Format Lansia PKM Mila 2023

KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :
Sasaran Lansia Jumlah Kunjungan Lans
Jumlah Jmlh Desa Jumlah Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-69
No Nama Desa Posyandu
Kelompok Panti
Lansia Wredha
L P Total ( L + P ) L P
L P (L+P) L P (L+P) L P (L+P) L P ( L + P) Jumlah
B L B L (B+ (%) B L B L
L)
1 2 3 4 5 6
1 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
2 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
3 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
4 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
5 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
6 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
7 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
8 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
9 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
10 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
11 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
12 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
13 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
14 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
15 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
16 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
17 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
18 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
19 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
20 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
21 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
22 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
23 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
24 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
25 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
26 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
Jumlah 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
Jumlah Kunjungan Lansia Kegiatan sehari-hari
60-69 > 70 Total Kunjungan Kemandirian Lansia IMT

Ggn ME
Total ( L + P ) L P Total ( L + P ) 45 - > 70 > 60 A B C Lebih Normal
Jumlah Jumlah
(%) B L B L (B (%) L P (L+P) (%) L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (L+P) (%) L P
(B+L) +L)
6 7 8 9
0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! #DIV/0! #DIV/0! 0 #DIV/0!
0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 113.00 #DIV/0! #DIV/0! 0 #DIV/0!

0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 284.20 30.01 11.69 727 9.7899272825
0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! #DIV/0! #DIV/0! 0 0 727 #DIV/0! 0 0

Jumlah Lansia dengan Kelainan
IMT Tekanan Darah

Hb Kurang Kolesterol tinggi DM As. Urat tinggi
Normal Kurang Tinggi Normal Rendah
(L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P)
9 10 11 12 13 14
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0
0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0 #DIV/0! 0

0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0 0 0 0 0
0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0

Pengobatan
Konseling
Pemberdayaan Jumlah Panti

As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Penyuluhan
Lansia Wredha dibina
B L S
(%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) (+) (-) (+) (-)
14 15 16 17 18 19 20 21 22 24 25 26
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 0 0 99 0 0
#DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0! 0 #DIV/0!

0 0 0 0 0 0 0 0 0 0 0
#DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 #DIV/0! 0 0 0 0

Jumlah
Kunjungan Ket.
Rumah
27 28
0 0
KABUPATEN Pidie
PUSKESMAS Mila
KECAMATAN Mila
BULAN Febuari
Sasaran Lansia Jumlah Kunjungan Lansia
Jumlah
Jumlah Jmlah Desa Jumlah Panti 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-69 >
No Nama Desa Kelompok
Posyandu Wredha
Lansia L P Total ( L + P ) L P Total ( L + P ) L
L P (L+P) L P (L+P) L P (L+P) L P ( L + P) Jumlah Jumlah
B L B L (B (%) B L B L (B (%) B
1 2 3 4 5 +L) 6 +L)
1 Ara Bungkok 1 1 1 1 26 32 58 10 14 24 7 13 20 43 59 102 0 0 8 0 8 14 1 0 5 0 6 25 2
2 Blang 1 1 1 1 27 32 59 11 14 25 7 13 20 45 59 104 0 0 9 0 9 15 0 0 6 0 6 24 0
3 Kumbang 1 1 1 1 45 50 95 20 25 45 14 24 38 79 99 178 5 0 12 0 17 18 9 0 16 0 25 56 3
4 M Ilot 1 1 1 1 42 44 86 16 20 36 11 18 29 69 82 151 1 0 6 0 7 8 0 0 9 0 9 25 4
5 Blang Cut 1 1 1 1 26 45 71 10 15 25 12 8 20 48 68 116 0 0 11 0 11 15 0 0 14 0 14 56 0
JUMLAH 5 5 5 5 166 203 369 67 88 436 51 76 127 284 367 651 6 0 46 0 52 14 10 0 50 0 60 13 9
Mengetahui
Kepala Puskesmas
Yunita. SKM
Nip: 197707 16200801 2001
Kunjungan Lansia Kegiatan sehari-hari
> 70 Total Kunjungan Kemandirian Lansia IMT

Ggn ME
L P Total ( L + P )
Jumlah 45 - > 70 > 60 A B C Lebih Normal Kurang Tinggi
(L+ (L+ (L+
L B L (B (%) L P (L+P) (%) L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (%) L P (%) L P (%) L P
P) P) P)
+L) 7 8 9
0 2 0 4 20 3 15 18 17.647058823529 3 7 10 10 100.00 0 0.00 0 0.00 0 0 0 0 0 0 3 7 10 55.55555555556 0 0 0 0 1 4
0 6 0 6 30 0 21 21 20.192307692308 0 12 12 12 100.00 0 0.00 0 0.00 0 0 0 2 2 9.52380952 0 10 10 47.61904761905 0 0 0 0 0 3
0 6 0 9 23.6842105263 17 34 51 28.651685393258 12 22 34 34 100.00 0 0.00 0 0.00 0 0 0 0 0 0 11 21 32 62.74509803922 1 1 2 3.92156863 7 6
0 8 0 12 41.3793103448 5 23 28 18.543046357616 4 17 21 21 100.00 1 4.76 0 0.00 0 0 0 0 0 0 4 17 21 75 0 0 0 0 3 7
0 5 0 5 25 0 30 30 25.862068965517 0 19 19 19 100.00 0 0.00 0 0.00 0 0 0 1 1 3.33333333 0 18 18 60 0 0 0 0 0 4
0 27 0 36 27.806427 25 123 148 102.896167 19 77 96 96 100.00 1 1.04 0 0.00 0 0 0 3 3 2.02702703 18 73 91 300.9197012138 1 1 2 3.92156863 11 24
Tekanan Darah
Hb Kurang Kolesterol tinggi DM As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan
Tinggi Normal Rendah
(L+P (L+ (L+P (L+P (L+ (L+ (L+P (L+ (L+ (L+
(%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P
) P) ) ) P) P) ) P) P) P)
10 11 12 13 14 15 16 17
5 27.7777777778 2 3 5 27.7777777778 0 0 0 0 0 0 0 0 0 1 1 5.555555556 0 3 3 16.66666667 0 2 2 11.11111 0 0 0 0 0 0 0 0 0 0 0
3 14.2857142857 0 9 9 42.8571428571 0 0 0 0 0 0 0 0 0 0 2 9.523809524 0 3 3 14.28571429 0 3 3 14.28571 0 0 0 0 0 0 0 0 0 0 0
13 25.4901960784 5 16 21 41.1764705882 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 3.921568627 3 2 5 9.803922 0 0 0 0 0 0 0 0 0 2 2
10 35.7142857143 1 10 11 39.2857142857 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 7.142857143 1 3 4 14.28571 0 0 0 0 0 1 1 3.5714286 0 0 0
4 13.3333333333 0 15 15 50 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 6.666666667 0 2 2 6.666667 0 0 0 0 0 0 0 0 0 0 1
35 116.60130719 8 53 61 201.097105509 0 0 0 0 0 0 0 0 0 1 3 15.07936508 1 11 12 48.68347339 4 12 16 56.15313 0 0 0 0 0 1 1 3.5714286 0 2 3

