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  • Lap.C - 1 CBMS

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    galih ismail adha
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    This document is a surveillance form from the Kahuripan Community Health Center in Tasikmalaya City for the month of [blank]. It collects epidemiological data on measles cases, including patient demographics, vaccination history, symptoms, specimen collection dates and results, current condition, and final classification. The form will be used to monitor measles cases and outbreaks in the area served by the health center.

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    Lap.C -1 CBMS

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    This document is a surveillance form from the Kahuripan Community Health Center in Tasikmalaya City for the month of [blank]. It collects epidemiological data on measles cases, including patient demographics, vaccination history, symptoms, specimen collection dates and results, current condition, and final classification. The form will be used to monitor measles cases and outbreaks in the area served by the health center.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    6 views38 pages

    Lap.C - 1 CBMS

    Uploaded by

    galih ismail adha
    This document is a surveillance form from the Kahuripan Community Health Center in Tasikmalaya City for the month of [blank]. It collects epidemiological data on measles cases, including patient demographics, vaccination history, symptoms, specimen collection dates and results, current condition, and final classification. The form will be used to monitor measles cases and outbreaks in the area served by the health center.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 38

    FORMA T C-1 CBMS

    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK


    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Vak.Campak.Se Tgl.D.ambl.Speci Keadaan


    JK Umur Per Gol. Umur blm. Tgl.Timbul men Hasil Specimen sekarang Klasifikasi Fina

    Campak

    Hidup
    Brp.K Tdk/Tdk Pemb.Vit.A

    Mat
    No.Epid.KLB Nama Kasus Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th >15 Th ali Tahu Demam Rash Darah urin Darah Urin Y/T Lab+
    Mengetahui Tasikamalya, ..........................................
    Kepala UPTD Puskesmas Kahuripan Surveilans Puskesmas Kahuripan

    Enok Riwayat,AMdKep
    NIP. 196606161988032011
    Klasifikasi Final*

    Campak Rubela Bkn.Campa


    Epid Klinis Lab(+) k
    a, ..........................................
    ns Puskesmas Kahuripan

    ok Riwayat,AMdKep
    96606161988032011
    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th

    Mengetahui
    Kepala UPTD Puskesmas Kahuripan
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T

    Tasikamalya, ..................
    Surveilans Puskesma

    Enok Riwayat,A
    NIP. 19660616198
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak

    Tasikamalya, ..........................................
    Surveilans Puskesmas Kahuripan

    Enok Riwayat,AMdKep
    NIP. 196606161988032011
    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th

    Mengetahui
    Kepala UPTD Puskesmas Kahuripan
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T

    Tasikamalya, ..................
    Surveilans Puskesma

    Enok Riwayat,A
    NIP. 19660616198
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak

    Tasikamalya, ..........................................
    Surveilans Puskesmas Kahuripan

    Enok Riwayat,AMdKep
    NIP. 196606161988032011
    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th

    Mengetahui
    Kepala UPTD Puskesmas Kahuripan
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T

    Tasikamalya, ..................
    Surveilans Puskesma

    Enok Riwayat,A
    NIP. 19660616198
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak

    Tasikamalya, ..........................................
    Surveilans Puskesmas Kahuripan

    Enok Riwayat,AMdKep
    NIP. 196606161988032011
    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th

    Mengetahui
    Kepala UPTD Puskesmas Kahuripan
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T

    Tasikamalya, ..................
    Surveilans Puskesma

    Enok Riwayat,A
    NIP. 19660616198
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak

    Tasikamalya, ..........................................
    Surveilans Puskesmas Kahuripan

    Enok Riwayat,AMdKep
    NIP. 196606161988032011
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN : JUNI TAHUN 2016
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Vak.Campak.Se Tgl.D.ambl.Sp
    JK Umur Per Gol. Umur blm. Tgl.Timbul ecimen Hasil Specimen Keadaan sekarang Klasifikasi

    Pemb.Vit.A Y/T
    Campak

    Hidup
    Brp.K Tdk/Tdk

    Mat
    No.Epid.KLB Nama Kasus Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th1--14Th>15 Th ali Tahu Demam Rash Darah urin Darah Urin Lab+

    N I H I L
    Mengetahui Tasikamalya, .......1 JULI 2016...................................
    Kepala UPTD Puskesmas Kahuripan Surveilans Puskesmas Kahuripan

    Enok Riwayat,AMdKep
    NIP. 196606161988032011
    Klasifikasi Final*

    Campak Rubela
    Bkn.Ca
    Epid Klinis Lab(+) mpak
    6...................................
    mas Kahuripan

    ,AMdKep
    988032011
    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak


    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak


    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak


    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak


    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak


    LEMBA

    PUSES

    JK Umur Per Gol. Umur

    No.Epid.KLB Nama Kasus


    Nama Orang Tua Alamat L P <1Th 1-4Th 5-9Th 1--14Th
    FORMA T C-1 CBMS
    LEMBAR SURVEILANS EPEDOMOLOGI CAMPAK
    BULAN :
    PUSESMAS KAHURIPAN KOTA TASIKMALAYA

    Umur Vak.Campak.Seblm. Tgl.Timbul Tgl.D.ambl.Specimen Hasil Specimen

    Tdk/Tdk Pemb.Vit.A
    >15 Th Brp.Kali Tahu Demam Rash Darah urin Darah Urin Y/T
    Keadaan sekarang Klasifikasi Final*
    Campak Rubela
    Hidup

    Mat

    Lab+ Epid Klinis Lab(+) Bkn.Campak

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