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\langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053
\langfe1033 \langfenp1033 M}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 enimbang}{\fs22 \loch \af0 \hich \af0
\dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 \tab }{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 : a. }
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 bahwa }{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 untuk memeberikn pelayanan pada
pasien di Puskesmas, maka}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-15 \cufi-7 \li3375
\culi1400 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin3375 \rin0 \tql
\tx2880 \tql \tx3119 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 jajaran petugas klinis diPuskesmas
Buleleng III harus melakukan Identifikasi, Dokumentasi dan Pelaporan pada kasus
KTD,KPC dan KNC}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-305 \cufi-139 \li3363
\culi1274 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin3363 \rin0 \tql
\tx2880 \tql \tx3119 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1053 \langnp1053 \langfe1033 \langfenp1033 b.}{\fs22 \loch \af0 \hich \af0
\dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 \tab }{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 bahwa }
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 sehubungan dengan }{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1053 \langnp1053 \langfe1033 \langfenp1033 butir }{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 diatas}{\fs22
\loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 .
Perlu ditetapkan dengan keputusan Kepala Puskesmas Buleleng III selaku Pimpinan
FKTP Puskesmas Buleleng III tentang Ke}{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 harusan melakukan identifikasi,
dokumentasi dan pelaporan kasus KTD, KPC dan KNC}{\fs22 \loch \af0 \hich \af0 \dbch
\f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 }{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 ;}{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
\par }\pard \plain \qj \fi-3402 \li3402 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin3402 \rin0 \tql \tx2880 \tql \tx3119 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
\par }\pard \plain \qj \fi-3402 \li3402 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin3402 \rin0 \tql \tx2880 \tql \tx3119 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
Mengingat}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053
\langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053
\langnp1053 \langfe1033 \langfenp1033 : }{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1053 \langnp1053 \langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 a. }{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 Undang-undang }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Republik Indonesia}{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 No}{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 mor :}
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 36 tahun 2009 tentang Kesehatan;}{\fs22 \loch \af0 \hich \af0
\dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj
\fi-3402 \li3402 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin3402 \rin0 \tql
\tx2880 \tql \tx3119 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs22
\loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
b. }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 \tab }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 Undang-undang }{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Republik Indonesia}{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 No}
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 mor :}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 29}{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 tahun 200}{\fs22 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 4}{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
tentang }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Praktek Kedokteran}{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 ;}{\fs22 \loch \af0 \hich \af0
\dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj
\fi-3402 \li3402 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin3402 \rin0 \tql
\tx2880 \tql \tx3119 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs22
\loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 c}
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033
\langfenp1033 .}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053
\langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 Undang-undang }{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Republik
Indonesia}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 No}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 mor :}{\fs22 \loch \af0 \hich \af0 \dbch
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 32}{\fs22 \loch \af0
\hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 tahun }{\fs22
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
1996 }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 tentang }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Tenaga Kesehatan}{\fs22 \loch \af0 \hich \af0 \dbch
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 ;}{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard
\plain \qj \fi-3402 \li3402 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin3402
\rin0 \tql \tx2880 \tql \tx3119 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0
\dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \tab }
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 e. }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 Peraturan Menteri Kesehatan Republik
Indonesia Nomor 75 }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 tahun 2014 tentang Pusat Kesehatan
Masyarakat.}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \fi-540 \li3420 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin3420 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 f}
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 . }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Peraturan Menteri kesehatan kesehatan RI No
1691/MenKes/Per/VII/ 2011 Tentang Keselamatan Pasien}{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 ;}{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
\par }\pard \plain \fi-540 \li3420 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin3420 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 g. Peraturan Mentri Kesehatan
Republik Indonesia nomor 5 tahun 2014 tentang Panduan Praktek Klinik diFasilitas
Pelayanan Primer}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 \par }\pard \plain \fi-540 \li3420 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin3420 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \loch \af0
\hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 \par }\pard
\plain \qc \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\b1 \fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053
\langfe1033 \langfenp1033 MEMUTUSKAN}{\b1 \fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1053 \langnp1053 \langfe1033 \langfenp1033 \par }\pard \plain \qc \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033
\par }\pard \plain \qj \fi-3150 \li3150 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin3150 \rin0 \tql \tx2400 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0
\hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 Menetapkan
