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KLINIK PRIMA MEDIKA GEDANGAN

Alamat : Jl. Raya Gedangan No. 4D Sidoarjo

E-mail : primamedika4d@gmail.com

Telp : 0851-0785-8998

RESUME MEDIS

Nama Pasien :.....................................................................................................................


No. Rekam Medis : ....................................................................................................................
Tanggal Lahir :.....................................................................................................................
Jenis Kelamin :.....................................................................................................................
Tanggal Pelayanan : ....................................................................................................................
Diagnosa Primer : ....................................................................................................................
Diagnosa Sekunder :.....................................................................................................................
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Tindakan Medis : ....................................................................................................................
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Pemeriksaan fisik : Tekanan Darah : mmHg Nadi : x / menit
0
Frekuensi Nafas : x / menit Suhu : C
Lain-lain :...................................................................................
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Keadaan waktu keluar : Sembuh Dirujuk Dirawat

Sidoarjo, - - 2017
Dokter,

Dr. Ida Susanti


KLINIK PRIMA MEDIKA GEDANGAN
Alamat : Jl. Raya Gedangan No. 4D Sidoarjo

E-mail : primamedika4d@gmail.com

Telp : 0851-0785-8998

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