Propinsi : Jawa Barat

Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L
1 2 3 4 5 6 7 8
1 Kolera A 00 0 0 0 0 0
2 Diare A 09 0 0 0 0 15
3 Diare Berdarah A 03.9 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 8
21 Sifilis A 51.9 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0
28 AFP 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan

Jumlah Puskesmas Pembantu melapor bulan laporan
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara Suryadi, SKM, M.Kes
NIP. 19661108 198803 1001
 SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
< 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
P L P L P L P L P L
9 10 11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0 0 0
9 19 6 12 7 11 8 5 8 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
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0
2 10 8 3 4 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 9
0 0 0 0 0 0 0 0 0 3
0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
KESMAS

Bulan Januari
Tahun 2021

Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 +
P L P L P L P L P L
19 20 21 22 23 24 25 26 27 28
0 0 0 0 0 0 0 0 0 0
11 0 0 0 0 0 0 0 0 76
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
1 1 0 0 0 2 0 0 0 3
0 1 0 1 0 0 0 0 0 2
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 21
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
35 22 62 13 27 29 17 8 55 81
5 2 12 3 15 2 5 1 6 16
0 0 0 0 0 0 0 0 0 0

Cianjur, 31 Januari 2021

Pengelola Program
Ghina Amalia, SKM
 Total
Total
Kunjung
P an
29 30
0 0
47 118
0 0
0 0
1 4
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
14 35
0 0
0 0
0 0
0 0
0 0
196 277
43 59
0 0
 Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 5 `18
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Deng A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 5 4
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..% )

Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..% )
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..% )

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
 SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
L P L P L P L P L P
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 0 0 0 0
3 7 5 8 2 4 7 5 24 17
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 1 0 0 1 0 0 0 1 0
0 0 0 0 0 0 0 0 9 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 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 0
0 0 0 0 0 0 0 0 0 0
16 9 7 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 0 0 0 0 0 0 0 0
0 0 0 0 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 23
0 0 0 0 0 0 0 0 0 6
0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
S

BULAN: Februari
Tahun 2021

Total
45 - 54 th 55 - 59 th 60 - 69 th 70 +
L P L P L P L P L P
20 21 22 23 24 25 26 27 28 29
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 48 59
0 0 0 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 3 1
0 0 0 0 0 0 0 0 9 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 23
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
10 27 32 50 9 36 3 7 59 136
2 2 3 2 1 0 5 3 23 17
0 0 0 0 0 0 0 0 0 0

Cianjur, 28 Februari 2021

Pengelola Program
Ghina Amalia, SKM
 Total
Kunjung
an
30
0
105
0
0
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
51
0
0
0
0
0
195
40
0
 Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L
1 2 3 4 5 6 7 8
1 Kolera A 00 0 0 0 0 0
2 Diare A 09 0 0 0 0 10
3 Diare Berdarah A 03.9 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0
18 Demam Berdarah Dengue A 91 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 7
21 Sifilis A 51.9 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0
28 AFP 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan

Jumlah Puskesmas Pembantu melapor bulan laporan
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
 SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
< 1 tahun 1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
P L P L P L P L P L
9 10 11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0 0 0
22 2 9 4 12 2 6 9 5 30
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 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 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
0 0 0 0 0 0 0 0 0 0
3 25 12 5 17 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 9
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
ESMAS

BULAN: Maret
Tahun 2021

Total
20 - 44 th 45 - 54 th 55 - 59 th 60 - 69 th 70 +
P L P L P L P L P L
19 20 21 22 23 24 25 26 27 28
0 0 0 0 0 0 0 0 0 0
19 0 0 0 0 0 0 0 0 57
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 37
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 14 30 39 52 7 42 2 5 94
9 3 5 2 3 2 1 7 4 18
0 0 0 0 0 0 0 0 0 0

