PENANGGULANGAN TBC NASIONAL

FORMULIR INVESTIGASI KONTAK TUBERKULOSIS

Provinsi : Sulawesi Selatan
Kabupaten/Kota : Kab. Bulukumba
Nama Fasyankes : Puskesmas Tana Toa
Periode : Januari - Desember 2020

Petugas yang menginvestigasi kontak Identitas Kontak

Jenis Kasus Tanggal

No. Nama Kasus Indeks
Indeks Investigasi
Kontak Kontak
Nama Kader / Petugas Kesehatan Nama Fasyankes/Organisasi Kader Nama NIK Umur L/P Alamat Serumah Erat

1 2 3 4 5 6 7 8 9 10 11 12 13
1 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO asni 7302066601040003 17 P sapanang V 17/06/2021
2 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO cia 7401101307690004 51 P sapanang V 17/06/2021
3 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO dia 7302064501600002 61 P sapanang V 17/06/2021
4 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO fadilla 7302066812030001 17 P sapanang V 17/06/2021
5 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO ica 7302064708800004 40 P sapanang V 17/06/2021
6 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO jenil susilo 7302061409040001 16 L sapanang V 17/06/2021
7 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO juani 7302065907920003 23 P sapanang V 17/06/2021
8 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO main 7401102705620001 59 L sapanang V 17/06/2021
9 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO mappa 7302060107650136 58 L sapanang V 17/06/2021
10 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO mardito 7302063011010001 19 L sapanang V 17/04/2021
11 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO maryanto samsul 7302060704040001 17 L sapanang V 17/06/2021
12 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO muh muhriadi 7302060605000002 21 L sapanang V 17/06/2021
13 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO nur ismi 7302066304150002 6 P sapanang V 17/06/2021
14 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO nurlaeli 7302064101990003 22 P sapanang V 17/06/2021
15 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO rahmawati 7302064303820000 39 P sapanang V 17/06/2021
16 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO rajjako 7302060108550002 65 L sapanang V 17/06/2021
17 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO resti 7302064405060001 15 P sapanang V 17/06/2021
18 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO sulaiman 7302060808740001 46 L sapanang V 17/06/2021
19 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO syamsidar 7302066511830001 37 P sapanang V 17/06/2021
20 andrie aswan pabisi Puskesmas Tana Toa Syamsir TBC SO syamsul 7302061212730005 43 L sapanang V 17/06/2021
21 nasrum Puskesmas Tana Toa cabonrong TBC SO amiruddin 7302062401660001 55 L tupare RT/RW 001/001 V 18/06/2021
22 nasrum Puskesmas Tana Toa cabonrong TBC SO anita 7302064404010003 21 P malleleng V 17/06/2021
23 nasrum Puskesmas Tana Toa cabonrong TBC SO anto 7302060107880021 32 L malleleng V 18/06/2021
24 nasrum Puskesmas Tana Toa cabonrong TBC SO aqifatul abqariah 7302065402160001 5 P malleleng V 18/06/2021
25 nasrum Puskesmas Tana Toa cabonrong TBC SO ardiyanto 7302060606040003 17 L tupare RT/RW 001/001 V 18/06/2021
26 nasrum Puskesmas Tana Toa cabonrong TBC SO Baco 7302060505670001 54 L malleleng V 18/06/2021
27 nasrum Puskesmas Tana Toa cabonrong TBC SO harmina 7302064710720003 48 P tupare RT/RW 001/001 V 18/06/2021
28 nasrum Puskesmas Tana Toa cabonrong TBC SO megawati 7302066508910001 32 P malleleng V 18/06/2021
