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PEMERINTAH KABUPATEN SAMBAS

DINAS KESEHATAN
RUMAH SAKIT PEMERINTAH UMUM DAERAH PEMANGKAT
Jl. A. Kadir Kasim No. 20- Telp dan Faks (0562) 241203 e-mail: rsu.pmk@gmail.com
PEMANGKAT- KALIMANTAN BARAT
Kode pos 79453

DIALYSIS PATIENT INFORMATION FOR TRAVELING PURPOSES

NAME : Mrs. Suharti

SEX : FEMALE

AGE : 60 YEARS

ADDRESS : Ds. PIPITTEJA Kec.TELLUK KERAMAT KAB. Sambas

DIALYSIS HISTORY:

DIAGNOSIS CKD ON HD
YEARS ON HEMODIALYSIS 0 YEAR
EVIDENCE OF HBsAg NEGATIVE
COMPOSITION OF DIALYSATE BICARBONATE
DIALYZER F7HPS
KNOWN INTRADIALYTIC COMPLICATION -
TYPE OF ACCESS CDL
HEPARINIZATION INITIAL DOSE 2000 IU/HOUR
MAINTENANCE DOSE 1000 IU/HOUR
FREQUENCY TWICE A WEEK
LENGTH OF DIALYSIS SESSION 5 HOURS
QUICK BLOOD 250 ML/MINUTE
KNOWN OF ALLERGIC CONDITION -
PRESENT DRY-WEIGHT 48 Kgs
RECENT BLOOD PRESSURE 170/90 mmHg

ATTENDING PHYSICIAN

dr. ERI PRABOWO

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