6 3 0 6 0 2 6 0 1 0 9 6 0 0 0 1 HELDA NORLIANI 20-Oct-1996 1 0 1 0 3 1 0 0 1 0 0 0
PADANG BATUNG
MUHAMMAD
37 01-Jun-2023 6 3 0 6 0 5 4 1 0 1 9 5 0 0 0 3 WARDATUL JANNAH 01-Jan-1995 BATU BINI 3 0 0 0 3 1 0 0 1 0 0 0
ANSHARI
JL BREGJEND H HASAN BASERY
38 01-Jun-2023 SYAHRANI 6 3 0 6 0 2 5 0 0 1 8 1 0 0 0 2 SYARKIAH 10-Jan-1981 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
DESA PADANG BATUNG KEC
39 01-Jun-2023 SYAHRIADI 6 3 0 6 0 2 4 9 0 1 7 5 0 0 0 2 SITI ZUBAIDAH 09-Jan-1975 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
JL BREGJEND H HASAN BASERY
40 01-Jun-2023 M YANI 6 3 0 6 0 2 4 7 0 8 8 4 0 0 0 4 RAHMAYATI 07-Aug-1984 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
JL BREGJEND H HASAN BASERY
41 01-Jun-2023 AHMAD ZAKIRIN 6 3 0 6 0 2 4 3 0 8 9 4 0 0 0 2 NORHAYATI AMIRA 03-Aug-1994 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
JL BREGJEND H HASAN BASERY
42 01-Jun-2023 SURIANI 6 3 0 6 0 2 4 4 0 8 7 9 0 0 0 1 SUWARNI 04-Jun-1979 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
MUHAMMAD ABDUL
65 01-Jun-2023 6 3 0 6 0 2 4 2 1 1 0 2 0 0 0 1 SITI HELMAH 02-Nov-2002 BATU BINI 3 0 0 0 3 1 0 0 1 0 0 0
RAUF
66 01-Jun-2023 SAIPULAH 6 3 0 6 0 2 6 1 1 1 9 4 0 0 0 3 WARTI 24-Nov-1994 DESA MALILINGIN 3 1 0 0 8 0 0 1 1 0 0 1
BATU BINI
75 01-Jun-2023 FITRIADI 6 3 0 6 0 2 6 5 0 5 9 1 0 0 0 4 LATIFAH 25-May-1991 3 0 0 0 3 1 0 0 1 0 0 0
MUHAMMAD
129 14-Jun-2023 6 3 0 6 0 5 4 1 0 1 9 5 0 0 0 3 WARDATUL JANNAH 01-Jan-1995 BATU BINI 3 0 0 0 3 1 0 0 1 0 0 0
ANSHARI
JL MUHAMMAD NOR
132 14-Jun-2023 MARLIANSYAH 6 3 0 6 0 2 4 1 0 7 8 2 0 1 0 9 HERLINA 01-Jul-1982 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
PANIUNGAN
158 14-Jun-2023 SYARIFUDDIN 6 3 0 6 0 2 4 1 0 8 7 9 0 0 0 6 SABARIAH 01-Aug-1979 3 1 0 0 8 0 0 1 1 0 0 1
DESA MALILINGIN
162 14-Jun-2023 MUHAMMAD RIJANI 6 3 0 6 0 2 5 8 0 8 9 4 0 0 0 1 JANIAH 18-Aug-1994 JL.MUHAMMAD NOOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
184 14-Jun-2023 UDIN 6 3 0 6 1 0 6 2 0 2 8 7 0 0 0 1 PATHUL JANNAH 22-Feb-1987 JL. MUHAMMAD NOOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
MUHAMMAD
201 14-Jun-2023 6 3 0 6 0 2 4 1 0 7 6 8 0 2 1 1 JARNIAH 01-Jul-1968 BATU BINI 3 0 0 0 4 1 0 0 1 0 0 0
RAMBELI
ABDUL HAVEZ
202 14-Jun-2023 6 3 0 6 0 2 4 7 0 9 9 1 0 0 0 2 HERLYANI EDIAWATI 03-Oct-1991 BATU BINI 1 0 1 0 3 1 0 0 1 0 0 0
