CLINCAL PATHWAYS

SMF Peny.Saraf RSUD ZAINOEL ABIDIN

SPONDILITIS TUBERKULOSIS
2019
Nama Pasien Umur Berat Badan Tinggi Badan Nomor Rekam Medik
................................... ...................... .................. Kg ................ cm ..................................
Diagnosis Awal : Kode ICD 10 : Rencana Rawat : hari
Aktivitas Ruang Rawat Tgl/Jam masuk Tgl/Jam Keluar Lama Rawatan Kelas Tarif/hr (Rp) Biaya (Rp)
Pelayanan
....................... ....................... ....................... 7 hari ..................... ....................... ............................
HR1 HR2 HR3 HR4 HR5 HR6 HR7 HR8 HR9 HR10
Diagnosis
▪ Penyakit
Utama ....................... ....................... ....................... ....................... ................... ................... ................... ................... ................... ...................
▪ Penyakit
Penyerta ....................... ....................... ....................... ....................... ................... ................... ................... ................... ................... ...................

▪ Komplikasi ....................... ....................... ....................... ....................... ................... ................... ................... ................... ................... ...................
*Decubitus
*ISK

Assesmen Klinis
▪Pemeriksa ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-)
an Dokter

▪ Konsultasi ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-)
1. Rehab medis
2. Bedah Saraf
3. Orthopaedi

Pemeriksaan Penunjang
Darah
lengkap (+)
Foto Thoraks (+)
Foto Col. Vert (+)
Lumbal punksi (+)
Analisa LCS (+)
MRI Col.Vert (+)
Tindakan
Pasang
IVFD/Inj
Pasang
catheter
Fisioterapi (+)
Obat-
obatan :

∙ Rifampisin

∙ Isoniazid

∙ Pirazinamid

∙ Etambutol

Vit B6

Nutrisi
Diet TKTP
Mobilisasi
Hasil (outcome)
............... ............... ............... ............... ............... ............... ............... ............... ...............

Pemulangan Penjelasan Penyakit Nasehat berobat teratur

Varian .................. .................. .................. .................. .................. .................. .................. .................. .................. ..................
Jumlah Biaya:
Tgl dirawat Diagnosa Akhir : ICD 10 Jenis Tindakan : ICD 9-CM
.............
Tgl Pulang ▪ Utama ▪ Visite/konsul : Anamnesis 89.0
.......... .......................................
▪ Penyerta ................ ▪ Visite/konsul P. Neurologi 89.7
Lama
Rawatan ....................................... ................ ▪ Pemeriksaan Mikroskop Darah 90.5
.......hari ▪ Komplikasi ....................................... ................ ▪ Foto Thorak PA 87.44
....................................... ................ ▪ Foto Columna Vertebralis
....................................... ................ ▪ Lumbal Punksi
....................................... ................ ▪ Analisa LCS
....................................... ................ ▪ MRI Columna Vertebralis
....................................... ................ ▪ Pemasangan IVFD & Inj. Obat 99.2
....................................... ................ ▪ Pemasangan Chateter
....................................... ................ ▪ Fisioterapi
Nama Pelaksana Verifikasi Nama Dokter Nama Perawat
............................................. ............................................. .............................................
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