ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAKALAMANAOAPAQARASATAUAVAWAXAYAZBABBBCBDBEBFBGBHBIBJBKBLBMBNBOBPBQBRBSBTBUBVBWBXBYBZCACBCCCDCECFCGCHCICJCKCLCMCNCOCPCQCRCSCTCUCV
1
INPUT ASIK (V)INPUT SIGIZI
KESGA (V)
TANGGAL KUNJUNGAN PERTAMAFASKES PEMERIKSAAN PERTAMA NO KOHORTNO RMNAMA IBUNAMA SUAMIALAMAT KTPALAMAT DOMISILIRTRWWILAYAH DOMISILIPENDIDIKAN TERAKHIR PEKERJAANNO HPNIK IBUNO BPJSFASKES BPJSNIK SUAMINO KARTU KELUARGATANGGAL LAHIRUMURGRAVIDAJARAK KEHAMILAN SEBELUMNYA (..THN...BLN )HPHTTPUSIA KEHAMILANTRIMESTER KEK1 MURNIK1 AKSESK4/K5K6/K8ANAMNESISBB SAAT INI (KG)TINGGI BADAN (CM)BB SEBELUM HAMIL (KG)IMT
(SEBELUM HAMIL)
Kategori IMTTD (MMHG)TFU (CM)LILA (CM)STATUS GIZI (KEK/
RESIKO KEK/N)
REFLEK PATELA (+/-)DJJ (X/MNT)KEPALA THDP PAP (M/BM)TBJ (GR)JUMLAH JANIN (T/G)PRESENTASISTATUS TDINJEKSI TTFE (TAB)KONSELING KIAVAKSIN COVIDDAPAT BUKU KIA (BK/BS)JARAK KEHAMILAN KURANG 2 TAHUN GOLDARHB (GR/DL)PROTEIN URINE (+/-)GULA DARAH SEWAKTUGDPGD2PPSIFILIS (+/-)HBSAG (+/-)ASAM URATUREUMKREATININSGOTSGPTIBU HAMIL DATANG DENGAN HIV (+)IBU HAMIL DITAWARKAN TESIBU HAMIL DITES HIVHASIL TES HIV (+/-)RUJUK POLI SAHABATIBU HAMIL MENDAPAT ARVKOMPLIKASI KEHAMILANRUJUK RSTGL PERSALINANKALA IKALA IIKALA IIIKALA IVJENIS PERSALINAN (SPT/SC)TEMPAT PERSALINANJENIS KELAMIN BAYIBB (GRAM)PB (CM)IMDNAMA BAYITANGGAL KF1/KN1TANGGAL KF2/KN2TANGGAL KF3/KN3TANGGAL KF4METODE KONTRASEPSI
2
v24/12/2025PUSTU RWS10014300intanDEFRIE WJL KP JAWA RAWASARI JL KP JAWA RAWASARI64RWSS1PPPK BNPB081388827690317105630379300010000042168216PUSKESMAS CEMPUT3174081702880005317105020818000323/07/199332G2P1A06 TH 6 BULAN15/08/202522/05/202619 MG 4 HRII-V--KRAM PERUT86,51608232OBESTITAS100/703 JARI BAWAH PUSAT33NORMALPOSITIF144BM-TBALTT4TIDAK30YAYABKTIDAKA12,9NEG99--NEGNEG-----TIDAKYAYANEGTIDAKTIDAKBSC 1X
OBESITAS
3
BSC 1X
OBESITAS
4
5
24/12/2025PUSTU RWS20000368RIA ANGGRAENIANDIKA PRATAMAJL PRAMUKA JAYASARIJL PRAMUKA JAYASARI22RWSSMAIRT08137115412731720454089200090001151464869KLINIK SUMBER SEHAT--14/08/199233G5P3A16 TH 4 BULAN10/11/202517/08/20266 MG 2 HRIV---TAK591445828NORMAL120/70BT28,5NORMALPOSITIF-----T5TIDAK30YAYABKTIDAKO14,6NEG366--NEGNEG-----TIDAKYAYANEGTIDAKTIDAKBSC 3X
DIABETES GESTASIONAL
6
BSC 3X
DIABETES GESTASIONAL
7
8
