Kunjungan Neonatal
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PEMERINTAH KABUPATEN KARANGANYAR DINAS KESEHATAN UPT.PUSKESMAS GONDANGREJO Alamat : Jl Raya Solo-Purwodadi Km.12 Desa Tuban Kec.Gondangrejo Telp.( 0271)6812264
LAPORAN PELAKSANAAN TUGAS 1. Dasar Penugasan : No. 445/ 2. Nama Petugas
/17/ IX / 2017,
tgl
2017
: ..............................................................................................................
3. Tujuan Perjalanan : Dusun...........................Desa................................................................ 4. Tanggal perjalanan : .............................................................................................................. 5. Maksud Perjalanan : Kunjungan Neonatal 6. Hasil Kunjungan Antara lain : a. Nama Bayi : .............................................................................................................. b. Nama ibu : .............................................................................................................. c. Pertumbuhan : BB......................kg, PB......................., lika....................................cm d. Status Gizi : .............................................................................................................. e. Bayi Sakit Apa: .............................................................................................................. f. Apakah ada penyakit berat/infeksi berat g. VS : RR .......x/menit, denyut jantung...........x/menit, suhu........°C h. Apakah diare : .............................................................................................................. i. Apakah Ikterus : .................................................................................................. j. Apakah BB rendah : .................................................................................................. k. Status Imunisasi : .................................................................................................. l. Inj Vit K 1 : .................................................................................................. m. Keluhan Ibu : .................................................................................................. n. Kepesertaan : Umum/ JKN PBI/ JKN Non PBI/ KIS/ Jamkesda/ SKTM/....... o. Rumah : Lantai................ pencahayaan............... ventilasi..................... p. Sumber Air :.......................................... MCK .............................................. q. Lingkungan Rumah : .................................................................................................. 7. pemberian Nasihat : ............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. KESIMPULAN/ SARAN ................................................................................................................................................. ................................................................................................................................................. .................................................................................................................................................
Tanggal, Pelapor
(
2017
)
LAPORAN PELAKSANAAN TUGAS 1. Dasar Penugasan : No. 445/ 2. Nama Petugas
/17/ IX / 2017,
tgl
2017
: ..............................................................................................................
3. Tujuan Perjalanan : Dusun...........................Desa................................................................ 4. Tanggal perjalanan : .............................................................................................................. 5. Maksud Perjalanan : Kunjungan Neonatal 6. Hasil Kunjungan Antara lain : a. Nama Bayi : .............................................................................................................. b. Nama ibu : .............................................................................................................. c. Pertumbuhan : BB......................kg, PB......................., lika....................................cm d. Status Gizi : .............................................................................................................. e. Bayi Sakit Apa: .............................................................................................................. f. Apakah ada penyakit berat/infeksi berat g. VS : RR .......x/menit, denyut jantung...........x/menit, suhu........°C h. Apakah diare : .............................................................................................................. i. Apakah Ikterus : .................................................................................................. j. Apakah BB rendah : .................................................................................................. k. Status Imunisasi : .................................................................................................. l. Inj Vit K 1 : .................................................................................................. m. Keluhan Ibu : .................................................................................................. n. Kepesertaan : Umum/ JKN PBI/ JKN Non PBI/ KIS/ Jamkesda/ SKTM/....... o. Rumah : Lantai................ pencahayaan............... ventilasi..................... p. Sumber Air :.......................................... MCK .............................................. q. Lingkungan Rumah : .................................................................................................. 7. pemberian Nasihat : ............................................................................................................. .............................................................................................................. .............................................................................................................. .............................................................................................................. KESIMPULAN/ SARAN ................................................................................................................................................. ................................................................................................................................................. .................................................................................................................................................
Tanggal, Pelapor
(
2017
)
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