Cianjur, 31 Maret 2021

Pengelola Program
Ghina Amalia, SKM
 Total
Total
Kunjung
P an
29 30
0 0
73 130
0 0
0 0
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 0
32 69
0 0
0 0
0 0
0 0
0 0
157 251
21 39
0 0
 Propinsi : Jawa Barat
Kabupaten : Cianjur
Puskesmas : Cibaregbeg
Kode
No. Jenis Penyakit ICD 10 0 - 7 hr 8 - 28 hr < 1 tahun
L P L P L P
1 2 3 4 5 6 7 8 9
1 Kolera A 00 0 0 0 0 0 0
2 Diare A 09 0 0 0 0 14 20
3 Diare Berdarah A 03.9 0 0 0 0 0 0
4 Tifus Perut Klinis A 01.4 0 0 0 0 0 0
5 TBC Paru BTA (+) A 15.0 0 0 0 0 0 0
6 Tersangka TBC Paru A 16.0 0 0 0 0 0 0
7 Kusta PB A 30.5 0 0 0 0 0 0
8 Kusta MB A 30.0 0 0 0 0 0 0
9 Campak B 05.9 0 0 0 0 0 0
10 Difteri A 36.9 0 0 0 0 0 0
11 Batuk Rejan A 37.9 0 0 0 0 0 0
12 Tetanus A 35 0 0 0 0 0 0
13 Hepatitis Klinis B 19 0 0 0 0 0 0
14 Malaria Klinis B 54 0 0 0 0 0 0
15 Malaria Vivax B 51.9 0 0 0 0 0 0
16 Malaria Falsiparum B 50.9 0 0 0 0 0 0
17 Malaria Mix B 53.8 0 0 0 0 0 0
18 Demam Berdarah Den A 91 0 0 0 0 0 0
19 Demam Dengue 0 0 0 0 0 0
20 Pneumonia J 18.9 0 0 0 0 5 2
21 Sifilis A 51.9 0 0 0 0 0 0
22 Gonorhoe A 54.9 0 0 0 0 0 0
23 Frambusia A 66 0 0 0 0 0 0
24 Filariasis B 74.9 0 0 0 0 0 0
25 Influenza J 11.1 0 0 0 0 0 0
26 Hypertensi I 10 0 0 0 0 0 0
27 Diabetus Militus E 14 0 0 0 0 0 0
28 AFP 0 0 0 0 0 0

Jumlah Puskesmas Pembantu yang ada Bulan Laporan : ……….. ( ………..%

Jumlah Puskesmas Pembantu melapor bulan laporan : ……….. ( ………..%
Jumlah Puskesmas Pembantu melapor tepat waktu bulan laporan : ……….. ( ………..%

Mengetahui :
Kepala Puskesmas Cibaregbeg
H. Agus Kuswara S, SKM., M.Kes
NIP. 196611108B198803 1 001
 SURVEILANS TERPADU PENYAKIT BERBASIS PUSKESMAS
( KASUS BARU )

Golongan Umur
1 - 4 th 5 - 9 th 10 - 14 th 15 - 19 th 20 - 44 th
L P L P L P L P L P
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 0 0 0 0
4 11 2 10 1 4 8 2 27 19
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 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 0
0 0 0 0 0 0 0 0 0 0
28 10 7 16 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 20
0 0 0 0 0 0 0 0 0 4
0 0 0 0 0 0 0 0 0 0

: ……….. ( ………..% )
: ……….. ( ………..% )
: ……….. ( ………..% )
S

BULAN: April
Tahun 2021

Total
45 - 54 th 55 - 59 th 60 - 69 th 70 +
L P L P L P L P L P
20 21 22 23 24 25 26 27 28 29
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 56 66
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 40 28
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
11 28 30 40 5 33 1 2 52 153
2 7 1 2 1 1 4 6 20 8
0 0 0 0 0 0 0 0 0 0

Cianjur, 31 April 2021

Pengelola Program
Ghina Amalia, SKM
 Total
Kunjung
an
30
0
122
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
68
0
0
0
0
0
175
28
0