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Format Lansia PKM Mila 2023
Format Lansia PKM Mila 2023
PUSKESMAS :
KECAMATAN :
BULAN :
Jumlah Jmlh Desa Jumlah Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-69
No Nama Desa Posyandu
Kelompok Panti
Lansia Wredha
L P Total ( L + P ) L P
L P (L+P) L P (L+P) L P (L+P) L P ( L + P) Jumlah
B L B L (B+ (%) B L B L
L)
1 2 3 4 5 6
1 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
2 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
3 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
4 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
5 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
6 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
7 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
8 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
9 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
10 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
11 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
12 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
13 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
14 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
15 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
16 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
17 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
18 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
19 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
20 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
21 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
22 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
23 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
24 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
25 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
26 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
Jumlah 0 0 0 0 0 0 0 0 0 #DIV/0! 0 0
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
(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)
9 10 11 12 13 14
B L S
(%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) (+) (-) (+) (-)
14 15 16 17 18 19 20 21 22 24 25 26
27 28
0 0
KABUPATEN Pidie
PUSKESMAS Mila
KECAMATAN Mila
BULAN Febuari
Sasaran Lansia Jumlah Kunjungan Lansia
Jumlah
Jumlah Jmlah Desa Jumlah Panti 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-69 >
No Nama Desa Kelompok
Posyandu Wredha
Lansia L P Total ( L + P ) L P Total ( L + P ) L
L P (L+P) L P (L+P) L P (L+P) L P ( L + P) Jumlah Jumlah
B L B L (B (%) B L B L (B (%) B
1 2 3 4 5 +L) 6 +L)
1 Ara Bungkok 1 1 1 1 26 32 58 10 14 24 7 13 20 43 59 102 0 0 8 0 8 14 1 0 5 0 6 25 2
2 Blang 1 1 1 1 27 32 59 11 14 25 7 13 20 45 59 104 0 0 9 0 9 15 0 0 6 0 6 24 0
3 Kumbang 1 1 1 1 45 50 95 20 25 45 14 24 38 79 99 178 5 0 12 0 17 18 9 0 16 0 25 56 3
4 M Ilot 1 1 1 1 42 44 86 16 20 36 11 18 29 69 82 151 1 0 6 0 7 8 0 0 9 0 9 25 4
Mengetahui
Kepala Puskesmas
Yunita. SKM
Nip: 197707 16200801 2001
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
0 27 0 36 27.806427 25 123 148 102.896167 19 77 96 96 100.00 1 1.04 0 0.00 0 0 0 3 3 2.02702703 18 73 91 300.9197012138 1 1 2 3.92156863 11 24
