PENGKAJIAN MEDIS
Pemeriksaan Dokter, Pukul :
Subjective :
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Objective :
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Pemeriksaan Penunjang :
EKG
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Radiologi : _____________________________________________________________________
Laboratorium : _____________________________________________________________________
Assessment :
Diagnosa Kerja
Diagnosa Banding
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Nama / Tanda Tangan Dokter
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