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loch \f0 \lang1035 \langnp1035 \langfe1041
\langfenp1041 \alang1081 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \
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dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 STIKES
TENGKU MAHARATU PEKANBARU}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \
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alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
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langnp1033 \langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 KEPERAWATAN MATERNITAS}{\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \
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pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
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\langfe1041 \langfenp1041 \alang1081 : .................................}{\rtlch \
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rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \
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}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \
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Masuk}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
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\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: .........................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 Ruang/Kelas}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
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Kamar No}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfenp1041 \alang1081 : .........................................}{\rtlch \fcs1
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\langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langfe1041 \langfenp1041 \alang1081 Tgl Pengkajian}{\rtlch \fcs1 \af0 \afs24 \ltrch
\fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \
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lang1035 \langnp1035 \langfe1041 \langfenp1041 \
alang1081 : .................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \tab }{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Jam
Pengkajian : .........................................}{\rtlch \fcs1 \af0 \afs24 \
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langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \fi-360 \li360 \ri0 \
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langfenp1041 \alang1081 {\listtext \pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 I.\tab }{\rtlch \fcs1 \af0 \
afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 IDENTITAS}{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \
plain \qj \li360 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin360 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch
\alang1081 \ltrch \loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033 \
langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
rtlch \alang1081 \ltrch \dbch \af4
\hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081
Nama Pasien}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \alang1081 : .................................}{\rtlch \fcs1 \af0 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \tab }{\rtlch \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Nama
Suami}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: ...........................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \li360 \
ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin360
\rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 Umur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfenp1041 \alang1081 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
Umur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
alang1081 Suku/Bangsa}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
Suku/Bangsa}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \alang1081 : ...........................................}{\rtlch \fcs1
rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \
langfe1041 \langfenp1041 \alang1081 Agama}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
Agama}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
alang1081 Pendidikan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
\ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \
Pendidikan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
adjustright \lin360 \rin0 \itap0
\rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \
hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\
Pekerjaan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfe1041 \langfenp1041 \alang1081 : .................................}{\rtlch \
Pekerjaan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
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Alamat}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfe1041 \langfenp1041 \alang1081 : ...........................................}
{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \
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}\pard \plain \qj \li360 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \fi-360 \
li450 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin450 \rin0 \itap0 \ls1 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \
rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033 \
langfe1041 \langfenp1041 \alang1081 {\listtext \pard \plain \rtlch \fcs1 \af6 \
afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \dbch \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 II.\tab }{\rtlch
\fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 ALASAN
KUNJUNGAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
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af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \
alang1081 .........................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
.........................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 III.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 KELUHAN UTAMA}{\rtlch \
pard \plain \qj \li450 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
langnp1035 \langfe1041 \langfenp1041 \
alang1081 .........................................................................
...................................................................................
...................................................................................
...........................................................}{\rtlch \fcs1 \af0 \
fi-360 \li450 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 IV.\tab }{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 RIWAYAT
KESEHATAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 \par }\pard \plain \qj \fi-360 \li810 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin810 \rin0 \itap0 \ls2 \
rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \
listtext \pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
\ltrch \loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \
langfenp1041 \alang1081 \f2 1.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 Riwayat Kesehatan Dahulu}{\rtlch \fcs1 \af0 \
afs24 \ltrch \fcs0
\fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \
alang1081 .........................................................................
...................................................................................
...................................................................................
...............................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 2.\tab }{\
Riwayat Kesehatan Keluarga}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \li810 \ri0 \lisb0 \
alang1081 .........................................................................
...................................................................................
...................................................................................
Riwayat Perkawinan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfenp1041 \alang1081 \par }\pard \plain \qj \li810 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin810 \rin0 \itap0 \rtlch \fcs1
\af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \dbch
\af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \
alang1081 .........................................................................
...................................................................................
...................................................................................
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Data
Sosial Ekonomi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Data
Psikologis}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 .........................................................................
...................................................................................
...................................................................................
langfenp1041 \alang1081 \f2 V.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 RIWAYAT MENSTRUASI}{\rtlch \fcs1 \af0 \afs24 \
langfe1041 \langfenp1041 \alang1081 Haid}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \tab }{\rtlch \fcs1
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af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : Teratur}
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : (
) Ya}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
( ) Tidak}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Dismenore}{\rtlch \fcs1 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : ( )
Ya}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4
\hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \
tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Warna}{\rtlch \fcs1 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \
alang1081 : ..................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 Lama}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 : ..................................}{\rtlch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Bau}{\rtlch \fcs1 \af0 \afs24 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \
alang1081 Lain-lain}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \
alang1081 : .......................................................................
langfenp1041 \alang1081 \f2 VI.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 RIWAYAT KEBIDANAN YANG LALU}{\rtlch \fcs1 \
langfe1041 \langfenp1041 \alang1081 G ........................
P ................................ A ...................................
H ......................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \par }\trowd \trql \trgaph0 \trleft90 \trbrdrt
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trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \
clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \
brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth288 \
clftsWidth3 \cellx378 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \
brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \
brdrw10 \brdrcf1 \cltxlrtb \clwWidth882
\clftsWidth3 \cellx1260 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \
brdrw10 \brdrcf1 \cltxlrtb \clwWidth900 \clftsWidth3 \cellx2160 \clvertalt \clbrdrl
\brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10
\brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth1080 \clftsWidth3 \
cellx3240 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \
brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \
cltxlrtb \clwWidth1170 \clftsWidth3 \cellx4410 \clvertalt \clbrdrl \brdrs \
brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \
brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth1080 \clftsWidth3 \
cltxlrtb \clwWidth1170 \clftsWidth3 \cellx9090 \pard \plain \qc \li0 \ri0 \lisb0 \
intbl \itap1 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 No}{\rtlch \fcs1 \af0 \afs20 \ltrch \fcs0 \fs20 \rtlch \alang1081 \
langfenp1041 \alang1081 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Anak
Ke}{\rtlch \fcs1 \af0 \afs20 \ltrch \fcs0 \fs20 \rtlch \alang1081 \ltrch \dbch \af4
cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin0 \rin0 \intbl \itap1 \rtlch \fcs1 \af6 \afs24 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 BB lahir}{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qc \
lin0 \rin0 \intbl \itap1 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langfe1041 \langfenp1041 \alang1081 Usia gestasi}{\rtlch \fcs1 \af0 \afs20 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qc \li0 \ri0 \
rin0 \intbl \itap1 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfe1041 \langfenp1041 \alang1081 Jenis persalinan}{\rtlch \fcs1 \af0 \afs20 \
langfe1041 \langfenp1041 \alang1081 Tempat/penolong}{\rtlch \fcs1 \af0 \afs20 \
langfe1041 \langfenp1041 \alang1081 Komplikasi persalinan}{\rtlch \fcs1 \af0 \afs20
\ltrch \fcs0 \fs20 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \
langfe1041 \langfenp1041 \alang1081 Komplikasi pada bayi}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Umur anak}{\rtlch \fcs1 \af0 \afs20 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \li0 \ri0 \
lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \
trowd \trql \trgaph0 \trleft90 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \
brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10 \
brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1 \
trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \
trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \
clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \
brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth288 \clftsWidth3 \cellx378 \clvertalt \
clftsWidth3 \cellx1260 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs
\brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \
brdrcf1 \cltxlrtb \clwWidth900 \clftsWidth3 \cellx2160 \clvertalt \clbrdrl \brdrs \
cltxlrtb \clwWidth1170 \clftsWidth3 \cellx9090 \row }\pard \plain \qj \li0 \ri0 \
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \
alang1081 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \rtlch \fcs1 \af6 \afs24 \
ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \dbch \af4 \
lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24
langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \
cell }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha
langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qj \li0 \ri0 \
brdrcf1 \cltxlrtb \clwWidth900 \clftsWidth3 \cellx2160 \clvertalt \clbrdrl \brdrs \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 VII.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 RIWAYAT KEHAMILAN
SEKARANG}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfe1041 \langfenp1041 \alang1081 HPHT}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .......................................................................
