BIDAN PRAKTEK MANDIRI

BPM ELISNIARTI MANDIANGIN

Jln. Raya Sarolangun – Tembesi kecamatan Mandiangin Tlp (0745).......
SAROLANGUN – JAMBI 37492
STATUS PASIEN KEBIDANAN

Hari.................................Tanggal.....................................Jam...........................................

I. Identitas Pasien.
Nama :.........................................................................
Umur :.........................................................................
No.Kartu :.........................................................................
Nama Suami :........................................................................
Agama :.........................................................................
Alamat :.........................................................................

II. Keluhan
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III. Pemeriksaan
HPHT :.....................................
TP :......................................
KU....................................TD........................Nadi..........................RR...................S.............
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Palpasi Leopold I :........................................
Leopold II :........................................
Leopold III :........................................
Leopold IV :........................................
Laboratorium HB :........................................
Protein Urine :.........................................
Malaria :........................................
Periksa Dalam
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IV. Diagnosa Kebidanan

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V. Tindakan
1. .......................................................................................................................................
2. .........................................................................................................................................
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5. .........................................................................................................................................

VI. Laporan persalinan

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Terapi Oral :............................................................................................................................
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Hari.....................................Tanggal...................................................Jam............................
Pemeriksaan Fisik
KU........................TD........................Nadi..........................RR...................S.........................
Kontraksi rahim:.....................................Perdarahan .............................ASI..............................
Pemeriksaan bayi
KU.............................Warna..........................RR..................N...........................S.................
Eksteremitas................................
Tindakan
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