Akses Pelayanan & Pembiayan Kesehatan (A)

No Nama Jenis Kelamin Umur Pendidikan Total

A1 A2 A3 A4

I Dewa Nyoman
1 L 67 Tamat SD 4 4 2 2 12
Asmara
2 Wito Utomo L 48 Tamat SD 4 4 2 2 12
3 Rastim L 46 Tamat SD 4 4 2 2 12
M. Siddiq Nugi
4 L 23 SLTA 4 4 2 2 12
Prayitno

5 I Gede Kusuma Dana L 25 SLTA 4 4 2 2 12

I Nyoman
6 L 72 Tdk Tamat SD 4 4 2 2 12
Mangkudana
7 I Ketut Budiastawa L 38 SLTA 4 4 2 2 12
8 I Wayan Badra L 60 SLTP 4 4 2 2 12
I Dewa Made
9 L 39 SLTA 4 4 2 2 12
Tamanyasma
10 I Komang Nuartha L 36 SLTA 4 4 2 2 12
11 I Nyoman Miasa L 76 SLTP 4 4 2 2 12
12 I Wayan Sukradana L 51 Tamat SD 4 4 2 2 12
13 Ramyo L 34 Tamat SD 4 4 2 2 12
14 Muh. Tahang L 43 SLTA 4 4 2 2 12
15 Risal L 30 SLTA 4 4 2 2 12
16 Mursalim L 50 SD 4 4 2 2 12
17 Darwis L 55 SLTA 4 4 2 2 12
18 Akbar Arfian L 24 SLTA 4 4 2 2 12
TOTAL 72 72 36 36 216

KETERANGAN ==> Manurung

Lakawali
Tarabbi
Lakawali Pantai
 Kesehatan Ibu dan Anak, KB, Gizi, & Imunisasi (B)
Kriteria Total
B7
B1 B2 B3 B4 B5 B6 B8 B9 B10 B11 B12 B13 B14 B15 B16 B17
B7.1 B7.2 B7.3 B7.4

1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 2 2 1 16

2 0 0 0 0 0 1 1 1 1 1 2 2 1 0 2 2 2 2 1 21
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 2 1 2 2 1 14

1 0 0 0 0 0 1 1 1 1 1 2 2 1 0 2 2 2 2 1 20

1 0 0 0 0 0 1 1 1 1 2 0 0 1 0 2 1 2 2 1 16

1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1 0 2 2 1 12

1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 2 0 1 2 1 16
1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 2 2 1 16

1 0 0 0 0 0 1 1 1 1 1 0 2 1 0 2 2 2 2 1 18

1 0 0 0 0 0 1 1 1 1 1 1 1 1 0 2 1 2 2 1 17
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1 0 2 2 1 12
1 0 0 0 0 0 1 1 1 1 1 1 1 1 0 2 1 2 2 1 17
1 0 0 0 0 0 1 1 1 1 1 2 2 1 0 2 2 2 2 1 20
1 0 0 0 0 0 1 1 1 1 1 2 2 1 0 1 0 2 2 1 17
1 0 0 0 0 0 1 1 1 1 1 2 2 1 2 2 2 2 2 1 22
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1 0 2 2 1 12
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1 0 2 2 1 12
1 0 0 0 0 0 1 1 1 1 1 0 2 1 0 2 1 2 2 1 17
0 19 0 0 0 0 0 18 18 18 18 19 15 19 13 5 29 15 35 36 18 295
 Rumah & Lingkungan Perilaku Anggota Keluarga (D)
Kriteria Total Kriteria
C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 D1 D2 D3 D4 D5 D6 D7 D8 D9 D10

3 3 4 2 3 1 1 2 2 1 22 1 2 3 2 2 2 2 2 2 2

3 3 4 1 1 2 1 1 2 1 19 2 2 3 2 2 2 2 2 2 2
3 2 4 2 3 2 2 2 1 1 22 1 2 3 2 2 2 2 2 2 2

3 3 4 2 1 1 2 2 2 1 21 2 2 3 2 2 2 2 2 2 2

3 3 4 2 3 3 1 2 2 1 24 1 2 3 2 2 2 2 2 2 2

3 3 4 2 3 3 1 2 1 1 23 2 2 3 2 2 2 2 2 2 2

3 3 4 2 3 2 1 1 2 1 22 1 2 3 2 2 2 2 2 2 2
3 4 4 2 3 3 2 2 2 1 26 2 2 3 2 2 2 2 2 2 2

3 3 4 2 3 3 1 2 1 1 23 2 2 3 2 2 2 2 2 2 2

3 3 4 2 3 3 2 2 2 2 26 2 2 3 2 2 2 2 2 2 2
3 2 4 2 3 3 1 2 1 1 22 1 2 3 2 2 2 2 2 2 2
3 3 2 2 3 3 1 2 2 1 22 1 2 3 2 2 2 2 2 2 2
3 3 4 2 3 1 1 1 2 1 21 2 2 3 2 2 2 2 2 2 2
3 3 4 2 1 3 1 2 2 1 22 2 2 3 2 2 2 2 2 2 2
3 3 4 2 1 2 1 1 2 1 20 2 2 3 1 2 2 2 2 2 2
3 4 2 2 2 2 2 2 2 1 22 1 2 3 2 2 2 2 2 2 2
3 3 2 2 2 1 1 2 1 1 18 1 2 3 2 2 2 2 2 2 2
3 3 4 2 1 1 1 2 1 1 19 1 2 3 2 2 2 2 2 2 2
0 54 54 66 35 42 39 23 32 30 19 394 0 27 36 54 35 36 36 36 36 36 36
 Survelance (E)
Total Kriteria Total Kriteria
E1 E2 E3 E4 E5 E6 E7 E8 E9 E10 E11 E12 E13 E14 E15 E16 E17

