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NAMA : DIAGNOSIS :

TTL :
NO RM :
DPJP : KAMAR/BED :

TANGGAL
WBC
HB
HCT
MCV/MCH
PLT
NEU/LYM
NLR
MONOSIT
GDS / HBA1C
GOT/GPT
UR / CR
EGFR
NA / K / CL
PT / APTT / INR
BIL TOTAL / DIREK
HBSAG/ANTI HCV
SARS COV2
KELUHAN

TANDA VITAL TD: TD: TD: TD: TD:


N: N: N: N: N:
P: P: P: P: P:
S: S: S: S: S:
RADIOLOGI
(THORAX, USG,
MSCT)

TERAPI PLAN

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