Bulan : Desember

Form (1ANC)

Penggunaan Buku KIA K1 Murni K1 Akses (K1 keseluruhan)

Sasaran 20%
NO. JanA Bumil Bumil BLN BLN BLN
Jan ABS % Jan ABS % Jan ABS
LALU LALU LALU
1 Api -Api 26 5 0 11 11 42 0 12 12 46 0 13 13
2 Barugelang 33 7 0 12 12 36 0 13 13 39 0 14 14
3 Batarang 12 2 0 13 13 108 0 14 14 117 0 15 15
4 Batuah 142 28 0 14 14 10 0 15 15 11 0 16 16
5 Beringin 17 3 0 15 15 88 0 16 16 94 0 17 17
6 Betung 37 7 0 16 16 43 0 17 17 46 0 18 18
7 Gusunge 22 4 0 17 17 77 0 18 18 82 0 19 19
8 Juku Eja 41 8 0 18 18 44 0 19 19 46 0 20 20
9 Kampung Baru 59 12 0 19 19 32 0 20 20 34 0 21 21
10 Kota Pagatan 91 18 0 20 20 22 0 21 21 23 0 22 22
11 Manurung 36 7 0 21 21 58 0 22 22 61 0 23 23
12 Mekar Jaya 9 2 0 22 22 244 0 23 23 256 0 24 24
13 Muara Tengah 23 5 0 23 23 100 0 24 24 104 0 25 25
14 Muara Pagatan 28 6 0 24 24 86 0 25 25 89 0 26 26
15 Mudalang 58 12 0 25 25 43 0 26 26 45 0 27 27
16 Pagaruyung 48 10 0 26 26 54 0 27 27 56 0 28 28
17 Pakatellu 23 5 0 27 27 117 0 28 28 122 0 29 29
18 Pasar Baru 93 19 0 28 28 30 0 29 29 31 0 30 30
19 Pejala 51 10 0 29 29 57 0 30 30 59 0 31 31
20 Penyolongan 14 3 0 30 30 214 0 31 31 221 0 32 32
21 Pulau Salak 15 3 0 31 31 207 0 32 32 213 0 33 33
22 Pulau Satu 31 6 0 32 32 103 0 33 33 106 0 34 34
23 Rantau Panjang Hilir 27 5 0 33 33 122 0 34 34 126 0 35 35
24 Rantau Panjang Hulu 13 3 0 34 34 262 0 35 35 269 0 36 36
25 Saring Sei Bubu 38 8 0 35 35 92 0 36 36 95 0 37 37
26 Sungai Lembu 30 6 0 36 36 120 0 37 37 123 0 38 38
27 Tanete 17 3 0 37 37 218 0 38 38 224 0 39 39
28 Wiritasi 47 9 0 38 38 81 0 39 39 83 0 40 40
29 Sepunggur 116 23 0 39 39 34 0 40 40 34 0 41 41
JUMLAH 1,197 239 0 725 725 61 0 754 754 63 0 783 783
eseluruhan) K4

BLN
% Jan ABS %
LALU
50 0 16 16 62
42 0 17 17 52
125 0 18 18 150
11 0 19 19 13
100 0 20 20 118
49 0 21 21 57
86 0 22 22 100
49 0 23 23 56
36 0 24 24 41
24 0 25 25 27
64 0 26 26 72
267 0 27 27 300
109 0 28 28 122
93 0 29 29 104
47 0 30 30 52
58 0 31 31 65
126 0 32 32 139
32 0 33 33 35
61 0 34 34 67
229 0 35 35 250
220 0 36 36 240
110 0 37 37 119
130 0 38 38 141
277 0 39 39 300
97 0 40 40 105
127 0 41 41 137
229 0 42 42 247
85 0 43 43 91
35 0 44 44 38
65 0 870 870 73
 Status T Bumi
ABORTUS
T1 T2 T3
BLN BLN BLN BLN
Jan ABS % Jan ABS % Jan ABS % Jan ABS %
LALU LALU LALU LALU
0 17 17 65 0 18 18 69 0 19 19 73 0 20 20 77
0 18 18 55 0 19 19 58 0 20 20 61 0 21 21 64
0 19 19 158 0 20 20 167 0 21 21 175 0 22 22 183
0 20 20 14 0 21 21 15 0 22 22 15 0 23 23 16
0 21 21 124 0 22 22 129 0 23 23 135 0 24 24 141
0 22 22 59 0 23 23 62 0 24 24 65 0 25 25 68
0 23 23 105 0 24 24 109 0 25 25 114 0 26 26 118
0 24 24 59 0 25 25 61 0 26 26 63 0 27 27 66
0 25 25 42 0 26 26 44 0 27 27 46 0 28 28 47
0 26 26 29 0 27 27 30 0 28 28 31 0 29 29 32
0 27 27 75 0 28 28 78 0 29 29 81 0 30 30 83
0 28 28 311 0 29 29 322 0 30 30 333 0 31 31 344
0 29 29 126 0 30 30 130 0 31 31 135 0 32 32 139
0 30 30 107 0 31 31 111 0 32 32 114 0 33 33 118
0 31 31 53 0 32 32 55 0 33 33 57 0 34 34 59
0 32 32 67 0 33 33 69 0 34 34 71 0 35 35 73
0 33 33 143 0 34 34 148 0 35 35 152 0 36 36 157
0 34 34 37 0 35 35 38 0 36 36 39 0 37 37 40
0 35 35 69 0 36 36 71 0 37 37 73 0 38 38 75
0 36 36 257 0 37 37 264 0 38 38 271 0 39 39 279
0 37 37 247 0 38 38 253 0 39 39 260 0 40 40 267
0 38 38 123 0 39 39 126 0 40 40 129 0 41 41 132
0 39 39 144 0 40 40 148 0 41 41 152 0 42 42 156
0 40 40 308 0 41 41 315 0 42 42 323 0 43 43 331
0 41 41 108 0 42 42 111 0 43 43 113 0 44 44 116
0 42 42 140 0 43 43 143 0 44 44 147 0 45 45 150
0 43 43 253 0 44 44 259 0 45 45 265 0 46 46 271
0 44 44 94 0 45 45 96 0 46 46 98 0 47 47 100
0 45 45 39 0 46 46 40 0 47 47 41 0 48 48 41
0 899 899 75 0 928 928 78 0 957 957 80 0 986 986 82
tatus T Bumil
T4
BLN
LALU
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
umil
FE1
T4 T5 T2+
BLN BLN BLN
Jan ABS % Jan ABS % Jan ABS % Jan ABS %
LALU LALU LALU
21 21 81 0 22 22 85 0 23 23 88 0 24 24 92
22 22 67 0 23 23 70 0 24 24 73 0 25 25 76
23 23 192 0 24 24 200 0 25 25 208 0 26 26 217
24 24 17 0 25 25 18 0 26 26 18 0 27 27 19
25 25 147 0 26 26 153 0 27 27 159 0 28 28 165
26 26 70 0 27 27 73 0 28 28 76 0 29 29 78
27 27 123 0 28 28 127 0 29 29 132 0 30 30 136
28 28 68 0 29 29 71 0 30 30 73 0 31 31 76
29 29 49 0 30 30 51 0 31 31 53 0 32 32 54
30 30 33 0 31 31 34 0 32 32 35 0 33 33 36
31 31 86 0 32 32 89 0 33 33 92 0 34 34 94
32 32 356 0 33 33 367 0 34 34 378 0 35 35 389
33 33 143 0 34 34 148 0 35 35 152 0 36 36 157
34 34 121 0 35 35 125 0 36 36 129 0 37 37 132
35 35 60 0 36 36 62 0 37 37 64 0 38 38 66
36 36 75 0 37 37 77 0 38 38 79 0 39 39 81
37 37 161 0 38 38 165 0 39 39 170 0 40 40 174
38 38 41 0 39 39 42 0 40 40 43 0 41 41 44
39 39 76 0 40 40 78 0 41 41 80 0 42 42 82
40 40 286 0 41 41 293 0 42 42 300 0 43 43 307
41 41 273 0 42 42 280 0 43 43 287 0 44 44 293
42 42 135 0 43 43 139 0 44 44 142 0 45 45 145
43 43 159 0 44 44 163 0 45 45 167 0 46 46 170
44 44 338 0 45 45 346 0 46 46 354 0 47 47 362
45 45 118 0 46 46 121 0 47 47 124 0 48 48 126
46 46 153 0 47 47 157 0 48 48 160 0 49 49 163
47 47 276 0 48 48 282 0 49 49 288 0 50 50 294
 48 48 102 0 49 49 104 0 50 50 106 0 51 51 109
49 49 42 0 50 50 43 0 51 51 44 0 52 52 45
1,015 1015 85 0 1,044 1044 87 0 1073 1073 90 0 1,102 1102 92

