Data Offline Surveilans PTM berbasis FKTP

IDENTITAS

Tanggal
No No Rekam Jenis
Pemeriksaan * No KTP * Nama Pasien
Medis Kelamin

1 01 April 2019 5311052101000001 Klara Bunga P

2 01 April 2019 5311052101000002 Mikael Seto L
3 01 April 2019 5311052101000003 Satu Sisu L
4 01 April 2019 5311052101000004 Oliva Kara P
5 02 April 2019 5311052101000005 Emanuel Atu L
6 02 April 2019 5311052101000006 Gaspar Tea L
7 05 April 2019 5311052101000007 Bernadeta Bene P
8 05 April 2019 5311052101000008 Martha Piri P
9 05 April 2019 5311052101000009 Andreas Roi L
10 08 April 2019 5311052101000010 Letisia M Beni P
11 08 April 2019 5311052101000011 Thomas Page L
12 08 April 2019 5311052101000012 Hadija Dona P
13 12 April 2019 5311052101000013 Idris Satu L
14 15 April 2019 5311052101000014 Stanis Toli L
15 16 April 2019 5311052101000015 Anselmus Beni Doa L
16 23 April 2019 5311052101000016 Agustina Gere P
17 24 April 2019 5311052101000017 Maria Cleofas Loti P
18 24 April 2019 5311052101000018 Nana A.J Jendo P
19 25 April 2019 5311052101000019 Fransiskus Wara L
20 26 April 2019 5311052101000020 Petrus Wonga L
21 29 April 2019 5311052101000021 Agnes M Ngaro P
22 30 April 2019 5311052101000022 Emiliana Baja P
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
 42
43
44
45
46
47
48
49
50
xxx xxx xxx xxx xxx xxx
 Tempat Lahir Tanggal Lahir Alamat Lengkap No HP

Wolojita 12/31/1942 Wolojita

Wolojita 12/31/1955 Wolojita
Wolojita 12/31/1935 Wolojita
Wolojita 12/31/1971 Wolojita
Wolojita 12/31/1954 Wolojita
Wolojita 12/31/1948 Wolojita
Wolojita 12/31/1964 Wolojita
Wolojita 12/31/1939 Wolojita
Wolojita 12/31/1935 Wolojita
Wolojita 12/31/1967 Wolojita
Wolojita 12/31/1941 Wolojita
Wolojita 12/31/1977 Wolojita
Wolojita 12/31/1955 Wolojita
Wolojita 12/31/1949 Wolojita
Wolojita 12/31/1982 Wolojita
Wolojita 12/31/1956 Wolojita
Wolojita 12/31/1965 Wolojita
Wolojita 12/31/1967 Wolojita
Wolojita 12/31/1971 Wolojita
Wolojita 12/31/1972 Wolojita
Wolojita 12/31/1963 Wolojita
Wolojita 12/31/1961 Wolojita
xxx xxx xxx xxx
 Golongan
No Telp. Rumah Status Suku Pekerjaan
Darah

Menikah Lio petani

Menikah Lio petani
Janda/Duda Lio petani
Menikah Lio petani
Menikah Lio petani
Janda/Duda Lio petani
Menikah Lio petani
Menikah Lio petani
Janda/Duda Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
xxx xxx xxx xxx xxx
 WAWANCARA IMT

Kurang Kurang Konsumsi Tinggi Berat Lingkar

Keterangan Merokok Aktivitas Makan Alkohol Badan Badan Perut
Fisik Sayur

Ya 158 46
164 59
ya ya 160 41
ya 156 50
ya ya 162 56
ya ya 159 49
ya 165 46
ya ya 159 42
ya ya 156 45
ya 156 51
ya 162 46
159 56
ya ya 160 50
ya ya 161 45
ya ya 161 56
ya ya 164 51
ya Ya 164 51
158 47
ya ya 160 47
ya ya 164 56
Ya 159 51
ya 161 49
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 Tekanan Darah Gula Darah Kolesterol

Arus
Gula Darah Gula Darah Kolesterol Puncak
Sistol Diastol Trigliserida LDL HDL
Sewaktu Puasa Total Ekspirasi
(APE)

150 100
140 90
170 110
140 70
150 70
160 100
100 60
110 70
130 70
160 100
120 80
110 70
130 90
150 100
140 90
170 110
140 90
110 70
150 90
120 80
150 100
160 90
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 DI

Kadar Tes Benjolan Hasil

Alkohol Amfetamin Abnormal Pap Smear Periksa Krioterapi Diagnosa 1
Pernafasan Urin Payudara IVA

