DEPARTEMEN (LMU KEOOKTERAN JIWA
FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN
UNIVERSITAS ISLAM NEGERI ALAUDDIN MAKASSAR
Khuauia MMPD
(Mahasiawa Program Profesi Doktar)
STATUS PASIEN
Nama Dokter Muda : ..{1}p,... bain No. Status’ No. Reg Oy
Masuk RS. NM] G/ren
Nama An. WY avesnens "
Jenis Kelamin Ya CTompatTgl Lahiri. cdl
‘Status Perkawinan Kevan, ' soon Agama
Warga Negara A Pension, . soy Suku Bangaa
Pekerjaan/ Sekolah
Alamat / No Telepon
Nama, alamat dan no tip keluarga terdekat
Dikirim Oleh
Dokter yg mengobati
Diagnosa sementara :. RIEO.CEXR Vv
Gejala-Gejala Utama :..kankoger... vieen....sanbie...
(Waktu pasion masuk)...
LAPORAN PSIKIATRIK :
L
RIWAYAT PENYAKIT
A. Keluhan utama Gan alssan MRSJ / Ter
ee ~ ww
eC eae en NE SE sas
B, Riwayat gangguan sekerang, perhatikan : pardtotit
4. Keluhan dan gejala .
ne eatedanyge Sears, Ubu wana, Gul Bo
2. Hendaya/ disfungs!
somal CA)
= ee Oe on C4)
3, Fakior soesot pokowosial:
— elon Relea toot
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