Hj. ANDI INDAH HM

 DETEKSI RISIKO RUJUKAN KASUS RISTI
FE3
NAKES MASYARAKAT MATERNAL
BLN BLN BLN BLN
Jan ABS % Jan ABS % Jan ABS % Jan ABS %
LALU LALU LALU LALU
0 26 26 100 0 27 27 519 0 28 28 538 0 29 29 558
0 27 27 82 0 28 28 424 0 29 29 439 0 30 30 455
0 28 28 233 0 29 29 1208 0 30 30 1250 0 31 31 1292
0 29 29 20 0 30 30 106 0 31 31 109 0 32 32 113
0 30 30 176 0 31 31 912 0 32 32 941 0 33 33 971
0 31 31 84 0 32 32 432 0 33 33 446 0 34 34 459
0 32 32 145 0 33 33 750 0 34 34 773 0 35 35 795
0 33 33 80 0 34 34 415 0 35 35 427 0 36 36 439
0 34 34 58 0 35 35 297 0 36 36 305 0 37 37 314
0 35 35 38 0 36 36 198 0 37 37 203 0 38 38 209
0 36 36 100 0 37 37 514 0 38 38 528 0 39 39 542
0 37 37 411 0 38 38 2111 0 39 39 2167 0 40 40 2222
0 38 38 165 0 39 39 848 0 40 40 870 0 41 41 891
0 39 39 139 0 40 40 714 0 41 41 732 0 42 42 750
0 40 40 69 0 41 41 353 0 42 42 362 0 43 43 371
0 41 41 85 0 42 42 438 0 43 43 448 0 44 44 458
0 42 42 183 0 43 43 935 0 44 44 957 0 45 45 978
0 43 43 46 0 44 44 237 0 45 45 242 0 46 46 247
0 44 44 86 0 45 45 441 0 46 46 451 0 47 47 461
0 45 45 321 0 46 46 1643 0 47 47 1679 0 48 48 1714
0 46 46 307 0 47 47 1567 0 48 48 1600 0 49 49 1633
0 47 47 152 0 48 48 774 0 49 49 790 0 50 50 806
0 48 48 178 0 49 49 907 0 50 50 926 0 51 51 944
0 49 49 377 0 50 50 1923 0 51 51 1962 0 52 52 2000
0 50 50 132 0 51 51 671 0 52 52 684 0 53 53 697
0 51 51 170 0 52 52 867 0 53 53 883 0 54 54 900
0 52 52 306 0 53 53 1559 0 54 54 1588 0 55 55 1618
 0 53 53 113 0 54 54 574 0 55 55 585 0 56 56 596
0 54 54 47 0 55 55 237 0 56 56 241 57 57 246
0 1,160 1160 97 0 1,189 1189 497 0 1,218 1218 509 0 1,247 1247 521
Mengetahui Pagatan, 30 November 2019
Kepala Puskesmas Perawatan Pagatan Bidan Koordinator

Hj. ANDI INDAH HM,S.Kep.Ners LISA MAYASARI, AM.Keb

NIP.19690319 199203 2 017 NIP.19870323 200904 2 003
PUSKESMAS: Pagatan
Bulan
Form : JANUARI Tahun : 2020
2 (Persalinan Dan Nifas)

Sasaran 20% PN DI FASYANKES

NO. JanA PN
Bulin Bulin RS RS SWASTA, RSIB, KLI
BLN BLN BLN
Jan ABS % Jan ABS % Jan
LALU LALU LALU
1 Api -Api 25 5 0 30 30 120 0 31 31 124 0 32
2 Barugelang 31 7 0 31 31 100 0 32 32 103 0 33
3 Batarang 11 2 0 32 32 291 0 33 33 300 0 34
4 Batuah 136 28 0 33 33 24 0 34 34 25 0 35
5 Beringin 16 3 0 34 34 213 0 35 35 219 0 36
6 Betung 35 7 0 35 35 100 0 36 36 103 0 37
7 Gusunge 21 4 0 36 36 171 0 37 37 176 0 38
8 Juku Eja 39 8 0 37 37 95 0 38 38 97 0 39
9 Kampung Baru 57 12 0 38 38 67 0 39 39 68 0 40
10 Kota Pagatan 87 18 0 39 39 45 0 40 40 46 0 41
11 Manurung 35 7 0 40 40 114 0 41 41 117 0 42
12 Mekar Jaya 9 2 0 41 41 456 0 42 42 467 0 43
13 Muara Tengah 22 5 0 42 42 191 0 43 43 195 0 44
14 Muara Pagatan 26 6 0 43 43 165 0 44 44 169 0 45
15 Mudalang 55 12 0 44 44 80 0 45 45 82 0 46
16 Pagaruyung 46 10 0 45 45 98 0 46 46 100 0 47
17 Pakatellu 22 5 0 46 46 209 0 47 47 214 0 48
18 Pasar Baru 89 19 0 47 47 53 0 48 48 54 0 49
19 Pejala 48 10 0 48 48 100 0 49 49 102 0 50
20 Penyolongan 13 3 0 49 49 377 0 50 50 385 0 51
21 Pulau Salak 15 3 0 50 50 333 0 51 51 340 0 52
22 Pulau Satu 29 6 0 51 51 176 0 52 52 179 0 53
23 Rantau Panjang Hilir 26 5 0 52 52 200 0 53 53 204 0 54
24 Rantau Panjang Hulu 12 3 0 53 53 442 0 54 54 450 0 55
25 Saring Sei Bubu 36 8 0 54 54 150 0 55 55 153 0 56
26 Sungai Lembu 29 6 0 55 55 190 0 56 56 193 0 57
27 Tanete 16 3 0 56 56 350 0 57 57 356 0 58
28 Wiritasi 45 9 0 57 57 127 0 58 58 129 0 59
29 Sepunggur 110 23 0 58 58 53 0 59 59 54 0 60
1,141 216 0 1276 1276 112 0 1,305 1305 114 0 1,334
 Persalinan Ditolong Nakes (PN)
N DI FASYANKES
WASTA, RSIB, KLINIK

ABS %

32 128
33 106
34 309
35 26
36 225
37 106
38 181
39 100
40 70
41 47
42 120
43 478
44 200
45 173
46 84
47 102
48 218
49 55
50 104
51 392
52 347
53 183
54 208
55 458
56 156
 57 197
58 363
59 131
60 55
1,334 117
 Persalinan Ditolong Nakes (PN)
PN DI NON FASYANKES
PN DI NON FASYANKES
PUSTU, POSKESJan, POLINJan, total total/ab DI RUMAH D
s pf %
BLN BLN BLN BLN
Jan ABS % Jan Jan ABS % Jan ABS %
LALU LALU LALU LALU
0 33 33 132 1 96 384 0 71 71 284 0 35 35 140 0
0 34 34 110 2 99 319 0 73 73 235 0 36 36 116 0
0 35 35 318 2 102 927 0 75 75 682 0 37 37 336 0
0 36 36 26 1 105 77 0 77 77 57 0 38 38 28 0
0 37 37 231 2 108 675 0 79 79 494 0 39 39 244 0
0 38 38 109 3 111 317 0 81 81 231 0 40 40 114 0
0 39 39 186 2 114 543 0 83 83 395 0 41 41 195 0
0 40 40 103 1 117 300 0 85 85 218 0 42 42 108 0
0 41 41 72 2 120 211 0 87 87 153 0 43 43 75 0
0 42 42 48 1 123 141 0 89 89 102 0 44 44 51 0
0 43 43 123 2 126 360 0 91 91 260 0 45 45 129 0
0 44 44 489 0 129 1433 0 93 93 1033 0 46 46 511 0
0 45 45 205 0 132 600 0 95 95 432 0 47 47 214 0
0 46 46 177 1 135 519 0 97 97 373 0 48 48 185 0
0 47 47 85 0 138 251 0 99 99 180 0 49 49 89 0
0 48 48 104 1 141 307 0 101 101 220 0 50 50 109 0
0 49 49 223 2 144 655 0 103 103 468 0 51 51 232 0
0 50 50 56 1 147 165 0 105 105 118 0 52 52 58 0
0 51 51 106 5 150 313 0 107 107 223 0 53 53 110 0
0 52 52 400 1 153 1177 0 109 109 838 0 54 54 415 0
0 53 53 353 0 156 1040 0 111 111 740 0 55 55 367 0
0 54 54 186 1 159 548 0 113 113 390 0 56 56 193 0
0 55 55 212 1 162 623 0 115 115 442 0 57 57 219 0
0 56 56 467 0 165 1375 0 117 117 975 0 58 58 483 0
0 57 57 158 0 168 467 0 119 119 331 0 59 59 164 0
0 58 58 200 1 171 590 0 121 121 417 0 60 60 207 0
0 59 59 369 1 174 1088 0 123 123 769 0 61 61 381 0
0 60 60 133 1 177 393 0 125 125 278 0 62 62 138 0
0 61 61 55 1 180 164 0 127 127 115 0 63 63 57 0
0 1,363 1,363 119 36 4002 351 0 2871 2871 252 0 1,421 1421 125 0
 Komplikasi Maternal Ditangani
Persalinan Ditolong Non Nakes Total Persalinan V
SYANKES (PK)
DI PERJALANAN
BLN BLN BLN BLN
Jan ABS % Jan ABS % Jan ABS % Jan ABS %
LALU LALU LALU LALU
36 36 144 0 34 34 136 0 64 64 256 0 37 37 740 0
37 37 119.3548 0 35 35 113 0 66 66 213 0 38 38 543 0
38 38 345.4545 0 36 36 327 0 68 68 618 0 39 39 1950 0
39 39 28.67647 0 37 37 27 0 70 70 51 0 40 40 143 0
40 40 250 0 38 38 238 0 72 72 450 0 41 41 1281 0
41 41 117.1429 0 39 39 111 0 74 74 211 0 42 42 600 0
42 42 200 0 40 40 190 0 76 76 362 0 43 43 1024 0
43 43 110.2564 0 41 41 105 0 78 78 200 0 44 44 564 0
44 44 77.19298 0 42 42 74 0 80 80 140 0 45 45 375 0
45 45 51.72414 0 43 43 49 0 82 82 94 0 46 46 256 0
46 46 131.4286 0 44 44 126 0 84 84 240 0 47 47 671 0
47 47 522.2222 0 45 45 500 0 86 86 956 0 48 48 2667 0
48 48 218.1818 0 46 46 209 0 88 88 400 0 49 49 980 0
49 49 188.4615 0 47 47 181 0 90 90 346 0 50 50 833 0
50 50 90.90909 0 48 48 87 0 92 92 167 0 51 51 425 0
51 51 110.8696 0 49 49 107 0 94 94 204 0 52 52 520 0
52 52 236.3636 0 50 50 227 0 96 96 436 0 53 53 1060 0
53 53 59.55056 0 51 51 57 0 98 98 110 0 54 54 284 0
54 54 112.5 0 52 52 108 0 100 100 208 0 55 55 550 0
55 55 423.0769 0 53 53 408 0 102 102 785 0 56 56 1867 0
56 56 373.3333 0 54 54 360 0 104 104 693 0 57 57 1900 0
57 57 196.5517 0 55 55 190 0 106 106 366 0 58 58 1000 0
58 58 223.0769 0 56 56 215 0 108 108 415 0 59 59 1135 0
59 59 491.6667 0 57 57 475 0 110 110 917 0 60 60 2000 0
60 60 166.6667 0 58 58 161 0 112 112 311 0 61 61 763 0
61 61 210.3448 0 59 59 203 0 114 114 393 0 62 62 1069 0
62 62 387.5 0 60 60 375 0 116 116 725 0 63 63 1969 0
63 63 140 0 61 61 136 0 118 118 262 0 64 64 711 0
64 64 58.18182 0 62 62 56 0 120 120 109 0 65 65 283 0
0 0 0 0 1392 1392 122 0 2668 2668 234 0 1,479 1479 685 0
VIT A NIFAS

