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Jl. Cendrawasih No 5, Singaraja Bali, Indonesia, 80116 Phone. + 62 62 262!!, 262!8 " #a$ + 62 62 22!%1 &'(ail ) in*o+,er-ha.sada.

./o( MEDICAL RECORD Na(e o* 0a-ienNa-ionali-6 4.7.B Se$ ) ) ) ) 1r. 2res &d(on Nar.a Indonesia 085055186% 1ale 3d(ission 4a-e ) 1%50152012 3la(a)Sorong Bara-5Pa0.a Bagian )91P 2eg.h Pri(a

MAIN COMPLAINT & EXPLANATION 1ain Co(0lain) n6eri 0ada dada dan .l. ha-i, diser-ai rasa le(as &$0lana-ion on de-ails ) ' N6eri 0ada dada, n6eri diser-ai rasa se0er-i di-.s.,'-.s., dengan -a(:ah :era- saa- :era,-i;i-as5nai, -angga, :e,erja :era-, dengan n6eri .l. ha-i, se0er-i di-.s.,'-.s., :adan -erasa le(as, na*s. (a,an (en.r.n. Pas- 1edi/al <is-or6 ) 9en/ing 1anis, <i0er-ensi VITAL SIGN & PHYSICAL EXAMINATION Blood Press.re ) 1%0580 P.lse =a-e ) 85$ 5 (in.-e 2e(0era-.re ) !>C =es0ira-ion ) 20$ 5 (in.-e Ph6si/al &$a(ina-ion ) ' 9e0ala Nor(al ' 4ada S.ara na*as ?nor(al@, B.n6i Jan-.ng I'II ?nor(al@ ' Per.- in/rease nor(al ' 2angan A ,a,i nor(al MEDICAL SUPPORT INVESTIGATION (ECG, USG, CT-Scan, Radiolo !" ' Blood -es) 9enai,an *.ngsi li;er, ,enai,an g.la darah ?,en/ing (anis@ ' &CB ) nor(al sin.s rh6-(e ' C'ra6 ) ga(:aran 0ar. dan jan-.ng nor(al Dor,ing 4iagnosis 7-her Possi:ili-ies DIAGNOSE & POSSI#LITIES ) Sa,i- Ei;er )

=eg.lar 1edi/a-ion ) ' (e-hioson 1$1 /a0s.les ' IS4N $1 -a:leI$%i&a'a% (-) *in Singaraja, 1% Jan.ar6 2012 4r. I Da6an Parna 3 ?do,-er 0er.sahaan@ DOCTOR RECOMMENDATION +, *in+* o,a% %-&a%+&

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