Laporan Jiwa

KODE PUSKESMAS : 5271021202
PUSKESMAS : SELAPARANG
KECAMATAN : SELAPARANG
KABUPATEN / KOTA : KOTA MATARAM
PROPINSI : NUSA TENGGARA BARAT
BULAN : 09
TAHUN : 2017
KODE ICD- 0-7hr

No Urut Jenis Penyakit
10 Baru
L P
1 2 3 4 5
14 F20.0 Paranoid schizophrenia 0 0

0-7hr 8-28hr 29hr-1thn
Lama Baru Lama Baru Lama
L P L P L P L P L P
6 7 8 9 10 11 12 13 14 15
0 0 0 0 0 0 0 0 0 0
LAPO
1-4thn 5-9thn 10-14thn

Baru Lama Baru Lama Baru
L P L P L P L P L P
16 17 18 19 20 21 22 23 24 25
0 0 0 0 0 0 0 0 0 0
LAPORAN BULANAN DATA KESAKITAN
Jumlah Penderita
10-14thn 15-19thn 20-44thn
L P L P L P L P L P
26 27 28 29 30 31 32 33 34 35
0 0 0 0 0 0 0 1 0 0
45-54thn 55-59 60-64thn
L P L P L P L P L P
36 37 38 39 40 41 42 43 44 45
0 0 0 0 0 0 0 0 0 0
60-64thn 65-69thn >70thn
L P L P L P L P L P
46 47 48 49 50 51 52 53 54 55
0 0 0 0 0 0 0 0 0 0
JUMLAH
Baru Lama Total
L P L P L P
56 57 58 59 60 61
0 1 0 0 0 1
LAPORAN BULA

BULAN : 08
TAHUN : 2017
KODE ICD- 0-7hr 8-28hr 29hr-1thn 1-4thn

10 Baru Lama Baru Lama Baru Lama Baru
L P L P L P L P L P L P L P
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
30 F41.9 Anxiety disorder, unspecified 0 0 0 0 0 0 0 0 0 0 0 0 0 0

32 G40.8 Epilepsi lainnya 0 0 0 0 0 0 0 0 0 0 0 0 0 0
33 G40.9 Epilepsi, tidak spesifik 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Jumlah Penderita
1-4thn 5-9thn 10-14thn 15-19thn 20-44thn 45-54thn 55-59 60-64thn 65-69thn
Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P L P
18 19 20 21 22 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 51
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 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
>70thn JUMLAH
Baru Lama Baru Lama Total
L P L P L P L P L P
52 53 54 55 56 57 58 59 60 61
0 0 0 0 1 0 0 0 1 0
0 0 0 0 1 1 0 0 1 1
0 0 0 0 0 3 0 0 0 3
BULAN : 07
TAHUN : 2017
KODE ICD- 0-7hr 8-28hr

10 Baru Lama Baru Lama
L P L P L P L
1 2 3 4 5 6 7 8 9 10
40 F41.9 Anxiety disorder, unspecified 0 0 0 0 0 0 0

42 G40.8 Epilepsi lainnya 0 0 0 0 0 0 0
43 G40.9 Epilepsi, tidak spesifik 0 0 0 0 0 0 0
38 F20.0 Paranoid schizophrenia 0 0 0 0 0 0 0
Jumlah Penderita
8-28hr 29hr-1thn 1-4thn 5-9thn 10-14thn 15-19thn 20-44thn 45-54thn
Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama
P L P L P L P L P L P L P L P L P L P L P L P L P L P L P
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 0 4 8 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 47 0 0 0 0 0 0
55-59 60-64thn 65-69thn >70thn JUMLAH
Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Total
L P L P L P L P L P L P L P L P L P L P L P
40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 2 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2
4 7 0 0 1 5 0 0 3 1 0 0 3 3 0 0 17 26 0 0 17 26
0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 49 0 0 1 49
BULAN : 06
TAHUN : 2017
KODE ICD- 0-7hr

