DATA DUSUN 3 komunitas
97
PROGRAM STUDI PROFESI NERS FAKULTAS ILMU KESEHATAN UNIVERSITAS MUHAMMADIYAH BENGKULU NO NAMA KK ALAMAT ( NO ,RT ,RW) DESA/KELURAHAN TANGGAL PENGAMBILAN DATA MHSW UMUR SEXS HBNGN DGN KK 1 2 3 4 5 6 7 8 9 L P 1 2 3 4 5 6 7 1 PARJIO RT 7 BP2 28-Apr ERNA 0 0 0 1 1 2 0 0 0 1 3 1 1 2 0 0 0 0 2 PANUT RT 7 BP2 28-Apr ERNA 0 0 0 0 0 2 0 0 2 2 2 1 1 2 0 0 0 0 3 TRIMAN RT 7 BP2 28-Apr ERNA 0 0 1 1 0 2 0 0 1 2 3 1 1 2 1 0 0 0 4 TUKIMAN RT 7 BP2 28-Apr ERNA 0 1 0 1 0 2 0 0 0 2 2 1 1 2 0 0 0 0 5 PANIO RT 6 BP2 28-Apr FIFIN 0 0 0 1 1 3 0 0 0 1 4 1 1 3 0 0 0 0 6 HARMAN RT7 BP2 28-Apr FIFIN 0 0 0 0 1 0 2 0 0 1 2 1 1 1 0 0 0 0 7 SITOTARUNO RT7 BP2 28-Apr YESRA 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 8 SUKITO RT 7 BP2 28-Apr YESRA 0 0 1 0 1 2 0 0 0 2 2 1 1 2 0 0 0 0 9 WARSITO RT7 BP2 28-Apr YESRA 0 0 1 0 0 3 1 0 0 2 3 1 1 3 0 0 0 0 10 HABE SUPRIANTO RT7 BP2 28-Apr YESRA 0 0 0 0 1 2 0 0 0 2 1 1 1 1 0 0 0 0 11 RORO MULYONO RK3 BP2 28-Apr IIN 0 0 0 0 0 2 0 0 0 2 2 1 1 2 0 0 0 0 12 SUHARMANTO RK3 BP2 28-Apr IIN 0 0 0 2 0 0 2 0 0 2 2 1 1 2 0 0 0 0 13 ENDIK SOPIAN SARIRK3 BP2 28-Apr IIN 0 0 1 0 0 2 0 0 0 1 2 1 1 3 0 0 0 0 14 SAIDIN RK3 BP2 28-Apr IIN 0 0 1 0 1 2 0 0 0 2 2 1 1 3 0 0 0 0 15 YULIANTO RK3 BP2 28-Apr FEBRI 0 0 1 0 0 2 0 0 0 1 3 1 1 3 0 0 0 0 16 ZAKARIA RK3 BP2 29-Apr HAMBA 0 0 1 2 0 2 0 0 0 2 3 1 1 3 0 0 0 0 17 JUMARI RK3 BP2 29-Apr HIDAYAT 0 1 0 1 0 2 0 0 0 1 3 1 1 2 0 0 0 0 18 SASTRO RK3 BP2 29-Apr HIDAYAT 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 19 SUKARDI RK3 BP2 29-Apr HIDAYAT 0 0 0 1 0 2 0 0 0 2 1 1 1 1 0 0 0 0 20 GIMAN RK3 BP2 29-Apr HAMBA 0 0 0 2 0 2 0 0 0 2 2 1 1 2 0 0 0 0 21 NOPIAN RK3 BP2 29-Apr HAMBA 0 1 0 0 0 2 0 0 0 2 1 1 1 1 0 0 0 0 22 SUBANDI RK3 BP2 29-Apr HIDAYAT 1 0 0 1 0 3 0 0 0 2 3 1 1 3 0 0 0 0 23 SUPARLAN RK3 BP2 29-Apr HAMBA 0 0 1 0 0 2 0 0 0 1 2 1 1 1 0 0 0 0 24 SURATNO RK3 BP2 29-Apr HAMBA 0 0 0 0 0 3 1 0 0 3 1 1 1 2 0 0 0 0 25 MARDI RK3 BP2 29-Apr HAMBA 0 0 0 0 0 0 0 0 2 1 1 1 1 0 0 0 0 0 26 NOPITRIANTORO RK3 BP2 29-Apr HAMBA 0 0 1 0 0 2 0 0 0 1 2 1 1 1 0 0 0 0 27 LAGIMAN RK3 BP2 29-Apr HIDAYAT 0 0 0 0 0 0 0 0 2 1 1 1 1 0 0 0 0 0 28 WIRANTO RK3 BP2 29-Apr HIDAYAT 0 0 0 0 0 1 2 0 0 1 2 1 1 1 0 0 0 0 29 SUTRA DILAGA RK3 BP2 29-Apr HIDAYAT 0 0 0 1 1 2 0 0 0 3 1 1 1 2 0 0 0 0 30 PANITO RK3 BP2 29-Apr HIDAYAT 0 0 1 0 0 2 0 0 0 2 1 1 1 1 0 0 0 0 31 SAMINU RK3 BP2 29-Apr HAMBA 0 0 0 0 0 1 0 0 2 1 2 1 1 1 0 0 0 0 32 DAMIRI RK3 BP2 29-Apr HAMBA 0 0 0 0 1 1 2 0 0 2 2 1 1 2 0 0 0 0 33 SUGIANTO RK3 BP2 29-Apr HAMBA 0 0 0 0 0 2 0 0 1 1 2 1 1 0 0 0 0 0 34 TEGUH RK3 BP2 29-Apr HIDAYAT 0 0 1 1 0 2 0 0 0 2 2 1 1 2 0 0 0 0 35 HAMDAN RK3 BP2 29-Apr HIDAYAT 0 0 0 0 1 2 0 0 0 2 1 1 1 1 0 0 0 0 36 37
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Transcript of DATA DUSUN 3 komunitas
PROGRAM STUDI PROFESI NERSFAKULTAS ILMU KESEHATANUNIVERSITAS MUHAMMADIYAH BENGKULU
NO NAMA KK ALAMAT ( NO ,RT ,RW) DESA/KELURAHAN TANGGAL PENGAMBILAN DATA MHSWUMUR SEXS HBNGN DGN KK
1 2 3 4 5 6 7 8 9 L P 1 2 3 4 5 6 7
1 PARJIO RT 7 BP2 28-Apr ERNA 0 0 0 1 1 2 0 0 0 1 3 1 1 2 0 0 0 02 PANUT RT 7 BP2 28-Apr ERNA 0 0 0 0 0 2 0 0 2 2 2 1 1 2 0 0 0 03 TRIMAN RT 7 BP2 28-Apr ERNA 0 0 1 1 0 2 0 0 1 2 3 1 1 2 1 0 0 04 TUKIMAN RT 7 BP2 28-Apr ERNA 0 1 0 1 0 2 0 0 0 2 2 1 1 2 0 0 0 05 PANIO RT 6 BP2 28-Apr FIFIN 0 0 0 1 1 3 0 0 0 1 4 1 1 3 0 0 0 06 HARMAN RT7 BP2 28-Apr FIFIN 0 0 0 0 1 0 2 0 0 1 2 1 1 1 0 0 0 07 SITOTARUNO RT7 BP2 28-Apr YESRA 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 08 SUKITO RT 7 BP2 28-Apr YESRA 0 0 1 0 1 2 0 0 0 2 2 1 1 2 0 0 0 09 WARSITO RT7 BP2 28-Apr YESRA 0 0 1 0 0 3 1 0 0 2 3 1 1 3 0 0 0 0
