PERESEPAN MYALGIA

FORMULIR PELAPORAN INDIKATOR PERES Puskesmas : KURUN Kabupaten Propinsi

: GUNUNG MAS : KALIMANTAN TENGAH  *um!a+ In,eksi Item Obat -a.Ti/ak

T!

No

Nama

Umur

" #$

"%$

"&$

"'$

"($

" )$

4/1/2016

1

Ny. Noranisa

21 thn



Ti!a"

4/1/2016

2

Ny. Asna Titin

6 thn

4

Ti!a"

#/1/2016



Tn. $%o" Naran&

'4 thn

#

Ti!a"

#/1/2016

4

Ny. Li!ia

#2 thn



Ti!a"

'/1/2016

#

Ny. Marsi

4( thn

4

Ti!a"

'/1/2016

6

Ny. )ahar Ga*i+ah

21 thn



Ti!a"

,/1/2016

'

Ny. En!an&

2# thn



Ti!a"

,/1/2016

,

Tn. A*-%rt 

6# thn



Ti!a"

(/1/2016

(

Ny. Sirah

24 thn

2

Ti!a"

(/1/2016

10

Ny. En!an& S

2# thn

2

Ti!a"

(/1/2016

11

Ny. %*ta Ria

26 thn

2

Ti!a"

11/1/2016

12

Ny. Nrsihan

46 thn



Ti!a"

12/1/2016

1

Ny. Raah 3*iyanti

2( thn



Ti!a"

1/1/2016

14

Ny. Isah $o&o

61 thn



Ti!a"

1/1/2016

1#

Ny. Rin&

#2 thn



Ti!a"

1(/1/2016

1,

Tn. Sa&ar

4' thn



Ti!a"

20/1/2016

1(

Ny. Rini S

2' thn

2

Ti!a"

21/1/2016

20

$%i Nata*ia

0 thn



Ti!a"

22/1/2016

21

Ny. Rin&

#2 thn

2

Ti!a"

22/1/2016

22

Anato*ianti

4' thn



Ti!a"

2/1/2016

2

Tn. Sa*oh  )at

60 thn



Ti!a"

2#/1/2016

24

Ny. $%si Nata*ia

1( thn

2

Ti!a"

2#/1/2016

2#

Ny. Ka*a

2# thn



Ti!a"

26/1/2016

26

Ny. 7"ta*ina

2# thn

2

Ti!a"

2,/1/2016

2'

Ny. No%r S

4 thn

2

Ti!a"

2(/1/2016

2,

Ny. arti

# thn



Ti!a"

2(/1/2016

2(

Ny. U8i%

4 thn



Ti!a"

2(/1/2016

0

5*i

22 thn

4

Ti!a"

0/1/2016

1

Ny. G%ta% )a"

41 thn



Ti!a"

0/1/2016

2

Ny. Ssana

4 thn



Ti!a"

0/1/2016



Ny. Sri 5anti

40 thn



Ti!a"

(2

0

Tota!

N 9 

Rerata

2'(

Persentasi in,eksi

Mengetahui Plt. Kepala Puskesmas Kurun

ELVINA MEILIN, Amd.Kep  NIP. 19800530 199903 2 004

0;

PAN MYALGIA

0u!an Ta+un

: 3ANUARI : 2016 Lama Sesuai Pemakaia Pe/oman n "5ari$  Ya.Ti/ak 

Nama Obat

Dosis

"1$

"2$

"3$

=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

      0 #                                     

a. . ). ?o a. ?T -. . a -. I-ro+%n >. $%=a !. . . . . . . . .
"#4$

 5a

 5a

 5a

 5a

 5a

 5a

 5a

 5a  5a  5a  5a  5a

 5a

 5a

 5a

a. AsM%+  -. . .
=1 =1 =1 =1 =1 =1 =1 =1

       

 5a  5a  5a

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

                                   

Kuala Kurun,1 Feruari 201! Pengel"la #at,

SRIWATI RIDWAN,Amd.Farm  NIP. 19831213 201403 2 002

 5a  5a

 5a  5a  5a  5a  5a  5a

 5a

 5a

 5a

 5a

 5a

FORMULIR PELAPORAN INDIKATOR PERES Puskesmas : KURUN Kabupaten Propinsi

: GUNUNG MAS : KALIMANTAN TENGAH  *um!a+ In,eksi Item Obat -a.Ti/ak

T!

