PEMERINTAH KABUPATEN BARRU

DINAS KESEHATAN
UPTD KESEHATAN PUSKESMAS PEKKAE
Jl. Sultan Hasanuddin No. 52 Pekkae Kec. Tanete Rilau Kab. Ba

RESUME MEDIS NRM :

NAMA PASIEN : UMUR : JENIS KELAMIN : L / P

TANGGAL MASUK : TANGGAL KELUAR : NO. KARTU PESERTA

JAM : JAM :
Penanggung Pembayaran

Ringkasan Riwayat Penyakit : ................................................................................................................

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Pemeriksaan Fisik : ................................................................................................................
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Pemeriksaan Penunjang / : ................................................................................................................
Diagnosa Terpenting
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Diagnosa Utama : ................................................................................................................
Diagnosa Sekunder : ................................................................................................................
Tindakan / Prosedur : ................................................................................................................
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Kondisi Waktu Keluar : 1. Sembuh 2. Pindah RS
Pengobatan dilanjutkan : Puskesmas

Terapi Pulang
Nama Obat Jumlah
KAE
b. Barru 90761

ALAMAT :

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3. PAPS 4. Meninggal
Rumah Sakit

Dosis
Pekkae, ............................... 201
Dokter Penanggung Jawab Pelayanan