10 HABE SUPRIANTO RT7 BP2 28-Apr YESRA 0 0 0 0 1 2 0 0 0 2 1 1 1 1 0 0 0 011 RORO MULYONO RK3 BP2 28-Apr IIN 0 0 0 0 0 2 0 0 0 2 2 1 1 2 0 0 0 012 SUHARMANTO RK3 BP2 28-Apr IIN 0 0 0 2 0 0 2 0 0 2 2 1 1 2 0 0 0 013 ENDIK SOPIAN SARIRK3 BP2 28-Apr IIN 0 0 1 0 0 2 0 0 0 1 2 1 1 3 0 0 0 014 SAIDIN RK3 BP2 28-Apr IIN 0 0 1 0 1 2 0 0 0 2 2 1 1 3 0 0 0 015 YULIANTO RK3 BP2 28-Apr FEBRI 0 0 1 0 0 2 0 0 0 1 3 1 1 3 0 0 0 016 ZAKARIA RK3 BP2 29-Apr HAMBA 0 0 1 2 0 2 0 0 0 2 3 1 1 3 0 0 0 017 JUMARI RK3 BP2 29-Apr HIDAYAT 0 1 0 1 0 2 0 0 0 1 3 1 1 2 0 0 0 018 SASTRO RK3 BP2 29-Apr HIDAYAT 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 019 SUKARDI RK3 BP2 29-Apr HIDAYAT 0 0 0 1 0 2 0 0 0 2 1 1 1 1 0 0 0 020 GIMAN RK3 BP2 29-Apr HAMBA 0 0 0 2 0 2 0 0 0 2 2 1 1 2 0 0 0 021 NOPIAN RK3 BP2 29-Apr HAMBA 0 1 0 0 0 2 0 0 0 2 1 1 1 1 0 0 0 022 SUBANDI RK3 BP2 29-Apr HIDAYAT 1 0 0 1 0 3 0 0 0 2 3 1 1 3 0 0 0 023 SUPARLAN RK3 BP2 29-Apr HAMBA 0 0 1 0 0 2 0 0 0 1 2 1 1 1 0 0 0 024 SURATNO RK3 BP2 29-Apr HAMBA 0 0 0 0 0 3 1 0 0 3 1 1 1 2 0 0 0 025 MARDI RK3 BP2 29-Apr HAMBA 0 0 0 0 0 0 0 0 2 1 1 1 1 0 0 0 0 026 NOPITRIANTORO RK3 BP2 29-Apr HAMBA 0 0 1 0 0 2 0 0 0 1 2 1 1 1 0 0 0 027 LAGIMAN RK3 BP2 29-Apr HIDAYAT 0 0 0 0 0 0 0 0 2 1 1 1 1 0 0 0 0 028 WIRANTO RK3 BP2 29-Apr HIDAYAT 0 0 0 0 0 1 2 0 0 1 2 1 1 1 0 0 0 029 SUTRA DILAGA RK3 BP2 29-Apr HIDAYAT 0 0 0 1 1 2 0 0 0 3 1 1 1 2 0 0 0 030 PANITO RK3 BP2 29-Apr HIDAYAT 0 0 1 0 0 2 0 0 0 2 1 1 1 1 0 0 0 031 SAMINU RK3 BP2 29-Apr HAMBA 0 0 0 0 0 1 0 0 2 1 2 1 1 1 0 0 0 032 DAMIRI RK3 BP2 29-Apr HAMBA 0 0 0 0 1 1 2 0 0 2 2 1 1 2 0 0 0 033 SUGIANTO RK3 BP2 29-Apr HAMBA 0 0 0 0 0 2 0 0 1 1 2 1 1 0 0 0 0 034 TEGUH RK3 BP2 29-Apr HIDAYAT 0 0 1 1 0 2 0 0 0 2 2 1 1 2 0 0 0 035 HAMDAN RK3 BP2 29-Apr HIDAYAT 0 0 0 0 1 2 0 0 0 2 1 1 1 1 0 0 0 03637
38 3940
umur sexs
HBNGN DGN KK AGAMA PEKERJAAN PENDIDIKANDATA KESEHATAN LINGKUNGAN
LINGKUNGAN FISIKPERUMAHAN
8 9 1 2 3 4 5 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7TIPE RMH STATUS KEPEMILIKAN RUMAH JENIS LANTAI DIRMH TDPT JENDELA
1 2 3 1 2 3 1 2 3 4 1 2 30 0 4 0 0 0 0 0 2 1 0 0 0 1 0 0 0 0 0 1 1 1 1 0 1 0 0 1 0 0 0 0 1 0 1 0 00 0 4 0 0 0 0 1 0 0 0 0 0 2 2 0 0 0 0 0 3 1 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 5 0 0 0 0 2 0 2 0 0 0 0 0 1 0 1 1 0 2 1 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 4 0 0 0 0 1 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 5 0 0 0 0 0 3 1 0 0 0 0 0 0 1 0 0 0 3 2 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 3 0 0 0 0 0 1 0 0 0 0 0 2 0 0 2 0 0 0 1 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 4 0 0 0 0 1 2 0 0 0 0 0 2 0 0 1 0 0 0 3 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 5 0 0 0 0 1 2 1 0 0 0 1 0 0 0 1 0 0 2 2 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 0 0 3 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 2 1 0 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 4 0 0 0 0 0 0 1 0 0 0 1 0 0 2 0 0 0 2 2 0 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 4 0 0 0 0 2 0 1 0 0 0 0 0 1 0 0 0 0 3 0 0 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 3 0 0 0 0 1 0 3 0 0 0 0 0 1 0 1 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 4 0 0 0 0 1 1 0 0 0 0 0 2 0 0 1 0 0 0 2 0 0 1 0 0 1 0 0 0 0 1 0 1 0 00 0 3 0 0 0 0 1 2 O 0 0 0 0 2 0 0 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 1 0 1 0 00 0 5 0 0 0 0 1 0 0 0 0 0 0 2 0 0 1 0 0 2 1 1 0 1 0 0 1 0 0 0 0 1 0 1 0 00 0 4 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 0 2 1 0 0 1 0 0 1 0 0 0 0 1 0 1 0 00 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 2 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 00 0 3 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 2 1 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 4 0 0 0 0 0 2 1 0 0 0 0 0 1 0 0 0 0 1 3 0 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 3 0 0 0 0 1 0 1 0 0 0 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 1 0 0 0 1 0 1 0 00 0 5 0 0 0 0 1 2 0 0 0 0 0 2 0 0 1 0 0 2 1 0 1 1 0 0 1 0 0 0 0 0 1 1 0 00 0 3 