Pengobatan
Konseling Jumlah
Pemberdayaan Jumlah Panti
Penyuluhan Kunjungan Ket.
Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Lansia Wredha dibina
Rumah
(L+P (L+ B L S
(%) L P (%) L P (%) (+) (-) (+) (-)
) P)
17 18 19 20 21 22 24 25 26 27 28
0 0 1 1 5.5555556 3 0 3 16.666667 3 7 0 0 10 0 0 0 0 0 0 0
0 0 1 1 4.7619048 0 3 3 14.285714 0 12 0 0 12 0 0 0 0 0 0 0
3.9215686 0 0 0 0 9 16 25 49.019608 12 22 0 0 34 0 0 0 0 0 0 0
0 0 0 0 0 2 12 14 50 4 17 0 0 21 0 0 0 0 0 0 0
3.3333333 0 1 1 3.3333333 0 13 13 43.333333 0 19 0 0 19 0 0 0 0 0 0 0
7.254902 0 3 3 13.650794 14 44 58 173.30532 19 77 0 0 96 0 0 0 0 0 0 0

KABUPATEN Pidie
PUSKESMAS Mila
KECAMATAN Mila
BULAN Maret
Sasaran Lansia
Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70)

Jumlah Jumlah Panti
No Nama Desa Jumlah Desa Kelompok
Posyandu Wredha
Lansia
L P (L+P) L P (L+P) L P (L+P) L P ( L + P)
1 2 3 4 5
1 Dayah Andeue 1 1 1 0 64 67 131 24 29 53 17 28 45 105 124 229
2 Lhok Lubu 1 1 1 0 19 22 41 7 9 16 5 9 14 31 40 71
3 Mesjid Andeue 1 1 1 0 39 44 83 15 20 35 11 18 29 65 82 147
4 Pulo Tanjong 1 1 1 0 34 38 72 13 16 29 9 16 25 56 70 126
5 Dayah Sinthop 1 1 1 0 56 62 118 19 26 45 11 12 23 86 100 186
JUMLAH 5 5 5 0 212 233 445 78 100 178 53 83 136 343 416 759
Mengetahui
Kepala Puskesmas
_Yunita.SKM
Nip: 197707 16200801 2001
Jumlah Kunjungan Lansia
45-59 60-69 > 70 Total Kunjungan
L P Total ( L + P ) L P Total ( L + P ) L P Total ( L + P ) 45 - > 70

Jumlah Jumlah
Jumlah B
B L B L (%) B L L (%) B L B L (B+ (%) L P (L+P) (%)
(B+L)
(B+L) L)
6
0 0 8 0 8 6 3 0 7 0 10 19 8 0 8 0 16 35.5555555556 11 23 34 14.8471615720524
3 0 14 0 17 41 2 0 8 0 10 63 2 0 5 0 7 50 7 27 34 47.887323943662
2 0 6 0 8 10 1 0 10 0 11 31 2 0 6 0 8 17.77778 5 22 27 18.3673469387755
3 0 10 0 13 18 2 0 6 0 8 28 1 0 5 0 6 26.66667 6 21 27 21.4285714285714
0 0 7 0 7 6 4 0 19 0 23 51 1 0 5 0 6 26.0869565217 5 31 36 19.3548387096774
8 0 45 0 53 81 12 0 50 0 62 192 14 0 29 0 43 31.6176470588 34 124 158 20.8168642951252

Kegiatan sehari-hari
Kemandirian Lansia IMT

Ggn ME
> 60 A B C Lebih Normal Kurang
L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (L+P) (%) L P (L+P) (%) L P (L+P) (%)
7 8 9
11 15 26 26 100.00 0 0.00 0 0.00 0 0 0 2 2 5.8823529412 11 11 22 64.7058823529 0 2 2 5.88235294118
4 13 17 17 100.00 0 0.00 0 0.00 0 0 0 0 0 0 4 13 17 50 0 0 0 0
3 16 19 19 100.00 0 0.00 0 0.00 0 0 0 0 0 0 3 16 19 70.3703703704 0 0 0 0
3 11 14 14 100.00 0 0.00 0 0.00 0 0 0 0 0 0 3 11 14 51.8518518519 0 0 0 0
5 24 29 29 100.00 0 0.00 0 0.00 0 0 1 3 4 11.111111111 4 20 24 66.6666666667 0 1 1 2.77777777778
26 79 105 105 100.00 0 0.00 0 0.00 0 0 1 5 6 3.7974683544 25 71 96 60.7594936709 0 3 3 1.89873417722

Tekanan Darah
Hb Kurang Kolesterol tinggi
Tinggi Normal Rendah
L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L
10 11 12
0 1 1 2.94118 11 13 24 70.5882352941177 0 1 1 2.94117647058824 0 0 0 0 2 2 4 11.76470588235 0
1 6 7 20.58823529412 3 6 9 26.4705882352941 0 1 1 2.94117647058824 0 0 0 0 0 2 2 5.882352941176 2
2 4 6 22.22222222222 1 12 13 48.1481481481481 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 11.11111111111 2 8 10 37.037037037037 0 1 1 3.7037037037037 0 0 0 0 1 1 2 7.407407407407 0
1 10 11 30.55555555556 4 13 17 47.2222222222222 0 1 1 2.77777777777778 0 0 0 0 0 2 2 5.555555555556 0
5 23 28 17.72151898734 21 52 73 46.2025316455696 0 4 4 2.53164556962025 0 0 0 0 3 7 10 6.329113924051 2

