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  • Universitas Katolik Widya Mandala Surabaya Fakultas Keperawatan

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    wahyu astri pratiwi
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    This certificate documents a patient's care and discharge from Widya Mandala Hospital in Surabaya, Indonesia. It includes the patient's admission and discharge dates, diagnosis, treating doctor, health education provided, medications, test results, and discharge status. Upon discharge, the patient or family member signs to acknowledge receiving information from the nurse on the patient's care, medications, follow-up instructions, and control date. The card is to be brought to future medical checkups.

    Original Description:

    Terimakasih

    Original Title

    Lembar Kontrol

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    This certificate documents a patient's care and discharge from Widya Mandala Hospital in Surabaya, Indonesia. It includes the patient's admission and discharge dates, diagnosis, treating doctor, health education provided, medications, test results, and discharge status. Upon discharge, the patient or family member signs to acknowledge receiving information from the nurse on the patient's care, medications, follow-up instructions, and control date. The card is to be brought to future medical checkups.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views3 pages

    Universitas Katolik Widya Mandala Surabaya Fakultas Keperawatan

    Uploaded by

    wahyu astri pratiwi
    This certificate documents a patient's care and discharge from Widya Mandala Hospital in Surabaya, Indonesia. It includes the patient's admission and discharge dates, diagnosis, treating doctor, health education provided, medications, test results, and discharge status. Upon discharge, the patient or family member signs to acknowledge receiving information from the nurse on the patient's care, medications, follow-up instructions, and control date. The card is to be brought to future medical checkups.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA

    FAKULTAS KEPERAWATAN
    Sekretariat : Jl. Raya Kalisari Selatan 1, Pakuwon City Telp. (031)96005299 Ext.10853
    Surabaya

    Certificate of control
    1. Date of entry :
    Out date :
    2. Incoming diagnosis ;
    3. The treating doctor :
    4. Health education / kie :
    A. disease :
    B. care :
    C. personal hygiene & environment :
    D. pain management :
    5. Drug list
    No Drug name Dose Total Informasi

    6. The Results Of The Tests Taken Home


    Laboratory
    Chest photo
    Ultrasound
    Ct scan
    Control card
    7. Came home from the hospital widya mandala under the circumstances :
    Healed
    Continue with the road medicine
    Moved another hospital
    Forced home
    8. Control to :
    Poly : Day / date :
    Note :
    I as a patient / family of the patient said that he had received information on the things
    mentioned above by the nurse Widya Mandala and understood.
    Surabaya,......................................
    Patient Family Nurse doctor

    ( ) ( ) ( )

    NB : This card please bring it and show it to the doctor who checks the time of
    control
    UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA
    FAKULTAS KEPERAWATAN
    Sekretariat : Jl. Raya Kalisari Selatan 1, Pakuwon City Telp. (031)96005299 Ext.10853
    Surabaya
    UNIVERSITAS KATOLIK WIDYA MANDALA SURABAYA
    FAKULTAS KEPERAWATAN
    Sekretariat : Jl. Raya Kalisari Selatan 1, Pakuwon City Telp. (031)96005299 Ext.10853
    Surabaya

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