29/12/2025PUSTU RWS30005559ZALIKA AFARINHUDZAIFAH AZZUKRUFJL PERCETAKAN NEGARA 4/74DJL PERCETAKAN NEGARA 4/74D54RWSSMKIRT0856702454031710551040810030000372502629PUSKESMAS CEMPUT--11/04/200817G1P0A0-SEPT 202526/07/202610 MG 1 HRIV---PUSING, MUAL, PILEK38,31513716,2KURUS100/704 JAS19,5KEKPOSITIF149--TBALTT5TIDAK30YAYABKTIDAKB12,8NEG115--NEGNEG-----TIDAKYAYANEGTIDAKTIDAKKEK
9
KEK
10
11
14/01/2026PUSTU RWS40014483DESIFIAN RAHMANINGRUMM. ANSHORUDDINJL C2 NO. IIAJL C2 NO. IIA77RWSS1PNS BPOM08386779379734041344129500010002279429728PUSKESMAS CEMPUT3471141003930001347114111122000104/12/199530G2P0A1-03/12/202510/09/20266 MGIV---MUAL57,3154,55523NORMAL90/60BT26NORMALPOSITIF----BALTT4TIDAK30YAYABKTIDAKA12,4NEG103--NEGNEG-----TIDAKYAYANEGTIDAKTIDAKSRQ 8
12
SRQ 8
13
14
22/01/2026PUSTU RWS50014532CITRA NUR'AUNIAGUSJL BACANG 41BJL BACANG 41B57RWSS1KARYAWAN SWASTA08122002417415022054069800010002377120432PUSKESMAS CEMPUT--04/06/199827G2P1A03 TH 4 BULAN27/09/202504/07/202616 MG 5 HRII-V--PUSING, KEPUTIHAN GATAL60,31625420,6NORMAL110/701427NORMALPOSITIF136--TBALTT5TIDAK60YAYABKTIDAKB9,8POS 193--NEGNEG-----TIDAKYAYANEGTIDAKTIDAKANEMIA SEDANG
BSC 1X
15
ANEMIA SEDANG
BSC 1X
16
17
28/01/2026PUSTU RWS60014580REFILTA FAUZIADIL HASSANSUMATRA BARATAPART GREEN PRAMUKA139RWSSMUIRT08119912374137103480192000300014220208341372022006860001137202260216000108/01/199234G6P5A05 TH 10 BLN28/04/202502/02/202639MGG 2HRIIIVBATUK 1 MGG61,7158,54919,5NORMAL100/703124,5NORMALPOSITIF134M2945TKEPALAT5TIDAK30YAYABKTIDAKA10,7NEG85--NEGNEG-----TIDAKYAYANEGTIDAKTIDAKBSC 1.ANEMIA RINGAN
18
BSC1X,ANEMIA RINGAN
19
20
04/02/2026PUSTU RWS70014624ELSA EMILIANISSYAIFUDINJL KP JAWAJL KP JAWA49RWSSMKIRT089580311474731720460129710030000378160413PUSKESMAS--20/12/199728G1POA0-17/11/202524/08/202615MGG4HRIIBAPIL61,41555522,9NORMAL90/6012CM27,5NORMALPOSITIF147BALTT5TIDAK30YAYABKTIDAKB11,7NEG94NEGNEGTIDAKYAYANEGTIDAKTIDAK-
21
22
06-02-2026PUSTU RWS80001074DHITTA MONIKAHENDRYJL. P .NEGARA XA 7/4JL. P .NEGARA XA 7/474RWSSMAIRT08829017744931710562079800020000372078494PUSKESMAS 22-07-199827G2P1A03 TH24-10-202501-08-202615 MGGIIVKRAM PERUT87,81557432,5OBESITAS120/807 CM 31NORMALPOSITIF137BMTBALTT5TIDAK30YAYA-TIDAKB12,7NEG112NEGNEGTIDAKYAYANEGTIDAKTIDAKOBESITAS
23
OBESITAS
24
25
