blangko ghpr,astina

8/15/2019 BLANGKO GHPR,ASTINA

1/66

LAPORAN KASUS GHPR DAN VAKSINASI ANTI RABIES

PUSKESMAS BANJARANGKAN IIPUSKESMAS/RS : BANJARANGKAN II KABUPATEN : KLUNGKUNG

BULAN : PROPINSI : BALI

NO NAMA PENDERITA NAMA KK ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITANTGL KEPKM/ RS

JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa


2/66


PUSKESMAS BANJARANGKAN IIPUSKESMAS/RS ! BANJARANGKAN II KABUPATEN ! KLUNGKUNG

BULAN ! OKTOBER "#$$ PROPINSI ! BALI

NO NAMA PENDERITA NAMA KK

ALAMAT LENGKAP

(JALAN, DUSUN,DESA )

UMUR PENGGIGITAN

LU

KA

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDI

SI HPR

KET.

B/L

VAR LOG

VAR

I

VAR

II

VAR

IIIDipaka

$ Pt S%k&'ti aa* S%+a'ka D%%* -%*%*a 0 Kaki ki'i $/$#/$$ A*1i* Mati L 2 $/$# 2 $

D&a Ti5i*a*

" K- a% %-a'+ika No-a* 6&*a D%%* -%*%*a $7 Kaki ki'i $/$#/$$ A*1i* Mati L 2 $/$# 2 $

D&a ti5i*a*

4 L%5 %ati*i N&*a5 ia'i D* 6&8ai'i 3 Kaki ki'i $/$#/$$ A*1i* Ti+ak B $/$# 2 2 "

D&a Aa* Pk8 $3.## 6ita 8ia' ta% Pt a% aka'a6ati K- %+i'a D* i+a% ka*i* 9 Ta*a* ki'i $/$#/$$ A*1i* Mati L 2 $/$# 2 $

tak-%* "0/9/$$

7 Kt -%'tiai5 K- &+a*a aa D* 6&8ai'i "3 Ta*a* ka*a* $/$#/$$ A*1i* Hi+%p B $/$# 2 2 "

D&a Aa* Pk8 $9.## 6ita

0 aa* *%a:a * -&'ta*a D* *a*8a* # Pa5a ki'i "/$#/$$ A*1i* Hi+%p B "/$# 2 2 "

3 Ma*k% +a8&- Ma*k% +a8&- D* 6&8ai'i 3# Kaki ka*a* "/$#/$$ A*1i* Ti+ak B "/$# 2 2 "

D&a Aa* 8ia' ta%

; Pt a% +ia* p'a+*a6ati * pa'6ata Na*8a* ka8&' 7,7 Da% :aia* 4/$#/$$ A*1i* Hi+%p L 2 4/$# 2 $

:a6a5

9 G+ ti'ta p'iat*a M+ 6i+ia'ta D%%* *&a'i $ Mata kaki ki'i /$#/$$ A*1i* Hi+%p B /$# 2 2 "

D&a *&a'i$# L%5 %8ia +&6i * + -%8ia6a* D%%* t&*a5 $# Pi*a* ka2 7/$#/$$ A*1i* Mati L 2 7/$# 2 $

D&a *a*8a* *a*


3/66





ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LU

KA

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISI HPR

KET.B/L

VAR LOG

VAR

I

VAR

II

VAR

IIIDipaka

$$ G%ti a% *i8a6ati Gt *'5 %a+*a D%%* &taka* 7 Kaki ki'i 7/$#/$$ A*1i* Mati L 2 7/$# 2 $

D&a &taka*

$" K&t%t 6ati N- iki a'ia*a D%%* ti5i*a* 04 Kaki ka*a* 7/$#/$$ A*1i* Mati L 2 2 7/$# $

D&a ti5i*a*

$4 K&t%t -a'iaa K&t%t -a'iaa D%%* ti5i*a* 43 Kaki ki'i 7/$#/$$ A*1i* Mati L 2 2 7/$# $

D&a ti5i*a*

$ No-a* k&'ti N- %ta-a D* *&a $ P&'&8a*a* 7/$#/$$ A*1i* Hi+%p B 7/$# 2 2 "

D :a*1a'a*ka* Kaki ka*a*

$7 Ka+&k %p'aa*a K&t%t 8a*% D* p&*a'%ka* $# P&'%t 7/$#/$$ A*1i* Hi+%p B 7/$# 2 2 "

D :%*:%*a* Pk8 $9.##

$0 Gt *'5 -&'taoa Gt *'5 p%1a*a D* &taka* 9 Ja'i ki'i 0/$#/$$ A*1i* Mati L 2 2 0/$# $

D &taka*

$3 Gt a% &8a-at Gt *'5 p%1a*a D* * 'ata 7 Kaki ka*a* 0/$#/$$ A*1i* Hi+%p B 0/$# 2 2 "

D &taka* Pk8.#9.4#

$; aa* %+a'-i Pa*+& %'a*a D *a8ia* # Kaki ka*a*/ki 0/$#/$$ A*1i* Hi+%p B 0/$# 2 2 "

Ba*1a'a*ka* 'i pk8 $0.##

$9 K- :a% p'ata-a Kt *a'ta Aka5 $" Pa5a ka*a* 0/$#/$$ A*1i* Hi+%p B 0/$# 2 2 "

Pk8 $0.4#"# Pt a+ita a+i ap%t'a M+ %ia'a*a D* p&k&* " Ta*a* ki'i 3/$#/$$ A*1i* Hi+%p L 2 3/$# 2 $

D aa*


4/66


5/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

4$ * &-i 1&*ita ai5 Kt '&-ika D* &'o-:o* "$ Ja'i kaki ki'i $#/$#/$$ A*1i* +i:%a* B $#/$# 2 2 "

D %8a*

4" 6i8a*%a*ta 6i8a*%a*ta D*- &'ia 77 L&*a* ka*a* $#/$#/$$ A*1i* Hi+%p B $#/$# 2 2 "

D *a8ia*

44 K+k %ia6ati aa* +a'-a+a B' p&-pata* $9 Pa5a ki'i $"/$#/$$ A*1i* Hi+%p L 2 $"/$# 2 $

D Aa*

4 Pt &ka 'ati*i*i5 M+ %k'a6a* D* p&ka*+&8a* 0 Kaki ki'i $"/$#/$$ A*1i* Hi+%p B $"/$# 2 2 "D Aka5

47 Kt 1ati Kt 1ati D* :oko* 09 Kaki ka*a* $"/$#/$$ A*1i* Hi+%p B $"/$# 2 2 "

D a-pa8a* Dit. VAR dari Din

s

40 Kt %'i * +&k&' D* k&8o+ ; Kaki ka*a* $/$#/$$ A*1i* Hi+%p B $/$# 2 2 "

D *a*8a* Pk8. $".4#

43 K+ p&'i a'+ika Kt ka'iaa B' pi*+i ; Bi:i' :a6a5 $/$#/$$ A*1i* Hi+%p B $/$# 2 2 "

D :%*:%*a*

4; * %'ata * %'ata B' p&-&*a* 47 Kaki ka*a* $7/$#/$$ A*1i* Hi+%p B $7/$# 2 2 "

D *a8ia* Pk8. #9.##

49 Pt a% aka'a6ati K- %+i'a D* i+a% ka*i* 9 Ta*a* ka*a* $7/$#/$$ A*1i* Mati L 2 $7/$# 2 $

D tak-%*

# M+ %&*a M+ %&*a D* ka*i* 3 Kaki ka*a* $0/$#/$$ A*1i* Hi+%p B $0/$# 2 2 "

D to1a*


6/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ aa* -&*k& M+ +6i %ta*&a'a D* p&k&* 07 Ta*a* ka*a* $;/$#/$$ A*1i* Hi+%p B $;/$# 2 2 "

D Aa*

" L%5 %8ia +&6i * + -%8ia6a* D* t&*a5 $# P&'%t,ta*a* $7/$#/$$ A*1i* Mati L 2 2 $9/$# $

D *a*8a*

4 K+k 8%5 6i+iai5 D6 + aa D* t&*a5 4$ Kaki ki'i $0/$#/$$ A*1i* Hi+%p B $9/$# 2 2 "

D ti-%5%* Pk8.$3.## J'o -k pa&k it'i N- %+a*a D* pa% 0# Pa5a ka*a* "#/$#/$$ A*1i* Hi+%p B "#/$# 2 2 "

D ti5i*a* Pk8 $$.##

7 Ni 6aa* '%*i N5 &'ia D* *a*8a* k8o+ 37 Ta*a* ka*a* "$/$#/$$ A*1i* Hi+%p B "$/$# 2 2 "

D *a*8a* P8k.$9.##

0 Kt a'i aa* +ak&' D* *a*8a* k8o+ 9 Kaki ka*a* "$/$#/$$ A*1i* Hi+%p L 2 "$/$# 2 $

D *a*8a*

3 * a'a*i N- a'1a*a D* 6&8ai'i 7 Kaki ki'i "/$#/$$ A*1i* Hi+%p B "/$# 2 2 "

D Aa* Pk8.#3.##

; Kt *ai: * 1%*ia'ta D* * 'ata 0 Kaki ki'i "/$#/$$ k%i* Hi+%p B "/$# 2 2 "

D &taka* Pk8.#3.## 8ia'

9 Aa i a *o


7/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

7$ N5 'ata N5 'ata D* pa*+& ;4 Ja'i ka*a* "7/$#/$$ A*1i* Hi+%p B "7/$# 2 2 "

D +a6a* k8o+ Pk8. "#.$7

7" K+ 8%5 6i+iai5 D6 + aa D* t&*a5 4$ Kaki ki'i "0/$#/$$ A*1i* Hi+%p L 2 "0/$# 2 $

D ti-%5%*

74 G+ pa'a-a%t5a Kt ata6a D* 8&pa* ka*i* $" L&*a* ki'i "0/$#/$$ A*1i* Mati L 2 2 "0/$# $

D tak-%*7 K- t%8%*i*i5 D6 pt a+*a*a D* ti5i*a* 43 Kaki ki'i "3/$#/$$ A*1i* Mati L 2 "3/$# 2 $

D ti5i*a*

77 Ni *- %ia N- %+a*a D* ti5i*a* 74 Kaki ka*a* "3/$#/$$ A*1i* Mati L 2 "3/$# 2 $

D ti5i*a*

70 Ma+& %+ia'ta Ma+& %+ia'ta D* :a*+a 4; Kaki ki'i "9/$#/$$ A*1i* Hi+%p B "9/$# 2 2 "

D tak-%* T8 "9/$#

73 Kt 6a*+a*i * -%tika D* %-&a8aka* 7 Kaki ka*a* "9/$#/$$ A*1i* Hi+%p B "9/$# 2 2 "

D tak-%* Pk8. $$.##

7; Ma+& 6ati aa* a+i D* ko'ipa* t5 0 Ja'i ta*a* k* "9/$#/$$ A*1i* Hi+%p B "9/$# 2 2 "

D :a*1a'a*ka* Pk8. #".7

79 Ni -a+& &'*i Kt 6&*a D* 8&pa* ka*i* 0$ Kaki ki'i 4#/$#/$$ A*1i* Hi+%p L 2 4#/$# 2 $

D tak-%*0# * +a'-ika N- k&'ta D* ka8&'a* 4 Pa5a ka*a* 4#/$#/$$ A*1i* Hi+%p B 4#/$# 2 2 "

D ti-%5%* Pk8. #3.##


PUSKESMAS BANJARANGKAN II


8/66

PUSKESMAS/RS ! BANJARANGKAN II KABUPATEN ! KLUNGKUNG



(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR III

Dipa

0$ aa* a'a*i N- a'1a*a D* 6&8ai'i Kaki ki'i 4$/$#/$$ A*1i* Hi+%p L 2 4$/$# 2 $D Aa*

0" Kt *ai: Ma+& koti D* * 'ata 0 Kaki ki'i 4$/$#/$$ k%i* Hi+%p L 2 4$/$# 2 $

D &taka*

04 Kt a'i-:a6a Kt + a'ia*ta'a D* 8&kok 7; Ja'i t&8%*1%k 4$/$#/$$ A*1i* Hi+%p B 4$/$# 2 2 "

D a-pa8a* k8o+ ki'i

NB :

GHPR BARU :

GHPR DIILA=AH PUSKESMAS BA II ! $7 ORANG

GHPR LUAR IL. PUSKESMAS BA II ! $; ORANG

GHPR LAMA >

KUNJUNGN GHPR LAMA SEMUAN=A ! 4# ORANG TOTAL ! 04 ORANG

M&*&ta5%i ! S&-a'ap%'a , " Nop&-:&' "#$$

P8t. K&pa8a UPT. P%k&-a Ba*1a'a*ka* II P&t. S%'