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 4 0 0 0 0 2 0 0 0 0 0 2 0 0 0 0 0 0 2 0 2 0 0 1 0 1 0 0 0 0 1 0 1 0 00 0 2 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 2 0 0 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 3 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 2 0 0 1 0 0 1 0 0 0 0 1 0 1 0 00 0 2 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 2 0 0 0 1 0 0 1 0 0 0 0 1 0 1 0 00 0 3 0 0 0 0 0 0 0 0 0 0 0 2 1 0 0 0 0 2 0 0 1 1 0 0 1 0 0 0 0 0 1 1 0 00 0 4 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 3 0 0 0 0 0 1 2 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 1 0 1 0 0 0 1 0 00 0 3 0 0 0 0 0 0 1 0 0 0 0 2 0 0 0 1 0 1 0 1 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 4 0 0 0 0 1 0 0 1 0 0 0 1 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 3 0 0 0 0 0 0 2 0 0 0 0 0 1 0 0 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 4 0 0 0 0 1 1 1 0 0 0 0 0 1 0 1 0 0 3 0 0 0 1 0 0 1 0 0 0 0 0 1 1 0 00 0 3 0 0 0 0 1 0 1 0 0 0 0 1 0 0 1 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0
agama pekerjaan pendidikan
tipe rumah
status kepemilikan
rumah
jenis lantai
luasjendela
DATA KESEHATAN LINGKUNGANLINGKUNGAN FISIK
PERUMAHANLUAS JENDELA/LUBANG ANGIN JENDELA DIBUKA SETIAP HARI CAHAYA MATAHARI MSK K DLM RMH BERSIHAN DALAM RUMAH VKTR YG BNYK DSKTR RMH HLMN SKTR RMH
1 2 1 2 1 2 1 2 1 2 3 4 5 6 7 1 20 1 1 0 1 0 1 0 0 1 0 0 0 0 0 1 01 0 1 0 1 0 1 0 0 1 0 0 0 0 0 1 00 1 1 0 1 0 1 0 0 1 0 0 0 0 1 1 00 1 1 0 1 0 2 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 01 0 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 1 0 0 0 0 0 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 0 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 O 0 0 0 1 1 00 1 0 1 1 0 1 0 0 1 0 0 0 0 0 1 00 1 1 0 1 0 1 0 0 1 0 0 0 0 0 1 00 1 1 0 1 0 0 1 1 1 1 1 0 1 1 0 10 1 1 0 1 0 0 1 1 1 1 1 1 1 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 1 0 0 0 0 0 1 00 1 1 0 1 0 1 0 1 0 0 0 0 0 0 0 10 1 1 0 1 0 1 0 0 1 0 0 0 0 0 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 00 1 1 0 1 0 1 0 0 0 0 0 0 0 1 1 0
luasjendela buka jndla
tiap hri
Chya mthri Bersih dalam rumah
Vektor yng banyak disekitar rumah
Halaman sekitar rumah
DATA KESEHATAN LINGKUNGANLINGKUNGAN FISIK
PERUMAHAN SUMBER AIR BERSIHPEMANFAATAN HLMN RMH SMBR UNTK MSK DN MNM SSTM PNGLHN AIR MNM SMBR AIR UNTK MNDI MNCCI JRK SMBR AIR DGN SEPTIK TANK TMPT PNMPNGN AIR SMNTR
1 2 3 4 5 6 1 2 3 1 2 3 1 2 3 1 2 1 2 30 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 11 0 0 1 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 1 0 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 1 0 00 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 10 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 0 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 1 0 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 0 0 0 1 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 1 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 1 0 00 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 1 0 0
Halaman sekitar rumah
Pemanfaatan halaman rumah
Sumber untuk msk dan mnm
Sstm pmlhrn air mnm
Smbr air untk mncci
Jrk smbr air dgn sptk tng
tmpat penampungan air smntra
DATA KESEHATAN LINGKUNGANLINGKUNGAN FISIK
SUMBER AIR BERSIH SISTEM PEMBUANGAN SAMPAHTMPT PENAMPUNGN SMNTR DKURAS KNDS TMPT PENMPUNGN AIR KNDS AIR PMBUANGAN SMPH TMPT PNMPNGN SMPH SMNTR DDLM RMH
1 2 1 2 1 2 3 4 1 2 3 4 5 6 1 21 0 1 0 0 0 0 1 0 0 0 0 1 0 1 01 0 1 0 0 0 0 1 1 0 0 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 0 1 0 0 0 1 1 0 0 0 0 0 0 10 1 0 1 0 0 0 1 0 0 0 1 0 0 0 10 1 1 0 0 0 0 1 0 0 0 1 0 0 0 10 1 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 0 1 0 0 0 11 0 1 0 0 0 0 1 0 0 0 1 0 0 1 00 1 1 0 0 0 0 1 0 0 0 1 0 0 1 00 1 1 0 0 0 0 1 0 0 0 1 0 0 0 10 1 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 00 1 1 0 0 0 0 1 0 0 0 1 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 01 0 1 0 0 0 0 1 0 0 1 0 0 0 1 0