29 nasrum Puskesmas Tana Toa cabonrong TBC SO muh aqil Reskatullah 7302062312120002 8 L malleleng V 18/06/2021
30 nasrum Puskesmas Tana Toa cabonrong TBC SO panno 7302064812670002 53 P malleleng V 18/06/2021
31 nasrum Puskesmas Tana Toa cabonrong TBC SO RESKY ANGGREANI SYAM 7302066608040001 17 P tupare V 18/06/2021
32 nasrum Puskesmas Tana Toa cabonrong TBC SO rosmawati 7302067112840050 36 P tupare V 18/06/2021
33 nasrum Puskesmas Tana Toa cabonrong TBC SO supriadi 7302063007940001 26 L tupare RT/RW 001/001 V 18/06/2021
34 nasrum Puskesmas Tana Toa cabonrong TBC SO syamsir 7302061001830002 38 L tupare V 18/06/2021
35 nasrum Puskesmas Tana Toa cabonrong TBC SO syamsir 7302062305950004 26 L tupare RT/RW 001/001 V 18/06/2021
36 nasrum Puskesmas Tana Toa Gusti TBC SO aldi 7302061205100001 11 L batuasang V 21/06/2021
37 nasrum Puskesmas Tana Toa Gusti TBC SO antiyani 7302065912970001 23 P Batuasang V 21/06/2021
38 nasrum Puskesmas Tana Toa Gusti TBC SO ariadi 7302060708010002 19 L Batuasang V 21/06/2021
39 nasrum Puskesmas Tana Toa Gusti TBC SO IRFAN JAYA 7302063011970002 23 L batuasang V 21/06/2021
40 nasrum Puskesmas Tana Toa Gusti TBC SO juiana 7302065107030002 17 P Batuasang V
41 nasrum Puskesmas Tana Toa Gusti TBC SO jumansia 7302065210730002 47 P batuasang V 21/06/2021
42 nasrum Puskesmas Tana Toa Gusti TBC SO MANCANG 7302064606570001 64 P batuasang V 21/06/2021
43 nasrum Puskesmas Tana Toa Gusti TBC SO muhamad riswan 7302062305140001 7 L batuasang V 21/06/2021
44 nasrum Puskesmas Tana Toa Gusti TBC SO muhammad risal 7302061111950008 25 L batuasang V 21/06/2021
45 nasrum Puskesmas Tana Toa Gusti TBC SO nanr0 7302060403520001 69 P batuasang V 21/06/2021
46 nasrum Puskesmas Tana Toa Gusti TBC SO nia 7302061106720001 49 P batuasang V 21/06/2021
47 nasrum Puskesmas Tana Toa Gusti TBC SO NUR ENDANG 7302064204980003 23 P batuasang V 21/06/2021
48 nasrum Puskesmas Tana Toa Gusti TBC SO rahim 6405021610880002 32 L batuasang V 21/06/2021
49 nasrum Puskesmas Tana Toa Gusti TBC SO RAMLI 740114121287002 33 L batuasang V 21/06/2021
50 nasrum Puskesmas Tana Toa Gusti TBC SO rumalla 7302060102620001 59 L batuasang V 21/06/2021
51 nasrum Puskesmas Tana Toa Gusti TBC SO sambe 7302060107660036 54 L batuasang V 21/06/2021
52 nasrum Puskesmas Tana Toa Gusti TBC SO sani 7302064107850107 35 P batuasang V 21/06/2021
53 nasrum Puskesmas Tana Toa Gusti TBC SO SATTU 7302060107820143 38 L batuasang V 21/06/2021
54 nasrum Puskesmas Tana Toa Gusti TBC SO suriani 7302067101740001 47 P Batuasang V 21/06/2021
55 nasrum Puskesmas Tana Toa Gusti TBC SO usran 7302061412060001 14 L batuasang V 21/06/2021
56 nasrum Puskesmas Tana Toa Hartati TBC SO ALDI RENALDI 7302060107080001 15 L SOBBU V 19/06/2021
57 nasrum Puskesmas Tana Toa Hartati TBC SO aliya jabal nur 7302061411150001 5 P Tanah Towa V 19/06/2021
58 nasrum Puskesmas Tana Toa Hartati TBC SO BASO 7302060107800379 40 L SOBBU V 19/06/2021
59 nasrum Puskesmas Tana Toa Hartati TBC SO bedde 7302064107670195 53 P Tanah Towa V 19/06/2021
60 nasrum Puskesmas Tana Toa Hartati TBC SO BUNDU 7302060107770191 43 L SOBBU V 19/06/2021
61 nasrum Puskesmas Tana Toa Hartati TBC SO FERDI 7302060107060098 13 L SOBBU V 19/06/2021
62 nasrum Puskesmas Tana Toa Hartati TBC SO HAMID 7302064107540067 66 P SOBBU V 19/06/2021
63 nasrum Puskesmas Tana Toa Hartati TBC SO HASA 7302064107820362 38 P SOBBU V 19/06/2021
64 nasrum Puskesmas Tana Toa Hartati TBC SO INA 7302064107970153 23 P SOBBU V 19/06/2021
65 nasrum Puskesmas Tana Toa Hartati TBC SO jabal nur 7302102112870007 41 L Tanah Towa V 19/06/2021
