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PEMERINTAH KOTA MANADO
DINAS KESEHATAN
UPT PUSKESMAS SARIO
Jalan Bethesda IV No.21 Kelurahan Sario Kecamatan Sario Kota Baru
Telp. 08114342722 Email: [email protected] Kode Pos 95114
RESUME KLINIS PASIEN RUJUKAN PUSKESMAS
I
Identitas pasien :
a. Nama pasien
:
b. Umur
:
c. Jenis kelamin
:
d. Alamat
:
e. No. BPJS/Jamkesda:
II
Keluhan utama pasien :
III
Pemeriksaan fisik
a. Keadaan umum :
b. GCS
:
c. Tanda-tanda Vital :
d. Tekanan darah :
e. Nadi
:
f. Pernafasan
:
g. Suhu
:
h. Kelainan yang bermasalah :
IV
Diagnosa:
V
Tindakan yang telah dilakukan:
a. ...................................................................................................................................
b. ..................................................................................................................................
c. ..................................................................................................................................
d. ..................................................................................................................................
VI
Terapi yang diberikan:
a. ..................................................................................................................................
b. ..................................................................................................................................
c. ...................................................................................................................................
d. ...................................................................................................................................
VII
Alasan merujuk:
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