Form Penyelidikan Epidemiologi.xlsx

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FORM PENYELIDIKAN EPIDEMIOLOGI BULAN MARET 2016 NAMA PENDERITA UMUR NAMA KK ALAMAT KECAMATAN

NO

NAMA KK

: Fitri : 6 tahun : Tn. Sutrisno : Karang Panasan : Blega

JENTIK (+)

JENTIK (-)

PENDERITA PANAS

UMUR

ABATESASI

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

( TERMASUK PENDERITA YANG PANAS 1 MINGGU YANG LALU ) Kesimpulan : Perlu Pengasapan ( FOGGING ) YA

TIDAK

Mengetahui KEPALA PUSKESMAS BLEGA

Blega, 16 Maret 2016 Petugas Pelaksana

H.SUDIYO S.Kep.NS NIP: 196609 10 198703 1008

SYAMSUL MUARIF, S.KM

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