2024 Laporan Kesehatan Mata Puskesmas Balongsari-8

Puskesmas : Balongsari
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

NO NAMA PENYAKIT L P L P L
Baru Lama Baru Lama Baru Lama Baru Lama Baru
Jenis Gangguan Penglihatan dan Kebutaan
A
(H00 - H59)
1 Kelainan Refraksi 0 0 0 0 0 0 0 0 0
a. Miopia (Rabun Jauh) / Minus 0 0 0 0 0 0 0 0 0
b. Hypermetropia (Rabun Dekat) / Plus 0 0 0 0 0 0 0 0 0
c. Presbiopia (Gangguan Penglihatan karena 0 0 0 0 0 0 0 0 0
Usia Lanjut)
d. Astigmatisme (Silinder) 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
2 Glaukoma 0 0 0 0 0 0 0 0 0
3 Retinopati Diabetik 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
5 Retinopati of prematurity (ROP) 0 0 0 0 0 0 0 0 0
6 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
c. Jumlah Operasi Katarak 0 0 0 0 0 0 0 0 0
d. Follow up pasca operasi katarak tajam 0 0 0 0 0 0 0 0 0
penglihatan 6/12 - 6/18
e. Follow up pasca operasi katarak tajam 0 0 0 0 0 0 0 0 0
f. Follow up pasca operasi katarak tajam 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
0 0 0 0 0 0 0 0 0
7 Penyakit Mata Lain - lain (Sebutkan)
a. Konjungtivitis 0 0 0 0 0 0 0 0 0
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
f. Retinoblastoma 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
n. Other retinal detachments 0 0 0 0 0 0 0 0 0
o. Disorder of vitreous body 0 0 0 0 0 0 0 0 0
p. Keratitis, unspecified 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 0
b. Anak Sekolah dan Remaja 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
d. Calon Pengantin (Catin) 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
KEGIATAN PROGRAM GANGGUAN MATA
JUMLAH PENDERITA MENURUT GOLONGAN UMUR

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru Lama Baru
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 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
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 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 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 1 0 0 0
0 0 0 1 3 0 0 0 1 0 1 0 2 1
0 0 0 1 3 0 0 1 30 0 31 5 46 5
0 0 0 1 3 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 30 0 31 5 46 5
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : Januari
Tahun : 2024
JUMLAH PENDERITA MENURUT GO
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 3 0 5 0 6 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 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 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 1 0 1 2 0 1 0 0 0 0
0 0 0 0 0 0 0 2 0 0 1 0 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 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 1 1 0 0 0 0 0 0 0 0
0 0 1 0 5 1 7 4 6 1 1 0 13 0
20 3 25 4 32 18 162 21 331 7 88 6 155 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
20 3 25 4 27 0 0 0 0 0 0 0 0 0
0 0 0 0 0 15 160 15 255 6 88 6 154 0
0 0 0 0 1 3 2 3 2 1 0 0 0 0
0 0 0 0 4 0 0 3 74 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
MLAH PENDERITA MENURUT GOLONGAN UMUR
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 8 1
0 0 2 0 3 0 2 0 0 1 1 0 3 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 1 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 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 0 1 0 4 0 4 0 0 0 3 0 7 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 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 1 0 0 0 0 2 3 2
0 0 0 0 1 0 0 0 0 0 0 0 4 2
0 0 1 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 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 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 0 0 0
1 0 0 0 1 0 1 0 0 0 0 0 2 0
1 0 0 0 1 0 3 0 0 0 0 1 2 0
4 0 4 0 11 0 10 0 0 1 4 3 30 6
43 3 81 0 12 1 18 0 0 1 4 35 409 41
0 0 0 0 0 0 0 0 0 0 0 1 3 0
0 0 0 0 0 0 0 0 0 0 0 9 101 9
43 3 81 0 0 0 0 0 0 0 0 21 291 24
0 0 0 0 0 0 0 0 0 0 0 4 2 3
0 0 0 0 0 0 0 0 0 0 0 0 0 3
0 0 0 0 12 1 18 0 0 1 4 0 12 2
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
P TOTAL KETERANGAN NO
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
18 8 19 27 8 19 27
5 3 6 9 3 6 9
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0
0 1 0 1 1 0 1 2
0 0 0 0 0 0 0 3
1 1 1 2 0 0 0 4
0 0 0 0 0 0 0 5
6
10 7 10 17 7 10 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
7
2 5 4 9 0 0 0
1 4 3 7 0 0 0
1 1 1 2 1 1 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
2 0 2 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
1 0 1 1 0 0 0
0 1 0 1 1 0 1
1 0 1 1 0 0 0
0 0 0 0 0 0 0
1 2 1 3 0 0 0
5 3 5 8 1 0 1
43 33 49 82 21 36 57
672 444 713 1157 28 38 66 B

0 4 0 4 0 0 0
78 110 87 197 4 5 9
490 312 514 826 12 24 36
3 6 6 12 0 0 0
79 0 82 82 0 0 0
22 12 24 36 12 9 21
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
0-7 hari 8-28 hari >29-1 thn 1-4 thn 5-9 thn
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Kelainan Refraksi 0 0 0 0 0 0 0 0 0
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Retinopati Diabetik 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Retinopati of prematurity (ROP) 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
Penyakit Mata Lain - lain (Sebutkan)
b. Hordiolum 0 0 0 0 0 0 2 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 4 0 1
Skrining / Deteksi Dini Gangguan Penglihatan

