RESUME MEDIS Nomor Rekam Medis :

Nama Pasien : Tanggal Lahir : Umur : Jenis Kelamin :

L/P
Tanggal Masuk: Tanggal Keluar : Ruang Rawat Terakir :

Diagnosis Sewaktu Masuk :

Ringkasan Riwayat Penyakit : _________________________________________________________

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Pemeriksaan Fisik : _________________________________________________________
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Pemeriksaan Penunjang : _________________________________________________________
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Terapi selama Perawatan : _________________________________________________________
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Diagnosa Utama : _________________________________________________________
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Keadaan saat Keluar : Sehat Belum Sehat Meninggal

Pulau Tello,
Dokter yang Merawat

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