Jumlah Lansia dengan Kelainan
Tekanan Darah
Hb Kurang Kolesterol tinggi DM As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan
Tinggi Normal Rendah
(L+P (L+ (L+P (L+P (L+ (L+ (L+P (L+ (L+ (L+
(%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P (%) L P
) P) ) ) P) P) ) P) P) P)
10 11 12 13 14 15 16 17
5 27.7777777778 2 3 5 27.7777777778 0 0 0 0 0 0 0 0 0 1 1 5.555555556 0 3 3 16.66666667 0 2 2 11.11111 0 0 0 0 0 0 0 0 0 0 0
3 14.2857142857 0 9 9 42.8571428571 0 0 0 0 0 0 0 0 0 0 2 9.523809524 0 3 3 14.28571429 0 3 3 14.28571 0 0 0 0 0 0 0 0 0 0 0
13 25.4901960784 5 16 21 41.1764705882 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 3.921568627 3 2 5 9.803922 0 0 0 0 0 0 0 0 0 2 2
10 35.7142857143 1 10 11 39.2857142857 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 7.142857143 1 3 4 14.28571 0 0 0 0 0 1 1 3.5714286 0 0 0
1 2 3 4 5
1 Dayah Andeue 1 1 1 0 64 67 131 24 29 53 17 28 45 105 124 229
2 Lhok Lubu 1 1 1 0 19 22 41 7 9 16 5 9 14 31 40 71
JUMLAH 5 5 5 0 212 233 445 78 100 178 53 83 136 343 416 759
Mengetahui
Kepala Puskesmas
_Yunita.SKM
Nip: 197707 16200801 2001
Jumlah Kunjungan Lansia
3 0 14 0 17 41 2 0 8 0 10 63 2 0 5 0 7 50 7 27 34 47.887323943662
2 0 6 0 8 10 1 0 10 0 11 31 2 0 6 0 8 17.77778 5 22 27 18.3673469387755
3 0 10 0 13 18 2 0 6 0 8 28 1 0 5 0 6 26.66667 6 21 27 21.4285714285714
0 0 7 0 7 6 4 0 19 0 23 51 1 0 5 0 6 26.0869565217 5 31 36 19.3548387096774
L P (L+P) Jumlah (%) Jumlah (%) Jumlah (%) L P L P (L+P) (%) L P (L+P) (%) L P (L+P) (%)
7 8 9
11 15 26 26 100.00 0 0.00 0 0.00 0 0 0 2 2 5.8823529412 11 11 22 64.7058823529 0 2 2 5.88235294118
Tekanan Darah
Hb Kurang Kolesterol tinggi
Tinggi Normal Rendah
L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L
10 11 12
0 1 1 2.94118 11 13 24 70.5882352941177 0 1 1 2.94117647058824 0 0 0 0 2 2 4 11.76470588235 0
2 4 6 22.22222222222 1 12 13 48.1481481481481 0 0 0 0 0 0 0 0 0 0 0 0 0
P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L
13 14 15 16 17 18
7 7 20.5882352941176 0 2 2 7.407407408 0 0 0 0 0 0 0 0 0 1 1 2.94117647059 1 1 2 5.882352941176 8
3 3 11.1111111111111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 3.703703703704 3
0 0 0 0 1 1 3.7037037037037 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2
2 2 5.55555555555556 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2.777777777778 5
6 8 23.5294117647059 3 13 1 0 17 0 0 17 0 0 0 0
12 15 55.5555555555556 3 16 0 0 19 0 0 19 0 0 0 0
8 10 37.037037037037 3 11 0 0 14 0 0 14 0 0 0 0
20 25 69.4444444444444 5 24 0 0 29 0 0 29 0 0 0 0
3 Krueng Lala 1 1 1 0 25 30 55 9 13 22 7 13 20 41 56 97 4 0 10 0 14 25 3 0 9 0
JUMLAH 5 5 5 0 178 213 391 101 148 249 47 85 132 326 446 772 21 0 70 0 91 23 14 0 48 0
Mengetahui
Kepala Puskesmas
Yunita.SKM
Nip: 197707 16200801 2001
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
62 25 10 0 34 0 44 33.3333 45 152 197 25.5181 24 82 106 105 99.06 1 0.94 0 0.00 0 0 0 2 2 1.0152 24 78 102
Jumlah Lansia dengan Kelainan
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 8 10 31.25 4 14 0 0 18 0 18 0 0 0 0
0 0 0 0 0 0 0 0 1 1 1.9231 0 1 1 1.9231 3 10 13 25 5 16 0 0 21 0 21 0 0 0 0
28
