Form Rekap Who Izfan 8249
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NO NAMA PEMERIKSA DUSUN NAMA UMUR
S KELAMI
L P 0
1 Izfan Yulviansyah Randusono E!o P"iha"#ono $0 L 0
% Izfan Yulviansyah Randusono D&'i Ind"iyani $0 P 0$ Izfan Yulviansyah Randusono A"afa M( Sa)u#"a * L 1
+ Izfan Yulviansyah Randusono ,a"iono -1 L 0
- Izfan Yulviansyah Randusono R"( Sulis#i!hanah +$ P 0
* Izfan Yulviansyah Randusono Dini Sia'a#i %$ P 0
. Izfan Yulviansyah Randusono Evi#a Ausi#ani 1/ P 0
/ Izfan Yulviansyah Randusono ai"uz a!i K( * L 1
2 Izfan Yulviansyah Randusono Su#an#o Yuli3iyan#o *% L 0
10 Izfan Yulviansyah Randusono Muniha"yan#i -- P 0
11 Izfan Yulviansyah Randusono Aun A34a"a P( %1 L 0
1% Izfan Yulviansyah Randusono Yulian#o +% L 01$ Izfan Yulviansyah Randusono S"i Su!a)#i $. P 0
1+ Izfan Yulviansyah Randusono ,andi!a P"a#a3a Pu#"i 1* P 0
1- Izfan Yulviansyah Randusono Di3as R&s#u Pu#"a Y( 10 L 0
1* Izfan Yulviansyah Randusono Sia 5udi $+ L 0
1. Izfan Yulviansyah Randusono Rno Pu"'an#i $. P 0
1/ Izfan Yulviansyah Randusono aisal 10 L 0
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MALOKLUSI LUOROSIS 6I6I DESIDUI
1 % 0 1 % $ + -S7A7US PERA8A7AN
A 5 9 D E 6 0 1 % $ * . / 2
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
1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 1 0 0 0 0 0 0 1* + 0 0 0 0 0 1* 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
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
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
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 1 0 0 0 0 0 0 2 2 0 0 0 0 0 2 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
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
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
1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 01 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 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 1 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
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
1 0 0 1 0 0 0 0 0 0 0 . 0 0 0 0 0 0 0 0 0 0 . 0 0
20
7ida! 4isadiu!u"
7ida! 4isadiu!u"
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6I6I PERMANEN O,I:S
S7A7US PERA8A7ANDI:S 9I:S NILAI
KA7E6O
0 1 % $ + - * . / 2 0 1 % $ * . / 2 AIK EDAN6
%0 1% 0 0 0 0 0 0 0 0 %0 0 1% 0 0 0 * 0 1 1 % 0 1
1$ 11 0 0 / 0 0 0 0 0 1$ 0 11 0 0 0 / 0 1 0;*. 1;*. 0 1+ 0 0 0 0 0 0 0 / 0 1% 0 0 0 0 0 0 0 0 0 0 1 0
12 . 0 0 * 0 0 0 0 0 12 0 0 - 0 % * 0 1 1 % 0 1
1/ 10 0 % % 0 0 0 0 0 %0 0 . % 0 1 % 0 1 0;/$ 1;/$ 0 1
%1 . 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 - 1 0 0 0 0 1 0;*. 1;*. 0 1
* 0 0 0 0 0 0 0 / 0 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
1% . 0 1 1% 0 0 0 0 0 1$ 0 + $ 0 0 1% 0 1 0;/$ 1;/$ 0 1
%+ + 0 % 0 0 0 0 % 0 %/ 0 $ 1 0 0 0 0 0;$$ 0 0;$$ 1 0
