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Nama :

Nama : SusantiSusanti

Alamat :

Alamat : Desa MricanDesa Mrican Rt Rt 05 05 Rw Rw 0202

Sragi,

Sragi, PekaPekalonganlongan

PB

MB

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KARTU

KARTU

PENDERITA

PENDERITA

KUSTA

KUSTA

Propinsi

Propinsi : : JAWJAWA A TE!A"TE!A" #a$upaten

#a$upaten % % #ota #ota : PEMA&A!: PEMA&A! #eca'atan

#eca'atan : : ()DE"()DE"

KLA KLA SIFI SIFI KAS KAS Evalu Evalu asi asi hasil hasil peng peng obata obata n n

KETERANGAN TENTANG PENDERITA KETERANGAN TENTANG PENDERITA

N NAAMMA A : : SSuussaanntti i AALLAAMMAAT T : : DDeessaa Mrican Mrican J JEENNIIS S KKEELLAAMMIIN N : : PPeerreemmppuuaan n DDEESSA A : : MMrriiccaann ( ( Rt Rt 02/ 02/ RW RW 02 02  CARA PENEMUAN CARA PENEMUAN RIWAYAT PENYAKIT RIWAYAT PENYAKIT

KELAINAN PADA K!LIT DIKETA"!I SEJAK

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PEMERIKSAAN AWA

PEMERIKSAAN AWAL : L : Tgl 29 Juli 2016Tgl 29 Juli 2016

PEMERIKSAAN KULIT DAN SARAF PEMERIKSAAN KULIT DAN SARAF

GAMBARLA

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HASIL

HASIL PEMERIKSAAN PEMERIKSAAN BAKTERIL!IK BAKTERIL!IK ::

+ Pe'eriksaan $akteriologik an-a .ilakukan $ila SDM .an sarana terse.ia / + Pe'eriksaan $akteriologik an-a .ilakukan $ila SDM .an sarana terse.ia /

Tgl Tgl peme"i#s peme"i#s aan aan Lo#a Lo#a si : si : Hasil : Hasil : Po Po s : s : $$ $$ Agustus Agustus %&$' %&$' (upi (upi ng ng telin telin ga ga Kana Kana n n (upi (upi ng ng telin telin ga ga Ki"i Ki"i Tan) Tan) a )i a )i #ulit #ulit : : 

TTulis tanggal ulis tanggal se*a"a leng#ap +se*a"a leng#ap + , tgl- bulan- tahun .

, tgl- bulan- tahun . 

 Penga'$ilan .i Penga'$ilan .i cuping telinga : cuping telinga : wa1i$wa1i$

 Penga'$ilan

 Penga'$ilan .i .i kulit kulit : : pililapilila $agian $ercak -ang paling akti  $agian $ercak -ang paling akti  

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PEN!B

PEN!BAATAN /AN TAN /AN E0AL1E0AL1ASI ASI HASIL HASIL PEN!BPEN!BATATAN AN ::

T

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KEA/AAN

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Cancel Anytime. Tanggal Tanggal peme"i#s peme"i#s aan : aan : Mata Mata Kan Kan an an Ki Ki "i "i A2 A2 al al &

& &&

Saa Saa t t RF RF T T

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PEMERIKSAAN

PEMERIKSAAN KNTAKNTAKK

SER1MAH SER1MAH N! N! N"#" N"#" $%&"$ $%&"$ '()u#"* '()u#"*   UMUR   UMUR L L$$:: PP)):: $ $ 2 2 & & 1 1   Men+i Men+i Wi+3+3 Wi+3+3 Saputra Saputra Rasm3na4 Rasm3na4  A-i  A-i Darma5an Darma5an Tar3n3 Tar3n3 &2 &2 6 6 &2 &2 &0 &0 2 2

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DA!TAR TI"IK PENYU"U#AN DA!TAR TI"IK PENYU"U#AN

H

Halal--hhal al yayanng g hhararuus s ddiikketetahahuui i ppenenddereriitta.a.

 Apa itu pen-akit kustaApa itu pen-akit kusta

 ProseProses s penularann-apenularann-a

 Per1alanaPer1alanan n pen-akitn-apen-akitn-a

R R

 Apa itu reaksi kustaApa itu reaksi kusta

 #apan $isa ter1a.i reaksi#apan $isa ter1a.i reaksi

 Siapa -ang $isa 'engala'i reaksiSiapa -ang $isa 'engala'i reaksi

 T  TEENNTTAANNG G RREEAAKKSSI I KKUUSSTTAA e e  T  TEENNTTAANNG G PPEENNYYAAKKIIT T KKUUSSTTAA  T  TEENNTTAANNG G PPEENNGGOOBBAATTAAN N KKUUSSTTAA

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Geala selanutnya :

Geala selanutnya : !a !a Tidak Tidak 

 Bila ada jaw

 Bila ada jawaban “YA” daaban “YA” dari 7 tanda-ri 7 tanda- tandatanda di

di atas, teliti atas, teliti dahulu, obati dahulu, obati seperluna!seperluna! Batuk

Batuk terus terus menemenerus rus 3 3 minmingguggu Dahak berdarah ?

Dahak berdarah ?

