Anda di halaman 1dari 1

FORM ILO POST LAPAROTOMI

No Identitas Diagnosis Operasi Tanggal Jenis ILO Komplikasi


Operasi
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................
Superficial/Deep/Organ Dehiscence/Burst/Fistula/lain-
lain : ..................

Anda mungkin juga menyukai