20 1 1 1 1 1 1 2 1 1 1 1 1 1 2 3 2 1 22

21 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 2 2 22
20 1 1 1 1 1 1 2 1 2 1 1 1 2 2 3 2 2 25

21 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 2 2 22

20 1 1 1 1 1 1 1 1 1 1 1 1 2 2 3 2 2 23

21 1 1 1 1 1 1 1 2 1 1 1 1 1 2 3 2 2 23

20 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 2 2 22
21 1 1 1 1 1 1 1 2 2 1 1 1 2 2 3 2 2 25

21 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 21

21 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 2 2 22
20 1 1 1 1 1 1 1 2 1 1 1 1 1 2 2 2 2 22
20 1 1 1 1 1 1 1 1 2 1 1 1 1 2 3 2 2 23
21 1 1 1 1 1 1 2 1 1 1 1 1 1 2 3 2 2 23
21 1 1 1 1 1 1 1 2 1 1 1 1 1 2 3 2 2 23
20 1 1 1 1 1 1 1 2 1 1 1 1 1 2 3 2 2 23
20 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 1 2 21
20 1 1 1 1 1 1 1 2 1 1 1 1 1 2 2 2 2 22
20 1 1 1 1 1 1 2 2 1 1 1 1 1 2 3 2 2 24
368 0 18 18 18 18 18 18 22 25 21 18 18 18 21 36 51 35 35 408 0
 Penderita
Gangguan Jiwa LANSIA (G)
(F) Total Kriteria Total Kriteria
F1 F2 G1 G2

1 0 1 2 2 4

1 0 1 1 0 1
1 0 1 1 0 1

1 0 1 1 0 1

1 0 1 1 0 1

1 0 1 1 0 1

1 0 1 1 0 1
1 0 1 2 2 4

1 0 1 1 0 1

1 0 1 1 0 1
1 0 1 1 0 1
1 0 1 1 0 1
1 0 1 1 0 1
1 0 1 1 0 1
1 0 1 1 0 1
1 0 1 1 0 1
1 0 1 1 0 1
1 0 1 1 0 1
18 0 18 0 20 4 24 0
m
 Akses Pelayanan & Pembiayan Kesehatan (A)
Pendidika
No Nama JK Umur Total
n
A1 A2 A3 A4

1 Rokhim L 43 Th SLTA 4 4 2 2 12
2 Rahmat Wahyono L 39 Th SD 4 4 2 2 12
3 Suprianto L 37 Th SLTP 4 4 2 2 12
4 Hadirianto L 64 Th SD 4 4 2 2 12
5 Hariyanto L 33 Th SD 4 4 2 2 12
6 Dedi Siswanto L 39 Th SD 4 4 2 2 12
7 Nursito L 72 Th SD 4 4 2 2 12
8 Sutarno L 39 Th SD 4 4 2 2 12
9 Subandi L 48 Th SD 4 4 2 2 12
10 Wakiman L 42 Th SD 4 4 2 2 12
11 Madsukarto L 70 Th SD 4 3 2 2 11
12 Ahmad Purwanto L 52 Th SLTP 4 3 2 2 11
13 Rangga Yuda L 32 Th TT 4 3 2 2 11
14 Nurdalia P 57 Th SD 4 3 1 2 10
15 Dirun L 46 Th SD 4 3 2 2 11
16 Daina P 41 Th D IV 4 4 2 2 12
17 Saliyem P 69 Th TT 4 3 2 2 11
TOTAL 68 62 33 34 197
 Kesehatan Ibu dan Anak, KB, Gizi, & Imunisasi (B)
Kriteria
B7
B1 B2 B3 B4 B5 B6 B8 B9 B10 B11 B12 B13
B7.1 B7.2 B7.3 B7.4
2 4 3 2 1 3 1 1 1 1 1 2 2 1 2 2
1 0 0 0 0 0 1 1 1 1 2 2 2 1 2 2
1 0 0 0 0 0 1 1 1 1 1 2 2 1 2 2
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 2
1 0 0 2 1 3 1 1 1 1 2 2 2 1 2 2
1 0 0 0 0 0 1 1 1 1 1 2 2 2 2 1
1 0 0 2 1 3 1 1 1 1 1 2 2 2 2 2
1 0 0 0 0 0 1 1 1 1 1 2 2 1 2 1
1 0 0 2 1 3 1 1 1 1 1 0 0 0 0 2
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 2
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 2
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 2
1 0 0 0 0 0 1 1 1 1 0 0 0 0 0 1
1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 1
0 18 4 3 8 4 12 17 17 17 17 18 14 14 9 14 27
 Rumah & Lingkungan
TotalKriteria TotalKriteria
B14 B15 B16 B17 C1 C2 C3 C4 C5 C6 C7 C8 C9 C10

1 2 2 1 35 3 3 3 1 1 2 2 2 2 1 20
2 2 2 1 23 3 3 4 1 3 2 1 1 2 1 21
2 2 2 1 22 2 3 4 1 3 3 1 1 2 1 21
1 2 2 1 13 2 3 4 2 3 2 1 1 2 1 21
2 2 2 1 15 2 3 4 2 3 2 1 1 2 1 21
2 2 2 1 29 3 3 4 2 3 3 2 2 2 1 25
1 2 2 1 21 3 3 4 2 3 3 2 2 2 2 26
2 2 2 1 29 3 3 4 2 3 3 2 2 2 1 25
1 2 2 1 20 2 3 4 2 3 3 1 1 1 1 21
2 2 2 1 21 3 3 4 2 1 3 1 1 2 1 21
0 2 2 1 12 3 3 4 2 3 1 2 1 2 1 22
2 2 2 1 15 3 3 4 2 0 3 1 2 2 1 21
2 2 2 1 15 3 3 4 2 1 3 1 1 2 1 21
0 2 2 1 12 3 3 4 2 1 1 1 1 2 1 19
2 2 2 1 15 3 3 4 1 1 1 1 1 2 1 18
0 2 2 1 11 3 3 2 2 3 1 1 1 2 1 19
0 2 2 1 12 3 3 4 2 3 3 1 2 2 1 24
22 34 34 17 320 0 47 51 65 30 38 39 22 23 33 18 366 0
 Perilaku Anggota Keluarga (D) Survel
TotalKriteria
D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 E1 E2 E3 E4 E5 E6

