PEMERIKSAAN HIV,SIFILIS DAN HEPATITIS

Laporan Bantu Eliminasi HIV, Sifilis dan Hepatitis B pada Ibu Hamil
Nama Fasyankes : Posyandu Melati IV Blok M Indarung
Nomor Fasyankes : Tahun 2018
Kecamatan : Lubuk Kilangan
Kota/Kabupaten : Padang
Propinsi : Sumbar

T8
Nama UMUR Alamat Catatan
T1-T7
Tanggal ANC usia
NO No KTP Ibu Hamil G P A kehamilan HPHT TP (tgt
K1
Ibu Hamil subdit HCG Goldar HB GDS HIV
Bumil)

1 Neneng 26 th Rt 03 Rw 03 10/10/2017 1371076104910002 1 0 0 24-25 7/5/2017 4/12/2018 O 11 118 √

2 Rini Eliza 32 th Rt 02 Rw 03 10/18/2017 1371076009850003 3 2 0 24-25 7/5/2017 5/12/2018
3 Jumartinis 34 th Rt 02 Rw 03 10/15/2017 1371074403830003 5 3 1 22-23 7/27/2017 5/3/2018 B 10.29 110 √
4 Nora 33 th Rt 01 Rw 03 1/28/2019 1371074804830001 3 2 0 11- 12 10/23/2017 7/30/2018
5 Yunita Marni 28 th Rt 03 Rw 03 12/14/2017 1371076107890004 1 0 0 14-15 9/24/2017 7/1/2018 O 11 99 √
6 Meri 20 th Rt 02 Rw 03 10/28/2017 1 0 0 23-24 7/12/2017 4/19/2018 O 12 110 √
7 Marnis Ningsih 38 th Rt 01 Rw 03 12/21/2017 1304105606870001 2 1 0 15-16 9/14/2017 6/21/2018 O 10.8 120 √
8 Nurfalino 29 th Rt 01 Rw 03 10/15/2017 1301047008880002 2 1 0 22-23 7/28/2017 5/5/2018 O 11.8 118 √
9 Fitri 27 th Rt 02 Rw 03 10/26/2017 1371074204900003 3 2 0 21-22 7/28/2017 5/5/2018
10 Tuti Nawanti 27 th Rt 03 Rw 03 2/21/2018 1218036910950001 2 0 1 11-12 11/13/2017 8/20/2018
11 Elvi Sesra 18 th Rt 02 Rw 03 10/13/2017 1371084402010002 1 0 0 24-25 7/29/2017 5/6/2018
12 Mezawati 20 th Rt 03 Rw 03 6/11/2018 1371076209000002 1 0 0 32-33 3/29/2018 1/6/2018
13 Serli Eka P 28 th Rt 02 Rw 03 10/19/2017 1 0 0 34-35 7/10/2017 4/17/2018 O 11.2 114 √
14 Marseli Silvia 25 th Rt 02 Rw 03 5/17/2017 1302075502830005 4 3 1 09-10 2/20/2018 11/27/2018 A 11 114 √
15 Devi Olivia 41 th Rt 03 Rw 03 5/25/2018 1371074312770006 3 2 0 07-08 2/10/2018 11/17/2018
16 Mira Y 31 th Rt 01 Rw 03 1/22/2018 2 1 0 06-07 10/22/2017 7/29/2018
17 Elma Tiana 22 th Indarung 2/24/2018 1 0 0 11-12 11/22/2017 8/29/2018 O 11 110 √
18 Thalia 17 th Rt 02 Rw 03 4/24/2018 1371074601010004 1 0 0 12-13 1/6/2018 10/13/2018 A 10.89 128 √
19 Yerma Kurniawati 32 th Rt 01 Rw 03 5/18/2018 3 2 0 15-16 2/26/2018 12/3/2018 O 11.59 111 √
20 EfEfriyani 28 th Rt 01 Rw 03 7/11/2018 1371075508910004 3 2 0 06-07 4/29/2018 2/6/2018 B 11.7 105 √
21 Resmanita 28 th Rt 01 Rw 03 7/28/2018 1304074902900002 3 2 0 08-09 4/17/2018 1/24/2019 O 11.2 111 √
22 Novrimadona 25 th Rt 01 Rw 03 12/18/2017 2 1 0 14-15 9/9/2017 6/16/2018 O 11.8 100 √
23 Elvi Neri 28 th Rt 02 Rw 03 2/26/2018 1371075010900007 2 1 0 12-13 11/5/2017 8/12/2018 AB 11.5 122 √
24 Kristina Monalisa 39 th Rt 03 Rw 03 18/0-9/2019 1371075606820007 4 3 0 07-08 6/8/2018 3/15/2019 O 10 112 √
25 Sri Hidayati 33 th Rt 01 Rw 03 10/25/2018 1371025207850001 3 2 0 04-05 7/21/2018 4/28/2019 O 11 118 √
26 Fiki Yolanda 28 Th Rt 02Rw 03 6/21/2018 4 3 0 16-17 3/30/2018 07/01/2019 B 11 121 √
27 Dewi 36 th Rt 04 Rw 08 4/13/2018 5 2 2 12-13 1/27/2018 11/4/2018 O 9.9 120 √
T8

Hepa Malari BTA T9 & 10

Sifilis titis B a

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 HASIL REAKTIF
Laporan Bantu Eliminasi HIV, Sifilis dan Hepatitis B pada Ibu Hamil
Nama Fasyankes :
Nomor Fasyankes :
Kecamatan :
Kota/Kabupaten :
Provinsi :

Konfirmasi
Catatan
T1-T7 Lahir Penangan Hasil
Nama Tanggal ANC No KTP Ibu usia Taksiran Tanggal Hidup/
NO G P A HPHT (tgt
K1 Hamil kehamilan Persalinan subdit Persalinan Mati an dini tgl
Hepa
Ibu Hamil Bumil) HIV Syipilis
titis
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Laporan Bantu Eliminasi HIV, Sifilis dan Hepatitis B pada Ibu Hamil
Nama Fasyankes :
Nomor Fasyankes :
Kecamatan :
Kota/Kabupaten :
Provinsi :
Konfirmasi
Risiko Penanganan Dini Pemeriksaan
Tanggal
Nama No KTP
Tanggal Tanggal TERAPI pemeriks Keteranga
NO Ibu
KN1 Hamil Lahir HIV Sifilis Hepatitis ASI/PASI /PROFI kONDISI aan n
B pertama tgl hasil
LAKSIS
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