...................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 2.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Gerakan Janin}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanda bahaya / penyulit}
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Obat yang dikonsumsi }{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Kekhawatiran khusus}{\
alang1081 : .......................................................................
langfenp1041 \alang1081 \f2 VIII.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
\rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \
langfe1041 \langfenp1041 \alang1081 RIWAYAT KONTRASEPSI}{\rtlch \fcs1 \af0 \afs24 \
Jenis Kontrasepsi yang digunakan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 : .......................................................................
......}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
\ltrch \loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033
\langfe1041 \langfenp1041 \alang1081 \f2 2.\tab }{\rtlch \fcs1 \af0 \afs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Lama Penggunaan}{\rtlch \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Keluhan}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Rencana KB}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................................................................
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 IX.\tab }{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 HASIL
PEMERIKSAAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfe1041 \langfenp1041 \alang1081 Tanda-tanda Vital}{\rtlch \fcs1 \af0 \afs24 \
langfe1041 \langfenp1041 \alang1081 Tekanan Darah }{\rtlch \fcs1 \af0 \afs24 \ltrch
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : ................mmHg}{\
langnp1035 \langfe1041 \langfenp1041 \alang1081 Nadi}{\rtlch \fcs1 \af0 \afs24 \
alang1081 : ................x/menit}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 Pernapasan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich
\af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \
alang1081 Suhu}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 : ................C}{\rtlch \fcs1 \af0 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB
Sebelum Hamil}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
\dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \
langfenp1041 \alang1081 : ............... kg}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0
alang1081 BB Sekarang}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : ............... kg}{\rtlch \fcs1 \af0 \afs24
langfe1041 \langfenp1041 \alang1081 TB}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
\langfe1041 \langfenp1041 \alang1081 : ............... cm}{\rtlch \fcs1 \af0 \afs24
Kepala }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
\af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \
langfenp1041 \
alang1081 : .......................................................................
alang1081 Mata}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
alang1081 Hidung}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfe1041 \langfenp1041 \
alang1081 : .......................................................................
alang1081 Telinga}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Mulut}{\rtlch \fcs1 \
alang1081 : .......................................................................
alang1081 Gigi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
Leher}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: .................................................................................
.....................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \fi-360 \li810 \ri0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Dada}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Inspeksi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0
alang1081 : .......................................................................
alang1081 Palpasi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
alang1081 Perkusi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
alang1081 Auskultasi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
alang1081 : .......................................................................
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard
\plain \qj \li720 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Jantung}{\rtlch \fcs1 \af0 \afs24 \
alang1081 : .......................................................................
Abdomen}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Inspeksi}{\rtlch \fcs1 \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Linea}{\rtlch \fcs1 \af0 \afs24 \
alang1081 : .......................................................................
alang1081 Striae}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
alang1081 Bekas Luka
OP : ..............................................................................
....................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \li810 \ri0 \lisb0 \
alang1081 Bising Usus}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : .......................}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 DJJ }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
afs24 \ltrch \fcs0 \fs24
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Leopold I}{\
alang1081 : .......................................................................
alang1081 Leopold II}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
alang1081 : .......................................................................
alang1081 Leopold III}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
alang1081 Leopold IV }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
Genetalia}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \
alang1081 : .......................................................................
Anus}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: .................................................................................
.....................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj
\fi-360 \li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
Ekstermitas atas / bawah}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 .........................................................................
.....................................................................}{\rtlch \fcs1
qj \fi-360 \li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 10.\tab }{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pola Nutrisi}
alang1081 : .......................................................................
...................................................................................
...................................................................................
.................................................}{\rtlch \fcs1 \af0 \afs24 \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pola
eliminasi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BAK}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
alang1081 BAB}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Pola Istirahat / Tidur}{\rtlch \fcs1 \af0 \
alang1081 .........................................................................
...................................................................................
...................................................................................
.............................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Data Lain-
lain}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
\par }\pard \plain \qj \li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin810 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \
alang1081 .........................................................................
...................................................................................
....................................
...................................................................................
...........}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 X.\tab }{\
PEMERIKSAAN PENUNJANG}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Hasil Lab}{\rtlch \fcs1 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 :
(cantumkan nilai normal)}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 USG}
alang1081 : .............................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Rongen}{\rtlch \fcs1 \af0
\afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \tab }{\rtlch \fcs1 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Terapi yg didapat : }{\
fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \dbch
\af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af0
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XI.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 DATA TAMBAHAN}{\rtlch \
alang1081 .........................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
.........................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \fi270 \li5490 \ri0 \
alang1081 Pekanbaru,........................................}{\rtlch \fcs1 \af0 \
fi270 \li5490 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin5490 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 Preseptee}{\rtlch \fcs1 \
plain \qj \fi270 \li5490 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \fi270 \
li5490 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright
\lin5490 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
alang1081 ...........................................................}{\rtlch \fcs1
qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \
alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch
alang1081 ANALISA DATA}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \
lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \
pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \
langfe1041 \langfenp1041 \alang1081 Nama Klien}{\rtlch \fcs1 \af0 \afs24 \ltrch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 :}{\rtlch \fcs1 \af0 \
Ruangan :}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Umur}{\rtlch \fcs1 \af0 \afs24 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 :}{\
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041
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langfenp1041 \alang1081 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \
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af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Etiologi}
cell }\pard \plain \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
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plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
alang1081 KEPERAWATAN MATERNITAS}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 PENGKAJIAN GYNEKOLOGY}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch
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\langfenp1041 \alang1081 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \
dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041
\alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XII.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 IDENTITAS}{\rtlch \fcs1 \
langfe1041 \langfenp1041 \alang1081 Nama Pasien}{\rtlch \fcs1 \af0 \afs24 \ltrch \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Nama Suami}{\
alang1081 : ...........................................}{\rtlch \fcs1 \af0 \afs24 \
langfe1041 \langfenp1041 \alang1081 Umur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich
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loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Suku/Bangsa}{\
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loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pekerjaan}{\
langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1
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loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Alamat}{\
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XIII.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 ALASAN KUNJUNGAN}{\
alang1081 .........................................................................
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.....................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XIV.\tab }{\rtlch \fcs1 \af0 \
alang1081 .........................................................................
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.........................................................}{\rtlch \fcs1 \af0 \afs24
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XV.\tab }{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 RIWAYAT
alang1081 .........................................................................
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.............................................}{\rtlch
\fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \
pard \plain \qj \fi-360 \li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin810 \rin0 \itap0 \ls2 \rtlch \fcs1 \af6 \afs24 \
lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\listtext \pard \plain \
hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2
7.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
alang1081 Riwayat Kesehatan Sekarang}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 .........................................................................
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lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Riwayat Kesehatan
Keluarga}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 .........................................................................
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Riwayat Perkawinan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
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\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Data Sosial
Ekonomi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
alang1081 .........................................................................
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\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Data
alang1081 .........................................................................
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\ltrch \loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041
\langfenp1041 \alang1081 \f2 XVI.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 RIWAYAT MENSTRUASI}{\rtlch \fcs1 \af0 \afs24 \
\langfe1041 \langfenp1041 \alang1081 : Teratur}{\rtlch \fcs1 \af0 \afs24 \ltrch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : ( ) Ya}{\rtlch \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : ( )
Ya}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4
alang1081 : .......................................................................
