CLINICAL PATHWAY

HEPATOMA
RSI DARUS SYIFA SURABAYA
TAHUN 2022

Nama Pasien: Umur: Berat badan: Tinggi Badan: Nomor Rekam Medis:
........................... .....................tahun ...................Kg ...................Cm .................................
Diagnosis Awal:.................. Kode ICD 10:.............. Rencana Rawat: 3 hari Biaya (Rp)
Ruang Rawat:...................... Kelas: Tarif/hari(Rp) Tgl masuk Tgl keluar Lama rawat
............ ..................... ................ ............... ..........hari ..................
Aktivitas Hari Rawat 1 2 3
Hari Sakit ................... ................... ...................
Diagnosis Utama .......................... ................... ................... ...................
Penyerta .......................... ................... ................... ...................
Komplikasi .......................... ................... ................... ...................
Asessmen Klinis Visite       .........................
Konsultasi
Pemeriksaan Penunjang:
 DL       ..........................
 BUN/SC, BIL D/T       .........................
 USG Abdomen       ..........................
 CT-Scan Abdomen       ..........................
Tindakan Pasang IVFD       ...........................
IVFD………..cc/hr       ...........................
Angkat IVFD       ..........................
Obat       ...........................
     
      ...........................
      ..........................
Nutrisi TKTP
Mobilisasi
Hasil Kesadaran      
(Outcome)      
     
Pendidikan & rencana pemulangan Rutin minum obat Pengawas Minum Obat (PMO) Kontrol poliklinik
Varians .................... .................... ....................
.................... .................... ....................
Jumlah Biaya ....................
Nama Perawat: Diagnosis Kode ICD 10 Jenis Tindakan Kode ICD 9 CM
......................................... Utama Hepatoma A15.0 Visite & konsultasi 89.0 dan 89.7
Nama & Kode Dokter IVFD dan injeksi 99.2
........................................ Penyerta ........................... ...................... ……………………….. …………………….
Verifikasi Keuangan: Komplikasi .......................... ...................... ………………………. ……………………..
......................................... .......................... ...................... ………………………. ……………………..