a. Balita 0 0 0 0 0 0 4 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
P L P L P L P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 1 1 1 3 5 6 0 9 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 2 3 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 1 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 1 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 2 3 1 4 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 0 0 0 0 0 0 0
0 0 0 0 1 1 2 1 0 0 0 1 1 0
0 0 0 0 0 0 2 1 1 0 0 1 0 0
0 0 0 0 0 1 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
1 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 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 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 1 0 1 1 0
1 0 0 0 1 1 0 0 0 1 0 1 3 0
1 2 1 1 5 8 10 2 13 4 4 11 10 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 51 25 28 31 0 0 0 0 0 0 0 0 0
0 0 0 0 0 175 270 94 160 43 84 0 0 0
0 0 0 0 1 5 5 1 0 0 0 0 0 0
0 0 0 0 4 0 77 0 1 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 12 19 0
Mengetahui,
Kepala Puskesmas,
Januari
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 0 1 8 18 8 19 27
2 0 1 3 5 3 6 9
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 1 0 1 0 1
0 0 0 0 0 0 0 0
0 0 0 1 1 0 0 0
0 0 0 0 0 0 0 0
3 0 0 7 10 7 10 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 2 2 3 2 0 0 0
0 0 2 4 1 0 0 0
0 0 0 1 1 1 1 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 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 1 0 0 0
0 1 0 0 0 1 0 1
0 0 0 0 1 0 0 0
0 0 0 0 0 0 0 0
0 0 0 2 1 0 0 0
0 1 0 2 5 1 0 1
5 3 6 30 43 21 36 57
0 1 0 3 0 0 0 0
0 9 9 101 78 4 5 9
0 21 24 291 490 12 24 36
0 4 3 2 3 0 0 0
0 0 3 0 79 0 0 0
5 0 2 12 22 12 9 21
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
Usia Lanjut)
0 0 0 0 0 0 0 0 0
2 Glaukoma 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
6 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
0 0 0 0 0 0 0 0 0
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. epifora 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 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 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 1 2 0 0 0 2 0 0 0 0 0
0 0 0 1 5 0 1 3 29 0 18 2 36 1
0 0 0 1 5 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 3 29 0 18 2 36 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
Bulan : Februari
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 1 1 1 6 0 4 0 6 1 0 0 4 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 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
1 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 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 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 5 1 0 0 0 0 2 0
1 1 0 0 0 0 1 0 2 0 0 0 1 0
0 0 0 0 1 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 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 1 0 0 0
0 0 0 0 1 0 0 0 0 0 1 0 1 0
0 0 0 0 1 0 1 0 0 0 2 0 1 0
4 2 1 1 9 1 11 1 9 2 2 0 11 1
36 3 27 2 41 24 157 15 248 5 61 7 138 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 3 25 2 36 0 0 0 0 0 0 0 0 0
0 0 0 0 0 19 152 12 189 5 61 7 138 2
0 0 2 0 0 5 5 2 5 0 0 0 0 0
0 0 0 0 5 0 0 1 54 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 2 0 0 2 9 1
1 0 2 0 6 0 6 0 0 0 0 1 7 0
0 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 1 0 2 0 0 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
2 0 1 0 8 0 5 0 0 0 4 1 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 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 2 0 0 0 0 2 6 1
0 0 0 0 0 0 0 0 0 0 0 1 1 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 0 0 0
0 0 0 0 0 0 0 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 1 0
0 0 0 0 0 0 2 0 0 0 0 0 1 0
0 0 0 0 0 0 2 0 0 0 0 0 4 0
3 0 5 0 16 0 17 0 2 0 4 7 39 2
39 1 76 0 47 0 101 0 16 0 8 40 417 26
0 0 0 0 0 0 0 0 0 0 0 1 5 0
0 0 0 0 0 0 0 0 0 0 0 8 90 3
39 1 76 0 0 0 0 0 0 0 0 26 252 20
0 0 0 0 0 0 0 0 0 0 0 5 7 2
0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 47 0 101 0 16 0 8 0 63 0
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
18 11 19 30 11 19 30
8 8 8 16 8 8 16
3 0 3 3 0 3 3
0 0 0 0 0 0 0
0 0
1 2 1 3 2 1 3 2
0 0 0 0 0 0 0 3
2 0 2 2 0 2 2 4
0 0 0 0 0 0 0 5
6
11 11 11 22 11 11 22
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
7
5 8 6 14 0 0 0
4 2 4 6 0 0 0
3 0 3 3 0 3 3
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 2 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 1 0 1 0 0 0
4 1 4 5 0 0 0
4 4 4 8 0 0 0
59 46 61 107 32 47 79
667 457 693 1150 32 47 79 B

1 6 1 7 0 0 0
90 98 93 191 4 11 15
403 278 423 701 10 19 29
5 12 7 19 0 0 0
59 0 60 60 0 0 0
109 63 109 172 18 17 35
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 1 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. epifora 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 1 0 0
JUMLAH TOTAL 0 0 0 0 0 0 3 0 2

a. Balita 0 0 0 0 0 0 6 1 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 2 2 7 4 6 1 4 0 0 0 0 2
0 0 0 0 0 0 0 0 0 2 2 6 6 0
0 0 0 0 0 0 0 0 1 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 1 2 0 0
0 0 0 0 0 0 0 0 0 0 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 0 0 0 0
0 0 0 0 0 0 0 1 1 2 1 8 5 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 6 1 0 2 0 0 0 2 0
0 0 1 1 0 1 2 0 1 0 0 0 0 0
0 0 0 0 1 0 0 0 1 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 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 1 1 0 0 0 2 0
0 0 0 0 1 1 0 2 1 0 0 0 2 0
0 0 4 3 10 12 10 4 11 4 5 16 17 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0
18 38 37 28 38 0 0 0 0 0 0 0 0 0
0 0 0 0 0 171 201 66 145 41 77 0 0 0
0 0 0 2 0 10 7 0 0 0 0 0 0 0
0 0 0 0 5 0 55 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 47 101 16
Mengetahui,
Kepala Puskesmas,
Februari
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 2 1 9 18 11 19 30
0 1 0 7 8 8 8 16
0 0 0 0 3 0 3 3
0 0 0 0 0 0 0 0
0 0 0 2 1 2 1 3
0 0 0 0 0 0 0 0
0 0 0 0 2 0 2 2
0 0 0 0 0 0 0 0
4 1 0 10 11 11 11 22
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 2 1 6 5 0 0 0
0 1 0 1 4 0 0 0
0 0 0 0 3 0 3 3
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 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 1 0 0 0 0
0 0 0 1 4 0 0 0
0 0 0 4 4 0 0 0
4 7 2 39 59 32 47 79
0 1 0 5 1 0 0 0
0 8 3 90 90 4 11 15
0 26 20 252 403 10 19 29
0 5 2 7 5 0 0 0
0 0 1 0 59 0 0 0
8 0 0 63 109 18 17 35
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
Usia Lanjut)
0 0 0 0 0 0 0 0 0
2 Glaukoma 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
6 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
0 0 0 0 0 0 0 0 0
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. Ablasio retina 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 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 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 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 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 2 0 2 0 0 1 0 0
0 0 0 1 0 0 5 3 20 0 25 3 28 2
0 0 0 1 0 0 5 0 0 0 0 0 0 0
0 0 0 0 0 0 0 3 20 0 25 3 28 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
Bulan : Maret
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 1 0 1 0 5 1 5 0 5 0 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 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 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 1 0 0 0 0 0 0 0
1 0 0 0 1 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 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 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 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 1 0 0 0 0 1 2 0 1 0 4 0
0 0 1 0 0 0 0 1 3 0 1 0 5 0
2 0 2 0 2 0 6 2 9 0 6 0 12 0
24 2 26 1 38 11 142 15 281 6 93 7 125 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 1 26 1 33 0 0 0 0 0 0 0 0 0
0 0 0 0 0 10 133 10 201 5 93 7 125 1
0 1 0 0 0 1 5 5 9 1 0 0 0 0
0 0 0 0 5 0 4 0 71 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 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 11 1
0 0 1 0 0 0 2 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 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
1 0 1 0 3 0 2 0 0 0 3 0 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 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 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 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 1 0 0 0 0 0 0 0 0 0 0 0
1 0 0 0 1 0 0 0 0 0 0 0 4 1
1 0 1 0 1 0 0 0 0 0 0 0 4 1
2 0 3 0 4 0 5 0 0 0 4 1 22 2
66 2 73 2 92 3 159 0 4 0 5 29 471 30
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 7 74 3
66 2 73 0 0 0 0 0 0 0 0 16 292 19
0 0 0 0 0 0 0 0 0 0 0 3 5 5
0 0 0 0 0 0 0 0 0 0 0 0 4 0
0 0 0 2 92 3 159 0 4 0 5 2 96 3
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
11 12 12 24 12 12 24
4 0 4 4 0 4 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0
2 0 2 2 0 2 2 2
0 0 0 0 0 0 0 3
1 0 1 1 0 1 1 4
0 0 0 0 0 0 0 5
6
6 4 6 10 4 6 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
7
0 2 0 2 0 0 0
6 0 6 6 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 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 1 1 0 1
0 0 0 0 0 0 0
1 0 1 1 0 1 1
0 0 0 0 0 0 0
1 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 0 0 0
0 0 0 0 0 0 0
1 0 1 1 0 1 1
6 4 7 11 0 0 0
9 4 10 14 0 2 2
39 23 41 64 17 27 44
735 500 765 1265 17 27 44 B

