Rekam Medik Bekam [PDF]

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Rekam Medik (Pasien Bekam) Alamat: Jl. Sungai Raya Dalam Komplek Korpri Gang Bringin 5 No. 160 Telp. 085654462853



================================================================ Nama : ………………….………………………… (….Th) Pekerjaan :…………………………….................................................. Alamat : ………………………................Telp : ............................... Keluhan Utama : ……………………………………(Hr/Minggu/Bln/Th) Keluhan Tambahan :............................................................................................... Hasil Diagnosis : .......................................................................................................... Tekanan Darah : ………… Berat Badan : ........Kg Gula Darah :........................ Syaraf :.......................................................................................................... Tangan : ……………………………………………………......…............... Iridologi : ......................................................................................................... Tangan/Kaki : Panas/ Dingin/ Normal Denyut Nadi : Atas/Bawah, laju/Lambat, Kuat/Lemah, Normal Lidah : Mengembang/mengecil,Kering/Licin,Berparit/Selaput putih Tulang Belakang: ......................................................................................................... Titik Bekam : Anjuran/ Herba : 01 Tingkatkan ibadah kpd Allah 02 Minum air putih min 2,5 ltr/hari 03 Jus buah/sayur 3x/hari 04 Kurangi makanan berlemak segera 05…………………………………. 06..................................................... 07.....................................................



Pontianak, ....., Agustus 2019 Pemeriksa



(..........……………………….) Terapi : Bekam/ Akupunktur/Refleksi/Moksa/PTB Akupunktur : Ten Nedle, ............................................ Moksa : ST36,SP6,CV8,GV4,BL23,..................... .....



Terapi Berikutnya tgl …………..