Kartu Identitas Pasien Tb.docx
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PENANGGULANGAN TB NASIONAL
T B 02
KARTU IDENTITAS PASIEN TB NAMA LENGKAP
:
Nomor induk
:
Kependudukan (NIK )
:
Alamat Lengkap
:
No Telp/HP
:
Jenis Kelamin
:
Nama Faskes
:
No.Reg.TB Faskes
:
No. Reg.TB Kab/Kota
: ____________________ Propinsi________________________
KLASIFIKASI BERDASARKAN LOKASI ANATOMIS Paru
Ektra paru
KLASIFIKASI BERDASARKAN LOKASI ANATOMIS
T B 02
KARTU IDENTITAS PASIEN TB NAMA LENGKAP
:
Nomor induk
:
Kependudukan (NIK )
:
Alamat Lengkap
:
No Telp/HP
:
Jenis Kelamin
:
Nama Faskes
:
No.Reg.TB Faskes
:
No. Reg.TB Kab/Kota
: ____________________ Propinsi________________________
KLASIFIKASI BERDASARKAN LOKASI ANATOMIS Paru
Ektra paru
KLASIFIKASI BERDASARKAN LOKASI ANATOMIS
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