HIDAYAT
JL MUHAMMAD NOR
203 14-Jun-2023 DARDA'I 6 3 0 6 0 2 4 8 0 6 8 5 0 0 0 5 NORAIDA SANTI 08-Jun-1985 3 0 0 0 4 1 0 0 1 0 0 0
BATU LAKI
204 14-Jun-2023 ARMAWI 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 SITI JUBAIDAH 04-Feb-1997 TAMBAK PIPI'I BATU LAKI 1 0 0 0 4 1 0 0 1 0 0 0
JL MUHAMMAD NOR
215 14-Jun-2023 RAMMADI 6 3 0 6 0 2 4 1 0 7 8 6 0 1 1 0 MILDAWATI 01-Jul-1986 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
IRHAMNI FEBTIANTO
222 14-Jun-2023 6 3 0 6 0 2 4 2 0 9 0 0 0 0 0 3 RABIATUL ADAWIAH 02-Sep-2000 BATU BINI 3 0 0 0 4 1 0 0 1 0 0 1
R
MUHAMMAD
225 14-Jun-2023 6 3 0 6 0 2 4 1 0 2 9 3 0 0 0 2 WAHYU MIRANTI 01-Feb-1993 JL MUHAMAD NOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
RUSLAN
MUHAMMAD
237 14-Jun-2023 6 3 0 6 0 2 4 2 0 8 8 7 0 0 0 1 SITI KHADIJAH 02-Aug-1987 MAWANGI 3 0 0 0 3 1 0 0 1 0 0 0
YADIANSYAH
MUHAMMAD
244 14-Jun-2023 6 3 0 6 0 2 5 8 0 8 9 5 0 0 0 1 MASKANAH 18-Feb-1995 BATU BINI 3 0 0 0 3 1 0 0 1 0 0 0
RAMDAN
JL MUHAMMAD NOR
254 14-Jun-2023 SYAMSIR ALAMSYAH 6 3 0 6 0 2 4 1 0 7 9 4 0 0 6 1 RAHMIATUL JANNAH 07-Jul-1994 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
255 14-Jun-2023 AGUS SALIM 6 3 0 6 0 2 5 7 0 4 8 2 0 0 0 2 MASDALINA 17-Apr-1982 JL MUHAMMAD NOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
256 14-Jun-2023 SIRAJUDIN 6 3 0 6 0 2 4 8 0 8 8 3 0 0 0 1 SITI RAHMAH 08-Aug-1983 LOKBAHAN MALILINGIN 3 0 0 0 4 1 0 0 1 0 0 0
MUHAMMAD
258 14-Jun-2023 6 3 0 5 0 8 5 8 1 0 1 1 0 0 0 1 HERLINDA 17-Apr-2001 LOKBAHAN MALILINGIN 3 0 0 0 4 1 0 0 1 0 0 0
SAMLANI
JL MUHAMMAD NOR
259 14-Jun-2023 NURDIN 6 3 0 6 0 2 4 1 0 7 7 7 0 0 9 3 ZUBAIDAH 01-Jul-1977 3 0 0 0 4 1 0 0 1 0 0 0
BATU LAKI
JL H ABDUL KADIR
263 14-Jun-2023 SURYA HARYADI 6 3 0 6 0 2 5 5 0 1 8 0 0 0 0 2 UMI HANI 15-Jan-1980 3 0 0 0 3 1 0 0 1 0 0 0
DURIAN RABUNG
SYAMSUL BAHRI
269 14-Jun-2023 6 3 0 6 0 2 4 1 0 7 7 7 0 1 5 5 RAMLAH 01-Jul-1977 MANDAPAI 3 0 0 0 4 1 0 0 1 0 0 0
YUSERI
JL MUHAMMAD NOR
273 14-Jun-2023 SAMSUL BAHRI 6 3 0 6 0 2 4 8 0 3 9 1 0 0 0 1 NORHAYATI 08-Mar-1991 3 0 0 0 4 1 0 0 1 0 0 0
BATU LAKI
274 14-Jun-2023 ARIFIN 6 3 0 6 0 2 4 1 0 7 7 4 0 1 0 0 INUR 01-Jul-1974 JL. MUHAMMAD NOOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
PANIUNGAN
299 14-Jun-2023 AHMADI 6 3 0 6 0 2 5 5 0 3 8 9 0 0 0 1 ASLAMIAH 15-Mar-1989 3 0 0 0 4 1 0 0 1 0 0 0
