SURVEY PHBS RUMAH TANGGA No. Dokumen : 027/UKM/PKMC/III/20! 027/UKM/PKMC/III/20! No. Re"#$# : 00 SOP T%n&&%' %n&&%' Te()#* e()#* : 0+ M%(e* M%(e* 20! 20! H%'%m%n : /2 PUSKESMAS CAKRANEGARA
. Pen&e(*#%n Pen&e(*#%n
2. Tu Tu-u%n 1. Ke)# Ke)#-% -%k% k%n n
,(. H-. Y. Ne" e$*%(# NIP.!1 NIP.!107701200 07701200
U%% un*uk mem)e(,%%k%n %n&&o*% (um%3 *%n&&% %&%( *%3u4 m%u ,%n m%mu me'%k$%n%k%n PHBS $e(*% )e(e(%n %k*#5 ,%'%m &e(%k%n ke$e3%*%n ,# m%$%(%k%* Un*uk me men6%%# Ru Rum%3 T%n&&% Se Se3%* SK Ke% Ke%'% '% Pu$k Pu$ke$ e$m% m%$$ C%k C%k(% (%ne ne&% &%(% (% No.1 No.1/ /AD ADM/ M/PK PKM. M.C/ C/II III/ I/20 20! ! Ten*% en*%n& n& Pen&e'o'% ,%n Pe'%k$%n%%n.
. Re R e5e(en$# 8. P(o$e, P(o$e,u( u(
Buku Pe Pe,om%n Su Su("e PH PHBS . Pe'%k%$ Pe'%k%$%n% %n% : P(omke P(omke$$ 2. A'%* A'%* ,%n B%3% B%3%n n %. A'%* A'%* : D%5* D%5*%( %( e(* e(*%n %n% %%n %n ). B%3%n : A'%* A'%* *u'#$
!. %n& %n&k% k%39 39 '%n&k%3
. Pe*u&%$ Pe*u&%$ (omke (omke$$ )e(koo( )e(koo(,#n ,#n%$# %$# ,en&%n ,en&%n '#n*%$ '#n*%$ (o&(% (o&(%m m *en*%n *en*%n& & (en6%n (en6%n%% $u("e PHBS Rum%3 *%n&&% 2. Pe*u&%$ Pe*u&%$ P(omke$ P(omke$ menen* menen*uk%n uk%n *%n&&%' *%n&&%' ,%n 'ok%$# 'ok%$# '#n&kun& '#n&kun&%n %n $e)%&%# $e)%&%# *em%* e'%k$%n%%n Su("e PHBS Rum%3 T%n&&% 1. Pe*u&%$ Pe*u&%$ P(omke$ P(omke$ men#%k% men#%k%n n ,%5*%( ,%5*%( *#'#k *#'#k un*uk un*uk $u("e $u("e PHBS Rum%3 Rum%3 T%n&&% . Pe*u Pe*u&% &%$$ P(om P(omke ke$$ ,%n ,%n '#n* '#n*%$ %$ (o& (o&(% (%m m me'% me'%kuk kuk%n %n en,% en,%*% *%%n %n PHBS PHBS Rum%3 T%n&&% 8. Pe*u Pe*u&% &%$$ (om (omke ke$$ men&e en&e''o'%3 o'%3 ,%*% ,%*% un*u un*uk k men&e en&e**%3u# %3u# u(u* u(u*%n %n e(m%$%'%3%n
7. B%&% B%&%n n A'#( A'#( Koo(,#n%$# #n*%$ (o&(%m
Menen* Menen*uk% uk%n n ;%k*u ;%k*u ,%n ,%n *em *em %*
Men#%k%n D%5*%( T#'#k
Me'%kuk%n Pen,%*%%n
Men&o'%3 D%*%
+. H%'9 H%'93% 3%'' Y%n Y%n& & e('u ,#e(3%*#k%n . Un#* Te(k%#*
9
. KIA 2. G## 1. Ke$' Ke$'##n&
0. Dokumen Te(k%#*
. B'%n&ko Su("e 2. %o(%n H%$#' Su("e
11. Rekaman
No
Y%n& D#u)%3
I$# Pe(u)%3%n
Historis Perubahan
2/2
T%n&&%' Mu'%# ,#)e('%kuk%n