9/66


BULAN ! NOPEMBER "#$$ PROPINSI ! BALI


(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR III

Dipa

$ * :a*+&- %6a'a * :a*+&- %6a'a D* tak-%* 44 Pa*tat ka*a* $/$$/$$ A*1i* Hi+%p B $/$$ 2 2 " Pet. Dns peternakan Sudah dpt pencghn 2x D tak-%* Da* ki'i

" * a 1%*i ata6a* * %ka'-aa D* t&*a5 3 P&'%t, pa5a $/$$/$$ A*1i* Hi+%p B $/$$ 2 2 "

D ti-%5%* ki'i

4 Sa* a% -+ pa'6ati Kt %:aa D* - a%* "; Kaki ka*a* $/$$/$$ A*1i* Hi+%p B $/$$ 2 2 "

D t%a* Pk8 $0.4#

Kt a% ita at%ti Nk -+ 'ata D* at'a Ta*a* ka*a* $/$$/$$ k%i* Hi+%p B $/$$ 2 2 "

D at'a 4$/$$/$$,#;##

7 M+ %+ia*ta M+ %+ia*ta D* i+a% 4$ Ja'i t&8%*1%k "/$$/$$ k%i* Hi+%p B "/$$ 2 2 "

D tak-%* Ka*a* $4."#

0 * %&*t&* Kt a*k&' D* p&-&*a* "" Kaki ka*a* "/$$/$$ a*1i* Hi+%p B "/$$ 2 2 "

D *a8ia* Pk8 $.##

3 Kt %a*ta'i * -%tika D* %-&a8aka* 7 Kaki ka*a* 7/$$/$$ a*1i* Hi+%p L 2 7/$$ 2 $D tak-%*

; A% 6i'a*+ika * %'a+*a D* p&-&*a* 4 Ta*a* ka*a* 7/$$/$$ a*1i* Hi+%p B 7/$$ 2 2 "

D *a8ia* Pk8 $3.##

9 Pt &ka - +a-aa*ti Kt -a*%a'ta D* ka6a* 4 Diata :i:i' 0/$$/$$ a*1i* Hi+%p B 0/$$ 2 2 "

D at'a Pk8 $#.4#

$# N5 -a*i I *- -%+a*a D* t&*a5 73 Kaki ka*a* 0/$$/$$ a*1i* Hi+%p B 0/$$ 2 2 "

D ti-%5%* Pk8 $#.#


10/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L P TEMPAT/ TGLGIGITAN

TGL KEPKM/ RS

JENISHPR

KONDISIHPR

KET.B/L

VAR LVAR I VAR II

VAR III

Dipa

$$ K+k +&6i * 'a1& D* &*ki+i* "4 Kaki ki'i 3/$$/$$ a*1i* Hi+%p B 3/$$ 2 2 "

D Aa* T8 3/$$/$$

$" * +a'-ika * +a'-ika D* ka8&'a* 4 Pa5a ka*a* 4#/$#/$$ a*1i* Hi+%p L 2 3/$$ 2 $

D* ti-%5%* Dit. Var dari dink

$4 * a 1%*ia'ta6a* N- %ka'-aa D* ka8&'a* 3 P&'%t +a* kaki $/$$/$$ a*1i* Hi+%p L 2 ;/$$ 2 $

D ti-%5%* ki'i

$ Ni 6* %6i*t&* N5 k%pa D* k&8o+a* ; Pa5a :&8aka* $#/$$/$$ k%i* Hi+%p B $#/$$ 2 2 "

D *a*8a* ki'i

$7 K- t%8i*i*i5 D6 pt a+*a*a D* ti5i*a* 4 Kaki ki'i $#/$$/$$ a*1i* +i:%*%5 L 2 $#/$$ $

D ti5i*a*$0 N- %8ia N- %+a*a D* pa% 7# Pa5a ka*a* $#/$$/$$ a*1i* +i:%*%5 L 2 $#/$$ $

D ti5i*a*

$3 * p'at-a *%'a5a * ka'ta D* p&-&*a* 4 Ta*a* ki'i $"/$$/$$ a*1i* Hi+%p B $"/$$ 2 2 "

D *a8ia*

$; K- +iki p&'-a*a N5 po*+ok D* ka8&'a* 3 T%*kai ki'i $"/$$/$$ a*1i* Hi+%p B $"/$$ 2 2 "

D ti-%5%*

$9 K+k -&i 6i1aa*ti N- ka'iaa D* ti5i*a* "7 Pa5a ka*a* $4/$$/$$ a*1i* Hi+%p B $4/$$ 2 2 "

D ti5i*a* Pk8 #9.##

"# N5 -a*i N- -%+a*a D ti-%5%* 03 Kaki ka*a* $4/$#/$$ a*1i* Hi+%p L 2 $4/$$ 2 $



11/66




(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

"$ K+ +&6i %'a M. * 'a1&k Aa* "4 Kaki ki'i $/$#/$$ a*1i* -ati L 2 $/$$ 2 $

"" L%5 A+& k%%-a . N5 %+ia*a D* a8& $4 Ja'i ki'i +a* $/$$/$$ k%i* Hi+%p B $/$$ 2 2 "

D Aa* 8%t%t

"4 K+k *o


12/66




(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

4$ N- '%-iati Kt %tapa D* ka6a* 7# Ja'i ta*a* ""/$$/$$ k%i* Hi+%p B ""/$$ 2 2 "

D ti-%5%* Ki'i ""/$$/$$

4" * %6&*t&* Kt a*k&' D* p&-&*a* "" Kaki ka*a* "4/$$/$$ A*1i* 8ia' L 2 2 "4/$$ $

D *a8ia*

44 * o-a oa * o-a oa D* ko'ipa* t*a5 44 Kaki ki'i "4/$$/$$ A*1i* 5i+%p L 2 "4/$$ 2 $

D Ba*1a'a*ka*

4 K+k *o


13/66




(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ Ni ka+&k +&6i * 'a1& a'+ika D* &*ki+i* "4 Kaki ki'i ";/$$/$$ A*1i* 5i+%p L 2 2 ";/$$ $

D Aa*

" Ni *- %ka'i*i N5 %a'1a*a D* Pa% 4; L&*a* ki'i "9/$$/$$ a*1i* Hi+%p B "9/$$ 2 2 "

D ti5i*a* Pk8."".##

4 Ni 6* %ati*i N5 a+6a*a D* pa&k 47 Ta*a* ki'i "$/$$/$$ A*1i* 5i+%p L 2 "9/$$ 2 $

D Aa*

NB :

GHPR BARU :


GHPR LUAR IL. PUSKESMAS BA II ! $4 ORANG GHPR LAMA >

KUNJUNGN GHPR LAMA SEMUAN=A ! $ ORANG

TOTAL ! 4 ORANG

M&*&ta5%i ! SEMARAPURA,7/$"/"#$$

P8t. K&pa8a UPT. P%k&-a Ba*1a'a*ka* II PETUGAS SURVAILANS

Dr. Ida Ayu Ketut Sri Handayani I KETUT ASTINA NIP. $939#;$#"##0#"#$3 NIP. $93#$"";$99"#4$##7


14/66



BULAN ! DESEMBER "#$$ PROPINSI ! BALI


ALAMAT LENGKAP


UMUR PENGGIGITAN L

UK

A

PENANGANAN/PENGOBATA


TGL KEPKM/ RS

JENISHPR

KONDISIHPR

KET.B/L

VAR LOGIS

VAR I

VAR II

VAR III

Dipak ai

$ K+k &*i &tia6ati M+ :aia+a D* :a*1a'a*ka* $$ Ta*a* ka*a* $/$"/$$ a*1i* Hi+%p B $/$" 2 2 " ";

D :a*1a'a*ka*

" M+ -%tika M+ -%tika D* :&*&* 74 Kaki ki'i (i:% "7/$$/$$ A*1i* 5i+%p L 2 " /$" 2 $ ";

D &taka* Ja'i)

4 Pt 'a+ika aa K+k %+ika B' ka*i* $" Kaki ka*a* 4/$"/$$ a*1i* Hi+%p B 4/$" 2 2 " ";

D t%a* 4/$"/$$

L%5 %ia*ti * &ka a*1aa D* pa%ta* Ta*a* ki'i 4/$"/$$ a*1i* Hi+%p B 4/$" 2 2 " ";

D :a*1a'a*ka* Da* ka*a*

7 Kt k&p'% M+ 8at'a D* *&a'i 37 Kaki ka*a* 4/$"/$$ a*1i* Hi+%p B 4/$" 2 2 " "3

D *&a'i

0 N5 *&-:&* N5 *a+a D* *a8ia* 0# Mata kaki /$"/$$ a*1i* Hi+%p B /$" 2 2 " "3

D *a8ia* ki'i

3 N- a'ta N- a'ta D* ti5i*a* 7$ Kaki ki'i 7/$"/$$ a*1i* Hi+%p B 7/$" 2 2 " "3

D ti5i*a*

; Dk a% -+ 'ati5 M+ %6i1a*a D* p&-&*a* $$ Kaki ki'i 7/$"/$$ a*1i* Hi+%p B 7/$" 2 2 " "3

D *a8ia* Pk8 $0.##

9 Ni *- %'at*i N5 %a'1a*a D* pa% 7$ Ta*a* ki'i "9/$$/$$ A*1i* 5i+%p L 2 0 /$" 2 $ "3

D ti5i*a*

$# * a+*a*i * a+*a*i D* :a*+a 49 Ja'i Kaki ki'i 0/$"/$$ a*1i* Hi+%p B 0/$" 2 2 " "0

D tak-%* 0/$"/$$



15/66




(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ $ Pt a% a'a*a p. * kata D* t&*a5 $; Kaki ka*a* 3/$"/$$ A*1i* 5i+%p L 2 3 /$" 2 $

D *a*8a*

$ " * %+ia'ta6a* * %+ia'ta6a* D* t&*a5 49 Kaki ki'i ;/$"/$$ A*1i* 5i+%p L 2 ; /$" 2 $

D *a*8a*

$ 4 Gt *'5 k'i*a Gt *'5 ti'taaa D* taki-%* Kaki ka*a* ;/$"/$$ A*1i* 5i+%p L 2 ; /$" 2 $

D tak-%*

$ * %ta * %k&+a*a D* ka8&'a* 30 Kaki ka*a* $#/$"/$$ a*1i* Hi+%p B $#/$" 2 2 "

D ti-%5%* 3/$"/$$

$ 7 Eka 8a


16/66


(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN L

UK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR II VAR IIIDipakai

" $ Pt oi &tia6a* K+ -%+ia'+a*a D* pa&k " Di p&'%t $#.## $/$"/$$ a*1i* Hi+%p B $/$" 2 2 "

D Aa* $/$"/$$

" " Pt 'i&* +i'a%a K+k i+&p a'ta*a D* ka*i* $# Kaki ki'i $7## $7/$"/$$ a*1i* Hi+%p B $7/$" 2 2 "

D t%a* $7/$"/$$

" 4 Dk -+ '6i 1%*ia*ta'i D6 pt :%+i D* &-&a%* "0 Ta*a* ka*a* $7/$"/$$ k%i* Hi+%p B $7/$" 2 2 "D :a*1a'a*ka* Pk8 "4.##

" N5 %k8& * &ka a+a D* p&*aa* t5 37 Kaki ka*a* $7/$"/$$ a*1i* Hi+%p B $7/$" 2 2 "

D ti5i*a*

" 7 Pt a% ap%t'a Kt a&t L&pa* ka6a* "$ Ja'i t&8%*1%k $3/$"/$$ a*1i* Hi+%p B $3/$" 2 2 "

D ti5i*a* $0/$"/$$

" 0 Ni k&t%t %a*ti N- ata6a D* p&k&* $9 Kaki ka*a* $3/$"/$$ a*1i* Hi+%p B $3/$" 2 2 "

D Aa* $0/$"/$$

" 3 * %ta N* %ka+a*a D* ti-%5%* t&*5 30 B&ti ka*a* $#/$"/$$ a*1i* Hi+%p L 2 $3/$" 2 $

D ti-%5%*

" ; * + +a'-a p * %k'a-a D* 8&pa* ka*i* Kaki ki'i $$/$"/$$ a*1i* Hi+%p L 2 $;/$" 2 $