1. 1$ 0 0 % 0 0 0 0 0 1. 0 * - 0 % % 0 1 1 % 0 1%0 / 0 0 % 0 0 0 % 0 %% 0 . 1 0 0 % 0 1 1 % 0 1
%$ - 0 0 0 0 0 0 + 0 %. 0 + 1 0 0 0 0 1 1 % 0 1
1. 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 1* 0 - * 0 - 0 0 1 1 % 0 1
12 1% 0 0 1 0 0 0 0 0 12 0 . - 0 0 1 0 1 0;/$ 1;/$ 0 1
1. 0 0 0 0 0 0 0 / 0 %- 0 0 0 0 0 0 0 1 0;*. 1;*. 0 1
121 55 4 13
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6IN6I
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9PI MAKAIAN 6I6I 7IRUA KE5U7U
+:* s&3&n 0 1 % $ +UPPER LO8ER UPPER
0 1 % 0 1 % 0 1 %
1 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0 0
1 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 10 0 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0
1 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 1
1 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 1
1 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0 0
1 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0 0
0 0 1 0 0 0 0 1 0 0 1 0 0 1 0 0
0 1 0 0 0 0 0 1 0 1 0 0 1 0 0 1 0
1 0 0 0 1 0 0 0 1 0 0 1 0 0 1 0
0 0 1 0 0 0 0 1 0 0 1 0 0 1 0 0
1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 11 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0
1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0
0 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0
1 0 0 0 1 0 0 1 0 0 1 0 0 0 0 1
1 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0
1 0 0 0 1 0 0 1 0 0 1 0 0 1 0 0
13 1 3 0 14 0 0 1 15 2 0 15 2 0 10 2 5
#ida! 4isadiu!u"
#ida!4isadiu!u"
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NONE GTS GTL NONE G
/$ 1 0 1 0 1 0
$+ 2 1 0 0 1 0
/ 3 1 0 0 1 0
-+ 4 1 1
+- 5 1 1
1- 6 1 1
* 7 1 1-% 8 1 1
+/ 9 1 1
1+ 10 1 1
-1 11 1 1
+* 12 1 1
%1 13 1 1
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1% 14 1 1
10 15 1 1
. 16 1 1
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AN 6I6I 7IRUAN IMMEDIA7E 9ARE
LO8ER
$ 0 1 % $
0 1 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 No0 1 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 1 0 0 0 0 0 0 0 1
0 1 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 1 0 0 0 0 0 0
0 1 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 10 0 0 1 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 1 0 0 0 0 0
0 0 0 1 0 0 0 0 0
0 1 0 0 0 0 0 0 0
0 9 2 7 0
No
1
%
$
+
GI
No
1
%
$
+
LIE7,REA7ENIN
6
JA8=SRA97UR
E
PAIN=INE97IO
N
REERAL 7O
9ARE
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CPI
No
1
%
$
+
No
1
%
$
+
-
*
NoS GTL epair
0
0 1
0 %
$
No
1
%
$
-
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+
No
1
%
$
+
-
-
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Status Karies Gigi
Kelompok Umur ( Tahun )
6 15 16 45 46 60 > 60 u(n!4) (n!11) (n!") (n!1)
# $ # $ # $ # $ #
%esi&ui
d > d&?ay 20 100 0 0 0 0 0 0 %0
& > &@#"a?#ion 0 0 0 0 0 0 0 0 0
f > fillin 0 0 0 0 0 0 0 0 0