DM As. Urat tinggi Ggn ginjal Ggn kongnitif Ggn Penglihatan Ggn pendengaran L
P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L
13 14 15 16 17 18
7 7 20.5882352941176 0 2 2 7.407407408 0 0 0 0 0 0 0 0 0 1 1 2.94117647059 1 1 2 5.882352941176 8
3 5 14.7058823529412 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2.94117647059 0 1 1 2.941176470588 2
3 3 11.1111111111111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 3.703703703704 3
0 0 0 0 1 1 3.7037037037037 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2
2 2 5.55555555555556 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2.777777777778 5
15 17 10.7594936708861 0 3 3 11.111111112 0 0 0 0 0 0 0 0 0 2 2 1.26582278481 1 4 5 3.164556962025 20

Pengobatan
Konseling
Jumlah
Lain-lain Diobati Dirujuk Jumlah Panti
Penyuluhan Pemberdayaan Lansia Kunjungan Ket.
Wredha dibina
Rumah
B L S
P (L+P) (%) (+) (-) (+) (-)
19 20 21 22 24 25 26 27 28
2 10 29.4117647058824 11 15 0 0 26 0 0 26 0 0 0 0
6 8 23.5294117647059 3 13 1 0 17 0 0 17 0 0 0 0
12 15 55.5555555555556 3 16 0 0 19 0 0 19 0 0 0 0
8 10 37.037037037037 3 11 0 0 14 0 0 14 0 0 0 0
20 25 69.4444444444444 5 24 0 0 29 0 0 29 0 0 0 0
48 68 214.97821351 25 79 1 0 105 0 0 105 0 0 0 0

KABUPATEN Pidie
PUSKESMAS Mila
KECAMATAN Mila
BULAN April
Sasaran Lansia Jumlah Kunjungan Lan
Jumla Jumlah Total Lansia (45-
Jumlah 45-59 60-69 > 70 45-59 60-69
Jumlah h 70)
Jmlah Kelomp
No Nama Desa Posyan Panti
Desa ok L P Total ( L + P ) L P
du Wred
Lansia Jumlah
ha L P (L+P) L P (L+P) L P (L+P) L P ( L + P)
B L B L ( (%) B L B L
B+L)
1 2 3 4 5 6
1 TuhaLala 1 1 1 0 40 50 90 30 42 72 12 21 33 82 113 195 3 0 12 0 15 17 2 0 10 0
Minyub Lala 1 1 1 0 32 36 68 22 34 56 9 16 25 63 86 149 2 0 12 0 14 21 3 0 8 0
3 Krueng Lala 1 1 1 0 25 30 55 9 13 22 7 13 20 41 56 97 4 0 10 0 14 25 3 0 9 0
4 Babah Jurong 1 1 1 0 32 39 71 13 17 30 9 16 25 54 72 126 7 0 24 0 31 44 3 0 11 0
5 Kulu 1 1 1 0 49 58 107 27 42 69 10 19 29 86 119 205 5 0 12 0 17 16 3 0 10 0
JUMLAH 5 5 5 0 178 213 391 101 148 249 47 85 132 326 446 772 21 0 70 0 91 23 14 0 48 0
Mengetahui
Kepala Puskesmas
Yunita.SKM
Nip: 197707 16200801 2001

Ggn ME
Total ( L + P )
Jumlah L P Total ( L + P ) 45 - > 70 > 60 A B C Lebih Normal
Jumlah
(L+
(%) B L B L (%) L P (L+P) (%) L P ( L + P ) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (%) L P (L+P)
(B+L P)
(B+L)
6 ) 7 8 9
12 17 2 0 11 0 13 39.3939 7 33 40 20.5128 4 21 25 25 100.00 0 0.00 0 0.00 0 0 0 1 1 2.5 4 19 23
11 20 3 0 7 0 10 40 8 27 35 23.4899 6 15 21 21 100.00 0 0.00 0 0.00 0 0 0 1 1 2.8571 6 14 20
12 55 1 0 5 0 6 30 8 24 32 32.9897 4 14 18 18 100.00 0 0.00 0 0.00 0 0 0 0 0 0 4 14 18
14 47 2 0 5 0 7 28 12 40 52 41.2698 5 16 21 21 0.00 0 0.00 0 0.00 0 0 0 0 0 0 5 15 20
13 19 2 0 6 0 8 27.5862 10 28 38 18.5366 5 16 21 20 95.24 1 4.76 0 0.00 0 0 0 0 0 0 5 16 21
62 25 10 0 34 0 44 33.3333 45 152 197 25.5181 24 82 106 105 99.06 1 0.94 0 0.00 0 0 0 2 2 1.0152 24 78 102
IMT Tekanan Darah

Hb Kurang Kolesterol tinggi DM As. Urat tinggi Ggn ginjal
(L+ (L+ (L+ (L+ (L+ (L+ (L+ (L+
(%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L
P) P) P) P) P) P) P) P)
9 10 11 12 13 14 15
57.5 0 1 1 2.5 1 6 7 17.5 3 15 18 45 0 0 0 0 0 0 0 0 1 2 3 7.5 0 1 1 2.5 0 3 3 7.5 0
57.1429 0 0 0 0 2 5 7 20 4 9 13 37.143 0 1 1 2.8571 0 0 0 0 0 0 0 0 1 1 2 5.7143 0 0 0 0 0
56.25 0 0 0 0 0 3 3 9.375 4 9 13 40.625 0 2 2 6.25 0 0 0 0 1 2 3 9.375 0 2 2 6.25 1 2 3 9.375 0
57.143 0 1 1 1.9231 1 4 5 9.6154 4 12 16 30.769 0 0 0 0 0 0 0 0 0 1 1 1.9231 0 1 1 1.9231 1 2 3 5.7692 0
55.2632 0 0 0 0 1 5 6 15.789 3 9 12 34.29 1 2 3 7.8947 0 0 0 0 1 2 3 7.8947 0 1 1 2.6316 0 2 2 5.2632 0
51.7766 0 2 2 1.0152 5 23 28 14.213 18 54 72 36.548 1 5 6 0 0 0 0 0 3 7 10 5.0761 1 6 7 3.5533 2 9 11 5.5838 0

Pengobatan
Konseling
Jumlah Panti Jumlah
Ggn ginjal Ggn kognitif Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Pemberdaya
Penyuluhan Wredha Kunjungan
an Lansia
dibina Rumah
(L+ (L+ (L+ (L+ (L+ B L S
P (%) L P (%) L P (%) L P (%) L P (%) (+) (-) (+) (-)
P) P) P) P) P)
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 1 1 2.5 0 1 1 2.5 3 13 16 40 4 21 0 0 25 0 25 0 0 0 0
0 0 0 0 0 0 0 1 1 2 5.7143 0 1 1 2.8571 4 12 16 45.714 6 15 0 0 21 0 21 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 8 10 31.25 4 14 0 0 18 0 18 0 0 0 0
0 0 0 0 0 0 0 0 1 1 1.9231 0 1 1 1.9231 3 10 13 25 5 16 0 0 21 0 21 0 0 0 0
0 0 0 0 0 0 0 0 1 1 2.6316 1 1 2 5.2632 4 9 13 34.211 5 16 0 0 21 0 21 0 0 0 0
0 0 0 0 0 0 0 1 4 5 2.5381 1 4 5 2.5381 16 52 68 34.518 24 82 0 0 106 0 106 0 0 0 0