D tak-%* $$/$"/$$

" 9 Eka 8a


17/66

BULAN ! DESEMBER "#$$ PROPINSI ! BAL


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

4$ K- t'i %+a p M+ %8ia*ta'a D* pa% 7 Kaki ki'i $;/$"/$$ a*1i* Hi+%p B $;/$" 2 2 "

D ti5i*a* Pk8 $7.##

4" K+k %atika * -%tika D* p&-&*a* "; Kaki ka*a* $9/$"/$$ a*1i* Hi+%p B $9/$" 2 2 "

D *a8ia* $9/$"/$$44 Pt +&


18/66



ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ K+k +6iki a*+i P * ta*t'a D* 8oa* $$ Kaki ka*a* "4/$"/$$ a*1i* Hi+%p B "4/$" 2 2 "

D tak-%* ""/$"/$$,$"##

" Ma+& 'a-a a+ita N- %ka'iaa D* pa% 4 Kaki ki'i "/$"/$$ a*1i* Hi+%p B "/$" 2 2 "

D ti5i*a* "/$"/$$,$9## 4 G+ p%paa*a N5 a'ia*a D* a-pa8a* k8o+ 3 Pa5a kaki "/$"/$$ a*1i* Hi+%p B "/$" 2 2 "

D a-pa8a* ka*a*

?it'ia*i Miaa D* p&-&*a* 9 Pa*tat ki'i "7/$"/$$ a*1i* Hi+%p B "/$" 2 2 "

D *a8ia*

7 D6 + 'aka D6 + 'aka D* t%a* ka*i* 07 Kaki ka*a* "7/$"/$$ a*1i* Hi+%p B "7/$" 2 2 "

D t%a*

0 Ma+& -&' pa+-a. Pt %ka+a*a D* :oko* 3 Ja'i kaki k*a* "0/$"/$$ a*1i* Hi+%p B "0$" 2 2 "

D a-pa8a* k8o+ "0/$"/$$,$4## Lia'

3 N-a* a'ta N-a* a'ta D* ti5i*a* 0# Kaki ki'i "0/$"/$$ A*1i* 5i+%p L 2 2 "0/$" $

D ti5i*a*

; IB +6i a*+ika IB ka+& ata6a B' +i*a -%*+%k " +i-%ka "0/$"/$$ a*1i* Hi+%p B "0$" 2 2 "

i*a'a1a "/$"/$$ 9 Pt a% ap%t'a Kt a&t D* 8&pa* ka6a* "$ Ja'i t&8%1%k "/$"/$$ a*1i* Hi+%p L 2 "/$" 2 $

D tak-%* ka*a*

7 # * *o-:o* * %'ata D* *a8ia* 4 Kaki ki'i "3/$"/$$ a*1i* Hi+%p B "3$" 2 2 "

D *a8ia*





19/66


(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR III

Dipa

7 $ * &8a-&t * &8a-&t D* p&-&*a* # Ta*a* ka*a* ";/$"/$$ a*1i* Hi+%p B ";$" 2 2 "

D *a8ia* ";/$"/$$

7 " * t%*a K&t%t *%'a5 D* t&a8 6a*i 7# Kaki ka*a* ";/$"/$$ a*1i* Hi+%p B ";$" 2 2 "

D *a8ia* ";/$"/$$

7 4 Kt tapa Kt tapa D* ti-%5a* 0; Pa5a ka*a* ";/$"/$$ a*1i* Hi+%p L 2 ";/$" 2 $D ti-%5a*

7 Pt 'a*i %k-a+&6i Kt %'a+*a*a B' t&*a5 $4 Kaki ki'i ";/$"/$$ a*1i* Hi+%p B ";$" 2 2 "

D ti-%5%*

7 7 Ma+& 'a-a N- %ka'ta D* Aa* 4,7 Pa5a ka*a* 4$/$"/$$ a*1i* Hi+%p L 2 4$/$" 2 $

D Aa*

7 0 * 6i+at'i N5 ki*t&* D* pa% 49 L&*a* ki'i 4$/$"/$$ a*1i* Hi+%p B 4$$" 2 2 "

D ti5i*a*

NB :

@ GHPR BARU :


GHPR LUAR IL. PUSKESMAS BA II ! " ORANG

@ GHPR LAMA >

KUNJUNGN GHPR LAMA SEMUAN=A ! $3 ORANG

TOTAL ! 70 ORANG

M&*&ta5%i ! SEMARAPURA,7/#$/"#$"




20/66

LAPORAN HARIAN

GHPR

PROGRAM SURVAILANS

TAHUN 2012


21/66



BULAN ! JANUARI "#$" PROPINSI ! BALI


ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

III Dipa

$ K- A% N5 6i'ata D* p&-&*a* 4,7 T%-it ki'i "/$/$" a*1i* Hi+%p B "/$ 2 2 "

D *a8ia*

" Pt a'i +a'-aa*ti * a'1a*a D* 8oa* "0 Ta*a* ka*a* "/$/$" a*1i* Hi+%p B "/$ 2 2 "

D tak-%* "/$/$"

4 K- %+ia*a a'ia'ta * a'1a*a D* 8oa* "# Ta*a* ka*a* "/$/$" a*1i* Hi+%p B "/$ 2 2 "

D tak-%* kaki "/$/$"

K+k a'i %iati * a'1a*a D* 8oa* " L&*a* ki'i "/$/$" a*1i* Hi+%p B "/$ 2 2 "

D tak-%* "/$/$"

7 Ni 6* a*i N* %a'ta D* 8oa* 34 Ja'i Ta*a* "/$/$" a*1i* Hi+%p B "/$ 2 2 "

D tak-%* "/$/$"

0 * a'ta*a N5 :a*tat D* *a*8a* k8o+ $ Kaki "/$/$" k%i* Hi+%p L 2 ";/$" 2 $D *a*8a*

3 M+ :%+i'ia*i G+ 5aat Bt* p&*aa* 4; J&-po8 kaki "/$"/$$ a*1i* Hi+%p L 2 ";/$" 2 $

p&'-ai Ka*a* "/$"

; G N A %k'a a+*a*a G N A %k'a a+*a*a D* *&a'i 47 T*a* ka*a* 4/$/$" k%i* Hi+%p B 4/$ 2 2 "

D *&a'i Pk8 "#.##

9 K+k :%+ia'a*a M+ -%+a D* k&-:&*a* 7 Ja'i ta*a* /$/$" a*1i* Hi+%p B /$ 2 2 "

T%8ik%p,ia*a' Ka*a* $7.##

$# Pt 'a*i %k-a+&6i Kt %'a+*a D* t&*a5 $ Kaki ki'i "9/$"/$$ a*1i* -ati L 2 ";/$" 2 $

D ti-%5%* "9/$"/$$ +i:%*%5


22/66


23/66





ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

III Dipa

" $ N- at'a N- at'a D* t&8aa ta6a* 3# Kaki ki'i $$/$/$" a*1i* Hi+%p B $$/$ 2 2 "

Si+&-&*,k'*a&- $#/$/$"

" " K'k 'i '&1&ki A * a+*a D* k8o+ 3 Pa5a ki'i $$/$/$" a*1i* Hi+%p B $$/$ 2 2 "

D *a*8a*

" 4 Pt '&*i a* k&-:a'aa D* p&k&* # Kaki ki'i $/$/$" a*1i* Hi+%p B $$/$ 2 2 "

D Aa* $/$/$"

" AA + a8it paa+*a AA + p'a1aa D* t&*a5 4 Pa5a ka*a* $/$/$" a*1i* Hi+%p L 2 $/$ 2 $

D ti-%5%*

" 7 K+k &


24/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA


TGL KEPKM/ RS

JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR III

Dipa

4$ AA G+ +6ipaa*a AA 'aka %-8& D* t&*a5 47 Kaki ka*a* $3/$/$" a*1i* Hi+%p B $3/$ 2 2 "

D ti-%5%*

4" K'k 'i '&1&ki A * a+*a D* k8o+ 3 Pa5a ki'i $$/$/$" a*1i* Hi+%p L 2 $;/$ 2 $

D *a*8a*

44 N- %+ia'ta N- %+ia'ta D* t&*a5 ; B&ti ki'i $9/$/$" a*1i* Hi+%p B $9/$ 2 2 "

D ti-%5%*

4 Pt 'a*i %k-a+&6i Kt %'a+*a D* t&*a5 $ Kaki ki'i "9/$"/$$ a*1i* -ati L 2 2 $9/$ $

D ti-%5%* "9/$"/$$ +i:%*%5

47 Gt *'5 a'ia*a Gt *'5 a'ia*a D* tak-%* 49 Kaki ki'i "#/$/$" a*1i* Hi+%p B "#/$ 2 2 "

D tak-%*

40 K+k a*i& Kt %-a*t'a D* ka*i* 3 Pa5a ka*a* "#/$/$" a*1i* Hi+%p B "#/$ 2 2 "

D t%a*

43 N* -i'& N- ka*+'i D* * 'ata 37 B&ti ki'i "#/$/$" a*1i* Hi+%p B "#/$ 2 2 "

D &taka*

4; K+k a+*a*a N5 6&*a D* 6&8ai'i "" Kaki ki'i "$/$/$" a*1i* Hi+%p B "$/$ 2 2 "

D Aa*

49 K- %+ia*a a'ia't5a * a'1a*a D* 8oa* "# Ta*a* ka*a* "/$/$" a*1i* -ati L 2 2 ""/$ $

D tak-%* kaki "/$/$"

# * k'i*a6ati * i-p&* D* t&*a5 4$ Pa5a ka*a* ""/$/$" a*1i* Hi+%p B ""/$ 2 2 "

D *a*8a* ""/$/$"


25/66





ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L P

TEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR II VAR III Dipa

$ K+k a'i %iati * a'1a*a D* 8oa* " L&*a* ki'i "/$/$" a*1i* -ati L 2 2 "4/$ $

D tak-%* "/$/$"

" Ni 6* a*i N* %a'ta D* 8oa* 34 Ja'i Ta*a* "/$/$" a*1i* -ati L 2 2 "4/$ $

D tak-%* "/$/$"

4 * k%%-a *ata * k%%-a *ata D* ka8&'a* 0$ Pa5a ka*a* $0/$/$" a*1i* -ati L 2 "4/$ 2 $

D ti-%5%* +i:%*%5

AA + Pa'6ati AA + Pa'6ati D* t&*a5 7 Kaki ka*a* "/$/$" a*1i* Hi+%p B "/$ 2 2 "

D ti-%5%* ""/$/$"

7 K+k %ti*a6ati N- t'i-a D* t%a* ka6a* "# ta*a* ka*a* "/$/$" a*1i* Hi+%p B "/$ 2 2 "

D t%a* "/$/$"

0 Kt %ai5 N- at%' D* ka8&'a* "7 B&ti ki'i $0/$/$" a*1i* -ati L 2 "7/$ 2 $D ti-%5%* +i:%*%5

3 * 6i8a*%a*ta * 6i8a*%a*ta D* 'ia 7 ta*a* ka*a* "7/$/$" a*1i* Hi+%p B "7/$ 2 2 "

D *a8ia*

; M+ a*+i a5a+i M+ '&*a D* t%a* ka6a* $ Ta*a* ki'i "7/$/$" a*1i* Hi+%p B "7/$ 2 2 "

D t%a*

9 AA + *%'a5 AA + *%'a5 D* t&*a5 0$ B&ti ki'i "0/$/$" a*1i* Hi+%p B "0/$ 2 2 "

D ti-%5%*

7 # Kt a'ta'i * p%1a at'ia6a* D* :oko* $" +ipi*%8 "3/$/$" a*1i* Hi+%p B "3/$ 2 2 "

D a-pa8a* k8o+


26/66





ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

7 $ K+k +6i a5a*i * -%*+'a D* :%*aa $" Kaki ki'i "3/$/$" a*1i* Hi+%p B "3/$ 2 2 "

D Aka5

7 " K+k a+ita p&'-a*a Kt %+'a D* i+a% 7 Kaki ki'i "3/$/$" a*1i* Hi+%p B "3/$ 2 2 "

D tak-%*

7 4 Kt a'a*i N5 -%+ia*a D* 6&8ai'i "; Kaki ki'i +a* "3/$/$" a*1i* Hi+%p B "3/$ 2 2 "

D Aa* ka*a*

7 * -%'*i * -%'a5 D* &taka* 0" L&*a* ka*a* "3/$/$" a*1i* Hi+%p B "3/$ 2 2 "

D &taka*

7 7 N* -i'& N- ka*+'i D* * 'ata 37 B&ti ki'i "#/$/$" a*1i* Hi+%p L 2 ";/$ 2 $

D &taka*

7 0 D6 a% +a-aa*ti D6 + 5i8ia*a D* t&*a5 Kaki ka*a* "3/$/$" a*1i* Hi+%p B "9/$ 2 2 "

