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Lampiran Rpi.pkb.1 Temuduga Ibubapa[1]

Lampiran Rpi.pkb.1 Temuduga Ibubapa[1]

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Published by: Angeline David on Jan 02, 2013
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PPKI SJK(T) KULAI BESAR

Lampiran RPI/PKBP/1
TEMUDUGA IBUBAPA
No.Rujuan !"""""".............
Tari# !""""""""".
A. MAKLUMAT PERIBADI MURID !
Nama ! ............................................................ Jan$ina ! .............................
K%$urunan ! ........................................................... A&ama ! ............................
Tari# La#ir ! ........................................................... Umur ! .............................
No. S.B%rana ! ....................................................... Ana K% B%rapa' ! .............................
No.M( Ki)/KP ! ........................................................ No.P%n)a*$aran JKM ! ................................
Ka$%&ori ! ........................................................
A+ama$ ! ..............................................................................................................................................
......................................................................................................................................
.......
.....................................................................................................................................
.......
No T%+%*on ! .........................................
B. MAKLUMAT IBU/BAPA/PENJAGA !
(i) Bapa !
Nama ! ...........................................................................................................
Nom,or K/P ! ...........................................................................................................
P%%rjaan ! ............................................................................................................
A+ama$ Majian ! ............................................................................................................
............................................................................................................
.............................................................................................................
No. T%+%*on P%ja,a$ ! ...............................................
No. -P ! ................................................
(ii) I,u !
Nama ! .............................................................................................................
Nom,or K/P ! ...............................................................................................................
P%%rjaan ! ...............................................................................................................
A+ama$ Majian ! ...............................................................................................................
...............................................................................................................
.
..............................................................................................................
.
No.T%+%*on P%ja,a$ ! .................................................
No.-P ! ..................................................
(iii) P%nja&a !
Nama ! ...............................................................................................................
Nom,or K/P ! ...............................................................................................................
P%%rjaan ! ...............................................................................................................
A+ama$ Majian ! ...............................................................................................................
..............................................................................................................
.............................................................................................................
No.T%+%*on P%ja,a$ ! ...................................................
No. -P ! ...................................................
.. PERSEKITARAN KEDIAMAN !
Tin&&a+ )%n&an /iapa ! ............................................................................................................
Siapa m%n&a/u# ! .............................................................................................................
Bi+. A#+i K%+uar&a ! .............................................................................................................
Ka0a/an P%n%mpa$an ! .............................................................................................................
D. SEJARA- PERUBATAN !
S%,%+um La#ir ! ...........................................................................................................
! ............................................................................................................
! .............................................................................................................
S%ma/a La#ir ! .............................................................................................................
! .............................................................................................................
! ..............................................................................................................
S%+%pa/ La#ir ! ...............................................................................................................
! ...............................................................................................................
! ...............................................................................................................
Diano&/i/ Do$or/Paar P%ru,a$an ! ...............................................................................................................
Nama Do$or/Paar ! ...............................................................................................................
J%ni/ Ma/a+a# 1an& Di%na+pa/$i ! ...............................................................................................................
E. LAIN2LAIN MASALA- PERUBATAN !
Pin$ar .%r)a/
.%+%,ra+pa+/(
Sin)rom Do0n
AD-D
ADD
Au$i/m%
Di/+%/ia
-(p%ra$i*
S+o0+%an%r
L%+a#
Spa/$i
P%n&+i#a$an Ra,un
Bu$a
P%n)%n&aran Rin&an
S%)%r#ana
T%ru
M%n$a+ Rin&an
S%)%r#ana
T%ru
Sa0an K%%rapan Da+am S%#ari !
J%ni/ Ra0a$an/U,a$ !
Lain2Lain P%n(ai$ (N(a$aan) !
3. JENIS IMUNISASI 1ANG TELA- DITERIMA
-%pa$i$i/ A/B
.ampa
Po+io
Ru,%++a
Lain2Lain (N(a$aan) !


G. EM4SI/TINGKA- LAKU
J%ni/ p%r+auan +uar ,ia/a ! .on$o# &o(an& $an&an ! ..........................................
K%$au$an pa)a /%/ua$u ! .......................................................................................
B%n5i pa)a
/%/ua$u ! ..............................................................................................
Mina$ pa)a /%/ua$u !
-. PERKEMBANGAN S4SIAL
P%rna# m%n)apa$ )i)ian Ta/a/Ta)ia' 1a/Ti)a
Bo+%# ,%rin$%ra/i )%n&an oran& +ain' 1a/Ti)a
N(a$aan Siapa ! .....................................................................................................
Rumu/an a$i6i$i (an& )i+auan /%#arian !
M%non$on T7
M%n)%n&ar La&u
M%m,a5a
Lain2Lain (N(a$aan) !
................................................................................................................................
................................................................................................................................
................................................................................................................................
Ba#a/a (an& %rap )i&unaan )i ruma#' !
...............................................................................................................................

................................................................................................................. : .................................................................................................................................HP (iii) Penjaga : Nama Nombor K/P Pekerjaan Alamat Majikan : ...................................................... : ..................................No............................... : ... HP C................................................................................................. : ...................... : ................................................... : ......... .............................................. : ................................... : ............................................................................ No................................................................................... No............................................ : .............................. PERSEKITARAN KEDIAMAN : Tinggal dengan siapa Siapa mengasuh Bil............................................................................... Ahli Keluarga Kawasan Penempatan : ............................................................................. ................................................................ : ........................................................................................................................ : .......................................................................... : .................................................................... : ............................. : .............................................................................................................. : ...................................................................................................................... HP (ii) Ibu : Nama Nombor K/P Pekerjaan Alamat Majikan ...................................................................................... .................................................. .......................................................................... ....... ...................................................................................................Telefon Pejabat No....Telefon Pejabat No........................................................................................................

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