Intervensi Fisio.docx

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PEMERINTAH KOTA PROBOLINGGO DINAS KESEHATAN

UPT PUSKESMAS KETAPANG Jalan Raya Bromo 1 B Ketapang PROBOLINGGO – 67222 No Telp. (0335) 425224 email : [email protected]

INTERVENSI DAN MONITORING FISIOTERAPI (berdasarkan PMK No 65 Th 2015 ttg Standar Pelayanan Fisioterapi)

NO REKAM MEDIS

:

........................................TANGGAL......................

NAMA PASIEN/UMUR/JENIS KELAMIN

:

...............................................................................

ALAMAT/TELP

:

............................................................................... Perkembangan

No.

Tgl

Tindakan

(S=Subyektif; O=Obyektif; A=Asesmen; R=Rencana.) S:

O:

A:

R:

Paraf

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