PEMERINTAH KOTA MALANG

D I N AS K E S E H ATAN
UPT PUSKESMAS RAWAT JALAN PANDANWANGI
Puskesmas Jalan Laksda Adi Sucipto No. 315 Kecamatan Blimbing
Pandanwangi

RESUME MEDIS PASIEN KEGAWATAN

Nomor Rekam Medis: Tanggal Masuk:

Nama Pasien: Jenis Kelamin:

Tanggal Lahir: Umur:

Keluhan Sewaktu
Masuk:______________________________________________________________________________
Ringkasan Riwayat Penyakit: -
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Pemeriksaan Fisik: Kesadaran :_____________ TD: N:
RR: __________________________________________________________________________________-
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Pemeriksaan Penunjung/ Diagnostik Terpenting:
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Terapi/Pengobatan Yang telah diberikan: -

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Diagnosis Sementara:
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Terima kasih
Salam Sejawat
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