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IKATAN FISIOTERAPI INDONESIA

LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa Tindakan
Periode STR :Januari 2017
2-Jan 1 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
2-Jan 2 14 119723 Ny. Wuryanti P 55 th LBP IR, TENS
2-Jan 3 14 122488 Tn. PB. Kartono L 67 th OA genu billateral IR, TENS
2-Jan 4 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
2-Jan 5 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
2-Jan 6 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
2-Jan 7 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
3-Jan 8 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
3-Jan 9 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA IR, TENS
3-Jan 10 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT
4-Jan 11 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
4-Jan 12 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
4-Jan 13 14 105853 Tn. Supomo L 60 th LBP IR, TENS
4-Jan 14 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
5-Jan 15 16 172122 Tn. Rujito L 70 th LBP IR, TENS
5-Jan 16 14 122530 Ny. Aminah L 60 th LBP IR, TENS
5-Jan 17 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
6-Jan 18 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
6-Jan 19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
6-Jan 20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
6-Jan 21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
6-Jan 22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
7-Jan 23 16 168044 Ny. Jumini P 50 th LBP IR, TENS
7-Jan 24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
7-Jan 25 09 019139 Tn. Danawi L 71 th LBP IR, TENS
7-Jan 26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
7-Jan 27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
7-Jan 28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
7-Jan 29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS
9-Jan 30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
9-Jan 31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
9-Jan 32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
9-Jan 33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
9-Jan 34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
9-Jan 35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
9-Jan 36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
9-Jan 37 16 172122 Tn. Rujito L 70 th LBP IR, TENS
10-Jan 38 14 122530 Ny. Aminah L 60 th LBP IR, TENS
10-Jan 39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
10-Jan 40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
10-Jan 41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
10-Jan 42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
11-Jan 43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
11-Jan 44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
11-Jan 45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
11-Jan 46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
12-Jan 47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
12-Jan 48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
12-Jan 49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
12-Jan 50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
12-Jan 51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
12-Jan 52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
13-Jan 53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
13-Jan 54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
13-Jan 55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
14-Jan 56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
14-Jan 57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
14-Jan 58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
14-Jan 59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
14-Jan 60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
14-Jan 61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
14-Jan 62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
16-Jan 63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
16-Jan 64 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
16-Jan 65 17 173283 Tn. Suparman L 50 th LBP IR, TENS
16-Jan 66 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
16-Jan 67 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