d&f B# %0 100 0 0 0 0 0 0 %0
R&"a#a - 0 0 0 1(
'ermanen
D > D&?ay 0 0(00 10$ /-(/$ 1+ 11(*. $ %(-0 1%0M > Missin 0 0 1- %.(%. 1/ $%(.$ %% +0(00 --
> illin 0 0 + /0(00 1 %0(00 0 0(00 -
DM:# 0 0(00 1%% *.(./ $$ 1/($$ %- 1$(/2 1/0
R&"a#a 0(00 11(02 1*(- %-(00 10
Kelompok Umur
enis 6 15 16 45 46 60 > 60u
(n!4) (n!11) (n!") (n!1)
# $ # $ # $ # $ #5ai! $ .- * -+(-- 0 0(00 0 0(00 2
S&dan 1 %- - +-(+- % 100(00 0 0(00 /
5u"u! 0 0 0 0 0 0(00 0 0(00 0
7ida! 5isa Diu!u" 0 0 0 0 0 0(00 1 100(00 1
Ju3lah + 100 11 100 % 100(00 1 100(00 1/
Kelompok Umur
enis 6 15 16 45 46 60 > 60u
(n!4) (n!11) (n!") (n!1)# $ # $ # $ # $ #
S&ha# % -0 1 2(02 0 0 0 0(00 $
1:$ s&3&n % -0 . *$(*+ 1 -0 0 0(00 10
+:* s&3&n 0 0 $ %.(%. 1 -0 0 0(00 +
7ida! 4isa diu!u" 0 0 0 0 0 0 1 100(00 1
Ju3lah + 100 11 100 % 100 1 100(00 1/
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Kelompok Umur
enis 6 15 16 45 46 60 > 60u
(n!4) (n!11) (n!") (n!1)
# $ # $ # $ # $ #
S&ha# % -0 1 2(02 0 0 0 0(00 $
1:$ s&3&n 1 %- 0 0 0 0 0 0(00 1
+:*s&3&n 1 %- 10 20(21 % 100 0 0(00 1$
7ida! 4isa diu!u" 0 0 0 0 0 0 1 100(00 1
Ju3lah + 100 11 100 % 100 1 100(00 1/
9PI AN6KA
Kelompok Umur
enis 6 15 16 45 46 60 > 60 u(n!4) (n!11) (n!") (n!1)
# $ # $ # $ # $ #
0 % -0 1 2(02 0 0 0 0(00 $
1 0 0 0 0 0 0 0 0(00 0
% % -0 10 20(21 % 100 0 0(00 1+
$ 0 0 0 0 0 0 0 0(00 0
+ 0 0 0 0 0 0 0 0(00 0
7ida! 4isa diu!u" 0 0 0 0 0 0 1 100(00 1
Cu3lah + 100 11 100 % 100 1 100(00 1/
Kelompok Umur
enis 6 15 16 45 46 60 > 60u
(n!4) (n!11) (n!") (n!1)
# $ # $ # $ # $ #
0 #ida! + 100(00 11 100 1 -0(00 0 0(00 1*
167S 0 0(00 0 0 1 -0(00 1 100(00 %
%67L 0 0(00 0 0 0 0(00 0 0(00 0
Ju3lah + 100(00 11 100 % 100(00 1 100(00 1/
Kelompok Umurenis 6 15 16 45 46 60 > 60
u(n!4) (n!11) (n!") (n!1)
# $ # $ # $ # $ #
0 #ida! + 100(00 - +-(+- 0 0(00 0 0(00 2
1 4u#uh )&"4ai!an 0 0(00 0 0 1 -0(00 1 100(00 %
% 67S 0 0(00 * -+(-- 1 -0(00 0 0(00 .
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$ 67L 0 0(00 0 0 0 0(00 0 0(00 0
Ju3lah + 100(00 11 100 % 100(00 1 100(00 1/
Kelompok Umur ( Tahun )
6 15 16 45 46 60 > 60u(n!4) (n!11) (n!") (n!1)
# $ # $ # $ # $ #
O)d&n# 1 %- 11 100 % 100 1 100(00 1-
Endodon#i! 0 0 0 0 0 0 0 0(00 0
E!sodonsi $ .- $ %.(%. 1 -0 0 0(00 .
P"os#odon#i! 0 0 * -+(-- % 100 1 100(00 2
S?alin % -0 10 20(21 % 100 1 100(00 1-
Keutuhan'era*atan
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lah
$
100
0 gigi
0
100
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**(*.$0(-*
%(./
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$-0(00
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lah
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1*(*.
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0(00
100(00
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$
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