DESA MALILINGIN
MUHAMMAD NOR
307 14-Jun-2023 6 3 0 3 0 1 6 9 0 9 9 6 0 0 0 3 RAYHANI FATIMAH 29-Sep-1996 JL H BUSRA MALUTU 3 0 0 0 4 1 0 0 1 0 0 0
FAZLI
308 14-Jun-2023 MUHAMMAD RIDUAN 6 3 0 6 0 2 7 0 1 1 9 8 0 0 0 2 HASNAWATI 30-Oct-1998 TAMBAK PIPI'I BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
BATU BINI
321 14-Jun-2023 FITRIADI 6 3 0 6 0 2 6 5 0 5 9 1 0 0 0 4 LATIFAH 25-May-1991 3 0 0 0 3 1 0 0 1 0 0 0
323 14-Jun-2023 MIFTAH FARID 6 3 0 6 0 5 5 7 0 4 8 9 0 0 0 2 IKA CITRA MEGA P 17-Apr-1989 JL H BUSRA MALUTU 3 0 0 0 3 1 0 0 1 0 0 0
325 14-Jun-2023 AHMAD SODIKIN 6 3 0 6 0 2 4 1 0 7 8 7 0 0 8 0 SALABIYAH 01-Jul-1987 JL. MUHAMMAD NOOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
LOKBAHAN MALILINGIN
339 14-Jun-2023 SAMLAN 6 3 0 6 0 6 6 0 0 8 0 0 0 0 0 3 NOR IKNA MAILIA 20-Aug-2000 3 0 0 0 4 1 0 0 1 0 0 0
JL MUHAMMAD NOR
341 14-Jun-2023 RIZKI FADILAH 6 3 0 6 0 2 4 1 0 7 9 3 0 0 7 4 MARINI 01-Jul-1993 1 0 1 0 4 1 0 0 1 0 0 0
BATU LAKI
357 14-Jun-2023 M. IDRIS 6 3 0 6 0 2 4 1 0 7 8 3 0 1 0 1 SITI AMINAH 01-Jul-1983 JL MUHAMAD NOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
M ANDRIYANI
361 14-Jun-2023 6 3 0 6 0 2 5 1 0 6 9 7 0 0 0 1 NORMALASARI 11-Jun-1997 MAWANGI 3 0 0 0 4 1 0 0 1 0 0 0
YULIZAR
AHMAD IMANOL
376 14-Jun-2023 6 3 0 6 0 2 6 7 1 2 9 4 0 0 0 1 SAIDAH 27-Dec-1994 BATU BINI 1 0 1 0 3 1 0 0 1 0 0 0
YAQIN
JL MUHAMMAD NOR
383 14-Jun-2023 SAMSUL BAHRI 6 3 0 6 0 2 4 2 0 5 8 5 0 0 0 2 MARIANI 02-May-1985 3 0 0 0 4 1 0 0 1 0 0 0
BATU LAKI
JL H ABDUL KADIR
407 14-Jun-2023 AKHMAD KARIADI 6 3 0 6 0 2 6 5 1 2 8 9 0 0 0 2 KHAIRIAH 25-Dec-1989 3 0 0 0 4 1 0 0 1 0 0 0
DURIAN RABUNG
408 14-Jun-2023 SYARIFULLAH 6 3 0 6 0 2 4 2 0 2 9 2 0 0 0 2 SRI MARIATI 02-Feb-1992 JL MUHAMMAD NOR BATU LAKI 3 1 0 0 8 0 0 1 1 0 0 1
JL MUHAMMAD NOR
418 14-Jun-2023 MUHAMMAD TABERI 6 3 0 6 0 2 5 6 1 1 7 6 0 0 0 1 RUSDIANA 16-Nov-1976 3 0 0 0 4 1 0 0 1 0 0 0
BATU LAKI
JL MUHAMMAD NOR
421 14-Jun-2023 RAYANI 6 3 0 6 0 2 5 3 0 3 8 0 0 0 0 2 MASITUN 13-Mar-1980 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
JL BREGJEND H HASAN BASERY
422 14-Jun-2023 MARHANI 6 3 0 6 0 2 6 1 0 6 9 0 0 0 0 1 MASLIANA 21-Jun-1990 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
MUHAMMAD
