LAPORAN F III GIZI

DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULAN JANUARI 2022

JML
POSY S=K
KADER
NO DUSUN 0-6 BL JML 6-11 BL JML 12-23 BL JML 2-3 TH JML 3-5 TH

AKTIF

AKTIF
ADA

ADA
0-5 6-11 12- 2-3
L P BL L P BL L P 23BL L P TH L P

1 SENGON 1 1 5 5 1 0 1 1 0 1 2 0 2 1 2 3 5 4
2 PAGERSARI 1 1 5 5 1 1 2 1 2 3 0 0 0 4 1 5 2 3
3 JALAKAN 1 1 5 5 0 3 3 2 0 2 8 3 11 2 4 6 11 5
4 PLUMBON 1 1 5 5 2 0 2 0 5 5 3 2 5 3 1 4 6 1
5 PUNDUNG 1 1 5 5 2 1 3 1 0 1 3 1 4 6 1 7 1 3
6 SOBO 1 1 5 5 0 2 2 4 1 5 6 2 8 4 5 9 16 5
7 JAJAR 1 1 5 5 2 0 2 1 0 1 3 5 8 1 2 3 5 3
8 BEJI 1 1 5 5 2 4 6 3 1 4 1 2 3 1 4 5 3 4
9 WATUGEDE 1 1 5 5 2 2 4 0 2 2 3 8 11 1 2 3 6 5
10 SEDENG 1 1 5 5 2 2 4 0 2 2 3 1 4 2 1 3 6 1
11 WATULIMO 1 1 5 5 1 0 1 1 0 1 1 0 1 0 2 2 2 1
15
TOTAL 11 11 55 55 15 15 30 14 13 27 33 24 57 25 25 50 63 35

Bidan Desa

SRI SULASTRI, A.Md.

NIP. 19850112 201704
 JML S = K
0-5 TH JML
JML S= K
3-5
TH L P

9 10 6 16
5 8 7 15
16 23 15 38
7 14 9 23
4 13 6 19
21 30 15 45
8 12 10 22
7 10 15 25
11 12 19 31
7 13 7 20
3 5 3 8

98 150 112 262

Desa

I, A.Md. Keb
201704 2 002
 LAPORAN F III GIZI
DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULAN JANUARI 2022

D JML D 0-5 N
0-6 BL JML 6-11 BL JML 12-23 BL JML 2-3 TH JML 3-5 TH JML TH JML 0-6 BL JML 6-11 BL JML 12-23 BL JML 2-3 TH JML
NO DUSUN
0-5 6-11 12- 2-3 3-5 D 0-5 6-11 12- 2-3
L P BL L P BL L P 23BL L P TH L P TH L P L P BL L P BL L P 23BL L P TH
1 SENGON 1 0 1 1 0 1 0 0 0 1 2 3 4 3 7 7 5 12 1 0 1 1 0 1 0 0 0 1 1 2
2 PAGERSARI 1 1 2 1 2 3 0 0 0 4 1 5 2 2 4 8 6 14 1 1 2 0 2 2 0 0 0 2 0 2
3 JALAKAN 0 0 0 1 0 1 6 2 8 2 3 5 9 5 14 18 10 28 0 0 0 1 0 1 3 2 5 1 1 2
4 PLUMBON 2 0 2 0 2 2 2 2 4 1 1 2 4 1 5 9 6 15 2 0 2 0 1 1 0 1 1 1 1 2
5 PUNDUNG 2 1 3 1 0 1 2 1 3 5 1 6 1 2 3 11 5 16 0 0 0 1 0 1 1 1 2 1 0 1
6 SOBO 0 2 2 4 1 5 5 1 6 4 5 9 16 5 21 29 14 43 0 0 0 4 1 5 1 0 1 3 2 5
7 JAJAR 2 0 2 1 0 1 3 5 8 1 2 3 5 3 8 12 10 22 2 0 2 1 0 1 1 3 4 0 0 0
8 BEJI 2 4 6 3 1 4 1 2 3 1 4 5 3 4 7 10 15 25 2 4 6 2 1 3 1 2 3 1 3 4
9 WATUGEDE 1 2 3 0 2 2 3 8 11 1 1 2 6 4 10 11 17 28 1 2 3 0 2 2 3 6 9 0 1 1
10 SEDENG 2 2 4 0 2 2 3 1 4 2 0 2 6 0 6 13 5 18 2 2 4 0 2 2 3 1 4 2 0 2
11 WATULIMO 1 0 1 1 0 1 1 0 1 0 2 2 2 1 3 5 3 8 1 0 1 1 0 1 1 0 1 0 1 1

