Scribd Logo
Upload

Welcome to Scribd!

  • 22 views

    Form D

    Uploaded by

    Suryo Menggolo
    This document is a registration form for early detection of breast cancer and cervical cancer in a community health center. It collects patient information like name, age, address and results of breast and cervical examinations. The form includes columns to record results of breast examinations for lumps, tumors or other abnormalities and results of cervical Pap smear tests. It also tracks the total number of patients screened and those referred to other facilities.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content

    You might also like

    Form D

    Uploaded by

    Suryo Menggolo
    22 views4 pages
    This document is a registration form for early detection of breast cancer and cervical cancer in a community health center. It collects patient information like name, age, address and results of breast and cervical examinations. The form includes columns to record results of breast examinations for lumps, tumors or other abnormalities and results of cervical Pap smear tests. It also tracks the total number of patients screened and those referred to other facilities.

    Original Description:

    Jvvkf

    Original Title

    FORM D

    Copyright

    © © All Rights Reserved

    Available Formats

    XLSX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a registration form for early detection of breast cancer and cervical cancer in a community health center. It collects patient information like name, age, address and results of breast and cervical examinations. The form includes columns to record results of breast examinations for lumps, tumors or other abnormalities and results of cervical Pap smear tests. It also tracks the total number of patients screened and those referred to other facilities.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    22 views4 pages

    Form D

    Uploaded by

    Suryo Menggolo
    This document is a registration form for early detection of breast cancer and cervical cancer in a community health center. It collects patient information like name, age, address and results of breast and cervical examinations. The form includes columns to record results of breast examinations for lumps, tumors or other abnormalities and results of cervical Pap smear tests. It also tracks the total number of patients screened and those referred to other facilities.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as xlsx, pdf, or txt
    of 4

    FORMULIR REGISTER DETEKSI DINI

    KANKER PAYUDARA DAN KANKER LEHER RAHIM


    PUSKESMAS/POLINDES/PONKESDES
    Puskesmas : ……………………
    Kabupaten : ………………
    Provinsi : ……………..
    Bulan : …………..
    Hasil Pemeriksaan Payudara Hasil Pemeriksaan Leher Rahim
    Dirujuk IVA Pap smear Dirujuk
    No Tgl No. Reg Nama Umur Alamat
    Normal Kel.
    Tumor/ Curiga Lesi Curiga Kel Gin
    Payudara Positif Negatif Kelas 1 Kelas 2 Kelas 3 Kelas 4 Kelas 5
    benjolan Ca luas Ca Lain
    Lain
    [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18) [19) [20)

    10

    11

    12

    13

    14

    dst

    TOTAL

    ………………,
    Kepala Puskesmas …………………… /

    …………………………………

    NIP. …………………………..
    Form D

    Dirujuk
    Keterangan

    IVA positif Papsmear

    [21) [22) [23)


    …… /

    You might also like