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  • Posyandu Melati 1 Mandalasari

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    Novi Ariyanto
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    The document is a form for recording immunization data from the National Child Immunization Program at the community health center level. It includes tables to record the number of children vaccinated and vaccination coverage rates for routine childhood vaccines including OPV, IPV, DPT-HB-Hib, measles, rubella and campak rubella, broken down by age groups. The form also includes spaces to record the name of the village/sub-district, health center, date, and officer name. The overall purpose is to summarize immunization coverage results at the community health center level on a monthly basis.

    Original Description:

    PERSIAPAN MENJADI ORANG TUA

    Original Title

    POSYANDU MELATI 1 MANDALASARI

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    The document is a form for recording immunization data from the National Child Immunization Program at the community health center level. It includes tables to record the number of children vaccinated and vaccination coverage rates for routine childhood vaccines including OPV, IPV, DPT-HB-Hib, measles, rubella and campak rubella, broken down by age groups. The form also includes spaces to record the name of the village/sub-district, health center, date, and officer name. The overall purpose is to summarize immunization coverage results at the community health center level on a monthly basis.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    6 views13 pages

    Posyandu Melati 1 Mandalasari

    Uploaded by

    Novi Ariyanto
    The document is a form for recording immunization data from the National Child Immunization Program at the community health center level. It includes tables to record the number of children vaccinated and vaccination coverage rates for routine childhood vaccines including OPV, IPV, DPT-HB-Hib, measles, rubella and campak rubella, broken down by age groups. The form also includes spaces to record the name of the village/sub-district, health center, date, and officer name. The overall purpose is to summarize immunization coverage results at the community health center level on a monthly basis.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 13

    FORMAT REKAPITULASI HASIL PELAYANAN BULAN IMUNISASI ANAK NASIONAL TINGKAT PUSKESMAS

    Desa/kelurahan : Tanggal :
    Puskesmas : Nama petugas :
    Isilah pada kolom yang berwarna

    Sasaran dan Cakupan Imunisasi Kejar Sasaran dan cakupan imunisasi campak rubela
    Usia 12 -<15 thn
    Usia 12 - 59 bulan Usia 9-59 bulan Usia 5 - <7 thn Usia 7-<12 thn
    Posyandu/Pos (bagi 5 Prov.) Total Total
    No layanan BIAN OPV IPV DPT-HB-Hib Campak Rubella Campak Rubela Campak Rubela Campak Rubela Sasaran dimunisasi Total
    lainnya Campak Campak Cakupan
    Jumlah Jumlah Jumlah Jumlah Jumlah
    Jumlah diimuni Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah
    % % % % % % % Rubella Rubella
    sasaran diimunisasi sasaran diimunisasi sasaran sasaran diimunisasi sasaran diimunisasi sasaran diimunisasi sasaran diimunisasi
    sasi
    a b c d e f g h i j k l m n o p q r s t u v w x y z
    200 50 25.0% 100 50 50.0% 100 50 50.0% 100 50 50.0% 100 80 80.0% 100 25 25.0% 100 50 50.0% 400 205 51.3%
    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% 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% 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% 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% 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 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%
    Total 200 50 25.0% 100 50 50.0% 100 50 50.0% 100 50 50.0% 100 80 80.0% 100 25 25.0% 100 50 50.0% 400 205 51.3%
    FORMAT PENCATATAN HASIL PELAYANAN
    Posyandu/Pos ayanan BIAN lainnya : POSYANDU MELATI 2 Nama petugas :
    Desa/kelurahan MANDALASARI Puskesmas : Mataram Baru
    Tanggal Kabupaten : Mataram Baru

    Imunisasi Kejar
    (Ya = 1, Tidak=0)
    Ket** (bila anak mendapatkan
    Campak dosis kedua/keetiga/keempat
    No. Nama Anak NIK ANAK Tgl lahir Umur Jenis Kelamin Nama orang tua Alamat No.Hp NIK IBU Rubela OPV/Penta saat BIAN, maka
    (L/P) (Ya=1, tetap dicatat namun tidak
    Tidak=0) dimasukkan sebagai cakupan
    OPV IPV DPT-HB-Hib BIAN)