5 1 5 6 0 0 0
82 81 85 166 3 2 5
399 308 418 726 11 16 27
9 8 14 22 0 0 0
76 4 76 80 0 0 0
164 98 167 265 3 9 12
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 2 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 1
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. Ablasio retina 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 2 2

a. Balita 0 0 0 0 0 0 1 5 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 1 1 1 1 5 6 5 4 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 1 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 1 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 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 1 1 3 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 1 0 0 0 0 0 0 0 0
0 0 1 0 1 0 1 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 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 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 1 0 0 0
0 0 0 1 0 0 3 1 4 1 0 1 0 0
0 0 0 1 0 0 4 1 5 1 1 1 0 0
0 1 2 2 2 6 11 6 12 2 3 4 5 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 31 26 27 34 0 0 0 0 0 0 0 0 0
0 0 0 0 0 143 211 98 132 67 75 0 0 0
0 0 0 1 0 6 14 1 0 0 0 0 0 0
0 0 0 0 5 4 71 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 94 162 4
Mengetahui,
Kepala Puskesmas,
Maret
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 1 1 11 11 12 12 24
1 0 0 0 4 0 4 4
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 2 0 2 2
0 0 0 0 0 0 0 0
0 0 0 0 1 0 1 1
0 0 0 0 0 0 0 0
3 0 0 4 6 4 6 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 2 0 0 0 0
0 0 0 0 6 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 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 1 0 1
0 0 0 0 0 0 0 0
0 0 0 0 1 0 1 1
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 1 0 1 1
0 0 1 4 6 0 0 0
0 0 1 4 9 0 2 2
4 1 2 22 39 17 27 44
0 1 0 0 5 0 0 0
0 7 3 74 82 3 2 5
0 16 19 292 399 11 16 27
0 3 5 5 9 0 0 0
0 0 0 4 76 0 0 0
5 2 3 96 164 3 9 12
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
Usia Lanjut)
0 0 0 0 0 0 0 0 0
2 Glaukoma 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
4 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. ablasi retina 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 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
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 1 0 1 0 0 0
0 0 0 0 0 0 0 0 1 0 1 1 0 0
0 0 0 2 18 1 11 6 42 1 33 8 39 4
0 0 0 2 18 1 11 0 0 0 0 0 0 0
0 0 0 0 0 0 0 6 42 1 33 8 39 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
Bulan : April
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 1 0 1 0 1 0 3 1 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 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 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 1 1 0 0 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 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 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 1 0 0 0
0 0 0 0 1 0 1 0 0 0 0 0 2 0
0 0 0 0 1 0 1 0 0 0 3 0 2 0
2 0 0 0 4 1 3 0 1 1 7 1 7 0
36 17 43 7 63 37 154 44 489 10 57 7 160 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 17 43 7 58 0 0 0 0 0 0 0 0 0
0 0 0 0 0 28 149 31 345 10 56 7 160 0
0 0 0 0 1 9 5 0 14 0 1 0 0 0
0 0 0 0 4 0 0 13 130 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 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 4 1
1 0 1 0 2 0 0 0 0 0 0 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 0 0 0 2 0 1 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 2 0 3 0 3 0 6 1 5 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 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 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 0 0
0 0 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 0 0 0 0 0 1 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 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 2 0
1 0 1 0 1 0 1 0 0 0 1 0 3 0
2 0 1 0 1 0 2 0 0 0 1 0 8 0
3 0 2 0 6 0 5 0 5 0 8 3 25 1
34 1 93 2 109 0 183 1 83 0 93 83 579 65
0 0 0 0 0 0 0 0 0 0 0 2 18 1
0 0 0 0 0 0 0 0 0 0 0 31 124 12
34 1 93 0 0 0 0 0 0 0 0 38 239 39
0 0 0 0 0 0 0 0 0 0 0 9 6 0
0 0 0 0 0 0 0 0 0 0 0 0 0 13
0 0 0 2 109 0 183 1 83 0 93 3 192 0
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
7 5 8 13 5 8 13
1 3 1 4 3 1 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0
1 3 1 4 3 1 4 2
0 0 0 0 0 0 0 3
1 0 1 1 0 1 1 4
0 0 0 0 0 0 0 5
4
9 6 9 15 6 9 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
7
1 3 1 4 0 0 0
2 0 2 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 1 0 1 0 0 0
0 0 0 0 0 0 0
1 1 1 2 1 1 2
0 1 0 1 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 2 0 2 2 0 2
7 3 7 10 0 0 0
8 8 8 16 3 1 4
30 28 31 59 20 21 41
1161 662 1226 1888 20 21 41 B

