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  • Form Medical Check Up 2019

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    suyanto4444
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    This document contains sections for general examination and physical examination of a patient visit to Klinik Budhi Pratama - Restu Ibu Group. It includes fields to record the patient's height, weight, body temperature, pulse rate, respiration rate, blood pressure, general condition, nutrition, head, eyes, nose and notes.

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    form untuk medical check up

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    This document contains sections for general examination and physical examination of a patient visit to Klinik Budhi Pratama - Restu Ibu Group. It includes fields to record the patient's height, weight, body temperature, pulse rate, respiration rate, blood pressure, general condition, nutrition, head, eyes, nose and notes.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    18 views1 page

    Form Medical Check Up 2019

    Uploaded by

    suyanto4444
    This document contains sections for general examination and physical examination of a patient visit to Klinik Budhi Pratama - Restu Ibu Group. It includes fields to record the patient's height, weight, body temperature, pulse rate, respiration rate, blood pressure, general condition, nutrition, head, eyes, nose and notes.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    KLINIK BUDHI PRATAMA – RESTU IBU GROUP No.

    Check Up :
    Jl. Raya Tengah No.26 Gedong Ps Rebo
    MRN :
    Tlp. 021-87783668 Nama :
    Tanggal Periksa :
    Instansi :

    PEMERIKSAAN UMUM / GENERAL EXAMINATION

    TINGGI NADI
    : Cm : /minute
    HEIGHT PULSE RATE
    BERAT PERNAFASAN
    : Kg : /minute
    WEIGHT RESPIRATION RATE
    SUHU BADAN 0 TEKANAN DARAH
    : C : mmHg
    TEMPERATURE BLOOD PRESSURE

    PEMERIKSAAN FISIK / PHYSICAL EXAMINATION


    KEADAAN UMUM GIZI
    : :
    GENERAL CONDITION NUTRITION

    KEPALA MATA KANAN/RIGHT EYE WARNA


    HEAD
    : MATA KIRI/ LEFT EYE
    :
    COLOR
    :
    HIDUNG KETERANGAN
    NOSE
    : NOTES

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