JENIS

NO NAMA REG KELAMI TTL USIA ALAMAT

N

Nasifah 70 p 18/07/1956 62 Granting II/38

1 Ny.Hj.Sutrialin Hatta 36 p 4/24/1939 79 Pumpungan V /48
2 Bpk. Moh Hadi 51 L 6/10/1948 70 Pumpungan IV / 22A
3 Ny. Siti Chalimah 44 P 5/5/1958 60 Pumpungan III / 57
4 Ny. Suharti 37 P 9/5/1953 65 Pumpungan IV / 32
5 Ny. Chaidaroh 42 P 5/3/1953 65 Pumpungan V/56
6 Ny.Siti Maslichah 50 P 12/5/1957 60 Pumpungan IV / 46
7 Ny.Sumi 41 P 6/27/1958 60 Pumpungan V/56
8 Ny.Istiqomah 34 P 6/10/1958 60 Manyar 69
9 H.Abd Djalin 39 L 9/5/1938 80 Pumpungan II/2
10 Ny.Widji Utami 43 P 6/20/1957 61 Pumpungan III / 57
11 Bpk.Sarwono 38 L 4/1/1943 75 Manyar 91A
12 Ny.Samrati 30 P 1/29/1958 60 Pumpungan IV/66C
13 Ny.Sukesi 33 P 60 Pumpungan IV/70
14 Ny.Saiyah 35 P 6/5/1958 60 Pumpungan IV/7i
15 Ny. Fauziah 31 P 4/22/1955 63 Pumpungan IV/ 76
16 Ny.Kahlas 28 P 6/30/1958 60 Pumpungan IV/17
17 Ny. Naimah 32 P 68 Pumpungan II / 55
18 Ny. Mistin 25 P 60 Manyar 39
19 Ny.Sri Sunarsih 27 P 6/15/1948 70 Pumpungan I/25
20 Ny. Indrati 29 P 11/10/1957 61 Pumpungan IV/18
21 Ny. Sukijah P 60 Pumpungan I/15
22 Ny.Rohai 24 P 8/13/1954 64 Pumpungan II/33
23 Ny. Cholifah 20 P 12/28/1955 62 pumpungan II/23
24 Ny. Sri Hani 21 P 11/27/1957 61 pumpungan /8
25 Ny Dewi Aminah 14 P 7/15/1951 67 Pumpungan IV/52
26 Ny. Baksum 18 P 31/09/1940 77 Pumpungan V/70
27 Ny. Suwarni 15 P 10/10/1955 63 Pumpungan IV/52
28 Ny. Maskanah 22 P 7/7/1951 67 pumpungan III/35
29 Ny. Nanik Demawasi 23 P 8/28/1957 61 Pumpungan IV/ 18
30 Ny.Nasila 19 P 6/20/1955 63 Pumpungan V/25
31 Ny.Kunah 13 P 1/1/1947 71
32 Tn. Sukamo 12 L 2/22/1943 75 Pumpungan IV/32
33 Bpk. Hajar fatoni 9 L 9/19/1952 66 Pumpungan IV/52
34 Ny. Niamah 11 P 7/21/1954 64 Pumpungan IV/62G
35 Ny. Sulika 6 P 8/16/1953 65 Pumpungan IV/88
36 Bu Luluk Helena 5 P 12/12/1957 60 Pumpungan I/25B
37 Ny. Nurhatiah 3 P 11/23/1943 75 Pumpungan IV/37
38 Bpk. Amari 10 L 1/14/1950 68 Pumpungan IV/ 62A
39 Bpk.Sabar 1 L 2/16/1957 61 Pumpungan V/ 32
40 B.Mudjinab 7 P 4/1/1905 100 Pumpungan IV/24
41 Ny.Sri Soemekti 4 P 4/3/1948 70 Pumpungan IV/22
42 Tn.Slamet Sariyono 2 L 9/28/1941 77 Pumpungan IV/37
43 Sri Supati 16 P 12/16/1957 60 Pumpungan IV/26
44 Bpk.Sansuri 8 L 6/30/1955 63 Pumpungan IV/ 66
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
118
 DATA DASAR

