STP Maret 2018

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS STP.PUS.
KA form 7
Propinsi : Sumatera Barat Tahun : 2018

Kabupaten : Lima Puluh Kota Bulan Maret
Puskesmas : Suliki Jumlah Kunjungan :
Golongan Umur (Tahun) Total Total
No Jenis Penyakit 0-7hr 8-28 hr <1 1. - 4 5.- 9 10. - 14 15 - 19 20 - 44 45 - 54 55 - 59 60 - 69 70 + Lk Pr Kunjungan
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
4 Tifus Perut Klinis 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
13 Hepatitis Klinis 0
14 Malaris Klinis 0
15 Malaria Vivak 0
16 Malaris Falcifarum 0
17 Malaria Mix 0
18 Demam Berdarah Dengue 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
26 Diabetes Melitus 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Laporan Awal/ Perbaikan (Lingkari Pilihan)
Jumlah Puskesmas Pembantu yang ada bulan Laporan …………………. Pelapor,
Jumlah Puskesmas Pembantu melapor bulan Laporan :………………….(…….%)
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan :………………….(…….%)
Nama
catatan : NIP
= WARNA HIJAU JANGAN DIISI
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS STP.PUS.KA form 7

Puskesmas : Mahat Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama
= WARNA HIJAU JANGAN DIISI NIP

Puskesmas : Banjo Laweh Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Kabupaten : Lima Puluh Kota Bulan : Maret
Puskesmas : Koto Tinggi Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Puskesmas : Padang Kandis Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Puskesmas : Mungka Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Puskesmas : Dangung Dangung Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Puskesmas : Mungo Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Puskesmas : Koto Baru Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Puskesmas : Piladang Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0
2 Diare 0
3 Diare Berdarah 0
5 TB Paru BTA + 0
6 TB Paru Klinis 0
7 Kusta PB 0
8 Kusta MB 0
9 Campak 0
10 Difteri 0
11 Batuk Rejan 0
12 Tetanus 0
14 Malaris Klinis 0
15 Malaria Vivak 0
17 Malaria Mix 0
19 Demam Dengue 0
20 Pnumonia 0
21 Sifilis 0
22 Gonorhoe 0
23 Frambusia 0
24 Filariasis 0
25 Influenza 0
27 Hipertensi 0
28 Chikungunya 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Puskesmas : Batu Ampa Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 2 5 1 0 2 2 2 1 1 1 8 9 17
3 Diare Berdarah 0 0 0 2 0 0 0 1 1 0 1 0 3 2 5
4 Tifus Perut Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaris Falcifarum 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 3 5 0 0 0 0 0 0 0 0 3 5 8
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 7 22 17 15 5 38 26 4 10 12 77 78 156
26 Diabetes Melitus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Hipertensi 0 0 0 0 0 0 0 5 18 4 11 11 25 24 49
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 12 34 18 15 7 46 47 9 23 24 116 118 235
catatan : Nama

Puskesmas : Situjuh Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 8 12 3 2 0 8 6 0 3 2 20 24 44
3 Diare Berdarah 0 0 0 0 0 1 0 1 0 0 0 0 1 1 2
5 TB Paru BTA + 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 3 2 0 0 0 0 0 0 0 0 2 3 5
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 21 47 25 11 8 29 18 9 11 15 100 94 194
27 Hipertensi 0 0 0 0 0 0 0 3 1 1 2 3 0 0 10
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 32 61 28 14 8 42 25 11 16 20 125 122 257
catatan : Nama

Puskesmas : Pakan Rabaa Jumlah Kunjungan :
No Jenis Penyakit 0-7hr 8-28 hr <1 1. - 4 5.- 9 10. - 14 15 - 19 20 - 44 45 - 54 55 - 59 60 - 69 70 + Lk Pr Kunjunga
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
n
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 3 15 4 3 2 14 4 4 1 3 27 26 53
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Den 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 1 2 2 0 0 0 0 3 2 1 5 6 11
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 20 31 36 19 12 31 32 24 13 6 100 124 224
27 Hipertensi 0 0 0 0 0 0 0 2 0 0 2 1 2 3 5
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 24 48 42 22 14 48 36 31 18 12 135 160 295
catatan : Nama

Puskesmas : Halaban Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 4 8 5 8 4 5 0 0 0 0 19 15 34
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 1 0 0 1 0 1 1 2
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 3 0 0 0 0 3 0 3
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 1 2 0 0 0 0 0 0 0 0 2 1 3
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 25 37 24 27 16 58 17 29 25 27 112 173 285
27 Hipertensi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 30 47 29 35 20 67 17 29 26 27 137 190 327
catatan : Nama

Puskesmas : Taram Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 8 5 2 0 2 4 1 2 1 2 15 12 27
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Hipertensi 0 0 0 0 0 0 0 7 9 7 20 36 42 37 79
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 8 6 2 0 2 11 16 10 24 38 62 55 117
catatan : Nama

