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RESUME MEDIS

Nomor Rekam Medis:

Nama Pasien: Tanggal Lahir: Umur: Jenis Kelamin: L/P

Tanggal Masuk: Tanggal Selesai Perawatan : Alamat :

Penanggung Pembayaran: Keluhan :

Ringkasan Riwayat Penyakit: _________________________________________________________


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Pemeriksaan Fisik: _________________________________________________________
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Pemeriksaan Penunjung/ _________________________________________________________
Diagnostik Terpenting: __________________________________________________________
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Terapi/Pengobatan _______________________________________________________________
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Hasil Konsultasi: _________________________________________________________
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Diagnosis Utama: _____________________________________ ICD 10: ______________________

Tindakan/ 1. _________________________________________ ICD9CM: 1.___________________


Prosedur: 2. ___________________________________________ 2.___________________
3._________________________________________ 3. ___________________
4. _________________________________________ 4. ___________________
Alergi (Reaksi Obat) _______________________________________________________________
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Diet: _______________________________________________________________
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Instruksi/Anjuran ________________________________________________________________
Dan Edukasi _______________________________________________________________
(Follow Up): _______________________________________________________________
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Terapi Yang Diberikan :


Nama Obat Jumlah Dosis Frekuensi Cara Pemberian

Banda Aceh
Paramedis Dokter Penanggung Jawab Pelayanan

Tanda Tangan Tanda Tangan

Lembar 1: Pasien
Lembar 2: Rekam Medis

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