R. Rawat
Aktivitas Pelayanan
.
Admisi
IGD
Diagnosis:
Penyakit Utama
Penyakit Penyerta
Komplikasi
Asessmen Klinis:
Pemeriksaan dokter
Konsultasi
Pemeriksaan Penunjang:
ntgen dada
IRJ
Umur:
Berat Badan:
..kg
Kode ICD 10 : S.22.5
Tgl/Jam masuk:
.
Hari Rawat 1
Tinggi Badan:
Nomor Rekam Medis:
..cm
.
Rencana rawat : 5 hari
Tgl/Jam keluar:
Lama Rwt
.
... hari
Rawat Inap
Hari Rawat 2
Hari Rawat 3
Kelas:
..
Tarif/hr (Rp):
.
Hari Rawat 4
Hari Rawat 5
Biaya (Rp)
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
..
Ro
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
..
..
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
..
Tindakan::
Int
ernal fixasi (SHAPP
plate)
Obat Obatan::
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
+/+/+/+/+/+/-
..
+/+/+/+/-
+/+/+/+/-
+/+/+/+/-
+/+/+/+/-
+/+/+/+/-
+/+/+/+/-
+/+/+/+/-
..
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
..
Mobilisasi::
+/-
+/-
+/-
+/-
+/-
+/-
+/-
..
Hasil (Outcome):
..
..
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
+/+/-
1.
2.
3.
Ciprofloxacin
3X500 mg
Metronidazole
3X500 mg
Paracetamol
3X500 mg
.
Pembuisan Umum Injeksi:
.
Pembiusan Regional/Lokal:
Nutrisi::
1500 .kkal/hari
Protein 100 .gram/hari
..
Pendidikan/Promosi
Kesehatan/Rencana
Pemulangan:
.
Varians:
Perawat (PPJP)
DPJP Admisi:
..
DPJP:
DPJP Operasi:
.
DPJP
Anestesi ...............
..............
Verifikator:
+/-
+/-
+/-
+/-
+/-
+/-
+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
+/+/+/-
..
..
Diagnosis Akhir:
Kode ICD 10
Utama
..
Penyerta
Komplikasi
..
....
...
Jenis Tindakan:
Jumlah Biaya
..
Kode ICD 9 CM
..
..
...
.
.
.
.