Laporan Ims

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LAPORAN BULANAN

PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Januari

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 30 Januari 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Februari

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 26 Februari 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Maret

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 31 Maret 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : April

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 30 April 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Mei

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 31 Mei 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Juni

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 30 Juni 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Juli

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 30 Juli 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Agustus

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 31 Agustus 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : September

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 30 September 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009
LAPORAN BULANAN
PENDERITA IMS

PUSKESMAS : Tentang
BULAN/TAHUN : Oktober

DESA
Desa Tentang Desa Golo Bore Desa Pong Narang Desa Golo Rua Desa Golo Poleng Desa Golo Keli Desa Raka Desa Kasong
NO ELEMEN DATA L P L P L P L P L P L P L P L P L P L P L
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
1 2 3 4 5 6 7 8 9 10 11
I Total Penderita IMS :
1 Bulan ini - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Kumulatif s.d. bulan ini - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

II Asal Pasien :
1 Datang Sendiri - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujukan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kiriman Kader - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kumulatif s.d. bulan ini 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 0 0 0
5 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

III Jenis Kasus :


1 5 - 9 tahun
2 10 - 14 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 15 - 19 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 20 - 44 tahun - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 45 - 54 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 55 - 59 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 60 - 69 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 > 70 tahun - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9 Kumulatif s.d. bulan ini - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
10 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

IV Diagnosa :
1 Klinis - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Laboratorium - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Kumulatif s.d. bulan ini - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

V Kategori Klinis :
1 Duh tubuh vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Erosi Partio - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Condiloma acuminata - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Duh tubuh urethra - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Ulkus vagina - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VI Pemeriksaan Laboratorium :
1 STO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 GO - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Clue cell - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Candida - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Tricho - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Syphilis - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7 PMN > 30/LP - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
8 Kumulatif s.d. bulan ini 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

VII Pelayanan :
1 Dapat kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2 Rujuk - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3 Konseling - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
4 Kasi Kondom - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5 Kumulatif s.d. bulan ini - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6 Keterangan Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Mengetahui
Kepala UPTD Puskesmas Tentang

NIP.19740908 199903 1 005


LAPORAN BULANAN
PENDERITA IMS

DESA
TOTAL

P L P L P L P L P L P L P L P
B L B L B L B L B L B L B L B L B L B L B L B L B L B L B L
11 12 13 14 15 16 17 18

- 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 0 0 0 1 0 0
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- 1 - -
- - - -
- - - -
- - - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- 1 - -
- - - -
- - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 0 0 0 0 0 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 - -
Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok Ok

Tentang 31 Oktober 2022


pengelola program

Frans Edison
NIP : 19860129 201001 1 009

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