NRM :

RS Ortopedi Prof.Dr.R.Soeharso Surakarta Nama :

Jl. Ahmad Yani, Pabelan, Surakarta 57162 Tanggal Lahir :
Telp: (0271) 714458 Fax: (0271) 714058 (Mohon diisi atau tempelkan stiker jika ada)

Ruang/ Kelas :………………/……

RM 7.1
RESUME PASIEN PULANG

Jenis Kelamin L/P Tgl Masuk : ................ Tgl Keluar : ...............

HARUS LENGKAP APABILA PASIEN PULANG

1. Diagnosa Masuk : ..................................................................................................................

2. Indikasi pasien dirawat :………………………………………………………………………

3. Diagnosa Akhir : ..................................................................................................................

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4. Riwayat Penyakit : ..................................................................................................................

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5. Konsultasi : ..................................................................................................................

6. Perkembangan Perawatan : ......................................................................................................

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7. Tindakan Operasi : ..................................................................................................................

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8. Pemeriksaan fisik/penunjang:………………………………………………………………...

9. Keadaan Waktu Keluar : .........................................................................................................

10. Prognosa : ..................................................................................................................

11. Tindakan Lanjut : ..................................................................................................................

12. Pengobatan :………………………………………………………………………….

Surakarta, ..............................................
Dokter

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NIP. .....................................................
NB : Dibuat rangkap 2 (1 untuk pasien, 1 untuk arsip)