: KEPUTUSAN KEPPALA PUSKESAMAS BULELENG III TENTANG KE}{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 HARUSAN
MELAKUKAN IDENTIFIKASI,DOKUMENTASI DAN PELAPORAN KASUS KTD, KPC DAN KNC}{\fs22
\loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033
DIPUSKESMAS BULELENG III.}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053
\langnp1053 \langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-3150 \li3150
\ri0 \widctlpar \aspalpha \aspnum \adjustright \lin3150 \rin0 \tql \tx2400
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053
\langfe1033 \langfenp1033 \par }\pard \plain \qj \fi-3120 \li3120 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin3120 \rin0 \tql \tx2880 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 KESATU}{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1053 \langnp1053 \langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 :}{\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1053 \langnp1053 \langfe1033 \langfenp1033 \tab }
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Setiap tenaga klinis }{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 mempunyai keharusan untuk melakukan
Identifikasi, Dokumentasi dan pelaporan kasus KTD, KPC dan KNC yang terjadi
diPuskesmas Buleleng III; }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx2880 \itap0 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1046 \langnp1046 \langfe1033
\langfenp1033 }{\fs22
\loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
\par }\pard \plain \qj \fi-3120 \li3120 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin3120 \rin0 \tql \tx2880 \tql \tx3120 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1046 \langnp1046 \langfe1033 \langfenp1033 KETIGA}
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1046 \langnp1046 \langfe1033
\langfenp1033 \tab }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1046 \langnp1046
\langfe1033 \langfenp1033 :}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 \tab }{\fs22 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Surat keputusan ini }{\fs22
\loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033
merupakan revisi SK No 800/SK/I/BLLIII/2016 dan }{\fs22 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 berlaku sejak tanggal
ditetapkan, dengan ketentuan akan dilakukan koreksi apabila ternyata dikemudian
hari terdapat perubahan atau kekeliruan.}{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 }{\fs22 \loch \af0 \hich \af0
\dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj
\li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx2880
\tql \tx3120 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx2880 \tql \tx3120
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs24 \dbch \af2 \hich \af0 \loch \af0 \lang1057 \langnp1057
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft5411 \shptop181
\shpright9563 \shpbottom2533 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz0 \shplid1030 {\sp {\sn shapeType}
{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn
fLockAspectRatio}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn anchorText}{\sv 0}}
{\sp {\sn txflTextFlow}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv
1}}{\sp {\sn fillColor}{\sv 16777215}}{\sp {\sn fillBackColor}{\sv 16777215}}{\sp
{\sn fFilled}{\sv 1}}{\sp {\sn lineColor}{\sv 16777215}}{\sp {\sn lineStyle}{\sv
0}}{\sp {\sn lineJoinStyle}{\sv 1}}{\sp {\sn fLine}{\sv 1}}{\sp {\sn shadowColor}
{\sv 8421504}}{\sp {\sn fshadowObscured}{\sv 0}}{\sp {\sn fShadow}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 6}}{\sp {\sn fLayoutInCell}{\sv 1}}{\shptxt \pard \plain \li0
\ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang3082 \langnp3082 \langfe1033
\langfenp1033 DITETAPKAN DI :}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 }{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 BULELENG III}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 }
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang3082 \langnp3082 \langfe1033
\langfenp1033 PADATANGGAL : }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 18 JANUARI 2109}{\fs20 \loch \af0 \hich
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fFlipV}{\sv 0}}{\sp {\sn fLockAgainstGrouping}{\sv 0}}{\sp {\sn fLockText}{\sv 0}}
{\sp {\sn fLockAspectRatio}{\sv 0}}{\sp {\sn fLockRotation}{\sv 0}}{\sp {\sn
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fFilled}{\sv 0}}{\sp {\sn lineWidth}{\sv 28575}}{\sp {\sn lineStyle}{\sv 0}}{\sp
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fBehindDocument}{\sv 1}}{\sp {\sn posrelh}{\sv 1}}{\sp {\sn posrelv}{\sv 1}}{\sp
{\sn fLayoutInCell}{\sv 0}}}{\shprslt {\pict }}}}{\fs24 \loch \af0 \hich \af0 \dbch
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx5812 \itap0 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033
}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \li0 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \tql \tx5812 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
LAMPIRAN : Keputusan Kepala Puskesmas Buleleng III}{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \qc \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 NOMOR
: }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 800 }{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 /SK/I//BLL III/2109}{\fs24 \loch \af0 \hich \af0 \dbch
\f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx5812 \itap0 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033
TANGGAL : 18 Januari 201}{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057
\langnp1057 \langfe1033 \langfenp1033 9}{\fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx5812 \itap0 \fs24
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{\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033
\langfenp1033 \par }\pard \plain \fi-992 \li5954 \ri0 \widctlpar \aspalpha
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\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch \af0
\hich \af0 \dbch \f0 \lang1057 \langnp1057 \langfe1033 \langfenp1033 \par }\pard
\plain \qj \fi1651 \cufi750 \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\b1 \fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Format Laporan Insiden ke Tim Keselamatan
Pasien Puskesmas Buleleng III}{\b1 \fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qc \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs22 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 (RAHASIA,
TIDAK BOLEH DIFOTOCOPY, DILAPORKAN MAKSIMAL 2X24 JAM)}{\fs22 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \qc \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\b1 \fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 LAPORAN INSIDEN KNC, KTD, DAN KEJADIAN SENTINEL}{\b1
\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \qc \li0 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\b1 \fs22 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-284
\li284 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \ls1
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 I.\tab }{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 DATA PASIEN}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
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\aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
Nama}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033
\langfenp1033 : ...................................................................
...................................................................................