..............................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qc \li0 \ri0 \
\ltrch \loch \af0
\hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \
f2 XVII.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
alang1081 RIWAYAT KONTRASEPSI}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Jenis Kontrasepsi yang
digunakan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Lama Penggunaan}{\rtlch \fcs1 \af0 \afs24 \
alang1081 : .......................................................................
alang1081 : .......................................................................
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XVIII.\tab }{\
HASIL PEMERIKSAAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfenp1041 \alang1081 \par }\pard \plain \qj \fi-360 \li810 \ri0 \lisb0 \lisa0 \
sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin810 \rin0 \itap0 \
ls5 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0
\hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\
alang1081 Pernapasan}{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB Sebelum
sakit}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: ............... kg}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB Sekarang}{\
alang1081 : ............... kg}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 TB}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Kepala }{\
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035
\langnp1035 \langfe1041 \langfenp1041 \
alang1081 : .......................................................................
alang1081 Mulut}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Leher}{\
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Dada}{\rtlch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Inspeksi}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
langfenp1041 \alang1081 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch
\alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \
alang1081 : .......................................................................
alang1081 Jantung}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Abdomen}{\
langfe1041 \langfenp1041 \alang1081 Bekas Luka
OP : ..............................................................................
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Palpasi}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................................................................
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Genetalia}{\
hich \af0 \loch \f0 \lang1035 \langnp1035
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Anus}{\rtlch \
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Ekstermitas
atas / bawah}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
....................................................................}{\rtlch \
23.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 Pola Nutrisi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
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alang1081 : .......................................................................
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pola Istirahat
/ Tidur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
alang1081 .........................................................................
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li810 \ri0 \lisb0 \lisa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin810 \rin0 \itap0 \
langfe1041 \langfenp1041 \alang1081 Data Lain-lain}{\rtlch \fcs1 \af0 \afs24 \ltrch
alang1081 .........................................................................
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langfenp1041 \alang1081 \f2 XIX.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 PEMERIKSAAN PENUNJANG}{\rtlch \fcs1 \af0 \
Hasil Lab}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \alang1081 : (cantumkan nilai normal)}{\rtlch \fcs1 \af0 \afs24 \ltrch
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 USG}
afs24 \ltrch
langnp1035 \langfe1041 \langfenp1041 \alang1081 Terapi yg didapat :}{\rtlch \fcs1 \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XX.\tab }{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 STATUS
GYNEKOLOGI}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 .........................................................................
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.........................................................}{\rtlch \fcs1 \af0 \afs24
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXI.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 LAPORAN PATOLOGI}{\
}\pard \plain \s28 \qj \fi-360 \li900 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin900 \rin0 \itap0 \ls7 \rtlch \fcs1 \af5 \afs21 \
alang1081 Diagnosa klinik }{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
..........}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 \par }\pard \plain \s28 \qj \fi-360 \li900 \ri0 \lisb0 \lisa0 \sl360 \
langfe1041 \langfenp1041 \alang1081 Cara pengambilan jaringan}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Gambaran makroskopis}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
alang1081 \par }\pard \plain \s28 \qj \li900 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4
\hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081
Kesan }{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 No Patologi}{\rtlch \fcs1 \af0 \afs21 \ltrch \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Gambaran Mikroskopis}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Diagnosa Patologik}{\rtlch \fcs1 \af0 \afs21 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Dokter Ruangan}{\rtlch \fcs1 \af0 \afs21 \ltrch
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Dokter Ahli Patologi}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXII.\tab }{\
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 DATA
TAMBAHAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 .........................................................................
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.......................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 \par }\pard \plain \qj \fi270 \li5490 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin5490 \rin0 \itap0 \rtlch \
pard \plain \qj \fi270 \li5490 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin5490 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch
\fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \dbch \af4 \lang1033 \
alang1081 Pekanbaru,........................................}{\rtlch \fcs1 \af0 \
alang1081 ...........................................................}{\rtlch \fcs1
qj \fi270 \li5490 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin5490
\rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 ANALISA
DATA}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \
Klien}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
:}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Ruangan :}{\
}\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright
\lin0 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 :}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
\langfe1041 \langfenp1041 \alang1081 No RM :}{\rtlch \fcs1 \af0 \afs24 \ltrch \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 NO}{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \
plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
langfe1041 \langfenp1041 \alang1081 Data (Symtom)}{\rtlch \fcs1 \af0 \afs28 \
alang1081 Masalah}{\rtlch \fcs1 \af0 \afs28 \ltrch \fcs0 \fs28 \rtlch \alang1081 \
langfenp1041 \alang1081 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Etiologi}
langfe1041 \langfenp1041 \alang1081 {\trowd \trql \trgaph0 \trleft-108 \trbrdrt \
\plain \qj \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \
lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl
\itap1 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
fcs1 \af0 \afs24 \ltrch
\fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035
\langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \li0 \ri0 \
langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \li0 \ri0 \lisb0 \lisa0 \
dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\trowd \
trql \trgaph0 \trleft-108 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \
trautofit1 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \
trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10 \
brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \
clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth648 \clftsWidth3 \cellx540 \
clwWidth2405 \clftsWidth3 \cellx9512 \row }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \af6 \
afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \
s28 \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \af0 \lang1033 \
langnp1033 \langfe1041 \langfenp1041 \alang1081 {\shp {\*\shpinst \shpleft520 \
shptop0 \shpright1650 \shpbottom1051 \shpfhdr0 \shpbxcolumn \shpbxignore \shpbypara
\shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz2 \shplid1028 {\sp {\sn shapeType}
{\sv 75}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn
fLockAspectRatio}{\sv 1}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn cropFromRight}{\sv
11592}}{\sp {\sn pib}{\sv {\pict \piccropl0 \piccropr0 \piccropt0 \piccropb0
\picscalex100 \picscaley100 \picw0 \pich0 \picwgoal0 \pichgoal0 \pngblip {\*\
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e426082}}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn f3DOK}{\sv 0}}{\sp {\sn fShadowOK}{\
sv 1}}{\sp {\sn fFilled}{\sv 0}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv
0}}{\sp {\sn fPreferRelativeResize}{\sv 1}}{\sp {\sn wzName}{\sv Picture 191}}{\sp
{\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\rtlch \fcs1 \af0 \afs24 \ltrch \
\par }\pard \plain \qc \li0 \ri0
\lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
alang1081 STIKES TENGKU MAHARATU PEKANBARU}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
b1 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \
langnp1035 \langfe1041 \langfenp1041 \alang1081 KEPERAWATAN MATERNITAS}{\rtlch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 PENGKAJIAN INTRANATAL}{\rtlch \fcs1
qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXIII.\tab }{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 IDENTITAS}{\
langnp1035 \langfe1041
\langfenp1041 \alang1081 Nama Pasien}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Nama
Suami}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
alang1081 Umur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXIV.\tab }{\
ALASAN KUNJUNGAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
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langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXV.\tab }{\rtlch \fcs1 \af0 \
alang1081 .........................................................................
...................................................................................
...................................................................................
.........................................................}{\rtlch \fcs1 \af0 \afs24
langfe1041 \langfenp1041
langfenp1041 \alang1081 \f2 XXVI.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
langfe1041 \langfenp1041 \alang1081 RIWAYAT KESEHATAN}{\rtlch \fcs1 \af0 \afs24 \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Riwayat
Kesehatan Dahulu}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
Kesehatan Keluarga}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
Perkawinan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 .........................................................................
...................................................................................
...................................................................................
alang1081 .........................................................................
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alang1081 .........................................................................