Jan ABS %

38 38 152
39 39 126
40 40 364
41 41 30
42 42 263
43 43 123
44 44 210
45 45 115
46 46 81
47 47 54
48 48 137
49 49 544
50 50 227
51 51 196
52 52 95
53 53 115
54 54 245
55 55 62
56 56 117
57 57 438
58 58 387
59 59 203
60 60 231
61 61 508
62 62 172
 63 63 217
64 64 400
65 65 144
66 66 60
1,508 1508 132

Hj. ANDI INDAH HM,S.Kep.Ners

 PERIODE INPUT
Kunjungan Nifas (KF) DATA

KF1 KF2 KF3

BULAN TAHUN
BLN BLN BLN
Jan ABS % Jan ABS % Jan ABS %
LALU LALU LALU
0 39 39 156 0 40 40 160 0 41 41 164
0 40 40 129 0 41 41 132 0 42 42 135
0 41 41 373 0 42 42 382 0 43 43 391
0 42 42 31 0 43 43 32 0 44 44 32
0 43 43 269 0 44 44 275 0 45 45 281
0 44 44 126 0 45 45 129 0 46 46 131
0 45 45 214 0 46 46 219 0 47 47 224
0 46 46 118 0 47 47 121 0 48 48 123
0 47 47 82 0 48 48 84 0 49 49 86
0 48 48 55 0 49 49 56 0 50 50 57
0 49 49 140 0 50 50 143 0 51 51 146
0 50 50 556 0 51 51 567 0 52 52 578
0 51 51 232 0 52 52 236 0 53 53 241
0 52 52 200 0 53 53 204 0 54 54 208
0 53 53 96 0 54 54 98 0 55 55 100
0 54 54 117 0 55 55 120 0 56 56 122
0 55 55 250 0 56 56 255 0 57 57 259
0 56 56 63 0 57 57 64 0 58 58 65
0 57 57 119 0 58 58 121 0 59 59 123
0 58 58 446 0 59 59 454 0 60 60 462
0 59 59 393 0 60 60 400 0 61 61 407
0 60 60 207 0 61 61 210 0 62 62 214
0 61 61 235 0 62 62 238 0 63 63 242
0 62 62 517 0 63 63 525 0 64 64 533
0 63 63 175 0 64 64 178 0 65 65 181
 0 64 64 221 0 65 65 224 0 66 66 228
0 65 65 406 0 66 66 413 0 67 67 419
0 66 66 147 0 67 67 149 0 68 68 151
0 67 67 61 0 68 68 62 0 69 69 63
0 1,537 1537 135 0 1,566 1566 137 0 1,595 1595 140

Mengetahui Pagatan, 30 November 2019

Kepala Puskesmas Perawatan Pagatan Bidan Koordinator

Hj. ANDI INDAH HM,S.Kep.Ners LISA MAYASARI, AM.Keb

NIP.19690319 199203 2 017 NIP.19870323 200904 2 003
Bulan : DESEMBER
Form 4 (Kematian)

SEBAB KE
JUMLAH KEMATIAN IBU HIPERTENSI DLM INFEKSI
NO. DESA PERDRH KEHAMILAN ( HT, (abortus,sepsis,sepsis
Preeklamsia, eklamsi) puerperalis)
BLN BLN BLN BLN
DES ABS DES ABS DES ABS DES
LALU LALU LALU LALU
1 Api -Api 0 0 0
2 Barugelang 0 0 0
3 Batarang 0 0 0
4 Batuah 0 0 0
5 Beringin 0 0 0
6 Betung 0 0 0
7 Gusunge 0 0 0
8 Juku Eja 0 0 0
9 Kampung Baru 0 0 0
10 Kota Pagatan 0 0 0
11 Manurung 0 0 0
12 Mekar Jaya 0 0 0
13 Muara Tengah 0 0 0
14 Muara Pagatan 0 0 0
15 Mudalang 0 0 0
16 Pagaruyung 0 0 0
17 Pakatellu 0 0 0
18 Pasar Baru 0 0 0
19 Pejala 0 0 0
20 Penyolongan 0 0 0
21 Pulau Salak 0 0 0
22 Pulau Satu 0 0 0
23 Rantau Panjang Hilir 0 0 0
24 Rantau Panjang Hulu 0 0 0
25 Saring Sei Bubu 0 0 0
26 Sungai Lembu 0 0 0
27 Tanete 0 0 0
28 Wiritasi 0 0 0
29 Sepunggur 0 0 0 0 0
JUMLAH 0 0 0 0 0 0 0 0 0 0 0
 SEBAB KEMATIAN IBU

FEKSI Gangguan darah ( ITP,

sepsis,sepsis Thalesemia,
peralis) Leukimia,dsb)
BLN
ABS DES ABS
LALU
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0
 JML BAYI LAHIR HIDUP JML BAYI LAHIR MATI IUFD Melaksanakan
LAIN2 (malaria, AMP
GGN METABOLIK (DM, meningitis, emboli
JANTUNG,DLL) ketuban, TB,HIV,dll)
BLN BLN BLN BLN BLN
DES ABS DES ABS DES ABS DES ABS DES ABS Ya
LALU LALU LALU LALU LALU
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 86 1 87 0 0
0 0 0 0 0 0 597 1 598 0 0 0 0 0 0
 PERIODE INPUT
DATA
Melaksanakan
AMP

BULAN TAHUN

Tidak
 TEMPAT MENINGGAL
PENOLONG

obgyn dokter bidan DK Keluarga RS PKM Klinik / BPM

INI ABS INI ABS INI ABS INI ABS INI ABS INI ABS INI ABS INI ABS
0 1 0 1 1 20 0 0 0 0 0 0 0 0 0 0
0 4 1 3 1 19 0 2 1 0 0 0 0 0 0 0
0 3 0 1 2 4 0 0 0 0 0 0 0 0 0 0
0 21 0 25 1 35 0 1 0 0 0 0 0 0 0 0
0 2 0 2 2 3 0 0 0 0 0 0 0 0 0 0
0 6 0 8 3 13 0 0 0 0 0 0 0 0 0 0
0 5 0 6 2 9 0 0 0 0 0 0 0 0 0 0
0 6 0 19 1 8 0 4 0 0 0 0 0 0 0 0
1 7 0 6 1 30 0 1 0 0 0 0 0 0 0 0
0 7 0 7 1 17 0 0 0 0 0 0 0 0 0 0
1 2 0 4 1 21 0 2 0 0 0 0 0 0 0 0
0 1 0 1 0 3 0 0 0 0 0 0 0 0 0 0
0 5 0 3 0 6 0 0 0 0 0 0 0 0 0 0
1 5 0 4 0 13 0 0 0 0 0 0 0 0 0 0
0 11 0 9 0 15 0 1 0 0 0 0 0 0 0 0
0 3 0 5 1 18 0 2 0 0 0 0 0 0 0 0
0 1 0 1 2 10 0 2 0 0 0 0 0 0 0 0
0 7 0 14 1 26 0 0 0 0 0 0 0 0 0 0
0 3 0 2 5 29 0 1 0 0 0 0 0 0 0 0
0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0
0 1 0 1 0 2 0 0 0 0 0 0 0 0 0 0
0 1 1 5 0 10 0 2 0 0 0 0 0 0 0 0
0 8 0 1 1 13 0 0 0 0 0 0 0 0 0 0
0 0 0 2 0 6 0 2 0 0 0 0 0 0 0 0
0 4 0 2 0 20 0 0 0 0 0 0 0 0 0 0
0 4 0 3 1 10 0 0 0 0 0 0 0 0 0 0
0 3 1 4 0 6 0 0 0 1 0 0 0 0 0 0
0 5 0 8 1 14 0 0 0 0 0 0 0 0 0 0
0 25 1 9 0 45 0 2 0 0 0 0 0 0 0 0
3 151 4 156 29 426 0 23 1 1 0 0 0 0 0 0
Mengetahui Pagatan, 30 November 2019
Kepala Puskesmas Perawatan Pagatan Bidan Koordinator

Hj. ANDI INDAH HM,S.Kep.Ners LISA MAYASARI, AM.Keb

NIP.19690319 199203 2 017 NIP.19870323 200904 2 003
NINGGAL

Rumah

INI ABS
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 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
0 1
 MASA MENINGGAL

diperjalanan HAMIL BERSALIN NIFAS

INI ABS INI ABS INI ABS INI ABS

0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 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
0 0 0 0 0 0 0 1
Laporan Rekapitulasi ANC Terpadu Tingkat Puskesmas Lampiran :
Bulan : DESEMBER Tahun : 2019
Form 5 (ANC Terpadu)

