PENANGANAN GIZI DALAM SITUASI DARURAT
cover a acc hitam putih.cdr
cover a acc hitam putih.cdr
- No tags were found...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Formulir III. Hasil Pengukuran Antropometri (LiLA) Ibu Hamil<br />
Tanggal : ............................... Kecamatan : ..............................<br />
Nama Posko : ............................... Kab/Kota : ..............................<br />
Desa/Kelurahan : ............................... Provinsi : ..............................<br />
No. Nama KK<br />
Nama Bumil<br />
Umur Bumil<br />
(Tahun)<br />
Umur Kehamilan (Trimester)<br />
II<br />
III<br />
LiLA (cm)<br />
LiLA<br />
(1)<br />
(2)<br />
(3)<br />
(4)<br />
(5)<br />
(6)<br />
(7)<br />
(8)<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
7<br />
8<br />
9<br />
10<br />
11<br />
12<br />
13<br />
14<br />
15<br />
JUMLAH<br />
Keterangan<br />
*1. LILA < 23,5 cm = Bumil risiko KEK<br />
2. LILA >= 23,5 cm = Bumil Normal<br />
Penanggung Jawab Petugas<br />
(.............................) (.............................)<br />
Kategori*<br />
(9)<br />
I<br />
69
Change language