D *a*8a* "9/$/$"7 3 D6 kt %+a*a D6 kt %+a*a D* ka6a* 4; Ja'i ta*a* "3/$/$" k%i* -ati B "9/$ 2 2 "

D t%a* ka*a* "9/$/$"

7 ; K+k a*a -a'ta+i * %k'ata 6i1aa D* ka*i* ; Kaki ki'i 4#/$/$" a*1i* Hi+%p B 4#/$ 2 2 "

D :aka 4#/$/$"

7 9 Pt a'i +a-aa*ti * %1a*a D* 8oa* "0 L&*a* ki'i 4#/$/$" a*1i* -ati L 2 4#/$ 2 $

D tak-%* "/$/$"

0 # N* %ata N* %ata D* 8oa* ; Ta*a* ki'i 4#/$/$" a*1i* -ati L 2 2 4#/$ $

D tak-%*


27/66





ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

0$ Pt :%+ia*a N5 %a'+ika D* Aa* $4 L&*a* ki'i 4#/$/$" a*1i* Hi+%p B 4#/$ 2 2 "

D Aa*

NB :

@ GHPR BARU :

GHPR DIILA=AH PUSKESMAS BA II ! "3 ORANG

GHPR LUAR IL. PUSKESMAS BA II ! $4 ORANG

@ GHPR LAMA >

KUNJUNGN GHPR LAMA SEMUAN=A ! "$ ORANG

TOTAL ! 0$ ORANG

M&*&ta5%i ! SEMARAPURA,7/#"/"#$"




28/66



BULAN ! PEBRUARI "#$" PROPINSI ! BALI


(JALAN, DUSUN,

DESA )

UMUR PENGGIGITANLUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ Kt :%+iaa K+k a'iaa D* 8&kok 7; Ja'i ka*a* $/"/$" k%* Hi+%p L 2 $/" 2 $

D&a a-pa8a* k8+ "7/$/$"

" N* a*itia p'a+*a G+ +a'-a6a* D* 1a:o* 7 Kaki ki'i "/"/$" a*1i* -ati L 2 2 "/" $

D a-pa8a* t&*5

4 * &ka'i*i N5 6a*a D* k&8o+a* 0# Ta*a* ki'i "/"/$" a*1i* 8ia' L 2 2 "/" $

D :&a*

AA + *%'a5 AA + *%'a5 D* t&*a5 0$ B&ti ki'i "0/$/$" a*1i* Hi+%p L 2 "/" 2 $

D ti-%5%*

7 K- 6a5%+i +ia*a * %'ata D* p&-&*a* " Ba6a5 p%a' "/"/$" a*1i* Hi+%p L 2 "/" 2 "D *a8ia*

0 * ka'tika %a+a * ka'tika %a+a D* p&*aa* ; Kaki ka*a* 4/"/$" a*1i* 8ia' L 2 2 4/" $

D ti5i*a*

3 K+k a+ita p&'-a*a Kt %+'a D* i+a% 7 Kaki ki'i "3/$/$" a*1i* Hi+%p L 2 4/" 2 $

D tak-%*

; N* %a*t5a N* %a*t5a D* a*i* 74 Kaki ka*a* 4/"/$" a*1i* -ati B 4/" 2 2 "

D ka-aa* 4 :8* 8a8%

9 * a'1a*a * a'1a*a D* 8oa* 7 Kaki ki'i 0/$/$" a*1i* -ati L 2 /" 2 $

D tak-%* 0/$/$"

$# D6 a% +a-aa*ti D6 + 5i8ia*a D* t&*a5 Kaki ka*a* "3/$/$" a*1i* Hi+%p L 2 7/" 2 $

D *a*8a* "9/$/$"


29/66


30/66





ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR II

VAR

III Dipa

" $ N5 a'6i*i Kt %+a'a D* p&*aa* t*5 " Kaki ka*a* $4/"/$" a*1i* Hi+%p L 2 0/" 2 $

D ti5i*a*

" " A% %'a * %'a 6i'a6a* D* pa% 0 Di5i+%* $4/"/$" a*1i* Hi+%p B $4/$ 2 2 "

D ti5i*a*

" 4 K+k 1aa a*+ika p * &+i %i8a D* 'a-& Kaki ka*a* $0/"/$" a*1i* Hi+%p B $0/$ 2 2 "

D&a k%a-:a

" * a'+a*a * a'+a*a D* t&*a5 4 pa5a $0/"/$" a*1i* Hi+%p B $3/$ 2 2 "

D *a*8a* $7/"/$"

" 7 Ni 8%5 %a'ti*i N5 iai5 D* 6&8ai'i 7 kaki $3/"/$" a*1i* -ati B $3/$ 2 2 "

D Aa* $/$#/$$ +i:%*%5

" 0 K- aa %ia*ta'a N5 +a'a*a D* &*ki+i* 4,7 Kaki ka*a* $3/"/$" a*1i* Hi+%p B $3/$ 2 2 "

D Aa* $3/"/$"

" 3 M K +a8&- a%* Kt %+a'a*a D* 6&8ai'i ;# Kaki ka*a* $;/"/$" a*1i* -ati B $;/$ 2 2 "

D Aa* $/$#/$$ +i:%*%5

" ; N5 ika * %tia'i D* 6&8ai'i 0$ Kaki ka*a* $;/"/$" a*1i* -ati B $;/$ 2 2 "

D Aa* $/$#/$$ +i:%*%5

" 9 Kt -%8iati Kt -%+a*a D* a-pa8a* 47 L%t%t ka*a* $;/"/$" a*1i* -ati B $;/$ 2 2 "

D a-pa8a*

4 # N- %+iti M+ -a'+ita D* tak-%* ; Pa5a ka*a* $9/"/$" a*1i* Hi+%p L 2 $9/" 2 $

D tak-%*


31/66





ALAMAT LENGKAP

(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR II

VAR

III Dipa4$ * pi*&t K+k %a'-ika D* 6&8ai'i 0 Kaki ki'i $9/"/$" a*1i* -ati B $9/$ 2 2 "

D Aa* $/$#/$$ +i:%*%5

4" N5 ka'i N5 ka'i D* 6&8ai'i 77 Kaki ka*a* $9/"/$" a*1i* -ati B $9/$ 2 2 "

D Aa* p&'*$/$#/$$ +i:%*%5

44 * %+a'ti N5 ka'i D* 6&8ai'i 74 1a'i Kaki $9/"/$" a*1i* -ati B $9/$ 2 2 "

D Aa* p&'*$/$#/$$ +i:%*%5

4 * i-p&* * %+a*a D* t&*a5 3# Kaki ki'i $;/"/$" a*1i* -ati B $;/$ 2 2 "

D k%a-:a

47 * ata a+i p'+*a * %ka'a D* k&-:&*a* 9 Kaki ka*a* $9/"/$" a*1i* 5i+%p B $9/$ 2 2 "

D t%8ik%p Dit. Var dari dink

40 Kt %kiati K+k %a'-ika D* 6&8ai'i " Kaki ki'i "#/"/$" a*1i* -ati B "#/$ 2 2 "

Ha-i8 :8* D Aa* $/$#/$$ +i:%*%5

43 Pt A% %'a * %'a 6i'a6a* D* pa% 0 Di5i+%* $4/"/$" a*1i* Hi+%p L 2 "#/" 2 $

D ti5i*a*

4; * 1%8ia*ta'a No-a* &8a-&t D* pa&k 0 +ipa*tat $9/"/$" a*1i* 8ia' B $9/$ 2 2 "

D Aa*

49 * *a:%5 * :i*a D* ka8&'a* 3# Kaki ki'i "$/"/$" a*1i* 5i+%p B "$/$ 2 2 "

D ti-%5%* "$3/"/$"

# Ma+& a+'% Ma+& a+'% D* *&a'i 7 Kaki ka*a* ""/"/$" a*1i* 5i+%p B ""/$ 2 2 "

D *&a'i ""/"/$"


32/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR II

VAR

III Dipa $ G+ 6i*% ap%t'a G+ %-&'ta D* &*ki+i* $# T&8apak ta** "4/"/$" a*1i* 5i+%p B "4/$ 2 2 "

D Aa* ka*a*

" Ni *5 ik8&k N5 :%+ia'ta*a D* pa% 37 Kaki ka*a* "4/"/$" a*1i* 5i+%p B "4/$ 2 2 "

D ti5i*a* "4/"/$"

4 N5 1o* a'ta6a* * 1o*i a'ta D* t&*a5 7 Pa*tat ki'i "4/"/$" a*1i* 5i+%p B "4/$ 2 2 "

D *a*8a* "4/"/$"

K+k 6i1a*a * -%+a -%8ia D* 6&8ai'i $" t%-it kaki "4/"/$" a*1i* 5i+%p B "4/$ 2 2 "

D Aa* ka*a*

7 Gt a okta


33/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR II

VAR

III Dipa7 $ G+ p&:'i i'a6a* * i'a -%+a D* ka*i* 0 Pa5a ka*a* "7/"/$" a*1i* 5i+%p B "7/$ 2 2 "

D t%a* "7/"/$"

7 " IB -+ p%1a +a'-a G. IB 'ai +a*ta D* &taka* Ta*a* ka*a* "0/"/$" a*1i* 5i+%p B "0/$ 2 2 "

D &taka* "0/"/$"

7 4 N5 ika * %tia'i D* 6&8ai'i 0$ Kaki ka*a* $;/"/$" a*1i* -ati L 2 "0/" 2 $

D Aa* $/$#/$$ +i:%*%5

7 * %+a'ti N5 ka'i D* 6&8ai'i 74 1a'i Kaki $9/"/$" a*1i* -ati L 2 "0/" 2 $

D Aa* p&'*$/$#/$$ +i:%*%5

7 7 N5 ka'i N5 ka'i D* 6&8ai'i 77 Kaki ka*a* $9/"/$" a*1i* -ati L 2 "0/" 2 $

D Aa* p&'*$/$#/$$ +i:%*%5

7 0 N- %ita N5 *a'ti D* 6&8ai'i 0" Kaki ki'i "0/"/$" a*1i* 5i+%p B "0/$ 2 2 "

D Aa*

7 3 * pi*&t K+k %a'-ika D* 6&8ai'i 0 Kaki ki'i $9/"/$" a*1i* -ati L 2 "0/" 2 $

D Aa* $/$#/$$ +i:%*%5

7 ; M K +a8&- a%* Kt %+a'a*a D* 6&8ai'i ;# Kaki ka*a* $;/"/$" a*1i* -ati L 2 "0/" 2 $

D Aa* $/$#/$$ +i:%*%5

7 9 Ni 8%5 %a'ti*i N5 iai5 D* 6&8ai'i 7 kaki $3/"/$" a*1i* -ati L 2 "0/" 2 $

D Aa* $/$#/$$ +i:%*%5

0 # Kt %kiati K+k %a'-ika D* 6&8ai'i "7 Kaki ki'i "#/"/$" a*1i* -ati L 2 "3/" 2 $

Ha-i8 :8* D Aa* $/$#/$$ +i:%*%5


34/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

0 $ * 1%8ia*ta'a N- &8a-&t D* pa&k 0 +ipa*tat $3/"/$" a*1i* -ati L 2 "3/" 2 $

D Aa*

0 " Pt 6i+i atika p%t'a Kt %+a'a*a D* 6&8ai'i $# T%*kai ki'i ";/"/$" k%i* 5i+%p B ";/$ 2 2 "

D Aa* Da* ka*a*

0 4 N- a+i* Kt0 a'*aa D* t&a86a*i 79 Dikaki ka*a* ";/"/$" a*1i* 5i+%p B ";/$ 2 2 "

D *a8ia*

0 * %a'+ika * %a'+ika D* tak-%* k** 9 Dikaki ka*a* "9/"/$" a*1i* 5i+%p B "9/$ 2 2 "

D tak-%*

0 7 * o8a * o8a D* tak-%* 73 Ta*a* ki'i "9/"/$" a*1i* 5i+%p B "9/$ 2 2 "

D tak-%*

0 0 Ni pt :%+iati .*- %a'+a*a D* &taka* "; Ja'i t&8%*1%k "9/"/$" k%i* 5i+%p B "9/$ 2 2 "

D &taka* ka*a* NB :

@ GHPR BARU :

