P E R I N T A H m u PAT EN M A L A N G C 이 フヌ4 3 0 3

D ◆ A S K E SE H AT A N
U P T D P U SK E SM A S D A U
Jln R a y a M u ly o A g u n g N o 2 12 T b ı
e po n (0 3 4 1) 4 6 2 12 3

F O R M U L IR D E T E K S I D IN I T U M B U H K E M B A N G A N A K

l ID E N T ı
TA S A N A K

A la m at

II A N A M N E S IS

2 A p a ka h ana k p u n ya m a s a la h tu m b u h k e m b a n g : 看山上M Tnıĺ A? U

lı
ıP E M E R ı
K S A A N R U T IN S E S U A I J A D U A L
1 BB : %R K g ; P B /T B : iL cm B B /T B : a G em u k ormal; c K u ru s ; d K u ru s s e k a li
e R u ju k : y a / tid a k
2 LK A 9 cm LÞ
W U No l; b M ik ro s e fa l; M k ro s e fa l; d R jk
: rm a c a u u : y a / tid a k
3 P e rk e m b a n g a n Anak

M İ
g u k a n : a G K a s a r b G H a lu s c B B a h a s a d S o s K e m a n d iń a n
e ra
,
,
e R j k : y a /tid a k
u u
3 ) P e n y im p a q a n : a G K a s a r b G H a ı c B B a ha s a
Q us d S o s K e m a n d iria n e R j k : y a /tid a k
u u
4 D a y a L ih a t : m o rm a l b C u rig a a d a g a n g g u a n
, c R u ju k : y a / tid a k ,

5 M e n ta ıe m o s io n a l: N o rm a l ,
b C u ńga a da g a n g gu a n c R u ju k : y a 1 tid a k

IV P E M E R IK S A A N A T A S IN D IK A S I / J ı KA A D A K E LU H A N
1 A u tis : a R e s ik o T in g g i; b R e s ik o R e n d a h ; c G a n g g u a n L a in ; d B a ta s N o rm ı
a : e R j k : y a /id a k
u u
2 G P P H : a K e m u n g k in a n G P P H b B u k a n G P P H ; c R u ju k : y a / tid a k

V K E S IM P U LA N

V I T IN D A K A N IN T E R V E N S I
1 K o n s e lin g s tim u ı
a s ib a g i ib u : D ib e rika n ; b T id a k d ib e rika n
2 In te rv e n s is tim u la s i p e rk e m b a n g a n : P a u n
yM uĮ atĄk u 小人 b c łn g tiļ k+ k g u Ķ
G K a s a r b G H a lu s ; c B B a ha s a d S o s ì(e m an d iria n ; e T gl Evaı
u a s i in te rv e n s i :

ik a n ; b T id a k a d a s u ra t ru ju k a n
 K A RTU A N A K

ld e n tita s

An Ą 赤心 ? n u
N am a An a k : Aı
am at w h [ łn IZ
o /U
T g l La h ir 2 6 JU 2 Đ \t D esa lKe l P a u ųha n
:

B e ra t L a hir ￡9 0 0
:
m tm p u s ke s m a s ; I} # u
Nm a A ya M b u : Ad ī / Elmo Kecam ab n : Do Ll

P e k\ n m M bu : Shan { ı
R T K a b / K o ta : M a ı
o ng

P e n d id iı
ta n A ya M b u SW W p ro p in s i
:
n u r

ı Peı a ya n a n ı
m u n is a s i d a T a n gga l
n II P e m b e ria n V it A d o s is tı
n ggi
P e m b e ria n ı
m u n is a s i da n ta n g g a ıp e m b e ria n

S ln g k a ı
a n d a ri k o ı (R d lru ju k
om : -
)
3) N = N o rm a l 4) Se Sesuaı
=
G K /G H - G e ra ka n H a s a r / H a lu s 5) N - N o rm a ı
M ı= M ikr o c e fa ll M M
r ・
g u ka n
e ra BHs - B a ha sa G G - G an ggu a n
M a - M a k r o c e fa ll p p e n y lm p a n g a
・
n sM . so sı
a lı
s a s lK e m an d lrla n
6) R R - R e s ik o R e n da h RT = R e sı
ko n gg ı
Tı M g kn M
-
un g kln G G L ・ G an g g u a n s e b a b L a ln N - N o rm a ı
 P E M E R IN T A H IM
C O ll O ßI 0 3
1iil
U PAT E N M A L A N G
D IN A S K E S E H A T A N
U P T D P U S K E S N IL & S D A U
Jln R a y a M u ı
yo A gu n g N o 2 12 T e le p o n (0 3 4 1) 4 6 2 12 3