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.................................................}{\rtlch \fcs1 \af0 \afs24 \
lin0 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXVII.\tab }{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 DATA UMUM
langfe1041 \langfenp1041 \alang1081 BB/TB}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .....................................................}{\rtlch \fcs1 \
plain \qj \fi-360 \li720 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
aspnum \adjustright \lin720 \rin0 \itap0 \ls8 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0
langnp1033 \langfe1041 \langfenp1041 \alang1081 {\listtext \pard \plain \rtlch \
af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 2.\
BB sebelum hamil}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .....................................................}{\rtlch \fcs1 \
Masalah kesehatan khusus}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .....................................................}{\rtlch \fcs1 \
Obat-obatan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 : .....................................................}{\rtlch \fcs1 \
Alergi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \alang1081 (obat/makanan/dll)}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .....................................................}{\rtlch \fcs1 \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXVIII.\tab }{\rtlch \fcs1 \af0
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 DATA UMUM KEBIDANAN }
}\pard \plain \qj \fi-360 \li990 \ri0 \lisb0 \lisa0
langfe1041 \langfenp1041 \alang1081 Kehamilan sekarang }{\rtlch \fcs1 \af0 \afs24 \
langfe1041 \langfenp1041 \alang1081 direncanakan ( ya/tidak)}{\rtlch \fcs1 \af0 \
alang1081 : .........................................................}{\rtlch \fcs1
Status obstetri}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 : G ......... P .......... A ..........
H ..........}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfe1041 \langfenp1041 \alang1081 Usia kehamilan }{\rtlch \fcs1 \af0 \afs24 \
alang1081 : ............................................ minggu}{\rtlch \fcs1 \
HPHT}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: .........................................................}{\rtlch \fcs1 \af0 \
Taksiran partus}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .........................................................}{\rtlch \fcs1
Jumlah anak dirumah}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .........................................................}{\rtlch \fcs1
\f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\trowd \trql \
trgaph0 \trleft522 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \
brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10 \brdrcf1 \
trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1 \trautofit1 \
brdrcf1 \cltxlrtb \clwWidth2070 \clftsWidth3 \cellx4680 \clvertalt \clbrdrl \
brdrs \brdrw10 \brdrcf1
\clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \
brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth1350 \clftsWidth3 \cellx9270 \pard \
langfe1041 \langfenp1041 \alang1081 No}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0
Jenis kelamin}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
alang1081 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Cara
lahir}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
\cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin0 \rin0 \intbl \itap1 \rtlch \fcs1 \af6 \afs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB lahir}{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \
langfe1041 \langfenp1041 \alang1081 keadaan}{\rtlch \fcs1 \af0 \afs24 \ltrch \
langfe1041 \langfenp1041 \alang1081 umur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \li0 \ri0 \lisb0 \lisa0 \
trql \trgaph0 \trleft522 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10
\brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10 \brdrcf1 \
brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \
brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth1260 \
clftsWidth3 \cellx9270 \row }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 1}{\
langnp1035 \langfe1041 \langfenp1041 \alang1081 2}{\rtlch \fcs1 \af0 \afs24 \
langfe1041 \langfenp1041 \alang1081 3}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 4}{\
langnp1035 \langfe1041 \langfenp1041 \alang1081 5}{\rtlch \fcs1 \af0 \afs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qj \
hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081
langfe1041 \langfenp1041 \alang1081 {\trowd \trql \trgaph0 \trleft522 \trbrdrt \
\plain \qj \li630 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Mengikuti kelas prenatal
(ya/tidak)}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \
alang1081 : .....................................................................}
}\pard \plain \qj \fi-360 \li990 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
alang1081 Jumlah kunjungan pada kehamilan ini }{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .....................................................................}
alang1081 Masalah kesehatan yang lalu}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .....................................................................}
alang1081 Masalah kehamilan sekarang}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 : .....................................................................}
dbch \af4 \hich \af0 \loch \f0 \lang1035
\langnp1035 \langfe1041 \langfenp1041 \alang1081 Rencana KB}{\rtlch \fcs1 \af0 \
alang1081 : .....................................................................}
alang1081 Makanan bayi sebelumnya}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
\langfe1041 \langfenp1041 \alang1081 : ASI/PASI/lain-
lain ......................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pelajaran yang
diinginkan saat ini (pilih)}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : relaksasi, manfaat ASI, cara memberikan
minuman botol, senam nifas, metode KB, perawatan perineum, perawatan payudara}{\
alang1081 Setelah bayi lahir, siapa yang diharapkan membantu : suami/teman/orang
tua}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
\par }\pard \plain \qj \fi-360 \li990 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin990 \rin0 \itap0 \ls9 \rtlch \fcs1 \af6 \afs24 \
alang1081 Masalah dalam persalinan yang lalu}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0
alang1081 : .....................................................................}
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXIX.\tab }{\
RIWAYAT PERSALINAN SEKARANG}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Mulai persalinan
(kontraksi/pengeluaran pervaginam)}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
\langfe1041 \langfenp1041 \alang1081 : tgl/jam .................................}{\
alang1081 Keadaan kontraksi (frekuensi dalam 10 menit, lama,
kekuatan) : ...................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
adjustright \lin990 \rin0 \itap0 \ls10 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \
\langfenp1041 \alang1081 {\listtext \pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Frekuensi dan kualitas
denyut jantung
janin : ..................................................................}{\
}\pard \plain \s28 \fi-360 \li990 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
Pemeriksaan dalam pertama}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : jam .......................
warna .......................................}{\rtlch \fcs1 \af0 \afs21 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \fi-360 \
li990 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin990 \rin0 \
itap0 \ls10 \rtlch \fcs1 \af5 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 {\listtext \pard \plain \rtlch \fcs1 \af5 \afs21 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 \f2 5.\tab }{\rtlch \fcs1 \af0 \afs21 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Hasil }{\rtlch \fcs1 \af0 \afs21 \
alang1081 : .......................................................................
alang1081 \par }\pard \plain \s28 \fi-360 \li990 \ri0 \lisb0 \lisa0 \widctlpar \
alang1081 Ketuban (utuh/pecah)}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \
alang1081 : .......................................................................
alang1081 \par }\pard \plain \s28 \fi-360 \li990 \ri0 \lisb0 \lisa0 \widctlpar \
alang1081 Jika pecah}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081
\langfe1041 \langfenp1041 \alang1081 : tgl/jam ........................
warna .................................}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch
\dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXX.\tab }{\
}\pard \plain \qj \li810 \ri0 \lisb0 \lisa0
Nadi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: ................x/menit}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : ................x/menit}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Suhu}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB Sebelum
Hamil}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
: ............... kg}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB Sekarang}{\
alang1081 : .......................................................................
alang1081 : .......................................................................
ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \rtlch \fcs1 \af6 \afs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Hidung}{\rtlch \fcs1 \af0
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
..............................................}
langnp1035 \langfe1041 \langfenp1041 \alang1081 Auskultasi}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Pernapasan}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................................................................
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Linea}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .......................................................................
alang1081 : .......................................................................
OP : ..............................................................................
alang1081 : .......................................................................
\langfe1041
\langfenp1041 \alang1081 \par }\pard \plain \qj \li810 \ri0 \lisb0 \lisa0 \sl360 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Bising Usus}{\
alang1081 : .......................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 DJJ }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 Leopold I}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
alang1081 Leopold II}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
alang1081 : .......................................................................
alang1081 Leopold III}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
alang1081 Leopold IV }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 .........................................................................
.....................................................................}{\rtlch \fcs1
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pola Nutrisi}
alang1081 : .......................................................................
...................................................................................
...................................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 .........................................................................
...................................................................................
...................................................................................
alang1081 .........................................................................
...................................................................................
