ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBKBLBMBNBOBPBQBRBSBTBUBVBWBX
1
REGISTER KEGIATAN KESEHATAN ANAK USIA SEKOLAH DAN REMAJA
2
NAMA SATUAN PENDIDIKAN
:
3
KELAS:
4
KAB/KOTA:
5
PROVINSI:
6
TAHUN AJARAN:
:
7
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NoNamaJenis KelaminJenjangKelasNISNNIKTempat Lahir Tgl LahirUsia (Ulang tahun terakhir)NIK ORANG TUA/IBUNAMA LENGKAP ORANG TUA/IBUAlamatNo. HPDisabilitasHasil Pemeriksaan FisikCO ANALYZERKesimpulanIMUNISASI
9
Faktor Resiko Gula Darah AnakResiko MalariaGejala Cemas RemajaTalasemiaGejala Depresi RemajaKesehatan Produksi PutraKesehatan Produksi PutriTingkat Aktifitas FisikKelayakan Tes KebugaranPerilaku MerokokFaktor Resiko HepatitisFaktor Resiko TBPenyakit Kusta Anak SekolahPenyakit SkabiesGiziKimia DarahTekanan DarahTelingaGigi (Jumlah Karies)Kebugaran (Kelas 7-9)
10
BB (kg)TB (cm)Indeks Massa Tubuh (kg/m2)IMT/U (SD)Status GiziHasil Pemeriksaan mmHgKlasifikasiGangguan TelingaSerumen TelingaInfeksi (Cairan) TelingaTajam PenglihatanMata SehatPenggunaan KacamataWaktuKlasifikasi
11
PLYaTidakYaTidakYa (1/2/3/4)Ya (1/2/3)Ya (1/2)Ya (1/2/3)Ya (1/2/3)Ya (1/2/3)0/1/2/3/4/5/6 hariYa (1/2/3/4)Ya (1/2)Ya (1/2/3/4/5/6/7/8)Ya (1/2/3/4)YaTidakYaTidakGizi Buruk
< -3SD
Gizi Kurang
-3SD sampai < -2SD
Gizi Baik
-2SD sampai +1SD
Gizi Lebih
> +1SD sampai +2SD
Obesitas
> +2SD
GDSHBNormal: Sistolik dan diastolik < persentil 90Prahipertensi: Sistolik dan diastolik ≥ persentil 90 tetapi <persentil 95, atau 120/80 mmHg tetapi < persentil 95Hipertensi tingkat 1: Sistolik dan diastolik diantara persentil 95 dan persentil 95 +12 mmHg
atau 130/80 mmHg -138/89 mmHg
Hipertensi tingkat 2: Sistolik atau Diastolik ≥ persentil
95 + 12 mmHg atau ≥140/90 mmHg
KananKiriKananKiriKananKiriMata Kanan 6/6-6/9Mata Kanan <6/9Mata Kiri 6/6-6/9Mata Kiri <6/9KananKiriTidakYaNormalKaries (1,2,3,>3)Baik sekali/ BaikCukupKurang/Kurang sekaliHasil CO Analyzer (1,2,3,4,5,>5)RujukTidak RujukImunisasi Yang di TerimaTanggal ImunisasiNo. Batch
12
1
AHMAD CATURANGGA HANISZA
LSMPVII141139845
3276012503140002
DEPOK25/03/201412
3276016705770008
Jl. Pipa Gas Kp. Sasak No. 28
081295879377
VV0000020000VV39144.07611,775/61NNNNNNVVNNV12
13
2AHMAD RIFAI ABDILLAHLSMPVII127467958
3276091105120001
JAKARTA11/5/201214
3276096303820003
Jl. H. Salam No. 6782211175477VV0000050200VV54149.010814124/102NNNYNNVVNNV22
14
3AHMAD YUSRIL HERMANSYAHLSMPVII3123549036
3674051705120001
TANGGERANG SELATAN
17/05/201214
3276094209870001
jl. Persahabatan85692237517vv2002030000vv67157.07815110/61NNNNNNVVNNVV2
15
4ALFIAN SYAUDINLSMPVII3130703478
3276090407130003
DEPOK4/7/201313
3276094512840001
DYAH SUSANTI
JALAN PANGKALAN JATI RT 003 RW 002 PANGKALAN JATI CINERE DEPOK
83896451192
16
5ARDELIA PUTRI RADITYAPSMPVII3131146829
3174065205131007
JAKARTA12/5/201313
3171076408890005
Jl h. Musa no 10 B87810598534VV00000100000VV34154.08010,482/60NNNNNNVVNNV1
17
6ATHIYYAH SA'ADAHPSMPVII3136803972
3276096107130001
DEPOK21/07/201313
3276046509820004
JL. LESTARI81295337287VV00000300000VV41152.09113,3126/76NNNNNNVVNNVV
18
7ATTAYA FAYYADH DZAHABILSMPVII3131168183
3276092904130003
TANGGERANG SELATAN
29/04/201313
3674055804830001
JL. SENGON NO 6385817043158