1 2 3 2 1 1 2 2 2 1 17 2 1 1 1 1 1
1 2 3 2 1 1 2 2 2 2 18 1 1 1 1 1 1
2 2 3 2 1 2 2 2 2 2 20 2 2 1 1 1 1
1 2 3 2 1 1 2 2 2 2 18 2 1 1 1 1 1
2 2 3 2 1 1 2 2 2 2 19 1 1 1 1 1 1
2 2 3 2 2 2 2 2 2 2 21 2 1 1 1 1 1
2 2 3 2 2 2 2 2 2 2 21 1 1 1 1 1 1
2 2 3 2 2 2 2 2 2 2 21 1 1 1 1 1 1
2 2 3 2 2 2 2 2 2 2 21 1 1 1 1 1 1
2 2 3 2 1 2 2 2 2 2 20 1 1 1 1 1 1
2 2 0 2 1 1 2 2 2 1 15 1 1 1 1 1 1
2 2 0 2 1 1 2 2 2 2 16 2 1 1 1 1 1
2 2 3 2 1 1 2 2 2 2 19 1 1 1 1 1 1
1 2 3 2 1 1 2 2 2 2 18 1 1 1 1 1 1
2 2 3 2 1 1 2 2 2 1 18 1 1 1 1 1 1
1 2 3 2 1 2 2 2 2 2 19 2 1 1 1 1 1
2 2 0 2 1 1 2 2 2 2 16 1 1 1 1 1 1
29 34 42 34 21 24 34 34 34 31 317 0 23 18 17 17 17 17
 Survelance (E) Penderita Gangguan Jiwa (F) LANSIA (G)
TotalKriteria TotalKriteria
E7 E8 E9 E10 E11 E12 E13 E14 E15 E16 E17 F1 F2 G1

1 1 1 1 1 2 1 2 3 2 2 24 1 1 2 1
1 1 1 1 1 1 1 2 3 2 2 22 1 1 2 1
2 1 1 1 1 1 1 2 3 2 2 25 1 1 2 1
1 2 1 1 1 1 1 2 3 2 2 24 1 1 2 2
1 1 1 1 1 1 1 2 3 2 2 22 1 1 2 1
1 1 1 1 2 1 1 2 3 2 2 24 1 1 2 1
1 2 1 1 1 1 1 2 3 2 2 23 1 1 2 2
1 1 1 1 1 1 1 2 3 2 2 22 1 1 2 1
1 1 2 1 1 1 1 2 2 2 2 22 1 1 2 1
1 2 1 1 1 1 1 2 3 2 2 23 1 1 2 2
1 1 1 1 1 1 1 2 3 2 2 22 1 1 2 2
1 1 1 1 1 1 1 2 3 2 2 23 1 1 2 1
2 1 1 1 1 1 1 2 3 2 2 23 1 1 2 1
1 1 1 1 1 1 1 2 3 2 2 22 1 1 2 1
1 1 1 1 1 1 1 2 3 2 2 22 1 1 2 1
1 2 1 1 1 1 1 2 3 2 2 24 1 1 2 1
2 1 1 1 1 1 1 2 3 2 2 23 1 1 2 1
20 21 18 17 18 18 17 34 50 34 34 390 0 17 17 34 0 21
LANSIA (G)
TotalKriteria
G2

1 2
1 2
1 2
2 4
1 2
1 2
1 3
1 2
1 2
2 4
2 4
1 2
1 2
1 2
1 2
1 2
1 2
20 41 0
m
 Akses Pelayanan & Pembiayan Kesehatan (A)
Jenis Pendidika
No Nama Umur Total Kriteria
Kelamin n
A1 A2 A3 A4

1 Very Mahjud L 43 D3 4 4 2 2 12
2 Suregar Goccang L 56 SMA 4 3 2 2 11
3 St. Chadijah P 26 D3 4 3 2 2 11
4 I Nyoman Sueca L 46 SD 4 3 2 2 11
5 I Wayan Murca L 62 SD 4 3 2 2 11
6 I Wayan Sunarta L 30 S1 4 3 2 2 11
7 I Wayan Suarsana P 40 SMP 4 3 2 2 11
8 I Wayan Tagel Sujana L 61 SD 4 3 2 2 11
9 I Nyoman Sutomo L 43 SD 4 3 2 2 11
10 Arahman L 28 SMP 4 3 2 2 11
11 I Wayan Kayun L 52 SD 4 4 3 2 13
12 I Kadek Wirawan L 39 SMP 4 4 2 2 12
13 I Wayan Warna L 62 SD 4 4 2 2 12
14 Nurna Luawo P 51 SMP 4 4 3 2 13
15 Jefri L 28 SMA 4 4 2 2 12
16 Musriadi L 31 SMA 4 4 2 2 12
17 Satip L 54 SD 4 4 2 2 12
TOTAL 68 59 36 34 197 0
 Kesehatan Ibu dan Anak, KB, Gizi, & Imunisasi (B)

