STATUS PASIEN

Nama
Umur
Jenis kelamin
Alamat
No CM
Tanggal Masuk
ANAMNESA
Keluhan Utama
Telaah

Riw.Peny. Dahulu
Riw. Peny. Keluarga
Riw. Peng. Obat

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PEMERIKSAAN FISIK
Status Kesadaran
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Vital Sign
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Nadi : ............................................................................................
Suhu : ............................................................................................
RR
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Status Lokalisata
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Kepala
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Leher
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Thoraks

Abdomen

\
Ekstremitas

Genetalia

Pem. Penunjang

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Laboratorium

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Diagnosis banding

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Diagnosis Kerja

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Terapi

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FOLLOW UP

Tanggal

Perjalanan Penyakit

FOLLOW UP

Perintah Dan Pengobatan

Yang Di Berikan

Tanggal

Perjalanan Penyakit

FOLLOW UP

Perintah Dan Pengobatan

Yang Di Berikan

Tanggal

Perjalanan Penyakit

Perintah Dan Pengobatan

Yang Di Berikan

Dokter Muda

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