10 Baru
L P
1 2 3 4 5
22 G40.8 Epilepsi lainnya 0 0

L P L P L P L P L P
6 7 8 9 10 11 12 13 14 15
0 0 0 0 0 0 0 0 0 0
LAPO

L P L P L P L P L P
16 17 18 19 20 21 22 23 24 25
0 0 0 0 0 0 0 0 0 0
Jumlah Penderita
10-14thn 15-19thn 20-44thn
L P L P L P L P L P
26 27 28 29 30 31 32 33 34 35
0 0 0 0 0 0 0 0 0 0
45-54thn 55-59 60-64thn
L P L P L P L P L P
36 37 38 39 40 41 42 43 44 45
0 1 0 0 0 1 0 0 0 0
60-64thn 65-69thn >70thn
L P L P L P L P L P
46 47 48 49 50 51 52 53 54 55
0 0 0 0 0 0 2 0 0 0
JUMLAH
Baru Lama Total
L P L P L P
56 57 58 59 60 61
2 2 0 0 2 2
BULAN : 05
TAHUN : 2017
KODE ICD- 0-7hr

10 Baru
L P
1 2 3 4 5
27 F41.9 Anxiety disorder, unspecified 0 0

28 G40.9 Epilepsi, tidak spesifik 0 0
L P L P L P L P L P
6 7 8 9 10 11 12 13 14 15
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPO

L P L P L P L P L P
16 17 18 19 20 21 22 23 24 25
0 0 0 0 0 0 0 0 0 5
0 0 0 0 0 0 0 0 0 0
Jumlah Penderita
10-14thn 15-19thn 20-44thn
L P L P L P L P L P
26 27 28 29 30 31 32 33 34 35
0 0 0 15 0 0 0 24 0 0
0 0 0 0 0 0 0 0 0 0
45-54thn 55-59 60-64thn
L P L P L P L P L P
36 37 38 39 40 41 42 43 44 45
0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 0 0 0 0 0
60-64thn 65-69thn >70thn
L P L P L P L P L P
46 47 48 49 50 51 52 53 54 55
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 0 0
JUMLAH
Baru Lama Total
L P L P L P
56 57 58 59 60 61
0 44 0 0 0 44
1 1 0 0 1 1
BULAN : 04
TAHUN : 2017
KODE ICD- 0-7hr

10 Baru
L P
1 2 3 4 5

L P L P L P L P L P
6 7 8 9 10 11 12 13 14 15
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPO

L P L P L P L P L P
16 17 18 19 20 21 22 23 24 25
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Jumlah Penderita
10-14thn 15-19thn 20-44thn
L P L P L P L P L P
26 27 28 29 30 31 32 33 34 35
0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 0 0
45-54thn 55-59 60-64thn
L P L P L P L P L P
36 37 38 39 40 41 42 43 44 45
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
60-64thn 65-69thn >70thn
L P L P L P L P L P
46 47 48 49 50 51 52 53 54 55
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0
JUMLAH
Baru Lama Total
L P L P L P
56 57 58 59 60 61
0 1 0 0 0 1
1 0 0 0 1 0
BULAN : 03
TAHUN : 2017
KODE ICD- 0-7hr

10 Baru
L P
1 2 3 4 5
40 G40.8 Epilepsi lainnya 0 0

36 F20.9 Skizofrenia, tidak spesifik 0 0
L P L P L P L P L P
6 7 8 9 10 11 12 13 14 15
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPO

L P L P L P L P L P
16 17 18 19 20 21 22 23 24 25
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Jumlah Penderita
10-14thn 15-19thn 20-44thn
L P L P L P L P L P
26 27 28 29 30 31 32 33 34 35
0 0 0 0 0 0 4 4 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 0 0
45-54thn 55-59 60-64thn
L P L P L P L P L P
36 37 38 39 40 41 42 43 44 45
2 1 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
60-64thn 65-69thn >70thn
L P L P L P L P L P
46 47 48 49 50 51 52 53 54 55
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
JUMLAH
Baru Lama Total
L P L P L P
56 57 58 59 60 61
6 5 0 0 6 5
1 0 0 0 1 0
0 1 0 0 0 1
BULAN : 02
TAHUN : 2017
KODE ICD- 0-7hr

