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  • Formulir Investigasi Kontak TB

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    Ivan Nugraha
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    Download as XLSX, PDF, TXT or read online from Scribd
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    12 views1 page

    Formulir Investigasi Kontak TB

    Uploaded by

    Ivan Nugraha

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    INVESTIGASI KONTAK TUBERKULOSIS

    UPT PUSKESMAS JATIGEDE


    TAHUN 2019

    BULAN :

    Identitas Kontak Hasil Skrining


    Hasil Pemeriksaan
    Faktor risiko Tanggal
    Pernah Fasyankes Pemberian
    No Kontak tanggal Berkeringat Dirujuk
    Nama Umur L/P Alamat Batuk Sesak Lansia berobat TBC Rujukan PP INH Pada
    Serumah investigasi malam hari Demam DM Ibu Hamil Perokok Sakit TBC Tidak TBC Anak <5 th
    Napas tanpa kegiatan >60 th tapi tidak
    Meriang tuntas
    >1 bulan
    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

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