.....}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 No MR}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 :..........................................}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033
Ruangan : ........................................................................
.........}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft6039 \shptop265 \shpright6363 \shpbottom576 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz9 \shplid1035 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 5}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft1855 \shptop265 \shpright2192 \shpbottom525 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz10 \shplid1036 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
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fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 6}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Umur*}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 :}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi1984 \li284 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0
\hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft1868 \shptop234 \shpright2192 \shpbottom545 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
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{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft6039 \shptop285 \shpright6363 \shpbottom596 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz12 \shplid1038 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
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{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 0-1bulan }{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 > 1 bulan-1
tahun}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi-720 \li2988 \ri0 \widctlpar \aspalpha
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\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft1868 \shptop255 \shpright2192 \shpbottom566 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz13 \shplid1039 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 9}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 >1 tahun-5 tahun}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 > 5 tahun}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi-720 \li2988 \ri0 \widctlpar \aspalpha
\aspnum \adjustright \lin2988 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft6039 \shptop15 \shpright6363 \shpbottom326 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz14 \shplid1040 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 10}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft1868 \shptop275 \shpright2192 \shpbottom586 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz15 \shplid1041 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
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{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 >15 tahun-30 tahun}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 > 30 tahun
\uc1 \u8211 ? 65 tahun}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-720 \li2988 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin2988 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft6039 \shptop478 \shpright6363 \shpbottom789 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz16 \shplid1042 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 12}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft1868 \shptop478 \shpright2192 \shpbottom789 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz17 \shplid1043 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 13}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 >60 tahun}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \fi284 \li0 \ri0 \widctlpar \aspalpha
\aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \fi200
\cufi100 \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Jenis Kelamin :}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Laki-laki}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Perempuan }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \fi200 \cufi100 \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0
\rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Penanggung biaya pasien :}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \fi284 \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0
\rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033
\langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft6039 \shptop-3
\shpright6363 \shpbottom308 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz18 \shplid1044 {\sp {\sn shapeType}
{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv
0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv
0}}{\sp {\sn wzName}{\sv Rectangle 14}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt
{\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft2432 \shptop308
\shpright2756 \shpbottom619 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz19 \shplid1045 {\sp {\sn shapeType}
{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv
0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv
0}}{\sp {\sn wzName}{\sv Rectangle 15}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt
{\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft2432 \shptop-3 \shpright2756
\shpbottom308 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
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{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 16}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Umum}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Asuransi
swasta}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \fi284 \li0 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0
\lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft6039
\shptop17 \shpright6363 \shpbottom328 \shpfhdr0 \shpbxcolumn \shpbxignore
\shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz21 \shplid1047 {\sp {\sn
shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn
WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn
lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 17}}{\sp {\sn fLayoutInCell}{\sv
1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033
\langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft2432 \shptop239
\shpright2756 \shpbottom550 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz22 \shplid1048 {\sp {\sn shapeType}
{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv
0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv
0}}{\sp {\sn wzName}{\sv Rectangle 18}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt
{\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 BPJS
Kesehatan}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Perusahaan}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \fi284 \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch
\af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft6039 \shptop37 \shpright6363 \shpbottom348 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz23 \shplid1049 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 19}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 BPJS PBI}{\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Jaminan Kesehatan Daerah}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \fi284 \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \fi284 \li0 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tanggal masuk
RS : .................................}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20
\loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