USIA JUMLAH JUMLAH

NAMA PASANGAN
PASANGAN ANAK CUCU TEMPAT TINGGAL STATUS PENDIDIKA
TINGGAL SERUMAH MARITAL N

Suparno 65 4 8 4 2 1 4
H.HM. Hatta Hatmuji Ruslan 106 3 10 1 1 2 7
Ny. Sri Sumarti 69 4 15 1 1 1 5
Alm Suwarno 50 5 7 1 6 2 4
Alm 7 10 1 6 2 5
Urip Santoso 56 5 7 1 1 1 3
Tn. Abdullah Musa 68 4 4 1 8 1 4
Bp. Kadimin 65 4 13 1 5 1 3
H. Abdurrohman 64 4 4 1 6 1 4
Ny….. 8 23 1 4 1 3
M. Jupri 61 3 3 1 4 4 2
Ny.salonoh 60 3 8 1 1 2 4
Alm 3 2 1 4 2 4
Alm 3 6 4 1 2 3
Alm Subandi 55 3 3 1 6 2 3
Alm 2 5 1 3 2 6
Iksan 48 3 3 1 7 2 3
Bpk. Tsun 5 1 1 1 2 1
Bpk. Romli 65 3 5 1 1 3 1
Sungkono 4 2 1 5 1 4
Alm 4 6 1 2 2 4
Bpk. Prayitno 62 4 1 1 6 1 3
Rohani 51 3 4 4 2 4
2 4 1 1 2 3
Edi Lestantiyo 42 2 3 1 6 2 5
1 0 1 2 2 3
Baksum 3 7 1 6 2 4
Bpk. H . Hajar fathoni 64 3 4 1 3 1 5
3 4 1 1 2 5
Pongwidjojo 60 4 5 1 1 2 3
Bpk. Kholis 59 7 15 1 4 1 5
Bpk.Soekara 74 5 13 1 3 1 3
konah 70 5 14 1 4 1 4
Ibu Suwarningsih 62 5 11 1 3 1 5
Tn. Amozi 67 4 5 1 6 1 4
Salamun 65 4 11 2 2 1 3
4 4 4 2 2 4 1
Slamet Sunartono 6 11 1 1 1 7 3
Ibu Namiah 58 4 5 1 4 1 3
 Ibu Siyam 75 6 17 1 3 1 4
4 15 1 1 2 1
Muhammad Hadi 70 5 15 1 4 1 5
Nurlailah 74 6 11 1 1 1 7
Faturahman 5 12 1 4 2 5 2
Jamira 55 2 4 1 4 1 3
DATA DASAR DATA FUNGSIONAL

PENANGGU
PENGHASIL PEKERJAA PEKERJAA KECUKUPA NAIK NYERI
NG BIAYA BERJALAN OLAHRAGA RIW JATUH
AN N DULU N SKRG N HIDUP TANGGA TULANG
HIDUP

1 2 2 2 2 1 1 2 1 1
3 4 1 3 3 1 2 1 1 2
4 4 4 3 1 2 2 2 2
1 1 1 3 3 1 2 2 1 1
1 1 3 3 3 1 2 2 2 1
1 1 1 3 3 1 2 2 2 1
3 1 1 3 3 1 2 2 1 1
1 1 1 3 3 1 2 2 2 2
2 1 1 3 3 1 2 1 1 1
1 1 1 3 3 1 2 1 1 1
4 1 1 3 3 1 1 2 1 1
3 2 1 3 3 1 2 2 1 1
1 1 1 3 3 1 2 2 2 1
1 6 1 3 3 2 1 1 2 1
1 1 2 1 3 1 2 2 1 1
1 1 1 2 3 1 2 2 1 1
2 1 3 3 1 2 1 1 1
2 1 2 1 3 1 2 2 1 1
3 1 3 3 1 2 2 1 1 1
1 4 2 2 1 2 2 1
1 3 5 2 3 1 2 1 2 1
1 1 1 3 3 1 2 2 2 1
3 2 2 3 3 1 2 1 1
1 1 1 2 3 1 2 1 2 1
2 1 4 1 3 1 2 2 1 1
1 1 1 1 4 3 2 2 1
2 2 1 3 3 1 1 1 1 1
1 6 1 1 3 1 2 2 2 1
1 1 1 4 3 1 1 2 2 1
1 2 2 1 3 1 2 2 1 1
2 3 2 1 4 1 2 2 1 1
1 1 1 3 3 1 2 1 2 1
2 4 4 1 2 1 2 2 1 1
1 2 2 1 3 1 2 2 2 1
1 1 3 3 1 2 2 1 1 1
1 2 2 1 3 1 2 2 1 1
6 5 2 3 1 2 2 2 1 1
1 1 4 3 1 2 1 1 1 2
1 3 1 2 3 1 2 1 1 1
1 1 5 1 3 1 2 1 2 2
1 6 1 3 3 1 2 1 1 1
1 2 1 4 3 1 2 1 1 1
3 4 1 4 3 2 2 2 1 1
2 2 1 3 1 2 2 1 1 1
1 3 5 2 3 1 2 2 1 1
A FUNGSIONAL ABBREVATED