11/02/2026PUSTU RWS90008142ZALFA YUSMA NADIAALVINJL PN XIAJL PN XIA55RWSSMKIRT08136877003131710461090200050001229064445PUSKESMAS-21/09/200223G2P1A015/12/202522/09/20268MGGIVMUAL83,71558334,5OBESITAS120/80BT33NORMALPOSITIF-BTT5TIDAK30YAYABKTIDAKO10,9NEG156NEGNEGTIDAKYAYANEGTIDAKTIDAKRIWAYAT SC 1X,ANEMIA RINGAN ,OBESITAS
26
ANEMIA RINGAN
27
28
sudah masuk sihepi12-02-2026PUSTU RWS100014691ALFI NUR AMALIAAFWANJL. P. NEGARA V 8/1JL. P. NEGARA V 8/181RWSD4PNS08389683044733290857020000030001083901871PUSKESMAS17-02-200025G1POA012-06-202519-03-202535 MGGIIIVTAK70,31596927,3NORMAL100/7030 CM27,5NORMALPOSITIF137BM2635TKEPALAT5TIDAK30YAYATDKTIDAKO10,6NEG82NEGNEGTIDAKYAYANEGTIDAKTIDAKANEMIA RINGAN
29
30
31
32
18-02-2026pustu rws110011050WIWIK ANARIANDRI EKAJL PERCETAKAN NGRJL PERCETAKAN NGR84RWSSMUIBU RUMSH TANGGA083804674877332710470395008507-03-199531G2P1A002-01-202609-10-20266MGGIVLEMAS461584518.4NORMAL90/60BLM TRB24,5NORMALPOSITIF-BLM TRBT5TIDAK-YAYABKO13,5NEG91NEGNEGTIDAKYAYANEGTIDAKTIDAK-
33
34
35
36
37
V09-03-2026PUSTU RWS120008978VITA WAHYU HIDAYANISYAKIRUN NI"AMSEMARANGPRAMUKA SARI III137RWSS1IRT08573341713135241870069400030002157632177PUSKESMAS30-06-199431G2P1A026-01-202602-11-20266MGG1VMUAL,PUSING56,81575522,3NORMAL130/80BLM TRB27NORMALPOSITIF----BLM TRBT5TIDAK30YAYABKTIDAKA12NEG82NEGNEGTIDAKYAYANEGTIDAKTIDAK-
38
39
40
sudah masuk sihepi&anemia kek09-03-2026PUSTU RWS130001078LINDA SANDRA SOPYANAHAMZAHPERC NGR VPERC NGR V81RWSSMAIRT08952872370731710368069000090001228843697PUSKESMAS28-06-199035G4P3A03 TH 8 BULAN18-01-202625-10-20267MGG1VMUAL,MUNTAH451474520,8NORMAL90/60BLM TRB23,5NORMALPOSITIF----BLM TRBT5TIDAK30YAYABKTIDAKB11,6NEG93NEGNEGTIDAKYAYANEGTIDAKTIDAKUSIA>35 THN
41
Lap. AprV25-03-2026PUSTU RWS140010956META ERVINDA SETYAWATIKHOIRUL ANWARPACITANPRAMUKA SARI108RWSSMAIRT08223418135535010165099600020002277840194PUSKESMAS350101080489000125-09-199827G3P1A15TH 6 BULAN13-02-202620-11-20265MGG1VMUAL.PERUT KDG KRAM501545021NORMAL110/80BLM TRB24NORMALPOSITIF----BLM TRBT5TIDAK30YAYABKTIDAKO11,9NEG125NEGNEGTIDAKYAYANEGTIDAKTIDAKBSC 1X
42
43
V30-03-2026PUSTU RWS150011498TIKA JUWITAHENDRIPERC NGRJL PERV NGR III141RWSSMKIRT08950557954231710550089300010001207376605PUSKESMAS-10-08-199332G4P2A119-02-202626-11-20265MGG1VDEMAM 2 HR611596124,1NORMAL100/60BLM TRB26,5NORMALPOSITIFBLM TRBT5TIDAK30YAYABKTIDAK11,9NEG104NEGNEGTIDAKYAYANEGTIDAKTIDAKRIWAYAT SC 1X
44
45