Jam : ...............................}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi-284 \li284 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \itap0 \ls1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
II.\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 RINCIAN KEJADIAN}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-436
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 1.\tab }{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tanggal
dan Waktu Insiden}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \li720 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
Tanggal : ..........................................}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Jam : ..............................}{\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-360
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 2.\tab }{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
Insiden : ........................................................................
...................................................................................
.}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \li720 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 .....................................................................
...................................................................................
....................}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-360 \li720
\ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0
\ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 3.\tab }{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kronologis Insiden :
}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \li720 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 .....................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
................................}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-360
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 4.\tab }{\fs20 \dbch
\af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft758 \shptop334 \shpright1082 \shpbottom645 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz24 \shplid1050 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 20}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Jenis Insiden* :}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \li1134 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin1134 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0
\hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft758 \shptop300 \shpright1082 \shpbottom611 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
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fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 21}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kejadian Nyaris
Cedera / KNC (Near miss)}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \fi1134 \li0 \ri0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft758 \shptop266 \shpright1082
\shpbottom577 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz26 \shplid1052 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 22}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Kejadian Tidak Cedera / KTC (No harm)}{\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\fi1134 \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Kejadian Tidak Diharapkan / KTD (Adverse
Event) / Kejadian Sentinel (sentinel event)}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \fi426
\li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-360 \li720
\ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0
\ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 5.\tab }{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft758 \shptop301 \shpright1082 \shpbottom612 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz27 \shplid1053 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 23}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict
}}}}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Orang Pertama Yang Melaporkan Insiden*}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi414 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0
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fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Karyawan : Dokter / Perawat /
Petugas lainnya}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
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{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
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{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Keluarga / Pendamping Pasien}{\fs20 \loch \af0 \hich \af0 \dbch
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\fi414 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
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{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 27}}{\sp {\sn
fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Lain-
lain .............................................................................
.....................................................(sebutkan)}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi414 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha
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\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi-360 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0
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\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
6.\tab }{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
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wzName}{\sv Rectangle 28}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Insiden Terjadi Pada* :}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414
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fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 29}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
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\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Lain-
lain ..............................................................................
.....................................................(sebutkan)}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi414 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha
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\s26 \fi-360 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
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\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
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\langfenp1033 Insiden Menyangkut Pasien :}{\fs20 \loch \af0 \hich \af0 \dbch \f0
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{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057
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Rectangle 31}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch
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{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
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\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Lain-
lain ..............................................................................
.....................................................(sebutkan)}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
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{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Lokasi
Kejadian ..........................................................................
