MODUL PRAKTIKUM

ASSESMEN DAN DIAGNOSA FISIOTERAPI

STATUS KLINIK

A. DATA-DATA MEDIS RUMAH SAKIT

a. Diagnosa medis :................................................................................................................
b. Catatan Klinis :................................................................................................................
c. Terapi Umum :

B. PEMERIKSAAN FISIOTERAPI
1. Anamnesis
a. Anamnesis Umum
Nama :................................................................................................................
Umur :........................................................................................(Mgg/Bln/Thn)
Alamat :................................................................................................................
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Jenis kelamin : ( L / P )
Agama :................................................................................................................
Pekerjaan :................................................................................................................
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 :..................................................................................
Denyut Nadi :..................................................................................
Pernapasan :..................................................................................
Temperatur :..................................................................................
b. Inspeksi
Statis :..................................................................................
Dinamis :..................................................................................
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 :................................................................................................................
Quo ad sanam :................................................................................................................
Quo ad fungsionam :................................................................................................................
Quo ad cosmeticam :................................................................................................................

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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