0
0
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :
Sasaran Lansia Jumlah Kunju
1 Teungoh Ilot 1 1 1 0 26 28 54 10 13 23 7 12 19 43 53 96 1 3 2 12 18 33 1 2 2
2 Baroh Ilot 1 1 1 0 28 36 64 9 11 20 4 10 14 41 57 98 0 2 1 12 15 23 2 3 2
3 Tunong Ilot 1 1 1 0 20 23 43 8 11 19 6 10 16 34 44 78 1 4 2 10 17 40 1 3 2
5 Lagang 1 1 1 0 30 36 66 19 31 50 8 15 23 57 82 139 0 5 3 12 20 30 0 3 2
Mengetahui
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
48 76 51 5 10 11 34 60 59.405941 55 166 221 39.323843 34 102 136 30 22.06 0 0.00 0 0.00 0 0 0 0 1 0.4524886877828 10 19
Jumlah Lansia dengan Kelainan
(%) 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
9 10 11 12 13 14
12.765957446809 0 0 0 0 0 0 0 0 2 4 6 12.76595744681 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1
As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Pemberdayaan
Penyuluhan
Lansia
B L S
(L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) (+) (-) (+) (-)
14 15 16 17 18 19 20 21 22 24 25
2 4.444444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 6.666667 2 4 0 0 6 21 21 0 0
3 6.976744 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 3 6.976744 2 5 0 0 7 21 21 0 0
2 4.878049 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 9.756098 2 4 0 0 6 18 18 0 0
1 2.222222 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 4 8.888889 2 3 0 0 5 21 21 0 0
2 4.255319 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 8.510638 2 4 0 0 6 22 22 0 0
26 27 28
0 0
0 0
0 0
0 0
0 0
0 0
KABUPATEN : Pidie
PUSKESMAS : Mila
KECAMATAN : Mila
BULAN : Juni
Sasaran Lansia
Jumlah Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59
Jumlah
No Nama Desa Jmlah Desa Kelompok Panti
Posyandu L P Total ( L + P )
Lansia Wredha
L P (L+P) L P (L+P) L P (L+P) L P ( L + P) Jumlah
B L B L (
B+L)
1 2 3 4 5
1 Blang 1 1 1 0 28 33 61 11 14 25 6 11 17 45 58 103 0 4 1 10 15
2 Lhok Lubu 1 1 1 0 20 22 42 7 10 17 4 8 12 31 40 71 2 7 2 11 22
3 Ara Bungkok 1 1 1 0 19 21 40 6 7 13 4 7 11 29 35 64 0 0 1 2 3
5 Teumeucet 1 1 1 0 27 33 60 10 14 24 6 11 17 43 58 101 0 2 2 8 12
Mengetahui
Kepala UPTD Puskesmas
Nip: Yunita
197707SKM
1620080 1
________________ 2001
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
Hb Kurang Kolesterol tinggi DM As. Urat tinggi Ggn ginjal Ggn kognitif Ggn Penglihatan
Rendah
(L+ (L+ (L+
(%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (L+P) (%) L P (%) L P (%) L P
P) P) P)
11 12 13 14 15 16 17
0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2.380952381 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 2.3255813953 0 0 0 0 0 1 1 2.3255813953 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 5.8823529412 0 0 0 0 0 1 1 5.8823529412 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 2.4390243902 0 0 0 0 2 1 3 7.3170731707 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 1 2.0833333333 0 0 0 0 1 1 2 4.1666666667 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 4 4 1.9704433498 0 0 0 0 3 5 8 3.9408866995 0 0 0 0 0 0 0 0 0 0 0
Pengobatan
Konseling
Jumlah Panti Jumlah
Ggn Penglihatan Ggn pendengaran Lain-lain Diobati Dirujuk Pemberdaya
Penyuluhan Wredha Kunjungan Ket.