423 14-Jun-2023 6 3 0 6 0 2 4 9 0 6 9 6 0 0 0 2 WIDYA PUTERI 09-Jun-1996 JL.H.ZAKARIA 3 0 0 0 4 1 0 0 1 0 0 0
SAPUANI
JL MUHAMMAD NOR
426 14-Jun-2023 RUDI 6 3 0 6 0 2 5 5 0 2 8 6 0 0 0 2 SITI FAUZIAH 15-Feb-1986 3 1 0 0 8 0 0 1 1 0 0 1
BATU LAKI
JL BREGJEND H HASAN BASERY
427 14-Jun-2023 M YANI 6 3 0 6 0 2 4 7 0 8 8 4 0 0 0 4 RAHMAYATI 07-Aug-1984 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
DESA PADANG BATUNG KEC
428 14-Jun-2023 MUHAMMAD BAKERI 6 3 0 6 0 2 5 0 1 1 7 3 0 0 0 2 HELMAH 10-Nov-1973 3 0 0 0 4 1 0 0 1 0 0 0
PADANG BATUNG
429 14-Jun-2023 KESUMA WARDANI 6 3 0 6 0 5 5 2 1 1 9 5 0 0 0 9 MARLIAN 12-Nov-1995 JL. MUHAMMAD NOOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
MUHAMMAD NOOR
438 14-Jun-2023 6 3 0 6 0 5 4 8 0 6 9 9 0 0 0 3 HELMA FITRIANI 01-Jul-1997 JL MUHAMMAD NOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
HIDAYAT
PANIUNGAN
445 14-Jun-2023 FAHRUR RAJI 6 3 0 3 1 7 4 1 0 7 0 6 0 0 0 8 FITRIANI 10-Sep-2007 3 0 0 0 4 1 0 0 1 0 0 0
DESA MALILINGIN
446 14-Jun-2023 JUARDI 6 3 0 6 0 2 4 1 0 4 9 4 0 0 0 2 SAMDANAH 30-Apr-1994 DESA MALILINGIN 3 0 0 0 3 1 0 0 1 0 0 0
452 14-Jun-2023 IBNU ARABI 6 3 0 6 0 2 4 1 0 7 9 1 0 0 7 3 HUSNUL HATIMAH 09-Mar-1990 JL MUHAMAD NOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
JL H ABDUL KADIR
459 14-Jun-2023 JUMALI 6 3 0 6 0 2 6 2 1 1 8 6 0 0 0 1 YULIANI 22-Nov-1986 3 0 0 0 4 1 0 0 1 0 0 0
DURIAN RABUNG
JL MUHAMMAD NOR
469 14-Jun-2023 LAJI 6 4 0 9 0 2 6 5 0 2 7 6 0 0 0 1 INA 25-Feb-1976 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
JL BREGJEND H HASAN BASERY
470 14-Jun-2023 AHMAD RIYADI 6 3 0 6 0 2 5 3 0 3 9 9 0 0 0 1 RISKA MULYANA 13-Mar-1999 3 0 0 0 3 1 0 0 1 0 0 0
PADANG BATUNG
482 14-Jun-2023 ARDI ANSYAH 6 3 0 6 0 2 5 0 0 1 9 0 0 0 0 3 MERJANIA ASDINA SARI 10-Jan-1990 JL H JAKARIA JELATANG 3 0 0 0 4 1 0 0 1 0 0 0
486 14-Jun-2023 MASLAN B 6 3 0 6 0 2 4 1 0 7 7 7 0 0 9 2 SITI KARTINAH 01-Jul-1977 TAMBAK PIPII BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
487 14-Jun-2023 MUHAMMAD HATA 6 3 0 3 0 2 4 5 0 9 8 4 0 0 0 2 SITI HARIPAH MUDIATI 05-Sep-1984 DESA MALILINGIN 3 0 0 0 4 1 0 0 1 0 0 0
MUHAMMAD
489 14-Jun-2023 6 3 0 6 0 2 4 7 0 8 8 6 0 0 0 2 RAHMAWATI 07-Aug-1986 JL H BUSRA MALUTU 3 0 0 0 4 1 0 0 1 0 0 0
SAUKANI
494 14-Jun-2023 NORDIANSYAH 6 3 0 6 0 2 6 2 0 4 8 3 0 0 0 1 MARIA ULFAH 24-Apr-1987 JL MUHAMMAD NOR BATU LAKI 3 1 0 0 8 0 0 1 1 0 0 1