tmpat penampungan air smntra
tmpat pnampngan smntra dkras
Kondisi tmpt pnmpngan air
Kondisi air Pembuangan sampah Tempat penampungan sampah sementara dalam rumah
Kondisi tempat pembuangan sampah sementara dalam rumah
DATA KESEHATAN LINGKUNGANLINGKUNGAN FISIK
SISTEM PEMBUANGAN SAMPAH SISTEM PEMBUANGAN KOTORAN RUMAH TANGGAKNDS TMPT PMBUNGN SMPH SMNTR DDLM RMH JRK PMBUNGN SMPH DGN RMH KNDS TMPT PMBUNGN SMPH DLUAR RMH KBIASAAN KLRG BUANG AIR BSR JNS JMBN YG DGNKN KNDS JMBN SSTM PMBUNGN AIR LMBH
1 2 1 2 1 2 3 4 1 2 3 1 2 1 2 10 1 0 1 1 0 0 0 1 0 0 1 0 1 0 00 1 0 1 0 0 0 1 1 0 0 1 0 0 1 00 1 0 1 0 0 0 1 1 0 0 0 1 1 0 10 1 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 00 1 0 1 0 0 0 1 1 0 0 0 1 1 0 00 1 0 1 0 0 0 1 1 0 0 0 1 1 0 00 1 0 1 0 0 0 1 1 0 0 1 0 1 0 00 1 0 1 0 0 0 1 1 0 0 1 0 1 0 00 1 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 11 0 1 0 0 0 1 1 0 0 0 1 1 0 11 0 0 1 0 0 0 1 1 0 0 0 1 1 0 11 0 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 1 0 1 0 0 0 1 0 0 1 0 1 0 01 0 1 0 1 0 0 0 1 0 0 0 1 1 0 11 0 0 1 1 1 1 0 1 0 0 1 0 0 1 10 1 0 1 1 1 1 0 1 0 0 0 1 0 1 11 0 0 1 0 0 0 1 1 0 0 0 1 1 0 00 1 0 1 0 0 0 1 1 0 0 0 1 1 0 10 1 0 1 0 0 0 1 1 0 0 0 1 1 0 10 1 0 1 0 0 0 1 1 0 0 1 1 0 11 0 0 1 0 0 0 1 1 0 0 0 1 1 0 11 0 1 0 0 0 0 1 1 0 0 0 1 0 1 11 0 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 11 0 1 0 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 01 0 0 1 0 0 0 1 1 0 0 0 1 1 0 11 0 0 1 0 0 0 1 1 0 0 0 1 1 0 11 0 0 1 0 0 0 1 1 0 0 0 1 1 0 1
1
1
1
1
1
1
Kondisi tempat pembuangan sampah sementara dalam rumah
Jarak pembuangan sampah dengan
rumah
Kondisi tempat pembuangan sampah diluar rumah
Kebiasaan keluarga
buang air besar
Jenis jamban yang
digunakan
Kondisi jamban
Sistem pembuangan air limbah
DATA KESEHATAN LINGKUNGANLINGKUNGAN FISIK KONDISI KESEHATAN UMUM
SISTEM PEMBUANGAN KOTORAN RUMAH TANGGA HEWAN PELIHARAAN PELAYANAN KESEHATANSSTM PMBUNGN AIR LMBH KNDS PMBUANGN AIR LMBH KPMLKN HWN TRNK DRMH LTK KNDNG KNDS KNDNG JARAK KANDANG DGN RMH SARANA KSHTN YG PLNG DKT TMPT BRBT KLRG KBIASAAN SBLM BRBT
2 3 1 2 1 2 1 2 1 2 1 2 1 2 3 4 5 1 2 3 4 5 1 20 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 00 1 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 00 0 0 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 1 0 1 01 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 00 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 11 0 1 0 1 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 00 0 1 0 0 1 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 00 0 1 0 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 0 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 00 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 00 0 0 1 1 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 1 0 0 0 00 0 0 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 10 0 0 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 1 0 0 0 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 00 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 00 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 00 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 00 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 00 0 1 0 1 0 0 0 1 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 01 0 1 0 1 0 0 0 1 0 0 1 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 00 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 01 0 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 1 0 0 0 0 1 01 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 00 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sistem pembuangan air limbah
Kondisi pembuangan air limbah
