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SUR

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 9 4
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 4 3
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara Suryadi, SKM, M.Kes
NIP. 19661108 198803 1001

SUR

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 8 11
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 4 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001

SUR

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 11 12
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 3 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001
SURVE

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 8 10
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 3 3
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001

SUR

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 15 18
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 3 3
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001

SURVE
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 18 18
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 1 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 8 4
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara Suryadi, SKM., M.Kes
NIP. 196611108B198803 1 001

SUR

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 18 18
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 1 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001

SUR

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 6 10
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 5 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001
SUR

Propinsi : Jawa Barat


Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 4 3
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 3 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
14 15 3 4 0 0 5 6 18 28 0
0 0 0 0 0 0 1 1 0 1 0
0 0 0 0 1 1 0 0 0 1 0
0 0 0 0 0 0 0 0 1 0 0
0 0 1 1 1 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 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 4
0 0 0 0 0 0 0 0 2 4 4
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
10 9 5 6 3 7 4 4 8 9 0
0 0 0 1 0 0 0 0 0 0 1
0 0 0 0 0 1 0 0 1 0 0
0 0 0 0 0 0 0 0 2 0 0
1 1 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 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 1 0 0
0 0 0 0 0 0 0 0 0 0 0
4 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 5 7 13 22 21
0 0 0 0 0 0 0 0 5 9 9
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
8 8 6 6 6 7 6 7 6 9 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 0 1 2
0 0 0 0 0 0 0 1 0 0 0
1 0 0 0 0 1 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0
2 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 5 12 9 15 12
0 0 0 0 0 0 0 0 4 5 6
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
6 8 6 8 8 6 11 7 7 7 0
0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 1 2 0 0
0 0 0 0 0 0 1 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
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 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 2 1 0
0 0 0 0 0 0 0 0 0 0 0
11 11 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 5 10 14 8
0 0 0 0 0 0 0 0 2 4 3
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
12 11 6 6 8 8 9 6 3 3 0
0 0 0 0 0 0 0 0 1 0 1
0 0 0 0 1 0 0 2 1 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 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 0 2
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 0 0
0 0 0 0 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 5 10 14 9
0 0 0 0 0 0 0 0 2 4 3
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
12 11 6 6 7 5 5 2 5 5 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 0 0 2 0
0 0 0 0 0 0 0 0 2 2 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 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 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 13 8
0 0 0 0 0 0 0 0 0 1 3
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
12 11 6 6 7 5 5 2 5 5 0
0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 1 1 1 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1 5 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 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 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 0 0
0 0 0 0 0 0 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 14 7
0 0 0 0 0 0 0 0 0 1 2
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
10 9 6 8 7 7 6 6 7 6 0
0 0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 1 2 0 0
0 0 0 0 0 0 0 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
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 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 0 1
0 0 0 0 0 0 0 0 0 0 0
5 6 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 5 7 5 12 5
0 0 0 0 0 0 0 0 1 2 1
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
L P L P L P L P L P L
10 11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0 0
4 4 5 8 5 7 4 4 3 4 6
0 0 0 0 0 0 0 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 0 1 1 3 1
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 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 0 0 0 0 0
4 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 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 13 7 6 12 5
0 0 0 0 0 0 0 0 2 4 1
0 0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
Bulan Januari
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 49 57 106
0 0 0 0 0 0 0 1 2 3
0 0 1 0 1 0 0 1 4 5
1 0 0 0 0 0 0 1 1 2
0 0 0 0 0 0 0 3 1 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 0 0 0
0 0 0 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 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 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 8 17
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
25 5 14 9 23 2 5 20 76 96
7 0 6 3 2 0 0 9 19 28
0 0 0 0 0 0 0 0 0 0

Cianjur, 31 Januari 2019


Pengelola Program
Rahmatiah Mulyani SKM
NIP.19660415 198803 2 008

BULAN; Februari
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 38 46 84
0 0 0 0 0 0 0 1 1 2
0 0 0 0 0 0 0 1 1 2
1 0 0 0 0 0 0 2 1 3
1 0 1 0 0 0 0 1 3 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 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 3 0 3
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 8 6 14
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
26 7 15 3 5 0 1 49 76 125
14 3 6 0 0 0 0 17 29 46
0 0 0 0 0 0 0 0 0 0

