PERATURAN-PERATURAN PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT (BORANG NOTIS) (PINDAAN) 2023

Peraturan-Peraturan

Pencegahan dan Pengawalan Penyakit Berjangkit (Borang Notis) (Pindaan) 2023.

Pencegahan dan

Pengawalan

Penyakit

Berjangkit

(Borang Notis) 1993 [P.U. (A) 328/1993] dipinda dengan menggantikan Jadual dengan jadual yang berikut:

3

”.

Borang Notifikasi: Rev/2023

No. Siri:

Nama Penuh (HURUF BESAR):

Nama Pengiring (Ibu/Bapa/Penjaga):

(Jika belum mempunyai Kad Pengenalan diri)

No. Kad Pengenalan Diri / Dokumen Perjalanan:

Sendiri

Pengiring

(Untuk Bukan Warganegara)

No. Daftar Hospital / Klinik:

Nama Wad:_______________ Tarikh Masuk Wad:

/

/

Kewarganegaraan:

Jantina:

Lelaki

Perempuan

Warganegara:

Ya

Keturunan:

Tarikh Lahir:

/

/

Suku keturunan:

(Bagi O/Asli, Pribumi Sabah/Sarawak)

Umur:

Tahun

Bulan

Hari

Tidak Negara Asal:

Kedatangan:

Izin

Tanpa Izin

Penduduk Tetap

(Jika tidak bekerja, nyatakan status diri)

No. Telefon:

Rumah

Tel. Bimbit

Pejabat

-

Alamat Kediaman:

Alamat Tempat Kerja / Belajar:

Tetanus Neonatorum yang mengancam nyawa, nyatakan:

Cara Pengesanan Kes:

Status Pesakit:

Tarikh Onset:

Kes

Kontak

FOMEMA

Hidup

-

-

Ujian Saringan ______________________

Mati

-

-

Ujian Makmal:

Keputusan Ujian Makmal:

Status Diagnosis:

Nama Ujian: (i)_____________________

Positif (_____________________________)

Sementara (Provisional/Suspected)

Komen:

Yang Relevan:

Nama Pengamal Perubatan:

Nama Hospital / Klinik dan Alamat:

Tarikh Pemberitahuan:

-

-

BORANG NOTIFIKASI PENYAKIT BERJANGKIT

PERATURAN-PERATURAN PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT (BORANG NOTIS) (PINDAAN) 2023

A. MAKLUMAT PESAKIT

(Seksyen 10, Akta Pencegahan Dan Pengawalan Penyakit Berjangkit 1988)

AKTA PENCEGAHAN DAN PENGAWALAN PENYAKIT BERJANGKIT 1988

(Peraturan 2)

Borang

Tandatangan

Pengamal Perubatan

(Untuk dihubungi)

C. MAKLUMAT PEMBERITAHU

………………………………………….

Penyakit berikut perlu dinotifikasi melalui telefon dalam tempoh 24 jam: Avian Influenza , Campak, Demam Denggi, Demam Kuning,

Difteria, Ebola, Jangkitan virus Zika, Keracunan Makanan, Kolera, Middle East Respiratory Syndrome Coronavirus (MERS-CoV),

Penyakit Koronavirus 2019 (COVID-19), Penyakit Tangan, Kaki dan Mulut (HFMD), Plague , Poliomielitis (Akut) dan Rabies. Penyakit selainnya perlu dinotifikasi dalam tempoh tujuh (7) hari.

B. DIAGNOSIS PENYAKIT

“

4

Dibuat 14 Ogos 2023

[KKM.600-1/1/66; PN(PU2)470/JLD. 8]

DR. ZALIHA BINTI MUSTAFA

Menteri Kesihatan

5

PREVENTION AND CONTROL OF INFECTIOUS DISEASES ACT 1988

PREVENTION AND CONTROL OF INFECTIOUS DISEASES (NOTICE FORM)

(AMENDMENT) REGULATIONS 2023

Full Name (CAPITAL LETTER):

Accompany by (Mother/Father/Guardian):

(If under age/without Identity Card)

Identity Card Number / Travelling Document:

Self

Accompany by

(For Non-Citizen)

Hospital / Clinic Reg. Number:

Ward Name:_____________ Date of Admission:

/

/

Citizenship:

Gender:

Male

Female

Citizen

Yes

Race/Ethnic:

Date of Birth:

/

/

Sub Ethnic:

(For Aborigines, Native of Sabah/Sarawak)

Age:

Year

Month

Day

No

Country of origin:

Entry:

Legal

Illegal

Permanent Resident

(If unemployed, please state self reference)

Telephone No.:

Resident

H.phone

Office

-

Current Address:

Address of Employer / School / College / University:

Tuberculosis - Drug Resistant 8.

Tetanus Neonatorum please specify:

Case Detection Classification:

Status of Patient:

Date of Onset:

Case

Contact

FOMEMA

Live/alive

-

-

Screening Test ______________________

Died

-

-

Laboratory Investigation:

Laboratory Investigation Result:

Diagnosis Status:

Investigation: (i)_____________________

Positive (_____________________________)

Provisional/Suspected

Comment:

Information:

Name of Medical Practitioner:

Name and Address of Hospital/Clinic:

Date of Notification:

-

-

B. DISEASE DIAGNOSIS

(Section 10, Prevention And Control Of Infectious Diseases Act 1988)

PREVENTION AND CONTROL OF INFECTIOUS DISEASES (NOTICE FORM) (AMENDMENT) REGULATIONS 2023

C. NOTIFIER

Form

(Regulation 2)

PREVENTION AND CONTROL OF INFECTIOUS DISEASES ACT 1988

………………………………………….

A. PATIENT INFORMATION

(Contact purposes)

Dengue haemorrhagic fever

NOTIFICATION FORM OF INFECTIOUS DISEASES

Signature of

Medical Practitioner

The following diseases must be notified by telephone within 24 hours: Avian Influenza, Measles, Dengue, Yellow Fever, Diptheria, Ebola,

Zika Virus Infection, Food Poisoning, Cholera, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Coronavirus Disease 2019

(COVID-19), Hand, Foot and Mouth Disease (HFMD), Plague, Poliomyelitis (Acute) and Rabies. Other diseases must be notified within seven