V02-04-2026PUSTU RWS16'0015034NAFA AZURA BUDIM BENI UMARHALIM JAKARTA TIMURPRAMUKA SARI88RWSD3KARYAWATI08969957233631750848040110020002085180693PUSKESMAS737202190395000508-01-200124G1P0A02-2-20269-11-20267MGG1VMUAL ,PUSING45,61584222,3NORMAL90/60BLM TRB23,5NORMALPOSITIFBLM TRBT3TIDAK30YAYABKTIDAKA12,2NEG88NEGNEGTIDAKYAYANEGTIDAKTIDAK-
46
47
RAHMAN V02-04-2026PUSTU RWS170015035MITHA MUTIARA DITARAHMAN SIGIT SATOTOJL BACANGJL BACANG57RWSS1WIRASWASTA08129443779131710566098900030000043664286PUSKESMS26-09-202636G2P1A01TH 7 BULAN18-01-202625-10-20268 MGG(USG)1VPUSING,MUAL72,21567028,8GEMUK90/60UT MEMB31NORMALPOSITIF136BMTUT MEMBT5TIDAK30YAYABKTIDAKO12,8NEG87NEGNEGTIDAKYAYANEGTIDAKTIDAKRIWAYAT SC 1X,USIA >35 TH,JARAK KEHAMILAN<2TH
48
49
sudah msk sihepiV02-04-2026PUSTU RWS180015035INTAN INDARWATIM IBNU FAJARJL PN VJL PN V 141RWSSMAIRT08380840755131710566049400010000372248201PUSKESMAS26-04-199432G2P1A01TH10 BLN01-02-202608-11-202610MGG1VMUAL PUSING40,71553920,1NORMAL90/60UT MEMB23RESIKO KEKPOSITIF132BMTUT MEMBT5TIDAK30YAYABKTIDAKAB13,5NEG114NEGNEGTIDAKYAYANEGTIDAKTIDAKKEK
50
V13-04-2026PUSTU RWS190001349DESTI RANTISYAHHELDI ARISKIJL PRAMUKA SARI IJL PRAMUKA SARI 1118RWSS1KARYAWATI08757770484031710546129400010001206302984PUSKESMAS317402101289000106-12-199431G2P1A05TH 6 BLN26-02-202603-12-20267MGG1VMUAL,MUNTAH,PUSING67,51586526NORMAL90/60BLM TRB30NORMALPOSITIFBLM TRBT5TIDAK30YAYABKTIDAKO11,5NEG84NEGNEGTIDAKYAYANEGTIDAKTIDAKRIW PERDARAHAN PERSALINAN SEBELUMNYA
51
V15-04-2026PUSTU RWS200015128DESY RETNAWATIMUH TANZIL MAULANAJL KP JAWA RWSJL KP JAWA RWS89RWSSMAKARYAWATI08960170256031710859039500010000039439607PUSKESMAS3217142709930003360425240717000419-03-199531G4P3A04TH1 BLN25-01-202601-11-202611MGG1VMUAL PUSING60,51566426,2GEMUK100/703JR ATAS SYM27NORMALPOSITIF137BMT3 JR AT SYMT5TIDAK30YAYABKTIDAKAB12,1NEG81NEGNEGTIDAKYAYANEGTIDAKTIDAKRIWAYAT SC
52
V15-04-2026PUSTU RWS210007757DIANA ROSITAMUH BIMO ARDAVAPRAMUKA SARI IPRAMUKA SARI I98RWSSMKIRT08521271555231710536090000020002131130237PUSKESMAS317103251202000506-09-200025G2P1A03 TH29-10-2505-08-202624MGG2VMUAL,PUSING45,21614417,3KURUS90/6018CM21KEKPOSITIF134BMSUNGSANGT5TIDAK60YAYABKTIDAKO9,6NEG101NEGNEGTIDAKYAYANEGTIDAKTIDAKANEMIA.KEK
53
V16-04-2026PKM CP
(66)
