Lampiran III

KEGIATAN ANTENATAL CARE (ANC)

NoHari/TanggalNama IbuUmur (Thn)GravidaUsia KehamilanBB (kg)TD (mmHg)TFU

1Selasa, 10 Maret 2015Nurhayati30G2P1A04 minggu6590/70-

2Selasa, 10 Maret 2015Aisarana24G1P0A08-10 minggu48100/70-

Banda Aceh, Maret 2015

Pembimbing IPembimbing II

dr.Roosmy dr. Taufik RidwanNip. 19641116 200112 2 001Nip. 19790605 201406 1 001

Diketahui,Kepala UPTD Puskesmas Lampulo

Hayatun Rahmi, SKMNip. 19670730 198803 2 002