TOTAL 14 12 26 13 10 23 26 22 48 22 22 44 58 30 88 133 96 229 12 9 21 11 9 20 14 16 30 12 10 22

Bidan Desa

SRI SULASTRI, A.
NIP. 19850112 2017
 JML N 0-5
3-5 TH JML TH JML
3-5 N
L P TH L P

3 2 5 6 3 9
1 2 3 4 5 9
5 0 5 10 3 13
3 0 3 6 3 9
0 0 0 3 1 4
6 4 10 14 7 21
2 0 2 6 3 9
3 4 7 9 14 23
4 4 8 8 15 23
6 0 6 13 5 18
2 1 3 5 2 7

35 17 52 84 61 145

Bidan Desa

LASTRI, A.Md. Keb

850112 201704 2 002
 LAPORAN F III GIZI
DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULANJANUARI 2022

JML T JML 2T JML R JML BGM IBU HAMIL

JML O JML B1 JML B6

BBLR
0-5 TH JML 0-5 TH JML 0-5 TH JML 0-5 TH JML JML JML JML DPT Fe /IOD
NO DUSUN
T 2T R BGM O B1 B6 RIIL KEK
L P L P L P L P L P L P L P 30 90 IOD

1 SENGON 3 1 4 0 0 0 0 0 0 0 0 0 2 2 4 0 0 0 0 0 0 0 1 0 0 0
2 PAGERSARI 5 0 5 1 0 1 1 1 2 0 0 0 0 0 0 0 0 0 0 0 0 1 4 1 0 0
3 JALAKAN 4 4 8 0 0 0 1 1 2 0 0 0 0 0 0 0 1 1 0 0 0 0 4 1 1 0
4 PLUMBON 4 4 8 0 0 0 0 0 0 0 0 0 2 0 2 0 0 0 0 0 0 0 3 0 0 0
5 PUNDUNG 9 3 12 2 0 2 1 0 1 0 0 0 2 0 2 0 0 0 0 0 0 0 3 0 0 0
6 SOBO 12 7 19 4 3 7 2 1 3 0 0 0 0 0 5 1 0 0
7 JAJAR 7 5 12 3 1 4 1 2 3 0 0 1 1 0 0 0 0 0 1 0 0 0
8 BEJI 3 4 7 1 0 1 1 2 3 1 1 1 0 1 0 1 1 0 0 2 0 0 0
9 WATUGEDE 4 4 8 0 1 1 1 1 0 0 0 0 4 1 1 1
10 SEDENG 0 0 0 0 0 0 0 0 2 0 1 0
11 WATULIMO 1 1 0 0 0 0 0 0 0 1 0 1 0

1
TOTAL 51 33 84 11 4 15 7 8 15 2 0 2 1 0 1 0 2 2 0 0 0 1 30 4 4 1

Wonogiri, ................................
Mengetahui,
Kepala UPTD Puskesmas Tirtomoyo II Bidan Desa

dr. Alba Shibghatulloh Azizi SRI SULASTRI, A.Md. Ke

NIP. 19890102 201502 1 002 NIP. 19850112 201704 2 0

LAPORAN F III GIZI

DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULAN PEBRUARI 2022
 JML T JML 2T JML R JML BGM IBU HAMIL
JML O JML B1 JML B6

