TINDAKAN OT PADA KONDISI FISIK

KEMENTERIAN KESEHATAN R.I.

POLITEKNIK KESEHATAN SURAKARTA
JURUSAN OKUPASI TERAPI

TINDAKAN OKUPASI TERAPI

DI :……………………………………

Nama Mahasiswa : ......................................................

NIM : ......................................................
Tempat praktik : ......................................................

A. IDENTITAS PASIEN
Nama / Inisial : .......................................................
Umur :.......................................................
Jenis Kelamin :.......................................................
Sisi Dominan :.......................................................
Alamat :.......................................................

B. DIAGNOSA PASIEN
Diagnosis Medis : ………………………………………………………
Diagnosis Topis : ………………………………………………………
Diagnosis Kausatif : ………………………………………………………

C. DATA SUBJEKTIF
Initial Assessment :
-Interview (keluhan, alasan pasien datang ke OT, riwayat kondisi pasien, harapan)
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-Observasi Klinis (hal-hal yang ditemukan saat pertama kali bertemu pasien:
penampilan, cara bicara, mobilitas, perilaku, tahap perkembangan, dll)
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- screening test (hasil sesuai blanko screening)

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D. MODEL TREATMENT YANG AKAN DIGUNAKAN (PEMILIHAN KERANGKA ACUAN)

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E. DATA OBJEKTIF
(ringkasan hasil pemeriksaan dari blanko- blanko pemeriksaan (terstandar) yang
sesuai problem pasien dan kerangka acuan yang digunakan )
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F. ANALISIS DATA / PENGKAJIAN DATA

Rangkuman data Subjektif dan Objektif :

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Aset : ……………………………………………………………………………………..
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Limitasi :
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Prioritas Masalah :
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Diagnosis OT :……………………………………………………………………………………..
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G. PERENCANAAN TERAPI

Tujuan Jangka Panjang I (ke arah occupation) :

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Tujuan Jangka Pendek (ke arah occupation / occupational component, sesuai

kurun waktu praktik klinik di lahan ybs):
G.1.
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G.2.
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G.3.
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G.4.
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Strategi / Teknik :……………………………..........................………………………………
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Frekuensi :

Durasi :

Media Terapi :
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Tujuan Jangka Panjang II (ke arah occupation) :

Tujuan Jangka Pendek (ke arah occupation / occupational component, sesuai

kurun waktu praktik klinik di lahan ybs):
G.1.
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G.2.
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G.3.
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G.4.
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Strategi / Teknik :……………..…………………………………………….............................

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Frekuensi :.....…………………………………………………………..........................
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Durasi :...........................……………………………………………………………
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Media Terapi :..............................…………………………………………………………

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……………………………, …
Mengetahui, Praktikan,
Pembimbing Praktik Klinik
Di ___________________________

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TINDAKAN OT PADA KONDISI FISIK