...................................................................................
langfenp1041 \alang1081 \f2 XXXI.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
langfe1041 \langfenp1041 \alang1081 PEMERIKSAAN PENUNJANG}{\rtlch \fcs1 \af0 \afs24
Hasil Lab}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \alang1081 : (cantumkan nilai normal)}{\rtlch \fcs1 \af0 \afs24 \ltrch
langfe1041 \langfenp1041 \alang1081 USG}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 : .............................}{\rtlch \
alang1081 Rongen}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfe1041 \langfenp1041 \alang1081 : .............................}{\rtlch \fcs1 \
langnp1033 \langfe1041 \langfenp1041 \alang1081
{\listtext \pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfenp1041 \alang1081 \f2 XXXII.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 DATA PSIKOSOSIAL}{\rtlch \fcs1 \af0 \afs24 \
Penghasilan keluarga tiap bulan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch
\alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041
\langfenp1041 \alang1081 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 : .......................................................................
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin990 \rin0 \itap0 \ls11 \rtlch
\dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\listtext \
pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 \f2 2.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langfe1041 \langfenp1041 \alang1081 Bagaimana perasaan anda terhadap kehamilan
sekarang ................................................}{\rtlch \fcs1 \af0 \afs24
alang1081 .........................................................................
.................................................................}{\rtlch \fcs1 \
aspnum \adjustright \lin990 \rin0 \itap0 \ls11 \rtlch \fcs1 \af6 \afs24 \ltrch \
Bagaimana perasaan suami terhadap kehamilan
sekarang ..............................................}{\rtlch \fcs1 \af0 \afs24 \
alang1081 .........................................................................
.................................................................}{\rtlch \fcs1 \
Jelaskan respon sibling terhadap kehamilan
sekarang ....................................................}{\rtlch \fcs1 \af0 \
alang1081 .........................................................................
................................................................}{\rtlch \fcs1 \af0
Pengalaman melahirkan yang
lalu ..............................................................................
.....}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
alang1081 .........................................................................
.................................................................}{\rtlch \fcs1 \
alang1081 .........................................................................
.................................................................}{\rtlch \fcs1 \
itap0 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \
langfe1041 \langfenp1041 \alang1081 LAPORAN PERSALINAN}{\rtlch \fcs1 \af0 \afs24 \
ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \
langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 I.\tab }{\rtlch \fcs1 \af0 \
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 PENGKAJIAN AWAL}{\
\par }\pard \plain \qj \fi-360 \li1080 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
widctlpar \aspalpha \aspnum \adjustright \lin1080 \rin0 \itap0 \ls13 \rtlch \fcs1 \
dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\listtext \
langfe1041 \langfenp1041 \alang1081 Tanggal }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0
alang1081 : .......................... Jam ................................}{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \
Tanda Vital}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfe1041 \langfenp1041 \alang1081 : TD ....... mmHg, Nadi ......x/mnt,
P ......... x/mnt, S ......C}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pemeriksaan palpasi
abdomen : .........................................................................
.............}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
alang1081 \par }\pard \plain \qj \fi-360 \li1080 \ri0 \lisb0 \lisa0 \sl360 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin1080 \rin0 \itap0 \ls13 \rtlch \
af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\
langfe1041 \langfenp1041 \alang1081 Hasil periksa dalam}{\rtlch \fcs1 \af0 \afs24 \
alang1081 : .......................................................................
......................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Persiapan periuneum}{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Klisma }{\rtlch \fcs1 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 :
ya/tidak, Jika tidak mengapa ..............................................}{\rtlch
aspnum \adjustright \lin1080 \rin0 \itap0 \ls13 \rtlch
\fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \
af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\
langfe1041 \langfenp1041 \alang1081 Pengeluaran pervaginam}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Perdarahan pervaginam}{\
ya/tidak,
jelaskan ................................................................}{\rtlch \
aspalpha \aspnum \adjustright \lin1080 \rin0 \itap0 \ls13 \rtlch \fcs1 \af6 \
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\listtext \pard \
plain \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \
langfe1041 \langfenp1041 \alang1081 Kontraksi uterus (frekuensi, lama,
kekuatan) : ..............................................................}{\
langfe1041 \langfenp1041 \alang1081 Denyut jantung janin (frekuensi,
kualitas) : ...................................................................}{\
langfe1041 \langfenp1041 \alang1081 Status janin (hidup/tidak, jumlah,
presentasi) : ..............................................................}{\
\lin1080 \rin0 \itap0 \ls12 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 II.\tab }{\rtlch \fcs1 \af0 \
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 KALA PERSALINAN }{\
\ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 KALA I}{\rtlch \fcs1 \af0
\afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \
Mulai persalinan }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 : tanggal ....................
jam ................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanda dan gejala}{\
alang1081 : .......................................................................
alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035
\langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \fi-360 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanda-tanda vital}{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \tab }{\
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : TD
.........mmHg, Nadi ....... x/mnt, P ....... x/mnt, S .......C}{\rtlch \fcs1 \af0 \
adjustright \lin1080 \rin0 \itap0 \ls14 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Lama
Kala I}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Keadaan psikososial}{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Kebutuhan khusus klien}{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tindakan }{\rtlch \fcs1 \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pengobatan }{\rtlch \fcs1
\f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \tab }{\rtlch \
alang1081 : .......................................................................
alang1081 OBSERVASI KEMAJUAN PERSALINAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \par }\trowd \trql \trgaph0 \trleft612 \
trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \brdrcf1 \trbrdrl \
brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10 \brdrcf1 \trbrdrh \brdrs \
brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1 \trautofit1 \trftsWidth1 \
trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \trpaddfl3 \trpaddft3 \trpaddfb3
\trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \
cellx4950 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10
\brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \brdrs \brdrw10 \brdrcf1 \
cellx9180 \pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanggal/jam}{\rtlch \fcs1
\f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \
langfe1041 \langfenp1041 \alang1081 Kontraksi uterus}{\rtlch \fcs1 \af0 \afs24 \
langfe1041 \langfenp1041 \alang1081 DJJ}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \
alang1081 Keterangan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
langfenp1041 \alang1081 \cell }\pard \plain \li0 \ri0 \lisb0 \lisa0 \widctlpar \
lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\trowd \trql \trgaph0 \
trleft612 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \brdrcf1 \
trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \brdrs \brdrw10 \brdrcf1 \trbrdrh \
brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \brdrw10 \brdrcf1 \trautofit1 \
alang1081 \cell }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
clwWidth1954 \clftsWidth3 \cellx9180 \row }\pard \plain \qj \li720 \ri0 \lisb0 \
alang1081 KALA II}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \
\langfenp1041 \alang1081 \f2 1.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 Kala II mulai }{\rtlch \fcs1 \af0 \afs24 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 :
tanggal .................... jam ...............................}{\rtlch \fcs1 \af0
qj \fi-360 \li1080 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
Lama kala II}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 : ............. jam ...............
menit ..................... detik}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanda gejala}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Jelaskan upaya meneran}{\
alang1081 : .......................................................................
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Kebutuhan khusus klien}{\
alang1081 : .......................................................................
alang1081 .......................................................................
alang1081 .......................................................................
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
alang1081 : .......................................................................
alang1081 .......................................................................
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 CATATAN KELAHIRAN }{\
\par }\pard \plain \qj \fi-360 \li1080 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
widctlpar \aspalpha \aspnum \adjustright \lin1080 \rin0 \itap0 \ls16 \rtlch \fcs1 \
dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 {\listtext \
langfe1041 \langfenp1041 \alang1081 Bayi lahir jam}{\rtlch \fcs1 \af0 \afs24 \ltrch
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Nilai APGAR}{\rtlch \fcs1
menit I .......................... menit V .......................................}
langfe1041 \langfenp1041 \alang1081 Perineum }{\rtlch \fcs1 \af0 \afs24 \ltrch \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : utuh
( ), episiotomi ( ), rupture ( ), tingkat ......................}{\rtlch \fcs1 \
Bonding ibu dan bayi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanda vital}{\rtlch \fcs1
....... mmHg, Nadi .....x/mnt, P ..... x/mnt, S ....... C}{\rtlch \fcs1 \af0 \afs24
langfe1041 \langfenp1041 \alang1081 {\listtext \pard \plain \rtlch \fcs1 \af6
\afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \dbch \
Pengobatan }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Karakteristik bayi baru
lahir : ...........................................................................