B7
B1 B2 B3 B4 B5 B6 B8 B9 B10 B11
B7.1 B7.2 B7.3 B7.4
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 2 1
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 2 1 1
1 0 0 0 0 0 1 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 0 0 0
1 0 0 0 0 0 1 1 1 1 1 2 1 1
1 0 0 0 0 0 1 1 1 1 1 0 0 0
17 0 0 0 0 0 17 17 17 17 17 5 5 4
si (B) Rumah & Lingkungan
Total Kriteria
B12 B13 B14 B15 B16 B17 C1 C2 C3 C4 C5 C6

0 2 2 2 2 1 15 3 3 4 2 1 3
0 2 1 2 2 1 14 3 3 4 2 3 1
0 1 1 2 2 1 13 3 3 4 2 3 1
0 2 2 1 2 1 14 3 3 4 2 3 3
0 1 1 1 2 1 12 3 3 4 2 3 3
0 2 2 1 2 1 14 3 3 4 2 3 3
0 2 2 2 2 1 18 3 3 4 2 2 3
0 1 1 2 2 1 13 3 3 4 2 3 3
0 2 2 2 2 1 15 3 3 4 2 3 3
1 2 1 2 2 1 19 3 3 4 2 1 1
1 2 2 2 2 1 19 3 3 4 2 3 2
0 2 2 2 2 1 15 3 3 4 2 3 2
0 1 1 1 2 1 12 3 3 2 3 3 2
0 1 1 2 2 1 13 3 3 4 2 3 3
0 1 1 2 2 1 13 3 3 4 2 1 1
0 2 2 2 2 1 19 3 3 4 2 1 1
0 1 1 2 2 1 13 3 3 4 2 1 1
2 27 25 30 34 17 251 0 51 51 66 35 40 36
& Lingkungan Perilaku Anggota Keluarga (D)
Total Kriteria
C7 C8 C9 C10 D1 D2 D3 D4 D5 D6 D7 D8

2 1 2 1 22 2 2 3 2 1 1 2 2
2 1 2 1 22 1 2 3 2 1 1 2 2
2 1 2 1 22 1 2 3 2 1 1 2 2
2 1 2 1 24 1 2 3 2 2 1 2 2
2 1 2 1 24 1 2 3 2 1 1 2 2
2 1 2 1 24 1 2 3 2 2 1 2 2
2 1 2 1 23 1 2 3 2 1 1 2 2
2 1 2 1 24 2 2 3 2 1 1 2 2
2 1 2 1 24 2 2 3 2 1 1 2 2
2 2 2 1 21 1 2 3 1 2 2 2 2
2 2 2 1 24 2 2 3 2 2 2 2 2
2 2 2 1 24 2 2 3 2 2 2 2 2
2 2 2 1 23 2 2 3 2 2 2 2 2
2 2 2 1 25 2 2 3 2 2 2 2 2
2 2 2 1 21 1 2 3 2 2 2 2 2
2 2 2 1 21 1 2 3 2 2 2 2 2
2 2 2 1 21 1 2 3 2 2 2 2 2
34 25 34 17 389 0 24 34 51 33 27 25 34 34
(D) Survelance (E)
Total Kriteria
D9 D10 E1 E2 E3 E4 E5 E6 E7 E8 E9 E10

2 2 19 1 1 1 1 1 1 1 1 1 1
2 2 18 1 1 1 1 1 1 1 1 1 1
2 2 18 1 1 1 1 1 1 1 1 1 1
2 2 19 1 1 1 1 1 1 1 1 1 1
2 2 18 1 1 1 1 1 1 1 1 1 1
2 2 19 1 1 1 1 1 1 1 1 1 1
2 2 18 1 1 1 1 1 1 1 1 1 1
2 2 19 1 1 1 1 1 1 1 1 1 1
2 2 19 2 1 1 1 1 1 1 1 1 1
1 1 17 1 1 1 1 1 1 1 1 1 1
2 1 20 1 1 1 1 1 1 2 1 1 1
2 2 21 1 1 1 1 1 1 1 1 1 1
2 2 21 1 1 1 1 1 1 1 1 2 1
2 2 21 1 1 1 1 1 1 1 1 1 1
2 1 19 1 1 1 1 1 1 1 1 1 1
2 2 20 2 1 1 1 1 1 1 1 1 1
2 1 19 1 1 1 1 1 1 1 2 2 1
33 30 325 0 19 17 17 17 17 17 18 18 19 17
nce (E) Penderita Gangguan Jiwa (F) LANSIA (G)
Total Kriteria Total Kriteria
E11 E12 E13 E14 E15 E16 E17 F1 F2 G1

1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 23 1 0 1 1
1 1 1 2 2 1 2 20 1 0 1 1
1 1 1 2 2 1 2 21 1 0 1 1
1 1 1 2 2 2 2 21 1 0 1 1
1 1 1 2 2 2 2 22 1 0 1 1
1 1 1 2 3 1 2 21 1 0 1 1
1 1 1 2 3 2 2 22 1 0 1 1
1 1 1 2 3 2 2 23 1 0 1 1
1 1 1 2 3 2 2 24 1 0 1 1
17 17 17 34 47 31 34 373 0 17 0 17 0 17
LANSIA (G)
Total Kriteria
G2

0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 1
0 17 0
m
 Akses Pelayanan &
Jenis Pembiayan Kesehatan (A)
No Nama Umur Pendidikan Total
Kelamin
A1 A2 A3 A4

