Siidakep Maret 2019 - Copy

Formulir 1 Pelaporan dan Pencatatan Kelahiran Bayi UPTD Puskesmas Lengkong Bulan/Tahun Mar-19 Uraian No Nomor Kartu Keluarga (KK)

Alamat Jelas

NIK Bayi Nama Bayi (jika ada)

Jenis Kelamin

1

3202073003170002 Kp sindanggalih, desa lengkong

By Ny Nursiti/salih

L

2

3202071101190001 kp bojong genteng

By Ny Sintia Dewi/Rizky

P

3 4

3202071604110003 kp padahurip 3202071407110010 kp padahurip

By Ny Fitri/Kusnadi By Ny Erna/hamdan

L P

5 6 7 8 9 10 11 12

3202072410180001 kp ciwangi atas 20/10 3202072408180004 kp wates 27/08 3202071501190001 kp babakan pada hurip 30/7 Kp Tegal Datar Desa Neglasari Kp babakan 3202071004130004 Kp sirna Hurip 25/06 3202072610180001 Kp Nyalindung 10/02 3202070108180002 Kp Cikadu 13/03

By Ny Meli/Hanan By Ny Rina/Indra By Ny Sri M/Majid By Ny Nanay/Dede By wita/Rustam By Ny Sumi/Asep By Ny Siti Salma/Ajum By Ny Novitasari/Maulana

L P P P L L P L

13 3202072608100143 Kp Bojong Sawah 17/04

By Ny siti latipah/Ujang P Hendar

14 3202073105180003 Kp Cadas ngampar

BY NY Dewi/Ujang rohman

L

15 3202070809170002 Kp Cipareang 16 3202071810130001 Kp Tegal Datar 17 Kp Cimanggu, Desa Langkap Jaya

By Ny Rini/Dede By Ny Aisyah/Misbah By Ny Dede/Madin

L L

18 19 20 21 22 23 24

BY NY Alwis/Abdul BY Ny Rini/Oman By NY Aisah/M.dede By Rani/Prana

P P L P

By Ny Lisnawati/ By NY Nurhasanah/Korib

P L

25 26 Kp Joglo 27 3202071107120007 KP Cicau 28 3202071607180004 Kp Cijulang

By Ny Sinta/Suryana By Devitasari/Nudiono BY NY Latipah/Andi BY NY Dea febrilia/Farid

L P L P

29 30

BY Ny desi/Yanto BY NY yusi/Amirullah

P P

3202072106100014 3202071001190002 3202072410180001 3202071108071556 3202070807120005

Kp Cibuluh Kp Cisuren Kp cibuluh Kp Sampalan 17/05 Kp Cijulang Kp Cimanggu Girang Kp Cimanggu Girang

KP Cikupa Kp Sampalan 17/05

31 3202070719180002 Kp Cijambe 17/06 Desa Cilangkap

By Ny Silvia/Aldin

32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77

BY Ny Sri maryati/TugionP BY NY Rika/Firman P BY Ny Rini/Aep L By Ny Neng desi/Denis L BY Ny Lia/Hasan L By Ny Dea/Ujang L By Ny lusi/Iwan L BY Ny Yanti/Juned P BY Ny Nina/Deri P By NY Aisyah/Paridudin P BY NY yayan/Encep P By NY Siti Nurhayati/BurP By Ny Fitri/Cecep L BY Ny Sri/Agus L BY Ny Sri/Agus L By Ny Nida/Agus P By Ny Yuyun/Heri L By Ny arum/Jepri L By Ny Nurohmah/Tatang L By Ny Susi/Uyok P By NY Yuni/Yadi L BY Ny Ai/Nasrane L By Ny aminah/Pendi P BY NY Iin/Dian P BY NY Ristawati/Dodi P By NY Maslilah/Nurmaw L

3202071802110016 Kp Sarongge 6/2 3202072211180002 KP Nangoh 33/11 KP Cingenca 3202070103180002 Kp Simpenan 31/11 KP Nungku KP Cipanengah Kp Sarongge 6/2 Kp Cigandok 3202071705120001 Kp Simpenan 31/11 KP Cicadas KP Cigandok Kp cikaso Kp Cikasap Kp Lengsar Kp Lengsar Kp Situmekar 3202072700150006 Kp Cibogo, Desa Tegallega 3202213101130001 Kp Malingping Kp tegallega 3202071008071117 Kp Tipar Kp cibandung 3202070808110005 Kp Cikaso 3202071512110002 Kp Cikupa 3202072504120023 Kp Cidite 3202071306120012 KP Cikaso KP Jantra

