MR.

3/I
CLINICAL PATHWAYS
RSI IBNU SINA
MAKASSAR
SMF : ILMU PENYAKIT SARAF

Nama Pasien : Tgl Lahir Berat Badan : Tinggi Badan : No. Rekam Medis :
.......................................................... ......................... ................. kg ................. cm
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Diagnosis Awal : Kode ICD 10 : (ICD .164) Rencana rawat : 5 hari
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Aktivitas R. Rawat Tgl/Jam masuk : Tgl/Jam keluar : Lama Rwt Kelas : Tarif/hr (Rp): Biaya(Rp)
Pelayanan ................. ........................... .......................... .......... hari ............ .................. ................
..
Admisi Rawat Inap
IGD IRJ Hari Hari Hari Hari Hari
1 2 3 4 5
Diagnosis :
Penyakit Cluster Type Headache
Utama
Penyakit
Penyerta +/- +/- +/- +/- +/- +/- +/-
Hipertensi +/- +/- +/- +/- +/- +/- +/-
Dislipidemia +/- +/- +/- +/- +/- +/- +/-
Psikosomatik +/- +/- +/- +/- +/- +/- +/-
Gangguan +/- +/- +/- +/- +/- +/- +/-
Jantung +/- +/- +/- +/- +/- +/- +/-
Menstruasi +/- +/- +/- +/- +/- +/- +/-
Ansietas
Depresi
Komplikasi
Stroke Iskemik +/- +/- +/- +/- +/- +/- +/-
Gangguan Nn +/- +/- +/- +/- +/- +/- +/-
cr +/- +/- +/- +/- +/- +/- +/-
Insomnia
Asesmen Klinis :
Pemeriksaan
dokter
Konsultasi :
Internist +/- +/- +/- +/- +/- +/- +/-
Kardiologi +/- +/- +/- +/- +/- +/- +/-
Obstetri- +/- +/- +/- +/- +/- +/- +/-
Ginekologi +/- +/- +/- +/- +/- +/- +/-
Gizi klinik +/- +/- +/- +/- +/- +/- +/-
Psikiater
Pem,
Penunjang: +/- +/- +/- +/- +/- +/- +/-
Pem. +/- +/- +/- +/- +/- +/- +/-
Laboratorium +/- +/- +/- +/- +/- +/- +/-
TCD
CT-Scan
Tindakan :
Bed Rest +/- +/- +/- +/- +/- +/- +/-
Rehabilitasi +/- +/- +/- +/- +/- +/- +/-
Medik +/- +/- +/- +/- +/- +/- +/-
Oksigen C
....................
Obat-Obatan :
Paracetamol +/- +/- +/- +/- +/- +/- +/-
NSAID +/- +/- +/- +/- +/- +/- +/-
Diazepam +/- +/- +/- +/- +/- +/- +/-
Kortikosteroid +/- +/- +/- +/- +/- +/- +/-
TCA +/- +/- +/- +/- +/- +/- +/-
Cafein +/- +/- +/- +/- +/- +/- +/-
Ergotamin +/- +/- +/- +/- +/- +/- +/-
Tartrat +/- +/- +/- +/- +/- +/- +/-
Triptan

Pembiusan
Umum Gas:
+/- +/- +/- +/- +/- +/- +/-
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+/- +/- +/- +/- +/- +/- +/-
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+/- +/- +/- +/- +/- +/- +/-
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Pembiusan
Umum Injeksi: +/- +/- +/- +/- +/- +/- +/-
.................... +/- +/- +/- +/- +/- +/- +/-
.................... +/- +/- +/- +/- +/- +/- +/-
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+/- +/- +/- +/- +/- +/- +/-

 MR.3/I
+/- +/- +/- +/- +/- +/- +/-
+/- +/- +/- +/- +/- +/- +/-
Pembiusan
Regional/Loka
l:
Lidokain HCL
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Nutrisi:
35- +/- +/- +/- +/- +/- +/- +/-
40kkal/KgBB/ +/- +/- +/- +/- +/- +/- +/-
hr
Protein...
gram/hr

Mobilisasi:
Duduk +/- +/- +/- +/- +/- +/- +/-
Berdiri +/- +/- +/- +/- +/- +/- +/-
Berjalan +/- +/- +/- +/- +/- +/- +/-
Hasil (Outcome):
SembuhSempu +/- +/- +/- +/- +/- +/- +/-
rna
Sembuh dg +/- +/- +/- +/- +/- +/- +/-
Sekuele
Meninggal +/- +/- +/- +/- +/- +/- +/-
Pndidikan/Pro
mosi
Ksehatan/Ren
cana +/- +/- +/- +/- +/- +/- +/-
Pemulangan : +/- +/- +/- +/- +/- +/- +/-
Pasien +/- +/- +/- +/- +/- +/- +/-
Keluarga
Pasien
....................
Varians :
Jumlah Biaya
Perawat (PPJP) Diagnosis Akhir : Kode ICD 10 Jenis Tindakan Kode ICD 9 – CM
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DPJP Admisi :  ...................................... .............................
..............................  Utama .................................. ....................  ...................................... .....
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DPJP :  Penyerta ................................... ....................  ...................................... .....
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DPJP Operasi : ................................... ....................  ...................................... .............................
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DPJP Anestesi  Komplikasi ................................... .....................  ......................................
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Verifikator: ................................... .................
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