70%
JUMLAH SASARAN Jumlah BUMIL
NO. DESA Diperiksa Hb Anemia Ringan (10-10,9)
DESA BUMIL Bidan (PPIA)
BLN BLN
DES ABS % DES
LALU LALU
1 Api -Api 1 26 2 7 0 7 27 5 0
2 Barugelang 1 33 1 51 0 51 155 7 0
3 Batarang 1 12 1 8 0 8 67 3 0
4 Batuah 1 142 2 139 10 149 105 114 10
5 Beringin 1 17 1 0 0 0 0 1 0
6 Betung 1 37 2 64 1 65 176 41 0
7 Gusunge 1 22 1 17 0 17 77 3 0
8 Juku Eja 1 41 1 44 0 44 107 28 0
9 Kampung Baru 1 59 2 36 0 36 61 25 0
10 Kota Pagatan 1 91 1 19 0 19 21 16 0
11 Manurung 1 36 1 51 1 52 144 25 1
12 Mekar Jaya 1 9 1 7 0 7 78 1 0
13 Muara Tengah 1 23 1 28 2 30 130 13 2
14 Muara Pagatan 1 28 1 34 0 34 121 15 0
15 Mudalang 1 58 1 34 0 34 59 18 0
16 Pagaruyung 1 48 2 19 0 19 40 6 0
17 Pakatellu 1 23 1 18 5 23 100 7 2
18 Pasar Baru 1 93 2 62 4 66 71 36 4
19 Pejala 1 51 1 28 0 28 55 14 0
20 Penyolongan 1 14 2 6 0 6 43 1 0
21 Pulau Salak 1 15 2 8 1 9 60 3 0
22 Pulau Satu 1 31 1 14 0 14 45 7 0
23 Rantau Panjang Hilir 1 27 2 23 2 25 93 12 2
24 Rantau Panjang Hulu 1 13 1 2 0 2 15 2 0
25 Saring Sei Bubu 1 38 2 6 0 6 16 2 0
26 Sungai Lembu 1 30 1 29 3 32 107 5 2
27 Tanete 1 17 1 15 0 15 88 3 0
28 Wiritasi 1 47 1 13 0 13 28 6 0
29 Sepunggur 1 116 2 16 0 16 14 8 0
JUMLAH 29 1,197 40 61.939 798 29 827 69 427 23
 HB

emia Ringan (10-10,9) Anemia sedang (7-9,9) Anemia berat (<7) Jumlah Anemia Diperiksa LiLA

BLN BLN BLN

ABS % DES ABS % DES ABS % ABS % DES
LALU LALU LALU
5 19 1 0 1 4 0 0 0 0 0 0 23 0
7 21 2 0 2 6 0 0 0 0 0 0 53 0
3 25 0 0 0 0 0 0 0 0 0 0 16 0
124 87 6 0 6 4 0 0 0 0 10 7 121 5
1 6 0 0 0 0 0 0 0 0 0 0 10 0
41 111 8 0 8 22 0 0 0 0 0 0 56 1
3 14 9 0 9 41 0 0 0 0 0 0 17 2
28 68 8 0 8 20 0 0 0 0 0 0 35 0
25 42 1 0 1 2 0 0 0 0 0 0 50 4
16 18 1 0 1 1 0 0 0 0 0 0 72 0
26 72 3 0 3 8 0 0 0 0 1 3 40 1
1 11 1 0 1 11 0 0 0 0 0 0 3 0
15 65 5 0 5 22 0 0 0 0 2 9 21 1
15 54 12 0 12 43 0 0 0 0 0 0 35 0
18 31 6 0 6 10 0 0 0 0 0 0 44 3
6 13 2 0 2 4 0 0 0 0 0 0 37 1
9 39 4 0 4 17 0 0 0 0 2 9 24 5
40 43 6 0 6 6 0 0 0 0 4 4 63 6
14 27 5 0 5 10 0 0 0 0 0 0 51 0
1 7 4 0 4 29 0 0 0 0 0 0 8 0
 3 20 2 0 2 13 0 0 0 0 0 0 16 0
7 23 3 0 3 10 0 0 0 0 0 0 24 1
14 52 3 0 3 11 0 0 0 0 2 7 18 2
2 15 0 0 0 0 0 0 0 0 0 0 11 0
2 5 4 0 4 11 1 0 1 2.63158 0 0 49 0
7 23 3 0 3 10 0 0 0 0 2 7 27 1
3 18 2 0 2 12 0 0 0 0 0 0 21 0
6 13 4 0 4 9 0 0 0 0 0 0 44 0
8 7 2 0 2 2 0 0 0 0 0 0 112 4
450 38 107 0 107 9 1 0 1 0.08354 23 2 1,101 37
 KEK Protein urin

Diperiksa LiLA KEK (LiLA < 23,5 cm) Diperiksa Positif (+)

BLN BLN BLN

ABS % DES ABS % DES ABS % DES ABS %
LALU LALU LALU
23 88 0 0 0 0 3 0 3 12 0 0 0 0
53 161 4 0 4 12 3 0 3 9 0 0 0 0
16 133 2 0 2 17 8 0 8 67 0 0 0 0
126 89 9 0 9 6 27 5 32 23 1 0 1 1
10 59 2 0 2 12 1 0 1 6 0 0 0 0
57 154 5 0 5 14 32 2 34 92 1 0 1 3
19 86 3 2 5 23 17 0 17 77 2 0 2 9
35 85 5 0 5 12 44 0 44 107 2 0 2 5
54 92 12 1 13 22 3 0 3 5 0 0 0 0
72 79 0 0 0 0 10 0 10 11 0 0 0 0
41 114 9 0 9 25 3 0 3 8 0 0 0 0
3 33 0 0 0 0 2 0 2 22 1 0 1 11
22 96 5 0 5 22 9 1 10 43 0 0 0 0
35 125 4 0 4 14 29 0 29 104 0 0 0 0
47 81 6 0 6 10 23 3 26 45 0 0 0 0
38 79 3 0 3 6 5 0 5 10 0 0 0 0
29 126 2 1 3 13 2 0 2 9 0 0 0 0
69 74 4 0 4 4 13 0 13 14 0 0 0 0
51 100 3 0 3 6 12 0 12 24 0 0 0 0
8 57 0 0 0 0 4 0 4 29 0 0 0 0
 16 107 0 0 0 0 2 0 2 13 0 0 0 0
25 81 0 0 0 0 2 0 2 6 0 0 0 0
20 74 5 0 5 19 10 2 12 44 0 0 0 0
11 85 1 0 1 8 2 0 2 15 0 0 0 0
49 129 3 0 3 8 7 0 7 18 0 0 0 0
28 93 3 0 3 10 7 2 9 30 1 0 1 3
21 124 1 0 1 6 8 0 8 47 0 0 0 0
44 94 4 0 4 9 8 0 8 17 0 0 0 0
116 100 3 1 4 3 5 0 5 4 0 0 0 0
1138 95.071 98 5 103 9 301 15 316 26 8 0 8 1
 Gula Darah (GD)

Diperiksa GD >140 g/dl Ibu Hamil Datang dengan HIV(+) Ibu Hamil ditawarkan Tes HIV

BLN BLN BLN BLN

DES ABS % DES ABS % DES ABS % DES
LALU LALU LALU LALU
3 0 3 12 0 0 0 0 0 0 0 0 17 0
23 0 23 70 0 0 0 0 0 0 0 0 52 0
9 0 9 75 0 0 0 0 0 0 0 0 10 0
2 0 2 1 0 0 0 0 0 0 0 0 51 5
0 0 0 0 0 0 0 0 0 0 0 0 1 0
1 1 2 5 0 0 0 0 0 0 0 0 22 1
7 0 7 32 0 0 0 0 0 0 0 0 18 2
16 0 16 39 0 0 0 0 0 0 0 0 76 0
13 0 13 22 1 0 1 1.69492 0 0 0 0 14 0
10 0 10 11 0 0 0 0 0 0 0 0 12 0
19 0 19 53 0 0 0 0 0 0 0 0 49 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 1 4 17 0 0 0 0 0 0 0 0 4 0
9 0 9 32 4 0 4 14.2857 0 0 0 0 43 0
37 3 40 69 0 0 0 0 0 0 0 0 5 0
0 0 0 0 0 0 0 0 0 0 0 0 25 0
12 0 12 52 0 0 0 0 0 0 0 0 24 1
0 0 0 0 0 0 0 0 0 0 0 0 10 5
0 0 0 0 0 0 0 0 0 0 0 0 24 0
0 0 0 0 0 0 0 0 0 0 0 0 3 0
 3 0 3 20 0 0 0 0 0 0 0 0 3 0
3 0 3 10 0 0 0 0 0 0 0 0 8 0
7 2 9 33 0 0 0 0 0 0 0 0 15 0
0 0 0 0 0 0 0 0 0 0 0 0 13 0
21 0 21 55 0 0 0 0 0 0 0 0 34 0
6 0 6 20 0 0 0 0 0 0 0 0 17 1
10 0 10 59 1 0 1 5.88235 0 0 0 0 16 0
4 0 4 9 0 0 0 0 0 0 0 0 17 0
2 0 2 2 0 0 0 0 0 0 0 0 16 0
220 7 227 19 6 0 6 0.50125 0 0 0 0 599 16
amil ditawarkan Tes HIV Ibu Hamil dites HIV Ibu Hamil Hasil Tes HIV (+) JUMLAH Bumil HIV (+)

