ceklis pertumbuhan
Post on 05-Jul-2018
217 Views
Preview:
TRANSCRIPT
-
8/15/2019 CEKLIS PERTUMBUHAN
1/4
1.Identitas
1 Nama Anak : .....................................................
..............
2 Nomor register : ..................................................................
3 Nama Orang Tua Ayah/Ibu : .....................................................
..............4 Alamat : .....................................................
..............
2.Data Kelahiran
1 Tanggal lahir : ......................................2 Umur Kehamilan : ................... ln.3 Kelahiran Tunggal/Kembar : 1 anak / 2 anak4 erat a!an "ahir : .............kg# $an%ang a!an : .............&m' "ingkaran Ke(ala : .............&m) Kelahiran Ke : ...................................* Tanggal lahir a!ik kan!ung
berikutnya tanggal
: ..................................
3.Pemberian Makan1 Umur (ertama kali !iberi makan atau minuman
lain +$,A-I: ................
2 Umur berhenti menyusu : ................
4.Peristiwa penting yang mempengaruhi pertumbuhan Anak( anggal !" Misalnya
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
....
#A$%KA& I " '$ A$% P'$ ')A)
1. A(akah anak ibu sakit atau ti!ak selama 1 bulan terakhir ini..............................................................................................................................................................................................
#A$%KA& II " M'$*A+I P'$ ')A).
1. +enga(a (ertumbuhan anak ibu lambat................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
1
*eklis pemantauan penilaianpertumbuhan
,awan-aratentang penyebab
-
8/15/2019 CEKLIS PERTUMBUHAN
2/4
#A$%KA& III P'+0)A&A$ P #A MAKA$ DA$ A A0 M'$ 0 0I
1. A(akah anak ibu masih menyusu !an men!a(at makanan lebih se!ikit!ari biasanya
.............................................................................................................
.............................................................................................................
........................................................
#A$%KA& I P'M)'+IA$ MAKA$ A$AK ' 0AI D'$%A$ 0M0+"1. A(akah ibu masih
menyusui ..........................................................................................2. era(a kali selama sehari
semalam ...............................................................................
3. A(akah ibu mem(unyai kesulitan !alammenyusui........................................................4. A(akah anak memlekat !engan baik saat menyusu !an
!isususi..............................................................................................................................................................................................................................................................................................................................................................................................................................................................
#. agaimana ara ibu menyia(kan susu 0ormula !anmakanan.........................................
.............................................................................................................
............................'. era(a kali ibu memberi susu 0ormula !an makanan selama seharisemalam
.............................................................................................................
............................#A$%KA& +I,A A P'$ AKI A$% )'+0#A$%
1. A(akah anak ibu seringsakit............................................................................................
.............................................................................................................
............................#A$%KA& I KA I K'M0$%KI$A$ P'$ ')A) MA A#A& IA# DA$
#I$%K0$%A$1. A(akah ibu mem(unyai kamar man!i !an& .............................................................
2. ari mana ibu men!a(at untuk kebutuhan rumahtangga..............................................
3. A(akah air selalu!imasak ..............................................................................................
4. era(a banyak anggota keluarga yang tinggal !i rumah sekaranini .............................
#. agaimana kesehatan anggota keluargasekarang ........................................................
.............................................................................................................
............................#A$%KA& II '$ 0KA$ P'$ ')A) )'+ AMA I)0 A A0 P'$%A 0&.
1. +enurut ibu menga(a anak ibu men!erita 2T + i5i kurang i5i buruk....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
#A$%KA& III.M'M)'+IKA$ K $ '#I$%........................................................................................................................................................................................................................................................................................................................................
2
-
8/15/2019 CEKLIS PERTUMBUHAN
3/4
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
.....................................
*atatan Kun5ungan "
anggal#ahir
"
anggalKun5ungan
0mur&ariini()ulanPenuh !
&asil Pengukuran( *atatan pada K6l6m di
bawah ini laluPl6t
dalam %ra7k
Alasan berkun5ung &asilPengamatan dan $asehat yang
diberikan
)erat)adan
(kg!
Pan5ang
8 inggi( *m!
9IM9
::::::::::::..
enaga %i/i Puskesmas &alilulik
6666666666666666666 NI$/N7$K
3
*atatan kun5ungan %ra7k anak laki;laki
-
8/15/2019 CEKLIS PERTUMBUHAN
4/4
4
top related