Lampiran 9.
Lembar Pengambilan Data
LEMBAR PENGAMBILAN DATA
NAMA :.........................................................
NOMOR REKAM MEDIS :.........................................................
JENIS KELAMIN :.........................................................
UMUR :.........................................................
TANGGAL MASUK RUMAH SAKIT :.........................................................
TANGGAL KELUAR RUMAH SAKIT :.........................................................
LAMA RAWAT INAP DI RUMAH SAKIT :.........................................................
DIAGNOSA :.........................................................
HASIL LABORATORIUM :
SC Hb C Mg Na K PT INR LFG
Awal Akhir Awal Akhir Awal Akhir Awal Akhir Awal Akhir Awal Akhir Awal Akhir Awal Akhir Awal Akhir
OBAT-OBATAN :.........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................
...........................................................