BLN BLN BLN

ABS % DES ABS % DES ABS % DES ABS %
LALU LALU LALU
17 65 14 0 14 54 0 0 0 0 0 0 0 0
52 158 50 0 50 152 0 0 0 0 0 0 0 0
10 83 10 0 10 83 0 0 0 0 0 0 0 0
56 39 30 5 35 25 0 0 0 0 0 0 0 0
1 6 1 0 1 6 0 0 0 0 0 0 0 0
23 62 19 1 20 54 0 0 0 0 0 0 0 0
20 91 16 0 16 73 0 0 0 0 0 0 0 0
76 185 31 0 31 76 0 0 0 0 0 0 0 0
14 24 15 0 15 25 0 0 0 0 0 0 0 0
12 13 13 0 13 14 0 0 0 0 0 0 0 0
50 139 25 0 25 69 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 17 3 0 3 13 0 0 0 0 0 0 0 0
43 154 13 0 13 46 0 0 0 0 0 0 0 0
5 9 7 0 7 12 0 0 0 0 0 0 0 0
25 52 13 0 13 27 0 0 0 0 0 0 0 0
25 109 14 0 14 61 0 0 0 0 0 0 0 0
15 16 8 0 8 9 0 0 0 0 0 0 0 0
24 47 25 0 25 49 0 0 0 0 0 0 0 0
3 21 3 0 3 21 0 0 0 0 0 0 0 0
 3 20 0 0 0 0 0 0 0 0 0 0 0 0
8 26 13 0 13 42 0 0 0 0 0 0 0 0
15 56 15 0 15 56 0 0 0 0 0 0 0 0
13 100 21 0 21 162 0 0 0 0 0 0 0 0
34 89 21 0 21 55 0 0 0 0 0 0 0 0
18 60 13 1 14 47 0 0 0 0 0 0 0 0
16 94 15 0 15 88 0 0 0 0 0 0 0 0
17 36 7 0 7 15 0 0 0 0 0 0 0 0
16 14 16 0 16 14 0 0 0 0 0 0 0 0
615 51 431 7 438 37 0 0 0 0 0 0 0 0
 Pencegahan Penularan HIV, SIFILIS, HEPATITIS B dari Ibu ke Anak (PPIA)
Ibu Hamil HIV(+)
Ibu Hamil Mendapat ART Ibu Hamil Dites Sifilis
Persalinan Pervaginam Persalinan Perabdominam (SC)
BLN BLN BLN BLN
DES ABS % DES ABS % DES ABS % DES
LALU LALU LALU LALU
0 0 0 0 0 0 0 0 0 0 0 0 2 0
0 0 0 0 0 0 0 0 0 0 0 0 14 0
0 0 0 0 0 0 0 0 0 0 0 0 5 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 6 4
0 0 0 0 0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 0 0 0 0 0 5 5
0 0 0 0 0 0 0 0 0 0 0 0 13 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 9 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 17 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 4 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 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 4 0
0 0 0 0 0 0 0 0 0 0 0 0 2 0
0 0 0 0 0 0 0 0 0 0 0 0 10 0
0 0 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 2
0 0 0 0 0 0 0 0 0 0 0 0 4 0
0 0 0 0 1 0 1 0.86207 0 0 0 0 0 0
0 0 0 0 1 0 1 0.08354 0 0 0 0 113 18
Anak (PPIA)

Ibu Hamil Dites Sifilis Ibu Hamil Sifilis (+) Ibu Hamil Sifilis diobat Ibu Hamil Sifilis Dirujuk

BLN BLN BLN

ABS % DES ABS % DES ABS % DES ABS %
LALU LALU LALU
2 7.69231 0 0 0 0 0 0 0 0 0 0 0 0
14 42.4242 0 0 0 0 0 0 0 0 0 0 0 0
8 66.6667 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 27.027 0 0 0 0 0 0 0 0 0 0 0 0
2 9.09091 0 0 0 0 0 0 0 0 0 0 0 0
10 24.3902 0 0 0 0 0 0 0 0 0 0 0 0
13 22.0339 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 25 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 34.4828 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 17.3913 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 29.4118 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 14.8148 0 0 0 0 0 0 0 0 0 0 0 0
2 15.3846 0 0 0 0 0 0 0 0 0 0 0 0
10 26.3158 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 23.5294 0 0 0 0 0 0 0 0 0 0 0 0
4 8.51064 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
131 10.944 0 0 0 0 0 0 0 0 0 0 0 0
 Integrasi Program

Ibu Hamil dites Hep B Ibu Hamil Hep. B (+) Ibu Hamil Hep.B (+) dirujuk

BLN BLN BLN

DES ABS % DES ABS % DES ABS %
LALU LALU LALU
4 0 4 15 0 0 0 0 0 0 0 0
21 0 21 64 1 0 1 3.0303 0 0 0 0
11 3 14 117 0 0 0 0 0 0 0 0
37 0 37 26 2 0 2 1.40845 1 0 1 0.70423
0 0 0 0 0 0 0 0 0 0 0 0
27 4 31 84 1 0 1 2.7027 0 0 0 0
4 1 5 23 0 0 0 0 0 0 0 0
23 5 28 68 0 0 0 0 0 0 0 0
16 0 16 27 0 0 0 0 0 0 0 0
13 0 13 14 0 0 0 0 0 0 0 0
21 0 21 58 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
2 0 2 9 0 0 0 0 0 0 0 0
31 6 37 132 3 0 3 10.7143 1 0 1 3.57143
23 3 26 45 0 0 0 0 0 0 0 0
10 0 10 21 0 0 0 0 0 0 0 0
12 0 12 52 1 0 1 4.34783 0 0 0 0
6 0 6 6 10 0 10 10.7527 0 0 0 0
17 0 17 33 0 0 0 0 0 0 0 0
4 0 4 29 0 0 0 0 0 0 0 0
 3 0 3 20 0 0 0 0 0 0 0 0
6 0 6 19 0 0 0 0 1 0 1 3.22581
8 0 8 30 0 0 0 0 0 0 0 0
7 0 7 54 0 0 0 0 0 0 0 0
22 0 22 58 0 0 0 0 0 0 0 0
5 0 5 17 0 0 0 0 0 0 0 0
17 2 19 112 1 0 1 5.88235 0 0 0 0
13 0 13 28 2 0 2 4.25532 1 0 1 2.12766
1 0 1 1 1 0 1 0.86207 0 0 0 0
364 24 388 32 22 0 22 1.83793 4 0 4 0.33417
 Pencegahan Malaria Dalam Kehamilan (PMDK)
Ibu Hamil Diperiksa Ibu Hamil mendapatkan Kina/
Ibu Hamil mendapatkan kelambu Ibu Hamil Malaria (+)
Mikroskopis/RDT ACT
BLN BLN BLN BLN
DES ABS % DES ABS % DES ABS % DES
LALU LALU LALU LALU
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
 TB dalam Kehamilan
amil mendapatkan Kina/ Ibu Hamil diperiksa Dahak Ibu Hamil Hasil Dahak TB(+)
ACT
BLN BLN
ABS % DES ABS % DES ABS %
LALU LALU
0 0 0 0 0 0 0 0 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 0 1 0.70423 1 0 1 0.70423
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 0 1 0.08354 1 0 1 0.08354
lan Kecacingan dalam Kehamilan

Ibu Hamil diperiksa Ankylostoma Ibu Hamil Hasil(+)

Tes Ankylostoma
Obat** Ibu Hamil diobati

BLN BLN BLN BLN

DES ABS % DES ABS % DES ABS % DES
LALU LALU LALU LALU
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 0 1 0.70423 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 0 1 0.08354 0 0 0 0 0 0 0 0 0 0
 Pencegahan IMS dalam Kehamilan

Ibu Hamil diobati Ibu Hamil diperiksa IMS Ibu Hamil Hasil Tes IMS (+) Ibu Hamil diobati

BLN BLN BLN

ABS % DES ABS % DES ABS % DES
LALU LALU LALU
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
 KELAS IBU HAMIL

Desa yang melaksanakan kelas Jumlah Kelas Ibu Hamil Jumlah Ibu Hamil yang mengikuti Jumlah suami/kelua
Ibu Hamil diobati ibu hamil yang terbentuk kelas ibu hamil mengikuti kelas ibu

BLN BLN BLN BLN

ABS % DES ABS % DES ABS DES ABS %
LALU LALU LALU LALU
0 0 2 0 2 200 2 0 2 17 0 17 65.38462 2
0 0 2 0 2 200 2 0 2 52 0 52 157.5758 0
0 0 2 0 2 200 2 0 2 17 0 17 141.6667 0
0 0 2 0 2 200 2 0 2 35 0 35 24.64789 5
0 0 2 0 2 200 2 0 2 9 0 9 52.94118 0
0 0 3 0 3 300 3 0 3 40 0 40 108.1081 5
0 0 2 0 2 200 2 0 2 16 0 16 72.72727 3
0 0 2 0 2 200 2 0 2 34 0 34 82.92683 6
0 0 2 0 2 200 2 0 2 30 0 30 50.84746 0
0 0 2 0 2 200 1 0 1 14 0 14 15.38462 0
0 0 2 0 2 200 2 0 2 26 0 26 72.22222 3
0 0 2 0 2 200 2 0 2 1 0 1 11.11111 0
0 0 2 0 2 200 2 0 2 18 0 18 78.26087 3
0 0 2 0 2 200 2 0 2 34 0 34 121.4286 3
0 0 2 0 2 200 2 0 2 34 0 34 58.62069 0
0 0 2 0 2 200 2 0 2 17 0 17 35.41667 0
0 0 2 0 2 200 2 0 2 27 0 27 117.3913 8
0 0 2 0 2 200 2 0 2 30 0 30 32.25806 2
0 0 2 0 2 200 2 0 2 42 0 42 82.35294 3
0 0 1 0 1 100 2 0 2 3 0 3 21.42857 1
0 0 2 0 2 200 2 0 2 16 0 16 106.6667 0
0 0 2 0 2 200 2 0 2 27 0 27 87.09677 0
0 0 2 0 2 200 2 0 2 30 0 30 111.1111 5
0 0 2 0 2 200 2 0 2 12 0 12 92.30769 4
0 0 2 0 2 200 2 0 2 34 0 34 89.47368 7
0 0 2 0 2 200 2 0 2 28 0 28 93.33333 3
0 0 2 0 2 200 2 0 2 20 0 20 117.6471 0
0 0 2 0 2 200 2 0 2 32 0 32 68.08511 5
0 0 2 0 2 200 2 0 2 30 0 30 25.86207 4
0 0 58 0 58 200 58 0 58 725 0 725 60.56809 72

