CLINICAL PATHWAY DAN SISTEM DRGs CASEMIX

BAGIAN/SMF ILMU KESEHATAN ANAK

FAK. KEDOKTERAN UNS/RSUD. Dr. MOEWARDI SURAKARTA
KOLESTASIS
2012
Nama Pasien:
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Diangnosis: Kolestasis
R. Rawat
Aktivitas Pelayanan

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HR 1-3
Hari Sakit

Diangnosis:
n Penyakit Utama
n Penyakit Penyerta
n Komplikasi
Assesmen Klinis:
n Pemeriksaan dokter
n Konsultasi
Pemeriksaan Penunjang:

(+)

Umur:
Berat Badan:
Tinggi Badan:
Nomor Rekam Medis:
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..........................kg
..................................cm
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Kode ICD 10: K71.0...........................................................
Rencana rawat :
Tgl/Jam masuk:
Tgl/Jam keluar:
Lama Rawat
Kelas:
Tarif/hr (Rp):
............................
.............................
......................hari
............... ...........................
HR 4-6
HR 7-9
HR 10-12
HR 13-14
Hari Sakit
Hari Sakit
Hari Sakit
Hari Sakit

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(-)
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(+)/(-)
(+)/(-)
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(+)/(-)
(+)/(-)
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(+)/(-)
(+)/(-)
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(+)/(-)
(+)/(-)
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(+)/(-)
(+)/(-)

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(+)/(-)
(+)/(-)
(+)/(-)
(+)/(-)
Gizi dan Imunisasi

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Kolestasis

Kode ICD 10
K71.0

Tindakan:
Obat-obatan:
n Vitamin D (calsitriol) 0,05-0,2 g/kgBB/hari
n Vitamin E 25-200 IU/kgBB/hari
(+)/(-)
n Asam Ursodeoksikolat (Urdafack)
(+)/(-)
Nutrisi:
Mobilisasi:
Hasil (Outcome):
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n BB/TB
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n Ststus neurologis
n Perkembangan
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Pendidikan/Rencana
(+)/(-)
Pemulangan:
(+)/(-)
Varians:
Penjelasan Penyakit
Jumlah Biaya
Jumlah Biaya
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Nama Perawat:
...........................................
Diagnosis Akhir:
n Utama
Nama Dokter:
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n Penyerta
Nama Pelaksana Verifikasi:
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n Komplikasi

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(+)/(-)
(+)/(-)
Kontrol poliklinik

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Jenis Tindakan:
n Visite/Konsul: Anamnesis & PF

....................................... Feses Rutin

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....................................... n Pemasangan IVFD, Inj. Obat
....................................... n Oksigen

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Nomor Rekam Medis:

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rawat :
Biaya (Rp)
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Kode ICD 9 - CM