RUMAH SAKIT UMUM

PERMATA MEDICAL CENTER

Jl. Raya Panyindangan Wetan Indramayu Telp. (0234) 275112 Fax. (0234) 275013
email : rsu_pmc_im@yahoo.com & rsu.com_pmc_yahoo.com

LEMBAR KONTROL CEK LIST ( )UNTUK CATATAN MEDIK (KLPCM)

RUMAH SAKIT UMUM PERMATA MEDICAL CENTER

1. RINGKASAN MASUK DAN KELUAR ..................................................................................

2. GENERAL CONSENT ........................................................................................................
3. PERSETUJUAN RAWAT INAP PASIEN UMUM DAN APS .................................................
4. PERSETUJUAN RAWAT INAP PASIEN BPJS, NAIK KELAS DAN APS .................................
5. TRIASE UGD ....................................................................................................................
6. STATUS LOKALIS .............................................................................................................
7. ASKEP UGD .....................................................................................................................
8. RESUME MEDIS PASIEN RAWAT INAP ...........................................................................
9. LEMBAR REKONSILIASI OBAT .........................................................................................
10. KARTU PEMBERIAN OBAT/VERIFIKASI OBAT .................................................................
11. PENILAIAN PASIEN YANG AKAN MENINGGAL/AKHIR KEHIDUPAN ...............................
12. ASESMENT AWAL DAN ULANG RISIKO JATUH PASIEN DEWASA ...................................
13. ASESMENT AWAL DAN ULANG RISIKO JATUH PASIEN ANAK ........................................
14. INTERVENSI DAN MONOTORING RISIKO JATUH ............................................................
15. CATATAN TERINTEGRASI ................................................................................................
16. FORM EDUKASI PASIEN DAN KELUARGA TERINTEGRASI ...............................................
17. PERSETUJUAN TINDAKAN KEDOKTERAN MEDIS ( INFORMED CONSENT ) ....................
18. SIOP (SURAT IZIN OPERASI ) ..........................................................................................
19. CONTROL ISTIMEWA ......................................................................................................
20. GRAFIK ............................................................................................................................
21. HASIL PEMERIKSAAN RADIOLOGI,USG,EKG,DLL ............................................................
22. HASIL PEMERIKSAAN LABOLATURIUM/ PA ...................................................................
23. PERMINTAAN KONSUL ...................................................................................................
24. JAWABAN KONSUL .........................................................................................................
25. REKAM ASUHAN KEPERAWATAN ..................................................................................
26. PELAKSANAAN KEPERAWATAN .....................................................................................
27. OPERAN PERAWAT ANTAR SHIFT ..................................................................................
28. SERAH TERIMA PASIEN ANTAR RUANGAN ...................................................................
29. RENCANA PEMULANGAN PASIEN (DISCHARGE PLANING ) ...........................................
30. CATATAN PASIEN PINDAH/TRANSFER RUANG RAWAT/DOKTER .................................
31. DAFTAR TILIK PEMBERIAN TRANSFUSI DARAH ..............................................................
32. KEGIATAN PELAYANAN ROHANI ....................................................................................
33. FORMULIR SURVEILANS RUMAH SAKIT .........................................................................
34. KEINGINAN PASIEN MEMILIK DPJP ................................................................................
35. PENUNJUK KEWENANGAN PENERIMA INFORMASI KONDISI PASIEN ...........................
36. PENOLAKAN RESUSITASI ( DNR) ....................................................................................
37. PERSETUJUAN PERMINTAAN PENDAPAT KEDUA ( SECOND OPINION ) ........................
38. PEMBERIAN INFORMASI MBO ( MATI BATANG OTAK ) .................................................
39. PERMINTAAN PRIVASI PASIEN .......................................................................................
40. SURAT PENGANTAR PULANG .........................................................................................
41. FORMULIR PENUNDAAN PELAYANAN ...........................................................................
42. RINCIAN PASIEN BIAYA PULANG ....................................................................................

Hal.