GHPR DIILA=AH PUSKESMAS BA II ! "7 ORANG

GHPR LUAR IL. PUSKESMAS BA II ! $3 ORANG

@ GHPR LAMA >

KUNJUNGN GHPR LAMA SEMUAN=A ! " ORANG

TOTAL ! 00 ORANG

M&*&ta5%i ! SEMARAPURA,7/#4/"#$"




35/66



BULAN ! MARET "#$" PROPINSI ! BALI


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ * -%'tika * -%'tika D* a*i* $ P&'&8a*a* $/4/$" A*1i* Lia' L 2 $/4 2 $

D Aka5 Kaki ka*a*

" N- %'&*a N- %'&*a D* :&*&* # Kaki ka*a* * "9/"/$" A*1i* 5i+%p B $/4 2 2 "

D &taka* L&*a* ka*a*

4 G+ 6i*a G+ %-&'ta D* &*ki+i* 9 T&8apak t** $/4/$" A*1i* 5i+%p L 2 $/4 2 $

D Aa* ka*a*

Ni *5 ik8&k N5 :%+ia'ta*a D* pa% 37 Kaki ka*a* "4/"/$" a*1i* +i:%*%5 L 2 $/4 2 $

D ti5i*a* "4/"/$"

7 N5 1o*i a'ta6a* * 1o*i a'ta D* t&*a5 7 Pa*tat ki'i "4/"/$" a*1i* 5i+%p L 2 $/4 2 $

D *a*8a* "4/"/$"

0 K+k 6i1a*a * -%+a -%8ia D* 6&8ai'i $" t%-it kaki "4/"/$" a*1i* 5i+%p L 2 $/4 2 $

D Aa* ka*a* 3 L%5 -+ -a'ia*a N5 ka'a6a* D* *a8ia* $" Kaki ka*a* 4/4/$" A*1i* 5i+%p B 4/4 2 2 "

D *a8ia*

; * %:%t * %:%t D* *&a'i ;# Kaki ka*a* * 4/4/$" A*1i* 5i+%p B 4/4 2 2 "

D *&a'i Ki'i, ta*a* 2 K*a* k'i

9 * %&*i * +ia*a D* *&a'i 7# Kaki ka*a* 4/4/$" A*1i* 5i+%p B 4/4 2 2 "

D *&a'i

$# Kt %ati*i M+ %ka +6i p%t'a D* p&k&* 7" Kaki ki'i 4/4/$" A*1i* 5i+%p B 4/4 2 2 "

D Aa*


36/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ $ * ka'*iai5 M+ 6&*t&* D* kapit "$ Ja'i ta*a* 4/4/$" A*1i* 5i+%p B 4/4 2 2 "

D *a8ia* ki'i

$ " N- %ita N5 *a'ti D* 6&8ai'i 0" Kaki ki'i "0/"/$" a*1i* 5i+%p L 2 /4 2 $

D Aa*

$ 4 IB -+ p%1a +a'-a G. IB 'ai +a*ta D* &taka* Ta*a* ka*a* "0/"/$" a*1i* 5i+%p L 2 /4 2 $

D &taka* "0/"/$"

$ Ni 8%5 &'ia*i N- i-p&* D* ti-%5%* ka8&' " Kaki ka*a* /4/$" A*1i* 5i+%p B /4 2 2 "

D ti-%5%*

$ 7 K- 'a+it p&:'ia*a * 'a*t&* D* 8&pa* ka*i* Ta*a* ka*a* 0/4/$" A*1i* 5i+%p B 0/4 2 2 "

D tak-%* Da* ki'i

$ 0 Pt 6i+i atika p%t'a Kt %+a'a*a D* 6&8ai'i $# T%*kai ki'i ";/"/$" k%i* 5i+%p L 2 0/4 2 $

D Aa* Da* ka*a*$ 3 D6 -+ +6i ap%t'a D6 -+ +6i ap%t'a D* *%* 'ata "4 Kaki ka*a* 0/4/$" A*1i* 5i+%p B 0/4 2 2 "

D &taka*

$ ; * %a'+ika * %a'+ika D* tak-%* k** 9 Dikaki ka*a* "9/"/$" a*1i* 5i+%p L 2 3/4 2 $

D tak-%*

$ 9 Ni pt :%+iati .*- %a'+a*a D* &taka* "; Ja'i t&8%*1%k "9/"/$" k%i* 5i+%p L 2 3/4 2 $

D &taka* ka*a*

" # K- ka'tika K- ka'tika D* tak-%* # Kaki ka*a* ;/4/$" k%i* 5i+%p L 2 ;/4 2 $

D tak-%*


37/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

" $ * o8a * o8a D* tak-%* 73 Ta*a* ki'i "9/"/$" a*1i* 5i+%p L 2 ;/4 2 $

D tak-%*

" " Kt a*+&*i D6 kt i:a* D* &-&a%* 49 Kaki ki'i ;/4/$" A*1i* 5i+%p B ;/4 2 2 "

D t%a*

" 4 S A pt -a5%*i AA 'ai a'+ika D* p&k&* 49 Ta*a* ka*a* ;/4/$" A*1i* 5i+%p B ;/4 2 2 "

D Aa*

" M+ %+ia'ta M+ %+ia'ta D* ka*i* " Ta*a* ki'i 9/4/$" A*1i* 5i+%p B 9/4 2 2 "

D t%a*

" 7 M+ +6i &tia6a* K+k :a'a6a* D* p&*aa* 3 6a1a5 $3/"/$" k%i* -ati L 2 2 9/4 $

D ti5i*a* +i:%*%5

" 0 G+ a% 6a'ta*ata G+ a% 6a'ta*ata Pok&6a* t%a* 40 Ja'i ka*a* 9/4/$" A*1i* 5i+%p B 9/4 2 2 "

" 3 N- %'&*a N- %'&*a D* :&*&* # Kaki ka*a* * 9/4/$" A*1i* 5i+%p L 2 9/4 2 $

D &taka* L&*a* ka*a*

" ; Kt %ati*i M+ %ka +6i p%t'a D* p&k&* 7" Kaki ki'i 4/4/$" A*1i* 5i+%p L 2 $#/4 2 $

D Aa*

" 9 N5 ika * %tia'i D* 6&8ai'i 0$ Kaki ka*a* $;/"/$" a*1i* -ati L 2 2 $$/4 $

D Aa* $/$#/$$ +i:%*%5

4 # * %+a'ti N5 ka'i D* 6&8ai'i 74 1a'i Kaki $9/"/$" a*1i* -ati L 2 2 $$/4 $

D Aa* p&'*$/$#/$$ +i:%*%5



38/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR III

Dipa

4$ M K +a8&- a%* Kt %+a'a*a D* 6&8ai'i ;# Kaki ka*a* $;/"/$" a*1i* -ati L 2 2 $$/4 $

D Aa* $/$#/$$ +i:%*%5

4" Kt -%8ia*a Kt -%8ia*a D* 6&8ai'i # Kaki ka*a* $$/4/$" A*1i* 5i+%p B $$/4 2 2 "

D Aa*

44 N5 ka'i N5 ka'i D* 6&8ai'i 77 Kaki ka*a* $9/"/$" a*1i* -ati L 2 2 $$/4 $

D Aa* p&'*$/$#/$$ +i:%*%5

4 * pi*&t K+k %a'-ika D* 6&8ai'i 0 Kaki ki'i $9/"/$" a*1i* -ati L 2 2 $$/4 $

D Aa* $/$#/$$ +i:%*%5

47 Ni 8%5 %a'ti*i N5 iai5 D* 6&8ai'i 7 kaki $3/"/$" a*1i* -ati L 2 2 $$/4 $

D Aa* $/$#/$$ +i:%*%5

40 Ni 8%5 &'ia*i N- i-p&* D* ti-%5%* ka8&' " Kaki ka*a* /4/$" A*1i* 5i+%p L 2 2 $$/4 $

D ti-%5%*

43 Kt %kiati K+k %a'-ika D* 6&8ai'i "7 Kaki ki'i "#/"/$" a*1i* -ati L 2 2 $"/4 $Ha-i8 :8* D Aa* $/$#/$$ +i:%*%5

4; N- 'a-:% * -&'ta*a+i D* 6&8ai'i 09 J&-po8 ta*a* $"/4/$" A*1i* 5i+%p B $"/4 2 2 "

D Aa* ka*a*

49 * 1a6i * 1a6i D* &*ki+i* 37 9/4/$" A*1i* 5i+%p B 9/4 2 2 "

D Aa*

# N5 %+a'-i*i Kt -%+ia*a D* ka6a* # Kaki ki'i $/4/$" A*1i* 5i+%p B $/4 2 2 "

D ti-%5%*


39/66





ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

III

Dipa

$ N5 &'a %ia'ti*i N5 i*a'a D* t&*a5 $" Pa5a ki'i $7/4/$" A*1i* 5i+%p B $7/4 2 2 "

D *a*8a* $7/4/$"

" Ba% 6i'a ata6a Eka 6i'a6a* D* &8at 0 Kaki ka*a* $7/4/$" A*1i* 5i+%p B $7/4 2 2 "

D :a*1a'a*ka* $7/4/$"

4 Ni *5 ik8&k N5 :%+ia'ta*a D* pa% 37 Kaki ka*a* "4/"/$" a*1i* +i:%*%5 L 2 2 $7/4 $

D ti5i*a* "4/"/$"

S A pt -a5%*i AA 'ai a'+ika D* p&k&* 49 Ta*a* ka*a* ;/4/$" A*1i* 5i+%p L 2 $7/4 2 $

D Aa*

7 K- a*a a+ip%t'a N- %+ia'ta D* :a*+a 7 T&8i*a ka*a* $0/4/$" A*1i* 5i+%p B $0/4 2 2 "

D tak-%*

0 * ta'-a * 1a*a D* k&-:&*a* 44 T%-it kaki $0/4/$" A*1i* 5i+%p B $0/4 2 2 "

D t%8ik%p Ki'i $0/4/$" 3 N- pat'a N- pat'a D* ka*i* 3# Ja'i kaki ki'i $3 /4/$" A*1i* 5i+%p B $3/4 2 2 "

D t%a* $3 /4/$"

; A% pt +&i -a5+&6i Nk *- -a5&+i D* *a8ia* $" Ka'i ki'i $;/4/$" A*1i* 5i+%p B $;/4 2 2 "

D *a8ia* $;/4/$"

9 N* 'i1a * -&'ta*a+i D* 6&8ai'i 0# Ta*a* ka*a* $9/4/$" A*1i* 5i+%p B $9/4 2 2 "

D Aa* $9/4/$"

7 # K- a*+ika 6i%*a Kt -%8a*a D* 6&8ai'i " +i&'ot%- "#/4/$" A*1i* 5i+%p B "#/4 2 2 "

D Aa* Ka*a*, $3.##



40/66




ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR III

Dipa

7 $ N5 %+a'-i*i Kt -%+ia*a D* ka6a* # Kaki ki'i $/4/$" A*1i* 5i+%p L 2 "$/4 2 $

D ti-%5%*

7 " * -&'taaa * ka'ika D* kapit "# B&ti ki'i "$/4/$" A*1i* 5i+%p B "$/4 2 2 "

D *a8ia*

7 4 N- -i*t&* * %+a*a D* ko'ipa* 9 Pa5a ki'i "$/4/$" A*1i* 5i+%p B "$/4 2 2 "

D :a*1a'a*ka*

7 K+k k&ia okta


41/66




ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

0 $ N- -at'i Kt t%8i D* :oko* 07 Pa5a ki'i ""/4/$" A*1i* 5i+%p B ""/4 2 2 "

D a-pa8a*

0 " N5 kai5 N5 kai5 D* p&&ka* 3 Kaki ki'i "/4/$" A*1i* 5i+%p L 2 "/4 2 $D pikat

0 4 Kt 8a*+'i Kt 8a*+'i D* ka6a* 70 Ja'i kaki "/4/$" A*1i* 5i+%p B "/4 2 2 "

D ti-%5%* ka*a*

0 +a'5a*+aa*i * %atika D* ka6a* 47 Kaki ki'i "/4/$" a*1i* +i:%*%5 L 2 2 "/4 $

D t%a*

0 7 Pt a*+ika 'ai+a p%t'a Ma+& a-:a D* ka*i* $# kaki ki'i "/4/$" A*1i* 5i+%p B "/4 2 2 "

D t%a*

0 0 D'a *i *- %+a*i * a+'a D* a*a' 3 Pa5a ka*a* "/4/$" A*1i* 5i+%p L 2 "/4 2 $

D k%a*:a

0 3 * a'i*a * a'i*a D* %8%*%i ; J&-po8 kaki "7/4/$" A*1i* 5i+%p B "7/4 2 2 "