L

Kepala UPTD Puskesmas Lengkong

Dr.Leaderman NIP. 19670523200212001

Uraian Usia Tempat Gestasi Lahir (minggu)

Berat Badan (gram)

Jenis Kelahiran

Tanggal Lahir

Panjang Tempat Bayi (cm) Persalinan

38

SMI

3000

SPONTAN

26-Feb-19

49

PONED

38

SMI

3000

SPONTAN

1-Mar-19

51

PONED

39 38

SMI SMI

2600 4000

SPONTAN SPONTAN

17-Mar-19 48 5-Mar-19 50

RUMAH RUMAH

40 37 37 40 40 39 39 39

SMI SMI SMI SMI SMI SMI SMI SMI

3600 3000 3000 3300 3500 3200 2900 3200

SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN

23-Mar-19 12-Mar-19 20-Mar-19 28-Feb-19 2-Mar-19 3-Mar-19 12-Mar-19 17-Mar-19

PONED PONED BPM PONED BPM BPM PONED PONED

39

SMI

2700

SPONTAN

20-Mar-19 49

BPM

40

SMI

3500

SPONTAN

21-Mar-19 51

BPM

39 40 39

SMI SMI SMI

2500 2800

SPONTAN SPONTAN SC

23-Mar-19 48 26-Mar-19 49 6-Mar-19

BPM PONED RS

39 40 39 40 40 38 39

SMI SMI SMI SMI SMI SMI SMI

3000 2900 2400 3000

SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN

12-Mar-19 14-Mar-19 16-Mar-19 22-Jan-19 22-Mar-19 27-Feb-19

RUMAH PONED PONED PONED RUMAH RUMAH RUMAH

42 38 39 38

SMI SMI SMI SMI

3400 3500 2700 3200

SPONTAN SPONTAN SPONTAN SPONTAN

25-Mar-19 51 8-Mar-19 50 18-Mar-19 51 48

PONED PONED PONED BPM

38 38

SMI SMI

3500 2800

SPONTAN SPONTAN

17-Mar-19 50 3/27/2019 48

BPM BPM

51 48 49 51 50 50 49 51

49 48 48 42

KET

37

SMI

3100

SPONTAN

3/1/2019

49

PONED

38 39 38 39 38 42 36 35 39 41 38 42 39 40 40 41 37 39 40 42 40 38 39 40 41 39

SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI SMI

3100 2800 2800 2800 3200 3300 3200 3200 3100 3200 3300 3100 3400 2200 2500 3200 3000 2500 3500 3000 3000 2800 2500 3000 3200 3000

SPONTAN SPONTAN SPONTAN SPONTAN SC SC SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SC SC SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN SPONTAN

1-Mar-19 5-Mar-19 6-Mar-19 7-Mar-19 13-Mar-19 13-Mar-19 11-Mar-19 28-Feb-19 18-Mar-19 26-Mar-19 26-Mar-19 26-Mar-19 21-Mar-19 2/27/2019 2/27/2019 2/27/2019 3/2/2019 3/3/2019 3/3/2019 3/3/2019 3/6/2019 3/7/2019 3/14/2019 3/14/2019 3/16/2019 3/23/2019

49 49 49 51 51 50 50 50 50 52 50 51 50 49 49 50 49 49 50 50 48 48 49 50 49 50

BPM PONED PONED PONED RS RS RS BPM PONED RUMAH BPM PONED PONED RS RS RS BPM PONED PONED RS BPM PONED PONED PONED PONED RUMAH

Sukabumi, Bidan Koordinator Puskesmas Lengkong

N.IDA SRINURWENDA NIP. 196512141986032007

Formulir 2 Pelaporan dan Pencatatan Ibu Melahirkan Lengkong UPTD Puskesmas Jan-19 Bulan/Tahun Uraian No

1 2 3 4 5 6 7 8

Nomor Kartu Keluarga (KK)

Nama Ibu/Suami

3202073003170002 Ny Nursiti/salih 3202071101190001 3202071604110003 3202071407110010 3202072410180001 3202072408180004 3202071501190001