Hipertensi
Hipertensi
Hipertensi
Hipertensi
Hipertensi
Hipertensi
Diabates Militus Tipe 2
Asma Bronchiale
Asma Bronchiale
Asma Bronchiale
Asma Bronchiale
Asma Bronchiale
Hipertropi Prostat
Hipertensi
Hipertensi
Hipertensi
Hipertensi
Asma Bronchiale
Hipertensi
Asma Bronchiale
Hipertensi
Hipertensi
xxx xxx xxx xxx xxx xxx xxx
 DIAGNOSA Pemeriksaan Penunjang

Diagnosa 2 Diagnosa 3 Diagnosa 4 Diagnosa 5 EKG

Hipertensi

Ginjal Kronik
xxx xxx xxx xxx xxx
Pemeriksaan Penunjang

Urin Rutin
Darah &
Radiologi Dirujuk
Lengkap Mikroskop
ik
xxx xxx xxx xxx
 tgl_periksa rekam_medis nik nama tgl_lahir alamat
2019-04-01 5311052101000001 Klara Bunga #REF! Wolojita
2019-04-01 5311052101000002 Mikael Seto 1955-12-31 Wolojita
2019-04-01 5311052101000003 Satu Sisu 1935-12-31 Wolojita
2019-04-01 5311052101000004 Oliva Kara 1971-12-31 Wolojita
2019-04-02 5311052101000005 Emanuel Atu 1954-12-31 Wolojita
2019-04-02 5311052101000006 Gaspar Tea 1948-12-31 Wolojita
2019-04-05 h Bernadeta Bene 1964-12-31 Wolojita
2019-04-05 5311052101000008 Martha Piri 1939-12-31 Wolojita
2019-04-05 5311052101000009 Andreas Roi 1935-12-31 Wolojita
2019-04-08 5311052101000010 Letisia M Beni 1967-12-31 Wolojita
2019-04-08 5311052101000011 Thomas Page 1941-12-31 Wolojita
2019-04-08 5311052101000012 Hadija Dona 1977-12-31 Wolojita
2019-04-12 5311052101000013 Idris Satu 1955-12-31 Wolojita
2019-04-15 5311052101000014 Stanis Toli 1949-12-31 Wolojita
2019-04-16 5311052101000015 Anselmus Beni Doa 1982-12-31 Wolojita
2019-04-23 5311052101000016 Agustina Gere 1956-12-31 Wolojita
2019-04-24 5311052101000017 Maria Cleofas Loti 1965-12-31 Wolojita
2019-04-24 5311052101000018 Nana A.J Jendo 1967-12-31 Wolojita
2019-04-25 5311052101000019 Fransiskus Wara 1942-12-31 Wolojita
2019-04-26 5311052101000020 Petrus Wonga 1972-12-31 Wolojita
2019-04-29 5311052101000021 Agnes M Ngaro 1963-12-31 Wolojita
2019-04-30 5311052101000022 Emiliana Baja 1961-12-31 Wolojita
 gender telp diagnosa1 diagnosa2 diagnosa3 diagnosa4 diagnosa5 merokok kurang_aktifitas
P 4
L 4
L 4 1
P 4
L 4 1 1
L 4 1
P 2
P 3 1
L 3 1 1
P 3 4
L 3 1
P 3
L 26 1
L 4 12 1
L 4 1
P 4 1
P 4 1
P 3
L 4 1
L 3 1
P 4
P 4 1
kurang_sayur
konsumsi_alkohol tb bb lp sistol diastol gds
1 158 46 150 100
164 59 140 90
1 160 41 170 110
1 156 50 140 70
162 56 150 70
1 159 49 160 100
1 165 46 100 60
1 159 42 110 70
156 45 130 70
1 156 51 160 100
162 46 120 80
159 56 110 70
1 160 50 130 90
1 161 45 150 100
1 161 56 140 90
1 164 51 170 110
1 164 51 140 90
158 47 110 70
1 160 47 150 90
1 164 56 120 80
1 159 51 150 100
161 49 160 90
gdp apebenjolan_payudara
positif_iva krioterapi papsmear tempat_lahir no_telprum
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
Wolojita
golongan_d status suku pekerjaan keterangan kolesterol_totrigliserida ldl
Menikah Lio petani
Menikah Lio petani
Janda/Duda Lio petani
Menikah Lio petani
Menikah Lio petani
Janda/Duda Lio petani
Menikah Lio petani
Menikah Lio petani
Janda/Duda Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
Menikah Lio petani
hdl kadar_alko tesamfetamekg radiologi darah_lengurin_rutin dirujuk
2 fktp