1 GIMAN SUSANTO LAKI LAKI 46THN TDK TMT SD 4 4 3 2 13

2 TOHA FIRMANTO LAKI LAKI 40THN SMP 4 4 2 2 12
3 MAUDIN LAKI LAKI 67THN TDK TMT SD 4 4 2 2 12
4 BAHARUDDIN LAKI LAKI 51THN SD 4 4 2 2 12
5 AHMAD BASORI LAKI LAKI 25THN SMP 4 4 2 2 12
6 FIRAN LAKI LAKI 38THN SD 4 4 2 2 12
7 MISJAUN LAKI LAKI 38THN SD 4 4 2 2 12
8 FATIMAH PEREMPUAN68THN TDK SEKOLA 4 4 2 2 12
9 AHMAD SAFI'I LAKI LAKI 30THN SD 4 4 2 2 12
10 JAKA PRANOTO LAKI LAKI 48THN DOPLOMA IV 4 4 2 2 12
11 EMI WARASTRI PEREMPUAN34THN DIII 4 4 2 2 12
12 WASJANI LAKI LAKI 44THN SD 4 3 3 2 12
13 SUKANDI LAKI LAKI 47THN SMP 4 3 2 2 11
14 YULIANTO LAKI LAKI 35THN SMP 4 3 3 2 12
15 MUHAMAD YUSUF LAKI LAKI 46THN SMP 4 3 2 2 11
16 ABDUL GAFUR LAKI LAKI 41THN SD 4 3 2 2 11
17 UMAR PACCI LAKI LAKI 74THN SD 4 3 2 2 11
TOTAL 68 62 37 34 201
 Kesehatan Ibu dan Anak, KB, Gizi, & Imunisasi (B)
Kriteri
a B7
B1 B2 B3 B4 B5 B6 B8 B9 B10
B7.1 B7.2 B7.3 B7.4
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 2 1 2
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 1
2 2 3 2 1 3 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 1 1
0 18 2 3 2 1 3 17 17 17 17 18 17 22
Imunisasi (B) Rumah & Lingkungan
Kriteri
Total
a
B11 B12 B13 B14 B15 B16 B17 C1 C2 C3 C4 C5

1 1 2 2 2 2 1 19 3 1 4 2 3
1 2 2 2 2 2 1 22 3 4 4 2 1
1 1 1 0 2 2 1 16 3 4 4 2 1
1 1 2 2 2 2 2 20 3 4 4 2 1
1 1 2 1 2 2 1 19 2 4 4 2 3
1 1 2 2 2 2 1 19 2 1 4 2 1
1 1 2 1 2 2 1 18 3 1 4 2 1
1 1 1 0 2 2 1 16 4 4 3 2 2
1 1 2 2 2 2 1 20 3 2 1 2 1
1 1 2 2 2 2 1 20 3 1 4 2 3
1 1 2 1 2 2 1 18 3 1 4 2 1
1 1 2 1 2 2 1 18 3 4 4 1 3
1 1 1 0 2 2 1 16 3 3 4 2 1
1 1 2 1 2 2 1 30 2 4 4 1 1
1 1 2 2 2 2 1 19 3 4 4 2 3
1 1 2 2 2 2 1 20 1 4 4 2 1
1 1 1 0 2 2 1 16 3 1 4 2 1
17 18 30 21 34 34 18 326 0 47 47 64 32 28
Rumah & Lingkungan Perilaku Anggota Keluarga (D)
Kriteri
Total
a
C6 C7 C8 C9 C10 D1 D2 D3 D4 D5 D6 D7

1 1 1 1 1 18 1 2 2 2 2 1 2
1 1 1 1 1 19 2 1 3 2 2 1 2
1 1 1 1 1 19 1 2 3 2 2 1 2
1 1 1 1 1 19 2 2 3 2 2 1 2
2 1 1 2 1 22 2 2 3 2 2 1 2
1 2 2 2 1 18 2 2 3 1 2 1 2
1 1 2 2 1 18 2 2 3 1 2 1 2
1 1 2 2 1 22 1 2 3 2 2 1 2
1 1 2 1 1 15 2 2 3 1 2 1 2
1 1 1 2 1 19 1 2 3 1 2 1 2
1 2 1 1 1 17 1 2 3 1 2 1 2
1 2 1 1 1 21 2 2 3 2 2 2 2
3 2 2 2 1 23 2 2 3 2 2 2 2
1 2 1 2 2 20 2 2 3 1 1 2 2
3 2 1 2 2 26 1 2 3 1 2 2 2
1 1 1 1 1 17 2 2 3 1 2 2 2
1 1 1 1 1 16 2 2 3 1 2 1 2
22 23 22 25 19 329 0 28 33 50 25 33 22 34
eluarga (D) Survelance (E)
Kriteri
Total
a
D8 D9 D10 E1 E2 E3 E4 E5 E6 E7 E8 E9

2 2 2 18 1 1 1 1 1 1 1 1 1
2 2 2 19 1 1 1 1 1 1 1 1 1
2 2 2 19 1 1 1 1 1 1 1 1 1
2 2 2 20 1 1 1 1 1 1 1 1 1
2 2 2 20 1 1 1 1 1 1 1 1 1
2 2 2 19 1 1 1 1 1 1 1 1 1
2 2 2 19 2 1 1 1 1 1 1 1 2
2 2 2 19 2 1 1 1 1 1 1 1 1
2 2 2 19 1 1 1 1 1 1 2 1 2
2 2 2 18 1 1 1 1 1 1 1 1 1
2 2 2 18 1 1 1 1 1 1 1 1 1
2 2 2 21 1 1 1 1 1 1 1 1 1
2 2 2 21 1 1 1 1 1 1 1 1 1
2 2 2 19 2 1 1 1 1 1 1 1 1
2 2 2 19 1 1 1 1 1 1 1 1 1
2 2 2 20 1 1 1 1 1 1 1 1 1
2 2 2 19 1 1 1 1 1 1 1 1 1
34 34 34 327 0 20 17 17 17 17 17 18 17 19
 Penderita
Survelance (E) Gangguan
Kriteri Jiwa (F) Kriteri
Total Total
a a
E10 E11 E12 E13 E14 E15 E16 E17 F1 F2