No

Nama

Umur

"#$

"%$

"&$

"'$

"($

")$

4/1/2016

1

Ny. Noranisa

21 thn



Ti!a"

4/1/2016

2

Ny. Asna Titin

6 thn

4

Ti!a"

#/1/2016



Tn. $%o" Naran&

'4 thn

#

Ti!a"

#/1/2016

4

Ny. Li!ia

#2 thn



Ti!a"

'/1/2016

#

Ny. Marsi

4( thn

4

Ti!a"

'/1/2016

6

Ny. )ahar Ga*i+ah

21 thn



Ti!a"

,/1/2016

'

Ny. En!an&

2# thn



Ti!a"

,/1/2016

,

Tn. A*-%rt 

6# thn



Ti!a"

(/1/2016

(

Ny. Sirah

24 thn

2

Ti!a"

(/1/2016

10

Ny. En!an& S

2# thn

2

Ti!a"

(/1/2016

11

Ny. %*ta Ria

26 thn

2

Ti!a"

11/1/2016

12

Ny. Nrsihan

46 thn



Ti!a"

12/1/2016

1

Ny. Raah 3*iyanti

2( thn



Ti!a"

1/1/2016

14

Ny. Isah $o&o

61 thn



Ti!a"

1/1/2016

1#

Ny. Rin&

#2 thn



Ti!a"

16/1/2016

16

Ny. 5ati%

6 thn



Ti!a"

1,/1/2016

1'

Ny. Sriani

6 thn

2

Ti!a"

1(/1/2016

1,

Tn. Sa&ar

4' thn



Ti!a"

20/1/2016

1(

Ny. Rini S

2' thn

2

Ti!a"

21/1/2016

20

$%i Nata*ia

0 thn



Ti!a"

22/1/2016

21

Ny. Rin&

#2 thn

2

Ti!a"

22/1/2016

22

Anato*ianti

4' thn



Ti!a"

2/1/2016

2

Tn. Sa*oh  )at

60 thn



Ti!a"

2#/1/2016

24

Ny. $%si Nata*ia

1( thn

2

Ti!a"

2#/1/2016

2#

Ny. Ka*a

2# thn



Ti!a"

26/1/2016

26

Ny. 7"ta*ina

2# thn

2

Ti!a"

2,/1/2016

2'

Ny. No%r S

4 thn

2

Ti!a"

2(/1/2016

2,

Ny. arti

# thn



Ti!a"

2(/1/2016

2(

Ny. U8i%

4 thn



Ti!a"

2(/1/2016

0

5*i

22 thn

4

Ti!a"

0/1/2016

1

Ny. G%ta% )a"

41 thn



Ti!a"

0/1/2016

2

Ny. Ssana

4 thn



Ti!a"

0/1/2016



Ny. Sri 5anti

40 thn



Ti!a"

(2

0

Tota!

N 9 

Rerata

2'(

Persentasi in,eksi

Mengetahui Plt. Kepala Puskesmas Kurun

ELVINA MEILIN, Amd.Kep  NIP. 19800530 199903 2 004

0;

PAN MYALGIA

0u!an Ta+un

: @E)RUARI : 2016 Lama Sesuai Pemakaia Pe/oman n "5ari$  Ya.Ti/ak 

Nama Obat

Dosis

"1$

"2$

"3$

=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

      0 #                                

a. . ). ?o a. ?T -. . a -. I-ro+%n >. $%=a !. . . . . . . .
"#4$

 5a

 5a

 5a

 5a

 5a

 5a

 5a

 5a  5a  5a  5a  5a

 5a

a. I-ro+%n -. . . . . . . . . . . .
=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

                                               

 5a

 5a

 5a  5a  5a  5a  5a  5a  5a

 5a  5a  5a  5a  5a  5a

 5a

 5a

 5a

>. . .
=1 =1 =1 =1 =1 =1 =1

      

Kuala Kurun,1 Maret 201! Pengel"la #at,

SRIWATI RIDWAN,Amd.Farm  NIP. 19831213 201403 2 002

 5a

 5a