PKU MUHAMMADIYAH PURBALINGGA

PKU MUHAMMADIYAH PURBALINGGA Jl. Kolonel Sugiri, Gandasuli, Bobotsari, Purbalingga 533353
Jl. Kolonel Sugiri, Gandasuli, Bobotsari, Purbalingga 533353 Telp 0281 758808 Email : pkum_pbg@yahoo.com
Telp 0281 758808 Email : pkum_pbg@yahoo.com
FORMULIR PEMERIKSAAN RADIOLOGI
FORMULIR PEMERIKSAAN RADIOLOGI No. RM : Tanggal :
No. RM : Tanggal : Nama Pasien :
Nama Pasien : Umur :
Umur : Jenis Kelamin :P/L
Jenis Kelamin :P/L Ruang Rawat :
Ruang Rawat : Tanggal Pemeriksaan :
Keterangan Klinis : Dr.
(..............................................)
Tanggal Pemeriksaan :
Keterangan Klinis : Dr.
(..............................................) NON CONTRAS ANGGOTA GERAK BAWAH
NON CONTRAS ANGGOTA GERAK BAWAH  Cranium  Pedis dextra/sinistra
 Cranium  Pedis dextra/sinistra  Sinus Paranasal  Ankle Joint dextra/sinistra
 Sinus Paranasal  Ankle Joint dextra/sinistra  Nasal  Cruris dextra/sinistra
 Nasal  Cruris dextra/sinistra  Thorax  Knee joint(Genu)
 Thorax  Knee joint(Genu)  Abdomen Ap dextra/sinistra
 Abdomen Ap dextra/sinistra  Abdomen 3 Posisi  Femur dextra/sinistra
 Abdomen 3 Posisi  Femur dextra/sinistra  Pelvis AP  Hip Joint dextra/sinistra
 Pelvis AP  Hip Joint dextra/sinistra ANGGOTA GERAK ATAS TULANG BELAKANG
ANGGOTA GERAK ATAS TULANG BELAKANG  Clavikula dextra/sinistra  Cervikal
 Clavikula dextra/sinistra  Cervikal  Scapula dextra/sinistra  ThoracaliS
 Scapula dextra/sinistra  ThoracaliS  Manus dextra/sinistra  Thoracolumbal
 Manus dextra/sinistra  Thoracolumbal  Wrist joint dextra/sinistra  Lumbal
 Wrist joint dextra/sinistra  Lumbal  Antebrachi dextra/sinistra  Lumbosacral
 Antebrachi dextra/sinistra  Lumbosacral  Elbow Joint dextra/sinistra USG
 Elbow Joint dextra/sinistra USG  Humerus dextra/sinistra  USG Abdomen
 Humerus dextra/sinistra  USG Abdomen  Shoulder Joint dextra/sinistra CONTRAS
 Shoulder Joint dextra/sinistra CONTRAS  BNO IVP
 BNO IVP  Colon In Loop
 Colon In Loop  OMD
 OMD  HSG
 HSG