STATUS PASIEN PRE / POST OPERASIFollow up koas Anastesi

No RM:..................................................Tanggal : ........,........,20.......Tanggal masuk:..................................................Nama:..................................................Umur: ...........Tahun.>40thn+EKGGenitalia : Laki-laki / Perempuan.Berat badan:............Kg.Tinggi Badan:............Cm.Temperatur :............C.Gol. Darah: A, B, AB, OTekanan Darah:............./.............mmhgHB:...............g%CT:...........'BT:...........'Hr :...........x/iRr :...........x/iRH: (.......)WH: (.......)Batuk : (.......)Sesak : (.......)R.Hipertensi: (.......)R.Alergi obat: (.......)R.Penykt. DM: (.......)R. Gigi Palsu: (.......)R. Mkan/Minum: Jam ....................WIBR. Maag: (.......)R. Astma: (.......)R.Operasi: (.......)Protein Urin: (.......)Atas Indikasi:..................................................Dokter:..................................................Ruang:..................................................

ACC Anestesi:............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................STATUS PASIEN PRE / POST OPERASIFollow up koas Anastesi

No RM:..................................................Tanggal : ........,........,20.......Tanggal masuk:..................................................Nama:..................................................Umur: ...........Tahun.>40thn+EKGGenitalia : Laki-laki / Perempuan.Berat badan:............Kg.Tinggi Badan:............Cm.Temperatur :............C.Gol. Darah: A, B, AB, OTekanan Darah:............./.............mmhgHB:...............g%CT:...........'BT:...........'Hr :...........x/iRr :...........x/iRH: (.......)WH: (.......)Batuk : (.......)Sesak : (.......)R.Hipertensi: (.......)R.Alergi obat: (.......)R.Penykt. DM: (.......)R. Gigi Palsu: (.......)R. Mkan/Minum: Jam ....................WIBR. Maag: (.......)R. Astma: (.......)R.Operasi: (.......)Protein Urin: (.......)Atas Indikasi:..................................................Dokter:..................................................Ruang:..................................................

ACC Anestesi:............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................STATUS PASIEN PRE / POST OPERASIFollow up koas Anastesi

No RM:..................................................Tanggal : ........,........,20.......Tanggal masuk:..................................................Nama:..................................................Umur: ...........Tahun.>40thn+EKGGenitalia : Laki-laki / Perempuan.Berat badan:............Kg.Tinggi Badan:............Cm.Temperatur :............C.Gol. Darah: A, B, AB, OTekanan Darah:............./.............mmhgHB:...............g%CT:...........'BT:...........'Hr :...........x/iRr :...........x/iRH: (.......)WH: (.......)Batuk : (.......)Sesak : (.......)R.Hipertensi: (.......)R.Alergi obat: (.......)R.Penykt. DM: (.......)R. Gigi Palsu: (.......)R. Mkan/Minum: Jam ....................WIBR. Maag: (.......)R. Astma: (.......)R.Operasi: (.......)Protein Urin: (.......)Atas Indikasi:..................................................Dokter:..................................................Ruang:..................................................

ACC Anestesi:............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................STATUS PASIEN PRE / POST OPERASIFollow up koas Anastesi

No RM:..................................................Tanggal : ........,........,20.......Tanggal masuk:..................................................Nama:..................................................Umur: ...........Tahun.>40thn+EKGGenitalia : Laki-laki / Perempuan.Berat badan:............Kg.Tinggi Badan:............Cm.Temperatur :............C.Gol. Darah: A, B, AB, OTekanan Darah:............./.............mmhgHB:...............g%CT:...........'BT:...........'Hr :...........x/iRr :...........x/iRH: (.......)WH: (.......)Batuk : (.......)Sesak : (.......)R.Hipertensi: (.......)R.Alergi obat: (.......)R.Penykt. DM: (.......)R. Gigi Palsu: (.......)R. Mkan/Minum: Jam ....................WIBR. Maag: (.......)R. Astma: (.......)R.Operasi: (.......)Protein Urin: (.......)Atas Indikasi:..................................................Dokter:..................................................Ruang:..................................................

ACC Anestesi:............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................