Puskcsims 8
Kmbupmtcd 8
Pmdggmf Pcdycfj`jkmd 8
M. J@CDPJPMQ PCD@CRJPM
1. DMIM 8
2. Siur (tmoud + bufmd) 8
1. Qtmtus `mfmi kcfumrgm 8
0. Mfmimt
RP/RW 8
Kcfurmomd/@csm 8
Kcamimtmd 8
Kmb/Kltm 8
Prlvjdsj 8
3. Pckcrjmmd Stmim 8
Mfmimt tcipmt kcrjm 8
5. Pckcrjmmd smipjdgmd 8
Mfmimt tcipmt kcrjm 8
B. RJWMZMP PCDZMKJP
1. Qmkjt ymdg sckmrmdg su`mo bcrmpm fmim < omrj
2. Mdtmrm 2-0 ijdggu scbcfui smkjt ymdg sckmrmdg, mpmkmo pcrgj bcrimfmi kc fumr
`mcrmo/`csm < Zm/Pj`mk
RP/RW/@usud 8...................................
@csm/ 8...................................
Kcfurmomd 8...................................
Kcamimtmd 8...................................
Kmbupmtcd 8....................................
Prlvjdsj
m. @cimi
b. Pusjdg
a. Iumf
`. Iudtmo
c. Icdggjgjf
e. Pcgmf-pcgmf
g. @jmrc
3. Pcrdmokmd smkjt `cdgmd gcjmfm scpcrtj smkjt ymdg sckmrmdg < Zm/Pj`mk
6. Jika Ya, kapan/tanggal berapa sakit yang terakhir?
a. Indigenous
b. Relaps
c. Import
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
20.00-22.00
22.00-24.00
00.00-02.00
02.00-04.00
04.00-06.00
Hasil Pemetaan
Lokasi
Penularan/Rumah Penderita
Lokasi Oabitat1.
Uektor2
3.
4.
5.
1.
2.
Lokasi Uektor 3.
Malaria 4.
5.
a. .........................................................................................................................................
b. .........................................................................................................................................
c.....................................................................................................................................
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Pewawanaara 8
(…………………………………………….)