220015133KINAN GHEAFAUZANCEMPAKA PUTIH TIMURKOMP BPKP109RWSS1IRT08569311053733290957039900130001306758881PUSKESMAS--17-03-199727G2P1A02,5 TH26-10-2502-08-202623MGG2VNYERI PERUT BAG BWH71,71526528,1GEMUK100/7023CM30NORMALPOSITIF148BMTBALLT5TIDAK30YAYABKYABTIDAKYAYANEGTIDAKTIDAKRIW SC,JARAK KEHAMILAN <20 TH
54
V16-04-2026PUSTU RWS230015143DESWINA RAFIQOLTEUKU GIBRANRAWASARI SELATANRAWASARI SELATAN149RWSSMAIRT08967502084331710558120400020001773492208PUSKESMAS-18-12-200421G2P1A02TH 8 BLN04-02-202611-11-20269MGG1VMUAL,PUSING65,91526028,1GEMUK100/70BLM TRB31NORMALPOSITIF149BLM TRBT5TIDAK30YAYABKTIDAKAB13,3NEG87NEGNEGTIDAKYAYANEGTIDAKTIDAK-
55
V22-04-2026PUSTU RWS240005213INDAH SULISTYAWATITEDI SEPTIANJL SAYUTI 5JL SAYUTI 586RWSSMAIRT08139978518131710556109500020001157463832PUSKESMAS16-10-199530G4P2A11 TAHUN15-03-202622-12-20265 MGG1VPUSING,MUAL,MUNTAH54153.55322.6NORMAL90/60BLM TRB28.5NORMALPOSITIFBLM TRBT5TIDAK30YAYABKYA12.1NEG78NEGNEGTIDAKYAYANEGTIDAKTIDAKJARAK ANAK <2 THN
56
Lap. MeiV27-04-2026PUSTU RWS250007845NURLENIM RIZALJL PRAMUKA SARI IIIJL PRAMUKA SARI III127RWSSMPIRT08595268751031710844129900030000372298116PUSKESMAS04-02-199926G3P1`A13 TH21-03-202628-10-20265MGG1VMUAL ,PUSING69,61557029,1GEMUK100/70BLM TRB31NORMALPOSITIF-BLM TRBT5TIDAK30YAYABKTIDAKAB12,3NEG91NEGNEGTIDAKYAYANEGTIDAKTIDAK-
57
V27-04-2026PUSTU RWS260015219SANTIWAHYUJL PN XIAJL PN XIA75RWSSDART08560626688232033246069600060000400338652PUSKESMAS6-6-199629G3P2A05 THN26-01-202602-11-202612MGG1VKELUAR FLEK 4 HR43,81514218,5NORMAL100/70BLM TRB24NORMALPOSITIFBLM TRBT5TIDAK30YAYABKTIDAKO13.5NEG89NEGNEGTIDAKYAYANEGTIDAKTIDAK-
58
sihepiV27-04-2026PUSTU RWS270009064KARENINAFAITHKP JAWA RWSKP JAWA RWS37RWSSMAIRT08967625244031710549070510010001208424082PUSKESMAS09-07-200520G1P0A0-24-10-202531-7-202626 MGG2VTAK79.31676222.2NORMAL100/7024CM30NORMALPOSITIF136BMTBALLT4TIDAK30YAYABK10.7NEG82POSNEGTIDAKYAYANEGYATIDALANEMIA,SIPHILIS +
59
sihepiV04-05-2026PUSTU RWS280001838EVARIA TONDANGTEDI JL P.SARIJL P SARI98RWSSMAIRT08569435893131710565078400070001208382906PUSKESMAS317105141279000631705010411000225-07-198441G6P3A24TH6BLN30-11-202506-09-202622MGG2VTAK75,71547531,6OBES128/8620CM27NORMALPOSITIF138BMTSUNGSANGT5TIDAK30YAYABKTIDAKO13,5NEG96NEGNEGTIDAKYAYANEGTIDAKTIDAKMULTIPARA,USIA >35 TH,OBESITAS,RIW HIPERTENSI PERSALINAN SEBELUMNYARUJUK RSIJ
60
