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    RESUME / RINGKASAN KELUAR PASIEN RAWAT INAP
    NO. REGISTER :
    TGL. MASUK : JAM :
    TGL. KELUAR : JAM :

    IDENTITAS PASIEN
    Nama Pasien : Jenis Kunjungan :
    Tgl. Lahir / Umur : Nomor Kartu :
    Jenis Kelamin : Penanggung Jawab Biaya :
    Agama : Nomor Telepon :
    Pekerjaan : Diagnosa Sementara :
    Alamat : Diagnosa Medik :
    Dokter Penanggung Jawab :
    DIAGNOSA SELAMA DI : ............................................................................................................................................
    RAWAT .............................................................................................................................................
    DIAGNOSA AKHIR : ............................................................................................................................................
    .............................................................................................................................................
    RINGKASAN RIWAYAT PENEMUAN HASIL PEMERIKSAAN
    RIWAYAT : ............................................................................................................................................
    ............................................................................................................................................................................................
    TEMUAN FISIK : ............................................................................................................................................
    ............................................................................................................................................................................................
    ............................................................................................................................................................................................

    HASIL DATA : 1. .......................................................................................................................................


    PENUNJANG 2. ........................................................................................................................................
    3. .........................................................................................................................................
    4. .........................................................................................................................................
    5. .........................................................................................................................................
    PERKEMBANGAN : ............................................................................................................................................
    SELAMA .............................................................................................................................................
    PERAWATAN / RAWAT .............................................................................................................................................
    INAP
    KEADAAN PENDERITA : ............................................................................................................................................
    dan KESIMPULAN SAAT .............................................................................................................................................
    KELUAR RAWAT INAP .............................................................................................................................................
    .............................................................................................................................................
    Kalijaga.......................................................2021
    Mengetahui

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

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