Dokumen Bantu REGISTER PRA ART

Tgl kunjungan
No. Tahun BLN LAPORAN No. Rekam Medik No.Reg.Nas
pertama

1 2014 4 04 Apr 2014 031390 73010150001

2 2014 9 09 Sep 2014 032715 73010150002

3 2014 4 23 Apr 2014 031658 73010150003

4 2014 4 17 Apr 2014 005092 73010150004

5 2014 9 03 Sep 2014 033351 73010150005

6 2014 5 08 May 2014 031904 73010150006

7 2014 5 10 May 2014 031906 73010150007

8 2014 7 01 Jul 2014 032395 73010150008

9 2014 11 03 Nov 2014 029544 73010150009

10 2015 2 06 Feb 2015 035557 73010150010

11 2015 2 16 Feb 2015 035696 73010150011

12 2015 2 16 Feb 2015 035709 73010150012

13 2015 2 20 Feb 2015 035766 73010150013

14 2015 3 09 Mar 2015 036005 73010150014

15 2015 4 08 Apr 2015 036458 73010150015

16 2015 5 25 May 2015 036908 73010150016

17 2015 6 25 Jun 2015 035222 73010150017

18 2015 7 03 Jul 2015 73010150018

19 2015 7 03 Jul 2015 73010150019

20 2015 7 03 Jul 2015 73010150020

21 2015 10 11 Oct 2015 039211 73010150021

22 2015 10 11 Oct 2015 73010150022

23 2015 10 73010150023

24 2015 10 28 Oct 2015 039129 73010150024

25 2015 73010150025

26 2015 032520 73010150026

27 2016 3 28 Mar 2016 041744 73010150027

28 2016 3 30 Mar 2016 041768 73010150028

29 2016 7 19 Jul 2016 035044 73010150029

30 2016 8 01 Aug 2016 042319 73010150030

31 2016 8 01 Aug 2016 043495 73010150031

32 2016 8 11 Aug 2016 043595 73010150032

33 2016 8 16 Aug 2016 043947 73010150033

34 2016 8 16 Aug 2016 041241 73010150034

35 2016 9 28 Sep 2016 73010150035

36 2016 10 20 Oct 2016 026259 73010150036

37 2016 11 29 Nov 2016 045416 73010150037

38 2017 1 06 Jan 2017 045802 73010150038

39 2017 1 06 Jan 2016 049236 73010150039

40 2017 1 24 Jan 2017 016659 73010150040

41 2017 2 24 Feb 2017 046728 73010150041

42 2017 2 25 Feb 2017 046055 73010150042

43 2017 3 22 Mar 2017 047128 73010150043

44 2017 4 17 Apr 2017 044517 73010150044

45 2017 5 18 May 2017 047960 73010150045

46 2017 5 18 May 2017 047961 73010150046

47 2017 5 20 May 2017 73010150047

48 2017 8 10 Aug 2017 049232 73010150048

49 2017 9 07 Sep 2017 049599 73010150049

50 2017 11 28 Nov 2017 051102 73010150050

51 2018 3 16 Mar 2018 052965 73010150051

52 2018 3 20 Mar 2018 053117 73010150052

53 2018 5 28 May 2018 054262 73010150053

54 2018 5 28 May 2018 73010150054

A ART

Umur Sex
NAMA ALAMAT No Telp TGL Lahir
(TAHUN) (L/P)