Cianjur, 25 Februari 2019


Pengelola Program

Rahmatiah Mulyani SKM


NIP.19660415 198803 2 008

Bulan Maret
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 43 49 92
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 2 2 4
0 0 0 0 0 0 0 0 1 1
0 0 0 1 0 0 0 2 1 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
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 5 6 11
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
18 7 10 2 1 0 0 35 56 91
9 1 2 0 0 0 0 11 16 27
0 0 0 0 0 0 0 0 0 0

Cianjur, 31 Maret 2019


Pengelola Program

Rahmatiah Mulyani SKM


NIP.19660415 198803 2 008
Bulan April
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 46 46 92
0 0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 2 1 3
0 0 1 0 0 0 0 1 1 2
0 0 0 0 0 0 0 1 1 2
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 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 4
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 14 14 28
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
13 4 5 1 1 0 0 25 38 63
6 1 1 0 0 0 0 6 11 17
0 0 0 0 0 0 0 0 0 0
Cianjur, 30 April 2019
Pengelola Program

Rahmatiah Mulyani SKM


NIP.19660415 198803 2 008

Bulan Mei
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 53 52 105
0 0 0 0 0 0 0 2 0 2
0 0 0 0 0 0 0 2 2 4
0 0 0 0 0 0 0 1 1 2
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 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 4
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 8 6 14
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
13 5 7 1 3 0 0 27 42 69
6 1 1 0 0 0 0 6 11 17
0 0 0 0 0 0 0 0 0 0

Cianjur, 31 Mei 2019


Pengelola Program

Rahmatiah Mulyani SKM


NIP.19660415 198803 2 008
Bulan Juni
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 53 47 100
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 2 0 2
0 0 0 0 0 0 0 0 2 2
0 0 0 0 0 0 0 2 2 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 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 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 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 12 14 26
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 2 6 8 17 1 0 23 56 79
6 2 3 1 0 0 5 11 16
0 0 0 0 0 0 0 0 0 0

Cianjur, 30 Juni 2019


Pengelola Program
Rahmatiah Mulyani SKM
NIP.19660415 198803 2 008

Bulan Juli
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 53 47 100
0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 2 1 3
0 0 0 1 0 0 0 1 0 1
1 0 0 0 0 1 0 2 6 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 3 5 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
18 6 12 7 5 3 7 24 56 80
1 2 2 0 0 2 6 8
0 0 0 0 0 0 0 0 0 0

Cianjur, 30 Juli 2019


Pengelola Program

Rahmatiah Mulyani SKM


NIP.19660415 198803 2 008

Bulan Agustus
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 42 46 88
0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 2 1 3
0 0 0 0 1 0 0 0 1 1
0 1 0 0 0 0 0 2 1 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
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 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 2 1 3
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 10 8 18
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 6 5 2 5 1 2 24 40 64
2 1 1 0 0 3 5 8
0 0 0 0 0 0 0 0 0 0

Cianjur, 31 Agustus 2019


Pengelola Program

Rahmatiah Mulyani SKM


NIP.19660415 198803 2 008
Bulan September
Tahun 2019
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
5 4 3 3 3 2 1 40 42 82
0 0 0 0 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 1
1 0 1 0 0 0 0 2 6 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 7 5 12
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
16 9 17 8 9 0 6 31 77 108
6 1 1 1 0 0 0 5 11 16
0 0 0 0 0 0 0 0 0 0

Cianjur, 30 September 2019


Pengelola Program
Rahmatiah Mulyani SKM
NIP.19660415 198803 2 008
SURV

Propinsi : Jawa Barat


Kabupaten: Cianjur
Puskesma: Cibaregbeg
Kode
No. Jenis PenyakitICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th
L P L P L P L
1 2 3 4 5 6 7 8 9 10
1 Kolera A 00 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 8 9 8
3 Diare Ber A 03.9 0 0 0 0 0 0 1
4 Tifus Perut A 01.4 0 0 0 0 0 0 0
5 TBC Paru A 15.0 0 0 0 0 0 0 0
6 Tersangka A 16.0 0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0
11 Batuk Rej A 37.9 \ 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0
13 Hepatitis K B 19 0 0 0 0 0 0 0
14 Malaria Kl B 54 0 0 0 0 0 0 0
15 Malaria Vi B 51.9 0 0 0 0 0 0 0
16 Malaria F B 50.9 0 0 0 0 0 0 0
17 Malaria Mi B 53.8 0 0 0 0 0 0 0
18 Demam Be A 91 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0
20 Pneumoni J 18.9 0 0 0 0 1 3 2
21 Sifilis A 51.9 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0
26 Hypertens I 10 0 0 0 0 0 0 0
27 Diabetus M E 14 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
P L P L P L P L P L
11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0
8 5 7 9 7 6 4 5 2 2
0 0 0 0 0 0 0 0 0 0
0 0 0 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 4 0
0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 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 13 8
0 0 0 0 0 0 0 0 1 3
0 0 0 0 0 0 0 0 0 0