..............}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langnp1035 \langfe1041 \langfenp1041 \alang1081 KALA III}{\rtlch \fcs1 \af0 \
qj \fi-360 \li1080 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
Kala III mulai}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 : Jam ..........................
menit ..............................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Lama Kala III}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanda dan gejala}{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Plasenta lahir jam}{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Cara lahir plesenta}{\
hich
\af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Karakteristik plasenta}{\
alang1081 : .......................................................................
alang1081 Ukuran }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
\langfe1041 \langfenp1041 \alang1081 : ...............cm x ...................cm
x .........................cm}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 Panjang tali pusat}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : ...........................................
cm}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4
par }\pard \plain \qj \li1080 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Pembuluh darah}{\rtlch \fcs1 \af0 \
alang1081 : ................................
arteri .................................... vena}{\rtlch \fcs1 \af0 \afs24 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \li1080 \ri0
alang1081 Kelainan }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Perdarahan }{\rtlch \fcs1
alang1081 : ........................... ml,
Karakteristik ....................................}{\rtlch \fcs1 \af0 \afs24 \ltrch
alang1081 : .......................................................................
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 9.\tab
}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
Kebutuhan khusus klien}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pengobatan }{\rtlch \fcs1
alang1081 : .......................................................................
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 KALA IV}{\rtlch \fcs1
Mulai jam}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanda vital ibu}{\rtlch \
.........mmHg, Nadi ......x/mnt, P ...... x/mnt, S ......... C}{\rtlch \fcs1 \af0 \
Keadaan uterus}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
lang1035 \langnp1035
\langfe1041 \langfenp1041 \alang1081 Perdarahan}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................... ml,
karakteristik .......................................}{\rtlch \fcs1 \af0 \afs24 \
Kandung kemih}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Bonding ibu dan anak}{\
alang1081 : .......................................................................
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BAYI}{\rtlch \fcs1 \af0 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Bayi
lahir tanggal/jam}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Jenis kelamin}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Nilai APGAR}{\rtlch \fcs1
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB/PB bayi}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Karakteristik bayi}{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Lengkar kepala}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Suboccipito }{\rtlch \
alang1081 : ......................................... cm}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Accipito-bregmatika}{\rtlch \fcs1 \af0 \afs24 \
langfe1041 \langfenp1041 \alang1081 Biparietal}{\rtlch \fcs1 \af0 \afs24 \ltrch \
\rtlch \alang1081 \ltrch \loch \af0
\hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081
{\listtext \pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfenp1041 \alang1081 \f2 7.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 Kaput }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 : suksadenum ( ), Chepalhematom ( )}{\
langfe1041 \langfenp1041 \alang1081 Suhu }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Berlubang}{\rtlch \fcs1 \
berlubang / tertutup}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
ls19 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \
alang1081 {\listtext \pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 \f2 10.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Perawatan tali pusat}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Perawatan mata}{\rtlch \
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tonus otot}{\rtlch \
aktif ( ), paralise ( ), tremor ( ), lemas ( ), kejang ( ),}{\rtlch \fcs1 \af0
langfe1041 \langfenp1041 \alang1081 Lemah ( )}{\rtlch \fcs1 \af0 \afs24 \ltrch \
afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch
\f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tangisan }{\rtlch \
keras ( ), lemah ( ), melengking ( ), merintih ( )}{\rtlch \fcs1 \af0 \afs24 \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pengobatan }{\
alang1081 : .......................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Lain-lain}{\rtlch \fcs1 \
alang1081 : .......................................................................
qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
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langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \
lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \li0 \
ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \
afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0
\lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \li0
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}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn f3DOK}{\sv 0}}{\sp {\sn fShadowOK}{\sv 1}}{\
sp {\sn fFilled}{\sv 0}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 0}}{\sp {\
sn fPreferRelativeResize}{\sv 1}}{\sp {\sn wzName}{\sv Picture 191}}{\sp {\sn
alang1081 PENGKAJIAN POSTNATAL}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanggal Masuk}{\rtlch \fcs1 \af0 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Jam Masuk}{\
alang1081 : .........................................}{\rtlch \fcs1 \af0 \afs24 \
alang1081 \ltrch \dbch
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXXIII.\tab }{\rtlch \fcs1 \af0
f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 IDENTITAS}{\rtlch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Nama Pasien}{\rtlch \fcs1 \af0 \
Suku/Bangsa}{\rtlch \fcs1 \af0 \afs24
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXXIV.\tab
}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
ALASAN KUNJUNGAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
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langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXXV.\tab }{\rtlch \fcs1 \af0 \
alang1081 .........................................................................
...................................................................................
...................................................................................
.........................................................}{\rtlch \fcs1 \af0 \afs24
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXXVI.\tab }{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 RIWAYAT
alang1081 .........................................................................
...................................................................................
...................................................................................
Kesehatan Sekarang}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
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langfenp1041 \alang1081 {\listtext \pard \plain \rtlch \fcs1
\af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \loch \af0 \hich \af0 \
dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 19.\tab }
Riwayat Kesehatan Keluarga}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 .........................................................................
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alang1081 .........................................................................
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alang1081 .........................................................................
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alang1081 .........................................................................
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langfenp1041 \alang1081 \f2 XXXVII.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
langfe1041 \langfenp1041 \alang1081 Dismenore}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................................................................
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XXXVIII.\tab }{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 DATA OBSTETRI}
}\pard \plain \s28 \qj \fi-360 \li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
\aspalpha \aspnum \adjustright \lin810 \rin0 \itap0 \ls20 \rtlch \fcs1 \af5 \
langfe1041 \langfenp1041 \alang1081 Status Obstetrik}{\rtlch \fcs1 \af0 \afs21 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : Nifas hari ke
.............. P .................. A .........................}{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\trowd \
brdrs \brdrw10 \brdrcf1
\clbrdrb \brdrs \brdrw10 \brdrcf1 \cltxlrtb \clwWidth1800 \clftsWidth3 \
cellx9000 \pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 No}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Tipe Persalinan}{\rtlch \fcs1 \af0 \afs22 \
langfe1041 \langfenp1041 \alang1081 BB Lahir}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0
langfe1041 \langfenp1041 \alang1081 Keadaan bayi waktu lahir}{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Komplikasi}{\rtlch \fcs1 \af0 \afs22 \ltrch \
langfe1041 \langfenp1041 \alang1081 Umur sekarang}{\rtlch \fcs1 \af0 \afs22 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \
alang1081 {\trowd \trql \trgaph0 \trleft450 \trbrdrt \brdrs \brdrw10 \brdrcf1 \
trbrdrb \brdrs \brdrw10 \brdrcf1 \trbrdrl \brdrs \brdrw10 \brdrcf1 \trbrdrr \
brdrs \brdrw10 \brdrcf1 \trbrdrh \brdrs \brdrw10 \brdrcf1 \trbrdrv \brdrs \
brdrw10 \brdrcf1 \trautofit1 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \
langfe1041 \langfenp1041 \alang1081 1.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22
alang1081 2.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1081 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 3.}
langnp1035 \langfe1041 \langfenp1041 \alang1081 4.}{\rtlch \fcs1 \af0 \afs22 \ltrch
hich \af0 \loch \f0
\lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qj
\li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \
clftsWidth3 \cellx9000 \row }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \
pard \plain \s28 \qj \fi-360 \li450 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
alang1081 Masalah kehamilan sekarang}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \qj \fi-360 \li450 \ri0
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Riwayat persalinan
sekarang}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfenp1041 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \qj \li0 \ri0 \lisb0 \
langfenp1041 \alang1081 \f2 XXXIX.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 RIWAYAT KONTRASEPSI}{\rtlch \fcs1 \af0 \
Jenis Kontrasepsi yang digunakan sebelumnya: }{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 .........................................................................