Colly pulopasi 085272684888 28 4/13/1986 L

Bau Raja Batangmata 085256486041 71 10/20/1943 P

Karni Pasilambena 085342286186 43 1/15/1971 L

Ahmad Balang Butung 085240863952 28 8/10/1988 L

Rosmiat Bonea 082292090668 42 4/20/1972 P

Abdul Razak Jampea 085145184812 24 5/9/1990 L

A. Patoppori Benteng 085242249937 54 L

Meicana Gauk Lembang Matene 081342553553 34 5/3/1980 P

A. Rusniar Benteng 085299827666 26 5/15/1988 P

Samsul Bahri Batangmata _ 42 9/14/1973 L

Bau Ansing Pasilambena 085298814411 35 8/1/1980 P

Suddin Karumpa 08134177900 41 6/21/1973 L

Safar Bonerate 081344020249 44 L

Muh. Tamrin Jl. Sultan hasanuddin 085395438899 53 7/1/1962 L

Andi Awang Bonto-Bonto 081241904518 55 8/2/1960 L

Andi Fitriani Jl. S Parman 085255023331 25 4/25/1990 P

Andi Rezki Zelviana Barugaiya 085824538662 25 11/28/1990 P

Muh. Umar Bonerate _ 4 11/30/2011 L

Dodok Ibrahim Bonerate _ 50 1/12/1965 L

Misa Bonerate _ 36 10/12/1979 P

Risnawat Bonerate 085146361877 23 1/19/1992 P

Muh.Ihsan Bonerate 085146361877 20 4/3/1990 L

Rafika Hartat Parangia _ 23 P

Ny "A" Barugaiya _ 41 P

Hamzah Gusung 082144811117 27 L

Fitriana Gusung _ 27 5/16/1987 P

Muh. Yasin Balikra _ 47 1/16/1969 L

Yust Yuliant Jl. RE Martadinata 085239751350 30 8/30/1986 P

Sitti Nuriani Dsn. Laiyolo 085240566619 29 11/17/1987 P

Ardi Wijaya Jl. KH. Hayyung 08234566333 29 8/22/1987 L

Tedi Bonerate _ 34 7/7/1982 L

Andi Aziz Batangmata 085756484213 42 8/18/1974 L

Fatmawat Batangmata 085696479248 36 5/4/1980 P

Sofiana Rahayu Pulo Pasi 085756373323 24 10/6/1992 P

Andi Ali Akbar Benteng 081394501527 26 1/3/1990 L

Said Akbar Anwar Benteng 085299636362 27 8/9/1989 L

Sri Wahyuni Jl. Jend. Sudirman 082290099007 30 12/11/1986 P

Alzeina Izza Assyifa Boneapara _ 1 3/21/2016 P

Rezky Milandari Boneapara 082158078999 29 10/9/1988 P

Ashar Jl. Kenari 085298346406 43 4/24/1974 L

Dahlia Batangmata 082345660660 27 1/3/1990 P

Taufan Muhtar Jl. Syarif Al Qadri _ 54 2/13/1963 L

Sarping Parak Selatan 082347263086 28 8/25/1989 L

Sapriadi Jl. Mangga 085397338984 39 4/24/1977 L

Samsul Bonerate 085347156825 30 3/21/1984 L

Syamsiah Bonerate 085347156825 34 7/19/1983 P

Kasriadi Gusung 082144006160 24 7/17/1993 L

Zulkarnaim Alasa 082240659825 29 7/25/1988 L

Pasongai Pammatata 081355817016 55 7/1/1962 L

Saju Bonerate _ 39 2/9/1978 L

Muh. Raba Jampea 082347312826 46 6/9/1971 L

Sahabu Bonerate 082343356607 28 7/7/1989 L

Dg.Lantng Jl. Muh. KRG Banto 085342764971 51 14 Jul 1967 L

Vera Jl. Muh. KRG Banto 085399131647 40 27 Oct 1978 P

 Laki-laki Perempuan

Hamil/Ti
dak
<1 1-14 15-19 20-24 25-49 ≥ 50 <1 1-14 15-19 20-24 25-49 ≥ 50

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 0

√ 1
 √ 1

√ 0

√ 0

√ 0

√ √ 1

√ 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
Keterangan tambahan Konfirmasi tes HIV+ IO yg terjadi
saat masuk

Faktor Risiko
Pendidikan
Entry
STATUS

Bekerja
point
PERKAWINA (No.
N kode)
BB TB Tgl Tempat Kode

40 kg - 1 04 Apr 2014 Lab.RSUD 3 4 1 1 K

Lab.RSUD
K.H
35 kg - 1 9/5/2014 Hayyung 3 1 0 1 K,PCP
Kepulauan
Lab.RSUD
Selayar
K.H
- + 3 4/21/2014 Hayyung 3 0 1 1 K
Kepulauan
Lab.RSUD
Selayar
K.H
48 kg - 1 4/17/2014 Hayyung 2 1 1 1.7 K
Kepulauan
Selayar
Lab.RSUD
29 kg + 3 5/20/2014 3 4 1 1 K
Takalar

Puskesmas
60 kg - 3 5/8/2014 2 1 1 1.2 K
Benteng

Puskesmas
- + 3 5/9/2014 3 4 1 1 K
Benteng
Lab.RSUD
K.H
- - 1 7/4/2014 Hayyung 3 3 1 1 K,Cr
Kepulauan
Lab.RSUD
Selayar
K.H
48 kg + 3 11/3/2014 Hayyung 3 3 0 1.6 K,D
Kepulauan
Lab.RSUD
Selayar
K.H
44 kg - 3 2/6/2015 Hayyung 3 2 1 1 K
Kepulauan
Lab.RSUD
Selayar
K.H
- - 1 2/14/2015 Hayyung 3 1 0 1 K
Kepulauan
Lab.RSUD
Selayar
K.H
77 kg - 1 2/17/2015 Hayyung 2 3 1 1
Kepulauan
Lab.RSUD
Selayar
K.H
44 kg - 3 2/20/2015 Hayyung 3 1 1 1 K
Kepulauan
Lab.RSUD
Selayar
K.H
- - 1 3/10/2015 Hayyung 3 1 1 1 K
Kepulauan
Lab.RSUD
Selayar
K.H
37 kg + 3 4/6/2015 Hayyung 3 2 1 1 K,D
Kepulauan
Lab.RSUD
Selayar
K.H
- - 1 5/25/2015 Hayyung 3 3 1 1
Kepulauan
Selayar
 Lab.RSUD
K.H
56 kg - 1 6/25/2015 Hayyung 2 3 1 1
Kepulauan
Selayar
Puskesmas
- - 2 1/15/2015 Pasimaran 0 0 4
nu
Puskesmas
- - 1 1/15/2015 Pasimaran 1
nu
Puskesmas
- - 1 1/15/2015 Pasimaran 1
nu
Lab.RSUD
K.H
- - 1 10/11/2015 Hayyung 3 2 0 1
Kepulauan
Lab.RSUD
Selayar
K.H
- - 1 10/13/2015 Hayyung 2 2 1 1
Kepulauan
Selayar
43 kg - 1 3 1
Lab.RSUD
K.H
- - 1 10/25/2015 Hayyung 1 0 1
Kepulauan
Selayar
- - 1 1