AHMAD GAZALI
501 14-Jun-2023 6 3 0 6 0 2 4 8 0 2 9 2 0 0 0 2 SUSILAWATI 08-Feb-1992 JL H ZAKARIA JELATANG 3 0 0 0 4 1 0 0 1 0 0 0
RAHMAN
511 14-Jun-2023 SARDI 6 3 0 6 0 2 6 1 0 1 9 0 0 0 0 1 EKO MUJI ASTUTI 21-Jan-1990 TAMBAK PIPI'I BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
PANIUNGAN
514 14-Jun-2023 BAHDIYANI 6 3 0 6 0 2 4 9 1 1 0 0 0 0 0 1 MULIANI 09-Nov-2000 3 0 0 0 4 1 0 0 1 0 0 0
DESA MALILINGIN
JL MUHAMMAD NOR
526 14-Jun-2023 MUHAMMAD FAHMI 6 3 0 6 0 2 4 4 0 3 6 1 0 0 0 3 ILMA TINA 01-Jul-1991 1 0 1 0 3 1 0 0 1 0 0 0
BATU LAKI
JL H ABDUL KADIR DURIAN
527 14-Jun-2023 YUSRAN 6 3 0 6 0 2 5 5 1 0 8 0 0 0 0 2 NOR ASNIATI 15-Oct-1980 3 0 0 0 3 1 0 0 1 0 0 0
RABUNG
JL MUHAMMAD NOR
529 14-Jun-2023 MUHAMMAD RAYANI 6 3 0 6 0 2 5 4 0 9 0 3 0 0 0 1 RUSMINA SARI 14-Sep-2003 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
549 14-Jun-2023 MASRUDI 6 3 0 6 0 1 4 1 0 7 8 8 0 0 3 6 NIA KURNIA 01-Jul-1988 JL MUHAMAD NOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
JL MUHAMMAD NOR
573 14-Jun-2023 ISRA 6 3 0 6 0 2 4 6 0 2 7 6 0 0 0 3 SINAH 06-Feb-1976 3 0 0 0 4 1 0 0 1 0 0 0
BATU LAKI
575 14-Jun-2023 WASUL FALAH 6 3 0 6 0 2 4 1 0 7 8 0 0 1 6 6 BAINAH 01-Jul-1980 JL MUHAMAD NOR BATU LAKI 3 0 0 0 4 1 0 0 1 0 0 0
597 14-Jun-2023 ASIAN SAID 6 3 0 6 0 2 6 6 0 9 9 5 0 0 0 1 SITI AISYAH 26-Sep-1995 JL. H BUSRA MALUTU 3 0 0 0 4 1 0 0 1 0 0 0
598 14-Jun-2023 WAHYUDI 6 3 0 6 0 2 4 9 1 1 9 1 0 0 0 4 HAMDAH 09-Nov-1991 DESA MALILINGIN 1 0 1 0 4 1 0 0 1 0 0 0
613 14-Jun-2023 MUHAMMAD LUTFI A 6 3 0 6 0 2 4 1 0 1 9 3 0 0 0 9 LAILA SAPITRI 01-Oct-1995 TAMBAK PIPI'I BATU LAKI 3 1 0 0 8 0 0 1 1 0 0 1
616 14-Jun-2023 SIYAM DONO 1 5 0 3 0 9 6 0 7 9 0 0 0 0 0 3 SRI MILDA WATI 27-Jul-1990 JL H ZAKARIA JELATANG 3 0 0 0 4 1 0 0 1 0 0 0
JL MUHAMMAD NOR
640 14-Jun-2023 ASNAN 6 3 0 6 0 2 4 1 0 7 8 7 0 0 5 8 MASLIANA 01-Jul-1987 3 0 0 0 3 1 0 0 1 0 0 0
BATU LAKI
MUHAMMAD
650 14-Jun-2023 6 3 0 6 0 2 5 5 0 7 8 3 0 0 0 1 MUSTAIDAH 15-Jul-1983 BATU BINI 3 0 0 0 4 1 0 0 1 0 0 0
FAHRUDIN
SAPRUDIN
655 14-Jun-2023 6 3 0 6 0 2 4 1 0 7 8 5 0 1 1 9 SARINAH 01-Jul-1985 BATU BINI 3 0 0 0 4 1 0 0 1 0 0 0
AMARULLAH
MUHAMMAD ABDUL
661 14-Jun-2023 6 3 0 6 0 2 4 2 1 1 0 2 0 0 0 1 SITI HELMAH 02-Nov-2002 BATU BINI 3 0 0 0 3 1 0 0 1 0 0 0
RAUF
MUHAMMAD
