RUMAH SAKIT UMUM DAERAH

KABUPATEN BUTON UTARA

Jl. Poros Ereke Waode Buri, Kode Pos 93741
E-mail : rsbutonutara2018@gmail.com
RM 2
No. RM 
Nama 
RESUME MEDIS Jenis Kelamin 
Tanggal Lahir 
(Mohon Diisi atau tempelkan Stiker Jika Ada)

Tanggal Masuk:......../......../....... Tanggal Keluar/Meninggal:....../......./.... Ruang Rawat

Terakhir:......................
Diagnosa/masalah waktu masuk :...............................................................

Penanggung jawab pembayaran :............................................................... Alergi...............................

Ringkasan riwayat : .........................................................................................................................

penyakit .........................................................................................................................
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Pemeriksaan fisik : .........................................................................................................................
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Pemeriksaan penunjang/ : .........................................................................................................................
Diagnotis terpenting .........................................................................................................................
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Terapi/ penobatan : .........................................................................................................................
selama di rumah .........................................................................................................................
sakit .........................................................................................................................
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Hasil Konsultasi : .........................................................................................................................
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Diagnosa utama : .........................................................................................................................
Diagnosa sekunder : 1................................................................. ICD 10 1...........................
2................................................................. 2...........................
3................................................................. 3...........................

Tindakan / prosedur : 1................................................................. ICD 9 1...........................

2................................................................. 2...........................

3................................................................. 3...........................

Instruksi anjuran dan : .........................................................................................................................

edukasi .........................................................................................................................

Kondisi waktu keluar : Sembuh / Pindah RS / Pulang atas permintaan sendiri / Meninggal
Lain-lain:..........................................................................................................
Terapi pulang : .........................................................................................................................
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...............................................20.....
Dokter penanggung jawab pelayanan

( .............................................................)

*) yang dimaksud dengan keluarga adalah suami/istri/orangtua/anak

*) yang dimaksud dengan keluarga adalah suami/istri/orangtua/anak