19
8AZKA NUR HIDAYAHPSMPVII139470752
3276096303130004
JAKARTA23/03/201313
3276095902960001
Jl.Cilobak 1 No.2589607527225vv2vv35145.09114.5115/80NNNNNNvvNNvv
20
9AZKI NUR HIDAYAHPSMPVII137291465
3276096303130003
JAKARTA23/03/201313
3276095902960001
Jl.cilobak No.2589607527225vv2vv33154.09714.3116/80NNNNNNvvNNvv
21
10DAMARA ROSE BIANCA ANIDYAPSMPVII3141411357
3521035705140001
DEPOK27/07/201412
3521036508890002
Jl Bambu 1 No 3585721731813VV00000000000VV37151.08412,9105/65NNNNNNVVNNVV
22
11DEANDRA RAMADHANIPSMPVII3131291714
3276096107130005
JAKARTA21/07/201313
3174064101890006
DEWI INDRIYANIJl. H. Rohili No.985719796985VV00000320000VV31155.09214122/71NNNNNNVVNNVV
23
12ELVIRA PRAMESWARI PUTRI .E.PSMPVII3148652419
3276096804140001
JAKARTA28/04/201412
3276046002820004
JL. PINTU AIR I NO.182114105205VV00000220000VV32155.09414,3103/78NNNNNNVVNNVV
24
13FERNINDA SYAKIRA PUTRIPSMPVII3135286509
3276096503130002
JAKARTA25/03/201313
3201046310811001
JL.KIRAY85780111228VV00000250000VV31149.08514127/76NNNNNNVVNNVV
25
14FIKRI AL HUSNALSMPVII3132103012
3276091809130001
DEPOK18/09/201313
3276094504880005
JL. MADRASAH85717382984VV00000040200VV47141.08413.3113/63NNNNNNVVNNV23
26
15GEMA SAPUTRALSMPVII3129783200
3276043112110002
DEPOK31/12/201115
3276046709830005
JL. ISMAYA N0.3989656348337VV00000060000VV50161.08915,595/64NNNNNNVVNNVV3
27
16HAIKAL KAMILLSMPVII3131885799
3276091011130002
JAKARTA10/11/201313
3276096107840001
JL. PLN GG H MUHAJIR NO 48 RT.12 RW.03 KEL.GANDUL KEC.CINERE
87885225941VV10000300000VV42152.08611.5109/66NNNNNNVVNNV21
28
17IBRAHIMLSMPVII3133638069
3214103005130001
JAKARTA30/05/201313
3214104701820004
JL. ISMAYA 2 NO.3881804786873VV00000000000VV46159.08415,1116/66NNNNNNVVNNVV1
29
18
MUHAMMAD AURIL FAUZUL UKBA
LSMPVII3138829191
3327012907130001
PEMALANG29/07/201313
3304126508860002
MUKTINIJl h jaeran cinere depok88707716176VV00000000000VV30145.09514117/86NNNNNNVVNNV12
30
19MUHAMMAD FADLI MUHAZALSMPVII3139308687
3174041109131005
JAKARTA11/9/201313
3174045611880005
Jl. H. Saumin No. 48 Rt. 028/008 Gandul - Cinere Depok85814486766VV0000000000VV31140.088/51NNNNNNVVNNV11
31
20RADITYA PRATAMA HARAHAPLSMPVII3130395400
3276030811130003
JAKARTA8/11/201313332808530590002KP KEKUPU0VV00000000000VV26136.010516106/83NNNNNNVVNNV31
32
21RADITYA RAMADHANLSMPVII137135852
3276090307130002
JAKARTA3/7/201313
3276094907900011
Jl Pertamina buntu no 4687769315699VV00000040000VV44150.09011114/72NNNNNNVVNNV12
33
22RAIHAN SAPUTRALSMPVII3130221180
3276090611130001
JAKARTA6/11/201313
3276096103920001
JL. LESTARI NO.1489658735846VV0000050000VV44151.08814,4112/62NNNNNNVVNNVV12
34
23RIFQY ALFARO DZAELANILSMPVII136468541
3276092702130002
JAKARTA27/02/201313
3276046406880010
Jl. Melati No. 6985719118911VV0000000000VV43158.09014104/64NNNNNNVVNNVV5
35
24SYAFA SITI KINARA PUTRIPSMPVII134616714
3276095812130005
JAKARTA18/12/201313
3276046204920002
JL. PERSATUAN NO 16877287746566VV00000120000VV52160.09112,7115/85NNNNNNVVNNVV
36
25VIOLLA MAULIDINA PUTRI .A.PSMPVII3140354134
3276094901140004
JAKARTA9/1/201412
3174064111830008
Karya Mina No. 108888919114vv00000320000vv31152.08214,2124/75NNNNNNVVNNVV
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