- - 1 2 1 1

PKM
- - 1 3/22/2016 Bontomara 4 1 1
nnu
Lab.RSUD
- - 1 3/30/2016 K.H 3 4 1 1
Hayyung
Lab.RSUD
32 kg - 2 7/11/2016 K.H 3 4 1 1 D
Hayyung
Lab.RSUD
68 kg + 2 7/30/2016 KH.Hayyun 3 3 1 1
g
Lab.RSUD
40 kg - 2 7/29/2016 K.H 3 1 1 1
Hayyung
Lab.RSUD
45 kg - 1 8/9/2016 K.H 3 4 1 1 H,D
Hayyung
Lab.RSUD
60 kg - 1 8/16/2016 K.H 2 3 0 1
Hayyung
Lab.RSUD
42 kg - 2 8/15/2016 K.H 2 4 1 1 K
Hayyung
Lab.RSUD
74 kg - 2 9/7/2016 K.H 2 4 1 1
Hayyung
Lab.RSUD
61 kg - 2 10/20/2016 K.H 7 4 1 1.3
Hayyung
Lab.RSUD
- - 1 11/29/2016 KH 2 1 1 1
Hayyung
 Lab.RSUD
- - 2 1/5/2017 K.H 3 0 0 4 D
Hayyung
Lab.RSUD
30 kg - 1 8/9/2017 K.H 3 3 0 1 K,PCP
Hayyung
Lab.RSUD
70 kg + 1 1/23/2017 K.H 2 3 1 1
Hayyung
Lab.RSUD
30 kg - 1 2/21/2017 K.H 2 4 0 1 PCP
Hayyung
Lab.RSUD
- - 1 2/25/2017 K.H 3 4 1 1 K,D,PCP
Hayyung
Lab.RSUD
56 kg - 2 3/21/2017 K.H 3 3 0 1 K,PCP
Hayyung

Lab.RSUD
50 kg + 1 4/17/2017 K.H 2 4 1 1
Hayyung
Lab.RSUD
- - 1 5/18/2017 K.H 2 1 1 1.2
Hayyung
Lab.RSUD
- - 1 5/18/2017 K.H 2 0 0 1
Hayyung
Lab.RSUD
- - 1 5/23/2017 K.H 2 3 1 1
Hayyung
Lab.RSUD
40 kg - 2 8/9/2017 K.H 3 4 1 1 K
Hayyung

Lab.RSUD
46 kg - 3 9/4/2017 K.H 3 1 1 1 H,K
Hayyung
Lab.RSUD
55 kg - 1 11/26/2017 K.H 3 1 1 1 PCP
Hayyung
Lab.RSUD
- + 3 3/13/2018 K.H 3 4 1 1.2 PCP
Hayyung
Lab.RSUD
43 kg - 2 3/19/2018 K.H 3 1 1 1 PCP
Hayyung
Lab.RSUD
51 kg - 1 25 May 2018 K.H 3 3 3 1 K
Hayyung
Lab.RSUD
43 kg - 1 29 May 2018 K.H 2 3 0 1 -
Hayyung
√ 3 19 Mar 2018
IO yg terjadi

Terapi IO

Tgl.

4/4/2014 cotrimoxazole,Ambroxol,CTM,GG

9/5/2014 cotrimoxazole,candistatn,ceftriaxone 1gr,

4/21/2014 cotrimoxazole,kandistatn,ambroxol

4/17/2014 cotrimoxazole,kandistatn,fluconazole,gentamysin

9/3/2014 cotrimoxazole,kandistatn,ambroxol

5/8/2014 cotrimoxazole,kandistatn,fluconazole,ottogenta

5/9/2014 cotrimoxazole,kandistatn

7/6/2014 cotrimoxazole.floconazole,piracetam,kandistatn

11/3/2014 Cotrimoxazole,kandistatn,fluconazole,metoclopramide.cefotaxime

2/6/2015 cottimoxazole,Kandistatn,ambroxol

2/14/2015 fluconazole,gentamisin,amboroxol,nystatn,ceftraxone,OAT

2/20/2015 Cotrimoxazole,fluconazole,ceftriaxone,nystatn,

3/9/2015 Cotrimoxazole,Kandistatn

4/6/2015 Cotrimoxazole,Kandistatn,fluconazole,inpepsa syr,injl.ceftriaxone

 Cotrimoxazole

Cotrimoxazole

Cotrimoxazole

Cotrimoxazole

Cotrimoxazole

Cotrimoxazole

7/11/2016 Cotrimoxazole,loperamide,metoclopramide,OAT

OAT,Cotrimoxazole,

Cotrimoxazole,OAT

8/4/2014 Cotrimoxazole,ceftazidine,metronodazole,zink,metoklopramide,flukonazole

8/15/2016 Kandistatn,cotrimoxazole,ambroxol
 1/3/2017 cotrimoxazole,zink syr,

8/10/2017 Cotrimoxazole,vipalbumin,myconys,ambacin

2/21/2017 Cotrimoxazole,ceftronidazole,

2/25/2017 Kandistatn,fluconazole,cotrimoxazole,proliver,loratadine,

3/21/2017 Cotrimoxazole,fluconazole,salbutamo,loratadine,kandistatn

Cotrimoxazole

Cotrimoxazole

8/9/2017 Cotrimoxazole,proliver,dompridone,myconis,OAT

9/4/2017 Cotrimoxazole,nysatn,ceftrinaxon,fluconazole

11/26/2017 Cotrimoxazole,fluconazole,salbutamo,loratadine

3/13/2018 Cefotaxime,proliver,cotrimoxazole,OAT

3/19/2018 Cotrimoxazole,flukonazole,ambroxol

25 May 2018 Cotrimoxazole,fluconazole,proliver,vipalbumin

 Skrining TB Alasan memenuhi syarat

Tgl memenuhi
Tgl pemberian syarat medis utk Tgl mulai ART
Cotrimoksazol ART
Tanggal +/- Stad. WHO CD4: TLC/VL:

04 Apr 2014 4/7/2017 - 25 May 2014 3 - - 4/25/2014

05 Sep 2014 16 Jan 2015 3 34 - 1/16/2015

21 Apr 2014 4 - -

17 Apr 2014 23 Apr 2014 3 - - 4/23/2014

03 Sep 2014 9/6/2014 + 03 Nov 2014 3 - - 11/3/2014

08 May 2014 28 May 2014 2 - - 6/1/2014

09 May 2014 + 4 - -

06 Jul 2014 6/24/2014 - 08 Jul 2014 3 - - 7/8/2014

03 Nov 2014 11/16/2014 + 09 Nov 2014 3 - - 11/10/2014

06 Feb 2015 2/7/2015 - 3 - -

2/21/2015 + 13 May 2015 3 - - 5/13/2015

17 Feb 2015 3 549 - 2/17/2015

20 Feb 2015 2/20/2015 - 3 - -

10 Mar 2015 3/9/2015 + 3 - -

06 Apr 2015 4/13/2015 + 3 - -

06 Jun 2015 3 - - 6/6/2015

 17 Sep 2015 3 - - 9/17/2015

15 Jan 2015 03 Jul 2015 3 - - 7/3/2015

15 Jan 2015 03 Jul 2015 3 - - 7/3/2015

15 Jan 2015 03 Jul 2015 3 - - 7/3/2015

13 Oct 2015 3 - - 10/13/2015

13 Oct 2015 3 - - 10/13/2015

3 - -

25 Oct 2015 3 - -

20 May 2016 3 - - 5/20/2016

20 May 2016 3 - - 5/20/2016

22 Mar 2016 1/7/2018 + 21 Mar 2018 3 - - 3/21/2018

2 - -

7/13/2016 7/15/2016 + 05 Jan 2016 3 82 - 1/5/2016

7/30/2016 5/9/2016 + 28 Oct 2016 3 15 - 28 Oct 2016

7/29/2016 8/3/2016 + 3 3 -

8/10/2016 16 Aug 2016 3 200 - 8/16/2016

30 Nov 2016 3 353 - 11/30/2016

8/15/2016 8/15/2016 - 16 Aug 2016 3 6 - 8/16/2016

- -

23 Jan 2017 3 500 - 1/23/2017

25 Mar 2017 3 - - 3/25/2017

 1/3/2017 - -

8/10/2017 8/11/2017 + 22 Jul 2017 3 - - 7/22/2017

+ 24 Jan 2017 3 - - 1/24/2017

2/21/2017 2/23/2017 - 06 May 2017 3 6 - 5/6/2017

2/25/2017 2/25/2017 - 22 Apr 2018 3 126 - 4/22/2017

3/21/2017 3/22/2017 - 03 Apr 2017 3 79 - 4/3/2017

10/4/2016 + 17 Apr 2017 3 35 - 4/17/2017

5/18/2017 5/21/2017 - 18 May 2017 3 19 - 5/22/2017

5/18/2017 5/21/2017 - 18 May 2017 3 214 - 5/22/2017

19 Jul 2017 3 332 - 7/19/2017

8/9/2017 8/9/2017 + 02 Sep 2017 3 - - 9/2/2017

9/4/2017 9/5/2017 + 09 Sep 2017 3 - - 9/9/2017

11/26/2017 11/27/2017 + 14 Dec 2017 3 - - 14 Dec 2017

3/13/2018 3/15/2018 + 19 Mar 2018 3 25 - 3/19/2018

3/19/2018 04 Apr 2018 3 119 - 4/4/2018

29 May 2018 02 Jun 2018 + 3 6

02 Jun 2018 - 3 257

 Akhir follow-up sebelum mulai ART

Tgl. Rujuk KELOMPOK POPULASI KHUSUS

Masuk Kembali
Tgl. kunjungan
Penyebab
Tgl. meninggal terakhir gagal Tgl. Rujuk Keluar
Kematian follow-up