Ket.
28
0
0
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :
Sasaran Lansia Jumlah Kunju
45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-69

Jumlah Jumlah
Jumlah
Jmlah Desa Kelompok Panti
Lansia Wredha
L P (L+P) L P (L+P) L P (L+P) L P ( L + P)
Jumlah
B L B L (%) B L B
(B+L)
1 2 3 4 5 6
1 Teungoh Ilot 1 1 1 0 26 28 54 10 13 23 7 12 19 43 53 96 1 3 2 12 18 33 1 2 2
2 Baroh Ilot 1 1 1 0 28 36 64 9 11 20 4 10 14 41 57 98 0 2 1 12 15 23 2 3 2
3 Tunong Ilot 1 1 1 0 20 23 43 8 11 19 6 10 16 34 44 78 1 4 2 10 17 40 1 3 2
4 Mesjid Ilot 1 1 1 0 42 44 86 16 20 36 11 18 29 69 82 151 1 4 2 12 19 22 1 3 1
5 Lagang 1 1 1 0 30 36 66 19 31 50 8 15 23 57 82 139 0 5 3 12 20 30 0 3 2
JUMLAH 5 5 5 0 146 167 313 62 86 148 36 65 101 244 318 562 3 18 58 89 28 5 14 9
Mengetahui

Ggn ME
P Total ( L + P ) L P Total ( L + P ) 45 - > 70 > 60 A B C Lebih Normal
Jumlah Jumlah
L (%) B L B L (B (%) L P (L+P) (%) L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (L+P) (%) L P
(B+L) +L)
6 7 8 9
8 13 57 1 2 2 9 14 73.684211 10 35 45 46.875 6 21 27 6 22.22 0 0.00 0 0.00 0 0 0 1 1 2.2222222222222 2 3
8 15 75 0 3 3 7 13 92.857143 10 33 43 43.877551 8 20 28 7 25.00 0 0.00 0 0.00 0 0 0 0 0 0 2 5
9 15 79 1 1 2 5 9 56.25 11 30 41 52.564103 6 18 24 6 25.00 0 0.00 0 0.00 0 0 0 0 0 0 2 4
11 16 44 1 2 2 5 10 34.482759 12 33 45 29.801325 7 19 26 5 19.23 0 0.00 0 0.00 0 0 0 0 0 0 2 3
10 15 30 2 2 2 6 12 52.173913 12 35 47 33.81295 7 20 27 6 22.22 0 0.00 0 0.00 0 0 0 0 0 0 2 4
48 76 51 5 10 11 34 60 59.405941 55 166 221 39.323843 34 102 136 30 22.06 0 0.00 0 0.00 0 0 0 0 1 0.4524886877828 10 19
IMT Tekanan Darah

(%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P
9 10 11 12 13 14
11.111111111111 0 0 0 0 0 1 1 2.2222222222222 2 3 5 11.11111111111 0 0 0 0 0 0 0 0 0 1 1 2.222222 0 0 0 0 0 2
16.279069767442 0 0 0 0 1 1 2 4.6511627906977 1 4 5 11.62790697674 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2.325581 1 2
14.634146341463 0 0 0 0 0 1 1 2.4390243902439 2 3 5 12.19512195122 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
11.111111111111 0 0 0 0 1 1 2 4.4444444444444 1 2 3 6.666666666667 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
12.765957446809 0 0 0 0 0 0 0 0 2 4 6 12.76595744681 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
13.122171945701 0 0 0 0 2 4 6 2.7149321266968 8 16 24 10.85972850679 0 0 0 0 0 0 0 0 0 1 1 0.452489 0 1 1 0.452489 3 7

Pengobatan
Konseling
As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Pemberdayaan
Penyuluhan
Lansia
B L S
(L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) (+) (-) (+) (-)
14 15 16 17 18 19 20 21 22 24 25
2 4.444444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 6.666667 2 4 0 0 6 21 21 0 0
3 6.976744 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 6.976744 2 5 0 0 7 21 21 0 0
2 4.878049 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 9.756098 2 4 0 0 6 18 18 0 0
1 2.222222 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 4 8.888889 2 3 0 0 5 21 21 0 0
2 4.255319 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 8.510638 2 4 0 0 6 22 22 0 0
10 4.524887 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 12 18 8.144796 10 20 0 0 30 103 103 0 0

Jumlah
Jumlah Panti
Kunjungan Ket.
Wredha dibina
Rumah
26 27 28
0 0
0 0
0 0
0 0
0 0
0 0
KABUPATEN : Pidie
PUSKESMAS : Mila
KECAMATAN : Mila
BULAN : Juni
Sasaran Lansia
Jumlah Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59
Jumlah
No Nama Desa Jmlah Desa Kelompok Panti
Posyandu L P Total ( L + P )
Lansia Wredha
B L B L (
B+L)
1 2 3 4 5
1 Blang 1 1 1 0 28 33 61 11 14 25 6 11 17 45 58 103 0 4 1 10 15
2 Lhok Lubu 1 1 1 0 20 22 42 7 10 17 4 8 12 31 40 71 2 7 2 11 22
3 Ara Bungkok 1 1 1 0 19 21 40 6 7 13 4 7 11 29 35 64 0 0 1 2 3
4 Dayah Andeue 1 1 1 0 66 69 135 25 29 54 14 23 37 105 121 226 0 2 1 7 10
5 Teumeucet 1 1 1 0 27 33 60 10 14 24 6 11 17 43 58 101 0 2 2 8 12
JUMLAH 5 5 5 0 160 178 338 59 74 133 34 60 94 253 312 565 2 15 7 38 62
Mengetahui
Kepala UPTD Puskesmas
Nip: Yunita
197707SKM
1620080 1
________________ 2001
45-59 60-69 > 70 Total Kunjungan Kemandirian Lansia
Total ( L + P ) L P Total ( L + P ) L P Total ( L + P ) 45 - > 70 > 60 A B C

