DINAS KESEHATAN KABUPATEN POHUWATO

PUSKESMAS DUHIADAA
FORMULIR PEMANTAUA
TAHUN 2

Riwayat Perjalanan

ODP

PP
No Nama Alamat No HP Tgl Tiba di
Negara/ Daerah Kab.
Pohuwato

Hj. RUMRIAH DESA BUNTULIA MAKASAR (LUWU

1 BAHTIAR JAYA DUSUN MEKAR 085394186211 TIMUR) 3/25/2020
1
DESA BUNTULIA
2 MIKAEL LANTI JAYA DUSUN MEKAR 082193068880 BANDUNG 3/28/2020
1
DESA BUNTULIA 27/3/2020,
3 AFIFAH SEPTIANI JAYA DUSUN MEKAR 081380889696 BOGOR JAM 10.30
1 WITA
DESA BUNTULIA 27/3/2020,
4 YOGI SUGIHARTA JAYA DUSUN MEKAR 081380889696 BOGOR JAM 10.30
1 WITA
DESA BUNTULIA 27/3/2020,
5 BELVANIA JAYA DUSUN MEKAR 081380889696 BOGOR JAM 10.30
1 WITA
DESA BUNTULIA 27/3/2020,
6 ALMAIRA JAYA DUSUN MEKAR 081380889696 BOGOR JAM 10.30
1 WITA
DESA BUNTULIA 28/3/2020,
7 KEVIN E. RORING JAYA DUSUN MEKAR 082187787896 JAKARTA JAM 22.00
1 WITA
5/4/2020
FEBRITA DIAN DESA BUNTULIA
8 ARIESTA BADU JAYA 081355026872 YOGYAKARTA JAM 16.00
WITA

DESA BUNTULIA
9 IFTITAH S. LAWANU JAYA 082259597887 YOGYAKARTA 4/5/2020

8/4/2020
10 SATRIA PAKAYA DESA BUNTULIA 082292475429 MANADO (MINUT) JAM 13.00
JAYA WITA

NUR AIN SUCI DESA BUNTULIA 8/4/2020

11 MANADO (MINUT) JAM 13.00
PAKAYA JAYA WITA

DESA BUNTULIA 9/4/2020

12 WAHAB MAISUN JAYA JAWA TENGAH JAM 21.00
WITA

DESA BUNTULIA 9/4/2020

13 ANDI KURNIAWAN JAWA TENGAH JAM 21.00
JAYA WITA
 9/4/2020
14 ZAENAL NGABIDIN DESA BUNTULIA 082190754000 JAWA TENGAH JAM 21.00
JAYA
WITA
ORMULIR PEMANTAUAN KASUS COVID-19
TAHUN 2020

TANGGAL DAN HASIL PEMANTAUAN

Tgl terakhir
Pemantaun
(14 Hari) 1 2 3 4 5 6 7 8 9 10 11 12

4/8/2020 27/3= 28/3= 29/3= 30/3= 31/3= 1/4= 2/4= 3/4= 4/4= 5/4= 6/4= 7/4=

4/11/2020 30/3= 31/3= 1/4= 2/4= 3/4= 4/4= 5/4= 6/4= 7/4= 8/4= 9/4= 10/4=

4/10/2020 30/3= 31/3= 1/4= 2/4= 3/4= 4/4= 5/4= 6/4= 7/4= 8/4= 9/4= 10/4=

4/10/2020 30/3= 31/3= 1/4= 2/4= 3/4= 4/4= 5/4= 6/4= 7/4= 8/4= 9/4= 10/4=

4/10/2020 30/3= 31/3= 1/4= 2/4= 3/4= 4/4= 5/4= 6/4= 7/4= 8/4= 9/4= 10/4=

4/10/2020 30/3= 31/3= 1/4= 2/4= 3/4= 4/4= 5/4= 6/4= 7/4= 8/4= 9/4= 10/4=

4/11/2020 30/3= 31/3= 1/4= 2/4= 3/4= 4/4= 5/4= 6/4= 7/4= 8/4= 9/4= 10/4=

4/19/2020 7/4= 8/4= 9/4= 10/4= 11/4= 12/4= 13/4= 14/4= 15/4= 16/4= 17/4= 18/4=

4/19/2020 9/4= 10/4= 11/4= 12/4= 13/4= 14/4= 15/4= 16/4= 17/4= 18/4= 19/4= SELESAI

4/22/2020 13/4= 14/4= 15/4= 16/4= 17/4= 18/4= 19/4= 20/4= 21/4= 22/4= SELESAI

4/22/2020 13/4= 14/4= 15/4= 16/4= 17/4= 18/4= 19/4= 20/4= 21/4= 22/4= SELESAI

4/23/2020 14/4= 15/4= 16/4= 17/4= 18/4= 19/4= 20/4= 21/4= 22/4= 23/4= SELESAI

4/23/2020 14/4= 15/4= 16/4= 17/4= 18/4= 19/4= 20/4= 21/4= 22/4= 23/4= SELESAI
4/23/2020 14/4= 15/4= 16/4= 17/4= 18/4= 19/4= 20/4= 21/4= 22/4= 23/4= SELESAI
 13 14 ≥ 14

8/4= SELESAI

11/4= SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

11/4= SELESAI

19/4= SELESAI

SELESAI

SELESAI

SELESAI

SELESAI

SELESAI
SELESAI