1 1 1 1 2 2 1 2 20 1 1 2
1 1 1 1 2 2 1 2 20 1 1 2
1 1 1 1 2 2 1 2 20 1 1 2
1 1 1 1 2 2 1 2 20 1 1 2
1 1 1 1 2 3 2 2 22 1 1 2
1 1 1 1 2 3 2 2 22 1 1 2
1 1 1 1 2 3 2 2 24 1 1 2
1 1 1 1 2 2 2 2 22 1 1 2
1 1 1 1 2 2 2 2 23 1 1 2
1 1 1 1 2 3 2 2 22 1 1 2
1 1 1 1 2 3 2 2 22 1 1 2
1 1 1 1 2 3 1 2 21 1 1 2
1 1 1 2 2 2 1 2 21 1 1 2
1 1 1 1 2 2 1 2 21 1 1 2
1 1 1 1 2 3 1 2 21 1 1 2
1 1 1 1 2 2 1 2 20 1 1 2
1 1 1 1 2 2 2 2 21 1 1 2
17 17 17 18 34 41 25 34 362 0 17 17 34 0
LANSIA (G)
Kriteri
Total
a
G1 G2

1 1 2
1 1 2
2 1 3
1 1 2
1 1 2
1 1 2
1 1 2
2 1 3
1 1 2
1 1 2
1 1 2
1 1 2
1 1 2
1 1 2
1 1 2
1 1 2
2 1 3
20 17 37 0
m
 Akses Pelayanan & Pembiayan Kesehatan (A)
Jenis Pendidika
No Nama Umur Total
Kelamin n
A1 A2 A3 A4

1 Ny. SRIWINARSIH P 36 Thn SD 4 4 2 2 12

2 Tn. RASIDA L 75 Thn SD 4 4 2 2 12
3 Tn.SUMONO L 77 SD 4 4 3 3 14
4 Ny. WAGIAH P 79 Thn SD 4 3 1 2 10
5 Ny. SURATI P 55 Thn SD 4 4 2 2 12
TIDAK
6 Tn. RAEDAH L 60 Thn SEKOLAH 2 4 2 2 10
TIDAK
7 Tn. GAGGA L 74 Thn SEKOLAH 4 4 2 2 12
8 Tn. TAHIR L 45 Thn SD 4 4 2 2 12
9 Ny. WIJI P 76 Thn TS 4 3 2 2 11
10 Tn. SLAMET RIADI P 46 Thn SLTP 4 3 2 2 11
11 Tn. MISKAN L 53 Thn SD 4 3 2 2 11
12 Tn. MULYONO L 44 Thn SLTP 4 3 2 2 11
13 Tn.MUJIRAN L 51 Thn SLTP 4 3 2 2 11
14 Tn.SUARDI L 48 Thn SD 4 3 2 2 11
TIDAK
15 Tn. KADENI L 66 Thn TAMAT SD 4 3 2 2 11
16 Ny. HARTINI P 46 Thn SD 4 3 2 2 11
17 Ny. HARNI P 39 Thn SD 4 3 2 2 11
TOTAL 66 58 34 35 193
 Kesehatan Ibu dan Anak, KB, Gizi, & Imunisasi (B)
Kriteria
B7
B1 B2 B3 B4 B5 B6 B8 B9
B7.1 B7.2 B7.3 B7.4
1 0 0 0 0 0 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 0 0

1 0 0 0 0 0 1 1 1 1 1 0

1 0 0 0 0 0 1 1 1 1 1 0
2 4 3 2 1 3 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 0 0
1 0 0 0 0 0 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0

1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
0 18 4 3 2 1 3 17 17 17 17 15 6
Gizi, & Imunisasi (B) Rumah & Li
Total Kriteria
B10 B11 B12 B13 B14 B15 B16 B17 C1 C2 C3

1 1 2 2 1 2 2 1 20 3 3 4
0 0 0 1 1 2 2 2 14 3 3 4
0 0 0 1 1 2 2 1 14 3 3 4
0 0 0 1 1 2 2 1 13 3 3 4
0 0 0 1 1 2 2 1 12 3 4 4

0 0 0 1 1 2 2 1 13 3 3 4

0 0 0 1 1 2 2 1 13 3 3 4
0 0 0 2 1 2 2 1 29 3 3 4
0 0 0 1 1 2 2 1 12 3 3 4
2 1 1 2 2 2 2 1 21 3 3 4
0 0 0 2 1 2 2 1 14 3 4 4
0 0 0 2 2 2 2 1 15 3 3 4
0 0 0 2 1 2 2 1 14 3 3 4
0 0 0 2 2 2 2 1 15 3 3 2

0 0 0 1 1 2 2 1 13 3 4 4
0 0 0 1 1 2 2 1 13 3 3 4
0 0 0 2 1 2 2 1 14 3 3 4
3 2 3 25 20 34 34 18 259 0 51 54 66
 Rumah & Lingkungan Perilaku Anggota Keluar
Total Kriteria
C4 C5 C6 C7 C8 C9 C10 D1 D2 D3 D4

2 3 3 2 2 2 2 2 2 3 2
2 1 3 2 2 2 2 2 2 3 2
2 3 3 2 2 2 2 2 2 3 2
2 1 1 1 1 2 1 2 2 3 2
2 1 3 2 2 2 1 2 2 3 2