…….. ( ………..% )
…….. ( ………..% )
…….. ( ………..% )
Bulan Juli
Tahun 2018
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
5 3 3 0 1 0 0 46 46 92
0 0 0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 0 0 0
0 0 0 65 0 0 0 1 0 1
2 0 0 0 0 1 0 2 6 8
0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
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 1 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 3 5 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 2 6 8 17 1 0 23 56 79
6 2 3 0 1 0 0 5 11 16
0 0 0 0 0 0 0 0 0 0

Cianjur, 30 Juli 2018


Pengelola Program
Rahmatiah Mulyani SKM
NIP.19660415 198803 2 008
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus I 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )
Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001

SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS


( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg

H. Agus Kuswara S, SKM., M.Kes


NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode Golongan Umur
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Kolera A 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0 0 0 0 0 0 0 1 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
7 Kusta PB A 30.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 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
20 Pneumonia J 18.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program

Rahmatiah Mulyani SKM


NIP.19660415 198803 2 008

SIS PUSKESMAS
Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program

Rahmatiah Mulyani SKM

SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0
Cianjur 30 Agustus 2018
Pengelola Program

Rahmatiah Mulyani SKM

SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program
Rahmatiah Mulyani SKM

SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program

Rahmatiah Mulyani SKM


SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program

Rahmatiah Mulyani SKM


SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program

Rahmatiah Mulyani SKM


SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
1 4 1 6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program

Rahmatiah Mulyani SKM


SIS PUSKESMAS

Bulan Agustus
Tahun 2018
Total
Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
L P L P L P L P L P L P an
18 19 20 21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0 0 0 0
0 2 1 1 0 0 0 0 0 0 2 3 5
2 2 1 0 0 0 0 0 0 0 3 2 5
0 4 1 1 0 0 0 0 0 0 1 6 7
0 0 0 0 0 0 0 0 0 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 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
7 25 11 36 9 30 10 16 2 7 39 114 153
SURV

Propinsi : Jawa Barat


Kabupaten: Cianjur
Puskesma: Cibaregbeg
Kode
No. Jenis PenyakitICD 10 0 - 7 hr 8 - 28 hr < 1 tahun 1 - 4 th
L P L P L P L
1 2 3 4 5 6 7 8 9 10
1 Kolera A 00 0 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0 0
3 Diare Ber A 03.9 0 0 0 0 0 0 0
4 Tifus Perut A 01.4 0 0 0 0 0 0 0
5 TBC Paru A 15.0 0 0 0 0 0 0 0
6 Tersangka A 16.0 0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0 0
11 Batuk Rej A 37.9 \ 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0 0
13 Hepatitis K B 19 0 0 0 0 0 0 0
14 Malaria Kl B 54 0 0 0 0 0 0 0
15 Malaria Vi B 51.9 0 0 0 0 0 0 0
16 Malaria F B 50.9 0 0 0 0 0 0 0
17 Malaria Mi B 53.8 0 0 0 0 0 0 0
18 Demam Be A 91 0 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0 0
20 Pneumoni J 18.9 0 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0 0
26 Hypertens I 10 0 0 0 0 0 0 0
27 Diabetus M I 11 0 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th 45 - 54 th
P L P L P L P L P L
11 12 13 14 15 16 17 18 19 20
0 0 0 0 0 0 0 0 0 0
0 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 2 1
0 0 0 0 0 0 0 2 2 1
0 0 0 0 0 0 1 0 4 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 7 25 11
0 0 0 0 0 0 0 1 4 1
0 0 0 0 0 0 0 0 0 0

…….. ( ………..% )
…….. ( ………..% )
…….. ( ………..% )
Bulan Agustus
Tahun 2018
Total
Total
45 - 54 th 55 - 59 th 60 - 69 th 70 + Kunjung
P L P L P L P L P an
21 22 23 24 25 26 27 28 29 30
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 126
0 0 0 0 0 0 0 0 0 0
1 0 0 0 0 0 0 2 3 5
0 0 0 0 0 0 0 3 2 5
1 0 0 0 0 0 0 1 6 7
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 1 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 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
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
36 9 30 10 16 2 7 39 114 153
6 1 5 1 0 0 0 4 15 19
0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program
Rahmatiah Mulyani SKM
NIP.19660415 198803 2 008
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 \ 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengu A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus I 11 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
L P L P L P L P L P
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 0 0 0 0
0 0 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 2
0 0 0 0 0 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 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 3 4 11 19
0 0 0 0 0 0 0 0 2 4
0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
S