......................................................(sebutkan)}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
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\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 (Tempat pasien berada)}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
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\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
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{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
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\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Penyakit Dalam}{\fs20 \loch
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{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Bedah Obstetri Ginekologi}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414
\li720 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 THT}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0
\hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft779 \shptop11 \shpright1103 \shpbottom322 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz43 \shplid1069 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 39}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Mata}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0
\hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft779 \shptop57 \shpright1103 \shpbottom368 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz44 \shplid1070 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 40}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Saraf}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0
\loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst
\shpleft779 \shptop264 \shpright1103 \shpbottom575 \shpfhdr0 \shpbxcolumn
\shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz45
\shplid1071 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}
{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}
{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 41}}{\sp {\sn
fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0
\lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft779
\shptop34 \shpright1103 \shpbottom345 \shpfhdr0 \shpbxcolumn \shpbxignore
\shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz46 \shplid1072 {\sp {\sn
shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn
WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn
lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 42}}{\sp {\sn fLayoutInCell}{\sv
1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Anastesi}{\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft779 \shptop230 \shpright1103
\shpbottom541 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz47 \shplid1073 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 43}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Kulit kelamin}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft779 \shptop199 \shpright1103 \shpbottom510 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz48 \shplid1074 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 44}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Jantung}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0
\loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst
\shpleft779 \shptop245 \shpright1103 \shpbottom556 \shpfhdr0 \shpbxcolumn
\shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz49
\shplid1075 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}
{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}
{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 45}}{\sp {\sn
fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Paru}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin720
\rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Jiwa}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26
\fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-11 \li720 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Lokasi
Kejadian ..........................................................................
......................................................(sebutkan)}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi-11 \li720 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi-360 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
10.\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Unit / Departemen yang terkait yang menyebabkan insiden}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \li720 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Unit kerja
penyebab ..........................................................................
................................................(sebutkan)}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi-360 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
11.\tab }{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft695 \shptop308 \shpright1019
\shpbottom619 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz50 \shplid1076 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 46}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Akibat Insiden Terhadap Pasien* :}{\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft695 \shptop274 \shpright1019
\shpbottom585 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz51 \shplid1077 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 47}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt
{\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Kematian}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft695 \shptop240 \shpright1019 \shpbottom551 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz52 \shplid1078 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 48}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\i1 \fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Cedera
Inversible}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 / Cedera Berat}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft695 \shptop206 \shpright1019 \shpbottom517 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz53 \shplid1079 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 49}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\i1 \fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Cedera
Reversible}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 / Cedera sedang}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft695 \shptop172 \shpright1019 \shpbottom483 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz54 \shplid1080 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 50}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Cedera Ringan}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tidak ada cedera}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0 \widctlpar \aspalpha
\aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi414 \li720 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-360 \li720 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \ls2
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 12.\tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tindakan yang
dilakukan segera setelah kejadian, dan hasilnya :}{\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033
\langfenp1033 .....................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
................................}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-360
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 13.\tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tindakan
dilakukan oleh* :}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057
\langfenp1057 {\shp {\*\shpinst \shpleft714 \shptop58 \shpright1038
\shpbottom374 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz55 \shplid1081 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 51}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Tim : terdiri
dari : ............................................................................
..........................................................}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi414 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0
\loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst
\shpleft714 \shptop29 \shpright1038 \shpbottom340 \shpfhdr0 \shpbxcolumn
\shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz56
\shplid1082 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}
{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}
{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 52}}{\sp {\sn
fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0
\lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft714
\shptop340 \shpright1038 \shpbottom651 \shpfhdr0 \shpbxcolumn \shpbxignore
\shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz57 \shplid1083 {\sp {\sn
shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn
WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn
lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 53}}{\sp {\sn fLayoutInCell}{\sv
1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Dokter}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft714 \shptop306 \shpright1038
\shpbottom617 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz58 \shplid1084 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 54}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Perawat}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \li1134 \ri0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin1134 \rin0 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft714 \shptop272
\shpright1038 \shpbottom583 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz59 \shplid1085 {\sp {\sn shapeType}
{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv
0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv
0}}{\sp {\sn wzName}{\sv Rectangle 55}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt
{\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Petugas
lainnya............................................................................