17-Jan 68 15 142388 An. Yaqda Rabha P 2 th DD IR, Exercise
17-Jan 69 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise
17-Jan 70 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
17-Jan 71 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
18-Jan 72 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
18-Jan 73 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS
18-Jan 74 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS
18-Jan 75 16 167885 Tn. Sutono L 45 th LBP IR, TENS
18-Jan 76 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
18-Jan 77 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
18-Jan 78 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
18-Jan 79 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
19-Jan 80 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
19-Jan 81 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
19-Jan 82 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise
19-Jan 83 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise
20-Jan 84 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
20-Jan 85 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
20-Jan 86 16 172122 Tn. Rujito L 70 th LBP IR, TENS
20-Jan 87 14 122530 Ny. Aminah L 60 th LBP IR, TENS
20-Jan 88 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
20-Jan 89 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
21-Jan 90 13 100 117 An. Naura Aqila P 8 BL Bayi sehat Baby Massage
21-Jan 91 14 0204 36 An. Naufal L 7bl Bayi sehat Baby Massage
21-Jan 92 15 0281 83 An. Ahza L 1 th Bayi sehat Baby Massage
21-Jan 93 16 0327 16 An. Reynand L 2 th Bayi sehat Baby Massage
21-Jan 94 14 0244 68 An. Ranu L 9 bl Bayi sehat Baby Massage
21-Jan 95 16 0311 10 An. Salman L 2 th Bayi sehat Baby Massage
23-Jan 96 14 0213 68 An. Arjuna L 2 th Bayi sehat Baby Massage
23-Jan 97 13 0941 97 An. Elvina Nur P 3 th CP NDT, Exercise
23-Jan 98 14 1071 26 An. Rasya yusuf L 2 th Bayi sehat Baby Massage
24-Jan 99 15 1293 54 An. Ericha Octavia P 3 th CP NDT, Exercise
24-Jan 100 16 1613 41 By. Tangguh L 4 bl Bayi sehat Baby Massage
24-Jan 101 16 1487 05 An. Rifqi akmal L 1 th DD NDT, Exercise
24-Jan 102 16 1551 02 By. Fitri Ajampiani P 4 bl Bayi sehat Baby Massage
25-Jan 103 14 1120 61 An. Ibrahim raito L 10 th kelemahan lengan kanan IR, ES, Exercise
25-Jan 104 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
25-Jan 105 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
26-Jan 106 10 050693 Ny. Rini Puji P 40 th OA genu billateral IR, TENS, Exercise
26-Jan 107 15 144451 Ny. Sumarni P 45 th LBP IR, TENS, Exercise
26-Jan 108 16 149293 Ny. Warti P 51 th Piriformis syndrome IR, TENS, Exercise
26-Jan 109 16 162829 Tn. Sukidjan L 49 th LBP IR, TENS, Exercise
26-Jan 110 13 097734 Ny. Anikmah P 45 th Frozen Shoulder IR, US, TENS
27-Jan 111 16 151074 Tn. Imam utomo L 61 th OA genu billateral IR, TENS, Exercise
27-Jan 112 16 162788 Tn. Kasmari L 63 th LBP IR, TENS, Exercise
27-Jan 113 16 160930 Ny. Suwarti P 38 th LBP IR, TENS, Exercise
27-Jan 114 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
28-Jan 115 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
28-Jan 116 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
28-Jan 117 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS
28-Jan 118 16 167885 Tn. Sutono L 45 th LBP IR, TENS
28-Jan 119 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
28-Jan 120 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
28-Jan 121 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
30-Jan 122 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS
30-Jan 123 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
30-Jan 124 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
30-Jan 125 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
30-Jan 126 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
30-Jan 127 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
30-Jan 128 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
30-Jan 129 15 0281 83 An. Ahza L 1 th Bayi sehat Baby Massage
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Bukti Fisik Verifikasi Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa
Periode STR :Februari 2017
RM 1-Feb 1 10 050387 Ny. Anita Susanti P 30th LBP
RM 1-Feb 2 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 1-Feb 3 13 101787 Ny. Patemi P 30th ischialgia