Jumlah Jumlah
(%) B L B L (%) B L B L ( (%) L P (L+P) (%) L P ( L + P ) Jumlah (%) Jumlah (%) Jumlah
(B+L) B+L)
6 7
25 0 1 2 10 13 52 1 2 1 10 14 82.352941176 8 34 42 40.7766990291 4 23 27 4 14.81 0 0.00 0
52 1 3 1 6 11 65 1 3 2 4 10 83.333333333 17 26 43 60.5633802817 8 13 21 5 23.81 0 0.00 0
8 0 4 1 4 9 69 0 1 1 3 5 45.454545455 5 12 17 26.5625 5 9 14 2 14.29 0 0.00 0
7 1 7 1 8 17 31 1 5 2 6 14 37.837837838 16 25 41 18.1415929204 14 17 31 5 16.13 0 0.00 0
20 1 7 2 10 20 83 0 5 1 10 16 94.117647059 15 33 48 47.5247524752 13 23 36 4 11.11 0 0.00 0
112 3 22 7 38 70 53 3 16 7 45 71 75.531914894 61 142 203 35.9292035398 44 97 141 20 14.18 0 0.00 0

egiatan sehari-hari
emandirian Lansia IMT Tekanan Darah

Ggn ME
C Lebih Normal Kurang Tinggi Normal Rendah
(L+ (L+
(%) L P L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (%) L P (%) L P (L+P)
P) P)
8 9 10
0.00 0 0 0 0 0 0 1 3 4 9.52380952381 0 0 0 0 0 0 0 0 1 3 4 9.5238095238 0 0 0
0.00 0 0 0 0 0 0 2 3 5 11.62790697674 0 0 0 0 0 0 0 0 2 3 5 11.627906977 0 0 0
0.00 0 0 0 0 0 0 0 2 2 11.76470588235 0 0 0 0 0 0 0 0 0 2 2 11.764705882 0 0 0
0.00 0 0 0 0 0 0 2 3 5 12.19512195122 0 0 0 0 1 1 2 4.87804878049 1 2 3 7.3170731707 0 0 0
0.00 0 0 0 0 0 0 1 3 4 8.333333333333 0 0 0 0 1 1 2 4.16666666667 0 2 2 4.1666666667 0 0 0
0.00 0 0 0 0 0 0 6 14 20 9.852216748768 0 0 0 0 2 2 4 1.97044334975 4 12 16 7.881773399 0 0 0

Hb Kurang Kolesterol tinggi DM As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan
Rendah
(L+ (L+ (L+
(%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (%) L P (%) L P
P) P) P)
11 12 13 14 15 16 17
0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2.380952381 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 2.3255813953 0 0 0 0 0 1 1 2.3255813953 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 5.8823529412 0 0 0 0 0 1 1 5.8823529412 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 2.4390243902 0 0 0 0 2 1 3 7.3170731707 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 2.0833333333 0 0 0 0 1 1 2 4.1666666667 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 4 4 1.9704433498 0 0 0 0 3 5 8 3.9408866995 0 0 0 0 0 0 0 0 0 0 0
Pengobatan
Konseling
Jumlah Panti Jumlah
Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Pemberdaya
Penyuluhan Wredha Kunjungan Ket.
an Lansia
dibina Rumah
(L+ (L+ B L S
(%) L P (%) L P (%) (+) (-) (+) (-)
P) P)
17 18 19 20 21 22 24 25 26 27 28
0 0 0 0 0 1 2 3 7.14285714286 1 3 0 0 4 23 23 0 0 0 0
0 0 0 0 0 2 1 3 6.97674418605 2 3 0 0 5 16 16 0 0 0 0
0 0 0 0 0 0 0 0 0 0 2 0 0 2 12 12 0 0 0 0
0 0 0 0 0 0 1 1 2.43902439024 2 3 0 0 5 26 26 0 0 0 0
0 0 0 0 0 0 1 1 2.08333333333 1 3 0 0 4 32 32 0 0 0 0
0 0 0 0 0 3 5 8 3.94088669951 6 14 0 0 20 109 109 0 0 0 0

KABUPATEN PIDIE
PUSKESMAS MILA
KECAMATAN MILA
BULAN JULI 2020
Sasaran Lansia
Jumlah Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-6
Jumlah
No Nama Desa Jmlah Desa Kelompok Panti
Posyandu L P Total ( L + P ) L
Lansia Wredha
B L B L ( (%) B
B+L)
1 2 3 4 5 6
1 Tuha Lala 1 1 1 0 18 22 40 10 17 27 28 39 67 56 78 134 0 2 1 3 6 15 2
2 Minyub Lala 1 1 1 0 13 17 30 8 14 22 21 31 52 42 62 104 2 4 3 1 10 33 2
3 Teungoh Ilot 1 1 1 0 10 12 22 6 10 16 16 22 38 32 44 76 2 3 3 5 13 59 1
4 Babah Jurong 1 1 1 0 12 17 29 7 14 21 20 31 51 39 62 101 1 10 1 10 22 76 2
5 Baroh ilot 1 1 1 0 9 11 20 5 9 14 14 19 33 28 39 59 1 4 2 12 19 95 1
JUMLAH 5 5 5 0 62 79 141 38 64 102 99 142 241 199 285 474 6 23 10 31 70 50 8
Mengetahui
Kepala Puskesmas
_Yunita.SKM_
Nip: 197707 16200801 2001
60-69 > 70 Total Kunjungan Kemandirian Lansia

Ggn ME
L P Total ( L + P )
Jumlah L P Total ( L + P ) 45 - > 70 > 60 A B C Lebih
Jumlah
(L+
L B L (%) B L B L (%) L P (L+P) (%) L P ( L + P ) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (%)
(B+L P)
(B+L)
6 ) 7 8
3 3 7 15 56 1 2 3 3 9 13.4328 10 20 30 22.3881 8 16 24 9 0.00 0 0.00 0 0.00 0 0 0 0 0 0
5 3 4 14 64 2 3 3 5 13 25 18 19 37 35.5769 12 15 27 10 0.00 0 0.00 0 0.00 0 0 0 0 0 0
3 3 3 10 63 2 5 3 5 15 39.4737 16 22 38 50 11 14 25 9 0.00 0 0.00 0 0.00 0 0 0 1 1 2.6316
7 2 5 16 76 2 8 2 5 17 33.3333 30 25 55 54.4554 19 14 33 8 24.24 0 0.00 0 0.00 0 0 0 0 0 0
4 2 6 13 93 0 2 2 8 12 36.3636 12 32 44 74.5763 7 18 25 5 20.00 0 0.00 0 0.00 0 0 0 0 0 0
22 13 25 68 67 7 20 13 21 61 25.3112 86 113 199 41.9831 57 77 134 41 30.60 0 0.00 0 0.00 0 0 0 1 1 0.5025

