/2016
Jl. kendung no. 115 – 117 Surabaya
Telp. (031) 7409135
ASSESMENT AWAL PASIEN THT
A. ANAMNESA
Keluhan Utama : ........................................................................................................................... ...........................................................................
Riwayat Penyakit Sekarang :
..................................................................................................................................................... ...................................................................................
............................................................................................................................................................................. ...........................................................
Riwayat Penyakit Dahulu : .......................................................................................................................................................................... .................
Riwayat Penyakit Keluarga: ...................................................................................... ....................................................................................................
Riwayat Pekerjaan: .......................................................................................................... ..............................................................................................
B. PEMERIKSAAN FISIK
Keadaan Umum : ............................................................................................................ .............................................................................................
Kepala/Leher : Anemis ikterik sianosis dipsnea Pembesaran KGB Lain-lain,...............................................................................
Thoraks : Simetris Asimetris
- Cor : Normal Murmur Besar Lain-lain,...............................................................................................................................
- Pulmo : Normal Rhonki Wheezing Lain-lain,..........................................................................................................................
Abdomen : Normal Distensi Meteorismus Peristaltik,...................................................................................................................
- Hepar : Normal Membesar Nyeri tekan
- Lien : Normal Membesar Lain-lain,............................................................................................................................ ..............
Ekstremitas : Normal Dingin Edema Lain-lain,.............................................................................................................................
Genitalia : Normal Tidak normal, sebutkan....................................................................................................... ....................................
C. STATUS LOKALIS
Telinga : a. MAE :
b. MT :
b. Konka :
Tenggorokan : a. Faring :
b. Tonsil :
D. PEMERIKSAAN PENUNJANG
Radiologi :.......................................................................................................... ..................................
Laboratorium : ............................................................................................................................................
Lain-lain :...................................................................................................................................... ......
E. DIAGNOSA SEMENTARA
F. RENCANA TERAPI
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