Kepemilikan hewan ternak
dirumah
Letak kandang Kondisi kandang Sarana kesehatan yg paling dekat
Tempat berbibit keluarga
Kebiasaan sebelum berbbt
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
PELAYANAN KESEHATAN IBU HAMILKBIASAAN SBLM BRBT SMBR PNDANAAN KSHTN KLRG PNYKIT YG SRNG DDRT KLRG DLM 6 BLN TRAKHR JARAK RMH K SARANA PEL KES SARANA TRASPORT KE PELKES KLG ADAKAH KLG MENINGGAL DLM 1 THN ADA IBU HML
3 1 2 3 4 5 1 2 3 4 5 6 7 8 1 2 3 4 1 2 3 4 1 2 1 21 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 10 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 00 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 00 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
Kebiasaan sebelum berbbt
Sumber pendanaankesehatan keluarga
Penyakit yg sering diderita
6 bln terakhir
Ada ibu hamil
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
IBU HAMILKEHAMILAN KE USIA IBU HML USIA KHMLN TMPT PERIKSA KHAMILN FREK. PRKS KHMLN JK TDK SESUAI DGN UMUR KHMLN ALSN KELUHAN IBU SAAT HML SAAT INI PNYKT PNYRT YG DDRTA OLH IBU HML
1 2 3 4 5 6 7 1 2 3 1 2 3 1 2 3 1 2 1 2 3 4 1 2 3 4 1 2 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 0 1 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Ada ibu hamil
kehamilan ke usia ibu hamil
usia kehamilan
tmpt prksa khmilan
tempat prksa khmlan
jika tdk sesuai deng usia khmlan
keluhan ibu saat hmil
pnkt yg di drta bumil
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
IBU HAMILPNYKT PNYRT YG DDRTA OLH IBU HML APKH PRNH DPRKSA HB JK DLAKUKAN PEMERIKSAAN HB HSLNY KNDSI KONJUNGTIVA IBU HML APAKH PERNAH MENDERITA MALARIA SLM HAMIL APAKH PRNH MENDPT KELAMBU IBU HAMIL DGN FAKTOR RESIKO
4 5 1 2 1 2 3 4 1 2 1 2 1 2 1 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 1 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 1 0 0 1 0 0 0 1 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
pnkt yg di drta bumil
periksa hb hasil HB kondisi knjungtiva
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
IBU HAMIL IBU BERSALIN DLM WAKTU 1 THN TERAKHIR IBU NIFASIBU HAMIL DGN FAKTOR RESIKO PRNH KNSMSI TBLET FE SLM HML IMUNISASI TT RNCN PRSLNAN DTLNG OLH ADAKAH IBU BERSALIN PENOLONG PERSALINAN TMP BERSALIN JENIS PERSALINAN ADAKAH IBU NIFAS
3 4 1 2 1 2 1 2 3 4 5 1 2 1 2 1 2 1 2 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0
0
0
0
0
0
0
kondisi knjungtiva
konsumsi fe
imunisasi TT RENCANA PERSALINAN
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
IBU NIFAS IBU MENYUSUIADAKAH IBU NIFAS KUNJUNGN POST PARTUM PEMERIKSAAN IBU NIFAS DI PEMBERIAN VIT .A PERMASALAHN PD IBU NIFAS ADA IBU MENYUSUI LM RNCN IBU MNYUSUI TNP MKNN ATAU SUSU TMBHN APKH PRNH MNDPT PENKES TNTNG
2 1 2 3 4 1 2 3 4 5 1 2 1 2 1 2 1 2 1 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
IBU MENYUSUI KELUARGA BERENCANAAPKH PRNH MNDPT PENKES TNTNG PENGETAHUAN IBU CR MENYUSUI YG BENAR APAKH PUS MJD AKSEPTOR KB JNS KONTRASEPSI YG DIGUNAKN BL BLM MNJD AKSPTR KB ALSAN BL PUS PRNH MNJDI AKSPTR KB DN SAAT INI TDK MNJD AKSPTR KB LG ALSAN
3 4 1 2 1 2 1 2 3 4 5 6 1 2 3 4 5 6 10 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
KELUARGA BERENCANA BAYIBL PUS PRNH MNJDI AKSPTR KB DN SAAT INI TDK MNJD AKSPTR KB LG ALSAN ADA BAYI KBIASAAN KE POSYANDU KPMLKN KARTU MNJU SHT HSL PNMBNGN BAYI USIA PRTMA MMBRI MKNAN BG BAYI YG BUMUR DI ATAS 6 BLN, MKNN YG DKONSUMSI STIAP HRI
2 1 2 1 2 1 2 1 2 3 4 5 1 2 3 1 2 30 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 1 0 1 0 1 0 0 0 0 1 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
BAYIBG BAYI YG BUMUR DI ATAS 6 BLN, MKNN YG DKONSUMSI STIAP HRI APAKAH BYI SDH DI IMUNISASI DASAR APKH JMLH DN JNS IMNSSI SESUAI DNGN USIA BYI BL TDK DIIMUNISASI ALSAN PNYKT YG PRNH DDERITA BAYI APAKH BAYI YG SAKIT SDH DPT PENGOBATAN
4 1 2 1 2 1 2 3 4 5 6 1 2 3 4 5 6 7 1 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