66 nasrum Puskesmas Tana Toa Hartati TBC SO JUSRIADI 7302060107990154 19 L SOBBU V 19/06/2021
67 nasrum Puskesmas Tana Toa Hartati TBC SO lahamid 7302060107530091 67 L sobbu V 19/06/2021
68 nasrum Puskesmas Tana Toa Hartati TBC SO MUSDALIFA 7302065904000003 21 P SOBBU V 19/06/2021
69 nasrum Puskesmas Tana Toa Hartati TBC SO PATE 7302060107680084 52 L SOBBU V 19/06/2021
70 nasrum Puskesmas Tana Toa Hartati TBC SO RIPAL 7302060304110002 10 L SOBBU V 19/06/2021
71 nasrum Puskesmas Tana Toa Hartati TBC SO RIRIN ARIYANTI 7302064107070045 9 P SOBBU V 19/06/2021
72 nasrum Puskesmas Tana Toa Hartati TBC SO RISKA 7302065005980005 23 P SOBBU V 19/06/2021
73 nasrum Puskesmas Tana Toa Hartati TBC SO SATU 7302064107810064 39 P SOBBU V 19/06/2021
74 nasrum Puskesmas Tana Toa Hartati TBC SO SUGIANTO 7302060610990002 21 L SOBBU V 19/06/2021
75 nasrum Puskesmas Tana Toa Hartati TBC SO SUMINGGI 7302064107680098 52 P SOBBU V 19/06/2021
76 nasrum Puskesmas Tana Toa hasi TBC SO ADI 7302060107900172 31 L BALAGANA V 07/08/2021
77 nasrum Puskesmas Tana Toa hasi TBC SO AHRIADI 7302060612900001 30 L BALAGANA V 07/08/2021
78 nasrum Puskesmas Tana Toa hasi TBC SO ASTUTI 7302065107926001 29 P balagana RT/RW 001/001 V 07/08/2021
79 nasrum Puskesmas Tana Toa hasi TBC SO IRMA 7302064110970001 23 P BALAGANA V 07/08/2021
80 nasrum Puskesmas Tana Toa hasi TBC SO M RAHMAT SYAWAL 7302062906150001 6 L balagana RT/RW 001/001 V 07/08/2021
81 nasrum Puskesmas Tana Toa hasi TBC SO MAGFIRA JUSNI PUTRI 7302064107010092 20 P BALAGANA V 07/08/2021
82 nasrum Puskesmas Tana Toa hasi TBC SO MANSYUR 7302061104940001 27 L BALAGANA V 07/08/2021
83 nasrum Puskesmas Tana Toa hasi TBC SO MEGAWATI 7302064909950002 25 P BALAGANA V 07/08/2021
84 nasrum Puskesmas Tana Toa hasi TBC SO MULA 7302060107720187 49 L BALAGANA V 07/08/2021
85 nasrum Puskesmas Tana Toa hasi TBC SO MUSDALIFA 7302065512030004 17 P BALAGANA V 07/08/2021
86 nasrum Puskesmas Tana Toa hasi TBC SO PAGGA 7302060107470112 74 L balagana RT/RW 001/001 V 07/08/2021
87 nasrum Puskesmas Tana Toa hasi TBC SO RAMLAH 7302064107730084 48 P BALAGANA V 07/08/2021
88 nasrum Puskesmas Tana Toa hasi TBC SO REZKI AL[YA NUR 7302065310110001 9 P BALAGANA V 07/08/2021
89 nasrum Puskesmas Tana Toa hasi TBC SO SAHORIA 7302064707980004 32 P BALAGANA V 07/08/2021
90 nasrum Puskesmas Tana Toa hasi TBC SO SERLIWATI 7302065004930001 28 P BALAGANA V 07/08/2021
91 nasrum Puskesmas Tana Toa hasi TBC SO SITI NURNAILAH 7302065811140001 6 P BALAGANA V 07/08/2021
92 nasrum Puskesmas Tana Toa hasi TBC SO SUHARDI 7302060107880195 31 L balagana RT/RW 001/001 V 07/08/2021
93 nasrum Puskesmas Tana Toa hasi TBC SO YULAN 7302064202970002 24 P BALAGANA V 07/08/2021
94 nasrum Puskesmas Tana Toa hasi TBC SO YULI 7302064904040001 17 P BALAGANA V 07/08/2021
95 nasrum Puskesmas Tana Toa hasi TBC SO YUSRIADI 7302060208060001 15 L BALAGANA V 07/08/2021
 TBC.16K FASYANKES
INDONESIA 2020/EDISI 3

ERKULOSIS

Hasil Skrining
Hasil Pemeriksaan Tanggal Pemberian TPT
Gejala Lain Faktor Risiko
Dirujuk Fasyankes Rujukan Diperiksa
Batuk Pernah
Sesak Berkeringat Demam Lansia >60 Ibu berobat TBC
napas malam hari tanpa meriang >1 DM th Hamil Perokok tapi tidak Sakit TBC Tidak TBC < 5 th ≥ 5 th
kegiatan bulan tuntas

14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

V
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V
V

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V V

V V

V
V
V
07/08/2021

07/08/2021

V 07/08/2021

V 07/08/2021