IMT Tekanan Darah

(L+ (L+ (L+ (L+ (L+ (L+ (L+
L P (L+P) (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P
P) P) P) P) P) P) P)
9 10 11 12 13 14
3 6 9 30 0 0 0 0 1 1 2 6.6667 2 5 7 23.333 0 0 0 0 0 0 0 0 0 1 1 3.3333 0 1 1 3.3333 0 2
4 5 9 24.3243 0 1 1 2.7027 1 2 3 8.1081 3 4 7 18.919 0 0 0 0 0 0 0 0 1 2 3 8.1081 0 0 0 0 0 2
3 5 8 21.0526 0 0 0 0 1 1 2 5.2632 2 5 7 18.421 0 0 0 0 0 0 0 0 1 1 2 5.2632 0 1 1 2.6316 1 1
4 4 8 14.5455 0 0 0 0 1 1 2 3.6364 3 3 6 10.909 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2
1 4 5 11.3636 0 0 0 0 1 1 2 4.5455 0 3 3 6.8182 0 0 0 0 0 0 0 0 0 1 1 2.2727 0 0 0 0 1 1
15 24 39 101.286 0 1 1 2.7027 1 6 11 28.22 10 20 30 78.401 0 0 0 0 0 0 0 0 2 5 7 18.977 0 2 2 5.9649 3 8

Pengobatan
Konseling
As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Pemberdaya
Penyuluhan
an Lansia
(L+ (L+ (L+ (L+ (L+ (L+ B L S

(%) L P (%) L P (%) L P (%) L P (%) L P (%) (+) (-) (+) (-)
P) P) P) P) P) P)
14 15 16 17 18 19 20 21 22 24 25
2 6.6667 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 5 16.667 3 6 0 0 9 20 20 0 0
2 5.4054 0 0 0 0 0 0 0 0 0 1 1 2.7027 0 0 0 0 2 2 4 10.811 4 6 0 0 10 22 22 0 0
2 5.2632 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 10.526 3 6 0 0 9 24 24 0 0
3 5.4545 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 5 9.0909 4 4 0 0 8 25 25 0 0
2 4.5455 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 4.5455 1 4 0 0 5 18 18 0 0
11 27.335 0 0 0 0 0 0 0 0 0 1 1 2.7027 0 0 0 0 9 11 20 51.64 15 26 0 0 41 109 109 0 0

Jumlah Panti Jumlah
Wredha Kunjungan Ket.
dibina Rumah
26 27 28
0 0
0 0
0 0
0 0
0 0
0 0
KABUPATEN PIDIE
PUSKESMAS MILA
KECAMATAN MILA
BULAN AGUSTUS
Sasaran Lansia Jumlah Kun

Jumlah Jumlah
Jumlah
Lansia Wredha
B L B L (B+ (%) B L B
L)
1 2 3 4 5 6
1 Dayah Andeue 1 1 1 0 25 29 54 14 23 37 39 52 91 78 104 0 0 4 4 4 12 22 0 3 4
2 Lagang 1 1 1 0 11 14 25 6 11 17 17 25 42 34 50 0 1 3 4 10 18 72 1 4 4
3 Mesjid Ilot 1 1 1 0 16 19 35 9 15 24 25 35 60 1 69 0 2 4 3 1 10 29 2 5 3
4 Kreung Lala 1 1 1 0 10 13 23 5 10 15 15 24 39 30 47 0 2 3 3 5 13 57 2 7 2
5 Dayah Sinthop 1 1 1 0 26 35 61 15 28 43 41 62 103 82 125 0 0 0 4 6 10 16 1 1 3
JUMLAH 5 5 5 0 0 0 0 0 0 5 14 20 26 65 #DIV/0! 6 20 16
Mengetahui
UPTD Kepala Puskesmas
YUNITA>SKM
Nip.197716200801 2001

Ggn ME
P Total ( L + P ) L P Total ( L + P ) 45 - > 70 > 60 A B C Lebih Normal
Jumlah Jumlah
L (%) B L B L (B (%) L P (L+P) (%) L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (L+P) (%) L P
(B+L) +L)
6 7 8 9
10 17 46 2 8 2 10 22 24.175824 17 34 51 #DIV/0! 13 26 39 7 17.95 0 0.00 1 2.56 0 0 0 0 0 0 2 6
7 16 94 1 2 2 9 14 33.333333 12 36 48 #DIV/0! 8 22 30 8 0.00 0 0.00 0 0.00 0 0 0 1 1 2.083333 1 6
4 14 58 2 3 3 5 13 21.666667 18 19 37 #DIV/0! 12 15 27 8 29.63 2 7.41 0 0.00 0 0 0 0 0 0 4 5
10 21 140 1 3 2 8 14 35.897436 18 30 48 #DIV/0! 13 22 35 7 20.00 0 0.00 0 0.00 0 0 0 0 0 0 3 4
10 15 35 0 0 3 9 12 11.650485 2 35 37 #DIV/0! 2 25 27 7 0.00 0 0.00 0 0.00 0 0 0 1 0 0 1 5
41 83 #DIV/0! 4 27 12 34 77 #DIV/0! 76 149 225 #DIV/0! 57 103 160 37 23.13 2 1.25 1 0.63 0 0 0 2 1 0.444444 11 26
IMT Tekanan Darah

(L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%)
9 10 11 12 13 14
8 15.686275 0 0 0 0 1 1 2 3.921569 1 5 6 11.76471 0 0 0 0 0 0 0 0 0 1 1 1.960784 0 1 1 1.960784 1 1 2 3.921569
7 14.583333 0 0 0 0 1 1 2 4.166667 1 5 6 12.5 0 0 0 0 0 0 0 0 0 1 1 2.083333 0 1 1 2.083333 0 1 1 2.083333
9 0 0 1 1 2.702703 1 2 3 8.108108 3 4 7 0 0 0 0 0 0 0 0 0 1 2 3 8.108108 0 0 0 0 0 2 2 5.405405
7 14.583333 0 0 0 0 1 1 2 4.166667 2 3 5 10.41667 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 2.083333 1 1 2 4.166667
6 16.216216 0 0 0 0 0 1 1 2.702703 1 5 6 16.21622 0 0 0 0 0 0 0 0 0 0 0 1 1 2 5.405405 0 1 1 2.702703
37 61.069157 0 1 1 2.702703 4 6 10 23.06571 8 22 30 50.89759 0 0 0 0 0 0 0 0 1 5 6 12.15223 1 4 5 11.53286 2 6 8 18.27968

