KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN

FAKULTAS KEDOKTERAN UNIVERSITAS PATTIMURA

Bag./SMF Ilmu Kesehatan Kulit dan Kelamin FK-UNPATTI/RSUD dr. M. Haulussy

STATUS PENDERITA

DIAGNOSIS : _______________________________________________

NAMA : Stazia Noija

NIM : 2016 84 024
PEMBIMBING : dr. Fitri Kadarsih Bandjar, Sp.KK
1. Nama : _______________________________________________________________________
Umur : _______________________________________________________________________
Alamat : _______________________________________________________________________
Status Perkawinan : _______________________________________________________________________
Tgl. Masuk RS/Klinik : _______________________________________________________________________

2. Anamnesis : Autoanamnesis/ Heteroanamnesis

Keluhan Utama : _______________________________________________________________________
Anamnesis Terpimpin : _______________________________________________________________________
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3. Status Presens
Keadaan Umum : Sakit (Ringan/Sedang/Berat) ; Kesadaran : _____________________
Gizi (Kurang/Cukup/Baik) ; Higiene (Buruk/Sedang/Baik)
Tanda vital : Tensi _________________ mmHg ; Nadi ________________ x/menit
Pernapasan _____________ x/menit ; Suhu ______________ C
Kepala : * Sclera : icterus ( +/ - )
* Konjunctiva : anemia ( +/ - )
* Bibir : sianosis ( +/ - )
Jantung/Paru : _______________________________________________________________________
Abdomen : _______________________________________________________________________
Ekstremitas : _______________________________________________________________________
Kelenjar Limfa : _______________________________________________________________________

4. Status Lokalis : Kepala, Wajah, Dada, Punggung, Bokong, Genitalia, Ekstremitas

(superior/inferior)
5. Status Dermato-Venereologi
Lokasi : _______________________________________________________________________
Ukuran : _______________________________________________________________________
Efloresensi : _______________________________________________________________________

6. Laboratorium
Kerokan : _______________________________________________________________________
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Dan lain-lain : _______________________________________________________________________
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7. Resume : _______________________________________________________________________
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8. Diagnosis Banding : _______________________________________________________________________

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9. Diagnosis : _______________________________________________________________________

10. Diskusi : _______________________________________________________________________

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11. Anjuran Pemeriksaan : _______________________________________________________________________

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12. Terapi
Sistemik : _______________________________________________________________________
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Topikal : _______________________________________________________________________
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13. Prognosis : _______________________________________________________________________

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14. Anjuran : _______________________________________________________________________

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Pembimbing

dr. Fitri Kadarsih Bandjar, Sp.KK

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