............................................................................}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \li1134 \ri0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin1134 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi-360 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \ls2 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
14.\tab }{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft2491 \shptop272
\shpright2815 \shpbottom583 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz60 \shplid1086 {\sp {\sn shapeType}
{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv
0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv
0}}{\sp {\sn wzName}{\sv Rectangle 56}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt
{\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft714 \shptop272 \shpright1038
\shpbottom583 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz61 \shplid1087 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 57}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Apakah kejadian yang sama pernah terjadi di Unit Kerja lain?*}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Ya}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Tidak}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-294
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-294 \li720 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Apabila Ya isi bagian di bawah ini.}{\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qj \li426 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin426 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Kapan? Dan Langkah/tindakan apa
yang diambil pada Unit kerja tersebut untuk mencegah terulangnya kejadian yang
sama?}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \qj \li426 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin426 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 .....................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
.............................................}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \qj
\li426 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin426 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\trowd \trql \trgaph0 \trleft426 \trbrdrt \brdrs
\brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10
\brdrcf1 \trbrdrr \brdrs \brdrw10 \brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1
\trbrdrv \brdrs \brdrw10 \brdrcf1 \trautofit \trftsWidth1 \trftsWidthB3
\trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3
\trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10
\brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1
\cltxlrtb \cellx2142 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr
\brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10
\brdrcf1 \cltxlrtb \cellx5049 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr
\brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10
\brdrcf1 \cltxlrtb \cellx6820 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr
\brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10
\brdrcf1 \cltxlrtb \cellx9356 \pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Pembuat laporan }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain \s26 \qj \li0 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Penerima Laporan}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain \s26 \qj \li0 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \cell }\pard \plain \li0 \ri0 \widctlpar \aspalpha
\aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\trowd \trql \trgaph0
\trleft426 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \brdrcf1
\trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10 \brdrcf1 \trbrdrh \brdrs
\brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1 \trautofit \trftsWidth1
\trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3
\trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr
\brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10
\brdrcf1 \cltxlrtb \cellx2142 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr
\brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10
\brdrcf1 \cltxlrtb \cellx5049 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr
\brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10
\brdrcf1 \cltxlrtb \cellx6820 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr
\brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10
\brdrcf1 \cltxlrtb \cellx9356 \row }\pard
\plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Paraf }{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Paraf}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard
\plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\trowd \trql \trgaph0 \trleft426 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs
\brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10
\brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1
\trautofit \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108
\trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10
\brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1
\clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx2142 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx5049 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx6820 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx9356 \row }\pard
\plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Tanggal terima}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Tanggal Lapor}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\trowd \trql \trgaph0 \trleft426 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs
\brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10
\brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1
\trautofit \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108
\trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10
\brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1
\clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx2142 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx5049 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx6820 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx9356 \row }\pard
\plain \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \qj \li0 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi-294 \li720 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft6137 \shptop298 \shpright6461 \shpbottom609 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz62 \shplid1088 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 58}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft3938 \shptop298 \shpright4262 \shpbottom609 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz63 \shplid1089 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 59}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft2420 \shptop298 \shpright2744 \shpbottom609 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz64 \shplid1090 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 60}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft461 \shptop298 \shpright785 \shpbottom609 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
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fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 61}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Grading Resiko
Kejadian*(dapat diisi atasan pelaporan)}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi273
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Biru}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Hijau}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kuning }{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Merah}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi273 \li720 \ri0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-294 \li720 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 BN.*= pilih satu jawaban}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-294
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-294 \li720 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi-294 \li720 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033
{\b1 \fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \qc \fi-294 \li720
\ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \qc \fi-294 \li720 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1
\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 FORMAT LAPORAN KPC}{\b1 \fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \qc \fi-294
\li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033
Puskesmas: .......................................................}{\b1 \fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 (RAHASIA,
TIDAK BOLEH DIFOTOKOPY, DILAPORKAN MAKSIMAL 2X24 JAM)}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \qc \fi-294 \li720 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\b1 \fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Laporkan Kondisi
Potensial Cedera (KPC)}{\b1 \fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-1134 \li1134 \ri0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin1134 \rin0 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-284 \li284 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \ls3
