Format Resume
1. IDENTITAS
a. Biodata Pasien
Nama : ………………………………………………....................
Jenis Kelamin : ………………………………………………....................
Umur : ………………………………………………....................
Agama : ………………………………………………....................
Suku Bangsa : ………………………………………………....................
Pendidikan : ………………………………………………....................
Pekerjaan : ………………………………………………....................
Alamat : ………………………………………………....................
b. Penanggung jawab
Nama : ………………………………………………....................
Jenis Kelamin : ………………………………………………....................
Agama : ………………………………………………....................
Pekerjaan : ………………………………………………....................
Alamat : ………………………………………………....................
Hubungan dg px : ………………………………………………....................
2. RIWAYAT KESEHATAN
a. Keluhan utama
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d. Evaluasi
I
E
Mengetahui,
(…………………………………) (…………………………………)
(…………………………………) (…………………………………)