Mengetahui Pagatan, 30 November 2019

Kepala Puskesmas Perawatan Pagatan Bidan Koordinator

Hj. ANDI INDAH HM,S.Kep.Ners LISA MAYASARI, AM.Keb

NIP.19690319 199203 2 017 NIP.19870323 200904 2 003
Jumlah suami/keluarga yang bidan yg melaksanakan kls bumil
mengikuti kelas ibu hamil

BLN
DES ABS % DES ABS %
LALU
0 2 4 0 4
0 0 2 0 2
0 0 2 0 2
0 5 4 0 4
0 0 1 0 1
0 5 6 0 6
0 3 2 0 2
0 6 2 0 2
0 0 4 0 4
0 0 2 0 2
0 3 2 0 2
0 0 2 0 2
0 3 2 0 2
0 3 2 0 2
0 0 0 0 0
0 0 3 0 3
0 8 2 0 2
0 2 3 0 3
0 3 2 0 2
0 1 3 0 3
0 0 4 0 4
0 0 2 0 2
0 5 4 0 4
0 4 2 0 2
0 7 4 0 4
0 3 2 0 2
0 0 2 0 2
0 5 2 0 2
0 4 4 0 4
0 72 0 76 0 76
 Timbang Badan dan Tinggi Badan Ukur TD
Sasaran jumlah
NO. DESA Bumil bumil
BLN BLN
DES ABS % DES ABS %
LALU LALU
1 Api -Api 26 0 91 91 350 0 92 92 354
2 Barugelang 33 0 92 92 279 0 93 93 282
3 Batarang 12 0 93 93 775 0 94 94 783
4 Batuah 142 0 94 94 66 0 95 95 67
5 Beringin 17 0 95 95 559 0 96 96 565
6 Betung 37 0 96 96 259 0 97 97 262
7 Gusunge 22 0 97 97 441 0 98 98 445
8 Juku Eja 41 0 98 98 239 0 99 99 241
9 Kampung Baru 59 0 99 99 168 0 100 100 169
10 Kota Pagatan 91 0 100 100 110 0 101 101 111
11 Manurung 36 0 101 101 281 0 102 102 283
12 Mekar Jaya 9 0 102 102 1133 0 103 103 1144
13 Muara Tengah 23 0 103 103 448 0 104 104 452
14 Muara Pagatan 28 0 104 104 371 0 105 105 375
15 Mudalang 58 0 105 105 181 0 106 106 183
16 Pagaruyung 48 0 106 106 221 0 107 107 223
17 Pakatellu 23 0 107 107 465 0 108 108 470
18 Pasar Baru 93 0 108 108 116 0 109 109 117
19 Pejala 51 0 109 109 214 0 110 110 216
20 Penyolongan 14 0 110 110 786 0 111 111 793
21 Pulau Salak 15 0 111 111 740 0 112 112 747
22 Pulau Satu 31 0 112 112 361 0 113 113 365
23 Rantau Panjang Hilir 27 0 113 113 419 0 114 114 422
24 Rantau Panjang Hulu 13 0 114 114 877 0 115 115 885
25 Saring Sei Bubu 38 0 115 115 303 0 116 116 305
26 Sungai Lembu 30 0 116 116 387 0 117 117 390
27 Tanete 17 0 117 117 688 0 118 118 694
28 Wiritasi 47 0 118 118 251 0 119 119 253
29 Sepunggur 116 0 119 119 103 0 120 120 103
JUMLAH 1,197 0 0 3,045 3045 254 0 3074 3074 257
 Nilai Status Gizi (lila)

BLN DES ABS %

LALU
0 93 93 358
0 94 94 285
0 95 95 792
0 96 96 68
0 97 97 571
0 98 98 265
0 99 99 450
0 100 100 244
0 101 101 171
0 102 102 112
0 103 103 286
0 104 104 1156
0 105 105 457
0 106 106 379
0 107 107 184
0 108 108 225
0 109 109 474
0 110 110 118
0 111 111 218
0 112 112 800
0 113 113 753
0 114 114 368
0 115 115 426
0 116 116 892
0 117 117 308
0 118 118 393
0 119 119 700
0 120 120 255
0 121 121 104
0 3,103 3103 259
 Ukur TFU Presentasi janin dan DJJ Skrining TT Pemberian TTD

BLN BLN BLN BLN

DES ABS % DES ABS % DES ABS % DES
LALU LALU LALU LALU
0 94 94 362 0 95 95 365 0 96 96 369 0 97
0 95 95 288 0 96 96 291 0 97 97 294 0 98
0 96 96 800 0 97 97 808 0 98 98 817 0 99
0 97 97 68 0 98 98 69 0 99 99 70 0 100
0 98 98 576 0 99 99 582 0 100 100 588 0 101
0 99 99 268 0 100 100 270 0 101 101 273 0 102
0 100 100 455 0 101 101 459 0 102 102 464 0 103
0 101 101 246 0 102 102 249 0 103 103 251 0 104
0 102 102 173 0 103 103 175 0 104 104 176 0 105
0 103 103 113 0 104 104 114 0 105 105 115 0 106
0 104 104 289 0 105 105 292 0 106 106 294 0 107
0 105 105 1167 0 106 106 1178 0 107 107 1189 0 108
0 106 106 461 0 107 107 465 0 108 108 470 0 109
0 107 107 382 0 108 108 386 0 109 109 389 0 110
0 108 108 186 0 109 109 188 0 110 110 190 0 111
0 109 109 227 0 110 110 229 0 111 111 231 0 112
0 110 110 478 0 111 111 483 0 112 112 487 0 113
0 111 111 119 0 112 112 120 0 113 113 122 0 114
0 112 112 220 0 113 113 222 0 114 114 224 0 115
0 113 113 807 0 114 114 814 0 115 115 821 0 116
0 114 114 760 0 115 115 767 0 116 116 773 0 117
0 115 115 371 0 116 116 374 0 117 117 377 0 118
0 116 116 430 0 117 117 433 0 118 118 437 0 119
0 117 117 900 0 118 118 908 0 119 119 915 0 120
0 118 118 311 0 119 119 313 0 120 120 316 0 121
0 119 119 397 0 120 120 400 0 121 121 403 0 122
0 120 120 706 0 121 121 712 0 122 122 718 0 123
0 121 121 257 0 122 122 260 0 123 123 262 0 124
0 122 122 105 0 123 123 106 0 124 124 107 0 125
0 3132 3132 262 0 3161 3161 264 0 3190 3190 266 0 3219
Pemberian TTD

ABS %

97 373
98 297
99 825
100 70
101 594
102 276
103 468
104 254
105 178
106 116
107 297
108 1200
109 474
110 393
111 191
112 233
113 491
114 123
115 225
116 829
117 780
118 381
119 441
120 923
 121 318
122 407
123 724
124 264
125 108
3219 269
 Tes Lab

HB Gol. Darah Protein urin HIV

BLN BLN BLN BLN
DES ABS % DES ABS % DES ABS % DES
LALU LALU LALU LALU
0 99 99 381 0 100 100 385 0 61 61 235 0 66
0 100 100 303 0 101 101 306 0 62 62 188 0 67
0 101 101 842 0 102 102 850 0 63 63 525 0 68
0 102 102 72 0 103 103 73 0 64 64 45 0 69
0 103 103 606 0 104 104 612 0 65 65 382 0 70
0 104 104 281 0 105 105 284 0 66 66 178 0 71
0 105 105 477 0 106 106 482 0 67 67 305 0 72
0 106 106 259 0 107 107 261 0 68 68 166 0 73
0 107 107 181 0 108 108 183 0 69 69 117 0 74
0 108 108 119 0 109 109 120 0 70 70 77 0 75
0 109 109 303 0 110 110 306 0 71 71 197 0 76
0 110 110 1222 0 111 111 1233 0 72 72 800 0 77
0 111 111 483 0 112 112 487 0 73 73 317 0 78
0 112 112 400 0 113 113 404 0 74 74 264 0 79
0 113 113 195 0 114 114 197 0 75 75 129 0 80
0 114 114 238 0 115 115 240 0 76 76 158 0 81
0 115 115 500 0 116 116 504 0 77 77 335 0 82
0 116 116 125 0 117 117 126 0 78 78 84 0 83
0 117 117 229 0 118 118 231 0 79 79 155 0 84
0 118 118 843 0 119 119 850 0 80 80 571 0 85
0 119 119 793 0 120 120 800 0 81 81 540 0 86
0 120 120 387 0 121 121 390 0 82 82 265 0 87
0 121 121 448 0 122 122 452 0 83 83 307 0 88
0 122 122 938 0 123 123 946 0 84 84 646 0 89
0 123 123 324 0 124 124 326 0 85 85 224 0 90
0 124 124 413 0 125 125 417 0 86 86 287 0 91
0 125 125 735 0 126 126 741 0 87 87 512 0 92
0 126 126 268 0 127 127 270 0 88 88 187 0 93
0 127 127 109 0 128 128 110 0 89 89 77 0 94
- 3,277 3277 274 0 3,306 3306 276 0 2,175 2175 182 0 2,320
HIV

ABS %

66 254
67 203
68 567
69 49
70 412
71 192
72 327
73 178
74 125
75 82
76 211
77 856
78 339
79 282
80 138
81 169
82 357
83 89
84 165
85 607
86 573
87 281
88 326
89 685
 90 237
91 303
92 541
93 198
94 81
2320 194