10 Baru
L P
1 2 3 4 5
32 F32.9 Depressive episode, unspecified 0 0

34 F48.9 Gangguan emosi (neurotik) lainnya 0 0
31 F20.0 Paranoid schizophrenia 0 0
35 F53.9 Puerperal mental disorder, unspecified 0 0
L P L P L P L P L P
6 7 8 9 10 11 12 13 14 15
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPO

L P L P L P L P L P
16 17 18 19 20 21 22 23 24 25
0 0 0 0 0 0 0 0 0 0
1 1 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
1 0 0 0 0 0 0 0 0 0
Jumlah Penderita
10-14thn 15-19thn 20-44thn
L P L P L P L P L P
26 27 28 29 30 31 32 33 34 35
0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 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
45-54thn 55-59 60-64thn
L P L P L P L P L P
36 37 38 39 40 41 42 43 44 45
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 1 0 0 1 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
60-64thn 65-69thn >70thn
L P L P L P L P L P
46 47 48 49 50 51 52 53 54 55
0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0
JUMLAH
Baru Lama Total
L P L P L P
56 57 58 59 60 61
1 0 0 0 1 0
1 1 0 0 1 1
3 2 0 0 3 2
0 1 0 0 0 1
1 0 0 0 1 0
BULAN : 01
TAHUN : 2017
KODE ICD- 0-7hr

10 Baru
L P
1 2 3 4 5

45 G40 Epilepsi 0 0
146 M10.08 Idiopathic gout, other sites 0 0
L P L P L P L P L P
6 7 8 9 10 11 12 13 14 15
0 0 0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
LAPO

L P L P L P L P L P
16 17 18 19 20 21 22 23 24 25
0 0 0 0 0 0 0 0 2 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Jumlah Penderita
10-14thn 15-19thn 20-44thn
L P L P L P L P L P
26 27 28 29 30 31 32 33 34 35
0 0 2 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0
45-54thn 55-59 60-64thn
L P L P L P L P L P
36 37 38 39 40 41 42 43 44 45
0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
60-64thn 65-69thn >70thn
L P L P L P L P L P
46 47 48 49 50 51 52 53 54 55
0 0 0 1 0 0 0 0 0 0
0 0 0 0 0 0 1 0 0 0
0 0 1 1 0 0 3 0 0 0
0 0 0 0 0 0 0 0 0 0
JUMLAH
Baru Lama Total
L P L P L P
56 57 58 59 60 61
5 1 0 0 5 1
2 0 0 0 2 0
7 1 0 0 7 1
1 0 0 0 1 0
DATA PASUNG PUSKESMAS SELAPARANG
BULAN : ___________
TAHUN : 2017
KASUS PASUNG UMUR PENATALAKSANAA
NO NAMA PASIEN ALAMAT
(THN) N
PENEMUAN PENANGANAN
N I H I L
1
Mataram,________________2017
Mengetahui : Koordinator Kesehatan Jiwa
Kepala Puskesmas Selaparang
= dr. Yulia Sari Risnawati = = Muhammad Tarmuzi =

NIP.198607262011012005 NIP.196912311992031151
LAPORAN BULANAN DATA PASIEN GANGGUAN JIWA BERDASARKAN DIAGNOSA
PUSKESMAS : Selaparang
BULAN :_____________
TAHUN : 2017
Jumlah Kasus dan Jumlah Kunjungan Kasus/Golongan U
KO 0 - 6 th 7 - 14 th 15 - 18 th 19 - 44 th 45 - 59 th 60 -
Jenis Penyakit
DE L P L P L P L P L P L
K K K K K
B L B L B L B L B L B L B L B L B L B L B
A Anak
Resiko Perilaku Kekerasan
Resiko Bunuh Diri
Ketidakberdayaan
B Dewasa
Harga Diri Rendah
Isolasi Sosial
Halusinasi
Waham
Resiko Perilaku Kekerasan
Resiko Bunuh Diri
Defisit Perawatan Diri
C LANSIA
Gangguan Proses Fikir : Pikun
Resiko Cidera : Jatuh
Ketidakberdayaan
Resiko Bunuh Diri
Gangguan Pola Fikir
Total
Jumlah/Bulan
Mengetahui :
= dr. Yulia Sari Risnawati =

