HARI PENYAKIT

1 2 3 4 5 6 7 Ming Minggu Minggu

gu 2 3 4
KEGIATAN URAIAN KEGIATAN CLINICAL PATHWAY KETERANGAN
HARI RAWAT
1 SUPERFICIAL
LUKA BAKAR 2 3DERMAL,
4 MID5DERMAL
6 DAN
7 FULL THICKNESS 20%-30% TBSA
ICD 10
1. Assesmen Awal
RSUP Dr. Sardjito T20.09XA Burn of unspecified degree of multiple sites of head, face, and neck, initial encounter,
Assesmen Awal DPJP  T20.00 Burn of unspecified degree of head, face, and neck, unspecified site
Medis Penapisan keadaan  T20.29 Burn
mengancamofjiwa second degree of multiple sites of head, face, and neck
(Survei Dilakukan saat pertama
T20.3 Burn
Primer; Airway, Breathing, of third degree of head, face, and neck
Circulation, diterima di RS
T21.00 Burn
Disability, Exposure, of Scale)
Fluid, Pain unspecified degree of trunk, unspecified site
Penegakan diagnosis  T21.2 Burn of second degree of trunk
(Survei Sekunder; Dilakukan saat pertama
anamnesis AMPLE, T21.3 Burn of third
pemeriksaan fisikdegree
head of trunk diterima di RS
to toe, x-ray sesuaiT23.2- Burn of second
indikasi, EKG, Produk degree of wrist and hand
Urin, Tekanan vena T23.3 Burn of third degree of wrist and hand
sentral, Laboratorium
darah lengkap, golT24.2- Burn
darah, kimiaof darah
secondsesuai
degree of lower limb, except ankle and foot
T24.3- Burn
indikasi, analisis gas of third degree of lower limb, except ankle and foot
darah, β-HCG)
Assemen Awal Melakukan assesmen  T25.2 Burn of asesmen
sesuai format second degree of ankle and foot
Keperawatan keperawatan T25.3 Burn of third degree of ankle and foot
2. Laboratorium Darah Rutin T31.2 Burns involving 20-29% of body surface Dilakukan sesuai
indikasi
PT dan APTT
Albumin No. RM : …………………………………

BUN
Creatinin
Nama Pasien SGOT BB Kg
Jenis kelamin SGPT TB Cm
Tanggal Lahir Elektrolit Tgl. Masuk Jam :
Diagnosa Masuk RS
AGD Tgl. Keluar Jam :
HbsAg
Penyakit Utama Kode ICD :
HIV
Lama Rawat Hari
PCT
Penyakit penyerta Kode ICD :
Rapid test/ Swab Covid-19
Rencana Rawat
3. Radiologi/ Imaging
Komplikasi X-Ray Kode ICD :
CT Scan R. Rawat/Klas /
4. Penunjang Lain
Tindakan EKG Kode ICD :
Kultur kuman dan sensitivas antibiotik (sediaan Rujukan Ya/Tidak
darah, jaringan dan pus)
Dietary Counseling and Surveilance Kode ICD :
5. Konsultasi Anestesi
Penyakit Dalam
PICU
Kardiologi
Rehabilitasi medik
Psikiatri
6. Asesmen Lanjutan
A. Asesmen Medis Dokter DPJP Visite harian/
 ……………………… , ………………………… , …………………

Dokter Penanggung Jawab Pelayanan Perawat Penanggung Jawab Pelaksana Verifikasi

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