: Ada Adanya nya Bi Bidan dan Des Desa, Pra Prakktek Pe Perawat wat di di De DesaTet Tetangga ngga,, dan dan Ada Adanya nya Dok Doktter pr praktek, PKM, Klinik nik da dan RS RS Swa Swassta di di ar area Ke Kecamat matan : Ifa Nofalia : Dasa Wisma Wisma (10 Rumah) Rt 1 Dusun Karang Karang Pilang, Desa Ngampel, Kec. Balongpangg ongpangg ang, Kab. Gresik
No. Re Regis gister Tanggal Pengkajian
: : 6 Oktober 2016
Tidak ter terka kajiji a Sejarah Sejarah Komunita Komunita : Tidak : ± 3500 m 2 b Luas Wilaya Wilayah h : Sebelah Utara: Utara: RT3, Sebelah Sebelah Selatan: RT 2, Sebelah Barat: Barat: RT 2 Dsn. Kr. Pilang dan Sebelah Sebelah Timur: Sung ai dan Dusun Talun c Batas atas Wilay Wilayah ah
Penyakit 6 bulan terakhir (tiap (tiap angg ota keluarga)
Pendapatan ( Pengeluaran per KK) (per KK)
Pekerjaan
Lain Wira Lain Non PNS/TNI/ Peg. Peta Brh Nela Tdk Lain 1-< <1 1Ggn Jawa MdrLain2 TS TK SD SMP SMA PT 2 swast < 1 jt 3 jt > 3 jt > ISP ISPA TBC HT Jtg Jtg Gnjl Gnjl Strok r ok DMDHFDiareG DMDHFDiareGat atal al 2 Formal Polri Swst ni Tani yan Bkj. 2 3 jt jt <3 jt Jiwa (Peg a
1 1 1 1 1 1
1 1 1
1 1 1
1
1 1 1 1 1 1
1 1 1
1 1 1
1
1 1 1 1 1 1
1 1 1
1 1 1
1 1 1 1 1 1
1 1 1
1 1 1
1 1
1
1
1 1
1 1 1 1 1 1 1
1 1
1 1
1
1 1 1
1 1
1 1
1 1
1 1 1 1
1 1
1 1
1 1
Dibuat oleh IPKKI Jawa Timur 2014
1 1 1
1 1
1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1
1 1 1 1
1 1
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Ny. La Sdr. Al
1
Ny. K An. If
1 1 1 1
1 1
1 1
1 1
1
1
1
1 1 1
1 1 1 1 1 1
1 1 1
1 1 1
1
1
1 1 1 1
1 1
1 1
1
Ny. P Ny. Mu Sdr. Is Nn. Us
1 1
1
1
1 1 1 1 1
1
1 1
1 1
1 1 1
1 1 1 1
1
Dibuat oleh IPKKI Jawa Timur 2014
1
1
1 1 1
1
1 1
1
1
1
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for
Pasangan Usia subur KB
Keluha Alasan Tidak n KB
Penyakit Kelamin
ANC
Imun TT TT
Buku KIA
Lain R TR TP T P L TL TP P 2
IUD Pil StkKdmIm StkKdmImp p MOW MOP Ya Tdk TktDilrglain TktDilrglain2 2 Go Sph Sph HIV
1
Bufas/ Buteki
Ibu h amil Pil Fe Fe
Keluhan
Gizi
Renc Lahir
Pen Penolon olong
Balita
BB di ASI ASI Kelu Keluh han KMS
Anak Sekolah
ASI Imunisasi Posy Posyan andu du Vit. t . A MP ASI ASI Gizi zi Dsr Eks
Remaja
Imuni TN GosokGigi Sakit Gigi sasi kelas
Kenakalan akalan Remaja Remaja
kut kut Org Posyandu
Seks Lain <6 >6 Ane Rok Napz Geng Tdk Akt Tdk TP R TR TP TP PE B C K Spt S C Dok Bid Duk Lcr TL Ya Tdk H K M Ya Tdk Tdk L BL TL R TR TP Tdk P TP Mrs Beba R TR T P T P R TR T P B C K L TL R TR TP Ya Tdk mi ok a Mtr ada if Aktif 2 bl bl s
1 1 1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
Dibuat oleh IPKKI Jawa Timur 2014
1
Titles you can't find anywhere else
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1
1
1 1 1
1
1
1
1
1
1 1
1
1 1
Dibuat oleh IPKKI Jawa Timur 2014
1
1