an Lansia
dibina Rumah
(L+ (L+ B L S
(%) L P (%) L P (%) (+) (-) (+) (-)
P) P)
17 18 19 20 21 22 24 25 26 27 28
0 0 0 0 0 1 2 3 7.14285714286 1 3 0 0 4 23 23 0 0 0 0
0 0 0 0 0 2 1 3 6.97674418605 2 3 0 0 5 16 16 0 0 0 0
0 0 0 0 0 0 0 0 0 0 2 0 0 2 12 12 0 0 0 0
0 0 0 0 0 0 1 1 2.43902439024 2 3 0 0 5 26 26 0 0 0 0
0 0 0 0 0 0 1 1 2.08333333333 1 3 0 0 4 32 32 0 0 0 0
Jumlah Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-6
Jumlah
No Nama Desa Jmlah Desa Kelompok Panti
Posyandu L P Total ( L + P ) L
Lansia Wredha
L P (L+P) L P (L+P) L P (L+P) L P ( L + P) Jumlah
B L B L ( (%) B
B+L)
1 2 3 4 5 6
1 Tuha Lala 1 1 1 0 18 22 40 10 17 27 28 39 67 56 78 134 0 2 1 3 6 15 2
3 Teungoh Ilot 1 1 1 0 10 12 22 6 10 16 16 22 38 32 44 76 2 3 3 5 13 59 1
5 Baroh ilot 1 1 1 0 9 11 20 5 9 14 14 19 33 28 39 59 1 4 2 12 19 95 1
Mengetahui
Kepala Puskesmas
_Yunita.SKM_
Nip: 197707 16200801 2001
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
2 5.2632 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 10.526 3 6 0 0 9 24 24 0 0
3 5.4545 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 5 9.0909 4 4 0 0 8 25 25 0 0
2 4.5455 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 4.5455 1 4 0 0 5 18 18 0 0
26 27 28
0 0
0 0
0 0
0 0
0 0
0 0
KABUPATEN PIDIE
PUSKESMAS MILA
KECAMATAN MILA
BULAN AGUSTUS
Sasaran Lansia Jumlah Kun
2 Lagang 1 1 1 0 11 14 25 6 11 17 17 25 42 34 50 0 1 3 4 10 18 72 1 4 4
3 Mesjid Ilot 1 1 1 0 16 19 35 9 15 24 25 35 60 1 69 0 2 4 3 1 10 29 2 5 3
4 Kreung Lala 1 1 1 0 10 13 23 5 10 15 15 24 39 30 47 0 2 3 3 5 13 57 2 7 2
JUMLAH 5 5 5 0 0 0 0 0 0 5 14 20 26 65 #DIV/0! 6 20 16
Mengetahui
UPTD Kepala Puskesmas
YUNITA>SKM
Nip.197716200801 2001
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
41 83 #DIV/0! 4 27 12 34 77 #DIV/0! 76 149 225 #DIV/0! 57 103 160 37 23.13 2 1.25 1 0.63 0 0 0 2 1 0.444444 11 26
Jumlah Lansia dengan Kelainan
(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) (%)
9 10 11 12 13 14
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 4 7.843137 1 5 1 0 8 22 22 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 3 5 10.41667 2 6 0 0 8 22 22 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 2 5 13.51351 4 6 0 0 10 22 22 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 3 6.25 3 4 0 0 7 23 23 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 10.81081 1 5 0 1 7 26 26 0 0 0 2
28
Nip.197716200801 2001
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :
Sasaran Lansia Jumlah Kunjungan Lan
1 0 0 0 0 0 0 4 8 12 #DIV/0! 3 14
2 0 0 0 0 0 0 4 14 18 #DIV/0! 5 11
3 0 0 0 0 0 0 6 4 10 #DIV/0! 7 7
4 0 0 0 0 0 0 5 8 13 #DIV/0! 9 12
5 0 0 0 0 0 0 0 10 10 #DIV/0! 2 13
Mengetahui
Kepala Puskesmas
________________
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0.00 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
Jumlah Lansia dengan Kelainan
(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) (%)
9 10 11 12 13 14
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
28
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :
Sasaran Lansia Jumlah Kunjungan Lans
1 0 0 0 0 0 0 4 8 12 #DIV/0! 3 14
2 0 0 0 0 0 0 4 14 18 #DIV/0! 5 11
3 0 0 0 0 0 0 6 4 10 #DIV/0! 7 7
4 0 0 0 0 0 0 5 8 13 #DIV/0! 9 12
5 0 0 0 0 0 0 0 10 10 #DIV/0! 2 13
Mengetahui
Kepala Puskesmas
________________
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
#NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME?