11 20 12 32 0 0 0
127 155 139 294 1 2 3
598 277 637 914 9 8 17
15 15 15 30 0 0 0
134 0 147 147 0 0 0
276 195 276 471 10 11 21
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 1
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. ablasi retina 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 1
JUMLAH TOTAL 0 0 0 0 0 0 0 0 1

a. Balita 0 0 0 0 0 0 20 12 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 1 2 0 1 1 1 3 4 0 0 0 0 0
0 0 0 0 0 0 0 0 0 1 1 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 1 0 2
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 1 0 0 0 2 3 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 2 0 1 1 0 0 0 0 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 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 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 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 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 1 0 0 0 0
1 0 0 0 1 1 0 0 2 1 1 1 1 0
1 0 0 0 1 1 0 3 2 2 1 1 2 0
1 1 2 0 4 4 1 8 8 3 2 6 5 5
0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 47 40 60 65 0 0 0 0 0 0 0 0 0
0 0 0 0 0 177 376 66 167 34 94 0 0 0
0 0 0 0 1 14 14 1 0 0 0 0 0 0
0 0 0 0 4 0 143 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 111 183 84
Mengetahui,
Kepala Puskesmas,
April
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 1 1 4 7 5 8 13
0 0 0 3 1 3 1 4
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
1 0 0 3 1 3 1 4
0 0 0 0 0 0 0 0
0 0 0 0 1 0 1 1
0 0 0 0 0 0 0 0
6 1 0 5 9 6 9 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 1 0 2 1 0 0 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 1 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 1 1 1 1 2
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 2 0 2 0 2
1 0 0 3 7 0 0 0
1 0 0 8 8 3 1 4
8 3 1 25 30 20 21 41
0 2 1 18 11 0 0 0
0 31 12 124 127 1 2 3
0 38 39 239 598 9 8 17
0 9 0 6 15 0 0 0
0 0 13 0 134 0 0 0
93 3 0 192 276 10 11 21
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
Usia Lanjut)
0 0 0 0 0 0 0 0 0
2 Glaukoma 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
6 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. stenosis 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 26 1 25
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 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 0 6
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 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 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 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 32 1 31
0 0 0 0 2 0 1 3 31 1 27 213 27 172
0 0 0 0 2 0 1 0 0 0 0 0 0 0
0 0 0 0 0 0 0 3 31 1 27 213 27 172
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : Mei
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 1 1 0 8 0 0 0 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 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 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 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 1 0
0 0 0 0 0 0 0 0 1 0 0 0 1 0
0 0 0 0 0 1 1 0 11 0 0 0 9 0
22 4 27 2 39 17 134 27 344 4 52 15 166 7
0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 4 26 1 36 0 0 0 0 0 0 0 0 0
0 0 0 0 0 10 125 20 254 4 52 15 165 7
0 0 1 1 0 7 9 2 12 0 0 0 1 0
1 0 0 0 3 0 0 5 78 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 3 0 0 0 0 0 0 0 0 27 2 25
0 0 0 0 2 0 2 0 1 0 0 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 5 0 6
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0
0 0 0 1 4 1 2 0 1 0 0 1 5 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 1 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 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 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 0 1 0 0 0 1 0 0 0
0 0 1 0 0 0 1 0 0 0 1 0 0 0
0 0 5 1 6 1 5 0 2 0 2 34 11 32
53 8 95 2 67 10 149 0 56 3 79 250 449 238
0 0 0 0 0 0 0 0 0 0 0 0 2 0
0 0 0 0 0 0 0 0 0 0 0 220 84 174
53 8 95 0 0 0 0 0 0 0 0 21 230 43
0 0 0 0 0 0 0 0 0 0 0 7 10 3
0 0 0 0 0 0 0 0 0 0 0 0 0 5
0 0 0 2 67 10 149 0 56 3 79 2 123 13
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
19 29 44 73 3 19 22
2 3 2 5 3 2 5
0 0 0 0 0 0 0
0 5 6 11 0 0 0
0 0
0 0 0 0 0 0 0 2
0 0 0 0 0 0 0 3
3 0 3 3 0 3 3 4
0 0 0 0 0 0 0 5
6
2 6 3 9 6 3 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
7
1 1 1 2 0 0 0
0 1 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
1 0 1 1 0 1 1
4 0 4 4 0 3 3
5 0 5 5 0 4 4
32 45 64 109 12 31 43
922 699 1160 1859 13 33 46 B

1 2 1 3 0 0 0
84 304 258 562 1 0 1
514 251 557 808 3 25 28
13 17 16 33 0 0 0
82 0 87 87 0 0 0
228 125 241 366 9 8 17
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 1 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. stenosis 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 1 0 0

a. Balita 0 0 0 0 0 0 2 1 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 27 25 0 0 2 8 0 8 0 3 0 0 0
0 0 0 0 0 0 0 0 0 0 0 2 2 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 5 6 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 2 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 5 3 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 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 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 1 0 1 0 0 0 1 0
0 0 0 0 0 0 1 0 1 0 1 0 1 0
0 33 31 0 0 2 11 0 9 0 5 7 6 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 240 193 30 37 0 0 0 0 0 0 0 0 0
0 0 0 0 0 135 274 56 180 60 103 0 0 0
0 0 0 1 1 16 14 0 1 0 0 0 0 0
0 0 1 0 3 0 83 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 69 159 56
Mengetahui,
Kepala Puskesmas,
Mei
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 27 25 2 19 3 19 22
0 0 0 3 2 3 2 5
0 0 0 0 0 0 0 0
0 5 6 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 3 0 3 3
0 0 0 0 0 0 0 0
0 1 1 5 2 6 3 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
1 1 0 0 1 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 0 0 1 0 1 1
1 0 0 0 4 0 3 3
1 0 0 0 5 0 4 4
2 34 32 11 32 12 31 43
0 0 0 2 1 0 0 0
0 220 174 84 84 1 0 1
0 21 43 230 514 3 25 28
0 7 3 10 13 0 0 0
0 0 5 0 82 0 0 0
82 2 13 123 228 9 8 17
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
Usia Lanjut)
0 0 0 0 0 0 0 0 0
2 Glaukoma 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
6 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
0 0 0 0 0 0 0 0 0
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s.ablasio retina 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 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 1 0
0 0 0 0 0 0 0 0 1 0 0 0 1 1
0 0 0 0 0 0 0 0 1 0 0 0 1 1
0 0 0 0 0 0 0 3 19 1 22 204 29 182
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 3 19 1 22 204 29 182
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : Juni
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 1 0 0 0 2 0 2 0 2 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 1 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 1 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 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 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 3 0 0 0 0 0 1 0 0 0 2 0
0 1 3 0 0 0 0 0 2 0 0 0 3 0
1 1 4 0 0 0 3 0 4 0 2 0 10 0
31 113 72 103 77 39 129 36 263 10 69 5 141 3
0 0 0 0 0 0 0 0 0 0 0 0 0 0
31 112 72 103 72 0 0 0 0 0 0 0 0 0
0 0 0 0 0 36 123 22 196 10 69 5 141 3
0 1 0 0 0 3 6 3 9 0 0 0 0 0
0 0 0 0 5 0 0 11 58 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 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 0
1 0 1 0 2 0 0 0 0 0 0 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 0 1 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 1 0 3 0 3 0 0 0 3 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 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 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 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 1 0 0 0 0 0 0 0 0 0 0 0
1 0 0 0 0 0 0 0 0 0 0 1 6 0
1 0 1 0 0 0 0 0 0 0 0 1 6 1
2 0 3 0 7 0 4 0 0 0 4 1 20 1
39 2 65 1 86 2 155 0 2 0 5 373 445 331
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 319 120 286
39 2 65 0 0 0 0 0 0 0 0 49 231 29
0 0 0 0 0 0 0 0 0 0 0 4 6 3
0 0 0 0 0 0 0 0 0 0 0 0 0 11
0 0 0 1 86 2 155 0 2 0 5 1 88 2
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
6 5 6 11 5 6 11
1 3 1 4 3 1 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0
1 1 1 2 1 1 2 2
0 0 0 0 0 0 0 3
0 0 0 0 0 0 0 4
0 0 0 0 0 0 0 5
6
10 3 10 13 3 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
7
0 1 0 1 0 0 0
0 1 0 1 0 0 0
2 0 2 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
1 0 1 1 0 0 0
0 0 0 0 0 0 0
1 0 2 2 0 2 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
1 0 1 1 0 1 1
3 7 3 10 0 3 3
6 7 7 14 0 6 6
26 21 27 48 12 24 23
759 818 1,090 1,908 17 30 47 B