RIW
OBAT-
RIW RIW OBAT OBATAN/JAMU/SUPLEMEN
RIW VIT D UMUR WAKTU ALAMAT TAHUN
OPNAME FRAKTUR /JAMU /
SUPLEMEN

1 1 1 2 simvastatin, allopurinol, nifedipin 1 1 1 1

2 2 1 2 B12,Tab,1x1 1 1 1 1
2 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1
1 1 1 2 Bcomp,analgesik 1 1 1 1
1 1 1 2 Obat diabet,Susu diabetasol 1 1 1 1
2 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
2 1 1 2 1 1 1 1
1 1 1 2 Dancow 1 1 1 1
2 1 1 2 susu Anline 1 1 1 1
2 1 1 2 1 1 1 1
2 1 1 1 1 1 1 1
2 1 1 2 susu eterasol 1 1 1 1
2 1 1 2 1 1 1 1
2 1 1 1 0 0 0 0
1 1 1 1 1 1 1 1
1 1 1 1 0 0 0 0
2 1 1 2 Mylanta 1 1 1 1
1 1 1 1 1 1 1 1
2 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 2 allopurinol , vit B complex 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 susu eterasol 1 1 1 1
1 1 1 1 1 1 1 1
2 1 1 2 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 2 susu Anline 1 1 1 1
1 1 1 2 obat sakit paru-paru 1 1 1 1
1 1 1 2 sakatonic, hemaviton 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 2 amodipin 1 1 1 1
1 1 1 2 vit c, alineprol 1 1 1 1
1 1 1 2 antangin tablet 1 1 1 1
2 1 1 2 ISDN,VITSON 1 1 1 1
2 1 1 2 vitamin 1 1 1 1
2 1 1 2 captopril, Betahistin 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 2 hasabi sauda 1 1 1 1
2 1 1 2 1 1 1 1
1 1 1 2 vitamin 1 1 1 1
1 1 1 1 1 1 1 1
ABBREVATED MENTAL TEST (AMT)

KENAL TAHUN KEPALA/LEHER

TAHUN NAMA HITUNG TOTAL
TEMPAT ORANG
MERDEKA PRESIDEN
LAHIR
TERBALIK
AFEKSI
SKOR TENSI NADI RR
LAIN ANAK
ANEMIS

1 1 1 1 1 1 A 10 155/75 100 20
1 1 1 1 0 1 A 9 150/100 98 dbn dbn
1 1 1 1 1 1 A 10 120/80 82 16 -/-
1 1 1 1 0 1 A 9 110/70 80 dbn dbn
1 1 1 1 1 1 A 10 130/80 82 12 dbn
1 1 1 1 1 1 A 10 120/70 82 16 dbn
1 1 1 1 1 1 A 10 140/80 88 dbn dbn
1 1 1 1 1 1 A 10 150/80 82 16 dbn
1 1 1 1 1 1 A 10 140/90 96 dbn dbn
1 1 1 1 1 1 A 10 130/70 18
1 1 1 1 1 1 A 10 110/80 88 dbn dbn
1 1 1 1 1 1 A 10 120/80 80 dbn dbn
1 1 1 1 1 1 A 10 110/70 72 15 -/-
1 1 1 1 0 0 A 8 120/70 16 -/-
1 1 1 1 0 1 A 9 120/80 76 dbn dbn
1 1 1 1 1 1 A 10 120/70 80 dbn dbn
0 0 0 0 0 0 A 0 140/80 76 dbn dbn
1 1 1 1 1 1 A 10 150/80 88 dbn dbn
0 0 0 0 0 0 0 130/80 70 dbn dbn
1 1 1 1 1 1 A 10 110/70 80 dbn dbn
1 1 1 1 1 1 A 10 120/70 70 dbn dbn
1 1 1 1 1 1 A 10 130/80 80 dbn dbn
1 1 1 1 1 1 A 10 130/80 80 dbn dbn
1 1 1 1 1 1 A 10 130/70 70 dbn dbn
1 1 1 1 1 1 A 10 110/70 80 dbn dbn
1 1 1 1 1 1 A 10 140/80 14 dbn
1 1 1 1 1 1 A 10 120/70 96 dbn dbn
1 1 1 1 1 1 A 10 180/110 80 dbn dbn
1 1 1 1 1 1 A 10 120/80 80 19 dbn
1 1 1 1 1 1 A 10 120/70 80 dbn dbn
1 1 1 1 1 1 A 10 130/90 80 dbn dbn
1 1 1 1 1 1 A 10 120/70 76 dbn dbn
1 1 1 1 1 1 A 10 110/70 dbn dbn
1 1 1 1 1 1 A 10 120/80 80 dbn dbn
1 1 1 1 1 1 A 10 160/90 dbn dbn dbn
1 1 1 1 1 1 A 10 140/80 88 dbn dbn
1 1 1 1 1 1 A 10 140/80 85 dbn dbn
1 1 1 1 1 1 A 10 120/80 88 dbn dbn
1 1 1 1 1 1 A 10 120/80 75 dbn dbn
1 1 1 1 1 1 A 10 130/70 76 dbn dbn
1 1 1 1 1 1 A 10 120/70 70 dbn dbn
1 1 1 1 1 1 A 10 140/70 100 28 dbn
1 1 1 1 1 1 A 10 140/90 96 24 dbn
1 1 1 1 1 1 A 10 120/80 80 dbn dbn
1 1 1 1 1 1 A 10 160/90 80 14 dbn
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 PEMERIKSAAN FISIK DASAR