    a b c d e f g h i j k l m n o

    1 1
    AHMAD GANJAR ASMORO1807161912160001 12/19/2016 L ERLIN UNGGUL MIRANTMANDALASARI 087747437346 1807027105970002
    2 1
    MUHAMMAD NADHIF FARI1807162008200001 8/20/2020 L ETI ROHAYATI MANDALASARI 082386545992 1807164109950001
    3 1
    AL FATIH AZKA SETIAWAN 1807163004180001 4/30/2018 L SUPRIHATIN MANDALASARI 082186010283 1807166006940002
    4 1
    BAGUS SETIAWAN 1807162409180001 9/24/2018 L GIARTI MANDALASARI 08287413171 1807162102950001
    5 1
    MUHAMAD RIDWAN 1807160111190001 11/1/2019 L FINA DEKASARI MANDALASARI 082282715897 1807025312900002
    6 1
    DHEA SEPTIANA PUTRI 1807025609160001 9/16/2016 P WAHYUNI MANDALASARI 087748685616 1807025009940006
    7 1
    IQBAL NOVRIANTO 1807162502180001 2/25/2018 L WAHYUNI MANDALASARI 087748685616 1807025009940006
    8 1
    AZHAM MAULANA SAPUTR1807161707180002 7/17/2018 L RATIPAH MANDALASARI 085268911197 1807164607850001
    9 1
    NAURA DELISA 1/14/2021 P SOLEHA MANDALASARI 085279221753 1807166910850001
    10 1
    GALIH PRAMANA 1807021403140003 3/14/2014 L KASMINI MANDALASARI 085692265419 2104014512750002
    11 1
    LUNA JULITA 1807164807170001 7/8/2017 P SARWATI MANDALASARI 085783745068 1807164511920002
    12 1
    HAFIZHAN RAFFA KHOIRI 1807160711190001 11/7/2019 L LASMINI MANDALASARI 087899764357 1807166402910001
    13 1
    ZAHRA 1/20/2021 P PAINI MANDALASARI 087768305747
    14 1
    ADNAN DZIKRI IRAWAN 1807161503200001 3/15/2020 L YULIANA MANDALASARI 085768714668 1807164407970004
    15 1

    16 1

    17 1

    18 1
    19 1

    20 1

    21 1

    22 1

    23 1

    24

    25

    26

    27

    28

    29

    30

    31

    32

    33

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    81
    82

    Jumlah vaksin (vial) dan logistik yang digunakan


    Jenis logistik OPV IPV DPT-HB-HIB CAMPAK RUBELA Pelarut Campak Dropper ADS 0,5 ML ADS 5 ML Safety Box Pen Marker
    Rubela

    Jumlah
    FORMAT REKAPITULASI HASIL PELAYANAN BULAN IMUNISASI ANAK NASIONAL TINGKAT KABUPATEN/KOTA
    Kabupaten : Tanggal :
    Provinsi : Nama petugas :
    Isilah pada kolom yang berwarna

    Sasaran dan Cakupan Imunisasi Kejar Sasaran dan cakupan imunisasi campak rubela
    Usia 12 -<15 thn
    Usia 12 - 59 bulan Usia 9-59 bulan Usia 5 - <7 thn Usia 7-<12 thn
    (bagi 5 Prov.) Total Total
    No Puskesmas OPV IPV DPT-HB-Hib Campak Rubella Campak Rubela Campak Rubela Campak Rubela Sasaran dimunisasi Total
    Jumlah Campak Campak Cakupan
    Jumlah Jumlah Jumlah Jumlah Jumlah diimuni Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Rubella Rubella
    sasaran diimunisasi % sasaran diimunisasi % sasaran % sasaran diimunisasi % sasaran diimunisasi % sasaran diimunisasi % sasaran diimunisasi %
    sasi
    a b c d e f g h i j k l m n o p q r s t u v w x y z
    200 50 25.0% 100 50 50.0% 100 50 50.0% 100 50 50.0% 100 80 80.0% 100 25 25.0% 100 50 50.0% 400 205 51.3%
    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% 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% 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% 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% 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 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%
    Total 200 50 25.0% 100 50 50.0% 100 50 50.0% 100 50 50.0% 100 80 80.0% 100 25 25.0% 100 50 50.0% 400 205 51.3%
    FORMAT REKAPITULASI HASIL PELAYANAN BULAN IMUNISASI ANAK NASIONAL TINGKAT PROVINSI
    Provinsi : Tanggal :
    Nama petugas :
    Isilah pada kolom yang berwarna

