LAPORAN SCREENING SISWA SD/MI SE- WILAYAH KERJA PUSKESMAS I SOKARAJA

TH AJARAN 2013/2014
Nama Sekolah : SDN 1 PAMIJEN
Jumlah Murid: Pa: Pi:
Jumlah Murid kelas I : Pa: Pi:
Jumlah Dokcil:............................
No Telp sekolah :...........................................
Nama Guru UKS :...........................................
tjm Tajam
Rambut bibir Sdt mulut Gigi&mulut Ganng
BB TB penglihatan dengar
N sek Status uan
Nama (Kg (cm IMT mdh OM ad Rongga Tonsil
o s Gizi kerin Peca dr luk peca Menta
) ) dicbu N RJ RB N gnngua mulut Gigi
g h h a h l
t n LB BB
1 BAGUS IMAM L 26 129 15.62
Normal _ _ _ _ _ _ _ _ _ _ _ _ _ caries 71
2 ELZA LISTRIANTO L 21 122 14.11
Normal _ _ _ _ _ _ _ _ _ _ _ _ _ 61P 78
3 ONGGO ARIF S L 22 123 14.54
Normal _ _ _ _ _ _ _ _ _ _ _ _ _ caries V 77
4 WISNU RIZKI DWI L 24 127 14.88
Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ 85UD V 73
5 ADHIBA LAELA I P 19 118 13.65
Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 82
6 ANISA NUR K P 19 115 14.37
Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 85
7 ANDKIKA RIZKY A P L 20 122 13.44
Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 78
8 ANTHONY FIDO F L 20 117 14.61
Normal _ _ _ _ _ _ _ _ _ _ _ _ _ caries 83
9 ASYIFA ISNAENI A P 18 115 13.61
Normal _ _ _ _ _ _ _ _ _ _ _ _ _ 5161P 85
10 DAFFA AL ANBIYA L 19 121 12.98
Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 79
11 DIVA APRILIANA P 18 115 13.61
Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 85
12 FAVIEN ANANTA S L 21 127 13.02
Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ 8485UD 73
13 HASNA IMROATUL A P 20 119 14.12
Normal _ _ _ _ _ _ _ _ _ _ _ _ _ 6151P 81
14 M AROFAH P 17 116 12.63
Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ 51P 84
Sgt
15 M FADIL ZAINUL A L 16 118 11.49 Kurus _ _ _ _ _ _ _ _ _ _ _ _ _ 61P 82
16 M NGATOILAH RIDHO L 21 118 15.08 Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ 5152UD V 82
17 NAYLA NABILA P P 35 124 22.76 Obesitas _ _ _ _ _ _ _ _ _ V _ _ _ _ caries V 76
5161628
18 NOVAN ZIVEN L L 22 117 16.07 Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ 182P 83
19 RAVA EKA S P 18 117 13.15 Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ 81P 83
Sgt
20 TANDRA DERBALA A W P 15 116 11.15 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries V 84
 tjm Tajam
Rambut bibir Sdt mulut Gigi&mulut
BB TB penglihatan dengar
N se Status Gannguan
Nama (K (cm IMT mdh OM ad Rongga Tonsil
o ks Gizi keri Pec dr luk pec Mental
g) ) dicb N RJ RB N gnng mulut Gigi
ng ah h a ah
ut uan LB BB
1 BAYU TRI AS L 18 119 12.71 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries V 81
2 LESTI APRILIANI P 19 118 13.65 Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 82
3 M IQBAL M L 20 125 12.8 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ 8451UD 75
Sgt
4 ABDUL AZIS T L 17 119 12 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries V 81
Sgt
5 ANGGARA A L 15 115 11.34 Kurus _ _ _ _ _ _ _ _ _ _ _ _ _ baik 85
Sgt
6 BARUNA REZZA L 15 117 10.96 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 83
7 ESTY KHOLIFATUL P 15 110 12.4 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries V 90
8 MOSZHA PUTRI A P 20 124 13.01 Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ 82P 76
9 M SYAFARUDDIN A R L 20 116 14.86 Normal _ _ _ _ _ _ _ _ _ _ _ _ _ 61UD V 84
10 M SYAH REZA L 17 115 12.85 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 85
11 RAFLI IHTIAR R L 23 127 14.26 Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 73
12 RANGGI BAYU S L 22 121 15.03 Normal _ _ _ _ _ _ _ _ _ _ _ _ _ baik 79
Sgt
13 RENDI RAMADHAN L 14 107 12.23 Kurus _ _ _ _ _ _ _ _ _ V _ _ _ _ caries 93
14 ROUTUL AZIZAH P 16 116 11.89 Kurus _ _ _ _ _ _ _ _ _ _ _ _ _ 5171P V 84
15 SEPTO AJI L 200 0 _ _ _ _ _ _ _ _ _ _ _ _ _
16 SELOMITA K P 18 111 14.61 Normal _ _ _ _ _ _ _ _ _ _ _ _ _ 81P 89
17 VEBRY RESTU B L 19 116 14.12 Normal _ _ _ _ _ _ _ _ _ V _ _ _ _ 61P V 84
18 TYUDA TYAS P P 200 0 _ _ _ _ _ _ _ _ _ _ _ _ _
19 DIVAN NUR S L 18 113 14.1 Normal _ _ _ _ _ _ _ _ _ _ _ _ _ 51P V 87
20 FANNISA TASYA K P 22 119 15.54 Normal _ _ _ _ _ _ _ _ _ _ _ _ _ caries 81