Hj. ANDI INDAH HM,S.Kep.Ners

 Tatalaksana Kasus Temu wicara/konseling
Sifilis Hep. B
BLN BLN BLN BLN
DES ABS % DES ABS % DES ABS % DES
LALU LALU LALU LALU
0 71 71 273.0769 0 74 74 285 0 0 0 0 0
0 72 72 218.1818 0 75 75 227 0 0 0 0 0
0 73 73 608.3333 0 76 76 633 0 0 0 0 0
0 74 74 52.11268 0 77 77 54 0 0 0 0 5
0 75 75 441.1765 0 78 78 459 0 0 0 0 0
0 76 76 205.4054 0 79 79 214 0 0 0 0 1
0 77 77 350 0 80 80 364 0 0 0 0 2
0 78 78 190.2439 0 81 81 198 0 0 0 0 5
0 79 79 133.8983 0 82 82 139 0 0 0 0 4
0 80 80 87.91209 0 83 83 91 0 0 0 0 6
0 81 81 225 0 84 84 233 0 0 0 0 1
0 82 82 911.1111 0 85 85 944 0 0 0 0 4
0 83 83 360.8696 0 86 86 374 0 0 0 0 2
0 84 84 300 0 87 87 311 0 0 0 0 0
0 85 85 146.5517 0 88 88 152 0 0 0 0 3
0 86 86 179.1667 0 89 89 185 0 0 0 0 1
0 87 87 378.2609 0 90 90 391 0 0 0 0 5
0 88 88 94.62366 0 91 91 98 0 0 0 0 6
0 89 89 174.5098 0 92 92 180 0 0 0 0 4
0 90 90 642.8571 0 93 93 664 0 0 0 0 1
0 91 91 606.6667 0 94 94 627 0 0 0 0 0
0 92 92 296.7742 0 95 95 306 0 0 0 0 2
0 93 93 344.4444 0 96 96 356 0 0 0 0 2
0 94 94 723.0769 0 97 97 746 0 0 0 0 0
 0 95 95 250 0 98 98 258 0 0 0 0 1
0 96 96 320 0 99 99 330 0 0 0 0 1
0 97 97 570.5882 0 100 100 588 0 0 0 0 0
0 98 98 208.5106 0 101 101 215 0 0 0 0 0
0 99 99 85.34483 0 102 102 88 0 0 0 0 4
0 2465 2465 205.9315 0 2,552 2552 213 0 0 0 0 0 60

Mengetahui Pagatan, 30 November 2019

Kepala Puskesmas Perawatan Pagatan Bidan Koordinator

Hj. ANDI INDAH HM,S.Kep.Ners LISA MAYASARI, AM.Keb

NIP.19690319 199203 2 017 NIP.19870323 200904 2 003
Temu wicara/konseling

ABS %

0 0
0 0
0 0
5 4
0 0
1 3
2 9
5 12
4 7
6 7
1 3
4 44
2 9
0 0
3 5
1 2
5 22
6 6
4 8
1 7
0 0
2 6
2 7
0 0
 1 3
1 3
0 0
0 0
4 3
60 5

30 November 2019

YASARI, AM.Keb
0323 200904 2 003
 Kunjungan Bumil Kunjungan Bumil Kunjungan Bumil
Jumlah Bumil K1 akses (murni + K2
dapat Buku KIA K1 murni akses)
No Nama Desa

1 Api -Api 11 12 13 14
2 Barugelang 12 13 14 15
3 Batarang 13 14 15 16
4 Batuah 14 15 16 17
5 Beringin 15 16 17 18
6 Betung 16 17 18 19
7 Gusunge 17 18 19 20
8 Juku Eja 18 19 20 21
9 Kampung Baru 19 20 21 22
10 Kota Pagatan 20 21 22 23
11 Manurung 21 22 23 24
12 Mekar Jaya 22 23 24 25
13 Muara Tengah 23 24 25 26
14 Muara Pagatan 24 25 26 27
15 Mudalang 25 26 27 28
16 Pagaruyung 26 27 28 29
17 Pakatellu 27 28 29 30
18 Pasar Baru 28 29 30 31
19 Pejala 29 30 31 32
20 Penyolongan 30 31 32 33
21 Pulau Salak 31 32 33 34
22 Pulau Satu 32 33 34 35
23 Rantau Panjang Hil 33 34 35 36
24 Rantau Panjang Hu 34 35 36 37
25 Saring Sei Bubu 35 36 37 38
26 Sungai Lembu 36 37 38 39
27 Tanete 37 38 39 40
28 Wiritasi 38 39 40 41
29 Sepunggur 39 40 41 42
Kunjungan Bumil Kunjungan Bumil Kunjungan TT 1 Kunjungan TT 2 Kunjungan TT 3
K3 K4

Abortus

15 16 17 18 19 20
16 17 18 19 20 21
17 18 19 20 21 22
18 19 20 21 22 23
19 20 21 22 23 24
20 21 22 23 24 25
21 22 23 24 25 26
22 23 24 25 26 27
23 24 25 26 27 28
24 25 26 27 28 29
25 26 27 28 29 30
26 27 28 29 30 31
27 28 29 30 31 32
28 29 30 31 32 33
29 30 31 32 33 34
30 31 32 33 34 35
31 32 33 34 35 36
32 33 34 35 36 37
33 34 35 36 37 38
34 35 36 37 38 39
35 36 37 38 39 40
36 37 38 39 40 41
37 38 39 40 41 42
38 39 40 41 42 43
39 40 41 42 43 44
40 41 42 43 44 45
41 42 43 44 45 46
42 43 44 45 46 47
43 44 45 46 47 48
Kunjungan TT 4 Kunjungan TT 5 Kunjungan TT 2+

FE 1 FE 2 FE 3

21 22 23 24 25 26
22 23 24 25 26 27
23 24 25 26 27 28
24 25 26 27 28 29
25 26 27 28 29 30
26 27 28 29 30 31
27 28 29 30 31 32
28 29 30 31 32 33
29 30 31 32 33 34
30 31 32 33 34 35
31 32 33 34 35 36
32 33 34 35 36 37
33 34 35 36 37 38
34 35 36 37 38 39
35 36 37 38 39 40
36 37 38 39 40 41
37 38 39 40 41 42
38 39 40 41 42 43
39 40 41 42 43 44
40 41 42 43 44 45
41 42 43 44 45 46
42 43 44 45 46 47
43 44 45 46 47 48
44 45 46 47 48 49
45 46 47 48 49 50
46 47 48 49 50 51
47 48 49 50 51 52
48 49 50 51 52 53
49 50 51 52 53 54
Kunjungan Bumil Kunjungan Bumil Rujukan kasus
resti oleh Persalinan nakes a. b.
resti oleh nakes masyarakat resti maternal

RS swasta, RSIB,
RS klinik

27 28 29 30 31 32
28 29 30 31 32 33
29 30 31 32 33 34
30 31 32 33 34 35
31 32 33 34 35 36
32 33 34 35 36 37
33 34 35 36 37 38
34 35 36 37 38 39
35 36 37 38 39 40
36 37 38 39 40 41
37 38 39 40 41 42
38 39 40 41 42 43
39 40 41 42 43 44
40 41 42 43 44 45
41 42 43 44 45 46
42 43 44 45 46 47
43 44 45 46 47 48
44 45 46 47 48 49
45 46 47 48 49 50
46 47 48 49 50 51
47 48 49 50 51 52
48 49 50 51 52 53
49 50 51 52 53 54
50 51 52 53 54 55
51 52 53 54 55 56
52 53 54 55 56 57
53 54 55 56 57 58
54 55 56 57 58 59
55 56 57 58 59 60
 Komplikasi
Persalinan non
c. a. b. Maternal di Vit A Nifas
nakes tangani

Pustu, PKD, Rumah Perjalanan

polindes

33 34 35 36 37 38
34 35 36 37 38 39
35 36 37 38 39 40
36 37 38 39 40 41
37 38 39 40 41 42
38 39 40 41 42 43
39 40 41 42 43 44
40 41 42 43 44 45
41 42 43 44 45 46
42 43 44 45 46 47
43 44 45 46 47 48
44 45 46 47 48 49
45 46 47 48 49 50
46 47 48 49 50 51
47 48 49 50 51 52
48 49 50 51 52 53
49 50 51 52 53 54
50 51 52 53 54 55
51 52 53 54 55 56
52 53 54 55 56 57
53 54 55 56 57 58
54 55 56 57 58 59
55 56 57 58 59 60
56 57 58 59 60 61
57 58 59 60 61 62
58 59 60 61 62 63
59 60 61 62 63 64
60 61 62 63 64 65
61 62 63 64 65 66
 Jumlah kematian Sebab Kematian
Ibu (tulis Tempat Kematian
Ibu sebabnya)
KF I KF II KF III

39 40 41 42 43 44
40 41 42 43 44 45
41 42 43 44 45 46
42 43 44 45 46 47
43 44 45 46 47 48
44 45 46 47 48 49
45 46 47 48 49 50
46 47 48 49 50 51
47 48 49 50 51 52
48 49 50 51 52 53
49 50 51 52 53 54
50 51 52 53 54 55
51 52 53 54 55 56
52 53 54 55 56 57
53 54 55 56 57 58
54 55 56 57 58 59
55 56 57 58 59 60
56 57 58 59 60 61
57 58 59 60 61 62
58 59 60 61 62 63
59 60 61 62 63 64
60 61 62 63 64 65
61 62 63 64 65 66
62 63 64 65 66 67
63 64 65 66 67 68
64 65 66 67 68 69
65 66 67 68 69 70
66 67 68 69 70 71
67 68 69 70 71 72
Masa Kematian Jumlah Bayi lahir Jumlah bayi lahir
(Hamil/ Bersalin/ hidup Jumlah IUFD a,
mati
nifas)
Penolong

