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o a :ecama an :us esmas :u an : :
No Nama Umu&
Jen'sA"amat Pee
Ke"
L P Ke" Rt R, No ! # - . %
a 4 c e ; +1NIHIL
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Pee&(aan ! Pee&(aan *+ 4e&)u4un+an + am'n'st&as's' : ABRI = Po"'s'=
- Pee&(aan *+ 4e&es'o t'n++' 5enu"a&an: ote&=5e&a,at=5et
. Bu&u) asa&: Ku"' Ban+unan=Pee&(aan 5a4&'=tuan+ o(e=s
% Pee&(aan + emam5uan eonom' menen+a) eatas=5en+u
/ Pee&(aan + emam5uan eonom' menen+a) e4a,a): 5e0 Pe"a(a&
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FORMULIR PENJARINGAN PEND
Kota : TANGERANG
Kecamatan : BENDA
Pusesmas : JURUMUDI BARU
Bu"an : : PEBRUARI #$!%
No Nama Umu&
Jen'sA"amat Pee&(
Ke"
L P Ke" Rt R, No ! # - . %
a 4 c e ; +
1NIHIL
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
1920
Pe e& aan ! Pe e& aan *+ e& u un+an + a m n st&as < anto&an : PNSs' : ABRI = Po"'s'= O
- Pee&(aan *+ 4e&es'o t'n++' 5enu"a&an: ote&=5e&a,at=5etu+
. Bu&u asa&: Ku Ban+unan=Pe e& aan 5a & =tu an+ o e =su5
% Pe e& aan + emam5uan e onom menen+a eatas=5en+us
/ Pe e& aan + emam5uan e onom menen+a e a,a : 5en+
0 Pe a a&
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@ +@ @ @ n@ L e& tan a 5a a o om sesua as *+ a5at
: s en+an an+ a sesua o om= m s R, : . Rt : 0 No : /
: s o om sesua as 5eme& saan m s s sto !#$ @ asto 1$ s !#$
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Petun u Pe a sanaan
a= 4 = c = e : ?uu5 Je"as
@ +@ (@ @ n@ L '4e&' tana 6 8 5aa o"om sesua' )as'" *+ 'a5at
; : 's' en+an an+a sesua' o"om= m's R, : . Rt : 0 No : /
' : 's' o"om sesua' )as'" 5eme&'saan m's s'sto"' !#$ @ 'asto"' 1$ 's' !#$
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0 Pe a a&
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/ Pe e& aan + emam5uan e onom menen+a e a,a : 5en
0 Pe a a&
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% Pe e& aan + emam5uan e onom menen+a eatas=5en+u
/ Pe e& aan + emam5uan e onom menen+a e a,a : 5en
0 Pe a a&
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. Bu&u asa&: Ku Ban+unan=Pe e& aan 5a & =tu an+ o e =su
% Pe e& aan + emam5uan e onom menen+a eatas=5en+u
/ Pe e& aan + emam5uan e onom menen+a e a,a : 5en
0 Pe a a&
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- Pe e& aan *+ e&es o t n++ 5enu a&an: o te&=5e&a,at=5etu
. Bu&u asa&: Ku Ban+unan=Pe e& aan 5a & =tu an+ o e =su
% Pe e& aan + emam5uan e onom menen+a eatas=5en+u
/ Pe e& aan + emam5uan e onom menen+a e a,a : 5en
0 Pe a a&
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# Pe e& aan *+ e& u un+an + e uatan s : ABRI = Po s =
- Pe e& aan *+ e&es o t n++ 5enu a&an: o te&=5e&a,at=5etu
. Bu&u asa&: Ku Ban+unan=Pe e& aan 5a & =tu an+ o e =su
% Pe e& aan + emam5uan e onom menen+a eatas=5en+us
/ Pe e& aan + emam5uan e onom menen+a e a,a : 5en
0 Pe a a&
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Pee&(aan ! Pee&(aan *+ 4e&)u4un+an + am'n'st&as'
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Pee&(aan ! Pee&(aan *+ 4e&)u4un+an + am'n'st&as's' : ABRI = Po"'s'=
- Pee&(aan *+ 4e&es'o t'n++' 5enu"a&an: ote&=5e&a,at=5et
. Bu&u) asa&: Ku"' Ban+unan=Pee&(aan 5a4&'=tuan+ o(e=s% Pee&(aan + emam5uan eonom' menen+a) eatas=5en+u
/ Pe e& aan + emam5uan e onom menen+a e a,a : 5en
0 Pe"a(a&
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20
Pe e& aan ! Pe e& aan *+ e& u un+an + a m n st&as < anto&an
# Pe e& aan *+ e& u un+an + e uatan s : ABRI
- Pe e& aan *+ e&es o t n++ 5enu a&an: o te&=5e&a
. Bu&u) asa&: Ku"' Ban+unan=Pee&(aan 5a4&'=tuan
% Pe e& aan + emam5uan e onom menen+a eata
/ Pe e& aan + emam5uan e onom menen+a e a,
0 Pe a a&
-
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nosaLa4 HBsA+
n's
698 678 698
"
-
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15/33
nosaLa4 HBsA+
n's
698678 698
"
-
7/25/2019 Form Hepatitis 2015
16/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
17/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
18/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
19/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
20/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
21/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
22/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
23/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
24/33
nosaLa4 HBsA+
n's
698 678 698
"
-
7/25/2019 Form Hepatitis 2015
25/33
nosaLa4 HBsA+
n's
698 678 698
"
-
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PUSESMAS ! """"""""""""""""##
NO NAMA DESA < 1 Thn 1 - 4
P M P
L P L P L P
JUMLAH 0 0 0 0 0 0
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KLINIS TIFOID
UMUR
Thn 5 - 14 Thn 15
M P M P
L P L P L P L P
0 0 0 0 0 0 0 0
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REKAPITULASI
BULAN : CCCCCCCC
JUM
44 45
M P M P
L P L P L P L P
0 0
0 0
0 0
0 0
0 0
0 0
0 00 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0
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ENAKIT DEMAM TIFOID PER DESA
CCC33 TAHUN : CCCCCCCCCCCCCCC
LAH
< 1 Thn 1 - 4
M P M P
L P L P L P L P
0 0
0 0
0 0
0 0
0 0
0 0
0 00 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0
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WIDAL POSITIP
UMUR
Thn 5 - 14 Thn 15 - 4
M P M P
L P L P L P L P
0 0 0 0 0 0 0 0
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JUM
4 Thn > 45 Thn
M P M P
L P L P L P L P
0 0
0 0
0 0
0 0
0 0
0 0
0 00 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 0 0 0 0 0 0
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LAH
M
L P
0 0
0 0
0 0
0 0
0 0
0 0
0 00 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