D a-pa8a* ka*a*

0 ; * 6a'i N5 6&*+'a D* k8o+ $ Kaki ka*a* "7/4/$" A*1i* 5i+%p B "7/4 2 2 "

D *a*8a* "7/4/$" Dit. Var dari dink

0 9 D6 + 6a'a6ia*a D6 pt -&a D* p&k&* Ta*a* ki'i "7/4/$" A*1i* 5i+%p B "7/4 2 2 "

D Aa* "7/4/$"

3 # N5 a% %ka+a N- %8a*+'a D* k8o+ $; Kaki ka*a* "3/4/$" A*1i* 5i+%p B "3/4 2 2 "

D *a*8a* "3/4/$"


PUSKESMAS BANJARANGKAN IIS S AS/ S A A A G A A A G G


42/66




ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

3 $ K- +a'-i*i * %+ia'ta D* 'ia 9 Pa5a kaki "3/4/$" A*1i* 5i+%p B "3/4 2 2 "

D *a8ia* ka*a*

3 " K+k a+i -&'ta aa * %a'+a*a D* 8&kok 0 Kaki ki'i "3/4/$" A*1i* 5i+%p B "3/4 2 2 "D a-pa8a* k8o+

3 4 K+k %-&'1aa M+ 8a:a D* ko'ipa* t*5 $; Pa5a ka*a* "3/4/$" A*1i* 5i+%p B "3/4 2 2 "

D :a*1a'a*ka*

3 G+ &ka &tia6a* M+ %a'tika D* &*ki+i* Ta*a* ka*a* ";/4/$" A*1i* 5i+%p B ";/4 2 2 "

D Aa*

3 7 Ni -a+& %6&ti M+ ka'a D* *&a'i 9 Ja'i ta*a* 4#/4/$" A*1i* 5i+%p B 4#/4 2 2 "

D *&a'i ka*a*

3 0 Ni 6* aa* * &p& D* i+a% ka6a* 49 I:% 1a'i ta*a* 4#/4/$" A*1i* Mati B 4#/4 2 2 "

D tak-%* ki'i

3 3 G+ a*+ika p'ata-a p. K- %8ia*a D* a-pa8a* k8o+ 7 Pa5a ki'i 4#/4/$" A*1i* 5i+%p B 4#/4 2 2 "

D a-pa8a*

3 ; Ni 6* ka*t&* Kt a'ka D* ti5i*a* 9 B&ti ki'i 4#/4/$" A*1i* 5i+%p B 4#/4 2 2 "

D ti5i*a*

3 9 Kt 8a*+'i Kt 8a*+'i D* ka6a* 70 Ja'i kaki "/4/$" A*1i* 5i+%p L 2 4#/4 2 $

D ti-%5%* ka*a*





43/66


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

NB :

@ GHPR BARU :

GHPR DIILA=AH PUSKESMAS BA II ! "$ ORANG

GHPR LUAR IL. PUSKESMAS BA II ! "" ORANG

@ GHPR LAMA >

KUNJUNGN GHPR LAMA SEMUAN=A ! 40 ORANG

TOTAL ! 39 ORANG

M&*&ta5%i ! SEMARAPURA,7/#/"#$"






BULAN ! APRIL "#$" PROPINSI ! BALI


44/66



(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR III

Dipa

$ * 6a'i N5 6&*+'a D* k8o+ $ Kaki ka*a* "7/4/$" A*1i* 5i+%p L 2 $/ 2 $

D *a*8a* "7/4/$"

" Nk *- -a5&+i p Nk *- -a5&+i p D* p&-&*a* 43 Ta*a* ka*a* $//$" A*1i* 5i+%p B $/ 2 2 "

D *a8ia* 4 M+


45/66



46/66


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

" $ * a'ta6a* * a'ta6a* D* *&a 4$ Kaki ka*a* $#//$" A*1i* 5i+%p B $#/ 2 2 "

D :a*1a'a*ka* 9//$"

" " M+ a*+'a M+ a*+'a D* %*%* 'ata 47 L%t%t ki'i "//$" A*1i* 5i+%p L 2 $#/ 2 $

D &taka*

" 4 D6 a% p%t'i 'a5a% D6 + %1a*a D* t&*a5 ; +i6a1a5 $$//$" A*1i* 5i+%p B $$/ 2 2 "D ti-%5%* $$//$"

" K+k 6itia *i*i5 Kt -&'ta D* pa&k " B&ti ka*a* $"//$" A*1i* 5i+%p B $"/ 2 2 "

D Aa* $$//$"

" 7 * %'a a+i . K- 6i%+a D* &*ki+i* 7 Ta*a* ki'i $"//$" A*1i* 5i+%p B $"/ 2 2 "

D Aa* $"//$"

" 0 K+k a'a +a*a N- a'ta*a D* pat% 9 Kaki ka*a* $"//$" A*1i* 5i+%p B $"/ 2 2 "

D %*aka $"//$"

" 3 K+k ap'i8io 6i1aa * %a'ta*a D* &taka* 4 Kaki ka*a* 0//$" A*1i* 5i+%p L 2 $4/ 2 $

D &taka* 0//$"

" ; N- '&*t% Kt %1a D* pa&k 07 P&'&8a*a* 0//$" A*1i* 5i+%p L 2 $4/ 2 $

D aa* Ta*a* ka*a*

" 9 A+5i pa'a-a*a*+a*a Pt %+ia*a D* p&*aa* ; Ja'i k8i*ki* $4//$" A*1i* 5i+%p B $4/ 2 2 "D ti5i*a* Ki'i $4//$"

4 # Kt 8a*+'i Kt 8a*+'i D* ka6a* 70 Ja'i kaki "/4/$" A*1i* 5i+%p L 2 2 $/ $

D ti-%5%* ka*a*






47/66


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

4 $ Sa* pt &ka %'a*ta Sa* pt a'+ika D* &-&a%* 0 Ta*a* ka*a* $//$" A*1i* 5i+%p L 2 $/ 2 $

D t%a* 3//$"

4 " K- 'iki %+i p. Kt :%*i* D* ka6a* ; Hi+%* %+a5 $//$" A*1i* 5i+%p B $/ 2 2 "

D t%a* Mi*% 8a8%

4 4 K+ +6i 'a*i -a%8i Kt :%*i* D* ka6a* $4 T** ki'i +5 $//$" A*1i* 5i+%p B $/ 2 2 "D t%a* Mi*% 8a8%

4 * a'+a*a Kt %+a*a D* +%k%5 $3 Pa5a ka*a* $7//$" A*1i* 5i+%p B $7/ 2 2 "

D *a8ia*

4 7 D6 + 'a-a ap%t'a D6 pt %'a+*a D* t&*a5 0 T&8apak kaki $7//$" K&'a 5i+%p B $7/ 2 2 "

D ti-%5%* ka*a*

4 0 M+ ita Kt %a'+a*a D* p&k&* 3 Pa5a ka*a* $0//$" A*1i* 5i+%p L 2 2 $0/ $

D Aa*

4 3 K+k +6i ap'i8ia N5 %a'+a*a D* pa&k $ L&*a*/ta** $7//$" A*1i* 5i+%p B $0/ 2 2 "

D Aa* ka*a* $7//$" Dit. Var dari dink

4 ; * %*a'ta M+ %1a*a J8* A%*, +p. "3 K&*a ai' 8i%' $0//$" a*1i* Mati B $0/ 2 2 "

(+ :aka) o'a* C 'a:i&

4 9 K- -%+ita K- -%+ita D* ka*i* 44 Kaki ki'i $0//$" a*1i* Hi+%p B $0/ 2 2 "D to5pati $0//$"

# K+k +a'-a+iaa * +a'ta D* p&-&*a* $$ B&ti ka*a* $3//$" a*1i* Hi+%p B $3/ 2 2 "

D *a8ia* $3//$"





48/66



ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ * %'a a+i K- 6i%+a D* &*ki+i* 7 Ta*a* ki'i $"//$" a*1i* Hi+%p L 2 $9/ 2 $

D aa*

" K+k 6itia *i*i5 Kt -&'ta D* pa&k " B&ti ka*a* $"//$" A*1i* 5i+%p L 2 $9/ 2 $D Aa* $$//$"

4 N5 %k8&k N5 %'a*ata D* ka6a* 07 Kaki ka*a* 9//$" A*1i* 5i+%p L 2 $9/ 2 $

D ti-%5%* 9//$"

N- p%'i N- p%'i Na*8a* ka1a " B&ti kaki $9//$" a*1i* Hi+%p B $9/ 2 2 "

:a*8i ki'i

7 * :%+ia*i * %k'a6a* D* *a*8a* k8o+ "0 Pa5a ka*a* $9//$" a*1i* Hi+%p B $9/ 2 2 "

D *a*8a*

0 A+5i pa'a-a*a*+a*a Pt %+ia*a D* p&*aa* ; Ja'i k8i*ki* $4//$" A*1i* 5i+%p L 2 "#/ 2 $

D ti5i*a* Ki'i $4//$"

3 Nk -+ %'aa Nk -+ p%1a D* *a8ia* " B&ti ki'i "#//$" a*1i* Hi+%p B "#/ 2 2 "

D *a8ia*

; Pt a'ita +a'-a+a*a K- + %a'+a*a D* ka6a* $# Ta*a* ka*a* "#//$" a*1i* Hi+%p B "#/ 2 2 "D t%a*

9 Pa*+& k+k -&8a*i M+ a%a*a D* ka6a* $# B&ti ki'i "#//$" a*1i* Hi+%p B "#/ 2 2 "

D t%a*

7 # * '%p& * '%p& D* p&k&* 7 Ta*a* ki'i "$//$" a*1i* Hi+%p B "$/ 2 2 "

D Aa*






49/66


(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR III

Dipa

7 $ I A p%t'i a*+i*i I B P%t% a*+ika D* p&k&* $,7 L&*a* ka*a* ""//$" a*1i* Hi+%p B ""/ 2 2 "

D :aka

7 " I B I*+'a +6ip%t'a IB M+ 6i'ata J8* 5aa*%+i* $3 L%t%t ka*a* ""//$" a*1i* Hi+%p B ""/ 2 2 "

K8k kota7 4 D6 + 'a-a ap%t'a D6 pt %'a+*a D* t&*a5 0 T&8apak kaki $7//$" K&'a 5i+%p L 2 ""/ 2 $

D ti-%5%* ka*a*

7 Pt + %+a*a Pt + %+a*a Di*a p&t&'*aka* # 2 2 2 2 2 2 $3/ $

Disnak VAR pencegahan

7 7 Ni *- a+&a*i G+ &ka +ia*ta'a Di*a p&t&'*aka* 4# 2 2 2 2 2 2 $9/ $


7 0 D6 a% p%t'i 'a5a% D6 + %1a*a D* t&*a5 ; +i6a1a5 $$//$" A*1i* 5i+%p L 2 $;/ 2 $

D ti-%5%* $$//$"

7 3 * %+ia*i * ko*+'a D* p&*aa* 0 Kaki ki'i "4//$" A*1i* 5i+%p L 2 "4/ 2 $

D ti5i*a*

7 ; K- %ka*ta M+ i-i D* 8oa* " Ja'i ta*a* "//$" a*1i* Hi+%p B "/ 2 2 "

D tak-%* ka*a*7 9 K+k +ia5 +6i ap'i8ia N5 %a'+a*a D* pa&k $ L&*a*/ta** $7//$" A*1i* 5i+%p L 2 "/ 2 $

D Aa* ka*a* $7//$"

0 # Ni 6* 8a*tik I 6* pi*t% D* 8&pa* ; Ta*a* ka*a* "//$" a*1i* Hi+%p B "/ 2 2 "

D tak-%*

LAPORAN KASUS GHPR DAN VAKSINASI ANTI RABIES PUSKESMAS BANJARANGKAN II



50/66


UMUR PENGGIGITAN PENANGANAN/PENGOBA


51/66


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

NB :

@ GHPR BARU :


GHPR LUAR IL. PUSKESMAS BA II ! "0 ORANG

@ GHPR LAMA >

KUNJUNGN GHPR LAMA SEMUAN=A ! "3 ORANG

TOTAL ! 3# ORANG

M&*&ta5%i ! SEMARAPURA,7/#7/"#$"





BULAN ! MEI "#$" PROPINSI ! BALI

UMUR PENGGIGITAN PENANGANAN/PENGOBA


52/66


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

$ .R&a* :a% &'a6a* M+ %ka*ta D* tk-%* k*i* 7t5 +ip&'%t $/7/$" a*1i* Hi+%p B $/7 2 2 "

D tak-%* 4#//$"

