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    PUSAT KEDOKTERAN DAN KESEHATAN POLRI

    RUMAH SAKIT BHAYANGKARA TK.I PUSDOKKES POLRI

    RESUME MEDIS

    Nama Pasien : .....................................................


    Jenis Kelamin : .....................................................
    Tanggal Lahir : .....................................................
    Nomor Rekam Medis : .....................................................
    Tanggal Pelayanan : .....................................................
    Tempat Pelayanan : .....................................................

    A. Anamnesa
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................
    Riwayat Penyakit Dahulu :.........................................................................................
    ...................................................................................................................................
    ...................................................................................................................................

    B. Pemeriksaan Fisik
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................

    C. Pemeriksaan Penunjang
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................

    D. Diagnosa
    ...................................................................................................................................
    ..................................................................................................................................................

    E. Terapi / Tindakan
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................

    F. Keterangan/Anjuran
    ...................................................................................................................................
    ...................................................................................................................................

    Jakarta, ..............................,20......

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

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