01 Sep 2017 _ 8/12/2017 ODHA dgn pasangan negatf

03 Feb 2015 - 2/3/2015 30 Sep 2014 16 Jan 2015 ODHA dgn pasangan negatf

28 Apr 2014 - 4/28/2014 Pasien TB

16 Apr 2015 - 4/23/2015 ODHA dgn pasangan negatf

- 11/20/2014 Pasien TB

3/24/2014 LSL

12 May 2014 5/12/2015 -

20 Aug 2014 8/20/2014 ODHA dgn pasangan negatf

11/16/2014 Pasien TB

10 Mar 2015 3/9/2014 Pasien TB

Pasien TB

7/14/2015 -

29 May 2015 2/20/2015 -

24 Mar 2015 3/24/2015 Pasien TB

10 Dec 2015 5/13/2015 Pasien TB

12/6/2016 ODHA dgn pasangan negatf

 ODHA dgn pasangan negatf

10/27/2015 -

22 Jul 2015 22 Jul 2015 03 Jul 2015 -

10/27/2015 -

10/13/2015 -

10/13/2015 -

25 Oct 2015 -

Pasien TB

01 Apr 2016 -

03 Jul 2017 1/5/2017 -

Pasien TB

9/2/2016 Pasien TB

Pasien Hepatts

10 Oct 2016 -

07 Sep 2016 -

24 Feb 2017 -

ODHA dgn pasangan negatf

 -

ODHA dgn pasangan negatf

ODHA dgn pasangan negatf

ODHA dgn pasangan negatf

Pasien TB

10/9/2017 -

10/9/2017 -

Pasien TB

02 Nov 2017 9/9/2017 Pasien TB

Pasien TB

Pasien TB

Pasien TB

-
Dokumen Bantu REGISTER ART Referensi warna: Rujuk Keluar Stop Gagal follow up
Mati Rujuk Masuk

Laki-laki Perempuan
Remarks

Bulan Nomor

Umur
BLN No Rekam Sex Hamil
No. Th Rujuk TGL mulai ART Register Nama TGL Lahir Alamat pasien
LAPORAN Medik / KODE (L/P) <1 1-14 15-19 20-24 25-49 ≥ 50 <1 1-14 15-19 20-24 25-49 ≥ 50 /Tidak
Masuk Nasional

1 2014 5 25 Apr 2014 031390 73010150001 Colly 28 4/13/1986 L √ 0 pulopasi

2 2014 5 01 Jun 2014 031904 73010150006 Abdul Razak 24 5/9/1990 L √ 0 Jampea
3 2014 7 08 Jul 2014 032395 73010150008 Meicana Gauk 34 5/3/1980 P √ 0 Lembang Matene
4 2014 7 23 Apr 2014 005092 73010150004 Ahmad 28 8/10/1988 L √ 0 Balang Butung
5 2014 11 03 Nov 2014 033351 73010150005 Rosmiat 42 4/20/1972 P √ 0 Bonea
6 2014 11 10 Nov 2014 029544 73010150009 A. Rusniar 26 5/15/1988 P √ 0 Benteng
7 2015 1 16 Jan 2015 032715 73010150002 Bau Raja 71 10/20/1943 P √ 0 Batangmata
8 2015 5 13 May 2015 035696 73010150011 Bau Ansing 35 9/14/1973 P √ 0 Pasilambena
9 2015 2 17 Feb 2015 035709 73010150012 Suddin 41 L √ 0 Karumpa
10 2015 6 06 Jun 2015 036908 73010150016 Andi Fitriani 25 4/25/1990 P √ 1 Jl. S Parman
11 2015 7 03 Jul 2015 73010150018 Muh. Umar 4 11/30/2011 L √ 0 Bonerate
12 2015 7 03 Jul 2015 73010150020 Nisa 36 10/12/1979 P √ 0 Bonerate
13 2015 7 03 Jul 2015 73010150019 Dodok Ibrahim 50 1/12/1965 L √ 0 Bonerate
14 2015 9 17 Sep 2015 035222 73010150017 Andi Rezki Zelviana 25 11/28/1990 P √ 1 Barugaiya
15 2015 10 13 Oct 2015 039211 73010150021 Risnawat 23 1/19/1992 P √ √ 1 Bonerate
16 2015 10 13 Oct 2015 73010150022 Muh.Ihsan 20 4/3/1990 L √ Bonerate
17 2016 5 20 May 2016 73010150025 Hamzah 27 L √ 0 Gusung
18 2016 8 20 May 2016 032520 73010150026 Fitriani 27 5/16/1987 P √ 0 Gusung
19 2016 8 16 Aug 2016 041241 73010150034 Sofiana Rahayu 24 10/6/1992 P √ 0 Pulo Pasi
20 2016 10 28 Oct 2016 042319 73010150030 Ardi Wijaya 29 8/22/1987 L √ 0 Jl. KH. Hayyung
21 2016 10 30 Nov 2016 043595 73010150032 Andi Aziz 42 8/18/1974 L √ 0 Batangmata
22 2016 10 30 Nov 2016 043947 73010150033 Fatmawat 36 5/4/1980 P √ 0 Batangmata
23 2017 1 05 Jan 2016 035044 73010150029 Sitti Nuriani 29 11/17/1987 P √ 0 Dsn. Laiyolo
24 2017 1 23 Jan 2017 026259 73010150036 Said Akbar Anwar 27 8/9/1989 L √ 0 Benteng
25 2017 4 24 Jan 2017 016659 73010150040 Ashar 43 4/24/1974 L √ 0 Jl. Kenari
26 2017 3 25 Mar 2017 045416 73010150037 Sri Wahyuni 30 12/11/1986 P √ 1 Jl. Jend. Sudirman
27 2017 4 03 Apr 2017 047128 73010150043 Sarping 28 8/25/1989 L √ 0 Parak Selatan
28 2017 4 17 Apr 2017 044517 73010150044 Sapriadi 39 4/24/1977 L √ 0 Jl. Mangga
29 2017 4 22 Apr 2017 046055 73010150042 Taufan Muhtar 54 2/13/1963 L √ 0 Jl. Syarif Al Qadri
30 2017 5 06 May 2017 046728 73010150041 Dahlia 27 1/3/1990 P √ 0 Batangmata
31 2017 5 18 May 2017 047960 73010150045 Samsul 30 3/21/1984 L √ 0 Bonerate
32 2017 5 18 May 2017 047961 73010150046 Syamsiah 34 P √ 0 Bonerate
33 2017 7 19 Jul 2017 73010150047 Kasriadi 24 7/17/1993 L √ 0 Gusung
34 2017 7 22 Jul 2017 049236 73010150039 Rezky Milandari 29 10/9/1988 P √ 0 Boneapara
35 2017 9 02 Sep 2017 049232 73010150048 Zulkarnaim 29 7/25/1988 L √ 0 Alasa
36 2017 9 09 Sep 2017 049599 73010150049 Pasongai 55 7/1/1962 L √ 0 Pammatata
37 2017 12 14 Dec 2017 051102 73010150050 Saju 39 2/9/1978 L √ 0 Bonerate
38 2018 3 20 Mar 2018 052965 73010150051 Muh. Raba 46 6/9/1971 L √ 0 Jampea
39 2018 3 28 Mar 2016 041744 73010150027 Muh. Yasin 47 1/16/1969 L √ 0 Balikra
40 2018 4 04 Apr 2018 053117 73010150052 Sahabu 28 7/7/1989 L √ 0 Bonerate
 CATATAN:
perhatikan konsistensi pengisian antara adherence dan keterangan pasien
dengan status fungsional, BB, dan CD4