Pengobatan
Konseling
Jumlah
Ggn ginjal Ggn kognitif Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Pemberdayaan Jumlah Panti
Penyuluhan Kunjungan
Rumah
B L S
L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) (+) (-) (+) (-)
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 7.843137 1 5 1 0 8 22 22 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 5 10.41667 2 6 0 0 8 22 22 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 5 13.51351 4 6 0 0 10 22 22 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 3 6.25 3 4 0 0 7 23 23 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 10.81081 1 5 0 1 7 26 26 0 0 0 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 13 21 48.83413 11 26 1 1 40 115 115 0 0 0 2

Ket.
28
Nip.197716200801 2001
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :
Sasaran Lansia Jumlah Kunjungan Lan

Jumlah Jumlah
Jumlah
Lansia Wredha
B L B L (B+ (%) B L B L
L)
1 2 3 4 5 6
1 0 0 0 0 0 0 4 8 12 #DIV/0! 3 14
2 0 0 0 0 0 0 4 14 18 #DIV/0! 5 11
3 0 0 0 0 0 0 6 4 10 #DIV/0! 7 7
4 0 0 0 0 0 0 5 8 13 #DIV/0! 9 12
5 0 0 0 0 0 0 0 10 10 #DIV/0! 2 13
6 0 0 0 0 0 0 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?

jumlah 0 0 0 0 0 0 #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME?
Mengetahui
Kepala Puskesmas
________________

Ggn ME
Jumlah Jumlah
(B+L) +L)
6 7 8 9
17 #DIV/0! 10 12 22 #DIV/0! 17 34 51 #DIV/0! 13 26 39 0.00 0.00 0.00 0 0
16 #DIV/0! 3 11 14 #DIV/0! 12 36 48 #DIV/0! 8 22 30 0.00 0.00 0.00 0 0
14 #DIV/0! 5 8 13 #DIV/0! 18 19 37 #DIV/0! 12 15 27 0.00 0.00 0.00 0 0
21 #DIV/0! 4 10 14 #DIV/0! 18 30 48 #DIV/0! 13 22 35 0.00 0.00 0.00 0 0
15 #DIV/0! 0 12 12 #DIV/0! 2 35 37 #DIV/0! 2 25 27 0.00 0.00 0.00 0 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0.00 0 #NAME?
#NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
IMT Tekanan Darah

9 10 11 12 13 14
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME?
0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 0 0 #NAME? 0 #NAME? 0 #NAME?
0 #NAME? 0 #NAME? 0 0 0 #NAME? 0 #NAME? 0 0 0 #NAME? 0 #NAME? 0 #NAME?
0 #NAME? 0 34 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME?

0 0 #NAME? 0 #NAME? 0 #NAME?

Pengobatan
Konseling
Jumlah
Rumah
B L S
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME?


Ket.
28
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :

Jumlah Jumlah
Jumlah
Lansia Wredha
B L B L (B+ (%) B L B L
L)
1 2 3 4 5 6
1 0 0 0 0 0 0 4 8 12 #DIV/0! 3 14
2 0 0 0 0 0 0 4 14 18 #DIV/0! 5 11
3 0 0 0 0 0 0 6 4 10 #DIV/0! 7 7
4 0 0 0 0 0 0 5 8 13 #DIV/0! 9 12
5 0 0 0 0 0 0 0 10 10 #DIV/0! 2 13

Jumlah 0 0 0 0 0 0 #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME?
Mengetahui
Kepala Puskesmas
________________

Ggn ME
Jumlah Jumlah
(B+L) +L)
6 7 8 9
17 #DIV/0! 10 12 22 #DIV/0! 17 34 51 #DIV/0! 13 26 39 0.00 0.00 0.00 0 0
16 #DIV/0! 3 11 14 #DIV/0! 12 36 48 #DIV/0! 8 22 30 0.00 0.00 0.00 0 0
14 #DIV/0! 5 8 13 #DIV/0! 18 19 37 #DIV/0! 12 15 27 0.00 0.00 0.00 0 0
21 #DIV/0! 4 10 14 #DIV/0! 18 30 48 #DIV/0! 13 22 35 0.00 0.00 0.00 0 0
15 #DIV/0! 0 12 12 #DIV/0! 2 35 37 #DIV/0! 2 25 27 0.00 0.00 0.00 0 0
#NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
IMT Tekanan Darah

9 10 11 12 13 14
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 0 0 #NAME? 0 #NAME? 0 #NAME?


Pengobatan
Konseling
Jumlah
Rumah
B L S
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0


Ket.
28
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :

Jumlah Jumlah
Jumlah
Lansia Wredha
B L B L (B+ (%) B L B L
L)
1 2 3 4 5 6
1 0 0 0 0 0 0 4 8 12 #DIV/0! 3 14
2 0 0 0 0 0 0 4 14 18 #DIV/0! 5 11
3 0 0 0 0 0 0 6 4 10 #DIV/0! 7 7
4 0 0 0 0 0 0 5 8 13 #DIV/0! 9 12
5 0 0 0 0 0 0 0 10 10 #DIV/0! 2 13

Jumlah 0 0 0 0 0 0 #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME?
Mengetahui
Kepala Puskesmas
________________

Ggn ME
Jumlah Jumlah
(%) B L B L (B (%) L P (L+P) (%) L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (L+P) (%) L P (L+P)
(B+L) +L)
6 7 8 9
17 #DIV/0! 10 12 22 #DIV/0! 17 34 51 #DIV/0! 13 26 39 0.00 0.00 0.00 0 0 0
16 #DIV/0! 3 11 14 #DIV/0! 12 36 48 #DIV/0! 8 22 30 0.00 0.00 0.00 0 0 0
14 #DIV/0! 5 8 13 #DIV/0! 18 19 37 #DIV/0! 12 15 27 0.00 0.00 0.00 0 0 0
21 #DIV/0! 4 10 14 #DIV/0! 18 30 48 #DIV/0! 13 22 35 0.00 0.00 0.00 0 0 0
15 #DIV/0! 0 12 12 #DIV/0! 2 35 37 #DIV/0! 2 25 27 0.00 0.00 0.00 0 0 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
IMT Tekanan Darah

(%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L
9 10 11 12 13 14 15
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
#NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME?
0 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME? 0 #NAME?


