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OTOPSI VERBAL USIA (1-59 BULAN)
Otopsi Verbal Khusus Selain Neonatus
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Nama Anak
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Nama Responden
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NIK Anak
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Tanggal Lahir Anak
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DD
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YYYY
Jenis Kelamin
L
P
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Alamat Lengkap
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Umur Ibu
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Pendidikan Terakhir Ibu
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Pekerjaan Ibu
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Nama Ayah
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Usia Ayah
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Pendidikan Terakhir Ayah
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Pekerjaan Ayah
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Usia Gravida
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Status ANC
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Jarak kelahiran
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Periode kematian
MM
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DD
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YYYY
Penolong persalinan
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Penolong pertama
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Penolong terakhir
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Penyebab kematian
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Keterlambatan
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Status gizi
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Kadar hb
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Status kb sebelumnya
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Jaminan kesehatan
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Cara persalinan
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Kesimpulan Akhir
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