BBLR
0-5 TH JML 0-5 TH JML 0-5 TH JML 0-5 TH JML JML JML JML DPT Fe /IOD
NO DUSUN
T 2T R BGM O B1 B6 RIIL KEK
L P L P L P L P L P L P L P 30 90 IOD
1 SENGON 1 2 3 0 0 0 0 0 0 0 0 0 2 1 3 0 0 0 0 0 0 0 1 0 1 0
2 PAGERSARI 3 2 5 0 0 0 2 1 3 0 0 0 0 0 0 1 0 1 0 0 0 0 4 0 1 0
3 JALAKAN 5 3 8 1 3 4 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 1 1
4 PLUMBON 2 0 2 0 0 0 0 0 0 0 0 0 2 2 4 0 0 0 0 0 0 0 3 0 1 0
5 PUNDUNG 1 3 4 4 2 6 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0
6 SOBO 14 6 20 5 1 6 0 0 0 2 2 4 1 1 2 2 0 0 5 0 0 0
7 JAJAR 2 2 4 1 1 0 2 2 0 0 0 0 0 0 0 0 1 0 1 0
8 BEJI 0 2 2 2 0 2 0 2 2 1 1 1 0 1 0 1 1 0 0 2 1 1 0
9 WATUGEDE 4 7 11 0 1 1 2 1 1 0 0 0 0 3 0 0 0
10 SEDENG 0 0 0 0 0 0 0 0 0 0 3 0 0 1
11 WATULIMO 0 0 0 0 0 0 0 0 0 0 1 0 0 0

0
TOTAL 32 27 59 12 7 19 4 7 11 3 3 6 1 0 1 1 3 4 0 0 0 0 31 1 6 2

Wonogiri, ................................
Mengetahui,
Kepala UPTD Puskesmas Tirtomoyo II Bidan Desa

dr. Alba Shibghatulloh Azizi SRI SULASTRI, A.Md. Ke

NIP. 19890102 201502 1 002 NIP. 19850112 201704 2 0
 IBU NIFAS
DAPAT Fe /IOD
RIIL Vit. Vit.A
Fe Iod
A1 2
0 0 0 0
1 1 1 1
1 1 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
1 1 1 1
0 0 0 0

3 3 3 3

...................

Md. Keb
04 2 002
 IBU NIFAS
DAPAT Fe /IOD
RIIL Vit. Vit.A
Fe Iod
A1 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
1 1 1 1
0 0 0 0
0 0 0 0
1 1 1 1

...................

Md. Keb
04 2 002
 LAPORAN ASI EKSKLUSIF
DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULAN JANUARI 2022

ASI EKSKLUSIF
SASARAN
NO DUSUN E1 E2 E3 E4 E5 E6
L P L P L P L P L P L P L
1 SENGON 1 0
2 PAGERSARI 1 1 1
3 JALAKAN 0 3 2 2
4 PLUMBON 2 0
5 PUNDUNG 2 1 2 1
6 SOBO 0 2 1
7 JAJAR 2 0
8 BEJI 2 4 1 1 1 1 1 1 1 1
9 WATUGEDE 2 2
10 SEDENG 2 2
11 WATULIMO 1 0

TOTAL 15 15 3 4 2 1 0 1 0 2 1 1 2

Wonogiri, .................................
Mengetahui,
Kepala UPTD Puskesmas Tirtomoyo II Bidan Desa

dr. Alba Shibghatulloh Azizi SRI SULASTRI, A.Md. Ke

NIP. 19890102 201502 1 002 NIP. 19850112 201704 2 00
 JUMLAH ASI
E6 EKSKLUSIF
P L P
0 0

1 0

2 2

0 0

2 1

0 1

0 0

3 5

0 0

0 0

0
0 0
0

0 8 9

..........................................

Bidan Desa

ULASTRI, A.Md. Keb

9850112 201704 2 002
 LAPORAN BALITA GIZBUR/GIZKUR/STUNTING
DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULANJANUARI 2022