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 1.\tab }{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tanggal dan Waktu
ditemukan Kondisi Potensial Cedera (KPC)}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \li0 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033
Tanggal : ..............................................................}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Jam : ................................................}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi-284 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \itap0 \ls3 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
2.\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 KPC}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033
\langfenp1033 : ...................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
.............................................................}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi-284 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \itap0 \ls3 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
3.\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Orang Pertama Yang Melaporkan Insiden*}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi425 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0
\loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst
\shpleft273 \shptop23 \shpright597 \shpbottom334 \shpfhdr0 \shpbxcolumn
\shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz66
\shplid1092 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}
{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}
{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 62}}{\sp {\sn
fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0
\lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft273
\shptop334 \shpright597 \shpbottom645 \shpfhdr0 \shpbxcolumn \shpbxignore
\shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz67 \shplid1093 {\sp {\sn
shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn
WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn
lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 63}}{\sp {\sn fLayoutInCell}{\sv
1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 Karyawan : Dokter / Perawat / Petugas
lainnya}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi425 \li284 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha
\aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft273 \shptop300 \shpright597 \shpbottom611 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz68 \shplid1094 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 64}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Pasien}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi425 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0
\loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst
\shpleft273 \shptop266 \shpright597 \shpbottom577 \shpfhdr0 \shpbxcolumn
\shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz69
\shplid1095 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}
{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}
{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 65}}{\sp {\sn
fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Keluarga}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi425 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich \af0
\loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst
\shpleft273 \shptop232 \shpright597 \shpbottom543 \shpfhdr0 \shpbxcolumn
\shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz70
\shplid1096 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}
{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}
{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 66}}{\sp {\sn
fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Keluarga / Pendamping Pasien}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi425 \li284 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Lain-
lain...............................................................................
..............................................................(sebutkan)}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \s26 \fi425 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain
\s26 \fi-284 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \itap0 \ls3 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2
4.\tab }{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Lokasi ditemukan KPC}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \itap0 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 .....................................................................
...................................................................................
............(sebutkan)}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-284 \li284 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426 \itap0
\ls3 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 5.\tab }{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Unit/Departemen
terkait KPC}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426 \itap0 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 .....................................................................
...................................................................................
............(sebutkan)}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-284 \li284 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426 \itap0
\ls3 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\listtext \pard \plain \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 6.\tab }{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Tindakan yang
dilakukan selama ini, dan Hasilnya :}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \li284 \ri0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033
\langfenp1033 .....................................................................
...................................................................................
...................................................................................
...................................................................................
............................................}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi-284
\li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0
\tql \tx426 \itap0 \ls3 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\listtext \pard \plain \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \f2 7.\tab }
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Tindakan dilakukan oleh* :}{\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \li709 \ri0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin709 \rin0 \tql \tx426
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft273 \shptop26 \shpright597
\shpbottom337 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz71 \shplid1097 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 67}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057
\langfenp1057 {\shp {\*\shpinst \shpleft273 \shptop337 \shpright597
\shpbottom648 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz72 \shplid1098 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 68}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Tim terdiri
dari : ............................................................................
.....................................................................}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \li709 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin709 \rin0 \tql \tx426 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \dbch \af0 \hich
\af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057 {\shp
{\*\shpinst \shpleft273 \shptop303 \shpright597 \shpbottom614 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz73 \shplid1099 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp
{\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle
69}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Dokter}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \li709 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin709 \rin0 \tql \tx426 \itap0 \fs24 \loch \af0
\hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20
\dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033 \langfe1057 \langfenp1057
{\shp {\*\shpinst \shpleft273 \shptop269 \shpright597 \shpbottom580 \shpfhdr0
\shpbxcolumn \shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0
\shpz74 \shplid1100 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn
fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn
fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn wzName}{\sv Rectangle 70}}
{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Perawat}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \li709 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin709 \rin0 \tql \tx426 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Petugas
lainnya............................................................................