Ny Sintia Dewi/Rizky Ny Fitri/Kusnadi Ny Erna/hamdan Ny Meli/Hanan Ny Rina/Indra Ny Sri M/Majid Ny Nanay/Dede

Tempat Persalinan

Kp sindanggalih, desa PONED lengkong kp bojong genteng PONED kp padahurip RUMAH kp padahurip RUMAH kp ciwangi atas 20/10 PONED kp wates 27/08 PONED kp babakan pada hurip 30/7 BPM Kp Tegal Datar Desa PONED Neglasari Kp babakan Kp sirna Hurip 25/06

BPM BPM

11 3202072610180001 Ny Siti Salma/Ajum 12 3202070108180002 Ny Novitasari/Maulana 13 3202072608100143 Ny siti latipah/Ujang Hendar 3202073105180003 NY Dewi/Ujang rohman 14

Kp Nyalindung 10/02 Kp Cikadu 13/03 Kp Bojong Sawah 17/04 Kp Cadas ngampar

PONED PONED BPM BPM

15 3202070809170002 Ny Rini/Dede 16 3202071810130001 Ny Aisyah/Misbah Ny Dede/Madin 17

Kp Cipareang

BPM

Kp Tegal Datar Kp Cimanggu, Desa Langkap Jaya

PONED RS

Kp Cibuluh Kp Cisuren Kp cibuluh Kp Sampalan 17/05 Kp Cijulang Kp Cimanggu Girang Kp Cimanggu Girang

RUMAH PONED PONED PONED RUMAH RUMAH RUMAH PONED PONED PONED BPM BPM BPM PONED

9 10

18 19 20 21 22 23 24 25 26 27 28 29 30 31

Ny wita/Rustam 3202071004130004 Ny Sumi/Asep

Alamat Jelas

NY Alwis/Abdul 3202072106100014 Ny Rini/Oman 3202071001190002 NY Aisah/M.dede 3202072410180001 Rani/Prana 3202071108071556 Ny Lisnawati/ 3202070807120005 NY Nurhasanah/Korib Ny Sinta/Suryana Ny Devitasari/Nudiono 3202071107120007 NY Latipah/Andi 3202071607180004 NY Dea febrilia/Farid Ny desi/Yanto NY yusi/Amirullah 3202070719180002 Ny Silvia/Aldin

Kp Joglo KP Cicau Kp Cijulang KP Cikupa Kp Sampalan 17/05 Kp Cijambe 17/06 Desa Cilangkap

32 3202071802110016 Ny Sri maryati/Tugiono 33 3202072211180002 NY Rika/Firman Ny Rini/Aep 34 35 3202070103180002 Ny Neng desi/Denis Ny Lia/Hasan 36

Kp Sarongge 6/2 KP Nangoh 33/11 KP Cingenca Kp Simpenan 31/11 KP Nungku

BPM PONED PONED PONED RS

KP Cipanengah

RS

Kp Sarongge 6/2 Kp Cigandok Kp Simpenan 31/11

RS BPM PONED

NY Aisyah/Paridudin

KP Cicadas

RUMAH

NY yayan/Encep NY Siti Nurhayati/Burhan Ny Fitri/Cecep Ny Sri/Agus Ny Nida/Agus Ny Yuyun/Heri Ny arum/Jepri Ny Nurohmah/Tatang Ny Susi/Uyok NY Yuni/Yadi Ny Ai/Nasrane Ny aminah/Pendi NY Iin/Dian NY Ristawati/Dodi NY Maslilah/Nurmawan

KP Cigandok Kp cikaso KP Cikasap Kp Lengsar Kp Situmekar Kp Cibogo, Desa Tegallega Kp Malingping Kp tegallega Kp Tipar Kp cibandung Kp Cikaso Kp Cikupa Kp Cidite KP Cikaso KP Jantra

BPM PONED PONED RS RS BPM PONED PONED RS BPM PONED PONED PONED PONED RUMAH

Ny Dea/Ujang

37

Ny lusi/Iwan Ny Yanti/Juned 3202071705120001 Ny Nina/Deri 40 38 39 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72

3202072700150006 3202213101130001 3202071008071117 3202070808110005 3202071512110002 3202072504120023 3202071306120012