2 3 3 2 2 2 2 1 3 2 1

2 1 1 2 2 2 2 2 2 3 2
2 3 3 2 2 2 2 2 2 3 2
2 1 1 1 1 1 1 1 2 3 2
2 1 3 2 1 1 1 2 2 3 2
2 1 3 1 2 2 1 2 2 3 2
2 3 1 1 2 1 1 2 2 2 2
2 3 3 1 2 2 1 1 2 3 2
2 3 2 2 1 2 1 2 2 3 2

2 3 3 2 2 1 1 2 2 3 2
2 3 3 1 2 1 1 1 2 3 2
2 1 3 2 1 2 1 1 2 3 1
34 35 42 28 29 29 23 0 0 29 35 49 32
Perilaku Anggota Keluarga (D)
Total Kriteria
D5 D6 D7 D8 D9 D10 E1 E2 E3 E4 E5

1 1 2 2 2 2 1 1 1 1 1
1 1 2 2 2 2 1 1 1 1 1
1 1 2 2 2 2 1 1 1 1 1
1 1 2 2 2 2 2 1 1 1 1
1 1 2 2 2 2 1 1 1 1 1

1 1 2 2 2 2 1 1 1 1 1

1 1 2 2 2 2 1 1 1 1 1
1 1 2 2 2 2 1 1 1 1 1
1 2 2 2 2 2 2 2 1 1 1
1 2 2 2 2 2 1 1 1 1 1
1 2 2 2 2 2 2 1 1 1 1
1 2 2 2 2 2 1 1 1 1 1
1 2 2 2 2 2 2 1 1 1 1
1 1 2 2 2 2 1 1 1 1 1

1 1 2 2 2 2 1 1 1 1 1
1 1 2 2 2 2 1 1 1 1 1
2 1 2 2 2 2 1 1 1 1 1
18 22 34 34 34 34 0 0 21 18 17 17 17
 Survelance (E)
Total
E6 E7 E8 E9 E10 E11 E12 E13 E14 E15 E16 E17

1 1 1 1 1 1 1 1 2 3 2 2 22
1 1 2 1 1 1 1 1 2 3 2 2 23
1 1 1 1 1 1 1 1 2 3 2 2 22
1 2 1 1 1 1 1 1 2 3 2 2 24
1 1 1 2 1 1 1 1 2 3 2 2 23

1 2 2 1 1 1 1 1 2 3 2 2 24

1 1 2 1 1 1 1 1 1 3 2 1 21
1 1 2 1 1 1 1 1 2 3 2 2 23
1 2 2 2 1 1 1 1 2 3 2 2 27
1 1 2 1 1 1 1 1 2 2 2 2 22
1 1 1 1 1 1 1 1 2 2 2 2 22
1 1 1 1 1 1 1 1 1 2 1 2 19
1 1 2 1 1 1 1 1 2 3 2 2 24
1 1 2 1 1 1 1 1 2 3 2 2 23

1 2 1 1 1 1 1 1 2 2 2 2 22
1 1 2 1 1 1 1 1 2 3 2 2 23
1 1 1 1 1 1 1 1 2 3 1 2 21
17 21 26 19 17 17 17 17 32 47 32 33 385
 Penderita Gangguan Jiwa (F) LANSIA (G)
Kriteria Total Kriteria Total Kriteria
F1 F2 G1 G2

1 1 2 1 1 2
1 1 2 2 1 3
1 1 2 2 2 4
1 1 2 2 2 4
1 1 2 1 1 2

1 1 2 2 2 4

1 1 2 2 1 3
1 1 2 1 1 2
1 1 2 2 1 3
1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 1 1 2

1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 1 1 2
0 17 17 34 0 23 20 43 0
m
 Akses Pelayanan & Pembiayan Kesehatan (A)
Jenis
No Nama Umur Pendidikan Total
Kelamin
A1 A2 A3 A4

1 Tn. OTTO L 50 THN SMA 4 4 2 2 12

2 Tn. LATUO L 51 THN SD 4 4 2 2 12
3 Tn. SUYARNO L 36 THN SD 4 4 2 2 12
4 Tn. SETTU L 52 THN SD 4 4 3 2 13
5 Tn. SAHRUL L 44 THN SD 4 4 2 2 12
6 Tn. AKSA PRIMA L 48 THN SMP 4 4 2 2 12
7 Tn. AHMAD L 50 THN SMA 4 4 2 2 12
8 Tn. PRAWORO L 36 THN SMP 4 4 3 2 13
9 Tn. AKHMAD JAWAWI L 51 THN SMA 4 4 2 2 12
10 Ny. HALIMA P 57 THN SD 4 4 3 2 13
11 Tn. HARIFIN MANDA L 38 THN SLTP 4 3 2 2 11
12 Tn. DEDI ASBULLOH L 41 THN SMA 4 3 2 2 11
13 Tn. MARUDDANI MUNTU L 44 THN SLTP 4 3 2 2 11
14 Tn.TOHARI L 72 THN SD 4 3 2 2 11
15 Ny. JUMU P 66 THN SD 4 3 2 2 11
16 Tn. IRFAN L 44 THN S1 4 3 2 2 11
17 Ny. SITTI KHOTIJAH P 54 THN SD 4 3 1 2 10
TOTAL 68 61 36 34 199
 Kesehatan Ibu dan Anak, KB, Gizi, & Imunisasi (B)
Kriteria
B7
B1 B2 B3 B4 B5 B6 B8 B9
B7.1 B7.2 B7.3 B7.4
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 1
1 0 0 0 0 0 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 1
2 2 3 3 1 3 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 2 1
2 4 3 2 4 1 1 1 1 1 1 2
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
1 0 0 0 0 0 1 1 1 1 1 0
0 19 6 6 5 5 4 17 17 17 17 18 9
Gizi, & Imunisasi (B) Rumah
Total Kriteria
B10 B11 B12 B13 B14 B15 B16 B17 C1 C2 C3