BAYI BALITAAPAKH BAYI SDH MDPTKN VIT.A DOSIS TINGGI (100.000 IU)APAKAH ADA BALITA MLKKN KUNJUNGAN POSYANDU RUTIN BRT DAN TNGGI BDN SESUAI DNGN USIA APAKAH BALITA PERNAH MENDAPAT VIT.A BL YA, RUTIN SETIAP 6 BLN
1 2 1 2 1 2 1 2 1 2 10 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 1 0 1 0 10 0 1 0 1 0 1 0 1 0 11 0 1 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 1 0 1 0 1 0 1 0 10 0 1 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 1 0 1 0 1 0 1 0 10 0 1 0 1 1 1 0 10 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 1 0 1 0 1 0 1 0 10 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 1 0 1 0 1 0 1 0 10 0 0 1 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
BALITABL YA, RUTIN SETIAP 6 BLN PNYKT YG PRNH ATAU SEDNG DDRTA BLTA SETHUN TRAKHR JK YA, APAKH SDH BEROBAT PRKMBNGN SESUAI DGN USIA PENDIDIKAN ANAK ADAKAH PENYIMPANGN PERKEMBGN ANAK JK YA
2 1 2 3 4 5 6 7 8 1 2 1 2 1 2 1 2 1 2 3 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
BALITA ANAK SEKOLAHJK YA ADAKAH PENYIMPANGM PERTUMBUHN JIKA YA ADA ANK SKLH KLHN YG SRNG DRSKN SAAT INI PNYKT YNG PRNH / SDNG DIDERITA APBLA ANK SKT DBWA KE APKH ANAK PRNH SKT GIGI
5 1 2 1 2 3 4 5 1 2 1 2 3 4 1 2 3 4 5 6 7 8 1 2 3 4 5 6 1 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 10 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 10 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 00 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 00 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
ANAK SEKOLAHKEADAAN GIGI ANAK BRP KLI ANAK MNGGSK GIGI KAPAN ANAK ANDA MENGGOSOK GIGI APAKAH KUKU ANAK PENDEK DAN BERSIH APAKAH ANAK KELUARRUMAH MENGGUNAKAN SANDAL APAKAH ANAK SEKOLAH CUCI TANGAN SEBELUM MAKAN
1 2 1 2 3 4 1 2 1 2 1 2 10 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 01 0 0 1 0 0 1 0 1 0 1 0 10 1 0 1 0 0 1 0 1 0 1 0 11 0 0 1 0 0 1 0 0 1 1 0 11 0 0 1 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 01 0 0 1 0 0 1 0 1 0 1 0 10 1 0 1 0 0 1 0 1 0 1 0 10 1 0 1 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 01 0 0 1 0 0 1 0 1 0 1 0 10 0 0 0 0 0 1 0 1 0 1 0 11 0 0 1 0 0 1 0 1 0 1 0 10 1 0 1 0 0 1 0 1 0 1 0 11 0 0 0 0 0 0 0 0 0 0 0 00 1 0 1 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 01 0 0 1 0 0 0 1 1 0 1 0 10 1 0 1 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 01 0 0 1 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 1 0 1 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 1 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
ANAK SEKOLAH REMAJAAPAKAH ANAK SEKOLAH CUCI TANGAN SEBELUM MAKAN ADAKAH PENYIMPANAGAN PERKEMBGN JIKA YA ADAKH PENYIMPANGAN PERTUMBUHN ANAK JIKA YA ADA REMAJA KEGIATAN REMAJA DILUAR SEKOLAH
2 1 2 1 2 3 4 5 6 1 2 1 2 3 4 5 1 2 1 2 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
REMAJA LANSIAKEGIATAN REMAJA DILUAR SEKOLAH PENGGUNAAN WAKTU LUANG KEBIASAAN REMAJA PENYAKIT ATAU SEDANG DIDERITA REMAJA 1 TAHUN TERAKHIR ADA LANSIA KELUHAN LANSIA JENIS PENYAKIT YANG DIDERITA LANSIA PENANGANAN PENYAKIT LANSIA
4 1 2 3 4 1 2 3 1 2 3 4 5 6 1 2 1 2 1 2 3 4 5 6 7 8 1 2 30 1 1 0 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 00 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 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 1 0 00 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
O 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 00 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 00 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 00 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
DATA KESEHATAN LINGKUNGANKONDISI KESEHATAN UMUM
LANSIAPENANGANAN PENYAKIT LANSIA PEMANFAATAN WAKTU LUANG APAKAH ADA POSYANDU LANSIA JIKA YA, IKT POSYANDU JIKA TIDAK, ALASAN
