BORANG SARINGAN KECEMASAN/MEDIKAL

JPAM DAERAH HULU LANGAT

Tarikh : ____________________
Masa : ___________ HRS

Nama pesakit :
___________________________________________________

Umur : __________ y.o.

Jantina :M/F
BORANG SARINGAN KECEMASAN/MEDIKAL
Bangsa : M / C / I / Lain-lain : _________________
JPAM DAERAH HULU LANGAT
IC/Passport : ______________________________

C/O : Tarikh : ____________________

____________________________________________________________ Masa : ___________ HRS
__

Vital sign : Bp - ______ /_____ Pr - _______ Temp -_______ Nama pesakit :

Dxt - _________ ___________________________________________________
SPO2 - _________ Umur : __________ y.o.

O/E : Jantina :M/F

Bangsa : M / C / I / Lain-lain : _________________

IC/Passport : ______________________________

C/O :
____________________________________________________________
__
Vital sign : Bp - ______ /_____ Pr - _______ Temp -_______
Dxt - _________

SPO2 - _________

O/E :