HOME VISIT REPORT

Compiled by:
Deby Ariandiny
NIM:
Disca Ariella Rucita
NIM:
Farida Nur Aini
NIM:
Leliana Saleh
NIM:
Muhammad Ihsan Sasraningrat NIM:

108103000024
108103000042
108103000053
108103000008
108103000019

CLINICAL WORK ADDICTION

HOSPITAL DRUG DEPENDENCE
(RSKO)
MEDICAL EDUCATION STUDY
PROGRAM
FACULTY OF MEDICINE AND HEALTH
SCIENCES
SYARIF HIDAYATULLAH STATE ISLAMIC
UNIVERSITY

I. BACKGROUND
To perform optimally in the treatment of addicts
(recovering addict), need cooperation between health
workers / medical personnel and family members of clients
who received treatment. For those reasons, the family
should be included in the client's treatment and recovery
programs for clients heal and clients can stop (clean) from
drug dependence consciously (sober). It is very important
that the client, who is experiencing a mental disorder due
to the influence of psychoactive substances (drugs), does
not always have to be hospitalized at detoxification and
drug rehabilitation of hospital drug dependency.
In this case, the role of the family is required to optimize
the client to independent, increase the fulfillment of daily
living, provide information, communication, education to
clients and families, empowering families in caring for
patients at home. For those, we can do home visit.

II. IMPLEMENTATION
a. Time, day, date, year : At 11:00,
Monday, February 3, 2014.
b. Responsible Person : Mr. Abidin.
c. Address : Cibubur IV RT. 005/002,
Cibubur, East Jakarta.

III. CLIENT IDENTITY

a. Name: Mr. Junaedi.
b. Medical Record Numbers: C.257 /
No. PTRM 028 318
c. Age: 31 Years.
d. Sex: Male.
e. Religion: Islam.
f. Room: Participant of PTRM.
g. Date of entry: Methadone
Treatment since 2011 to 2014.

IV. PURPOSE OF PATIENTS

HOME VISIT
To determine biopsychosocial of
patients and their families.
In addition, for health education on
family and validation of data.

V. GENOGRAM

VI. INTERVENTION
Provide health education to families about
home care of client during treatment and
recovery in order to achieve the level of clean
and sober. Health education includes:
a. Do activities in accordance with the patient's
ability and pray in accordance with the
patients faith. With these, patient is expected
to have positive activities so that they can
build patients confidence and keep patient
from negative events (reuse drugs) because
there are no activities and patients memories
(flash back).

VI. INTERVENTION
b. Involve client in every state in his family and
environment (such as social events, religion
etc.).
c. Provide information about the importance of
regular outpatient (in this case, the treatment of
PTRM), report to the doctor/ medical officer at
the hospital when the patient returns to have
suggest (a desire to use drugs again) and
withdrawal symptoms, and monitor patient to
consume Methadone correctly if the patient is
taking THD (Take Home Dose).

VII. EVALUATION
a. Acceptance of family: the family is very
cooperative (the patient's mother) and can
cooperate with the officer of home visit.
b. The results of family health
education: familiy can understand the
importance of regular PTRM medication
and family has a good spirit and desire to
maintain and care for the patient (as a
recovering addict) that patient can recover
and achieve clean and sober.

FIRST ATTACHMENT
HOUSE PLAN

SECOND ATTACHMENT HOME

VISIT PHOTOS

THIRD ATTACHMENT FORM HOME

VISIT
A.1. Patient Identity / Rehabilitant:
Medical Record Numbers
: C257 / 028 318
Name
: Mr. Junaedi Age : 31 Years
Education
: High School
Address : Cibubur No. IV. 97 RT 005/002
Cibubur, East Jakarta
Have Been Treated
:Last Treated
: Treatment Metadone (2011 s / d 2014)
Out of Treatment
:Occupation
: Retail Trader (Pedagang Eceran)
Ethnicity : Betawi
Religion : Islam
Diagnosis
: Opioid Dependent
Status in The Family : Children Bladder
Marital Status : Single

A.2. The identity of the head of family:

Name : Mr. Abidin
Education
: SMP
Address of the head of family : Cibubur IV. 005/002,
Cibubur, East Jakarta
Occupation : Construction worker
Marital status
: Married
Relationship Status of the head of family
:
Father
The composition of family in the house :
1. Father
: Mr. Abidin, 57 years old
2. Mother
: Mrs. Jumimah, 51 years old
3. Child 1
: Tn. Junaedi, 31 years old
4. Child 2
: Ny. Maisaroh, 26 years old (not at home)
5. Child 3
: Ms. Titin, 21 years old
6. Child 4
: Ms. Ade, 12 years old

B. Purpose of Home Visit

Knowing biopsychosocial of patient and Family
C. The State of Social and Economic of Family
1. Status residence
: own property
2. Separate room for patient : yes
3. Condition of the house
: moderate
4. Home hygiene
: moderate
5. Neatness of the house
: poor
6. Atmosphere of residential area :
a. Occupancy
: medium
b. Cleanliness : moderate
c. Serenity
: Quiet

7. Economic condition of the family / patient : enough

8. Living costs are borne by
: father
9. Number of dependents
: 4 people
10. Breadwinner in the family : father
11. Attitude of patient towards family : obedient
12. Attitude of family towards patient : accept
13. The difficulty of family in the care of patient at
home: no
14. Attitude of patient towards neighbors : good
15. Attitude of neighbors towards patient : indifferent

D.1. Physical and appearance changes :

Fat
Net
Friendly
Agile

D.2. Familys complaints about the behavior of

patient:
a. Suicide attempt
b. Self-isolation : no
c. Insomnia
: no
d. Hostile : no
e. Suspicious
: no
f. Threatening : no
g. Glum : no
h. Agrasi : no

: no

E. Disability Conditions of patient:

1. Behaviors related to the needs of daily living (ADL)
1.
2.
3.
4.

Wake up: independent

Defecate
: independent
Urination
: independent
Bath time
: independent

5.
6.
7.
8.
9.

Change clothes
: independent
Eating and drinking
: independent
Maintaining personal hygiene
: independent
Keeping the safety of self
: independent
Go to sleep
: independent

2. Social Behaviors:
10. Relationship to child / husband / significant others :
good
11. Social contacts of the officers
: good
12. Eye contact when talking/speaking : good
13. Associating
: good
14. Obeying the order
: good
15. Manners
: good
3. Occupational Behaviors:
16. Interested in the activities / work
: agree
17. Want to do activities : agree
18. Active / diligent to do activity / work
: agree
19. Productive in doing work / activity : agree
20. Skilled in do activities
: agree
21. Appreciating the work results
: agree
22. Want to receive command / criticism : agree

F. Conclusion:
1. Psychosocial stressors : not married yet, not
having a permanent job
2. Adaptation function of one last year: no
symptoms, maximum functioning, no problems are
not insurmountable
3. Familys response to the home visit officer :
open and friendly
4. Familys motivation to take medication for
patient : patient recovers and has a permanent job
Family,
Signature
Mrs. Tamimah (Patients Mother)