Resume Medis Rawat Jalan [PDF]

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RESUME MEDIS (RAWAT JALAN) Nama Lengkap Pasien Tanggal Lahir Alamat Ringkasan Riwayat Penyakit Pemeriksaan Fisik Pemeriksaan Penunjang Terapi



No. RM



RESUME MEDIS (RAWAT JALAN)



Tahun



: _____________________________ : _____________________________



Tanggal Pemeriksaan :



__________________ : _____________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________



Nama Lengkap Pasien Tanggal Lahir Alamat Ringkasan Riwayat Penyakit Pemeriksaan Fisik Pemeriksaan Penunjang Terapi



No. RM Tahun



: _____________________________ : _____________________________



Tanggal Pemeriksaan :



__________________ : _____________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________



Diagnosis Masuk : 1. ___________________________________ 2. ___________________________________



ICD 10 1.____________________________ 2.____________________________



Diagnosis Masuk : 1. ___________________________________ 2. ___________________________________



ICD 10 1.____________________________ 2.____________________________



Tindakan / Prosedur : 1. ___________________________________ 2. ___________________________________



ICD 10 1.____________________________ 2.____________________________



Tindakan / Prosedur : 1. ___________________________________ 2. ___________________________________



ICD 10 1.____________________________ 2.____________________________



Kondisi Waktu Keluar :



○ 1. Berobat jalan ○ 3. Dirawat di RS Bethesda



Kondisi Waktu Keluar :



○ 2. Dirujuk ke : .......................................... ○ 4.Meninggal : ..........................................



○ 1. Berobat jalan ○ 3. Dirawat di RS Bethesda



Bogor, .................................. Dokter yang merawat



Bogor, .................................. Dokter yang merawat



(........................................)



(........................................)



○ 2. Dirujuk ke : .......................................... ○ 4.Meninggal : ..........................................