" M+ %ka*ta M+ %ka*ta D* 8oa* 44 Ja'i ta*a* $/7/$" a*1i* Hi+%p L 2 $/7 2 $

D tak-%* ka*a*

4 Ni 6* 8a*tik I 6* pi*t% D* 8&pa* ; Ta*a* ka*a* "//$" a*1i* Hi+%p L 2 $/7 2 $D tak-%*

N- a% 6a5a*a N- -a8i5 D* t&*a5 $" Kaki ki'i "//$" a*1i* Hi+%p L 2 "/7 2 $

D *a*8a*

7 K- tataka'i*a N5 %a'tika D* ka*i* 4 Pipi ki'i "/7/$" a*1i* Hi+%p B "/7 2 2 "

D to5pati

0 Pt +&6i K+k a'ia6a* D* p&*aa* 4# Kaki ki'i "/7/$" a*1i* Lia' B "/7 2 2 "

D ti5i*a*

3 * 1%8ia'i * %-&'ta D* k8o+ $0 Dita*a* "/7/$" a*1i* Di:%*%5 B "/7 2 2 "

D *a*8a* ka*a*

; * a8i5 * a8i5 D* p&*a'%ka* 73 Kaki ka*a* "/7/$" a*1i* Hi+%p B "/7 2 2 "

D :%*:%*a*

9 K+k %-:a6ati %k&'ta D* ka*i* 4; Kaki ki'i 4/7/$" a*1i* Hi+%p B 4/7 2 2 "D t%a* 4/7/$"

$# N5 %*a'ta N- -&'ta D* -%*%*a $ pa*tat 4/7/$" a*1i* Lia' B 4/7 2 2 "

D ti5i*a* 4/7/$"




NO NAMA PENDERITA NAMA KKALAMAT LENGKAP

(JALAN DUSUN

UMUR PENGGIGITAN

LUK

PENANGANAN/PENGOBA

TEMPAT/ TGL TGL KE JENIS KONDISI KETVAR L


53/66

NO NAMA PENDERITA NAMA KK (JALAN, DUSUN,

DESA )AL P

TEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L VAR I VAR IIVAR III

Dipa

$ $ K- t'i a+*a*a N5 -%+a8a'a D* ka6a* $$ Pa5a +a* kaki "0//$" a*1i* Hi+%p L 2 4/7 2 $

D ti-%5%* ka*a*

$ " D6 + a+i p%t'a6a* D6 + ta-a* D* pa&k $7 Ta*a* ki'i /7/$" a*1i* Hi+%p B /7 2 2 "

D aa*

$ 4 Pt :&8a *i*+ia a'i * +iat-ika D* t&*a5 4 Kaki ki'i "0//$" a*1i* Hi+%p L 2 /7 2 $

D *a*8a*$ Ra%8i -a*%'%* * -%tika D* p&k&* 3 Ja'i ki'i 7/7/$" a*1i* Hi+%p B 7/7 2 2 "

D :aka

$ 7 * &tia6a* * &tia6a* D* tak-* k6* "; Ta*a* ka*a* 7/7/$" a*1i* Hi+%p B 7/7 2 2 "

D tak-%* 7/7/$"

$ 0 IB pa1a' IB -+ 6i'ata D* %%ka* $9 Dikaki ka*a* 7/7/$" a*1i* Hi+%p B 7/7 2 2 "

D &8at 7/7/$"

$ 3 IA a*%* 'i apa'i IB -+ 6i'ata D* %%ka* 9 Dikaki ka*a* 7/7/$" a*1i* Hi+%p B 7/7 2 2 "

D &8at 7/7/$"

$ ; K+k a'ia*i N5 toa D* p&-&*a* 9 Kaki k8i'i 7/7/$" a*1i* Hi+%p B 0/7 2 2 "

D *a8ia* 0/7/$"

$ 9 G+ i


54/66


ALAMAT LENGKAP


LUK

AL PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

" $ AA + 6i*ata AA + %ia*a D* ko'ipa* $$ Kaki ki'i ;/7/$" a*1i* Hi+%p B ;/7 2 2 "

D :a*1a'a*ka*

" " * 'a*i* * %ka'+a D* pa% 70 Ja'i ki'i ;/7/$" a*1i* Hi+%p B ;/7 2 2 "

D ti5i*a* Dit. Var dari dink

" 4 Gt A -%'ti*i IB -+ 6i'ata J8* 5aa*%+i* # Kaki ka*a* 4#//$" a*1i* Hi+%p L 2 3/7 2 $K8k kota "9//$"

" M+ %'ati K+k ka'iaa D* %-&a8aka* "4 Kaki ka*a* 9/7/$" a*1i* Hi+%p B 9/7 2 2 "

D tak-%*

" 7 Pt +&6i K+k a'ia6a* D* p&*aa* 4# Kaki ki'i "/7/$" a*1i* Lia' L 2 $#/7 2 $

D ti5i*a*

" 0 Ni 6* 6a5%*i * 6i*% D* p&-&*a* 0 kaki $#/7/$" a*1i* Hi+%p B $#/7 2 2 "

D *a8ia* Pk8 $9.##

" 3 Kt po8o Kt po8o D* %*%* 'ata " kakiki'i $$/7/$" a*1i* Hi+%p B $$/7 2 2 "

D &taka* $#/7/$"

" ; G+ &p'ia+i p%t'a Kt *ata D* p&-&*a* 0 Pa5a :8aka* $$/7/$" a*1i* Hi+%p B $$/7 2 2 "

D *a8ia* $$/7/$"

" 9 * 1%8iai5 * 6i+iaa D* tk-%* k6* "; Dikaki ka*a* $$/7/$" a*1i* Hi+%p B $$/7 2 2 "D tak-%* $$/7/$"

4 # * &*i N* +a'ta D* p&-&*a* 79 Pa5a ki'i $$/7/$" a*1i* Hi+%p B $$/7 2 2 "

D *a8ia* $$/7/$"






(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

Dipa


55/66

DESA ) GIGITAN PKM/ RS HPR HPR B/L VAR I VAR IIIII

Dipa

4 $ D6 + a+i p%t'a6a* D6 + ta-a* D* pa&k $7 Ta*a* ki'i /7/$" a*1i* Hi+%p L 2 $#/7 2 $

D aa*

4 " N5 -&*+'i * %k'a D* pa8ak 7" Kaki ki'i $"/7/$" a*1i* Hi+%p B $"/7 2 2 "

D &8at $"/7/$"

4 4 * &tia6a* * &tia6a* D* tak-* k6* "; Ta*a* ka*a* 7/7/$" a*1i* Hi+%p L 2 $"/7 2 $

D tak-%* 7/7/$"

4 IB pa1a' IB -+ 6i'ata D* %%ka* $9 Dikaki ka*a* 7/7/$" a*1i* Hi+%p L 2 $"/7 2 $D &8at 7/7/$"

4 7 IA a*%* 'i apa'i IB -+ 6i'ata D* %%ka* 9 Dikaki ka*a* 7/7/$" a*1i* Hi+%p L 2 $"/7 2 $

D &8at 7/7/$"

4 0 N5 k%pa N5 k%pa D* k8o+ 7" Kaki ka*a* $4/7/$" a*1i* Hi+%p B $4/7 2 2 "

D *a*8a*

4 3 G+ a'a 1a*%a'ta * &'ia D* ka8&' $ Ta*a* ka*a* $4/7/$" a*1i* Hi+%p B $4/7 2 2 "

D t%a* $4/7/$"

4 ; D6 pt a8it %*taka D6 pt a8it %*taka D* ka*i* 7; p&'&8a*a* $4/7/$" a*1i* Lia' B $4/7 2 2 "

D t%a* Kaki ki'i

4 9 IB i*+'a +6ip%t'a IB -a+& 6i'ata D* %%ka* $3 Kaki ka*a* $/7/$" a*1i* Mati L 2 2 $/7 $

D &8at

# D6 + oka p%'*a-a D6 + +a*a D* ka6a* "" Ta*a* ki'i $/7/$" k%i* Hi+%p B $/7 2 2 "

D ti-%5%*






ALAMAT LENGKAP

(JALAN DUSUN

UMUR PENGGIGITAN

LUK

PENANGANAN/PENGOBA

TEMPAT/ TGL TGL KE JENIS KONDISI KETVAR L


56/66

NO NAMA PENDERITA NAMA KK (JALAN, DUSUN,DESA )

AL PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L VAR I VAR II

VAR

IIIDipa

$ * &'&*k& Kt *ata' D* :&*&* 79 Kaki ki'i $/7/$" a*1i* Mati L 2 $/7 2 $

D &taka*

" AA + 'aka a'*a6a AA + 'aka a'*a6a Ka: ia*a' 7 Ja'i ki'i $/7/$" a*1i* T+k ta5% L 2 2 $/7 $

(+i*ak)

4 * 6i+a*a * 6i+a*a D* %*%*'ata 4; Kaki ki'i $7/7/$" a*1i* Hi+%p B $7/7 2 2 "

D &taka* * 'a*i* * %ka'+a D* pa% 70 Ja'i ki'i $7/7/$" a*1i* Hi+%p L 2 $7/7 2 $

D ti5i*a*

7 N- a% %a'ti*i Ma+& %a*+a D* ti5i*a* " Kaki ka*a* $0/7/$" a*1i* Hi+%p L 2 $0/7 2 $

D ti*i*a*

0 D6 a% &ka' P D6 + p%'*a6a* D* &taka* ; Ta*a* ka*a* $0/7/$" a*1i* Hi+%p B $0/7 2 2 "

D &taka*

3 K+k :a8ita N* %a'+a*a D* p&-&*a* $# Kaki ka*a* $0/7/$" a*1i* Hi+%p B $0/7 2 2 "

D *a8ia*

; AA a'i k'i*a+&6i AA + 'aka a'+ika D* p&k&* $7 Kaki ki'i $0/7/$" a*1i* Hi+%p B $0/7 2 2 "

D Aa*

9 * oka M+ %+a'-a D* &8at 73 L&*a* ki'i $0/7/$" a*1i* Hi+%p B $0/7 2 2 "

D :a*1a'a*ka*

7 # D6 kt i:a* . D6 kt i:a* . D* &-&a%* $ Kaki ka*a* $0/7/$" a*1i* Hi+%p B $0/7 2 2 "

D t%a*






(JALAN, DUSUN,

UMUR PENGGIGITAN LUK

A

PENANGANAN/PENGOBA

L P TEMPAT/ TGL TGL KE JENIS KONDISI KET. VAR L

DESA )GIGITAN PKM/ RS HPR HPR B/L VAR I VAR II

VAR

IIIDipa

7 $ * 6a5%*i * 6i*% D* p&-&*a* 0 Kaki ka*a* $3/7/$" a*1i* T+k ta5% L 2 $3/7 2 $

D 8i


57/66

D *a8ia*

7 " * 1%8iai5 * 6i+iaa D* tak-%* k6* "; Kaki ka*a* $;/7/$" a*1i* Hi+%p L 2 $;/7 2 $

D tak-%*

7 4 * 'i-:& Kt -%+'a D* *&a 39 Ta*a* ka*a* $;/7/$" a*1i* Hi+%p B $;/7 2 2 "

D :a*1a'a*ka*

7 Kt 6&*t&* N5 k%ta* D* %-&a*a' 0# T&8%*1%k 1a'i $;/7/$" a*1i* Hi+%p B $;/7 2 2 "

D *a8ia* ki'i

7 7 Kt 6i8i %8ia*ti * 1%*ia'ta D* 6&8ai'i 44 Kaki ka*a* $;/7/$" a*1i* Hi+%p B $;/7 2 2 "D Aa*

7 0 * &ka 6i+ia*a * 8&1&k D* p&*a'%ka* $4 Kaki ka*a* $;/7/$" a*1i* Hi+%p B $;/7 2 2 "

D :%*:%*a*

7 3 * a8i* N5 %'a*a D* 6&8ai'i 7$ Kaki ka*a* $9/7/$" a*1i* Hi+%p B $9/7 2 2 "

D Aa*

7 ; N5 k%pa N5 k%pa D* k8o+ 7" Kaki ka*a* $4/7/$" a*1i* Hi+%p L 2 "#/7 2 $

D *a*8a*

7 9 N* %a'1a*a N* %a'1a*a D* &*ki+i* 3# J&-po8 ta*a* "#/7/$" a*1i* Hi+%p B "#/7 2 2 "

D Aa* Ki'i * ka*a*

0 # * %ka * %ka D* *&a 4 Kaki ka*a* "#/7/$" a*1i* Hi+%p B "#/7 2 2 "