...................................................................}{\rtlch \fcs1 \
langnp1033 \langfe1041 \langfenp1041 \alang1081 {\listtext
\pard \plain \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfe1041 \langfenp1041 \alang1081 Rencana penggunaan kontrasepsi :}{\rtlch \
alang1081 .........................................................................
..................................................................}{\rtlch \fcs1 \
Lainnya :}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 .........................................................................
..................................................................}{\rtlch \fcs1 \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XL.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 HASIL PEMERIKSAAN}{\rtlch
Tanda-tanda Vital}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tekanan Darah }
alang1081 : ................mmHg}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 Nadi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfe1041 \langfenp1041 \alang1081 Pernapasan}{\rtlch \fcs1 \af0 \afs24 \ltrch \
\langfe1041 \langfenp1041 \alang1081 \tab }{\rtlch \fcs1
alang1081 : ................C}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB}{\rtlch \fcs1 \af0 \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0 \lang1035
\langnp1035 \langfe1041 \langfenp1041 \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
fs24 \rtlch
langfe1041 \langfenp1041 \alang1081 Inspeksi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0
langfe1041 \langfenp1041 \alang1081 Linea}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .......................................................................
alang1081 : .......................................................................
OP : ..............................................................................
alang1081 : .......................................................................
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \qj \
\langfe1041 \langfenp1041 \alang1081 Keadaan }{\rtlch \fcs1 \af0 \afs21 \ltrch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : lembek/distensi, lain-
\par }\pard \plain \s28 \qj \fi270 \li450 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Diastasis rektus
abdominis : panjang ............. cm, lebar ............... cm}{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \
\alang1081 Fundus uteri}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : tinggi ...................... cm}{\rtlch \
pard \plain \s28 \qj \li450 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin450 \rin0 \itap0 \rtlch \fcs1 \af5 \afs21 \ltrch \fcs0 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081
Posisi ............................................................................
..............................}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \qj \li450 \ri0 \
\langfe1041 \langfenp1041 \alang1081
Kontraksi .........................................................................
...........................}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Lochea}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \qj \li810 \ri0 \lisb0
\lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin810 \rin0 \
alang1081 Jumlah }{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Warna }{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Konsisten }{\rtlch \fcs1 \af0 \afs21 \ltrch \
ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Bau }{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Perineum }{\rtlch \fcs1 \af0 \afs21 \ltrch \
langfe1041 \langfenp1041 \alang1081 Keadaan }{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 : utuh/episiotomi/ruptur
(tingkat .......................... )}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \
alang1081 Tanda
REEDA : ...........................................................................
........................................}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \
alang1081 .........................................................................
.....................................................................}{\rtlch \fcs1
s28 \qj \li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
langfe1041 \langfenp1041 \alang1081 Kebersihan }{\rtlch \fcs1 \af0 \afs21 \ltrch \
alang1081 : .......................................................................
alang1081 : .......................................................................
langfenp1041 \alang1081 \par }\pard \plain \s28 \qj \li810 \ri0 \lisb0 \lisa0 \
Verises }{\rtlch \fcs1 \af5 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langfe1041 \langfenp1041 \alang1081 : \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1
\u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?}{\rtlch \fcs1 \af5 \afs21 \ltrch \
langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af5 \afs21 \ltrch
langnp1033 \langfe1041 \langfenp1041 \alang1081 Tanda Homan}{\rtlch \fcs1 \af5 \
loch \f0 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 : \uc1 \
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1
\u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
?}{\rtlch \fcs1 \af5 \afs21 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Lainnya }{\rtlch \fcs1 \
alang1081 : .......................................................................
.................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pola Nutrisi}{\rtlch \
alang1081 : .......................................................................
...................................................................................
...................................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 .........................................................................
...................................................................................
...................................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Penyesuaian
dengan bayi :}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
\dbch \af4 \hich
\af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\
alang1081 .........................................................................
...................................................................................
...................................................................................
alang1081 .........................................................................
...................................................................................
...................................................................................
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XLI.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 PEMERIKSAAN PENUNJANG}{\
alang1081 Hasil Lab}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfe1041 \langfenp1041 \alang1081 : (cantumkan nilai normal)}{\rtlch \fcs1 \
langfe1041 \langfenp1041 \alang1081 USG}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041
\alang1081 : .............................}{\rtlch \fcs1 \af0 \afs24 \ltrch \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Rongen}{\rtlch
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \tab }{\
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Terapi yg didapat : }{\
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XLII.\tab }{\
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 DATA
TAMBAHAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 .........................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
langfe1041 \langfenp1041 \alang1081
Pekanbaru,........................................}{\rtlch \fcs1 \af0 \afs24 \ltrch
loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033
\langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \fi270 \li5490 \ri0 \
alang1081 ...........................................................}{\rtlch \fcs1
alang1081 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \
langnp1035 \langfe1041 \langfenp1041 \alang1081 ANALISA DATA}{\rtlch \fcs1 \af0 \
qj \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Nama Klien}{\rtlch \fcs1 \af0 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 :}{\rtlch \fcs1
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 No
RM :}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\trowd \trql \trgaph0 \
trleft-108 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \brdrcf1 \
clftsWidth3 \cellx9512 \pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 NO}{\rtlch \fcs1 \af0 \
\itap1 \rtlch \fcs1 \af6 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
\loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \
alang1081 Data (Symtom)}{\rtlch \fcs1 \af0 \afs28 \ltrch \fcs0 \fs28 \rtlch \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Masalah}{\
cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
langfe1041 \langfenp1041 \alang1081 Etiologi}{\rtlch \fcs1 \af0 \afs28 \ltrch \fcs0
alang1081 \ltrch \loch \af0 \hich \af0 \dbch \af4 \lang1033 \langnp1033
\langfe1041 \langfenp1041 \alang1081 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \
langfe1041 \langfenp1041 \alang1081
\cell }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
\langfe1041 \langfenp1041 \alang1081 \cell }\pard \plain \qj \li0 \ri0 \lisb0 \
brdrcf1 \cltxlrtb \clwWidth2405 \clftsWidth3 \cellx9512 \row }\pard \plain \qj \li0
\par }\pard \plain \s28 \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \af5 \afs21 \ltrch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \s28 \qj \li0 \
ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \af0 \lang1033 \
langnp1033 \langfe1041 \langfenp1041 \alang1081 {\shp {\*\shpinst \shpleft542 \
shptop22 \shpright1672 \shpbottom1073 \shpfhdr0 \shpbxcolumn \shpbxignore \
shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz5 \shplid1031 {\sp {\sn
shapeType}{\sv 75}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn
fLockAspectRatio}{\sv 1}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn cropFromRight}{\sv
11592}}{\sp {\sn pib}{\sv {\pict \piccropl0 \piccropr0 \piccropt0 \piccropb0 \
picscalex100 \picscaley100 \picw0 \pich0 \picwgoal0 \pichgoal0 \pngblip {\*\blipuid
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5d0bbfdcb99d578ebeee0cafc00eff0f8b115774aade47c70000000049454e44ae426082}}}{\sp {\
sn fLineOK}{\sv 1}}{\sp {\sn f3DOK}{\sv 0}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn
fFilled}{\sv 0}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 0}}{\sp {\sn
fPreferRelativeResize}{\sv 1}}{\sp {\sn wzName}{\sv Picture 191}}{\sp {\sn
alang1081 PENGKAJIAN KLINIK KELUARGA BERENCANA}{\rtlch \fcs1 \af0 \afs24 \ltrch \
dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035
\langfe1041 \langfenp1041 \alang1081 Ruang/Kelas}{\rtlch \fcs1 \af0 \afs24 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Kamar No}{\
alang1081 : .........................................}{\rtlch \fcs1 \af0 \afs24 \
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XLIII.\tab }{\rtlch \fcs1 \
loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 IDENTITAS}{\
langnp1035 \langfe1041 \langfenp1041 \alang1081 Nama Pasien}{\rtlch \fcs1 \af0 \
dbch
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XLIV.\tab }{\
rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
langfe1041 \langfenp1041 \alang1081 ALASAN KUNJUNGAN}{\rtlch \fcs1 \af0 \afs24 \
alang1081 .........................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XLV.\tab }{\rtlch \fcs1 \af0 \
alang1081 .........................................................................