1
1
Titles you can't find anywhere else
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m 1b
Lansia Px. Kesh
Keg. Sosial
R T R TP R TR TP TP
Dibuat oleh IPKKI Jawa Timur 2014
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1
1
Dibuat oleh IPKKI Jawa Timur 2014
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form 2
No. KK
Status Rumah Sendiri Sewa
1
Jenis Rumah P
SP
1
1
TP
Lantai
Ventilasi
KA TKA < 20% > 20%
1
1
1
L Rmh: 8m2/org Ya
T dk
Sumber Sumber Air bersih bersih Sumber Sumber Air Minum Minum Jenis JambanTempat JambanTempat BAB Jentik PAM Sumur Sungai Lain2
Air Tdk Lehar Cemplu Tidak Air Mineral Masak dimasak angsa ng Punya
Konsums Tdk Kebiasaa Makan Sayur Olah Raga/ i Lauk / Merokok n CTPS &buah /hari hari hari dlm Rmh
Ladan Ditimb Dibaka Sung Tdk Piaraa Penger SerangBersi Tdk Alterna Mandir A da T dk dk T PA PA G ot Kotor R S P KM KM K li ni k BPJS Lain2 Ya T dk g un r ai ada n at ga h ada tif i
1 1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
Ya Tdk
Ya
Tdk
Ya
Tdk
Ya
Tdk
1 1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Dibuat oleh IPKKI Jawa Timur 2014
1
1
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Dibuat oleh IPKKI Jawa Timur 2014
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Dibuat oleh IPKKI Jawa Timur 2014
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Dibuat oleh IPKKI Jawa Timur 2014
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form 4
1. Fasil silitas Pendidikan kan
2. Fasil silitas Keseh eseha atan
No
No
Jenis P endidika n Jum la h
1 TK 2 SD 3 SMP
1 1
4 SMA 5 PT
0 0
0
4. Sarana Ibadah No 1 2 3 4 5 6
Jenis Tempat Masjid Mushola Gereja Vihara Pura Lain - lain
Jenis
1 Pasar Tradisional 2 Pasar Swalayan kelontong 3 Toko ke 4 Wa rung 5 Lain - lain
1 RS 2 PKM 3 Klinik Swasta 4 Poskesdes/ 5 Posyandu Balita 6 Posyandu Lansia 7 Klinik Alternatif Lain - lain (Bidan 8 Praktek)
J u m la h
N o.
2 1
1 2
Jenis Kegiatan kelompok Karang taruna PKK
2
3
TPA
1
0 1 1 0
4 5
Kegiatan keagamaan Lain - lain
3
J u m la h 1 4 0 0 0 0
J u m la h 1 0 Ba ny nya k Ba nya k
No 1 2 3 4
Tempa t Ola h Raga Lap. Sepak Bola Lap. Bola Volley Lap. Bulu Tangkis Lain - lain
Jumlah 1 1
1
5 Sarana Olah Raga
7 Pusat Kegiatan Ekonomi No
Jenis Fasilitas Kesehatan
3. Sar Sarana Kegi egiatan Kelompok
6 Tempat Pertemuan J u m la h 1 1 0 0
No 1 2 3 4 5
Tem pa t P ertem uan Balai desa Balai Dukuh Balai RW Balai RT Lain - lain
J u m la h 1 0 0 0 0
8 Industri No
Jenis
J u m la h
1 Keamanan No Fa silita s K ea ma na n
1 Makanan 2 Pakaian
0 0
1
Pemadam Kebakaran
0
3 Sepatu 4 Lain - lain
0
2
Pos Polisi
0
0
3
Poskamling
0
4
Lain - lain
0
0
J u m la h
2 Transportasi Ada/ Tidak Strukt ktur ur Organi rganisa sasi si Ada Ada 1 Stru Ada 2 P KK , LK MD, dll