4 5 1 2 3 4 1 2 1 2 1 2 30 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 00 0 0 0 0 1 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 1 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 1 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 1 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 01 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0
SURVEY KESEHATAN MASYARAKAT Nama KK :Alamat ( NO ,RT ,RW) :Desa / Kelurahan :Tangal pengambilan data :NO NAMA MHSSWA
NO NAMA KK MHS UMUR
1 2 3 41 0 0 0 22 0 0 0 03 0 0 0 04 1 0 0 1
2 2 3 73 2 3 10
UMUR SEXS
5 6 7 8 9 L P0 2 0 0 0 1 30 1 1 1 0 2 10 2 0 0 2 3 11 0 2 0 0 3 26 11 10 9 11 2 27 16 13 10 13 11 9
HBNGN DGN KK AGAMA PEKERJAAN
1 2 3 4 5 1 24 0 0 0 0 1 23 0 0 0 0 0 04 0 0 0 0 0 15 0 0 0 0 2 0
PEKERJAAN
3 4 5 6 7 8 9 100 0 0 0 0 0 1 00 0 0 0 3 0 0 00 0 0 1 0 0 1 00 0 0 0 3 0 0 0
PENDIDIKAN
1 2 3 4 5 6 71 0 0 2 1 0 00 0 0 2 1 0 00 0 0 3 1 0 00 2 0 1 2 0 0
PERUMAHANTIPE RMH STATUS KEPEMILIKAN RUMAH JENIS LANTAI
1 2 3 1 2 3 10 1 0 1 0 0 00 1 0 1 0 0 00 1 0 1 0 0 00 1 0 1 0 0 0
LINGKUNGAN FISIK
JENIS LANTAI LUAS JENDELA JENDELA DIBUKA SETIAP HARI2 3 4 1 2 1 20 1 1 1 0 0 10 1 0 0 1 1 00 1 0 0 1 0 10 1 0 1 0 1 0
CAHAYA MATAHARI BERSIHAN DALAM RUMAH VKTR YG BNYK DSKTR RMH1 2 1 2 1 2 31 0 1 0 0 0 01 0 1 0 0 0 01 0 0 1 0 0 00 1 0 1 0 0 0
VKTR YG BNYK DSKTR RMH HLMN SKTR RMH PEMANFAATAN HLMN RMH4 5 6 7 1 2 1 21 0 0 1 1 0 0 11 1 0 1 1 0 1 00 1 0 1 1 0 0 01 0 0 1 1 0 1 1
PEMANFAATAN HLMN RMH SMBR UNTK MSK DN MNM SSTM PNGLHN AIR MNM3 4 5 6 1 2 3 10 0 0 0 1 0 0 11 0 0 0 1 0 0 10 0 1 0 1 0 0 10 0 0 0 1 0 0 1
SUMBER AIR BERSIHSSTM PNGLHN AIR MNM SMBR AIR UNTK MNDI MNCCI JRK SMBR AIR DGN SPTK TNG
2 1 2 3 4 1 20 1 0 0 0 0 10 1 0 0 0 0 10 1 0 0 0 0 10 1 0 0 0 0 1
TMPT PNMPNGN AIR SMNTR TMPT PNMPNGN SMNTR DKRAS KNDS TMPT PNMPNGN AIR1 2 3 1 2 1 21 0 1 1 0 1 01 0 0 1 0 1 00 0 1 0 1 0 10 0 1 0 1 0 1
SISTEM PEMBUANGAN SAMPAHKNDS TMPT PNMPNGN AIR KNDS AIR PMBUANGAN SMPH
1 2 3 4 1 2 30 0 0 1 1 0 10 0 0 1 0 0 00 0 0 1 0 0 10 0 0 1 0 0 1
PMBUANGAN SMPH TMPT PNMPNGN SMPH SMNTR DDLM RMH KNDS TMPT PMBUNGN SMPH SMNTR DDLM RMH4 5 6 1 2 10 0 0 1 0 11 0 0 1 0 10 0 0 1 0 10 0 0 1 0 1
KNDS TMPT PMBUNGN SMPH SMNTR DDLM RMH JRK PMBUNGN SMPH DGN RMH KNDS TMPT PMBUNGN SMPH DLUAR RMH2 1 2 10 1 0 00 1 0 00 0 1 00 0 1 0
SISTEM PEMBUANGAN KOTORAN RUMAH TANGGAKNDS TMPT PMBUNGN SMPH DLUAR RMH KBIASAAN KLRG BUANG AIR BSR JNS JMBN YG DGNKN
2 3 4 1 2 3 10 0 1 1 0 0 10 1 0 1 0 0 10 1 0 1 0 0 10 1 0 1 0 0 1
SISTEM PEMBUANGAN KOTORAN RUMAH TANGGAJNS JMBN YG DGNKN KNDS JMBN SSTM PMBUNGN AIR LMBH KNDS PMBUANGN AIR LMBH
2 1 2 1 2 3 10 1 0 0 1 0 10 1 0 1 0 0 00 0 1 0 1 0 10 0 1 0 1 0 0
HEWAN PELIHARAANKNDS PMBUANGN AIR LMBH KPMLKN HWN TRNK DRMH LTK KNDNG KNDS KNDNG
2 1 2 1 2 10 1 0 0 1 11 1 0 0 1 10 1 0 1 0 11 1 0 0 1 1
KONDISI KESEHATAN UMUM
PELAYANAN KESEHATANKNDS KNDNG SRNA KSHTN YG PLNG DKT TMPT BRBT KLRG
2 1 2 3 4 5 1 20 0 1 1 0 0 0 00 0 2 0 0 0 1 00 0 1 0 0 0 0 00 0 1 0 0 0 0 0
KONDISI KESEHATAN UMUM
TMPT BRBT KLRG KBIASAAN SBLM BRBT SMBR PNDANAAN KSHTN KLRG3 4 5 1 2 3 1 20 1 0 0 0 1 0 00 0 0 0 1 0 0 00 1 0 1 1 0 0 00 1 0 1 0 0 0 0
SMBR PNDANAAN KSHTN KLRG PNYKIT YG SRNG DDRT KLRG DLM 6 BLN TRAKHR3 4 5 1 2 3 4 50 0 1 1 0 0 1 00 1 0 1 0 0 0 10 1 0 1 1 0 0 10 1 0 1 0 0 0 1
IBU HAMILPNYKIT YG SRNG DDRT KLRG DLM 6 BLN TRAKHR ADA IBU HML KHMLN KE 5
6 7 8 1 2 1 2 30 0 0 0 1 0 0 00 0 0 0 1 0 0 00 0 0 0 1 0 0 00 0 0 0 1 0 0 0
KHMLN KE 5 USIA IBU HML USIA KHMLN4 5 1 2 3 1 2 30 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0
TMPT PRKS KHMLN FREK. PRKS KHMLN JK TDK SESUAI DGN UMUR KHMLN ALSN1 2 3 1 2 1 2 30 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0
JK TDK SESUAI DGN UMUR KHMLN ALSN KLHN IBU SAAT HML SAAT INI PNYKT PNYRT YG DDRTA OLH IBU HML4 1 2 3 4 1 2 30 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0
PNYKT PNYRT YG DDRTA OLH IBU HML APKH PRNH DPRKSA HB JK DLKKN PMRKSAAN HB HSLNY4 5 1 2 1 2 30 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 0
