DATA KASUS DBD PER GOLONGAN UMUR

UPT. PUSKESMAS................................

BULAN :
TAHUN :

Golongan Umur
≤ 1 th 1 - 4 th 5 - 14 th 15 - 44 th
NO Desa
Lk Pr Lk Pr Lk Pr Lk Pr
P M P M P M P M P M P M P M P
1
2
3
4
5
6
7
8
9
10
11
12 dst..
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui,
Kepala UPT. Puskesmas........................

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PER GOLONGAN UMUR
S................................

total Jumlah Kasus

15 - 44 th ≥ 44 th
di
Pr Lk Pr Lk Pr larvasidas Rata-rata
P M
M P M P M P M P M di fogging i ABJ
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0

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Pengelola Program DBD

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