...................................................................................
...................................................................................
.........................................................}{\rtlch \fcs1 \af0 \afs24
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 XLVI.\tab }{\
RIWAYAT KESEHATAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
Kesehatan Sekarang}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Riwayat Kesehatan
Keluarga}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
dbch \af4 \hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041
\alang1081 \par }\pard \plain \qj \li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
alang1081 .........................................................................
...................................................................................
...................................................................................
alang1081 .........................................................................
...................................................................................
...................................................................................
alang1081 .........................................................................
...................................................................................
...................................................................................
alang1081 .........................................................................
...................................................................................
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langfenp1041 \alang1081 \f2 XLVII.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
alang1081 : ( ) Ya}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081
langfe1041 \langfenp1041 \alang1081 ( ) Tidak}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 Warna}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Lama}{\rtlch \fcs1 \af0 \afs24 \
alang1081 Bau}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
langfe1041 \langfenp1041 \alang1081 : ..................................}{\rtlch \
langnp1035 \langfe1041 \langfenp1041 \alang1081 Menstruasi
Terakhir : ........................................................................
........................................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
alang1081 : .......................................................................
langfenp1041 \alang1081 \f2 XLVIII.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\langfe1041 \langfenp1041 \alang1081 JUMLAH ANAK}{\rtlch \fcs1 \af0 \afs24 \ltrch \
trleft360 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \brdrcf1 \
brdrcf1 \cltxlrtb \clwWidth1628 \clftsWidth3 \cellx9180 \pard \plain \qj \li0 \
ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
alang1081 \ltrch \dbch
alang1081 No }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tanggal
lahir / umur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
langfenp1041 \alang1081 \cell }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Tipe
persalinan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Keadaan
Sekarang}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
alang1081 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Ket}{\
langfe1041 \langfenp1041 \alang1081 {\trowd \trql \trgaph0 \trleft360 \trbrdrt \
langnp1035 \langfe1041 \langfenp1041 \alang1081 2.}{\rtlch \fcs1 \af0 \afs24 \ltrch
alang1081 4.}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
trautofit1 \trftsWidth1 \trftsWidthB3 \trftsWidthA3 \trpaddl108 \trpaddr108 \
trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3
\clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1 \clbrdrr \brdrs \brdrw10 \brdrcf1 \
clwWidth1628 \clftsWidth3 \cellx9180 \row }\pard \plain \qj \li450 \ri0 \lisb0 \
langfenp1041 \alang1081 \f2 XLIX.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24
langfe1041 \langfenp1041 \alang1081 RIWAYAT KONTRASEPSI}{\rtlch \fcs1 \af0 \afs24 \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Jenis
Kontrasepsi yang digunakan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Lama Penggunaan}{\rtlch \fcs1 \af0 \afs24 \
alang1081 : .......................................................................
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Rencana KB}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Lain-lain}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 .........................................................................
....................................................
...................................................................................
............................................................................}{\
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 L.\tab }{\
langfe1041 \langfenp1041 \alang1081 Suhu}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 BB}{\rtlch \
\ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich
\af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }\
alang1081 Kepala }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
langnp1035 \langfe1041 \langfenp1041 \alang1081 Inspeksi}{\rtlch
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
langfe1041 \langfenp1041 \alang1081 Bekas Luka
OP : ..............................................................................
alang1081 : .......................................................................
langfenp1041 \alang1081 \tab }{\rtlch \fcs1 \af0
\afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch \af4 \hich \af0 \loch \f0
\lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 }{\rtlch \fcs1 \af0 \
langfe1041 \langfenp1041 \alang1081 Bising Usus}{\rtlch \fcs1 \af0 \afs24 \ltrch \
alang1081 : .......................}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 : .......................................................................
alang1081 .........................................................................
....................................................................}{\rtlch \
alang1081 Pola Nutrisi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 : .......................................................................
...................................................................................
...................................................................................
eliminasi}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0
alang1081 BAK}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch
alang1081 : .......................................................................
alang1081 : .......................................................................
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Pola Istirahat
/ Tidur}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \dbch
alang1081 .........................................................................
...................................................................................
...................................................................................
alang1081 .........................................................................
...................................................................................
...................................................................................
langfenp1041 \alang1081 \f2 LI.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
langfe1041 \langfenp1041 \alang1081 PEMERIKSAAN PENUNJANG}{\rtlch \fcs1 \af0 \afs24
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Hasil Lab}{\
(cantumkan nilai normal)}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1081 \par }\pard \plain \qj \fi-360
\li810 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
\loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 USG}{\rtlch \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Terapi yg didapat :}{\
af4 \lang1033 \langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 LII.\tab }{\
STATUS GYNEKOLOGI}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \
alang1081 .........................................................................
...................................................................................
...................................................................................
.........................................................}{\rtlch \fcs1 \af0 \afs24
langnp1033 \langfe1041 \langfenp1041 \alang1081 \f2 LIII.\tab }{\rtlch \fcs1 \af0 \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 DATA TAMBAHAN}{\rtlch \
alang1081 .........................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
...................................................................................
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081
Pekanbaru,........................................}{\rtlch
langnp1035 \langfe1041 \langfenp1041 \alang1081 Preseptee}{\rtlch
alang1081 ...........................................................}{\rtlch \fcs1
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 ANALISA
DATA}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1081 \ltrch \
hich \af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 No
RM :}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1081 \ltrch \
trleft-108 \trbrdrt \brdrs \brdrw10 \brdrcf1 \trbrdrb \brdrs \brdrw10 \brdrcf1 \
trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalt \clbrdrl \brdrs \brdrw10 \brdrcf1
\clbrdrr \brdrs \brdrw10 \brdrcf1 \clbrdrt \brdrs \brdrw10 \brdrcf1 \clbrdrb \
clftsWidth3 \cellx9512 \pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \
lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 NO}{\rtlch \fcs1 \af0 \
alang1081 Data (Symtom)}{\rtlch \fcs1 \af0 \afs28 \ltrch \fcs0 \fs28 \rtlch \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 Masalah}{\
cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
langfe1041 \langfenp1041 \alang1081 Etiologi}{\rtlch \fcs1 \af0 \afs28 \ltrch \fcs0
langfe1041 \langfenp1041 \alang1081 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0
af0 \dbch \af4 \lang1033 \langnp1033 \langfe1041
brdrcf1 \cltxlrtb \clwWidth2405 \clftsWidth3 \cellx9512 \row }\pard \plain \qc \li0
\ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \
af0 \loch \f0 \lang1035 \langnp1035 \langfe1041 \langfenp1041 \alang1081 \par }}

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{\rtf1 \ansi \ansicpg1252 \deff0 \stshfdbch2 \stshfloch0 \stshfhich0 \deflang1033 \

deflangfe1033 {\fonttbl {\f0 \froman \fcharset0 \fprq2 {\*\panose

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