JK DLKKN PMRKSAAN HB HSLNY KNDSI KNJNGTVA IBU HML PRNH KNSMSI TBLET FE SLM HML IMUNISASI TT4 1 2 1 2 10 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0
IBU MENETEKIIMUNISASI TT RNCN PRSLNAN DTLNG OLH ADA IBU MENETEKI
2 1 2 3 4 5 1 20 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0 0 1
LM RNCN IBU MNYSUI TNP MKNN ATAU SUSU TMBHN APKH PRNH MNDPT PENKES TNTNG1 2 1 2 30 0 0 0 00 0 0 0 00 0 0 0 00 0 0 0 0
KELUARGA BERENCANNA ( PSNGN PUS )APKH PRNH MNDPT PENKES TNTNG APKH PUS MNJDI AKSPTOR KB JNS KNTRSPSI YG DGNKN
4 1 2 1 2 3 40 1 0 0 0 1 00 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 0
NA ( PSNGN PUS )JNS KNTRSPSI YG DGNKN BL BLM MNJD AKSPTR KB ALSAN
5 6 1 2 3 4 5 60 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0
BAYIBL PUS PRNH MNJDI AKSPTR KB DN SAAT INI TDK MNJD AKSPTR KB LG AL ADA BAYI
1 2 10 0 00 0 00 0 00 0 0
ADA BAYI KBIASAAN KE POSYANDU KPMLKN KTU MNJU SHT HSL PNMBNGN BAYI2 1 2 1 2 10 0 0 0 0 01 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0
HSL PNMBNGN BAYI USIA PRTMA MMBRI MKNAN BG BY YG PREMTUR DI ATAS 6 BLN, MKNN YG DKNSMSI STIAP HR2 3 4 5 1 2 3 10 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0
BG BY YG PREMTUR DI ATAS 6 BLN, MKNN YG DKNSMSI STIAP HRAPAKAH BYI SDH DI IMNSSI DSR2 3 4 5 1 20 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0
APAKAH BYI SDH DI IMNSSI DSRAPKH JMLH DN JNS IMNSSI SESUAI DNGN USIA BY BL TDK DIIMNSSI ALSAN1 2 1 20 0 0 00 0 0 00 0 0 00 0 0 0
BL TDK DIIMNSSI ALSAN PNYKT YG PRNH DDRT BAYI3 4 5 6 1 2 3 40 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0
BALITAPNYKT YG PRNH DDRT BAYI BRT DN TNGGI BDN SESUAI DNGN USIA APKH BLTA PRNH MNDPT VIT. A
5 6 7 1 2 10 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0
APKH BLTA PRNH MNDPT VIT. A BL YA, RTN SETIAP 6 BLPRKMBNGN SESUAI DGN USIA2 1 2 1 20 0 0 0 00 0 0 0 00 0 0 0 00 0 0 0 0
PNYKT YG PRNH ATAU SEDNG DDRTA BLTA SETHUN TRAKHR1 2 3 4 5 6 7 80 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 0
ANAK SEKOLAHADA ANK SKLH KLHN YG SRNG DRSKN SAAT INI PNYKT YNG PRNH / SDNG DDRT
1 2 1 2 3 4 1 21 0 0 0 0 0 0 00 0 0 0 0 0 0 00 0 0 0 0 0 0 01 0 1 0 0 0 1 0
PNYKT YNG PRNH / SDNG DDRT APBLA ANK SKT DBWA KE3 4 5 6 7 8 1 20 0 0 0 0 1 1 00 0 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 1 0 1 0
APBLA ANK SKT DBWA KE APKH ANAK PRNH SKT GIGI KEADAAN GIGI ANAK3 4 5 6 1 2 10 0 0 0 1 0 10 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 1 0 1
KEADAAN GIGI ANAK BRP KLI ANAK MNGGSK GIGI KAPAN ANAK ANDA MENGGOSOK GIGI2 1 2 3 4 1 20 0 1 0 0 1 00 0 0 0 0 0 00 0 0 0 0 0 00 0 1 0 0 1 0
KAPAN ANAK ANDA MENGGOSOK GIGI APAKAH KUKU ANAK PENDEK DAN BERSIH APAKAH ANAK KELUARRUMAH MENGGUNAKAN SANDAL1 2 1 21 0 1 00 0 0 00 0 0 01 0 1 0
APAKAH ANAK KELUARRUMAH MENGGUNAKAN SANDAL APAKAH ANAK SEKOLAH CUCI TANGAN SEBELUM MAKAN1 21 00 00 01 0
REMAJAAPAKAH ANAK SEKOLAH CUCI TANGAN SEBELUM MAKAN KEGIATAN REMAJA DILUAR SEKOLAH PENGGUNAAN WAKTU LUANG
1 2 3 4 1 21 0 1 0 1 00 0 0 0 0 00 0 0 1 1 01 0 0 0 0 0
PENGGUNAAN WAKTU LUANG KEBIASAAN REMAJA PENYAKIT ATAU SEDANG DIDERITA REMAJA 1 TAHUN TERAKHIR3 4 1 2 3 1 2 30 1 0 0 1 1 0 00 0 0 0 0 0 0 00 0 1 0 0 1 0 00 0 0 0 0 0 0 0
LANSIAPENYAKIT ATAU SEDANG DIDERITA REMAJA 1 TAHUN TERAKHIR ADA LANSIA KELUHAN LANSIA
4 5 6 1 2 1 20 0 1 0 0 0 00 0 0 1 0 1 00 0 0 1 0 1 00 0 0 0 0 0 0
JENIS PENYAKIT YANG DIDERITA LANSIA1 2 3 4 5 6 7 80 0 0 0 0 0 0 00 0 1 0 1 0 0 01 0 0 0 1 0 0 00 0 0 0 0 0 0 0
PENANGANAN PENYAKIT LANSIA PEMANFAATAN WAKTU LUANG LANSIA1 2 3 4 5 1 2 30 0 0 0 0 0 0 01 0 1 1 0 1 0 01 0 0 0 0 0 0 10 0 0 0 0 0 0 0
PEMANFAATAN WAKTU LUANG LANSIA APKH ADA SENAM LANSIA SETIAP MINNG APAKAH BB LANSIA DALAM BATAS NORMA4 5 1 2 1 20 0 0 0 0 00 0 0 1 1 01 0 0 1 1 00 0 0 0 0 0
APAKAH BB LANSIA DALAM BATAS NORMA APAKAH ADA POSYANDU LANSIA1 20 01 01 00 0
