format laporan kbkp.xlsx
TRANSCRIPT
![Page 1: FORMAT LAPORAN KBKP.xlsx](https://reader031.vdokumen.com/reader031/viewer/2022021122/577c78191a28abe0548eb9fa/html5/thumbnails/1.jpg)
7/25/2019 FORMAT LAPORAN KBKP.xlsx
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DAFTAR HADIR PENYULUHAN
PUSKESMAS 7 ULU TAHUN 2015
NO NAMA PESERTA NOMOR KARTU BPJS UMUR NO. HP
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DAFTAR KUNJUNGAN HO
PUSKESMAS 7 ULU TAHU
NO NAMA PESERTA NOMOR KARTU BPJS UMUR
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DAFTAR PESERTA KONTAK KOMUNIKASI
PUSKESMAS 7 ULU TAHU
TANGGALKUNJUNGAN
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7/25/2019 FORMAT LAPORAN KBKP.xlsx
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NO NAMA PESERTA NOMOR KARTU BPJS UMUR
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DAFTAR KUNJUNGAN PESERTA
PUSKESMAS 7 ULU TAHU
NONAMA PESERTA NOMOR KARTU BPJS UMUR
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TANGGALKONTAK
TANGGALKONTAK
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TANDA TANGAN
E VISIT
N 2015
NO. HP
ELALUI SMS/TELEPON
N 2015
TANDA TANGAN
CATATAN HASILKUNJUNGAN
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NO. HP
ROLANIS DM
N 2015
NO. HPHASIL PEMERIKSAAN
TANDA TANGAN CATATAN HASIL
KONTAK KOMUNIKASI
TANDA TANGAN
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FORMAT LAPORAN KUNJUNGAN DAN RUJUKAN
BULAN ……….
PUSKESMAS/ DOKKEL ……………
NO TANGGAL NO KARTU PESERTA NAMA PESERTAKUNJUNGAN PESERTA
JK USIAPESERTA TERDAFTAR PESERTA TAK TERDAFTAR
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DIAGNOSARUJUKAN
TANDA TANGAN KETERANGANDIRUJUK TIDAK
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DAFTAR KONTAK KOMUNIKASI DI POSYAND
NAMA PUSKESMAS..................
b!"#……………. T"$#………………
TANGGAL KEGIATAN DI POSANDU !
NAMA TENAGA MEDIS PUSKESMAS !
NO NAMA PESERTA NOMOR KARTU BPJS UMUR NO. HP
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K"# ! $%&"'()*+% $"'(*' ,-#-$-)/"'#*%
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U.............
TANDA TANGANPESERTA
CATATAN HASILKONTAK KOMUNIKASI
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DAFTAR KONTAK KOMUNIK
NAMA PUSKESM
b!"#……………. T"
NO TANGGAL KONTAK NAMA PESERTA NOMOR KARTU BPJS UMUR
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SI PESERTA PROLANIS
S..................
$#………………
NO. HP TANDA TANGAN
PESERTA
CATATAN HASIL KONTAK
KOMUNIKASI
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DAFTAR KONTAK KOMUNIKASI PE
NAMA PUSKESMA
b!"#……………. T"
NO NAMA PESERTA NOMOR KARTU BPJS UMUR
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TANGGAL
PELAANANIMUNISASI
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ERTA PELAYANAN IMUNISASI
..................
#………………
NO. HP TANDA TANGANPESERTA CATATAN HASIL KONTAKKOMUNIKASI
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DAFTAR KONTAK KOMUNIKASI
NAMA PUSKESM
b!"#……………. T"
NO TANGGAL KONTAK NAMA PESERTA NOMOR KARTU BPJS UMUR
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ENGAN PESERTA IBU HAMIL
S..................
$#………………
NO. HP
TANDA TANGAN
PESERTA
CATATAN HASIL KONTAK
KOMUNIKASI
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DAFTAR HO
NAMA PUSKESM
b!"#……………. T"
NO NAMA PESERTA NOMOR KARTU BPJS UMUR
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TANGGAL HOME
ISIT
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E VISIT
S..................
$#………………
NO. HP TANDA TANGAN
PESERTA
CATATAN HASIL KONTAK
KOMUNIKASI
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DAFTAR KONTAK KOMUNIKASI
NAMA PUSKESM
b!"#……………. T"
NO NAMA PESERTA NOMOR KARTU BPJS UMUR
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TANGGAL
SMSTELPON
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ELALUI SMS DAN TELEPON
S..................
$#………………
NO. HP TANDA TANGAN
PETUGAS
CATATAN HASIL KONTAK
KOMUNIKASISMS
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DAFTAR HADIR SENAM
PUSKESMAS .............
b!"#……………. T"$#………………
TANGGAL KEGIATAN !
TEMPAT KEGIATAN !
NO NAMA PESERTA NOMOR KARTU BPJS UMUR NO. HP
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K"# ! $%&"'()*+% $"'(*' ,-#-$-)/"'#*%
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TANDA TANGAN
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DAFTAR HADIR PENYULUHAN/EDUKASI
PUSKESMAS ..................
b!"#……………. T"$#………………
TANGGAL KEGIATAN !
TEMPAT KEGIATAN !
NARASUMBER !
NO NAMA PESERTA NOMOR KARTU BPJS UMUR NO. HP
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K"# ! $%&"'()*+% $"'(*' ,-#-$-)/"'#*%
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TANDA TANGAN
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DAFTAR NAMA PESERTA PROLANIS TERDAF
NAMA PUSKESMAS.............
b!"#……………. T"$#………
NO NOMOR KARTU BPJS UMUR NO. HP
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NAMA PESERTA
PROLANIS
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AR DI PUSKESMAS
.....
……
TANDA TANGAN
PESERTA
JENIS PENAKIT PROLANIS
DMHT
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REGISTER OBAT
UNIT
BULAN
TANGGAL NAMA PASIEN DIAGNOSA KODE OBAT NAMA OBAT
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JUMLAH KELIUAR KETERANGAN
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