0 0 0 0 0 0 0
125 439 411 850 3 1 4
402 280 431 711 8 21 29
9 10 12 22 0 0 0
63 0 74 74 0 0 0
160 89 162 251 6 8 14
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s.ablasio retina 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 1
dll 0 0 0 0 0 0 0 0 1
JUMLAH TOTAL 0 0 0 0 0 0 0 0 1

a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 1 0 2 2 2 3 0 0 0 0 0
0 0 0 0 0 0 0 0 0 1 1 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 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 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 3 0 1 3 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 1 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 1 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 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 1 0 0 0
0 1 0 4 0 0 1 0 2 1 0 0 0 0
0 1 1 4 0 0 2 0 3 1 1 0 0 0
0 1 2 5 0 3 4 2 10 2 3 7 4 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
23 233 213 184 175 0 0 0 0 0 0 0 0 0
0 0 0 0 0 159 218 79 146 42 67 0 0 0
0 0 0 1 0 9 12 0 0 0 0 0 0 0
0 0 0 0 5 0 69 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 87 157 2
Mengetahui,
Kepala Puskesmas,
Juni
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 0 0 5 6 5 6 11
0 0 0 3 1 3 1 4
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 1 1 1 1 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
3 0 0 3 10 3 10 13
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 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 1 0 0 0 0
1 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 1 0 0 0
0 0 0 0 0 0 0 0
0 0 1 0 1 0 2 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 1 0 1 1
0 1 0 6 3 0 3 3
0 1 1 6 6 0 6 6
4 1 1 20 26 12 24 36
0 0 0 0 0 0 0 0
0 319 286 120 125 3 1 4
0 49 29 231 402 8 21 29
0 4 3 6 9 0 0 0
0 0 11 0 63 0 0 0
5 1 2 88 160 6 8 14
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
Usia Lanjut)
0 0 0 0 0 0 0 0 0
2 Glaukoma 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
6 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
0 0 0 0 0 0 0 0 0
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. Ablasio retina lainnya 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 2
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 3 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 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 0 0 0 0 0 0 0 1 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 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 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 1 0 0 0 0 0
1 0 0 0 0 0 0 0 2 0 1 0 4 1
1 4 0 18 58 15 58 9 50 7 37 9 39 8
1 4 0 18 58 15 58 0 0 0 0 0 0 0
0 0 0 0 0 0 0 9 50 7 37 9 39 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
Bulan : Juli
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 1 3 1 6 0 1 1 14 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0
1 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
0 0 0 0 0 0 0 0 0 1 2 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 1 0
0 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 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 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 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 1 0 0 1 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 1 0 0 0 0 0 0
0 0 0 0 0 0 3 0 0 0 2 0 1 0
0 0 0 1 1 0 4 2 0 0 3 0 1 0
3 1 3 2 7 1 7 3 14 1 6 0 8 0
36 20 38 13 51 51 142 81 357 6 66 13 135 4
0 0 0 0 0 0 0 0 0 0 0 0 0 0
36 20 37 13 47 0 0 0 0 0 0 0 0 0
0 0 0 0 0 43 137 64 281 6 66 12 134 4
0 0 1 0 1 8 5 7 6 0 0 1 1 0
0 0 0 0 3 0 0 10 70 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 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 7 3
0 0 0 0 1 0 1 0 4 0 2 0 5 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 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 0
0 0 0 0 0 0 0 0 0 0 0 0 2 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 4 0 3 0 2 0 2 1 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 1 0 0 0 0 0 0 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0 1 2 0
0 0 2 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 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 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 1 0 0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 1 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 1 0 0 0 0 0 0 0
1 0 0 0 0 0 0 0 0 0 0 0 1 1
0 0 0 0 0 0 0 0 0 0 0 0 5 0
1 0 1 0 0 0 2 0 0 0 0 0 9 3
1 0 5 0 5 0 7 0 6 0 5 3 35 6
36 3 63 11 86 27 154 4 62 12 82 134 578 183
0 0 0 0 0 0 0 0 0 0 0 20 59 19
0 0 0 0 0 0 0 0 0 0 0 38 126 28
36 3 63 0 0 0 0 0 0 0 0 53 239 79
0 0 0 0 0 0 0 0 0 0 0 8 6 8
0 0 0 0 0 0 0 0 0 0 0 0 0 10
0 0 0 11 86 27 154 4 62 12 82 15 148 39
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
22 8 25 33 8 25 33
7 5 7 12 5 7 12
0 0 0 0 0 0 0
0 0 0 0 0 0 0
1 0 1 1 0 1 1 2
0 0 0 0 0 0 0 3
1 2 1 3 2 1 3 4
0 0 0 0 0 0 0 5
6
8 9 8 17 9 8 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
7
2 1 2 3 0 1 1
1 3 1 4 3 1 4
3 0 3 3 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 1 0 1 1 0 1
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 2 0 2 0 0 0
1 0 1 1 0 1 1
0 0 0 0 0 0 0
1 1 2 3 1 2 3
1 0 2 2 0 0 0
0 0 0 0 0 0 0
1 0 1 1 0 0 0
0 1 1 2 1 1 2
1 5 1 6 4 1 5
5 9 8 17 0
50 38 56 94 34 49 83
973 712 1156 1868 34 52 86 B

