Resume Klinis Pasien Rujukan.docx

PEMERINTAH KOTA BATAM DINAS KESEHATAN

UPT PUSKESMAS KAMPUNG JABI Jalan Hang Kesturi, Kel Batu Besar, Kec Nongsa, Kota Batam Telp (0778) 710076, e-mail : [email protected]

RESUME KLINIS PASIEN RUJUKAN I. IDENTITAS PASIEN a. Nama Pasien :....................................................... b. Umur :....................................................... c. Jenis Kelamin :....................................................... d. Alamat :....................................................... e. Jaminan :....................................................... II. KELUHAN UTAMA PASIEN ……………………………………………………………………………………………… ……………………………………………………………………………………................ III. PEMERIKSAAN FISIK a. Keadaan Umum : ........................................................................................................ b. GCS : ........................................................................................................ c. Tanda-Tanda Vital :  Tekanan Darah : ..................................................  Nadi : ..................................................  Pernafasan : ..................................................  Suhu : .................................................. d. Kelainan yang Bermasalah : ........................................................................................... IV. DIAGNOSA ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... V. TINDAKAN YANG TELAH DILAKUKAN ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... VI. TERAPI YANG TELAH DIBERIKAN ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... VII. ALASAN DIRUJUK ............................................................................................................................................... Dokter yang merujuk

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