TGL. UMUR BB TB STATUS GIZI BPJS

NO NAMA BALITA L/P TGL.LAHIR NAMA ORTU ALAMAT
TIMBANG (bln) (kg) (cm)
BB/U TB/U BB/TB YA

1 Dias Saputra L 7/28/2017 siti-didik Sobo 1/14/2022 13 92

2 Aska rahmat Febian L 2/7/2018 Sutini-Parno Sobo 1/14/2022 12.5 91

3 Virly Nirmala Cahya F P 7/28/2022 Narni-Tardi Sobo 1/14/2022 7.5 76

4 Untsa Qonitatut dinni P 1/26/2019 Sri waningsih-Rohmat Jajar 1/21/2022 9.5 85

5 Alifa Naufalyn P 3/21/2020 Sarni-Ristanto Jajar 1/21/2022 8.1 74

6 Rifqil Mustofa L 1/26/2018 Sularsih-Agus Beji 1/16/2022 11.3 92

7 Adila Salma P 12/11/2018 Dwi Lestari-Sulardi Beji 1/16/2022 10.5 89

8 Humaira Alfatunisa P 12/29/2017 Yuli Ernasari-Romi A Jalakan 1/18/2022 12.1 91

 LAPORAN BALITA GIZBUR/GIZKUR/STUNTING
DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULAN PEBRUARI 2022

TGL. UMUR BB TB STATUS GIZI BPJS

NO NAMA BALITA L/P TGL.LAHIR NAMA ORTU ALAMAT
TIMBANG (bln) (kg) (cm) BB/U TB/U BB/TB YA
1 Dias Saputra L 7/28/2017 siti-didik Sobo 2/14/2022 13 92
2 Aska rahmat Febian L 2/7/2018 Sutini-Parno Sobo 2/14/2022 12.5 91
3 Virly Nirmala Cahya F P 7/28/2022 Narni-Tardi Sobo 2/14/2022 7.7 76
4 Aqila Aska Aulia p 1/4/2019 Hartini-Kasno Sobo 2/14/2022 10.5 86
5 Untsa Qonitatut dinni P 1/26/2019 Sri waningsih-Rohmat Jajar 2/21/2022 10 85
6 Alifa Naufalyn P 3/21/2020 Sarni-Ristanto Jajar 2/21/2022 8.1 74
7 Rifqil Mustofa L 1/26/2018 Sularsih-Agus Beji 2/16/2022 11.3 92
8 Elvina Clarissa Geraldine P 11/25/2020 Sri Sunarsih-Alvian Beji 2/16/2022 7.5 66
9 Adila Salma P 12/11/2018 Dwi Lestari-Sulardi Beji 2/16/2022 10.3 89
10 Humaira Alfatunisa P 12/29/2017 Yuli Ernasari-Romi A Jalakan 2/18/2022 50 12.1 91
11 Sela Vania Pratiwi p 9/21/2018 Riski-Tukat Watugede 2/15/2022 10.2 91
12 Yasna Syauqiya P 8/11/2020 Sri Lestari-Ristiyanto Watugede 2/15/2022 8 82
13 M Rafa Alfarisi L 7/13/2020 Suratin-Suyanto Watugede 2/15/2022 7 86
14 Tri Angga Agustino L 7/31/2019 Jumiasih-Maryoto Pundung 2/15/2022 10.4 86
15 Rafka Arsya Fatan L 11/6/2021 Sri Utami-Jono Pagersari 2/19/2022 4.9 53
16 Arumi Raiszeya M p 10/31/2021 Watik Ambarsari-Aris Pagersari 2/19/2022 4.6 54
17 Alvian Akbar Pratama L 9/18/2019 Nurrofik-Puguh Pagersari 2/19/2022 10 77