Kecurigaan lain untuk TB ? Kecurigaan lain untuk TB ? Atau trachoma ?

Atau trachoma ?

Diare berdarah / lendir ? Diare berdarah / lendir ? Bercak

Bercak kulit ykulit yang gatal ang gatal ?? Scabies ?

Scabies ?

Tan)a5tan)a )an ge4ala Tan)a5tan)a )an ge4ala

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FORM EVALUASI PENGOBATAN

FORM EVALUASI PENGOBATAN

PREDNISON

PREDNISON

I Innddiikkaassi i PPeemmbbeerriiaan n PPrreeddnniissoonn SSaarraann Kesimpulan Kesimpulan pemeriksaan: pemeriksaan: 1.

1. AdaAdakah kah berbercak cak yanyang g ecaecah ! h ! n"n"d#$d#$ee yang ecah %

yang ecah % &.

&. AdAdakakah nah nyeyer' (r' (ekekan an aada )da )arara* %a* % +.

+. AaAakah kah kekkek#a(#a(an "("an "("( a( a(a# (a# ra)ra)a ra rabaaba berk# rang da

berk# rang da$a, -ak(#  dar' $a, -ak(#  dar' // b#$an (erakh'r%

b#$an (erakh'r% 0.

0. AaAakah kah ada ada $a$ag"g"(ha(ha$,#$,#) y) yang ang barbar## (erad' da$a, -ak(#  dar' /

(erad' da$a, -ak(#  dar' / b#$anb#$an (erakh'r % (erakh'r % 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak 3a ! ('dak Pemberian Pemberian prednison : prednison : ( dosis ( dosis tunggal) tunggal)

-- 04 ,g )e$a,a & M'ngg#04 ,g )e$a,a & M'ngg#

-- +4 ,g )e$a,a & M'ngg#+4 ,g )e$a,a & M'ngg#

-- &4 ,g )e$a,a & M'ngg#&4 ,g )e$a,a & M'ngg#

-- 12 ,g )e$a,a & M'ngg#12 ,g )e$a,a & M'ngg#

-- 14 ,g )e$a,a & M'ngg#14 ,g )e$a,a & M'ngg#

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Tangga$ Tangga$ Ma(aMa(a

Lag"h Lag"h Tha$ Tha$ M#) M#) ' 'aannggaann KKaakkii 9ek#a(an 9ek#a(an Gangg# Gangg# an Ra)a an Ra)a Raba Raba Nyer' )ara* Nyer' )ara*9e9e 9#a 9#a (an "("( (an "("( Gang Gang g#an g#an Ra)a Ra)a Raba Raba 5('('k6 5('('k6 = =aarr' ' 22 IIbb# # aar Pr Peerrggee$$ PPeerr""nnee##)T'b. P")T'b. P")) 9a 9a 9a9a 9a9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9' 9a 9a 9' 9'

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Rea#si I :

Rea#si I :

$6

$6  Jenis reaksi k Jenis reaksi kusta :usta :





%6

%6  T Tanggal .iagnosa reaanggal .iagnosa reaksi :ksi :

6

6

76

76 (erlangsung $erapa la'a :(erlangsung $erapa la'a :





Rea#si II :

Rea#si II :

$6

$6  Jenis reaks Jenis reaksi kusta :i kusta :

66

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PEMERIKSAAN KLINIK ULANG

PEMERIKSAAN KLINIK ULANG

• &e'$ar ini .ise.iakan untuk 'encatat &e'$ar ini .ise.iakan untuk 'encatat peru$aan3peru$aan tan.a3tan.a -angperu$aan3peru$aan tan.a3tan.a -ang

'ungkin .i1u'pai sela'a pengo$atan, saat R7T setela R7T, atau tentang pengo$atan

'ungkin .i1u'pai sela'a pengo$atan, saat R7T setela R7T, atau tentang pengo$atan

% asil pengo$atan -ang .i$erikan6

% asil pengo$atan -ang .i$erikan6

• 4atatla al3al -ang penting64atatla al3al -ang penting6 •

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Cancel Anytime. % %   KARTU ,ER,AT MDT KARTU ,ER,AT MDT -Nama : Nama : 7777777777777777777777777777778888 Ke-amin / !

Ke-amin / !mur : mur : L, :7778Pr: 777L, :7778Pr: 7777777

Pe,er9aan : 77777777777777 Pe,er9aan : 77777777777777  A-amat  A-amat : 7777877777777777: 7777877777777777 1ntu# 1ntu# pengambilan pengambilan obat )ilua" obat )ilua" pus#esmas pus#esmas asal6 asal6

 Ti.ak perlu .iisi  Ti.ak perlu .iisi

$ila $ila o$at .ia'$il .i o$at .ia'$il .i puskes'as asal6 puskes'as asal6 Bliste" Bliste" #e #e /ibe"i#a /ibe"i#a n )i n )i pus#es pus#es mas: mas:

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 JADW

 JADW

A& M

A& MA

A

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A PE&

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AJAR

AJAR

A

A

#E&AS =A SMP  9

#E&AS =A SMP  9

PETAR>#A

PETAR>#A

S

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IN/NESIA

IN/NESIA

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