    Sasaran dan Cakupan Imunisasi Kejar Sasaran dan cakupan imunisasi campak rubela
    Usia 12 -<15 thn
    Usia 12 - 59 bulan Usia 9-59 bulan Usia 5 - <7 thn Usia 7-<12 thn
    (bagi 5 Prov.) Total Total
    No Kabupaten/Kota OPV IPV DPT-HB-Hib Campak Rubella Campak Rubela Campak Rubela Campak Rubela Sasaran dimunisasi Total
    Jumlah Campak Campak Cakupan
    Jumlah Jumlah Jumlah Jumlah Jumlah diimuni Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Jumlah Rubella Rubella
    sasaran diimunisasi % sasaran diimunisasi % sasaran % sasaran diimunisasi % sasaran diimunisasi % sasaran diimunisasi % sasaran diimunisasi %
    sasi
    a b c d e f g h i j k l m n o p q r s t u v w x y z
    200 50 25.0% 100 50 50.0% 100 50 50.0% 100 50 50.0% 100 80 80.0% 100 25 25.0% 100 50 50.0% 400 205 51.3%
    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% 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% 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% 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% 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 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%
    Total 200 50 25.0% 100 50 50.0% 100 50 50.0% 100 50 50.0% 100 80 80.0% 100 25 25.0% 100 50 50.0% 400 205 51.3%
    FORMAT REKAPITULASI LOGISTIK PUSKESMAS
    Provinsi : Tanggal :
    Kabupaten/Kota :

    Puskesmas :

    Isilah Kolom yang berwarna kuning!


    OPV IPV DPT-HB-Hib Campak Rubela Jumlah Logistik yang digunakan
    Posyandu/Pos
    No.
    Imunisasi lainnya Jumlah Jumlah Vial Jumlah Jumlah Vial Jumlah Jumlah Vial Jumlah Jumlah Vial ADS 0,5 ADS 5 Safety Pen
    IP IP IP IP Pelarut Dropper
    diimunisasi digunakan diimunisasi digunakan diimunisasi digunakan diimunisasi digunakan ML ML Box Marker

    a b c d e f g h i j k l m n o p q r s t
    100 10 10 30 10 3 50 40 1.25 80 10 8 4 5 4 5 7 3
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    TOTAL 100 10 10 30 10 3 50 40 1.25 80 10 8 4 5 4 5 7 3

    Catatan :
    IP = Jumlah yang diimunisasi/jumlah vial vaksin yang digunakan
    FORMAT REKAPITULASI LOGISTIK KABUPATEN/KOTA
    Provinsi : Tanggal :
    Kabupaten/Kota :

    Isilah Kolom yang berwarna kuning!


    OPV IPV DPT-HB-Hib Campak Rubela Jumlah Logistik yang digunakan

    No. Puskesmas
    Jumlah Jumlah Vial Jumlah Jumlah Vial Jumlah Jumlah Vial Jumlah Jumlah Vial ADS 0,5 ADS 5 Safety Pen
    IP IP IP IP Pelarut Dropper
    diimunisasi digunakan diimunisasi digunakan diimunisasi digunakan diimunisasi digunakan ML ML Box Marker

    a b c d e f g h i j k l m n o p q r s t
    100 10 10 30 10 3 50 40 1.25 80 10 8 4 5 4 5 7 3
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    TOTAL 100 10 10 30 10 3 50 40 1.25 80 10 8 4 5 4 5 7 3

    Catatan :
    IP = Jumlah yang diimunisasi/jumlah vial vaksin yang digunakan
    FORMAT REKAPITULASI LOGISTIK PROVINSI
    Provinsi : Tanggal :

    Isilah Kolom yang berwarna kuning!


    OPV IPV DPT-HB-Hib Campak Rubela Jumlah Logistik yang digunakan

    No. Kabupaten/Kota
    Jumlah Jumlah Vial Jumlah Jumlah Vial Jumlah Jumlah Vial Jumlah Jumlah Vial ADS 0,5 ADS 5 Safety Pen
    IP IP IP IP Pelarut Dropper
    diimunisasi digunakan diimunisasi digunakan diimunisasi digunakan diimunisasi digunakan ML ML Box Marker

    a b c d e f g h i j k l m n o p q r s t
    100 10 10 30 10 3 50 40 1.25 80 10 8 4 5 4 5 7 3
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    #DIV/0! #DIV/0! #DIV/0! #DIV/0!
    TOTAL 100 10 10 30 10 3 50 40 1.25 80 10 8 4 5 4 5 7 3

    Catatan :
    IP = Jumlah yang diimunisasi/jumlah vial vaksin yang digunakan

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