LAPORAN BALITA GIZBUR/GIZKUR/STUNTING

DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II
BULAN MARET 2022

TGL. UMUR BB TB STATUS GIZI BPJS

NO NAMA BALITA L/P TGL.LAHIR NAMA ORTU ALAMAT
TIMBANG (bln) (kg) (cm) BB/U TB/U BB/TB YA
1 Dias Saputra L 7/28/2017 siti-didik Sobo 3/14/2022 12.9 92
2 Aska rahmat Febian L 2/7/2018 Sutini-Parno Sobo 3/14/2022 12.5 91
4 Aqila Aska Aulia p 1/4/2019 Hartini-Kasno Sobo 3/14/2022 11 86
5 Untsa Qonitatut dinni P 1/26/2019 Sri waningsih-Rohmat Jajar 3/21/2022 10 85
6 Muhammad Hanif Attaqi L 8/17/2018 Nila Rinjani-Sukarno Jajar 3/21/2022 12 92
 7 Alifa Naufalyn P 3/21/2020 Sarni-Ristanto Jajar 3/21/2022 8.1 74
8 Rifqil Mustofa L 1/26/2018 Sularsih-Agus Beji 3/16/2022 11 92
9 Elvina Clarissa Geraldine P 11/25/2020 Sri Sunarsih-Alvian Beji 3/16/2022 7.7 66
10 Abid Dzaka Pranaja L 2/22/2021 Nurul-Saryanto Beji 3/16/2022 7.4 71
11 Adila Salma P 12/11/2018 Dwi Lestari-Sulardi Beji 3/16/2022 10.3 89
12 Asna farhan Mubarok L 3/10/2018 Yatmi-Sugito JAlakan 3/18/2022 12.8 90
12 Humaira Alfatunisa P 12/29/2017 Yuli Ernasari-Romi A Jalakan 3/18/2022 50 12.1 92
13 Sela Vania Pratiwi p 9/21/2018 Riski-Tukat Watugede 3/15/2022 10.3 93
14 M Rafa Alfarisi L 7/13/2020 Suratin-Suyanto Watugede 3/15/2022 7.3 86
15 Tri Angga Agustino L 7/31/2019 Jumiasih-Maryoto Pundung 3/15/2022 10.4 86
16 Arumi Raiszeya M p 10/31/2021 Watik Ambarsari-Aris Pagersari 3/19/2022 5.1 54
17 Alvian Akbar Pratama L 9/18/2019 Nurrofik-Puguh Pagersari 3/19/2022 10 77
BPJS PENYAKIT
PENYERTA
TIDAK
BPJS PENYAKIT
TIDAK PENYERTA

BPJS PENYAKIT
TIDAK PENYERTA
 LAPORAN VITAMIN A
DESA HARGOSARI
UPTD PUSKESMAS TIRTOMOYO II

BULAN FEBRUARI 2022

PENDATAAN HASIL DISTRIBUSI
NO DUSUN 6-11 bln 1-5 th 6-11 bln 1-5 th KET
L P L P L P L P
1 SENGON 1 9 5 1 9 5
2 PAGERSARI 1 2 6 3 1 2 6 3
3 JALAKAN 2 20 11 2 20 11
4 PLUMBON 1 4 12 5 1 4 12 5
5 PUNDUNG 1 10 5 1 10 5
6 SOBO 4 1 26 12 4 1 26 12
7 JAJAR 1 9 10 1 9 10
8 BEJI 2 2 8 9 2 2 8 9
9 WATUGEDE 1 10 15 1 10 15
10 SEDENG 2 11 2 2 11 2
11 WATULIMO 2 3 3 2 3 3
TOTAL 15 12 124 80 15 12 124 80

BULAN AGUSTUS
PENDATAAN HASIL DISTRIBUSI
NO DUSUN 6-11 bln 1-5 th 6-11 bln 1-5 th KET
L P L P L P L P
1 SENGON
2 PAGERSARI
3 JALAKAN
4 PLUMBON
5 PUNDUNG
6 SOBO
7 JAJAR
8 BEJI
9 WATUGEDE
10 SEDENG
11 WATULIMO
TOTAL 0 0 0 0 0 0 0 0
 DATA IBU HAMIL KEK
UPTD PUSKESMAS TIRTOMOYO II

UMUR UK LILA
NO BULAN NAMA IBU NAMA SUAMI ALAMAT GRAVIDA Hb
(TH) (MINGGU) (cm)

1 Januari Rika Ristiana 23 Lukman Watugede G2P0A1 21

2 Leonita 20 Januari Sobo G2P0A1 21.5

3 Istiyar Isnawati 23 Agus Jalakan G1P0A0 22

Pebruari

1 Nurhidayah 17 Widodo Beji G1P0A0 12 22.5

Maret NIHIL
BPJS
KET
(Y/T)

y
 DATA PASIEN GONDOK
UPTD PUSKESMAS TIRTOMOYO II

GRADE
NO BULAN NAMA NIK UMUR ALAMAT
0 I II
 BPJS
KET
(YA/TIDAK)