MODUL PRAKTIKUM

ASSESMEN DAN DIAGNOSA FISIOTERAPI

STATUS KLINIK
A. DATA-DATA MEDIS RUMAH SAKIT
a. Diagnosa medis
b. Catatan Klinis
c. Terapi Umum

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B. PEMERIKSAAN FISIOTERAPI
1. Anamnesis
a. Anamnesis Umum
Nama

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Umur

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Alamat

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Jenis kelamin : ( L / P )
Agama

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Pekerjaan

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b. Anamnesis Khusus
Keluhan Utama

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Riwayat penyakit

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Riwayat penyakit dahulu :.............................................................................................

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Riwayat penyakit penyerta :.............................................................................................
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c. Anamnesis Sistem

1) Musculoskeletal
2) Kardiovaskuler
3) Respirasi
4) Neuromuscular
2. Pemeriksaan Fisik
a. Vital Sign
Tekanan Darah

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Denyut Nadi
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Pernapasan
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Temperatur
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b. Inspeksi
Statis
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Dinamis
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3. Pemeriksaan Spesifik
a. MMT
b. Tes Tonus otot :
c. Tes Keseimbangan
d. Pengukuran Nyeri
e. Tes Koordinasi
f. Tes Apresiasi Reaksi :
g. Tes sensorik :
h. Tes Reflek
i. Tes Rasa Posisi
j. Tes Transfer
k. Tes ADL
4. Kognitif,intrapersonal, dan interpersonal
Kognitif

Intrapersonal

Interpersonal

C. DIAGNOSIS FISIOTERAPI :..............................................................................................

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D. PROBLEMATIK FT

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E. PROGRAM RENCANA TINDAKAN FISIOTERAPI

1. Tujuan jangka panjang
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2. Tujuan jangka pendek:..
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F. INTERVENSI FISIOTERAPI

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G. PROGNOSIS
Quo ad vitam

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Quo ad sanam

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Quo ad fungsionam

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Quo ad cosmeticam

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H. EVALUASI
1) Evaluasi sesaat

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2) Evaluasi berkala :
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I. HASIL TERAPI AKHIR
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J. HOME PROGRAM

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K. UNDERLIYING PROCESS

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