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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 :……………………………………………………………………......................
Data Subyektif : ……………………………………………………………………………..........
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Daftar Masalah :
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Perencanaan Selanjutnya : ..............................................................................................................
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Tanggal kontrol (periksa) kembali pasca perawatan : ......................................................................

Jakarta, ......................................................................

PPDS : ............................................................. DPJP : ………………………………….............

JJE-CMBM-20081225