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FORMAT PENGKAJIAN DEVELOPMENTAL SCREENING TEST II



Nama Mahasiswa NIM



: Luh Putu Yuli Pratami, S.Kep :17089142080



1. IDENTITAS ANAK Nama : Tanggal lahir : Jenis kelamin : Agama : Pendidikan : Alamat : 2. IDENTITAS ORANG TUA Nama : Tanggal lahir : Jenis kelamin : Agama : Pendidikan : Pekerjaan : Alamat : 3. RIWAYAT PERTUMBUHAN DAN PERKEMBANGAN a) Personal sosial/kemandirian bergaul ........................................................................................................................ ........................................................................................................................ ........................................................................................................................ ........................................................................................................................ b) Motorik Halus ........................................................................................................................ ........................................................................................................................ ........................................................................................................................ ........................................................................................................................ c) Bahasa ........................................................................................................................ ........................................................................................................................ ........................................................................................................................ ........................................................................................................................



d) Motorik Kasar ........................................................................................................................ ........................................................................................................................ ........................................................................................................................ ........................................................................................................................ 4. PENGHITUNGAN UMUR Tanggal test : Tanggal lahir : Umur anak : 5. PELAKSANAAN TEST DDST II SEKTOR Personal sosial



Motorik halus



Bahasa



Motorik kasar



RESPON ANAK



KESIMPULAN



6. INTERPRETASI HASIL TEST DARI DDST II ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... 7. KESIMPULAN DARI KEEMPAT SEKTOR ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... 8. SARAN KEPADA ORANG TUA/PENGASUH ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... ...............................................................................................................................



LAPORAN DENVER DEVELOPMENTAL SCREENING TEST (DDST) II Pada An. Umur: Tanggal: Oktober 2017 Di RSUD Kabupaten Buleleng Tahun 2017



OLEH : Luh Putu Yuli Pratami, S.Kep 17089142080



SEKOLAH TINGGI ILMU KESEHATAN STIKES BULELENG PROGRAM PROFESI NERS 2017