FO R M U Lı
R D ET E K S ID ı
N IT U M B U H K E M B A N G A N A K

ı ID E N T ı
TA S A NAK

N am a

A la m a t

T a n g g a l L a h ir

Iı A N A M N E S IS

ı
ıi PEM ERı
KSAA N R UTı
N S E S U A IJ A D U A L
1 BB : 7 K g ; P B JT B : cm B B IT B : a G e m u k Ormal; c K u ru s ; d K u ru s s e k a li
e R j k : ya
u u / tid a k
2 LK A
4! L K A /U N b M ik ro s e fa l;
cm : o rm a ı
; c M a k ro s e fa l; d R u u jk : y a / tid a k
3
H '" M M

2) M e ra g u ka n :a G K asar b G H a lu s c B B a ha sa ,
d So s Ke m an d ir ia n e R j k : y a /tid a k
u u

3) P e n y im p a w a n :a G Ka s a r, b G Haı
us ,
c B B a ha sa ,
d So s Ke m an d iria n ,
e R u ju k y a /tid a k

4 D a y a L ih a t : O rmai b C u r ig a a
d a ga n ggu a n c R u ju k : y a / tid a k

5 M e n ta le m o s io n a ı: o rm a i ,
b C u rig a a d a g a n g g u a n C R u ju k : y a / tid a k,

Iv N D IK A S I/ J IK A A D A K E Lu H A N
p E M E R IK S A A N A T A S ı
1 A u tis : a R es ik o T in g g i; b R e s ik o R e n da h; c G a n ggu a n L a in ; d B a ta s N o rm a l; e R u ju k : ya /id a k
2 G PPH : a Kem un g k in a n G PPH; b B u ka n G PPH ; c R u ju k : y a / tid a k

V I T IN D A K A N IN T E R V E N S I
1 K o n s e lin g s tim u la s i b a g i ib u : D ib e rik a n ; b T id a k d ib e rik a n
2 In te rv e n s i s tim u la s i p e r ke m b a n g a n :m m Ac ü í W a IY Į Unmmctkłb B c &ï ( d u n b e
Ł
,m a in lm iw
G Kasar H a lu s ; c B B a ha s a ; d S o s K e m an d iria n ; e T gl E v a lu a s i in te rv e n s i :

/
 K A RT U A N A K

ı
d e n tita s

N am a Anak : h fa ru u M Ąin i J l \r Fo e ķo 34 o /
: m o ×r
lręj・
Tg l L a h ir : ız /s / e m /Ke ı : ı
ctprei・
B e ra t L a h ir : 3 30 0 g ra m P u s ke s m as : Ou u

N a m a A ya M b u P ln d r\ / sï b M K e ca m a ta n : Da ?

P e k e ūa a n A y a M b u : Ĵw a s+ c ł {św u sm K a b / K o ta : M aı
cg

P e n did ika n A ya M b u : S ĺ / sz p in s i : U a 1fm u r

1 P e la ya n a n ı u n is a s id a T
m n a n gga l lı p e m b e ria n V IL A d o s is tin g g i
Pe m b e ria n lm u n is a s i da n ta n g g a l p e m b e ria n

BCG
\J /￡ tt

D P T

P o lio : 1

ı
ıl H a s il P e m e rik s a a n T um bu h K e m ba n g A na k

黼 ・・ ・ ・
国国 x齧 窿劃 国園 三
兰 粵粵
国區团团 ı 2 1 3 4 l 5 l 6

ł
iy G G
fi P
D_ (R )
êiiniGGnb ň? /

苏枋 8 ：i
TB ：. 怬"
u

凳
懿
m u r
一 一
尹 一 s , . ."

S in g k a ta n d a ri k o lo m (R d iru
: =
ju k )
3) N - N o rm a l 4) Se Sesuai
-
G K /G H G e ra ka n K a s a r / H a lu s 5) N
=
= N o rm a l
M i = M ikr o c e fa ll M M
r ・
g u ka n
e ra
G G
ı

M
・ G a n ggu a n
a - M a k ro c e fa ll P p e n y im p a n g a n
・
SM = S o s ia ı
ls a s l K e m a n dı
rï a n
6) R R - R e s ik o R e n d a h RT - R e s ik o T in g g i M g kn M GG L
- u n g kln = G a n g g u a n S e b a b L a in N = N o rm a ı
 D ı
ı
― ―
m l tb p o tö L ' " R
r t ? o k
e nve r

C u ku p

i m = a = i
'
Ĥ A A «
'