KEPALA/LEHER THORAX ABDO

SPIDER GINEKO FLAT / CAPUT

IKTERIK SIANOSIS DYSPNE SIMETRIS RETRAKSI COR PULMO LAIN2
NEVI MASTI BUNCIT MEDUSA

dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
-/- - - +/+ -/- - -
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn

dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
-/- - - +/+ dbn dbn dbn dbn dbn dbn dbn dbn
-/- - - dbn -/- dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
AN FISIK DASAR

ABDOMEN EKSTREMITAS

V SUPEL / HANGAT/ MERAH/ ERITEMA ULKUS/G

ASCITES HEPAR LIEN LAIN2 EDEMA
KOLATERAL TEGANG KERING PUCAT PALMARIS ANGREN

dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
Supel hangat Merah edemi -/- - -
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn hangat Merah edemi -/- - -
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn

dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn Supel ttb dbn dbn hangat merah dbn dbn dbn
- dbn - dbn dbn dbn hangat merah -/- - -
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn supel dbn dbn dbn hangat merah dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn supel dbn dbn dbn hangat merah dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn hangat merah dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn dbn
TAS

MOTORIK LAIN2

dbn dbn

dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn

dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
dbn dbn
 JENIS
NO NAMA REG
KELAMIN
TTL USIA ALAMAT

70 p 18/07/1956 62 Granting II/38

 DATA DASAR
USIA
NAMA JUMLAH JUMLAH
PASANGA
PASANGAN ANAK CUCU TEMPAT TINGGAL STATUS PENGHASILA PEKERJAAN
N PENDIDIKAN
TINGGAL SERUMAH MARITAL N DULU

Suparno 65 4 8 4 2 1 4 1 2
AR DATA FUNGSIONAL

PENANGGUN
PEKERJAAN KECUKUPAN NYERI RIW
G BIAYA BERJALAN OLAHRAGA NAIK TANGGA RIW JATUH RIW OPNAME
SKRG HIDUP TULANG FRAKTUR
HIDUP

2 2 2 1 1 2 1 1 1 1
 ABBREVATED MENT

RIW OBAT OBAT-OBATAN/JAMU/SUPLEMEN

RIW VIT D /JAMU / UMUR WAKTU ALAMAT TAHUN TEMPAT
SUPLEMEN

1 2 simvastatin, allopurinol, nifedipin 1 1 1 1 1

ABBREVATED MENTAL TEST (AMT)

KENAL TAHUN NAMA TAHUN LAHIR HITUNG

ORANG LAIN MERDEKA PRESIDEN ANAK TERBALIK
AFEKSI TOTAL SKOR TENSI NADI RR

1 1 1 1 1 A 10 155/75 100 20
 PEMERIKSAAN FIS

KEPALA/LEHER THORAX

GINEKOMAST
ANEMIS IKTERIK SIANOSIS DYSPNE SIMETRIS RETRAKSI SPIDER NEVI COR PULMO
I
PEMERIKSAAN FISIK DASAR

ABDOMEN E

CAPUT SUPEL / HANGAT/

LAIN2 FLAT / BUNCIT V KOLATERAL ASCITES HEPAR LIEN LAIN2
MEDUSA TEGANG KERING
 EKSTREMITAS

MERAH/ ERITEMA ULKUS/GANG

EDEMA MOTORIK LAIN2
PUCAT PALMARIS REN