kole stasis

CLINICAL PATHWAY DAN SISTEM DRGs CASEMIXBAGIAN/SMF ILMU KESEHATAN ANAK

FAK. KEDOKTERAN UNS/RSUD. Dr. MOEWARDI SURAKARTAKOLESTASIS

2012Nama Pasien: Umur: Berat Badan: Tinggi Badan: Nomor Rekam Medis:................................................................................................. .............................. ..........................kg ..................................cm ............................................................Diangnosis: Kolestasis Kode ICD 10: K71.0........................................................... Rencana rawat :

R. Rawat Tgl/Jam masuk: Tgl/Jam keluar: Lama Rawat Kelas: Tarif/hr (Rp):Aktivitas Pelayanan ............... ............................ ............................. ......................hari ............... ...........................

HR 1-3 HR 4-6 HR 7-9 HR 10-12 HR 13-14Hari Sakit Hari Sakit Hari Sakit Hari Sakit Hari Sakit

Diangnosis:................... ................... ................... ................... ...................................... ................... ................... ................... ...................................... ................... ................... ................... ...................

Assesmen Klinis:................... ................... ................... ...................

................... ................... ................... ................... ...................Pemeriksaan Penunjang: Urin, Biakan urin dan Feses rutin

DL 2, SGPT-SGP, TORCH Gamma Glutamil Transpeptidase Kolesterol, Masa Protombir Bilirubin Total/Direck/Indireck

Tindakan: Pasang IVFDObat-obatan:n Vitamin D (calsitriol) 0,05-0,2 µg/kgBB/harin Vitamin E 25-200 IU/kgBB/hari (+)/(-) (+)/(-) (+)/(-) (+)/(-) (+)/(-)n Asam Ursodeoksikolat (Urdafack) (+)/(-) (+)/(-) (+)/(-) (+)/(-) (+)/(-)Nutrisi: ................... ................... ................... ...................Mobilisasi: ................... ................... ................... ...................Hasil (Outcome): ...................

................... ................... ................... ................... ...................(+)/(-) (+)/(-) (+)/(-) (+)/(-)

................... (+)/(-) (+)/(-) (+)/(-) (+)/(-)Pendidikan/Rencana (+)/(-) Gizi dan Imunisasi Kontrol poliklinikPemulangan: (+)/(-)Varians: Penjelasan Penyakit ................... ................... ................... ...................

Jumlah BiayaJumlah Biaya ................... Kode ICD 10 Jenis Tindakan:

Nama Perawat: Kolestasis K71.0........................................... Diagnosis Akhir:Nama Dokter: ....................................... ....................................... Feses Rutin........................................... ....................................... .......................................Nama Pelaksana Verifikasi: ....................................... .................................................................................. ....................................... .......................................

n Penyakit Utaman Penyakit Penyertan Komplikasi

n Pemeriksaan dokter ( + ) ( - )n Konsultasi

n BB/TBn Ststus neurologisn Perkembangan

n Visite/Konsul: Anamnesis & PF

n Utama

n Penyerta n Pemasangan IVFD, Inj. Obat n Oksigen

n Komplikasi

Nomor Rekam Medis:............................................................

Rencana rawat : Biaya (Rp)

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Kode ICD 9 - CM