Status fungsional 1 (Kerja), 2 (Ambulatori), 3 (Baring) Berat badan (kg) Nilai CD4 (% utk anak dan ibu hamil)

Menerima ARV
sebelumnya
Stad klinis
WHO pd

(1/2)
no Telp Nama PMO & No. Telp Pd 6 Pd 12 Pd 24 Pd 36 Pd 48 Pd 60 Pd 72 Pd 84 Pd 96 Pd saat Pd 6 Pd 12 Pd 24 Pd 36 Pd 48 Pd 60 Pd 72 Pd 84 Pd 96 Pd saat Pd 6 Pd 12 Pd 24 Pd 36 Pd 48 Pd 60 Pd 72 Pd 84
saat mulai Pd saat mulai Rx
bulan bulan bulan bulan bulan bulan bulan bulan bulan mulai Rx bulan bulan bulan bulan bulan bulan bulan bulan bulan mulai Rx bulan bulan bulan bulan bulan bulan bulan bulan
ART

085272684888 Agustna/085287780600 2 3 1 1 1 1 1 45 kg 59 kg 60 kg 63 kg 50 kg
085145184812 Muh. Aspah/085145184812 2 2 1 1 1 60 kg -
81342553553 Andi Syamsul/085255830910 2 3 3 48 kg -
085240863952 Maya/085240863952 2 3 2 3 48 kg 44kg -
082292090668 Aisyah/082292090668 2 3 3 29 kg -
085299827666 Hamsina/085341664150 2 3 3 48 kg -
085256486041 Andi Risma/085256486041 2 3 35 kg 34
085298814411 Saripuddin/085342581111 2 3 1 1 1 1 1 220
_ 2 3 1 77 kg 549
085255023331 Riomy Nugerah/085255023331 2 3 626
085395304708 Hasraruddin/085395304708 2 3 2
085395304708 Hasraruddin/085395304708 2 3 3
085395304708 Hasraruddin/085395304708 2 3 3
085824538662 Rasmeila Nur 2 3 1 1 1 56 kg
085146361877 Erwani 2 3 3
085146361877 Risnawaty/085146361877 2 3 1
082144811117 Fitriani 2 3 3
082144811117 Hamzah 2 3 1
085756373323 Rameila Nur 2 3 1 42 kg 6
08234566333 Andi Lela/ 082393404010 2 3 1 68 kg 15
085756484213 Fatmawat/085696479248 2 3 1 1 1 1 45 kg 200
085696479248 Andi Aziz/085756484213 2 3 1 1 1 1 60 kg 353
085240566619 Wahyudin/085240566619 2 3 3 32 kg 82
085299636362 Rasmeila Nur 2 3 1 61 kg 500
085298346406 85298346406 2 3 1 1 1 70 kg
082290099007 Andi Nakirwan/082290099007 2 3 1
082347263086 Rasmeila Nur 2 3 56 kg 79
085397338984 Jumriani 2 3 1 1 1 50 kg 35
_ Hj. St. Ramlah 2 3 1 1 1 126
082345660660 Muh. Nur 2 3 1 1 30 kg 6
085347156825 Syamsiah/085347156825 2 3 1 1 19
085347156825 Samsul/085347156825 2 3 1 1 214
082144006160 Andi Indayani/085792851659 1 3 1 1 332
082158078999 Muh. Nurdiansyah/08215807899 2 3 3 1 1 30 kg
082240659825 Sofiana Rahayu 2 3 3 1 40 kg
085256486041 Andi Nur Efendi/081355817016 2 3 3 46 kg
_ Asia 2 3 3 55 kg
082347312826 Kawang 2 3 3 25
_ Junaedah 2 3 3
082343356607 Tante/082343356607 2 3 3 43 kg 119
 TB selama ART IO yang terjadi IMS Substitusi dgn ARV lini ke-1
Tgl mulai
tgl
pemberian
Pd 96 Screening / tgl mulai Terapi Nama rejimen ART orisinal
P/EP Kode IO Tgl IO Terapi IO profilaksis Tgl. subst. Alasan
bulan Tapis TB terapi IMS
Kotrimoksazol

