Form Pe Flu Burung



Search



Home



Saved

0

46 views



Sign In

Upload

RELATED TITLES

0

Form Pe Flu Burung Uploaded by MFauziAditya



Books



Audiobooks



Magazines



Form Pe Flu Burung









Save

Embed

Share

Print

Langkah2 Persiapan

1

Download



News



Documents



Sheet Music

Join

of 2

 

Form Penyelidikan

FORM W.1.doc

 Search document



PENYELIDIKAN EPIDEMIOLOGI AVIAN INFLUENZA H5N1 H5 N1 I.

1. 2. 3. 4. II.

Identitas Pelapo Nama : ............................................. .................................................................... ................................. .......... Nama kantor dan : ............................................. .................................................................... ................................ ......... Kabupaten / Kota : ................................................................. Tanggal laporan : .............../ ......................./ ..................

Identitas Pendeita  Nama : ......................................... ......................................... Jenis Kelamin Kelamin : .......... ............... .......... .......... .......... ........ ...

Nama Orang Tua/KK Tua/KK : .................................. .................................. Tgl Lair : .......... ............... .......... .......... .......... .......... .......... ......... ......... .....

Tempat Tempat tinggal saat ini : !lamat : ............................................. ........................................................... .............. "t. ...................... "#. ......................... ......................... $esa / Keluraan : ............................................ ................................................................... .............................................. ..................................... .............. Ke%amatan : ............................................. ................................................... ...... Kabupaten ..........................................  No Telp Telp / &' : .............................................. ..................................................................... .......................... ...

'eke 'ekerj rjaa aan n : 1. "( / Klinik 4. 'eternakan ). 'eternak *abi 2. Laboratorium +. 'e 'eternak ,nggas -. 'a 'asar unggas / *abi 3. Lainlain : ............................................ ................................................................... ........................................ ................. !lamat tempat kerja : .............................................. ..................................................................... .............................................. ................................. .......... (audara dekat ang dapat diubungi : ............................................Tilp. ............................................Tilp. / &' ............... !lamat lengkap : ........................................... ................................................................... ............................................... .......................................... ................... III.

!i"a#at $a%it Tanggal Tanggal mulai sakit 0demam :.................................................... :.................................................... ejala / Tanda sakit serta asil pemeriksaan lain : $emam Leukosit dara terenda Sign up to vote on this title

*atuk

Trombosit terenUseful da

'ilek

Limposit terenda



 Not useful







Home



Saved



Books



Audiobooks



Magazines



News



Documents



Sheet Music



Upload

Sign In

Join



Search



Home



Saved

0

46 views



Sign In

Upload

RELATED TITLES

0

Form Pe Flu Burung Uploaded by MFauziAditya



Books



Audiobooks



Magazines News



Documents



Sheet Music



Form Pe Flu Burung









Save

Embed

Share

Print

Langkah2 Persiapan

1

Download



Join

of 2

 

Form Penyelidikan

FORM W.1.doc



 Search document

,nggas mati 6ulai $emam 'a(ai)ana %eadaan pendeita saat ini * 1 (embu 3 (akit dira#at Klinik

2

(akit dira#at di "(

4

+

6eninggal Tgl 5 ..............................

(akit dira#at diruma

Na)a Klini% + !$ #an( pena, )e)ei%sa ata- )ea"at 

 Nama Klinik / "(

IV.

!lamat

Tgl 6asuk Klini

!i"a#at Konta%  

You're Reading a Preview Unlock full access with a free trial.

Download With Free Trial

Sign up to vote on this title



Useful

 Not useful







Home



Saved



Books



Audiobooks



Magazines



News



Documents



Sheet Music



Upload

Sign In

Join