MODUL PRAKTIKUM

ASSESMEN DAN DIAGNOSA FISIOTERAPI

STATUS KLINIK

A. DATA-DATA MEDIS RUMAH SAKIT

a. Diagnosa medis :................................................................................................................
b. Catatan Klinis :................................................................................................................
c. TerapiUmum :…………………………………………………………………………

B. PEMERIKSAAN FISIOTERAPI
1. Anamnesis
a. Anamnesis Umum
Nama :................................................................................................................
Umur :........................................................................................(Mgg/Bln/Thn)
Alamat :................................................................................................................
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Jenis kelamin : ( L / P )
Agama :................................................................................................................
Pekerjaan :................................................................................................................
b. Anamnesis Khusus
Keluhan Utama :.............................................................................................
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Riwayat penyakit :.............................................................................................
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Riwayat penyakit dahulu :.............................................................................................
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Riwayat penyakit penyerta :.............................................................................................
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 c. Anamnesis Sistem
1) Musculoskeletal :..............................................................................................
2) Kardiovaskuler :..............................................................................................
3) Respirasi :..............................................................................................
4) Neuromuscular :..............................................................................................
2. Pemeriksaan Fisik
a. Vital Sign
 Tekanan Darah :..................................................................................
 Denyut Nadi :..................................................................................
 Pernapasan :..................................................................................
 Temperatur :..................................................................................
b. Inspeksi
 Statis :..................................................................................
 Dinamis :..................................................................................
3. PemeriksaanSpesifik
a. MMT
b. Tes Tonus otot :
c. TesKeseimbangan
d. PengukuranNyeri
e. Tes Koordinasi
f. TesApresiasiReaksi :
g. Tessensorik :
h. Tes Reflek
i. Tes Rasa Posisi
j. Tes Transfer
k. TesADL
4. Kognitif,intrapersonal, dan interpersonal
Kognitif :
Intrapersonal :
Interpersonal :
C. DIAGNOSIS FISIOTERAPI :..............................................................................................
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D. PROBLEMATIK FT :..............................................................................................
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E. PROGRAM RENCANA TINDAKAN FISIOTERAPI

1. Tujuanjangkapanjang :……………………………………………………………..
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2. Tujuanjangkapendek :……………………………………………………………..
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F. INTERVENSI FISIOTERAPI
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G. PROGNOSIS
Quo ad vitam :................................................................................................................
Quo ad sanam :................................................................................................................
Quo ad fungsionam :................................................................................................................
Quo ad cosmeticam :................................................................................................................

H. EVALUASI
1) Evaluasisesaat :…………………………………………………………………............
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2) Evaluasiberkala :…………………………………………………………………………
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I. HASIL TERAPI AKHIR

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J. HOME PROGRAM
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K. UNDERLIYING PROCESS
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