KARTU KEWASPADAAN KESEHATAN. KEMENTERIAN KESEHATAN RI LEMBAR LUNTUK PETUGAS KKP Nama Umar denis Kelamin: LP ‘ebangsaan No, Pasport ‘Aamat Time Datang dar nogara ol Kedatangan No, PesawatiKapal ‘Nama Pesawatlkapal No. Kuri ‘Dalam 14 har terakirpornah berkunjunadart ‘Negara Tl Datang ToT Berenatat Koluhan sokarang : 4. Demam Ya( )Tidak( ) 2. SesakNepas —:Ya( )Tidak( ) 3. Diare Ya( )Tidak( ) 4 Kojang Ya( )Tidak() 5. Kaku Kudu Ya( )Tidak( ) 8. Mata Merah Ya( )Tidak( ) 7. Mata Kuning Ya( )Tidak( ) 8, RusmKomerahan Kult :¥a()Tidek( 9 Ya( )Tidak( ‘Bet tande (x) pada jawaban yang sosual dongan yang saudara alam saat ini KARTU KEWASPADAAN KESEHATAN (Health Alert Card) § KEMENTERIAN KESEHATAN REPUBLIK INDONESIA (Ministry of Health Republic of Indonesia) LEMBAR2/ PAGE? UNTUK PENUMPANG [FOR PASSENGER Nama (Name) Umur (Age) Jenis Kelamin (Sex) UP (ar) ‘ebangsaan National) No. Paspor (Passport No) ‘Alamat (Address) Datang deri negara (arrived from) ‘Tol kedatangan (arrival date) Keluhan sekarang eran (Fea (), Sesh Nelo (Shrnass of Bat) () Dae (Dares) |) (present iiness) emg mao) aK i |) tai od a angen) Rum Keech Ka St), ( BILA ANDA MENGALAM! SAKIT DALAM 14 HARI TERAKHIR SETELAH BEPERGIAN DARI LUAR NEGER! ATAU. DATANG. DARI NEGARA ENDEMIS' DANATAUTERJANGKIT.AGAR SEGERA [BEROBAT KE FASILITAS KESEHATAN TERDEKAT DAN MENYERAHKAN KARTU IN IF YOU BECOME ILL 14 DAY'S AFTER TRAVELLING ABROAD, OR CAME FROM ENDEMIC AND OR APFECTED COUNTRIES “OR AREA, YOU SHOULD IMMEDIATELY SEEK TREATMENT FROM THE NEAREST HEALTH FACILITY AND PRESENT THIS CARD. ‘Untuk Doktor yang memerisa= ‘rang yams eyes kau i ela datang dan usr eget tu lag der negrsendomis dan au oan (epee: ua ada Kecuan eta pont rebut, Aid ints taporkan (city wats ja a Puskesmaaianior Kesehatan PelabunantOras Keashla dott ola eepon ke PHEOO (Babe Heatn Emerpency. Operation, Conte) DITIEN P2P KEMENTERIAN KESEHATAN Fu Pa? 9828777730007, (County iF eres suspen of contacting te dieace, you we requred ‘ott eer! pinay hea carl saith Gta Heath Ofcs win 24 Nourse ent PIEOC (Pubic Heth Emerponcy ‘Soeratan Guay BILEN P2P hry of Heath Repco donee HP. 62 8777750007, WhatsApp #82 7B 067S- 398, Ema posklibayanco com‘Kenali dan Cari Tahu Ponyakit Endomis atau Ponyakit Yang Sedang Gerjangklt di Negara Asal dan MERS Cov HE ov in Su rn gtr Core) sa i yang epttan ey nena ah ‘tds Ca ua En foatay yr Cana Vy a roles ore ct spray ros ars ome eb ating eh ha pp od im WES COV hos 7a Cuan, SnroasoFbma Cate ed aGUethan anak ata sat paen bane a bn, era eat bn yorgtetontariae ve, at {rra Sra augue ana ot ra Guster agony sate owing cpio stained ie. oer hd pay esooaa Nec mace cing aka stun PS (Pla io Bash Seal ra au neni Brana pend Un) Efe wn nt tcp ayn nr ecco tin he ont Corona Virus (nov) ‘Gerona vrs (C9 aan vs Dr yang menyebakan peat ssn pmalasan dn capt menvebslan Kein. Carne Vins row at cure repay econ and cu ofa human Sr Egy, Sacre bau + Cac Saniaissn” als prcan daa pl pedo sn pasion batik ans bri, Meai oak organ ana yang anti per gapana ta, poaroa gia, beioat organ, oma lected pron moet ei air sing senna Tia crated engnan nose cc gan fa sb, PHES (Peri sp Bors Sha. meu maging err Prevention. ‘ate mashs, wating hands wih sap, Heat ese Banoo, eet os coat th wi anna. dontiy and find out ‘Demam Kuning/ Yellow Fever ryt it eo i xn nha perigee Pe Penal Yin aan ring ot aaa re ata tn al Soa ‘Shon ron ane et era vas oar te rag iy Te Caan amr fet Pinos Se ee i as and arched egos Songs eek eh Ceara ee renee reson te apa te on nig tt ote pone. eto eter [Scarves 30 ar cabeun pasta erage trot Sb cnaon 30 ys ttre rveing to eacid counties HEALTH ALERT CARD MINISTRY OF HEALTH REPUBLIC OF INDONESIA PAGE1 FOR PORT HEALTH OFFICER Name Age Sex Me Natonalty Passport No Address Phone No ‘ved Fem ‘red dle ‘Ship/Fight No. ShipFlght Name ‘Seat No. ‘The county you visited in ast 14 day. Gouniy Dae oft Oats ef Oops 2 3 ‘A present, are you suring rom 4. Fever ‘Yes( )No( 2. Shortness of Breath : Yes( No) 3. Diarrhea ‘Yes( }No( 4, Convulsions: Yes( )No( ) 5. Stiff Neck ‘Yes( )No( ) 8 Rea eye Yes )No( ) 7. Yellow Eye ‘Yes( }No( ) 8. Skin Rash ‘Yes( )No( ) a Yos()No( Please sign (X) atthe conton you are suflering at present.