58 79 77 156 0 0 0
120 164 148 312 8 13 21
478 292 557 849 14 29 43
8 14 16 30 0 0 0
73 0 83 83 0 0 0
236 163 275 438 12 10 22
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 1
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 1
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. Ablasio retina lainnya 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 1
JUMLAH TOTAL 0 0 0 0 1 0 0 0 2

a. Balita 0 0 0 0 3 4 76 73 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 3 3 4 7 1 15 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 4 0 0 1 1 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 1 0 0 1 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 3 2 0 1 4 3 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 1 0 1 0 0 0
1 1 0 0 0 2 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 2 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 1 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 1 1 0 0 1 0 0 0
0 0 0 0 1 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 1 0
0 0 0 0 0 0 1 0 0 1 0 0 0 0
0 0 0 0 0 3 0 2 1 0 0 0 0 0
0 0 0 0 2 4 2 3 1 1 1 0 2 0
1 4 4 4 9 8 17 7 8 1 5 5 7 6
0 0 0 0 0 0 0 0 0 0 0 0 0 0
44 48 44 57 60 0 0 0 0 0 0 0 0 0
0 0 0 0 0 180 345 72 146 40 66 0 0 0
0 0 0 1 1 13 13 0 2 0 0 0 0 0
0 0 0 0 3 0 80 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 97 181 66
Mengetahui,
Kepala Puskesmas,
Juli
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 1 3 7 22 8 25 33
2 0 0 5 7 5 7 12
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
1 0 0 0 1 0 1 1
0 0 0 0 0 0 0 0
0 0 0 2 1 2 1 3
0 0 0 0 0 0 0 0
2 1 0 8 8 9 8 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 1 2 0 1 1
0 1 0 2 1 3 1 4
0 0 0 0 3 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 1 0 1 0 1
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 2 0 0 0 0
0 0 0 0 1 0 1 1
0 0 0 0 0 0 0 0
0 0 1 1 1 1 2 3
0 0 1 0 1 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 1 0 0 0
0 0 1 1 0 1 1 2
0 0 0 5 1 4 1 5
0 0 3 9 5 0 0 0
5 3 6 35 50 34 49 83
0 20 19 59 58 0 0 0
0 38 28 126 120 8 13 21
0 53 79 239 478 14 29 43
0 8 8 6 8 0 0 0
0 0 10 0 73 0 0 0
94 15 39 148 236 12 10 22
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
1 Kelainan Refraksi
a. Miopia (Rabun Jauh) / Minus
b. Hypermetropia (Rabun Dekat) / Plus
c. Presbiopia (Gangguan Penglihatan karena
Usia Lanjut)
d. Astigmatisme (Silinder)
2 Glaukoma
3 Retinopati Diabetik
4 Low Vision
5 Retinopati of prematurity (ROP)
6 Katarak
a. Katarak > 3/60
b. Katarak ≤ 3/60
c. Jumlah Operasi Katarak
d. Follow up pasca operasi katarak tajam
e. Follow up pasca operasi katarak tajam
f. Follow up pasca operasi katarak tajam
penglihatan < 6/60
a. Konjungtivitis
b. Hordiolum
c. Pterigium
d. Pseudofakia
e. Xeroftalmi
f. Retinoblastoma
g. Gonoblenore
h. Trachoma
i. Strabismus
j. Papilloedema
k. Pterygium
l. Bleparitis
m. chalazion
n. Other retinal detachments
o. Disorder of vitreous body
p. Keratitis, unspecified
q. corneal ulcer
r. scleritis
s.
t.dll
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita
b. Anak Sekolah dan Remaja
c. Dewasa
d. Calon Pengantin (Catin)
e. Ibu Hamil (Bumil)
f. Lansia
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : Agustus
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui, Surabaya, 26 Juni 2024
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
, 26 Juni 2024
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
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 2
0 0 0 0 0 3
0 0 0 0 0 4
0 0 0 0 0 5
6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 B
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0

a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
Agustus
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 2 2 4
0 0 0 0 0 6 3 9
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 2 3 5
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
1 Kelainan Refraksi
Usia Lanjut)
2 Glaukoma
4 Low Vision
6 Katarak
a. Katarak > 3/60
b. Katarak ≤ 3/60
penglihatan < 6/60
a. Konjungtivitis
b. Hordiolum
c. Pterigium
d. Pseudofakia
e. Xeroftalmi
f. Retinoblastoma
g. Gonoblenore
h. Trachoma
i. Strabismus
j. Papilloedema
k. Pterygium
l. Bleparitis
m. chalazion
q. corneal ulcer
r. scleritis
s.
t.dll
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita
c. Dewasa
f. Lansia
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : September
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
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 2
0 0 0 0 0 3
0 0 0 0 0 4
0 0 0 0 0 5
6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 B
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0

a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
September
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
1 Kelainan Refraksi
Usia Lanjut)
2 Glaukoma
4 Low Vision
6 Katarak
a. Katarak > 3/60
b. Katarak ≤ 3/60
penglihatan < 6/60
a. Konjungtivitis
b. Hordiolum
c. Pterigium
d. Pseudofakia
e. Xeroftalmi
f. Retinoblastoma
g. Gonoblenore
h. Trachoma
i. Strabismus
j. Papilloedema
k. Pterygium
l. Bleparitis
m. chalazion
q. corneal ulcer
r. scleritis
s.
t.dll
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita
c. Dewasa
f. Lansia
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : Oktober
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
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 2
0 0 0 0 0 3
0 0 0 0 0 4
0 0 0 0 0 5
6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 B
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0

a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
Oktober
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
1 Kelainan Refraksi
Usia Lanjut)
2 Glaukoma
4 Low Vision
6 Katarak
a. Katarak > 3/60
b. Katarak ≤ 3/60
penglihatan < 6/60
a. Konjungtivitis
b. Hordiolum
c. Pterigium
d. Pseudofakia
e. Xeroftalmi
f. Retinoblastoma
g. Gonoblenore
h. Trachoma
i. Strabismus
j. Papilloedema
k. Pterygium
l. Bleparitis
m. chalazion
q. corneal ulcer
r. scleritis
s.
t.dll
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita
c. Dewasa
f. Lansia
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : November
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
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 2
0 0 0 0 0 3
0 0 0 0 0 4
0 0 0 0 0 5
6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 B
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0

a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
November
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
1 Kelainan Refraksi
Usia Lanjut)
2 Glaukoma
4 Low Vision
6 Katarak
a. Katarak > 3/60
b. Katarak ≤ 3/60
penglihatan < 6/60
a. Konjungtivitis
b. Hordiolum
c. Pterigium
d. Pseudofakia
e. Xeroftalmi
f. Retinoblastoma
g. Gonoblenore
h. Trachoma
i. Strabismus
j. Papilloedema
k. Pterygium
l. Bleparitis
m. chalazion
q. corneal ulcer
r. scleritis
s.
t.dll
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita
c. Dewasa
f. Lansia
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bulan : Desember
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
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 2
0 0 0 0 0 3
0 0 0 0 0 4
0 0 0 0 0 5
6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
7
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0 B
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0

a. Balita 0 0 0 0 0 0 0 0 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Bulan :
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
Desember
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
Kab/Kota : Surabaya
0-7 hari 8-28 hari >29-11 bln