K 4/4/2014 cotrimoxazole 04 Apr 2014 TDF(300)+3TC(150)+EFV(600)

K 5/8/2014 cotrimoxazole,kandistatn,fluconazole,ottogenta 08 May 2014 ZDV(300)+3TC(150)+EFV(600)
6/24/2014 K,Cr 7/6/2014 cotrimoxazole.floconazole,piracetam,kandistatn 06 Jul 2014 TDF(300)+3TC(150)+EFV(600)
K 4/16/2014 cotrimoxazole,kandistatn,fluconazole,gentamysin 17 Apr 2014 ZDV(300)+3TC(150)+EFV(600)
9/6/2014 1 9/10/2014 K 9/3/2014 cotrimoxazole,kandistatn,ambroxol 03 Sep 2014 TDF(300)+3TC(150)+EFV(600)
11/16/2014 1 11/16/2014 K,D 11/3/2014 Cotrimoxazole,kandistatn,fluconazole,metoclopramide.cefotaxime 03 Nov 2014 ZDV(300)+3TC(150)+EFV(600)
K,PCP 9/5/2014 cotrimoxazole,candistat,ceftriaxone 1gr, 05 Sep 2014 ZDV(300)+3TC(150)+EFV(600)
2/21/2015 1 2/24/2016 K 2/14/2015 Cotrimoxazole,Kandistatn 14 Feb 2015 TDF(300)+3TC(150)+EFV(600)
Cotrimoxazole ZDV(300)+3TC(150)+EFV(600)
TDF(300)+3TC(150)+EFV(600)
Cotrimoxazole TDF(300)+3TC(150)+EFV(600)
Cotrimoxazole ZDV(300)+3TC(150)+EFV(600)
Cotrimoxazole ZDV(300)+3TC(150)+EFV(600)
Cotrimoxazole TDF(300)+3TC(150)+EFV(600)
ZDV(300)+3TC(150)+EFV(600)
ZDV(300)+3TC(150)+EFV(600)
ZDV(300)+3TC(150)+EFV(600)
ZDV(300)+3TC(150)+EFV(600)
K,D 8/15/2016 Kandistatn,cotrimoxazole,ambroxol 15 Aug 2016 ZDV(300)+3TC(150)+EFV(600)
5/9/2016 1 8/29/2016 OAT,COTRIMOXAZOLE 30 Jul 2016 TDF(300)+3TC(150)+EFV(600)
H,D 8/4/2016 Cotrimoxazole,ceftazidine,metronodazole,zink,metoklopramide,flukonazole 10 Aug 2016 TDF(300)+3TC(150)+EFV(600)
TDF(300)+3TC(150)+EFV(600)
7/15/2016 1 7/28/2016 D 7/11/2016 Cotrimoxazole,loperamide,metoclopramide,OAT 13 Jul 2016 ZDV(300)+3TC(150)+EFV(600)
ZDV(300)+3TC(150)+EFV(600)
1 TDF(300)+3TC(150)+EFV(600)
TDF(300)+3TC(150)+EFV(600)
K,PCP 3/21/2017 Cotrimoxazole,fluconazole,salbutamo,loratadine,kandistatn 21 Mar 2017 TDF(300)+3TC(150)+EFV(600)
TDF(300)+3TC(150)+EFV(600)
K,D,PCP 2/23/2017 Kandistatn,fluconazole,cotrimoxazole 23 Jan 2017 TDF(300)+3TC(150)+EFV(600)
PCP 2/21/2017 Cotrimoxazole.fluconazole 21 Feb 2017 TDF(300)+3TC(150)+EFV(600)
Cotrimoxazole 18 May 2017 TDF(300)+3TC(150)+EFV(600)
Cotrimoxazole 18 May 2017 TDF(300)+3TC(150)+EFV(600)
TDF(300)+3TC(150)+EFV(600)
8/11/2017 1 K,PCP 8/10/2017 Cotrimoxazole,vipalbumin,myconys,ambacin 8/10/2017 TDF(300)+3TC(150)+EFV(600)
8/9/2017 1 8/10/2017 K 8/9/2017 Cotrimoxazole,proliver,dompridone,OAT 09 Aug 2017 TDF(300)+3TC(150)+EFV(600)
9/5/2017 1 H,K 9/4/2017 Cotrimoxazole,nysatn,ceftrinaxon,fluconazole 04 Sep 2017 TDF(300)+3TC(150)+EFV(600)
11/27/2017 1 12/5/2017 PCP 11/26/2017 Cotrimoxazole,fluconazole,salbutamo,loratadine 11/26/2017 TDF(300)+3TC(150)+EFV(600)
3/15/2017 1 PCP 3/13/2018 Cefotaxime,proliver,cotrimoxazole,OAT 3/13/2018 TDF(300)+3TC(150)+EFV(600)
1/7/2018 Cotrimoxazole TDF(300)+3TC(150)+EFV(600)
3/20/2018 1 3/23/2018 PCP 3/19/2018 Cotrimoxazole,flukonazole,ambroxol 3/19/2018 TDF(300)+3TC(150)+EFV(600)
stitusi dgn ARV lini ke-1 VL Switch dengan ARV lini ke-2 Akhir follow-up dengan ART