sihepiV22-05-2026PUSTU RWS290015403EVI AMALIAH MUHAMMAD ARLIN ILHAM JL. RAWA BEBEK RT 05 / RW 03 , PENJARINGANAPARTEMENT GREEN PRAMUKA RT 13 / RW 09 , KEL RAWASARI , KEC CEMPAKA PUTIH139RWSS1KARYAWAN SWASTA081310349188/ 08123451015231720155019500010001294211744PUSKESMAS CEMPAKA PUTIH3171060107920001317201091225003315/01/199531G1P0A0-10/12/202516/9/202623 MGG 2 HR 2VTANGAN KEBAS691495524,7NORMAL 120/701432NORMAL POSITIF147BMTBALLOTEMENT T5TIDAK 30YAYA2XBKTIDAKA12,6NEG91NEGNEGTIDAKYAYANEGTIDAKTIDAK1 FR SEDANG PE
61
Lap. JuniV25-05-2026PUSTU RAWASARI300007637YUNISA PRATIWIDANI APRIANTOJL PNJL PN124RWSSMAIRT08581456338732760649068700070001739678466PUSKESMAS3175031504830008-09/06/198738G6P2A34 THN 20/04/202627/1/20275MGG1VMUAL91,61558535,3OBES100/70BLM TRB34NORMALPOSITIF-BLM TRBT5TIDAK30YAYABKTIDAKB12,8NEG97NEGNEGTIDAKYAYANEGTIDAKTIDAKRIW SC 2X,RIW ABORTUS 3X,USIA >35 THRUJUK RSIJ
62
V04-06-2026PUSTU RWS310015462FIRDHA WIDYASARIHARDIAN NUGRAHAPRAMUKA SARI IIPRAMUKA SARI II88RWSSMAIRT0852112078843171077005010003000120782189PUSKESMAS317108270302000430-05-200125G2P1A01 TH 9 BLN22-11-202529-08-202628MGG3VLEMAS69,21596224,5NORMAL90/6019CM29NORMALPOSITIF147BMTSUNGSANGT5TIDAK30YAYABKYAA8NEG93NEGNEGTIDAKYAYANEGTIDAKTIDAKANEMIA SEDANG,RIW PERDARAHAN,JARAK KEHAMILAN <2THRUJUK RSIJ
63
V05-06-2026PUSTU RWS320015462TAHARAH RAFIKAWAHYUPRAMUKA SARI IIIPRAMUKA SARI III107RWSS1KARYAWATI08138836587931710559099900040002329699206PUSKESMAS-19-09-199926G1P0A0-10-11-202617-08-202628 MGG3VVTAK70.71595522.9NORMAL110/8026CM31.5NORMALPOSITIF139BMTSUNGSANGT2+TIDAK30YAYABKTIDAKO11.6NEG97NEGNEGTIDAKYAYANEGTIDAKTIDAKMATA MINUS 3/3
64
65
V08-06-2026PUSTU RWS330015484DWI SYIFAFITRIANIADE RAFLIPN XBPN XB84RWSSMKIRT089539193675331710556120100030000043547894PUSKESMAS3171053012970003317105210524000916-12-200126G2P1A016-03-202623-12-202612MGG1VPUSING,BAPIL 4 HARI86,21517037,7OBESITAS90/6010CM36NORMALPOSITIF134BMBLM TRBT5TIDAK30YAYABKTIDAKO13,7NEG92NEGNEGTIDAKYAYANEGTIDAKTIDAKOBESITAS
66
11-06-2026PUSTU RWS340003553MUTIARA R FEBRIYANIHARRY WIDIATNOPRAMUKA GG TAMIANGPRAMUKA GG TAMIANG24RWSS1KARYAWATI08577072065031710548029800020001647972437PUSKESMAS08-02-199828G3P2A04 TH 2 BL10-01-202617-10-202622MGG2VKEPUTIHAN ,GATAL,BAU+821578530.1OBESITAS100/6020CM33NORMALPOSITIF143BMTSUNGSANGT5TIDAK30YAYABMTIDAKO12NEG97NEGNEGTIDAKYAYANEGTIDAKTIDAKOBESITAS ,RIW SC
67
Lap. Juli
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100