0 0 0 2 1 2 2 1 14 3 3 4
0 0 0 1 1 2 2 1 13 3 3 4
2 1 2 2 2 2 2 1 22 3 3 4
0 0 0 1 1 2 2 1 13 3 3 4
1 1 1 1 2 2 2 1 18 3 3 4
0 0 0 2 2 2 2 1 17 3 3 2
0 0 0 2 1 2 2 1 14 3 3 4
0 0 0 2 2 2 2 1 16 3 3 3
0 0 0 2 1 2 2 1 27 3 3 4
0 0 0 1 1 2 2 1 13 3 3 4
0 0 0 2 2 2 2 1 15 3 3 4
2 1 2 2 2 2 2 1 22 3 3 4
2 1 1 2 1 2 2 1 35 3 3 4
0 0 0 1 1 2 2 1 13 3 3 4
0 0 0 1 1 2 2 1 13 3 3 4
0 0 0 2 1 2 2 1 14 3 1 4
0 0 0 1 1 2 1 1 12 3 4 4
7 4 6 27 23 34 33 17 291 0 51 50 65
 Rumah & Lingkungan Perilaku Anggota K
Total Kriteria
C4 C5 C6 C7 C8 C9 C10 D1 D2 D3 D4

2 1 3 1 1 1 1 20 2 2 3 2
2 1 3 1 1 1 1 20 2 2 3 2
2 1 1 1 1 1 1 18 2 2 3 2
2 1 1 1 1 1 1 18 2 2 3 2
2 3 3 1 1 1 1 22 2 2 3 2
2 1 3 1 1 1 1 18 1 2 3 2
2 1 1 1 1 1 1 18 1 2 3 2
4 2 2 1 1 1 1 21 1 2 2 3
2 1 1 1 1 1 2 19 1 2 3 2
2 1 1 1 1 1 1 18 1 2 3 1
2 1 1 1 2 1 1 19 2 2 3 1
2 3 1 1 2 1 1 21 2 2 3 1
2 1 1 1 2 1 1 19 2 2 3 1
2 3 1 2 2 2 1 23 1 2 3 2
2 1 1 1 1 1 1 18 1 2 3 1
2 1 1 2 2 2 1 19 2 2 3 2
2 1 1 1 2 1 1 20 1 2 3 2
36 24 26 19 23 19 18 331 0 26 34 50 30
Perilaku Anggota Keluarga (D)
Total Kriteria
D5 D6 D7 D8 D9 D10 E1 E2 E3 E4 E5

2 1 2 2 2 2 20 1 1 1 1 1
2 1 2 2 2 2 20 1 1 1 1 1
2 1 2 2 2 2 20 1 1 1 1 1
2 1 1 1 1 1 16 1 1 1 1 1
2 1 2 2 2 2 20 1 1 1 1 1
2 1 2 2 2 2 19 1 1 1 1 1
1 1 2 2 2 2 18 1 1 1 1 1
2 1 1 1 1 1 15 1 1 1 1 1
2 2 2 2 2 2 20 1 1 1 1 1
2 2 2 2 2 2 19 2 1 1 1 1
2 2 2 2 2 2 20 2 1 1 1 1
2 2 2 2 2 2 20 2 1 1 1 1
2 2 2 2 2 2 20 1 1 1 1 1
2 2 2 2 2 2 20 1 1 1 1 1
2 2 2 2 2 2 19 1 1 1 1 1
2 2 2 2 2 2 21 1 1 1 1 1
2 2 2 2 2 2 20 1 1 1 1 1
33 26 32 32 32 32 327 0 20 17 17 17 17
 Survelance (E)
Total
E6 E7 E8 E9 E10 E11 E12 E13 E14 E15 E16 E17

1 1 1 1 1 1 1 1 2 3 1 2 21
1 1 1 1 1 1 1 1 2 3 1 2 21
1 1 1 1 1 1 1 1 2 3 1 2 21
1 1 1 2 1 1 1 2 2 2 1 2 22
1 1 1 1 1 1 1 1 2 3 1 2 21
1 1 1 1 1 1 1 1 2 3 1 2 21
1 2 1 1 1 1 1 1 2 2 1 2 21
1 1 1 1 1 1 1 1 2 2 1 2 20
1 1 1 1 1 1 1 1 2 2 1 2 20
1 1 1 1 1 1 1 1 2 2 2 1 21
1 1 1 1 1 1 1 1 2 2 2 2 22
1 1 1 1 1 1 1 2 2 2 2 2 23
1 1 1 1 1 1 1 1 2 2 2 2 21
1 1 1 1 1 1 1 1 2 2 2 2 21
1 1 1 1 1 1 1 1 2 2 2 2 21
1 1 1 1 1 1 1 1 2 2 2 2 21
1 1 1 1 1 1 1 2 2 2 2 2 22
17 18 17 18 17 17 17 20 34 39 25 33 360
 Penderita Gangguan Jiwa (F) LANSIA (G)
Kriteria Total Kriteria Total Kriteria
F1 F2 G1 G2

1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 2 1 3
1 1 2 1 1 2
1 1 2 2 1 3
1 1 2 2 1 3
1 1 2 1 1 2
1 1 2 2 1 3
1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 1 1 2
1 1 2 2 2 4
1 1 2 2 1 3
1 1 2 1 1 2
1 1 2 1 1 2
0 17 17 34 0 23 18 41 0
m