DETASEMEN KESEHATAN WILAYAH MALANG

RUMAH SAKIT TINGKAT III BALADHIKA HUSADA

LAPORAN OPERASI
Nama Pasien : …………………………… No. Reg :…………. .......... L/ P
Tanggal : …………………………… OK : …………………….....
Masuk Jam : …………………………… Keluar jam :……………….........
Nama Dokter Bedah :…………………………… Asisten Bedah :…………..........
Nama Dokter Anestesi : …………………………… Perawat Anestesi : ………….....
Nama Perawat Instrument : ………………………… Perawat Sirkuler : ……………..
Jenis Anestesi : □ Umum □ SAB □ Epidural □ Lokal
CATATAN DOKTER BEDAH INTRA OPERASI
Diagnosa Sebelum Operasi : …………………………………………………………….......
Nama Prosedur Operasi : …………………………………………………………….......
Diagnosa Sesudah operasi : ……………………………………………………………......
Jaringan yang di Eksisi/Insisi: ……………………………………………………………........
Pemeriksaan Spesimen : □ Vriescoupe □ PA □ Kultur □ Analisa □ Lain-lain : ……..
Drain / Tampon : .......................................... Perdarahan : ……………... cc
Komplikasi : ……………………………………………………………........
Jalannya Operasi : ……………………………………………………………......
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CATATAN DOKTER BEDAH PASCA OPERASI
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Tanda Tangan Dokter Bedah

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