Nama : Muhammad Nuril Wahid Fauzi

Nim : 04194890
Kelas : D/KP/2

A : Assalamu’alaikum, good morning nurse

B : Wa’alikumsalam, good morning to miss, how can i help you?
A : My head feels dizzy and feels weak nurse
B : Okay, please fill in the registration form first
A : Yes nurse
B : What is your name..?
A : My name is indah
B : How your old..?
A : Twenty one years
B : Your address..?
A : Kedunggalar
B : Do you have a history of illness before?
A : Pain in the head this week
B : Especially complaints other than headaches?
A : I felt headaches, body weakness, blurred vision, chest pain, shortness of breath, and
difficulty sleeping
B : Well please supine on the bed to be examined by doctor rosyid
A : Yes nurse (sambil berjalan ke bad)
MELAKUKAN PEMERIKSAAN
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C : I will check it first miss. please supine in the bed...!
A : Yes doc
C : Good please sit back miss
A : Yes doc
C : So the mother turned out to suffer from hypertension because his blood pressure is
180/110 v and now I give the prescription medicine, you can take a nurse to look after it
at the cashier
A : Yes doc. Thank you dock
PENGAMBILAN OBAT DAN PETUNJUK
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B : How are the results of the examination miss..?
A : I suffer from hypertension nurses and doctors have prescribed the medicine. This is a
recipe nurse
B : Ok miss I will get the medicine first
A : Yes doc
B : Here's the medicine miss (sambil memberikan obat)
A : Thank you nurse
B : So for instructions on use please miss take the medicine three times a day and take it
after eating and for the medicine can be stored in a cool place miss
A : Yes nurse. Thank you, I leave first
B : You're welcome, ma'am. I hope you get well soon miss
A : Yes nurse, Assalamualaikum
B : Wa’alaikumsalam miss

Keterangan:
 A: Sebagai pasien
 B: Sebagai perawat
 C : Sebagai dokter

PATIENT ADMISSION FORM

PERSINAL DETAILS

Name : Ms. Indah Kolifatun Azizah

Address : Kedunggalar
Name of GP : Dr. Rosyid
Patient’s understanding of admission: Headache.

MEDICAL INFORMATION

Relevant Medical History :

feel a headache and body weakness, blurred vision, chest pain, shortness of breath, and
difficulty sleeping in this week