D :a*1a'a*ka*



PUSKESMAS/RS ! BANJARANGKAN II KABUPATEN ! KLUNGKUNGBULAN ! MEI "#$" PROPINSI ! BALI


(JALAN, DUSUN,UMUR PENGGIGITAN LUK

APENANGANAN/PENGOBA

L P TEMPAT/ TGL TGL KE JENIS KONDISI KET. VAR L

DESA )GIGITAN PKM/ RS HPR HPR B/L VAR I VAR II

VAR

IIIDipa

0 $ Rat*a +&6i at%ti N5 %*%' D* t&*a5 $ Ta*a* ka*a* "$/7/$" a*1i* Hi+%p B "$/7 2 2 "

D *a*8a* "#/7/$"


58/66

D *a*8a* "#/7/$"

0 " Pt a% 1%*i A. K- a'ta*a D%%* ka8&' 3 Ta*a* ka*a* "$/7/$" a*1i* Hi+%p B "$/7 2 2 "

D t%a* "#/7/$"

0 4 G+ i


59/66

3 $ Sa* -a+& pa'a Sa* -a+& pa'a D* p&*a'%ka* 47 Kaki ki'i "4/7/$" a*1i* Hi+%p B "4/7 "

D :%*:%*a*

3 " AA a'i k'i*a+&6i AA + 'aka a'+ika D* p&k&* $7 Kaki ki'i "/7/$" a*1i* Hi+%p B "/7 2 2 "

D Aa*

3 4 Pt %+i +a'-ap%t'a G+ %+a*a D* :8i-:i* 4,7 Kaki ka*a* "4/7/$" a*1i* Hi+%p B "4/7 2 2 "

D to5pati

3 * %-&*+'a * %-&*+'a D* 1a:o* 0 L&*a* ka*a* "/7/$" a*1i* Hi+%p B "/7 2 2 "

D a-pa8a* Dit. Var dari dink3 7 Ni *- a+ia*i G+ &ka +ia*ta'a Di*a p&t&'*aka* 4# 2 2 2 2 2 2 2 "/7 2 $


3 7 M+ p&:'i %:aia*a N* %+ika D* %-&a*a' 4," Ja'i ta*a* k'i "7/7/$" a*1i* Hi+%p B "7/7 2 2 "

D *a8ia*

3 0 Kt 6i8i %8ia*ti * 1%*ia'ta D* 6&8ai'i 4$ Kaki ka*a* "7/7/$" a*1i* Hi+%p L 2 "7/7 2 $

D Aa*

3 3 K- %:'ata K- %:'ata D* %-aa8aka* 9 Dip&'%t "7/7/$" a*1i* Hi+%p B "7/7 2 2 "

D tak-%*

3 ; N- k%%-a 6a'+a*i * ka'+a*a D* p&k&* Kaki ka*a* "7/7/$" a*1i* Hi+%p B "7/7 2 2 "

D :aka "7/7/$"

3 9 Ni *- %-iati Kt 1&8a*tik D* ka6a* 49 Kaki ka*a* "7/7/$" a*1i* Di:%*%5 B "7/7 2 2 "

D ti-%5%* "7/7/$"







UMUR PENGGIGITAN LUK

A

PENANGANAN/PENGOBA


TGL KEPKM/ RS

JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR II VAR Dipa

III

; # N- 'a1i* N- 'a1i* D* &*ki+i* 0; +ita*a* "3/7/$" a*1i* Hi+%p L 2 "3/7 2 $

D Aa*

+ k : + k + ik ki k / / 1i i+ /


60/66

; $ M+ k&-:a' * + %k&+a*a D* *&a ;7 Dikaki ka*a* "3/7/$" a*1i* Hi+%p B "3/7 2 2 "

D :a*1a'a*ka*

; " * &'i*k& K&t%t *ata' D* :&*&* 79 Kaki ki'i ";/7/$" a*1i* Hi+%p L 2 2 ";/7 $

D &taka*

; 4 D6 a% +&'ia*i D6 + a8it D* ka8&'a* $3 Pa5a ka*a* "$/7/$" a*1i* Hi+%p L 2 ";/7 2 $

D ti-%5%* :&8aka*

; M+ 6a'ti Ka+&k ka'iaa D* %-&a8aka* 7" Kaki ka*a* ";/7/$" a*1i* Hi+%p B ";/7 2 2 "

D tak-%*

; 7 * 'a*i* * %ka'+a D* pa% 70 Ja'i ki'i $7/7/$" a*1i* Mati L 2 2 "9/7 $

D ti5i*a*

; 0 Kt *a+i N5 :a*tat D* k8o+ 7 Ta*a* 8&** "9/7/$" a*1i* Hi+%p B "9/7 2 2 "

D *a*8a* ka*a*

; 3 N5 ka'iaa N5 ka'iaa D* ka8&' "; Ja'i ta*a* ""/7/$" k%i* T+k ta% L 2 "9/7 2 $

D ti-%5%* ka*a*

; ; K+k 6i+a 1aa*ti * +a'ta*a D* p&k&* " Ta*a* ki'i 4#/7/$" k%i* 5i+%p L 2 4#/7 2 $

D Aa*

; 9 N5 6a'i * -%tika D* %-&a8aka* $ Kaki ka*a* 4#/7/$" a*1i* Hi+%p B 4#/7 2 2 "

D tak-%*






ALAMAT LENGKAP


UMUR PENGGIGITANLUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL


JENISHPR

KONDISIHPR

KET.B/L

VAR L

VAR I VAR IIVAR

IIIDipa

9 # Ma+& %-&'+a*a N- %i8a D* i+a% to1a* ; Kaki ki'i 4#/7/$" a*1i* Hi+%p B 4#/7 2 2 "


61/66

" K- %:'ata K- %:'ata D* %-aa8aka* 9 Dip&'%t "7/7/$" a*1i* Mati L 2 $/0 2 $

D tak-%*

4 Ni *- %-iati Kt 1&8a*tik D* ka6a* 49 Kaki ka*a* "7/7/$" a*1i* Di:%*%5 L $/0 $


62/66

4 Ni *- %-iati Kt 1&8a*tik D* ka6a* 49 Kaki ka*a* "7/7/$" a*1i* Di:%*%5 L 2 $/0 2 $

D ti-%5%* "7/7/$"

D6 *- k%'*ia6a* D6 *- k%'*ia6a* D* p&*a'%ka* "7 Kaki ki'i 4/0/$" a*1i* Hi+%p L 2 4/0 2 $

D :%*:%*a*

7 Pt a+ita p'a+*a*a * 1a'a D* k&*:&*a* $" B&ti kaki ki'i 4/0/$" a*1i* Hi+%p B 4/0 2 2 "

D t%8ik%p

0 M+ 6a'ti Ka+&k ka'iaa D* %-&a8aka* 7" Kaki ka*a* ";/7/$" a*1i* Di:%*%5 L 2 $/0 2 $

D tak-%* 3 IB -+ 'ai %a*ta'a IB *- %'a+*a D* t&a86a*i 9 Kaki ka*a* /0/$" a*1i* Hi+%p B /0 2 2 "

D *a8ia* /0/$"

; Foko'+a it'i +&6i Foko'+a -a5ap%t'a D* p&-&*a* 44 Pa5a ka*a* /0/$" a*1i* Hi+%p B /0 2 2 "

D *a8ia*

9 N- -a'%ti N- -a'%ti D* ka*i* 7# T&8%*1%k ki'i /0/$" a*1i* Hi+%p B /0 2 2 "

D to5pati

$# I -a+& kop&' Gt *- ka*ia D* ka6a* 09 Kaki ki'i 0/0/$" a*1i* Hi+%p L 2 0/0 2 $

D tak-%*



BULAN !JUNI "#$" PROPINSI ! BALI


ALAMAT LENGKAP


UMUR PENGGIGITAN

LUK A

PENANGANAN/PENGOBA


TGL KEPKM/ RS

JENISHPR

KONDISIHPR

KET.B/L

VAR LVAR I VAR II

VAR

IIIDipa

$ $ Ma+& %-&'+a*a N- %i8a D* i+a% to1a* ; Kaki ki'i 0/0/$" a*1i* Hi+%p L 2 0/0 2 $

D tak-%* 4#/7/$"

$ " N5 6a'i * -%tika D* %-&a8aka* $ Kaki ka*a* 0/0/$" a*1i* Mati L 2 0/0 2 $

D tak-%*

$ 4 * ti'ta * ti'ta D ti-%5%* 4 Ta*a* ki'i 0/0/$" a*1i* Hi+%p B 0/0 2 2 "


63/66

$ Ma+& %'a+*a Ma+& %'a+*a D* 8oa* 7# Ja'i ta*a* 4$/7/$" a*1i* Hi+%p L 2 3/0 2 $

D Tak-%* ka*a*

$ 7 Kt 6i8i %8ia*ti * 1%*ia'ta D* 6&8ai'i 4$ Kaki ka*a* "7/7/$" a*1i* Hi+%p L 2 2 ;/7 $

D Aa*

$ 0 * 1%*ia'ta6a* N5 %8aka*a D* a*i* 3 Kaki ki'i +a* ;/0/$" a*1i* Hi+%p B ;/0 2 2 "

D Aka5 Ta*a* ki'i

$ 3 Pt a% 'a+ita p. Kt %a'*aa D* pa% ; Ta*a* 1&-p8 9/0/$" a*1i* Hi+%p B 9/0 2 2 "D ti5i*a* ki'i

$ ; M+ +a'-iati Kt %a'a*a D* :a*+a 9 B&ti kaki 9/0/$" a*1i* Hi+%p B 9/0 2 2 "

D tak-%* ka*a*

$ 9 Gt *'5 a%* 'iki G N A %k'a a+*a*a. D* *&a'i 0 p%*%* $#/0/$" a*1i* Hi+%p B $#/0 2 2 "

D *&a'i $#/0/$"

" # Pt t'i a'i*a T. Kt %+ia*a D* k&8o+a* " Pi*a* $#/0/$" a*1i* Hi+%p B $#/0 2 2 "

D *a8ia* Ka*a* $#/0




BULAN ! JUNI "#$" PROPINSI ! BALI


(JALAN, DUSUN,

DESA )

UMUR PENGGIGITAN

LUK

A

PENANGANAN/PENGOBA

L PTEMPAT/ TGL

GIGITAN

TGL KE

PKM/ RS

JENIS

HPR

KONDISI

HPR

KET.

B/L

VAR L

VAR I VAR IIVAR

IIIDipa

" $ Ma+& %a-:a Ma+& %a-:a Di*a p&t&'*aka* 4# 2 2 2 2 2 2 $9/ $


" " * a*+'& %+ia*ta'a * %a'tika D* p&ka* 9 Kaki ki'i 9/0/$" a*1i* Hi+%p B 9/0 2 2 "

D Aa* 9/0/$"


64/66

D Aa* 9/0/$"

" 4 * %:a'ti N* t%-p%k D* 1%*%t 77 Mata kaki ki'i $$/0/$" a*1i* Hi+%p B $$/0 2 2 "

D :%*:%*a*

" N- *a-:'% Kt %a'1a*a D* ka8&'a* 09 Kaki ki'i $4/0/$" k%i* Hi+%p B $4/0 2 2 "

D ti-%5%*

" 7 * ti'ta * ti'ta D* t&*a5 4 Ta*a* ki'i 0/0/$" a*1i* Hi+%p L 2 $4/0 2 $

D ti-%5%*

" 0 * a*ti * '%p& D* &8at ;# Pa*ka8 pa5a $4/0/$" a*1i* Hi+%p B $4/0 2 2 "D :a*1a'a*ka* Ba. ka*a*

" 3 AA + k'i*a p. AA 'ai a'+ika D* p&k&* $$ J&-po8 t*a* $/0/$" a*1i* Hi+%p B $/0 2 2 "

D Aa* ka*a*

" ; N- 'i a% *i*i5 Kt aa D* *&a B&ti ki'i $/0/$" a*1i* Hi+%p B $/0 2 2 "

D :a*1a'a*ka* $/0/$"

" 9 D6 + a'1a*a p%t'a D6 +a'-a p%t'a D* ti-%5%* 4 k&pa8a $7/7/$" a*1i* +i:%*%5 L 2 2 $7/7 $

D ti-%5%*

4 # D6 kt 'ai Dk -a*i D* k&8o+a* 40 Kaki ki'i $7/0/$" a*1i* Hi+%p B $7/0 2 2 "

D *a8ia* $7/0/$"



PUSKESMAS/RS ! BANJARANGKAN II KABUPATEN !

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