e Jl.

Tajem – Pasar Stan RT 04 RW 44

NO. RM : RM. 24a
Maguwoharjo Depok Sleman D. I
Yogyakarta 55282 Telp. : (0274) 881229 /
NAMA : L/P
0815 7552 1009, (0274) 4462405,
Fax : (0274) 881229 TGL. LAHIR :
Website:rskiaarvitabunda.com, Email :
rsia.arvitabunda@yahoo.com RUANG/ KELAS :

ANAMNESIS / PEMERIKSAAN BAYI BARU LAHIR

1. ANAMNESIS
 Catatan mengenai kehamilan dan partus  Kelainan Bawaan  Hamil Beberapa Kali
1) ................................................................................................
2) ................................................................................................
3) ................................................................................................
4) ................................................................................................
5) ................................................................................................
2. KELAINAN KEHAMILAN
 Tidak  Ada : ........................................................................................................................................
3. RIWAYAT PARTUS
 Presentasi Bayi  Spontan  Forseps  Vakum Extraksi  Sectio Caesaria
 Lain-lain : .............................................................. Dilaksanakan karena : ...........................................
4. KOMPLIKASI
 Tidak Ada  Placenta Previa  Komplikasi / Tali Pusat  Dibantu Dengan Pengobatan
 Komplikasi Lain  Narkose  Keadaan Placenta / Ketuban : ..................................................
5. NILAI APGAR
1 Menit 5 Menit 2 Jam
Frekuensi Jantung : .............................. ................................... ...............................
Usaha Bernafas : .............................. ................................... ...............................
Tonus Obat : .............................. ................................... ...............................
Iribilitas Reflex : .............................. ................................... ...............................
Warna Kulit : .............................. ................................... ...............................
Jumlah : .............................. ................................... ...............................
6. PEMERIKSAAN FISIK
Jenis Kelamin : Laki-laki / Perempuan Berat Badan : ..................... gr
Golongan darah Bayi : A / B / O * RH + / - Panjang Badan : ..................... cm
Golongan darah Ibu : A / B / O * RH + / - Lingkar Kepala : ..................... cm
Golongan darah Ayah : A / B / O * RH + / - Lingkar Dada : ..................... cm
Lingkar Lengan : .................... cm

 Beri Tanda  pada pilihan yang sesuai * Lingkari pilihan yang sesuai
 7. TINDAKAN RM. 24b
Nafas Buatan : .......................... menit Pekerjaan Resusitasi lain-lain : .........................................
 Perawatan Mata  vitami K1

8. KEADAAN UMUM
Sensorium : ....................................................
Sikap Badan : ....................................................
Tonus Otot : ....................................................
Mortilitas : ....................................................
Warna Kulit : ....................................................
Turgor : ....................................................
Kelainan Kulit : .....................................................
Maturitas : ....................................................

CAPUT : KERANGKA :
Caput Seksudaneum : ....................................... Clavikula : .........................................
Fontanella Anterior : ....................................... Antikurasi Koxa : .........................................
Suture Capitis : ....................................... Tulang Belakang : .........................................
Mata : ......................................
Mulut : ......................................
Palatum : ......................................
Tenggorokan : ......................................

LEHER GENETALIA :

THORAX EKSTREMITAS :
Bentuk : ...........................................................
Pergerakan : ..........................................................
Cor : ...........................................................
Pulmones : ...........................................................

ABDOMEN : ANUS :
Hepar : ..............................................................
Lien : ..............................................................
Pusat : ..............................................................

9. PEMERIKSAAN NEUROLOGIS
Kanan Kiri
Refleksi Biceps : .................. ...................... Refleksi Mulut/ Mencari : .............................
Babinski : .................. ...................... Refleksi Menghisap : .............................
Reflek Telapak : .................. ...................... Refleksi Menelan : .............................
Tangan Memegang : ................. ......................
Refleks Moro : ................. .......................

10. DIAGNOSIS KERJA :

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Tanda Tangan dan Nama Dokter
Revisi : 1 / September 2022