Pengobatan
Konseling
Jumlah
Rumah
B L S
P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) (+) (-) (+) (-)
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0


Ket.
28
KABUPATEN Pidie
PUSKESMAS Mila
KECAMATAN Mila
BULAN Januari
Sasaran Lansia Jumlah Kunjungan La
Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-69
Jumlah Jumlah
Jmlah Panti
No Nama Desa Posyand Kelompo
Desa Wredh
u k Lansia L P Total ( L + P ) L P
a
B L B L (B (%) B L B L
+L)
1 2 3 4 5 6
1 Teungoh Ilot 1 1 1 0 26 28 54 10 13 23 7 12 19 43 53 96 4 4 19 8 35 65 2 3 9 14
2 Lagang 1 1 1 0 30 36 66 19 31 50 8 15 23 57 82 139 2 4 7 14 27 41 2 5 12 11
3 Baroh 1 1 1 0 28 36 64 9 11 20 4 10 14 41 57 98 7 6 10 4 27 42 5 7 11 7
4 Tunong Ilot 1 1 1 0 20 23 43 8 11 19 6 10 16 34 44 78 1 #NAME? 13 #NAME? #NAME? #NAME? 3 #NAME? 5 #NAME?
5 Teumeucet 1 1 1 0 26 32 58 17 27 44 7 13 20 50 72 122 2 #NAME? 10 #NAME? #NAME? #NAME? 2 #NAME? 15 #NAME?
JUMLAH 5 5 5 0 130 155 285 63 93 156 32 60 92 225 308 533 16 #NAME? 59 #NAME? #NAME? #NAME? 14 #NAME? 52 #NAME?
Mengetahui
Kepala Puskesmas
Yunita. SKM
Nip:197707162008012001

Ggn ME
Jumlah Jumlah
( (%) B L B L (%) L P (L+P) (%) L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (L+P) (%) L P (L+P)
B+L) (B+L)
6 7 8 9
28 122 2 10 7 12 31 163.15789 25 69 94 97.916667 17 42 59 20 33.90 0 0.00 0 0.00 0 0 0 1 1 1.06383 4 14 18
30 60 1 3 5 11 20 86.956522 17 60 77 55.395683 11 39 50 20 40.00 0 0.00 0 0.00 0 0 0 2 2 2.597403 3 15 18
30 150 2 5 5 8 20 142.85714 32 45 77 78.571429 19 31 50 23 46.00 0 0.00 0 0.00 0 0 0 0 0 0 7 14 21
#NAME? #NAME? 2 #NAME? 9 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 19 #NAME? 0 #NAME? 0 #NAME? 0 0 0 0 0 #NAME? 5 14 19
#NAME? #NAME? 3 #NAME? 9 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 26 #NAME? 3 #NAME? 0 #NAME? 0 0 0 2 2 #NAME? 5 22 27
#NAME? #NAME? 10 #NAME? 35 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0 0 0 5 5 #NAME? 24 79 97
IMT Tekanan Darah

(%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L
9 10 11 12 13 14 15
19.14894 0 1 1 1.06383 0 4 4 4.25532 4 12 16 17.0213 0 0 0 0 0 0 0 0 0 2 2 2.12766 0 3 3 3.19149 2 6 8 8.51064 0
23.37662 0 0 0 0 0 6 6 7.79221 3 11 14 18.1818 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 3.8961 0 2 2 2.5974 0
27.27273 0 2 2 2.5974 2 6 8 10.3896 5 10 15 19.4805 0 0 0 0 0 0 0 0 0 0 0 0 3 2 5 6.49351 1 4 5 6.49351 0
#NAME? 0 0 0 ### 3 4 7 ### 2 10 12 ### 0 0 0 ### 0 0 0 ### 0 1 1 ### 0 2 2 ### 1 4 5 ### 0
#NAME? 0 0 0 ### 3 10 13 ### 2 13 15 ### 0 1 1 ### 0 0 0 ### 0 0 0 0 0 5 5 ### 1 7 8 ### 0
#NAME? 0 0 3 5 8 30 38 ### 16 56 72 ### 0 1 1 ### 0 0 0 ### 0 3 3 ### 3 15 18 ### 5 23 28 ### 0

Pengobatan
Konseling
Jumlah
Rumah
B L S
P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) (+) (-) (+) (-)
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 5 7 7.44681 4 16 0 0 20 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 14 17 22.0779 3 17 0 0 20 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 10 13 16.8831 7 16 0 0 23 0 0 0 0 0 0
0 0 ### 0 0 0 ### 0 0 0 ### 0 1 1 ### 4 6 10 ### 5 14 0 0 19 0 0 0 0 0 0
0 0 ### 0 0 0 ### 0 0 0 ### 0 0 0 ### 4 12 16 ### 5 24 0 0 29 0 0 0 0 0 0
0 0 ### 0 0 0 ### 0 0 0 ### 0 1 1 ### 16 47 63 ### 24 87 0 0 111 0 0 0 0 0 0

Ket.
28
FORMAT PENCATATAN DAN PELAPORAN KESEHATAN LANJUT USIA DI POSYANDU LANSIA
POSYANDU :
NAMA KELOMPOK LANSIA :
DESA/KELURAHAN :
PUSKESMAS :
KECAMATAN :
BULAN :
Jml Kasus
Umur Kegiatan sehari-hari Hasil pemeriksaan (Angka) Pengobatan
Kunjungan Konseling
Pemberd
45-59 60-69 > 70 Kemandirian Ggn IMT Tek. Darah Hb Kolesterol Gula Darah Asam Urat Gangguan Penyulu
No Nama Lansia ayaan
han
pendenga Diobati Dirujuk B L S Lansia
B L L P L P L P A B C ME L N K T N R N K N T N T N T ginjal kognitif Penglihatan Lain-lain
ran
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 Ny. Sutinah √ 49 √ + + B + +
2 Tn. Jek √ 61
JUMLAH 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1
Mengetahui
Penanggung jawab wilayah Ketua kader Posyandu ......
________________ ________________
AN PELAPORAN KESEHATAN LANJUT USIA DI POSYANDU LANSIA
Ket.
23
Ketua kader Posyandu ......

Format Lansia PKM Mila 2023

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KABUPATEN :

Sasaran Lansia Jumlah Kunjungan Lans

Jumlah Kunjungan Lansia Kegiatan sehari-hari

60-69 > 70 Total Kunjungan Kemandirian Lansia IMT

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IMT Tekanan Darah

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Pemberdayaan Jumlah Panti

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