2 4 6 9 m 4 S
 P E M E R IN T A H m u PAT E N M A L A N G
C O lt 3 7x 0 3
D IN A S K E S E H A T A N
U P T D P U SK E SM A S D A U
Jı
n R aya M u ly o A g u n g N o 2 ı2 T e le p o n (0 3 4 1) 4 6 2 12 3

F O R M U U R D E T E K S I D IN IT U M B U H K E M B A N G A N A K

D E N T IT A S A N A K
1 ı

N am a

ı
ı A N A M N E S IS

2 A pa ka h a na k p u n ya m a s a la h tu m b u h k e m ba n g :

ı
ıl p E M E R IK S A A N R U T ı
N S E S U A ıJ A D U A L
1 BB : 9 ,ı K g ; P B JT B : l cm B B )T B : a G e m u o rm a l; c K u ru s ; d K u ru s s e k a ı
i
e R u u jk : y a / tid a k
2 LK A 4 cm L K A /U : N o rm a l; b M ik ro s e fa l; c M a k ro s e fa l; d R u ju k : y a / tid a k
3 P e rke m ba n ga n A na k
{@ s e su a i
2) M e ra g u ka n :a G Kasar b G H a lu s c B B a ha sa d So s Ke m an d iria n e R j k : y a /tid a k
u u
3) P y im p a G Ka b G H a lu s B .B a h a s a d Sos Kem a n d iria n u ju k y a /tid a k
e n
T " :a sa r c , ,
e R
4 D a y a L ih a t : W o rm a l,
b C u rig a a
da g a n gg u a n c R u ju k : y a / ti? k
,

5 M e n ta le m o s io n a l: m o rm a l ,
b C u rig a a d a g a n g g u a n C R u ju k : y a / tid a k ,

IV P E M E R IK S A A N A T A S IN D IK A S I / J IK A A D A K E L U H A N
1 A u tis :a R e s ik o T in g g i; b R e s ik o R en da h; c G g g u a n L a in ; d B a ta s N o rm
an a l: e R jk
u u : y a /id a k
2 G PPH : a Ke m u n g k in a n G PPH; b B u ka n G P P H ; c R u ju k : y a / tid a k

V K E S IM P U L A N

V I T IN D A K A N IN T E R V E N S I
1 Ko nse lin g s tim u la s i b a g i ib u : D ib e rika n ; b T id a k d ib e rik a n
2 In te rv e n s is tim u la s i p e rke m b a n g a n : Ħim Jm d n c\L L】nL b (y :c h ń , n
c cıl « t a n ci
ţ km bcarct
@ G Ka sar b G H a lu s ; B a ha s a ; d S o s K e m an d iria n ; e Tgl e v a lu a s i in te rv e n s i :

4 D iru ju k k e
:A ? b T id a k a da j
s u r a t ru u ka n
 K A RT U A N A K

d e n üta s
ı

Nam a Anak : Ån Tm M r cl m S A la m at ß4 m r Åfr i

T g l La h ir m em lm /Ke l : Lg M u rw a ・ i
B e ra t L a h ir : 30 o 0 同巨m Lp u s ke s m a s ：
坠 诮

Nam a A ya M b u : hoììnl\ Im a
l lm m 10 c4 .
P e ke ı
ja a n m M ib u : l \R T K a b / K o ta :

P e n d id ika n A y a h /Ib u :
SM A / SM Ą P ro p in s i Jc u ł[A 飞W
ł

1 P e la y a n a n lm tin is a s i d a T
n an gga l II p e m b e r ia n V it A d o s is tin
gg i
P e m b e ria n lm u n is a s i
da n ta n g g a l p e m b e ria n

D P T

P o lio ： 1 凇g 2 ゴ搖e イ初 ばぱ 4 堋 。引K e 四国堅园 Ke 9 ：

C a m pa k

III H as iıP e m e rik s a a n Tu bu h Ke

m m ba n g A n a k

: '
P
G G /N
U m u r :
G P P Hj

S in g k a ta n d a ri k o lo m : (R - d iru ju k )
3) N - N o rm a l 4) Se - Sesuai G K IG H - G e ra ka n K a s a r / H a ı
us 5) N - N o rm a l
M i - M ik ro c e fa ll M M
r ・ e ra g u ka n BHS - B a ha s a G G
M M k ro
・ G an ggu a n
a -
a c e fa ll p p e n y im p a n g a n
.
sM - s o s ia lis a s i K e m a n dı
ria n
6) R R = R e s ik o R e n d a h RT - R e s ik o T ln g g i M g kn M
- un g kin GG L = G an g g u a n S e b a b L a in N - N o rm a ı