676 15-Jun-2023 6 3 0 6 0 2 4 1 0 7 6 8 0 2 1 1 JARNIAH 01-Jul-1968 BATU BINI 3 0 0 0 4 1 0 0 1 0 0 0
RAMBELI
SYAMSUL BAHRI
679 15-Jun-2023 6 3 0 6 0 2 4 1 0 7 7 7 0 1 5 5 RAMLAH 01-Jul-1977 MANDAPAI 3 0 0 0 4 1 0 0 1 0 0 0
YUSERI
SAPRUDIN
690 15-Jun-2023 6 3 0 6 0 2 4 1 0 7 8 5 0 1 1 9 SARINAH 01-Jul-1985 BATU BINI 3 0 0 0 4 1 0 0 1 0 0 0
AMARULLAH
1) Keterangan Kode
STATUS PESERTA KB KODE JENIS ALOKON (Diisi Pada Jenis Tindakan dan Kasus)
1 : Peserta KB Baru 3 : Peserta KB Ulangan 1 : Suntikan 1 Bulanan 3 : Suntikan 3 Bulanan 5 : Pil Progestin 7 : Implan 1 Batang 9 : IUD 11 : Tubektomi
2 : Peserta KB Ganti 4 : Komplikasi 2 : Suntikan 3 Bulanan 4 : Pil Kombinasi 6 : Kondom 8 : Implan 2 Batang 10 : Vasektomi
2) SELAIN STATUS PESERTA KB, JENIS TINDAKAN DAN KASUS DIISI TANDA CENTANG (V)
1. Petugas Entri Lamp.R/I/KB/20
Data LAMPIRAN R/I/KB/20 Lembar 20
1 2 3 4 5 V
6 3 0 6 0 0 6 Bulan : 2023
NAMA FASKES/ Puskesmas Padang Batung 7 8 9 10 11 12
:
JARINGAN/JEJARING Kode Provinsi Kode No. Register Faskes No. Jaringan/
Kabupaten/ Jejaring Faskes
Kota
PEMBERIAN
PEMBERIAN INFORMED PB DAN KESERTAAN JKN INFORMED CONSENT
METODE
NO. CONSENT (Untuk Peserta KB
KONTRASEPSI
(Untuk PB) PB PASCA PB PASCA Ulangan) PELAYANAN ULANG KOMPLIKASI BERAT
GANTI CARA PENCABUTAN KEGAGALAN
PERSALINAN KEGUGURAN
PB JKN PB NON JKN TOTAL PB
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 PIL 0 0 0 0 0 0 0 0 1 0 0
2 PIL 0 0 0 0 0 0 0 0 1 0 0
3 PIL 0 0 0 0 0 0 0 0 1 0 0
4 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
5 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
6 PIL 0 1 0 1 1 0 0 0 0 0 0
7 PIL 0 1 0 1 1 0 0 0 0 0 0
8 PIL 0 0 0 0 0 0 0 0 1 0 0
9 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
10 PIL 0 0 0 0 0 0 0 0 1 0 0
11 PIL 0 0 0 0 0 0 0 0 1 0 0
12 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
13 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
14 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
15 PIL 0 0 0 0 0 0 0 0 1 0 0
16 PIL 0 0 0 0 0 0 0 0 1 0 0
17 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
18 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
19 SUNTIKAN 0 0 0 0 0 0 0 0 1 0 0
20 SUNTIKAN 0 1 0 1 1 0 0 0 0 0 0
21 PIL 0 0 0 0 0 0 0 0 1 0 0
22 IMPLAN 0 0 0 0 0 0 1 0 1 0 0
JUMLAH 8 54 4 58 54 0 64 12 633 0 0 0
NIP/NRP
* Coret yang tidak perlu