Offline Posbindu2007
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Data Ofine Surveilans PTM berbasis POSBINDU No Identitas Peserta Posbindu No KTP Nama Pasien 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 Tanggal Pemeriksaan 42 43 44 45 46 47 48 49 50 xxx xxx xxx xxx Nama Panggilan Tanggal Lahir gama !enis Kelamin
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Transcript of Offline Posbindu2007
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Data Ofine Surveilans PTM berbasis POSBINDU
No
Identitas Peserta Posbindu
No KTP Nama Pasien
1
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TanggalPemeriksaan
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42
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xxx xxx xxx xxx
xxx xxx xxx xxx
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Nama Panggilan Tanggal Lahir gama !enis
Kelamin
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xxx xxx xxxxxx xxx xxx xxx
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lamat No Tel"# $P Pendidikan Terakhir
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xxx xxx
xxx xxx
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Peker%aan Status&olongan
Darah
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xxx xxx
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'i(a)at Pen)akit Tidak Menular Pada Keluarga
eMailPen)akitDiabetes
Pen)akit$i"ertensi
Pen)akit !antung
Pen)akitStroke
Pen)akitsma
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xxx xxxxxx xxx
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'i(a)at Pen)akit Tidak Menular Pada Diri Sendiri
Pen)akitKanker
KolesterolTinggi
Pen)akitDiabetes
Pen)akit$i"ertensi
Pen)akit !antung
Pen)akitStroke
Pen)akitsma
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xxx xxx
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**N+' Tekana
Merokok SistolPen)akitKanker
KolesterolTinggi
Kurangktivitas
,isik
KurangSa)ur dan
Buah
Konsumsilkohol
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xxx xxx xxx
xxx xxx xxx xxx xxx
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Darah IMT Pemerik
Diastol &ula Kolesterol
LingkarPerut
Pengukuran,ungsi ParuTinggi
BadanBeratBadan
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xxx xxx xxx xxx xxx xxx
xxx xxx xxx xxx xxx xxx
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aan Lab-
I.Trigliserida
Kadarlkohol
Perna/asan
Tesm/etamin
UrinBen%olanPa)udara
Pen)uluhanI. 0 +B1
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xxx xxx xxx xxx xxx xxx
xxx xxx xxx xxx xxx xxx
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Pen)uluhan
Pen)uluhan'okok
Pen)uluhanPotensi
+edera
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xxx xxx
xxx xxx
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al_pemeri no_ktp nama_pasinama_pan tanggal_la nis_kelami agama
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alamat no_telp idikan_tera pekerjaan status longan_dar email
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yakit_diab akit_hipert yakit_jant nyakit_stro nyakit_as nyakit_kan esterol_tin
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yakit_diab akit_hiper yakit_jant nyakit_stronyakit_as nyakit_kan esterol_tin merokok
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ang_aktiiurang_say sumsi_alk sistol diastol tinggi_bad berat_bad lingkar_pe
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pengukuragula kolesterol trigliseridabenjolan_pia kadar_alkotes_am!et
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penyuluha penyuluha penyuluhan_"edera
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1 posbindu