Puskesmas : Tanjung Pati Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 0 11 8 3 1 11 3 1 0 3 30 11 41
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 17 31 61 38 30 114 111 44 12 10 178 290 468
27 Hipertensi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 17 42 69 41 31 125 114 45 12 13 208 301 509
catatan : Nama

Puskesmas : Pangkalan Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 7 16 5 2 2 12 6 0 0 1 25 26 51
3 Diare Berdarah 0 0 0 6 1 1 4 3 2 0 2 1 10 10 20
5 TB Paru BTA + 0 0 0 0 0 0 1 9 5 3 0 3 10 11 21
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 35 97 50 27 17 71 37 25 13 13 201 184 385
27 Hipertensi 0 0 0 0 0 0 0 12 35 14 27 74 0 0 162
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 43 119 56 35 25 116 95 46 46 92 254 239 673
catatan : Nama

Puskesmas : Rimbo Data Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 0 0 0 0 0 1 1 1 0 0 1 2 3
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Hipertensi 0 0 0 0 0 0 0 0 2 1 0 0 2 1 3
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 1 3 2 0 0 3 3 6
catatan : Nama

Puskesmas : Muaro Paiti Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 11 12 4 2 2 12 0 0 0 3 20 26 46
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 2 0 0 0 0 1 1 2
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 2 15 72 23 7 9 43 17 7 6 5 100 106 206
27 Hipertensi 0 0 0 0 0 0 0 11 23 14 10 10 30 38 68
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 2 26 84 27 9 11 70 43 22 16 18 154 174 328
catatan : Nama

Puskesmas : Baruah Gunuang Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 4 3 1 1 2 3 2 3 2 0 10 11 21
3 Diare Berdarah 0 0 0 0 0 1 0 1 0 1 0 0 1 2 3
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 1 5 0 0 0 0 0 0 0 0 3 3 6
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 8 20 16 9 2 22 13 5 8 4 63 44 107
27 Hipertensi 0 0 0 0 0 0 0 1 0 0 6 2 6 3 9
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 13 28 17 12 5 27 15 9 16 6 84 64 148
catatan : Nama

Puskesmas : Sialang Jumlah Kunjungan :
No Jenis Penyakit 0-7hr 8-28 hr <1 1. - 4 5.- 9 10. - 14 15 - 19 20 - 44 45 - 54 55 - 59 60 - 69 70 + Lk Pr Kunjunga
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 n
17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 0 11 3 0 1 10 6 3 4 0 22 16 38
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Den 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 38 72 26 17 10 80 15 10 6 2 100 176 276
27 Hipertensi 0 0 0 0 0 0 0 12 11 13 12 8 25 31 56
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 38 83 29 17 11 102 34 26 22 10 147 225 372
catatan : Nama

Puskesmas : Gunung Malintang Jumlah Kunjungan :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 TB Paru BTA + 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pnumonia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Hipertensi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
catatan : Nama

Jumlah Kunjungan :
Golongan Umur (Tahun) Total Total Kunjungan
No Jenis Penyakit 0-7hr 8-28 hr < 1-1 1. - 4 5.- 9 10. - 14 15 - 19 20 - 44 45 - 54 55 - 59 60 - 69 70 + Lk Pr
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare 0 0 47 98 36 21 18 82 31 15 12 15 197 178 375
3 Diare Berdarah 0 0 0 8 1 3 4 6 3 1 3 1 15 15 30
5 TB Paru BTA + 0 0 0 0 0 0 1 13 5 3 1 4 14 13 27
6 TB Paru Klinis 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1
7 Kusta PB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaris Klinis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivak 0 0 0 0 0 0 0 3 0 0 0 0 3 0 3
17 Malaria Mix 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Pneumonia 0 0 10 17 2 0 0 0 0 3 2 1 17 18 35
21 Sifilis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza 0 2 186 429 278 170 109 486 286 157 104 94 1031 1269 2301
27 Hipertensi 0 0 0 0 0 0 0 53 99 54 90 145 132 137 441
28 Chikungunya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 2 243 552 317 200 134 655 445 240 219 260 1425 1651 3267
Laporan Awal/ Perbaikan (Lingkari Pilihan) Payakumbuh, 2 April 2018

Jumlah Puskesmas Pembantu yang ada bulan Laporan …………………. Ka Bid Bina Pengendalian Kesehatan
Note : Puskesmas Gng Malintang belum masuk

STP Maret 2018

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Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Propinsi : Sumatera Barat Tahun : 2018

Laporan Awal/ Perbaikan (Lingkari Pilihan) Payakumbuh, 2 April 2018

Note : Puskesmas Gng Malintang belum masuk

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