Jumlah Lansia dengan Kelainan
(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) (%)
9 10 11 12 13 14
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
28
KABUPATEN :
PUSKESMAS :
KECAMATAN :
BULAN :
Sasaran Lansia Jumlah Kunjungan Lans
1 0 0 0 0 0 0 4 8 12 #DIV/0! 3 14
2 0 0 0 0 0 0 4 14 18 #DIV/0! 5 11
3 0 0 0 0 0 0 6 4 10 #DIV/0! 7 7
4 0 0 0 0 0 0 5 8 13 #DIV/0! 9 12
5 0 0 0 0 0 0 0 10 10 #DIV/0! 2 13
Mengetahui
Kepala Puskesmas
________________
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
#NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #DIV/0! #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0
Jumlah Lansia dengan Kelainan
(%) 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
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 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
28
KABUPATEN Pidie
PUSKESMAS Mila
KECAMATAN Mila
BULAN Januari
Sasaran Lansia Jumlah Kunjungan La
Jumlah 45-59 60-69 > 70 Jumlah Total Lansia (45-70) 45-59 60-69
Jumlah Jumlah
Jmlah Panti
No Nama Desa Posyand Kelompo
Desa Wredh
u k Lansia L P Total ( L + P ) L P
a
L P (L+P) L P (L+P) L P (L+P) L P ( L + P) Jumlah
B L B L (B (%) B L B L
+L)
1 2 3 4 5 6
1 Teungoh Ilot 1 1 1 0 26 28 54 10 13 23 7 12 19 43 53 96 4 4 19 8 35 65 2 3 9 14
2 Lagang 1 1 1 0 30 36 66 19 31 50 8 15 23 57 82 139 2 4 7 14 27 41 2 5 12 11
3 Baroh 1 1 1 0 28 36 64 9 11 20 4 10 14 41 57 98 7 6 10 4 27 42 5 7 11 7
JUMLAH 5 5 5 0 130 155 285 63 93 156 32 60 92 225 308 533 16 #NAME? 59 #NAME? #NAME? #NAME? 14 #NAME? 52 #NAME?
Mengetahui
Kepala Puskesmas
Yunita. SKM
Nip:197707162008012001
FORMAT PENCATATAN DAN PELAPORAN LANSIA TINGKAT PUSKESMAS
#NAME? #NAME? 2 #NAME? 9 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 19 #NAME? 0 #NAME? 0 #NAME? 0 0 0 0 0 #NAME? 5 14 19
#NAME? #NAME? 3 #NAME? 9 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 26 #NAME? 3 #NAME? 0 #NAME? 0 0 0 2 2 #NAME? 5 22 27
#NAME? #NAME? 10 #NAME? 35 #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 0 #NAME? 0 0 0 5 5 #NAME? 24 79 97
Jumlah Lansia dengan Kelainan
(%) 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
9 10 11 12 13 14 15
19.14894 0 1 1 1.06383 0 4 4 4.25532 4 12 16 17.0213 0 0 0 0 0 0 0 0 0 2 2 2.12766 0 3 3 3.19149 2 6 8 8.51064 0
15 16 17 18 19 20 21 22 24 25 26 27
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 5 7 7.44681 4 16 0 0 20 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 14 17 22.0779 3 17 0 0 20 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 10 13 16.8831 7 16 0 0 23 0 0 0 0 0 0
28
FORMAT PENCATATAN DAN PELAPORAN KESEHATAN LANJUT USIA DI POSYANDU LANSIA
POSYANDU :
NAMA KELOMPOK LANSIA :
DESA/KELURAHAN :
PUSKESMAS :
KECAMATAN :
BULAN :
Jml Kasus
Umur Kegiatan sehari-hari Hasil pemeriksaan (Angka) Pengobatan
Kunjungan Konseling
Pemberd
45-59 60-69 > 70 Kemandirian Ggn IMT Tek. Darah Hb Kolesterol Gula Darah Asam Urat Gangguan Penyulu
No Nama Lansia ayaan
han
pendenga Diobati Dirujuk B L S Lansia
B L L P L P L P A B C ME L N K T N R N K N T N T N T ginjal kognitif Penglihatan Lain-lain
ran
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
1 Ny. Sutinah √ 49 √ + + B + +
2 Tn. Jek √ 61
JUMLAH 1 1 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1
Mengetahui
Penanggung jawab wilayah Ketua kader Posyandu ......
________________ ________________
AN PELAPORAN KESEHATAN LANJUT USIA DI POSYANDU LANSIA
Ket.
23