Rsud Tengku Sulung: Pemerintah Kabupaten Indragiri Hilir [PDF]

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PEMERINTAH KABUPATEN INDRAGIRI HILIR



RSUD TENGKU SULUNG Jalan Penunjang No HP 085220132875 Pulau Kijang Email : [email protected] Kecamatan Reteh – Riau (Diisi oleh Dokter) RESUME MEDIS PASIEN PULANG (Discharge Summary)



Tanggal Masuk : (Admission Date)(Discharge Date) Ruang Rawat Terakhir (Last Ward)  RINGKASAN RIWAYAT PENYAKIT :



Hal. 1/2 Label Identitas Pasien



Tanggal Keluar :



(History of disease summary) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………







PEMERIKSAAN FISIK :







PEMERIKSAAN PENUNJANG :







TERAPI/PENGOBATAN SELAMA DIRUMAH SAKIT :







REAKSI OBAT :



(Physical Findings) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



(Supporting Examination) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



(Therapy/Treatment in Hospital) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



(Bilaya) : NO







DIET :







HASIL KONSULTASI :







DIAGNOSA UTAMA :



NAMA OBAT



MANIFESTASI KLINIS



KETERANGAN



(Diet) …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



(The Results of consultations) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… (Primary diagnosa) ……………………………………………………………………………………………………………………………………………………………ICD10………………………………………………



RM.RI 02/13 Rev 01







DIAGNOSA TAMBAHAN :







TINDAKAN/PROSEDUR/OPERASI :







INSTUKSI PERAWATN LANJUTAN/EDUKASI :



  



Cara Pulang Izin Dokter : Pindah Rumah Sakit : Permintaan Sendiri : Melarikan diri*) Kondisi Saat Pulang Sembuh: Perbaikan: Tidak Sembuh : Meninggal ≤ 48 Jam : Meninggal ≥ 48 Jam Pengobatan dilanjutkan ke : Poli Klinik Rs ……………. Dokter PUSKESMAS……………………………………………… TERAPI PULANG (Take Home therapy)







(Additional diagnosis) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



(Action/Procedur/Surgery) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



(Continued Care Instruction/education) …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



NO







NAMA OBAT



PROCNOSIS : Ad Vitam :



JUMLAH



Ad Bonam



Ad Dalam



DOSIS



Dubia



FREKUENSI



Bonam Dubia Ad



CARA PEMEBERIAN



am



(Prognosis )*) Ad Functionam Ad ) Ad Bonam Ad Malam Dubia Bonam Dubia Malam …………………………………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………………………



8)



Dokter Penanggung Jawab



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