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  • Status Kesehatan Gigi Dan Mulut: Pemerintah Kabupaten Maluku Tengah Dinas Kesehatan Puskesmas Perawatan Amahai

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    Enggelberth Wattimena
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    The document is a health record form from a community health center in Central Maluku Regency, Indonesia. It collects information about a patient's name, address, age, gender, type of health insurance, and arrival time/registration. It includes an odontogram to chart the patient's teeth and any issues. The form also includes a treatment table to record the date, complaint, diagnosis, therapy provided, signature, and notes for future dental visits and patient education.

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    Rm Poli Gigi

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    Rm Poli Gigi

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    The document is a health record form from a community health center in Central Maluku Regency, Indonesia. It collects information about a patient's name, address, age, gender, type of health insurance, and arrival time/registration. It includes an odontogram to chart the patient's teeth and any issues. The form also includes a treatment table to record the date, complaint, diagnosis, therapy provided, signature, and notes for future dental visits and patient education.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    30 views2 pages

    Status Kesehatan Gigi Dan Mulut: Pemerintah Kabupaten Maluku Tengah Dinas Kesehatan Puskesmas Perawatan Amahai

    Uploaded by

    Enggelberth Wattimena
    The document is a health record form from a community health center in Central Maluku Regency, Indonesia. It collects information about a patient's name, address, age, gender, type of health insurance, and arrival time/registration. It includes an odontogram to chart the patient's teeth and any issues. The form also includes a treatment table to record the date, complaint, diagnosis, therapy provided, signature, and notes for future dental visits and patient education.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    PEMERINTAH KABUPATEN MALUKU TENGAH

    DINAS KESEHATAN
    PUSKESMAS PERAWATAN AMAHAI
    Jl. Kuako – Negeri Soahuku – Kecamatan Amahai

    STATUS KESEHATAN GIGI dan MULUT

    Nama Pasien : No Index :

    Nama KK : Jenis Jaminan Kesehatan : UMUM/KIS/KIS Mandiri

    Umur : No. Kartu Jaminan :

    Jenis Kelamin : L / P Jam Kedatangan/Pendaftaran : : WIT

    Alamat :

    11 [51] [61] 21
    12 [52] [62] 22
    13 [53] [63] 23
    14 [54] [64] 24
    15 [55] [65] 25
    16 26
    17 27
    18 28

    ODONTOGRAM

    55 54 53 52 51 61 62 63 64 65

    18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
    48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

    85 84 83 82 81 71 72 73 74 75

    41 [81] [71] 31
    42 [82] [72] 32
    43 [83] [73] 33
    44 [84] [74] 34
    45 [85] [75] 35
    46 36
    47 37
    48 38

    Diperiksa oleh Tanggal Periksa Tanda Tangan Pemeriksa

    …………………………………………………. ……………………………………………….. …………………………………………………..


    TABEL PERAWATAN
    TANGGAL KELUHAN DIAGNOSA TERAPI PARAF KETERANGAN
    Edukasi :

    Ttd Pasien

    Edukasi :

    Ttd Pasien

    Edukasi :

    Ttd Pasien

    Edukasi :

    Ttd Pasien

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