Obgyn/sc

45 46 47 48 49 50
46 47 48 49 50 51
47 48 49 50 51 52
48 49 50 51 52 53
49 50 51 52 53 54
50 51 52 53 54 55
51 52 53 54 55 56
52 53 54 55 56 57
53 54 55 56 57 58
54 55 56 57 58 59
55 56 57 58 59 60
56 57 58 59 60 61
57 58 59 60 61 62
58 59 60 61 62 63
59 60 61 62 63 64
60 61 62 63 64 65
61 62 63 64 65 66
62 63 64 65 66 67
63 64 65 66 67 68
64 65 66 67 68 69
65 66 67 68 69 70
66 67 68 69 70 71
67 68 69 70 71 72
68 69 70 71 72 73
69 70 71 72 73 74
70 71 72 73 74 75
71 72 73 74 75 76
72 73 74 75 76 77
73 74 75 76 77 78
 Anemia ringan
b. c. d. e. Di periksa HB (10-10,9)

Dokter Bidan DK Keluarga

51 52 53 54 55 56
52 53 54 55 56 57
53 54 55 56 57 58
54 55 56 57 58 59
55 56 57 58 59 60
56 57 58 59 60 61
57 58 59 60 61 62
58 59 60 61 62 63
59 60 61 62 63 64
60 61 62 63 64 65
61 62 63 64 65 66
62 63 64 65 66 67
63 64 65 66 67 68
64 65 66 67 68 69
65 66 67 68 69 70
66 67 68 69 70 71
67 68 69 70 71 72
68 69 70 71 72 73
69 70 71 72 73 74
70 71 72 73 74 75
71 72 73 74 75 76
72 73 74 75 76 77
73 74 75 76 77 78
74 75 76 77 78 79
75 76 77 78 79 80
76 77 78 79 80 81
77 78 79 80 81 82
78 79 80 81 82 83
79 80 81 82 83 84
Anemia sedang Anemia berat Protein Urin di Hasil Protein Urin
Diperiksa LiLa KEK (LiLa <23,5)
(7-9,9) (<7) periksa (++++)

57 58 59 60 61 62
58 59 60 61 62 63
59 60 61 62 63 64
60 61 62 63 64 65
61 62 63 64 65 66
62 63 64 65 66 67
63 64 65 66 67 68
64 65 66 67 68 69
65 66 67 68 69 70
66 67 68 69 70 71
67 68 69 70 71 72
68 69 70 71 72 73
69 70 71 72 73 74
70 71 72 73 74 75
71 72 73 74 75 76
72 73 74 75 76 77
73 74 75 76 77 78
74 75 76 77 78 79
75 76 77 78 79 80
76 77 78 79 80 81
77 78 79 80 81 82
78 79 80 81 82 83
79 80 81 82 83 84
80 81 82 83 84 85
81 82 83 84 85 86
82 83 84 85 86 87
83 84 85 86 87 88
84 85 86 87 88 89
85 86 87 88 89 90
 Ibu Hamil datang Ibu Hamil
Di Periksa Gula Hasil GD > 140 Ibu hamil hasil Jumlah ibu hamil
ditawarkan tes
Darah g/dl dengan HIV+ tes HIV (+) HIV +
HIV

63 64 65 66 67 68
64 65 66 67 68 69
65 66 67 68 69 70
66 67 68 69 70 71
67 68 69 70 71 72
68 69 70 71 72 73
69 70 71 72 73 74
70 71 72 73 74 75
71 72 73 74 75 76
72 73 74 75 76 77
73 74 75 76 77 78
74 75 76 77 78 79
75 76 77 78 79 80
76 77 78 79 80 81
77 78 79 80 81 82
78 79 80 81 82 83
79 80 81 82 83 84
80 81 82 83 84 85
81 82 83 84 85 86
82 83 84 85 86 87
83 84 85 86 87 88
84 85 86 87 88 89
85 86 87 88 89 90
86 87 88 89 90 91
87 88 89 90 91 92
88 89 90 91 92 93
89 90 91 92 93 94
90 91 92 93 94 95
91 92 93 94 95 96
Persalinan Persalinan SC Ibu Ibu hamil dites Ibu Hamil sifilis+ Ibu hamil sifilis Ibu hamil dites
Pervaginam Ibu Hamil HIV + sifilis dirujuk Hep B
Hamil HIV +

69 70 71 72 73 74
70 71 72 73 74 75
71 72 73 74 75 76
72 73 74 75 76 77
73 74 75 76 77 78
74 75 76 77 78 79
75 76 77 78 79 80
76 77 78 79 80 81
77 78 79 80 81 82
78 79 80 81 82 83
79 80 81 82 83 84
80 81 82 83 84 85
81 82 83 84 85 86
82 83 84 85 86 87
83 84 85 86 87 88
84 85 86 87 88 89
85 86 87 88 89 90
86 87 88 89 90 91
87 88 89 90 91 92
88 89 90 91 92 93
89 90 91 92 93 94
90 91 92 93 94 95
91 92 93 94 95 96
92 93 94 95 96 97
93 94 95 96 97 98
94 95 96 97 98 99
95 96 97 98 99 100
96 97 98 99 100 101
97 98 99 100 101 102
 Pencegahan
Ibu hamil Hep B+ Malaria dalam
Ibu hamil Hep B+ dirujuk a. b. c.
kehamilan
(PMDK)

Ibu hamil Ibu hamil Ibu hamil

mendapatkan diperiksa mendapatkan
kelambu Mikrskopis (RDT) KINA /ACT

75 76 77 78 79 80
76 77 78 79 80 81
77 78 79 80 81 82
78 79 80 81 82 83
79 80 81 82 83 84
80 81 82 83 84 85
81 82 83 84 85 86
82 83 84 85 86 87
83 84 85 86 87 88
84 85 86 87 88 89
85 86 87 88 89 90
86 87 88 89 90 91
87 88 89 90 91 92
88 89 90 91 92 93
89 90 91 92 93 94
90 91 92 93 94 95
91 92 93 94 95 96
92 93 94 95 96 97
93 94 95 96 97 98
94 95 96 97 98 99
95 96 97 98 99 100
96 97 98 99 100 101
97 98 99 100 101 102
98 99 100 101 102 103
99 100 101 102 103 104
100 101 102 103 104 105
101 102 103 104 105 106
102 103 104 105 106 107
103 104 105 106 107 108
 Desa yang Jumlah Kelas Ibu
Ibu hamil Ibu hamil Hasil Kecacingan dalam Ibu hamil melaksanakan hamil yang
diperiksa dahak Dahak TB (+) kehamilan diperiksa IMS kelas Ibu Hamil terbentuk

81 82 83 84 85 86
82 83 84 85 86 87
83 84 85 86 87 88
84 85 86 87 88 89
85 86 87 88 89 90
86 87 88 89 90 91
87 88 89 90 91 92
88 89 90 91 92 93
89 90 91 92 93 94
90 91 92 93 94 95
91 92 93 94 95 96
92 93 94 95 96 97
93 94 95 96 97 98
94 95 96 97 98 99
95 96 97 98 99 100
96 97 98 99 100 101
97 98 99 100 101 102
98 99 100 101 102 103
99 100 101 102 103 104
100 101 102 103 104 105
101 102 103 104 105 106
102 103 104 105 106 107
103 104 105 106 107 108
104 105 106 107 108 109
105 106 107 108 109 110
106 107 108 109 110 111
107 108 109 110 111 112
108 109 110 111 112 113
109 110 111 112 113 114
 Jumlah
Jumlah ibu hamil Bidan yang Ibu hamil
suami/keluarga
yang mengikuti melaksanakan diperiksa dengan a. b.
yang mengikuti
kelas ibu hamil kelas bumil ANC terpadu 10 T
kelas ibu hamil

Timbang badan Ukur TD

dan tinggi badan

87 88 89 90 91 92
88 89 90 91 92 93
89 90 91 92 93 94
90 91 92 93 94 95
91 92 93 94 95 96
92 93 94 95 96 97
93 94 95 96 97 98
94 95 96 97 98 99
95 96 97 98 99 100
96 97 98 99 100 101
97 98 99 100 101 102
98 99 100 101 102 103
99 100 101 102 103 104
100 101 102 103 104 105
101 102 103 104 105 106
102 103 104 105 106 107
103 104 105 106 107 108
104 105 106 107 108 109
105 106 107 108 109 110
106 107 108 109 110 111
107 108 109 110 111 112
108 109 110 111 112 113
109 110 111 112 113 114
110 111 112 113 114 115
111 112 113 114 115 116
112 113 114 115 116 117
113 114 115 116 117 118
114 115 116 117 118 119
115 116 117 118 119 120
 c. d. e. f. g.

Tes LAB

Nilai status Gizi Presentasi janin

Ukur TFU Skrining TT Pemberian TTD
(LiLa) dan DJJ

93 94 95 96 97 98
94 95 96 97 98 99
95 96 97 98 99 100
96 97 98 99 100 101
97 98 99 100 101 102
98 99 100 101 102 103
99 100 101 102 103 104
100 101 102 103 104 105
101 102 103 104 105 106
102 103 104 105 106 107
103 104 105 106 107 108
104 105 106 107 108 109
105 106 107 108 109 110
106 107 108 109 110 111
107 108 109 110 111 112
108 109 110 111 112 113
109 110 111 112 113 114
110 111 112 113 114 115
111 112 113 114 115 116
112 113 114 115 116 117
113 114 115 116 117 118
114 115 116 117 118 119
115 116 117 118 119 120
116 117 118 119 120 121
117 118 119 120 121 122
118 119 120 121 122 123
119 120 121 122 123 124
120 121 122 123 124 125
121 122 123 124 125 126
 a. b.

HB Golongan Darah

99 100
100 101
101 102
102 103
103 104
104 105
105 106
106 107
107 108
108 109
109 110
110 111
111 112
112 113
113 114
114 115
115 116
116 117
117 118
118 119
119 120
120 121
121 122
122 123
123 124
124 125
125 126
126 127
127 128