RSPAD GATOT SOEBROTO DITKESAD DEPARTEMEN OBSTETRI GINEKOLOGI Jl. Abdurachman Salen no 24 Jakarta 10410
RESUME MEDIK STATUS CMBM OBGIN Nama Pasien : ………………………………………… Nomor CM : ……………………………… Umur : ………………………………………… Tgl Masuk : ……………………………... Nama Suami : ………………………………………… Tgl Keluar : ……………………………… Diagnosis masuk : .................................................................................................................. Diagnosis Keluar
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Data Subyektif
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........................................................................................................................................................... Data Obyektif : ……………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… Daftar Masalah : 1. …………………………………………………………………………………………………………….. 2. …………………………………………………………………………………………………………….. 3........................................................................................................................................................ 4. ...................................................................................................................................................... Penanganan : …………………………………………………………………………….......................... ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… Perencanaan Selanjutnya : .............................................................................................................. ........................................................................................................................................................... ........................................................................................................................................................... ........................................................................................................................................................... ........................................................................................................................................................... ........................................................................................................................................................... Tanggal kontrol (periksa) kembali pasca perawatan : ...................................................................... Jakarta, ......................................................................
PPDS : ............................................................. DPJP
JJE-CMBM-20081225
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