.......................................................................}{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\pard \plain \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \tql \tx426 \itap0 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \fi-284 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \tql \tx426 \itap0 \ls3 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\listtext \pard
\plain \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \f2 8.\tab }{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033
\langnp1033 \langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft2446 \shptop324
\shpright2770 \shpbottom635 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz75 \shplid1101 {\sp {\sn shapeType}
{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv
0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv
0}}{\sp {\sn wzName}{\sv Rectangle 71}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt
{\pict }}}}{\fs20 \dbch \af0 \hich \af0 \loch \af0 \lang1033 \langnp1033
\langfe1057 \langfenp1057 {\shp {\*\shpinst \shpleft273 \shptop324 \shpright597
\shpbottom635 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara \shpbyignore
\shpwr3 \shpwrk0 \shpfblwtxt0 \shpz76 \shplid1102 {\sp {\sn shapeType}{\sv 1}}{\sp
{\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn
wzName}{\sv Rectangle 72}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Apakah kejadian yang sama pernah terjadi di Unit Kerja lain?*}
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 \par }\pard \plain \s26 \fi425 \li284 \ri0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426 \tql \tx709 \itap0
\fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Ya}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0 \hich \af0 \dbch
\f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \tab }
{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 Tidak}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426 \tql \tx709
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426 \tql \tx709
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 Apabila Ya, isi bagian di bawah ini.}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \tql \tx426 \tql \tx709 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Kapan?
Dan Langkah/tindakan apa yang diambil pada Unit kerja tersebut unutuk mencegah
terulangnya kejadian yang sama?}{\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 \par }\pard \plain \s26 \li284 \ri0 \sl360
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin284 \rin0 \tql \tx426
\tql \tx709 \itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033
\langnp1033 \langfe1033
\langfenp1033 .....................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...........................................................}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \s26 \li284 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin284 \rin0 \tql \tx426 \tql \tx709 \itap0 \fs24 \loch \af0 \hich
\af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\par }\trowd \trql \trgaph0 \trleft284 \trbrdrt \brdrs \brdrw10 \brdrcf1
\trbrdrb \brdrs \brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs
\brdrw10 \brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10
\brdrcf1 \trautofit \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108
\trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx1985 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx5049 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx6820 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx9356 \pard \plain
\s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Pembuat laporan }{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Penerima Laporan}{\fs20 \loch
\af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\trowd \trql \trgaph0 \trleft284 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs
\brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10
\brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs
\brdrw10 \brdrcf1 \trautofit \trftsWidth1 \trftsWidthB3 \trftsWidthA3
\trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt
\clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs
\brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx1985 \clvertalt
\clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs
\brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx5049 \clvertalt
\clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs
\brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx6820 \clvertalt
\clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs
\brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx9356
\row }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch
\af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 Paraf }{\fs20
\loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Paraf}{\fs20 \loch \af0 \hich
\af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard
\plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain \li0 \ri0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch
\af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\trowd \trql \trgaph0 \trleft284 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs
\brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10
\brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1
\trautofit \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108
\trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10
\brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1
\clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx1985 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx5049 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx6820 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx9356 \row }\pard
\plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Tanggal terima}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033
\langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 Tanggal Lapor}{\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
\cell }\pard \plain \s26 \qj \li0 \ri0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \intbl \itap1 \fs24 \loch \af0 \hich \af0 \dbch \af0
\lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0 \hich \af0
\dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \cell }\pard \plain
\li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \fs24
\loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033
{\trowd \trql \trgaph0 \trleft284 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs
\brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10
\brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1
\trautofit \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108
\trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10
\brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1
\clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx1985 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx5049 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx6820 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \cellx9356 \row }\pard
\plain \s26 \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs20 \loch \af0 \hich \af0 \dbch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \par }\pard \plain \s26 \fi414 \li720 \ri0 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \fs24 \loch \af0 \hich \af0
\dbch \af0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 {\fs20 \loch \af0
\hich \af0 \dbch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \par }\pard
\plain \li0 \ri0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx5812
\itap0 \fs24 \loch \af0 \hich \af0 \dbch \af0 \lang1033 \langnp1033 \langfe1033
\langfenp1033 {\fs22 \loch \af0 \hich \af0 \dbch \f0 \lang1057 \langnp1057
\langfe1033 \langfenp1033 \par }}