NIP.198607262011012005
GNOSA KEPERAWATAN
olongan Umur
60 - 69 th 70 th > Total Jumlah
Kasus
L P L P L P
K K K Dirujuk
L B L B L B L B L B L
Mataram, ____________2017
Koordinator Kesehatan Jiwa
= Muhammad Tarmuzi =
NIP.196912311992031151
LAPORAN BULANAN DATA PASIEN GANGGUAN JIWA BERDASARKAN DIAG
PUSKESMAS : Selaparang
BULAN : ___________
TAHUN : 2017
Jumlah Kasus dan Jumlah Kunjungan Kasus/Golongan U

KO 0 - 6 th 7 - 14 th 15 - 18 th 19 - 44 th 45 - 59 th 60 -
Jenis Penyakit
DE L P L P L P L P L P L
K K K K K
B L B L B L B L B L B L B L B L B L B L B
1 Gangguan Mental Organik

2 Gangguan Penggunan NAPZA
Skizofrenia dan Gg. Psikotik

3
Kronik Lain
4 Gangguan Psikotik Akut

5 Gangguan Bipolar
6 Gangguan Defresi
7 Gangguan Neorotik
8 Retardasi Mental
Gangguan Kesehatan Jiwa
9
Anak dan Remaja
10 Epilepsi
Mengetahui :
= dr. Yulia Sari Risnawati =

NIP.198607262011012005
N DIAGNOSA MEDIK
olongan Umur
60 - 69 th 70 th > Total Jumlah
Kasus
L P L P L P
K K K Dirujuk
L B L B L B L B L B L
Mataram,___________2017
Koordinator Kesehatan Jiwa
= Muhammad Tarmuzi =
NIP.196912311992031151

Laporan Jiwa

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KODE PUSKESMAS : 5271021202

KODE ICD- 0-7hr

14 F20.0 Paranoid schizophrenia 0 0

1-4thn 5-9thn 10-14thn

KODE PUSKESMAS : 5271021202

KODE ICD- 0-7hr 8-28hr 29hr-1thn 1-4thn

30 F41.9 Anxiety disorder, unspecified 0 0 0 0 0 0 0 0 0 0 0 0 0 0

KODE ICD- 0-7hr 8-28hr

40 F41.9 Anxiety disorder, unspecified 0 0 0 0 0 0 0

KODE ICD- 0-7hr

22 G40.8 Epilepsi lainnya 0 0

1-4thn 5-9thn 10-14thn

KODE ICD- 0-7hr

27 F41.9 Anxiety disorder, unspecified 0 0

1-4thn 5-9thn 10-14thn

KODE ICD- 0-7hr

35 F41.9 Anxiety disorder, unspecified 0 0

1-4thn 5-9thn 10-14thn

KODE ICD- 0-7hr

40 G40.8 Epilepsi lainnya 0 0

1-4thn 5-9thn 10-14thn

KODE ICD- 0-7hr

32 F32.9 Depressive episode, unspecified 0 0

1-4thn 5-9thn 10-14thn

KODE ICD- 0-7hr

43 F41.9 Anxiety disorder, unspecified 0 0

1-4thn 5-9thn 10-14thn

= dr. Yulia Sari Risnawati = = Muhammad Tarmuzi =

= dr. Yulia Sari Risnawati =

Jumlah Kasus dan Jumlah Kunjungan Kasus/Golongan U

1 Gangguan Mental Organik

Skizofrenia dan Gg. Psikotik

4 Gangguan Psikotik Akut

= dr. Yulia Sari Risnawati =

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