Scribd Logo
Upload

Welcome to Scribd!

  • Rev - RR IMUNISASI HEP B NADIS & NAKES

    Uploaded by

    M Jafar
    5 views11 pages
    This document is a hepatitis B immunization registration form and report for medical and health personnel at various levels - facility, district/city, and provincial. It collects names, gender, date of birth, immunization dates and calculates coverage rates. The forms track targets, doses administered and coverage rates at each level to monitor and report on hepatitis B immunization progress.

    Original Description:

    3.rev_rr imunisasi hep b nadis& nakes

    Original Title

    3. Rev_RR IMUNISASI HEP B NADIS & NAKES

    Copyright

    © © All Rights Reserved

    Available Formats

    XLSX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a hepatitis B immunization registration form and report for medical and health personnel at various levels - facility, district/city, and provincial. It collects names, gender, date of birth, immunization dates and calculates coverage rates. The forms track targets, doses administered and coverage rates at each level to monitor and report on hepatitis B immunization progress.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views11 pages

    Rev - RR IMUNISASI HEP B NADIS & NAKES

    Uploaded by

    M Jafar
    This document is a hepatitis B immunization registration form and report for medical and health personnel at various levels - facility, district/city, and provincial. It collects names, gender, date of birth, immunization dates and calculates coverage rates. The forms track targets, doses administered and coverage rates at each level to monitor and report on hepatitis B immunization progress.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 11

    REGISTER IMUNISASI HEPATITIS B UNTUK TENAGA MEDIS DAN TE

    NAMA FASKES :
    ALAMAT FASKES :
    PENANGGUNGJAWAB WILAYAH LAYANAN :
    KABUPATEN/KOTA :
    PROVINSI :

    JENIS KELAMIN
    NO NAMA TANGGAL LAHIR NIK
    L P
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    21
    22
    23
    24
    25
    AGA MEDIS DAN TENAGA KESEHATAN

    TANGGAL IMUNISASI HEPATITIS B


    ASAL INSTANSI
    DOSIS 1 DOSIS 2 DOSIS 3
    LAPORAN HARIAN IMUNISASI HEPATITIS B UNTU

    TANGGAL/BULAN/TAHUN :
    NAMA FASYANKES :
    ALAMAT FASYANKES :
    PENANGGUNGJAWAB WILAYAH LAYANAN :
    KABUPATEN/KOTA :
    PROVINSI :
    Isilah pada kolom yang berwarna

    JUMLAH SASARAN
    NO DESA/KELURAHAN CAPAIAN DOSIS 1
    L P TOTAL
    L %
    1 3 3 6 1 33%
    2 0 0%
    3 0 0%
    4 0 0%
    5 0 0%
    6 0 0%
    7 0 0%
    8 0 0%
    9 0 0%
    10 0 0%
    JUMLAH 3 3 6 1 33%
    NISASI HEPATITIS B UNTUK TENAGA MEDIS DAN TENAGA KESEHATAN TINGKAT FASYANKES

    CAKUPAN IMUNISASI HEPATITIS B


    CAPAIAN DOSIS 1 CAPAIAN DOSIS 2
    P % TOTAL % L % P % TOTAL %
    2 67% 3 50% 1 33% 1 33% 2 33%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 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 67% 3 50% 1 33% 1 33% 2 33%
    SYANKES

    CAPAIAN DOSIS 3
    L % P % TOTAL %
    1 33% 1 33% 2 33%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    1 33% 1 33% 2 33%

    ………, ………………………. 202…..


    Kepala Fasyankes

    (…………………………………..)
    LAPORAN IMUNISASI HEPATITIS B UNTUK
    TANGGAL/BULAN/TAHUN :
    DINAS KESEHATAN KAB/KOTA :
    ALAMAT DINKES :
    PROVINSI :
    Isilah pada kolom yang berwarna

    JUMLAH SASARAN

    NO PUSKESMAS/FASYANKES CAPAIAN DOSIS 1


    L P TOTAL
    L % P

    1 3 3 6 1 33% 2
    2 0 0%
    3 0 0%
    4 0 0%
    5 0 0%
    6 0 0%
    7 0 0%
    8 0 0%
    9 0 0%
    10 0 0%
    JUMLAH 3 3 6 1 33% 2
    EPATITIS B UNTUK TENAGA MEDIS DAN TENAGA KESEHATAN TINGKAT KABUPATEN/KOTA

    CAKUPAN IMUNISASI HEPATITIS B

    CAPAIAN DOSIS 1 CAPAIAN DOSIS 2

    % TOTAL % L % P % TOTAL %
    67% 3 50% 1 33% 1 33% 2 33%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    67% 3 50% 1 33% 1 33% 2 33%
    EN/KOTA

    CAPAIAN DOSIS 3

    L % P % TOTAL %
    1 33% 1 33% 2 33%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    1 33% 1 33% 2 33%

    ………, ………………………. 202…..


    Kepala Bidang …………….
    Dinas Kesehatan Kabupaten/Kota …………….

    (…………………………………..)
    LAPORAN IMUNISASI HEPATITIS B UNT

    TANGGAL/BULAN/TAHUN :
    DINAS KESEHATAN PROVINSI :
    ALAMAT DINKES :
    Isilah pada kolom yang berwarna

    JUMLAH SASARAN

    NO KABUPATEN/KOTA CAPAIAN DOSI


    L P TOTAL
    L %

    1 3 3 6 1 33%
    2 0 0%
    3 0 0%
    4 0 0%
    5 0 0%
    6 0 0%
    7 0 0%
    8 0 0%
    9 0 0%
    10 0 0%
    JUMLAH 3 3 6 1 33%
    SASI HEPATITIS B UNTUK TENAGA MEDIS DAN TENAGA KESEHATAN TINGKAT PROVINSI

    CAKUPAN IMUNISASI HEPATITIS B

    CAPAIAN DOSIS 1 CAPAIAN DOSIS 2

    P % TOTAL % L % P % TOTAL %
    2 67% 3 50% 1 33% 1 33% 2 33%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 0% 0 0%
    0% 0 0% 0% 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 67% 3 50% 1 33% 1 33% 2 33%
    NSI

    CAPAIAN DOSIS 3

    L % P % TOTAL %
    1 33% 1 33% 2 33%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    0% 0% 0 0%
    1 33% 1 33% 2 33%

    ………, ………………………. 202…..


    Kepala Bidang …………….
    Dinas Kesehatan Provinsi …………….

    (…………………………………..)

    You might also like