ADHERENC

ADHERENC
ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC
Tgl lolos FU Tgl Rujuk

bln 10

bln 12
bln 11
bln 1

bln 2

bln 3

bln 4

bln 5

bln 6

bln 7

bln 8

bln 9
Tgl Tgl stop yg
Rejimen baru Tanggal VL Alasan Rejimen baru Tgl Meninggal (kunjungan Keluar dgn Lokasi

E
switch pasti
terakhir) ART

01 Sep 2017 9/1/2017 12 Aug 2017 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T

5/6/2015 24 Mar 2015 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T A
20 Aug 2014 8/20/2014 20 Aug 2014 3 T M M M M M M M M M M M
16 Apr 2015 2/18/2015 19 Jan 2014 1 T 1 T 1 T 1 T 1 T 1 T 1 T M M M M M
12/2/2014 03 Nov 2014 1 T M M M M M M M M M M M
12/20/2014 16 Nov 2014 1 T M M M M M M M M M M M
1 T M M M M M M M M M M M
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
8/16/2015 14 Jul 2015 1 T 1 T 1 T 1 T 1 T 1 T A A A A A A
1/5/2017 06 Dec 2016 1 T A A A A A A A A A A A
11/28/2015 27 Oct 2015 1 T 1 T 1 T 1 T A A A A A A A A
11/28/2015 27 Oct 2015 1 T 1 T 1 T 1 T A A A A A A A A
22 Jul 2015 22 Jul 2015 03 Jul 2015 1 T M M M M M M M M M M M
1 T A A A A A A A A A A A
11/12/2015 13 Oct 2015 1 T A A A A A A A A A A A
11/12/2015 13 Oct 2015 1 T A A A A A A A A A A A
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
10 Oct 2016 1 T 1 T 1 T RK RK RK RK RK RK RK RK RK
11/30/2017 1 T RK RK RK RK RK RK RK RK RK RM 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
03 Jul 2017 2/23/2017 24 Jan 2017 1 T 1 T 1 M M M M M M M M M M
24 Feb 2014 1 T RK RK RK RK RK RK RK RK RK RK RK
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
2/24/2017 25 Mar 2017 1 T A A A A A A A A A A A
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
12/8/2017 09 Nov 2017 1 T 1 T 1 A A A A A A A A A A
11/8/2017 09 Nov 2017 1 T 1 T 1 A A A A A A A A A A
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T RK RK
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
02 Nov 2017 11/8/2017 08 Oct 2017 1 T 2 T M M M M M M M
1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T
1 T A
1 T 1 T
ADHERENC
ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC

ADHERENC
bln 13

bln 14

bln 15

bln 16

bln 17

bln 18

bln 19

bln 20

bln 21

bln 22

bln 23

bln 24

bln 25

bln 26

bln 27

bln 28

bln 29

bln 30

bln 31

bln 32

bln 33

bln 34

bln 35

bln 36

bln 37

bln 38

bln 39

bln 40

bln 41

bln 42

bln 43

bln 44

bln 45
E

E
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T M M M M M M M
A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A
M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M
M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M
M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M
M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M
M M M M M M M M M M M M M M M M M M M M M M M M M M M M M
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 3 T
A A A A A A A A A A A A A A A A A A A A A A A A A A A A
A A A A A A A A A A A A A A A A A A A A A A A A
A A A A A A A A A A A A A A A A A A A A A A T
A A A A A A A A A A A A A A A A A A A A A A T
M M M M M M M M M M M M M M M M M M M M M M M
A A A A A A A A 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 3 T 3
A A A A A A A A A A A A A A A A A A A T
A A A A A A A A A A A A A A A A A A A T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T 1 T
RK RK RK RK RK RK RK RK RK RK
1 T 1 T RK RK RK RK RK RK
1 T 1 T 1 T 1 T 1 T 1 T
1 T 1 T 1 T 1 T 1 T 1 T
M M M M M M M M M M M M M M M M M
RK RK RK RK RK
1 T 1 T 1 T 1 T 1 T
A A A
1 T 1 T
1 T 1 T
1 T 1 T
1 T
T
 ADHERENC
E

M
M
M
bln 46
ADHERENC
E

M
M
bln 47
ADHERENC
E
bln 48
ADHERENC
E
bln 49
ADHERENC
E
bln 50
ADHERENC
E
bln 51
ADHERENC
E
bln 52
ADHERENC
E
bln 53
ADHERENC
E
bln 54
ADHERENC
E
bln 55
ADHERENC
E
bln 56
ADHERENC
E
bln 57
ADHERENC
E
bln 58
ADHERENC
E
bln 59
ADHERENC
E
bln 60
ADHERENC
E
bln 61
ADHERENC
E
bln 62
ADHERENC
E
bln 63
ADHERENC
E
bln 64
ADHERENC
E
bln 65
ADHERENC
E
bln 66
ADHERENC
E
bln 67
ADHERENC
E
bln 68
ADHERENC
E
bln 69
ADHERENC
E
bln 70
ADHERENC
E
bln 71
ADHERENC
E
bln 72
ADHERENC
E
bln 73
ADHERENC
E
bln 74
ADHERENC
E
bln 75
ADHERENC
E
bln 76
ADHERENC
E
bln 77
ADHERENC
E
bln 78
 ADHERENC
E
bln 79
ADHERENC
E
bln 80
ADHERENC
E
bln 81
ADHERENC
E
bln 82
ADHERENC
E
bln 83
ADHERENC
E

T
bln 84