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STATUS PASIEN RAWAT INAP & RAWAT JALANDIVISI GASTROENTERO HEPATOLOGI

DEPT. ILMU PENYAKIT DALAM / FK. USU / RSUP. HAM---------------------------------------------------------------------------------------------------------------------------------------------------Tanggal Konsul :Ka. Divisi : Prof. Dr. Lukman Hakim Zain, SpPD-KGEHSupervisor :PPDS Stase Gastroentero-Hepatologi :

-------------------------------------------------------------------------------------------------------------------------------------------------

--Anamnese Pribadi

Tanggal Msk / Asal : MR :Nama / Umur : thn Suku :Jenis Kelamin : Agama :Pekerjaan : Alamat :

---------------------------------------------------------------------------------------------------------------------------------------------------Anamnese PenyakitKeluhan utama :Telaah :

RPT :RPO :

Riwayat Keluarga :

---------------------------------------------------------------------------------------------------------------------------------------------------Status Present :Sensorium : HR : T/V :Tekanan Darah : RR : Temp :

---------------------------------------------------------------------------------------------------------------------------------------------------Pemeriksaan FisikKepala : Leher :Telinga / Hidung / Mulut: Torax :Abdomen : Genitalia :Pinggang : Ekstremitas Superior :Inguinal : Ekstremitas Inferior :

---------------------------------------------------------------------------------------------------------------------------------------------------LaboratoriumTanggal :Darah Rutin * LFT- Hb : Bil Tot : Direk : SGOT / SGPT :- Ht : ALP : LDH : AFP :

- WBC : * SPE Alb : Glob : Glob:- PLT : Protein Total :- LED : * RFT Ureum : Kreatinin :

asam urat :- Diffell : / / / / / * Analisa cairan asites :Urinalisa * Sitologi cairan asites :- Warna : Protrombine time :

- Reduksi :- Protein : RT :- Bilirubin :- Urobilinogen :- Erit / Leu / Ept :

---------------------------------------------------------------------------------------------------------------------------------------------------Pemeriksaan PenunjangUSG :Kolonoskopi :Pemeriksaan lain :

---------------------------------------------------------------------------------------------------------------------------------------------------Diagnosa Banding : 1.

2.3.

Diagnosa Sementara :Terapi :1. 3. 5. 7.2. 4. 6. 8.

Anjuran :

FOLLOW UP HARIAN

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Tanggal History Morbi Terapi

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