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  • I. Pemeriksaan Fisik: Formulir Transfer Pasien Antar Bangsal / Igd / Bangsal

    Uploaded by

    Ilma Iswara
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    This document is a form for transferring patients between wards/emergency room/wards in a hospital. It includes information such as the patient's name, gender, date of birth, admitting date and time of transfer. It documents the patient's current and admitting diagnoses, physical examination findings, medical history, tests performed, treatments given such as IV fluids, injections, oral medications. Spaces are provided for the treating and receiving doctors to sign when transferring the patient.

    Original Description:

    Form Transfer Antar Ruangan

    Original Title

    Lembar Assesment Bayi

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    This document is a form for transferring patients between wards/emergency room/wards in a hospital. It includes information such as the patient's name, gender, date of birth, admitting date and time of transfer. It documents the patient's current and admitting diagnoses, physical examination findings, medical history, tests performed, treatments given such as IV fluids, injections, oral medications. Spaces are provided for the treating and receiving doctors to sign when transferring the patient.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    14 views1 page

    I. Pemeriksaan Fisik: Formulir Transfer Pasien Antar Bangsal / Igd / Bangsal

    Uploaded by

    Ilma Iswara
    This document is a form for transferring patients between wards/emergency room/wards in a hospital. It includes information such as the patient's name, gender, date of birth, admitting date and time of transfer. It documents the patient's current and admitting diagnoses, physical examination findings, medical history, tests performed, treatments given such as IV fluids, injections, oral medications. Spaces are provided for the treating and receiving doctors to sign when transferring the patient.

    Copyright:

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

    FORMULIR TRANSFER PASIEN ANTAR BANGSAL / IGD / BANGSAL

    Nama Pasien : ……………………………………………………………………………………………


    Jenis Kelamin :……………………………………………………………………………………………
    Tanggal lahir / Umur : Tanggal Masuk :
    DPJP : Ruang / Kamar :
    Dokter Konsulen 1 : Tanggal / Jam Pindah :
    Dokter Konsulen 2 : Pindah Keruang / Kamar :
    Diangnosa Masuk : Diagnosa Sekarang :

    I. PEMERIKSAAN FISIK
    Keadaan Umum :
    Kesadaran :
    Pemeriksaan Tanda Vital :
    Keluhan :
    Riwayat Penyakit :
    Riwayat Alergi :
    Alasan Pindah Ruangan :

    II. PEMERIKSAAN DIAGNOSIS YANG SUDAH DILAKUKAN


    Laboratorium : ………………………………………………………………………………………………
    …………………………………………………………………………………………………………………………………………….
    …………………………………………………………………………………………………………………………………………….
    EKG Foto Abdomen CT Scan
    Toraks Foto Spritometri Endoskopi
    Foto Cervical/Vertebra Echo/Treadmill CTG
    Foto Genu/ Femur USG/MRI/A Lainnya

    III. TINDAKAN MEDIS YANG SUDAH DILAKUKAN


    ……………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………

    IV. PEMBERIAN TERAPI


    Infus : …………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………
    Obat Injeksi : ………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………
    Obat Oral : ………………………………………………………………………………………………………………………….
    ……………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………
    Lain – Lainnya : …………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………
    ……………………………………………………………………………………………………………………………………………

    Yang Menyerahkan Yang Menerima

    (…………………………) (………………………..)

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