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  • Klinik Abah Medical Check Up Report

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    Nuansa Chalid Awaluddin
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    This document is a medical check-up report from Klinik Abah clinic in Aceh Tamiang, Indonesia. It contains sections for the patient's identity, medical history, physical examination findings, and results of any medical tests. The physical examination includes measurements of vital signs, general health status, and system-specific exams of the eyes, ears/throat/nose, mouth, neck, chest, abdomen, extremities, and neurological system. Any laboratory tests, chest x-rays, or electrocardiograms ordered are also documented. The report is signed by the examining physician, Dr. Nuansa Chalid Awaluddin, and dated for 2019 from Aceh Tamiang.

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    Medical Check Up Klinik Abah

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    Medical Check Up

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    This document is a medical check-up report from Klinik Abah clinic in Aceh Tamiang, Indonesia. It contains sections for the patient's identity, medical history, physical examination findings, and results of any medical tests. The physical examination includes measurements of vital signs, general health status, and system-specific exams of the eyes, ears/throat/nose, mouth, neck, chest, abdomen, extremities, and neurological system. Any laboratory tests, chest x-rays, or electrocardiograms ordered are also documented. The report is signed by the examining physician, Dr. Nuansa Chalid Awaluddin, and dated for 2019 from Aceh Tamiang.

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    © All Rights Reserved
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    26 views2 pages

    Klinik Abah Medical Check Up Report

    Uploaded by

    Nuansa Chalid Awaluddin
    This document is a medical check-up report from Klinik Abah clinic in Aceh Tamiang, Indonesia. It contains sections for the patient's identity, medical history, physical examination findings, and results of any medical tests. The physical examination includes measurements of vital signs, general health status, and system-specific exams of the eyes, ears/throat/nose, mouth, neck, chest, abdomen, extremities, and neurological system. Any laboratory tests, chest x-rays, or electrocardiograms ordered are also documented. The report is signed by the examining physician, Dr. Nuansa Chalid Awaluddin, and dated for 2019 from Aceh Tamiang.

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    © All Rights Reserved
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    KLINIK ABAH NOMOR IZIN : 441 / DPMTSP – KL / 129 / 2017

    Jl. Medan ˗ Banda Aceh, Bukit Rata, Kejuruan Muda, Aceh Tamiang
    Kode Pos 24477, HP 081360208556, Email: klinikabah@gmail.com

    RESUME MEDICAL CHECK UP


    NOMOR : 445 / / 418.67 / 2015

    I. IDENTITAS
     Nama : ……………………………………………………………………………………….
     Umur : ………………… Tahun
     No Registrasi : ……………………………………………………………………………………….
     Alamat : ……………………………………………………………………………………….
    ………………………………………………………………………………………

    II. ANAMNESE
    1. Keluhan Sekarang : ………………………………………………………………………...
    2. Penyakit Riwayat Dahulu : ………………………………………………………………………...
    ………………………………………………………………………...
    3. Riwayat Penyakit Keluarga : ………………………………………………………………………..
    ………………………………………………………………………...
    4. Kebiasaan Sehari – hari : ………………………………………………………………………...
     Aktivitas : ……………………………………………………………………………….
     Olahraga : ……………………………………………………………………………….
     Merokok : ……………………………………………………………………………….
     Minum Alkohol : ……………………………………………………………………………….

    III. PEMERIKSAAN FISIK


    1. Keadaan Umum : ……………………………………………………………………………….
    2. Berat Badan : ……….. kg
    3. Tinggi Badan : ……….. cm
    4. Vital Sign
     Tekanan Darah : ……….. mmHg
     Nadi : ……….. x/m
     Pernafasan : ……….. x/m
     Suhu Tubuh : ……….. °C
    KLINIK ABAH NOMOR IZIN : 441 / DPMTSP – KL / 129 / 2017
    Jl. Medan ˗ Banda Aceh, Bukit Rata, Kejuruan Muda, Aceh Tamiang
    Kode Pos 24477, HP 081360208556, Email: klinikabah@gmail.com

    5. Pemeriksaan
     Mata : ……………………………………………………………………………….
     THT : ……………………………………………………………………………….
     Mulut : ……………………………………………………………………………….
     Leher : ……………………………………………………………………………….
     Thorax : ……………………………………………………………………………….
     Abdomen : ……………………………………………………………………………….
     Extrimitas : ……………………………………………………………………………….
     Pemeriksaan Neurologis : …………………………………………………………………….

    IV. PEMERIKSAAN PENUNJANG


    1. Laboratorium : ……………………………………………………………………………….
    2. Foto Thorax PA : ……………………………………………………………………………….
    3. Elektrokardiografi : ……………………………………………………………………………….

    Aceh Tamiang, 2019


    Dokter Pemeriksa

    dr. Nuansa Chalid Awaluddin

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