Kepala UPTD Puskesmas Lengkong

Dr.Leaderman

NIP. 19670523200212001

Uraian

GPA

Berat keterangan Penolong Komplikasi Frekuensi Badan Saat Komplikasi Persalinan Kelahiran Kehamilan ANC Melahirkan

G1P0A0

BIDAN

-

13

60

-

G1P0A0 G3P2A0 G3P2A0 G1P0A0 G1P0A0 G1P0A0

BIDAN PARAJI PARAJI BIDAN BIDAN BIDAN

-

9 5 4 10 9 10

54 58 63 66 60 80

-

G3P2A0

BIDAN

-

8

59

-

G3P2A0

BIDAN

-

8

58

-

G3P2A0

BIDAN

-

7

60

-

G1P0A0 G1P0A0 G3P2A0

BIDAN BIDAN BIDAN

-

7 7 5

60 59 58

-

G3P2A0

BIDAN

-

8

62

-

G1P0A0 G5P4A0

BIDAN BIDAN

-

6 5

59 58

-

DOKTER

PEB

7

-

-

G1P0A0 G2P1A0 G1P0A0 G3P2A0 G1P0A0 G2P1A0 G1P0A0 G2P1A0 G3P2A0 G3P2A0 G1P0A0 G2P1A0 G1P0A0

PARAJI BIDAN BIDAN BIDAN BIDAN PARAJI PARAJI BIDAN BIDAN BIDAN BIDAN BIDAN BIDAN

-

1 7 6 5 6 6 5 5 7 -

-

-

G1P0A0

BIDAN

-

6

-

-

G2P1A0 G1P0A0 G3P2A0 G1P0A0

BIDAN BIDAN BIDAN BIDAN

plasenta previa

7 7 7 8

-

-

G2P1A0

DOKTER

3

-

-

G1P0A0

DOKTER

serotinus

6

-

-

G2P1A0 G3P2A0

BIDAN BIDAN

sungsang -

7 6

-

-

G2P1A0

BIDAN

-

9

-

-

PARAJI BIDAN BIDAN BIDAN DOKTER BIDAN BIDAN BIDAN BIDAN BIDAN BIDAN BIDAN BIDAN BIDAN BIDAN PARAJI

-

6 6 9 9 4 6 7 10 8 14 11 12 7 11 10 11

60 58 55 60 61 58 59 64 65 67

kala 2 lama -

G2P1A0 G1P0A0 G1P0A0 G2P1A0 G1P0A0 G1P0A0 G1P0A0 G1P0A0 G5P2A2 G4P3A0 G2P1A0 G2P1A0 G2P1A0 G3P2A0 G2P1A0 G4P3A0

Sukabumi, Bidan Koordinator Puskesmas Lengkong

N.IDA SRINURWENDA NIP. 196512141986032007

Formulir 3 Pencatatan dan Pelaporan Kematian Ibu UPTD Puskesmas : Lengkong Bulan/Tahun Mar-19 Uraian No

Nomor Kartu Keluarga (KK)

Alamat Jelas

Nama Ibu

Tanggal Kematian

Sebab Meninggal

Mengetahui Kepala UPTD Puskesmas Lengkong

Bidan Koordinator Puskesmas Lengkon

dr. L E A D E R M A N NIP. 196705232002121001

N.IDA SRINURWENDA NIP. 196512141986032007

Periode Meninggal

Tempat Meninggal

Sukabumi, Bidan Koordinator Puskesmas Lengkong

N.IDA SRINURWENDA NIP. 196512141986032007

KET

Formulir 4 Pencatatan dan Pelaporan Kematian Neonatal, Bayi dan Balita UPTD Puskesmas : Lengkong Bulan/Tahun Friday, March 01, 2019 Uraian No

Nomor Kartu Keluarga (KK)

Alamat Jelas

1 2 3 4

Mengetahui, Kepala UPTD Puskesmas Lengkong

dr. L E A D E R M A N NIP. 196705232002121001

NIK Anak

Nama Anak

Jenis Kelamin

Uraian Tanggal Meninggal

Berat Badan Bayi/Anak (gram)

Sebab Meninggal

Tempat Panjang Meningga Bayi (cm) l

Sukabumi, Bidan Koordinator Puskesmas Lengkong

N.IDA SRINURWENDA NIP. 196512141986032007

KET