Dan vi:

DANH SACH NGlTCXl NGHIEN MA TUY CO H6 SO QUAN L Y TAI DIA PHlTOfNG Tinh den ngay^ thang 4 nam 2017

(Kem theo Ki hoach s6:^<^:^ /KH-UBND nga}!LJ^/4/2017 cua UBND tinh)

Bieu so 01

Lo^i ma tiiy sOr

d\ing chu ykn

Hinh So l in cai nghi?n tru6e day H 6 trgr gidi quyet cac v in dd xa hpi

TT Hp vdtSn Chung

minh nhan dan so

N5m sinh

Gidi tinh Dja chi

Trhih dp van h6a

Dan tOc

Ton gido

Ngh6 nghi?P /tinh t r ^g vifc lam

Tinh trang hon nhan

Tinh tr^ng sue

khoe

Txhn an, tien syr

Nam bdt dau su

dung ma tiiy

Lo^i ma tiiy sOr

d\ing chu ykn

thuc sir

d\mg ma tuy chii ykn

Cai bat buQC tai Trung

tam/Ca sd

Cai bat

bUQC tai

cgng dong

Cdc hinh thuc cai

nghi?n khdc (ghi rO)

Chua du<3re cai

nghi?n

Hpc nghe (ngh^ dugc hpc)

Giai quyet vi?c lam

(vi?c 1dm

duprc sap

xip)

Hotrg von tai

h6a nhap cpng

d6ng (s6 tiSn)

Vay von uu dai(s6 tiln)

Cac ho tra khdc (phap iy ,y

ta, gia dinh, cho a

. . . )

Hinh thuc dang quan

ly (ghi r5)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 1 2

Liru y: Hinh thuc dang quan ly (cpt 26) ghi rQ: Cai nghi?n t^i gia dinh, cai nghien t\ nguy^n t^i cpng d6ng, cai nghi?n bat bupc t^i cpng dong, gido d\ic t?i xa, phuimg, thj tran, qudn ly sau cai nghifn, tarn hoan cai nghien theo chu truomg cua tinh, chua dupe cai nghi?n, dieu trj Methadone./.

, ng^y thang nam 2017

Thu truang dan vi Can bo thong ke

Dan vj: I Bieu so 02

DANH SACH NGlTCH NGHIEN, StT DyNG MA TUY TAI TRAI TAM GIAM, NHA TAM GIlT Tmh den ngky^ thang q nam 2017

(Kem theo Ke hogch so}^:i6/KH-UBND ngay^/4/2017 cua UBND tm^^

Nam bat dau six

dung ma tuy

Hinh So lan da cai nghi?n

H6 trp giai quyet cac van d8 xa hoi

T T Hp vd ten

Chung minh nhan

dan so

Nam sinh

Gidi tfnh Nori a hi?n nay

Trinh dp v5n h6a

Dan tpc

Ton gido

Nghe nghi?p/

Tinh trang

vi$c Idm

T\nh trang hon nhan

1

Thih trang sure

khoe

Tien an, tien sv

Nam bat dau six

dung ma tuy

Loai ma

tiiy su dung chu y8u

thuc su

dung ma tuy chii yeu

Cai bat bupc

tai Co sd/

trung tam

Cai bat

bupc t?i

cpng dong

Cdc hinh

thurc cai nghien khac

Hpc van h6a

Hpc nghe (nghe dupe hpc)

T6 chuc lao

dpng san xuat

C O thu nhap

H6 trp

khac

Ghi chu

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3

Can bo thong ke

ngay thang

Thu truang dan vj

nam 2017

Den vi: Bieu so 03

DANH SACH NGlTCH NGHIEN MA TUY CAI NGHIEN MA TUY TAI C A C C O S d CAI NGHIEN Tinh den ngay^ thang d nam 2017

\ theo Ke hogch s6:^^:fQ/KH-UBND ngay^4/2017 cu^

Nam bat dau su

d\mg ma tuy

Hhih S6 Ian cai nghi?n trudc

day H6 trp giai quySt cdc vdn

d6 xa hpi

T T

Hp \h ten Chung minh nhan

dan s6

Nam sinh

Giai tinh Noi 6 hi?n nay

Trhih dp van

h6a

Dan tpc

Ton gido

NghS nghifp/

Thih trang

vi?c lam

Tinh t r ^ g hon nhan

Thih t r ^ g sue

khoe

Ti6n an, tien s\

Nam bat dau su

d\mg ma tuy

Lo?ii ma

tuy su d\mg chu yeu

thuc su

dvmg ma tuy chii ySu

Cai bat bupc

t^ii C a sal

Trung tam

Cai bat

bupc t^i

cpng d6ng

cac hmh thuc cai nghi$n

khac(ghi rS)

Hpc van h6a

Hpc nghg (ngh^ dupe hpc)

T6 chuc lao

dpng san xuat

c6 thu nhap

H S trp

khac

Ghi chii

1 2 3 •4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 1 2 3

, ngay thang nam 2017

Can bo thong ke I Thu trirang dan vi

Dan vi:

DANH SACH NGl/Cfl CO B I E U HIEN NGHI VAN SlT DyNG MA TUY Tinh den ngaj^^ thang nam 2017

(Kem theo Ke hogch sS^^:f^ /KB- UBND ngay;i^4/20l 7 cua UBND tinh)

Bieu so 04

T T Ho ten Nam sinh Gi6i

tinh Que quan

Noi a hien nay Dan toe v a n hoa

\

Ngh8 nghi^p hien nay Tidn an, tien sir

Thai gian bat dau

nghi van

Loai MT nghi van su dung

Ghi chu T T Ho ten Nam sinh Gi6i

tinh Que quan

Noi a hien nay Dan toe v a n hoa

\

Ngh8 nghi^p hien nay Tidn an, tien sir

Thai gian bat dau

nghi van a 1-1 o 5"

H

O

Ghi chu

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15)

1 2 3

Can bo thong ke .., ngay thang nam 2017 Thu trirang dan vj

Don vi: , , Bieu so 05

DANH SACH NGlTCH NGHIEN MA TUY DANG D I E U T R I NGHIEN BANG THUOC T H A Y T H E METHADONE T A I C A C C O sd

Tinh den ngay ^ thang 4 nam 2017 (Kem theo Ki hoach s6:^'^/KH-UBNDngayXC^4/2017cu^

Hhih thijrc

su d\mg ma tuy chu y6u

So l4n cai nghien tnr6c dSy Ho trp giai quyet cdc van de xa hpi

TT Hp vd ten Chung

minh nhan dan s6

Nam sinh

Gi6i tinh

Dja chi

Trhih dp van h6a

Dan tpc

Ton giao

Ngh^ nghi?p/

Thih trang vi^c lam

Thih tr^ng hon nhan

Thih tr^ng sure

kh6e

Tien an, iihn s\

Nam bat dau

S I J

dyng ma tuy

Lo^i ma tuy sir

d\mg chu yeu

Hhih thijrc

su d\mg ma tuy chu y6u

Cai bat bupc t^i Trung

tam/Ca sd

Cai bat

bupc t^i

cpng ddng

cac hhih thuc cai

nghipn khac

Chua dupe cai

nghi$n

Hpc nghe (nghe dupe hpc)

Gidi quyet vi?c 1dm

(vi$c lam

dupfc sip

xep)

Ho trp von tdi

h6a nhap cpng

d6ng (s6 tien)

Vay von iru dai (s6 tien)

Cdc h6 trp khdc (phdp

te, gia dhih, ch6 a

. . . )

Ghi chu

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

1 JL

2 4M

, ngay thang nam 2017

Can bo thong ke Thu truang dan vj