RSUD dr. FAUZIAH BIREUEN UNIT PRE OPERASI Jln. Mayjen T. Hamzah Bendahara No. 13

ASESMEN PRASEDASI

Nama :

No. RM :

Tgl. Lahir : □ Laki-laki □ Perempuan

ANAMNESA:............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

PEMERIKSAAN PENUNJANG:..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................

DIAGNOSA KLINIS:..........................................................................................................................................................

RENCANA TINDAKAN:..........................................................................................................................................................

PRE MEDIKASI: ..........................................................................................................................................................

JENIS ANASTESI DIRENCANAKAN:..........................................................................................................................................................

KESIMPULAN/ INTERVENSI.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Bireuen, .......................... 2015

(.......................................) DPJP Anastesi

TECKONG/DOK/PAB/DR.FAUZIAH/2015

TECKONG/DOK/PAB/DR.FAUZIAH/2015