A
(H00 - H59)
Usia Lanjut)
2 Glaukoma 0 0 0 0 0 0 0 0 0
4 Low Vision 0 0 0 0 0 0 0 0 0
6 Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 0 0 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 0
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 0
m. chalazion 0 0 0 0 0 0 0 0 0
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 0
dll 0 0 0 0 0 0 0 0 0
JUMLAH TOTAL 0 0 0 0 0 0 0 0 0
a. Balita 0 0 0 0 0 0 0 0 2
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN

>29-11 bln 1-4 thn 5-9 thn 10-14 thn
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 3 0 0 28 5 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 5 0 6
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 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 2 2 0 0 0 1 0 0 1 0 0
0 0 0 0 3 0 2 0 0 0 1 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 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 1 0 1 0 0 0
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 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 1 0
0 0 0 0 1 0 0 0 3 0 2 0 1 1
1 0 0 2 6 0 2 0 9 0 3 34 8 34
1 4 0 23 86 16 76 28 221 10 193 444 244 374
1 4 0 23 86 16 76 0 0 0 0 0 0 0
0 0 0 0 0 0 0 28 221 10 193 444 244 374
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tahun : 2024
14 thn 15-19 thn 20 - 44 45 - 54 55 - 59
P L P L P L P L
0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 2 7 2 17 1 19 2 42 1 10 1 31 0
0 0 0 0 0 0 0 0 0 0 0 0 4 1
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 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 1 0 3 0 1 0 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 3 2 0 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 2 2 8 3 0 1 1 0 4 0
2 1 0 0 3 1 3 2 3 0 1 0 3 0
0 0 0 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 2 0
0 0 0 0 0 0 1 0 0 0 0 0 0 0
0 0 0 0 1 0 1 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 1 0 0 2 0 0 0
0 0 0 1 1 0 0 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 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 0 0 2 0 0 0
0 1 4 0 2 0 4 1 4 0 4 0 11 0
0 1 4 1 4 1 6 3 6 0 9 0 13 0
12 4 11 3 27 5 38 10 54 5 24 1 70 1
205 162 258 132 341 197 1,020 239 2,313 48 486 60 1,020 17
0 0 0 0 0 0 0 0 0 0 0 0 0 0
204 160 254 131 309 0 0 0 0 0 0 0 0 0
0 0 0 0 0 161 979 174 1,721 46 485 59 1,017 17
0 2 4 1 3 36 37 22 57 2 1 1 2 0
1 0 0 0 29 0 4 43 535 0 0 0 1 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mengetahui,
Kepala Puskesmas,
JUMLAH
55 - 59 60 - 69 70+
L P L P L P L P
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 3 0 0 0 0 0 2 0 0 32 46 32
3 0 7 0 16 0 13 0 5 1 4 1 24 1
0 0 0 0 0 0 2 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 5 0 6
0 0 1 0 5 0 2 0 2 0 2 0 7 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 3 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 5 1 28 1 22 0 6 0 21 4 42 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 1 0 2 0 3 0 0 0 1 6 15 3
0 0 0 0 1 0 0 0 0 0 0 2 9 2
0 0 4 0 0 0 1 0 0 0 1 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 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 1 0 0 0 0 0 2 0
0 0 0 0 0 0 0 0 0 0 0 0 3 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 0 0 0 1 0 0 0 0 0 2 1
0 0 0 0 0 0 1 0 0 0 0 0 1 1
0 0 0 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 2 0 0 0 0 0 0 0
2 0 3 0 0 0 0 0 0 0 0 0 4 1
4 0 1 0 3 0 5 0 0 0 2 1 21 1
6 0 5 0 3 0 10 0 0 0 2 2 33 5
15 0 27 1 55 1 53 0 15 1 31 52 182 50
310 20 546 18 499 43 919 5 223 16 276 944 3,348 914
0 0 0 0 0 0 0 0 0 0 0 25 87 20
0 0 0 0 0 0 0 0 0 0 0 632 719 515
310 20 546 0 0 0 0 0 0 0 0 224 1,774 253
0 0 0 0 0 0 0 0 0 0 0 40 42 24
0 0 0 0 0 0 0 0 0 0 0 0 4 43
0 0 0 18 499 43 919 5 223 16 276 23 722 59
Surabaya,
Penanggung jawab
Puskesmas
Kab/Kota
JUMLAH DIRUJUK
L P L P TOTAL
Lama
A
0 0 0 0 0 0 0 1
101 78 133 211 52 108 160
28 25 29 54 25 29 54
3 0 3 3 0 3 3
0 5 6 11 0 0 0
6 7 6 13 7 6 13 2
0 0 0 0 0 0 0 3
9 3 9 12 0 0 0 4
0 0 0 0 0 0 0 5
6
56 46 57 103 46 57 103
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
7
11 21 14 35 0 1 1
14 11 16 27 3 1 4
9 1 9 10 1 4 5
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 0 0 0 0 0 0
0 2 0 2 2 0 2
0 0 0 0 0 0 0
2 0 2 2 0 1 1
2 2 2 4 0 0 0
3 3 4 7 0 3 3
0 0 0 0 0 0 0
2 2 3 5 2 3 5
2 1 3 4 0 0 0
0 1 0 1 1 0 1
2 0 2 2 0 0 0
3 4 4 8 3 4 7
26 22 27 49 4 7 11
42 35 47 82 4 13 17
279 234 329 563 146 227 373
5,889 4,292 6,803 11,095 161 248 409 B

76 112 96 208 0 0 0
706 1,351 1,221 2,572 24 34 58
3,284 1,998 3,537 5,535 67 142 209
62 82 86 168 0 0 0
566 4 609 613 0 0 0
1,195 745 1,254 1,999 70 72 142
LA
KEGIATAN PROGR
Kab/Kota : Surabaya
JUMLAH PENDE
NAMA PENYAKIT
L P L P L P L P L

