Download as xlsx, pdf, or txt
Download as xlsx, pdf, or txt
You are on page 1of 10

FORMULIR 3.

B REKAPITULASI HASIL PEMANTAUAN 3 (TIGA) BULANAN BAGI ANA

KUARTAL KE 1…. BULAN …januri………. S/D BULAN …maret……….

Umur dan Status Gizi

Jenis Kelamin (L/P)


Indikator Layanan

Pemberian Imunisasi

Konseling Gizi Bagi


Pengukuran Tinggi

Kunjungan Rumah
Pengukuran Berat
No NO NIK Nama Anak

Orang Tua
Badan

Badan
Dasar
Umur (Buruk/Kurang/S
(Bulan) tunting)

a b c f e h i j k1 (L) k2 (P) l

1 3504092106180001 Hafizan L 21 N v v x X v X
2 3504095703190001 Naura P 12 N v v x X v X
3 3504092307180001 Fathulloh L 20 N v v x X v X
4 3515060410190001 Alfatih L 5 N x v x X v X
5 350409604190001 Arkhatama L 11 N v v x X v X
6 3504094108180001 Indah P 19 N v v x X v X
7 3504096205190001 Devira P 10 N X V X X V X
8 3504090306190001 Arfan L 8 N X V X X V X
9 3504096901180001 Dhafin L 25 N V V X X V X
10 3504090805190002 Adyasta L 10 N v V X X V X
11 3504096405190001 Meisila P 10 N v V X X V X
12 3504091009190001 Devan L 6 N X V X X V X
13 350409060318004 Gibran L 12 S V V X X V X
14 3504095507180002 Azkayra L 20 N V V X X V X
15 3504090505180001 Aditiya L 22 N V V X X V X
16 3504094711180003 Rubi P 16 N V V X X V X
17 3504096008180002 Arsila P 6 N X V X X V X
18 3504091102180001 Arkana L 24 N V V X X V X
19 Almira P 14 N V V X X V X
20 3504092704180001 Aska Nur L 23 N V V X X V X
21 3504091909180001 Bristo L 16 N V V X X V X
22 Rafan L 7 N X V X X V X
23 3504090106180001 Haidar L 21 N V V X X V X
24 3504092504180001 Ismail L 23 N V V X X V X
25 Arun L 22 N V V X X V X
26 Dafi L 4 N X V X X V X
27 3504095309190001 Arsila P 19 N V V X X V X
28 3504171805180001 Rifki L 22 N V V X X V X
29 3504092806180005 m.yusuf L 21 N V V X X V X
30 3504092306180003 Gohan L 22 N V V X X V X
31 Naya P 21 N V V X X V X
32 3504092509180002 Ilham L 18 N V V X X V X
33 3504096309180001 Yasmin P 18 N V V X X V X
34 Naufalin P 18 N V V X X V X
35 Safira P 17 N V V X X V X
36 3504091102190005 Nahirul L 13 N V V X X V X
37 3504091303190004 Rafasya L 12 N V V X X V X
38 Almira P 12 N V V X X V X
39 3504091803190001 Gesit L 12 N V V X X V X
40 3504096604190003 Zahra P 11 N v V X X V X
41 3504092505190002 Zafar L 10 N v V X X V X
42 3504182906190001 Ismail L 9 N X V X X V X
43 Zaidan L 5 N X V X X V X
44 3504091811190003 Novian L 3 N X V X X V X
45 Refan L 2 N X V X X V X
46 Natusha p 3 N X V X X V X
Jumlah Diterima 34 46 46 46 46 46
Tingkat Capaian Konvergensi Jumlah Seharusnya 46 46 46 46 46 46
% 74% 100% 100% 100% 100% 100%
A) BULANAN BAGI ANAK 0-2 TAHUN

D BULAN …maret……….

kator Layanan
Kepemilikan Akses Air
Bersih

v
v
v
v
v
v
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
V
46
46
100%
NAN BAGI ANAK 0-2 TAHUN

…maret……….
Tingkat Konvergensi Indikator
anan
Kepemilikan Jamban

Pengasuhan (PAUD)
Jaminan Kesehatan

Jumlah Seharusnya
jumlah diterima
Akta Lahir
Sehat

n o p q q r
v v x x 6 11 55%
v v x x 6 11 55%
v v x x 6 11 55%
v v x x 5 11 45%
v v x x 6 11 55%
v v x x 6 11 55%
V V x X 5 11 45%
V V x X 5 11 45%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 5 11 45%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 5 11 45%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 5 11 45%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 5 11 45%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 6 11 55%
V V x X 5 11 45%
V V x X 5 11 45%
V V x X 5 11 45%
V V X X 5 11 45%
V V X X 5 11 45%
46 46 46 46
46 46 46 46
100% 100% 100% 100%

You might also like