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PEMERINTAH KABUPATEN MALANG

DINAS KESEHATAN
UPT PUSKESMAS NGAJUM
Jl. Ahmad Yani No. 18 NgajumTelp: (0341)398100
Email: puskesmasngajum@gmail.com
MALANG- 65164

RESUME MEDIK
Nama : ..................................................
Umur : ..................................................
Jenis Kelamin : ..................................................
Alamat : ..................................................
MRS : ...................................................
KRS : ...................................................
Dokter yang merawat :
I. ANAMNESE
II. PEMERIKSAAN FISIK
Tensi : ...................................................
Nadi : ...................................................
Suhu : ...................................................
Respirasi : ...................................................
III. PEMERIKSAAN PENUNJANG
Laborat : ...................................................
IV. DIAGNOSA : ...................................................
V. THERAPY : ...................................................
VI. PROGNOSA : ...................................................
VII. KEADAAN LUAR
Sembuh : ...................................................
Berobat Jalan : ...................................................
Rujuk : ...................................................
Pulang Paksa : ...................................................
VIII. SARAN : ...................................................