(H00 - H59)
Usia Lanjut)
Glaukoma 0 0 0 0 0 0 0 0 0
Low Vision 0 0 0 0 0 0 0 0 0
Katarak
a. Katarak > 3/60 0 0 0 0 0 0 0 0 0
b. Katarak ≤ 3/60 0 0 0 0 0 0 0 0 0
penglihatan < 6/60
b. Hordiolum 0 0 0 0 0 0 3 2 0
c. Pterigium 0 0 0 0 0 0 0 0 0
d. Pseudofakia 0 0 0 0 0 0 0 0 0
e. Xeroftalmi 0 0 0 0 0 0 0 0 0
g. Gonoblenore 0 0 0 0 0 0 0 0 0
h. Trachoma 0 0 0 0 0 0 0 0 0
i. Strabismus 0 0 0 0 0 0 0 0 2
j. Papilloedema 0 0 0 0 0 0 0 0 0
k. Pterygium 0 0 0 0 0 0 0 0 0
l. Bleparitis 0 0 0 0 0 0 0 0 1
m. chalazion 0 0 0 0 0 0 1 0 1
q. corneal ulcer 0 0 0 0 0 0 0 0 0
r. scleritis 0 0 0 0 0 0 0 0 0
s. 0 0 0 0 0 0 0 0 0
t.dll 0 0 0 0 0 0 0 0 1
dll 0 0 0 0 0 0 1 0 3
JUMLAH TOTAL 0 0 0 0 1 0 8 2 9

a. Balita 0 0 0 0 3 4 109 92 0
c. Dewasa 0 0 0 0 0 0 0 0 0
e. Ibu Hamil (Bumil) 0 0 0 0 0 0 0 0 0
f. Lansia 0 0 0 0 0 0 0 0 0
LAPORAN
Tahun :
5-9 thn 10-14 thn 15-19 thn 20 - 44 45 - 54 55 - 59 60 - 69 70+
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 33 35 9 19 20 44 11 32 0 3 0 0 2
0 0 0 0 0 0 0 0 4 4 7 16 13 5
0 0 0 0 0 0 0 0 1 0 0 0 2 0
0 5 6 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 1 0 1 5 2 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 1 2 0 0 1 3 1 3 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 5 8 6 5 29 23 6
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 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 2 10 3 2 4 0 1 2 3 0
1 1 2 1 3 4 5 1 3 0 0 1 0 0
0 0 0 0 1 1 0 0 2 0 4 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 2 0 0 0 0 0
1 0 0 0 0 1 0 0 0 0 0 0 1 0
0 0 1 0 1 1 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 1 2 0 0 1 0 1 0
0 0 0 0 2 0 0 1 0 0 0 0 1 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 2 0
0 0 0 0 0 0 1 2 0 2 3 0 0 0
1 1 0 5 2 4 5 4 11 4 1 3 5 0
2 1 1 5 5 7 9 9 13 6 5 3 10 0
3 42 46 15 30 43 64 29 71 16 27 56 54 15
0 0 0 0 0 0 0 0 0 0 0 0 0 0
203 688 578 414 440 0 0 0 0 0 0 0 0 0
0 0 0 0 0 1,140 1,895 531 1,076 327 566 0 0 0
0 0 0 6 4 73 79 3 3 0 0 0 0 0
0 0 1 0 29 4 578 0 1 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 517 962 228
Mengetahui,
Kepala Puskesmas,
2024
TOTAL
DIRUJUK
70+ BARU LAMA
P L P L P L P TOTAL
0 0 0 0 0 0 0 0
0 32 32 46 101 52 108 160
5 1 1 24 28 25 29 54
0 0 0 0 3 0 3 3
0 5 6 0 0 0 0 0
2 0 0 7 6 7 6 13
0 0 0 0 0 0 0 0
0 0 0 3 9 0 0 0
0 0 0 0 0 0 0 0
21 4 1 42 56 46 57 103
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 6 3 15 11 0 1 1
0 2 2 9 14 3 1 4
1 0 0 1 9 1 4 5
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 2 0 2 0 2
0 0 0 0 0 0 0 0
0 0 0 0 2 0 1 1
0 0 0 2 2 0 0 0
0 0 1 3 3 0 3 3
0 0 0 0 0 0 0 0
0 0 1 2 2 2 3 5
0 0 1 1 2 0 0 0
0 1 0 0 0 1 0 1
0 0 0 0 2 0 0 0
0 0 1 4 3 3 4 7
2 1 1 21 26 4 7 11
2 2 5 33 42 4 13 17
32 52 50 182 279 146 227 373
0 25 20 87 76 0 0 0
0 632 515 719 706 24 34 58
0 224 253 1,774 3,284 67 142 209
0 40 24 42 62 0 0 0
0 0 43 4 566 0 0 0
292 23 59 722 1,195 70 72 142

2024 Laporan Kesehatan Mata Puskesmas Balongsari-8

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2024 Laporan Kesehatan Mata Puskesmas Balongsari-8

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Puskesmas : Balongsari

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

20 3 25 4 32 18 162 21 331 7 88 6 155 0

672 444 713 1157 28 38 66 B

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

36 3 27 2 41 24 157 15 248 5 61 7 138 2

667 457 693 1150 32 47 79 B

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

24 2 26 1 38 11 142 15 281 6 93 7 125 1

735 500 765 1265 17 27 44 B

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

36 17 43 7 63 37 154 44 489 10 57 7 160 0

34 1 93 2 109 0 183 1 83 0 93 83 579 65

1161 662 1226 1888 20 21 41 B

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

22 4 27 2 39 17 134 27 344 4 52 15 166 7

53 8 95 2 67 10 149 0 56 3 79 250 449 238

922 699 1160 1859 13 33 46 B

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

31 113 72 103 77 39 129 36 263 10 69 5 141 3

39 2 65 1 86 2 155 0 2 0 5 373 445 331

759 818 1,090 1,908 17 30 47 B

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 2

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

36 20 38 13 51 51 142 81 357 6 66 13 135 4

36 3 63 11 86 27 154 4 62 12 82 134 578 183

973 712 1156 1868 34 52 86 B

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln

B Skrining / Deteksi Dini Gangguan Penglihatan 0 0 0 0 0 0 0 0 0

JUMLAH PENDERITA MENURUT GOLONGAN UMUR

Jenis Gangguan Penglihatan dan Kebutaan

Skrining / Deteksi Dini Gangguan Penglihatan

0-7 hari 8-28 hari >29-11 bln