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PENCAPAIAN TARGET DAN JENIS KASUS Nama Peserta : No.ID Peserta : Pendamping : 1. Usaha Kesehatan Perorangan (UKP) Kasus UKP Jumlah Persentase (%) Berdasarkan umur: a. Bayi-anak b. Dewasa (15-60 th) c. Lansia (>60 th) Total Berdasarkan jenis kelamin: a. Laki-laki b. Perempuan Total Berdasarkan kelompok: a. Medik b. Bedah c. Kegawatdarurat an d. Kejiwaan e. Medikolegal Total 2. Usaha kesehatan masyarakat (UKM) Kode Kegiatan Laporan F.1 Upaya Promosi Kesehatan dan Pemberdayaan Masyarakat F.2 Upaya Kesehatan Lingkungan F.3 Upaya Kesehatan Ibu dan Anak serta Keluarga Berencana (KB)

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PENCAPAIAN TARGET DAN JENIS KASUSNama Peserta:No.ID Peserta:Pendamping:1. Usaha Kesehatan Perorangan (UKP)Kasus UKPJumlahPersentase (%)

Berdasarkan umur:a. Bayi-anakb. Dewasa (15-60 th)c. Lansia (>60 th)

Total

Berdasarkan jenis kelamin:a. Laki-lakib. Perempuan

Total

Berdasarkan kelompok:a. Medikb. Bedahc. Kegawatdaruratand. Kejiwaan e. Medikolegal

Total

2. Usaha kesehatan masyarakat (UKM)KodeKegiatanLaporan

F.1Upaya Promosi Kesehatan dan Pemberdayaan Masyarakat

F.2Upaya Kesehatan Lingkungan

F.3Upaya Kesehatan Ibu dan Anak serta Keluarga Berencana (KB)

F.4Upaya Perbaikan Gizi Masyarakat

F.5Upaya Surveillance, Pencegahan, dan Pemberantasan Penyakit Menular dan Tidak Menular

F.6Upaya Pengobatan Dasar

F.7Mini Project

3. Portofolio/Laporan KasusJenis kasusTanggal presentasiTopik

Kasus menarik (medik, bedah, kegawatdaruratan)

Kasus kematian

Kasus etik/jiwa


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