Bulan Agustus
Tahun 2018

Total
45 - 54 th 55 - 59 th 60 - 69 th 70 +
L P L P L P L P L P
20 21 22 23 24 25 26 27 28 29
0 0 0 0 0 0 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 1 0 0 0 0 0 0 2 3
0 0 0 0 0 0 0 0 0 0
0 0 0 1 1 0 0 0 3 1
0 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 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
7 21 3 17 1 4 0 0 25 65
5 7 1 3 0 1 0 0 8 15
0 0 0 0 0 0 0 0 0 0

Cianjur 30 Agustus 2018


Pengelola Program
Rahmatiah Mulyani SKM
NIP.19660415 198803 2 008
Total
Kunjung
an
30
0
87
0
5
0
4
0
0
1
0
0
0
0
0
0
0
0
0
0
17
0
0
0
0
0
90
23
0
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 10 5
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Deng A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 3 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus I 11 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )


Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
L P L P L P L P L P
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 0 0 0 0
8 11 5 7 9 7 6 4 2 4
0 0 0 0 1 0 0 0 0 1
0 0 0 0 0 0 1 0 0 1
0 0 0 0 0 0 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 0 0 0 0 0 0 0
0 0 0 0 0 1 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 4 1 2 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 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 12 4 23
0 0 0 0 0 0 0 2 4 6
0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
S

Bulan November
Tahun 2018

Total
45 - 54 th 55 - 59 th 60 - 69 th 70 +
L P L P L P L P L P
20 21 22 23 24 25 26 27 28 29
0 0 0 0 0 0 0 0 0 0
3 1 2 2 1 0 47 41 47 41
1 0 0 0 0 0 0 0 2 1
1 0 0 0 0 0 0 0 2 1
0 0 1 0 0 0 0 0 1 0
0 1 2 0 1 1 1 0 4 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 1 0 0 0 1
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 8 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
8 21 5 7 3 0 0 0 22 63
7 2 3 0 0 0 0 0 14 10
0 0 0 0 0 0 0 0 0 0

Cianjur 30 november 2018


Pengelola Program
Rahmatiah Mulyani SKM
NIP.19660415 198803 2 008
Total
Kunjung
an
30
0
88
3
3
1
8
0
0
1
0
0
0
0
0
0
0
0
0
0
16
0
0
0
0
0
85
24
0
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 6 3
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 3 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus I 11 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
L P L P L P L P L P
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 0 0 0 0
5 4 5 5 9 7 6 5 4 2
0 0 0 0 1 0 0 0 1 1
0 0 0 0 1 0 0 0 1 1
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 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 4 1 2 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 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 12 8 23
0 0 0 0 0 0 0 4 2 5
0 0 0 0 0 0 0 0 0 0
Bulan Desember
Tahun 2018

Total
45 - 54 th 55 - 59 th 60 - 69 th 70 +
L P L P L P L P L P
20 21 22 23 24 25 26 27 28 29
0 0 0 0 0 0 0 0 0 0
2 2 2 4 3 2 1 1 43 35
1 0 0 0 0 0 0 0 3 1
0 0 0 0 1 0 0 0 3 1
0 0 0 1 0 0 0 0 0 1
0 2 0 0 2 0 0 1 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
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 8 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
12 21 5 7 3 0 0 0 32 65
6 9 2 3 0 0 0 0 10 21
0 0 0 0 0 0 0 0 0 0
Total
Kunjung
an
30
0
78
4
4
1
8
0
0
0
0
0
0
0
0
0
0
0
0
0
16
0
0
0
0
0
97
31
0
Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 0 0
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 0 0
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus I 11 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0
SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
L P L P L P L P L P
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 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 2 5 6
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Bulan Desember
Tahun 2018

Total
45 - 54 th 55 - 59 th 60 - 69 th 70 +
L P L P L P L P L P
20 21 22 23 24 25 26 27 28 29
0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 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 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 8 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 2 3 0 0 0 0 0 21 10
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Total
Kunjung
an
30
0
0
0
2
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
16
0
0
0
0
0
31
0
0

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