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SKRINING ANAK BALITA DAN PRA SEKOLAHÂ
(>6 BULAN-71 BULAN)
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* Indicates required question
NAMA ANAK
*
Your answer
NAMA ORANG TUA
*
Your answer
TANGGAL LAHIR
*
MM
/
DD
/
YYYY
NIK
*
Your answer
JENIS KELAMIN
*
LAKI-LAKI
PEREMPUAN
ALAMAT
*
Your answer
TANGGAL KUNJUNGAN
*
MM
/
DD
/
YYYY
BUKU KIA
*
YA
TIDAK
BERAT BADAN
*
Your answer
PANJANG / TINGGI BADAN
*
Your answer
LINGKAR KEPALA
*
Your answer
LILA
Your answer
IMUNISASI
USIA 0 BULAN
*
Hb 0
Required
USIA 1 BULAN
BCG
POLIO 1
USIA 2 BULAN
DPT-HB-Hib 1
POLIO 2
PCV 1
ROTAVIRUS 1
USIA 3 BULAN
DPT-HB-Hib 2
POLIO 3
PCV 2
ROTAVIRUS 2
USIA 4 BULAN
DPT-HB-Hib 3
POLIO 4
IPV 1
ROTAVIRUS 3
USIA 9 BULAN
CAMPAK-RUBELLA
IPV 2
USIA 12 BULAN
PCV 3
USIA 18 BULAN
DPT LANJUTAN
MR LANJUTAN
MAKANAN PENDAMPING ASI (MP ASI)
MAKANAN POKOK
YA
TIDAK
Clear selection
PROTEIN HEWANI
YA
TIDAK
Clear selection
PROTEIN NABATI
YA
TIDAK
Clear selection
BUAH DAN SAYUR
YA
TIDAK
Clear selection
OBAT CACING
ADA
TIDAK
Other:
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KAPSUL VITAMIN A
USIA 6 - 11 BULAN (BIRU)
FEBRUARI
AGUSTUS
USIA > 11 BULAN (MERAH)
FEBRUARI
AGUSTUS
PMT
YA
TIDAK
Other:
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EDUKASI
*
Your answer
TANDA BAHAYA
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