RM 2-Feb 4 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 2-Feb 5 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 2-Feb 6 15 144451 Ny. Sumarni P 45 th LBP
RM 2-Feb 7 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 2-Feb 8 16 162829 Tn. Sukidjan L 49 th LBP
RM 2-Feb 9 13 097734 Ny. Anikmah P 45 th Frozen Shoulder
RM 3-Feb 10 16 151074 Tn. Imam utomo L 61 th OA genu billateral
RM 3-Feb 11 16 162788 Tn. Kasmari L 63 th LBP
RM 3-Feb 12 16 160930 Ny. Suwarti P 38 th LBP
RM 3-Feb 13 13 094197 An. Elvina Nur P 3 th CP
RM 4-Feb 14 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 4-Feb 15 16 162221 An. Nathan Deniswara L 2 th Bayi sehat
RM 4-Feb 16 16 163197 An. Joana Lettysia P 7 bl Bayi sehat
RM 4-Feb 17 16 1613 41 By. Tangguh L 4 bl Bayi sehat
RM 4-Feb 18 16 1487 05 An. Rifqi akmal L 1 th DD
RM 4-Feb 19 16 1551 02 By. Fitri Ajampiani P 4 bl Bayi sehat
RM 4-Feb 20 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat
RM 5-Feb 21 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat
RM 5-Feb 22 16 154287 Ny. Martik P 42 th ischialgia
RM 5-Feb 23 16 156832 Tn. Sukardi L 47 th OA genu billateral
RM 5-Feb 24 15 144455 Ny. Mariyam P 50 th OA genu
RM 5-Feb 25 16 159937 Ny. Karmini P 49 th OA genu billateral
RM 6-Feb 26 14 122172 Ny. Muntamah P 61 th LBP
RM 6-Feb 27 10 050006 Ny. Muktiyah P 62 th LBP
RM 6-Feb 28 10 04 9960 Tn. Muzayin L 71 th ischialgia
RM 6-Feb 29 14 105883 Tn. Subadar L 61 th ischialgia
RM 6-Feb 30 15 129697 An. Senditya Restu P 4 th CP
RM 6-Feb 31 13 100572 Ny. Tuminah P 55 th LBP
RM 7-Feb 32 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 7-Feb 33 16 162252 Ny. Munarsi P 47 th OA genu
RM 7-Feb 34 16 155995 Ny. Zubaidah P 60 th LBP
RM 7-Feb 35 16 167885 Tn. Sutono L 45 th LBP
RM 7-Feb 36 12 077759 Ny. Suntiati P 45 th Post Stroke
RM 7-Feb 37 17 173283 Tn. Suparman L 50 th LBP
RM 8-Feb 38 08 015435 Ny. Sri indrawati P 40 th LBP
RM 8-Feb 39 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM 8-Feb 40 10 050387 Ny. Anita Susanti P 30th LBP
RM 9-Feb 41 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 9-Feb 42 13 101787 Ny. Patemi P 30th ischialgia
RM 9-Feb 43 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 9-Feb 44 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 9-Feb 45 15 144451 Ny. Sumarni P 45 th LBP
RM 9-Feb 46 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 9-Feb 47 13 094197 An. Elvina Nur P 3 th CP
RM 9-Feb 48 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 9-Feb 49 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 10-Feb 50 16 162116 An. Evan Ardani L 3th DD
RM 51 16 166178 An. Aqsel Tristan L 3 th CP
RM 52 16 155995 Ny. Zubaidah P 60 th LBP
RM 53 16 167885 Tn. Sutono L 45 th LBP
RM 54 14 106073 Tn. Sukarwi L 47 th OA genu
RM 55 09 019139 Tn. Danawi L 55 th Post Stroke
RM 11-Feb 56 14 106996 Ny. Prapti Mulyani P 46 th myalgia
RM 57 15 141179 Tn. Masikan L 38 th OA genu
RM 58 16 172122 Tn. Rujito L 70 th LBP
RM 59 14 122530 Ny. Aminah L 60 th LBP
RM 60 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 61 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 12-Feb 62 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 63 16 162116 An. Evan Ardani L 3th DD
RM 64 15 140319 An. Rafa Nasron L 2 th CP
RM 13-Feb 65 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 66 16 168044 Ny. Jumini P 50 th LBP
RM 67 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 68 15 136876 Ny. Dartik Sri P 45 th LBP
RM 14-Feb 69 14 119723 Ny. Wuryanti P 55 th LBP
RM 70 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
RM 71 16 170947 Tn. Sutoyo L 65 th LBP
RM 15-Feb 72 16 163387 Ny. Anisfatun P 50 th LBP
RM 73 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 74 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 75 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 76 13 102314 An. Azalea Kholiqo P 7 th CP
RM 77 15 127548 an. Adhysta Zaidan L 2 th DD
RM 16-Feb 78 16 162116 An. Evan Ardani L 3th DD
RM 79 16 166178 An. Aqsel Tristan L 3 th CP
RM 80 13 094197 An. Elvina Nur P 3 th CP
RM 81 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 17-Feb 82 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 83 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 84 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 85 16 163958 Ny. Suparmi P 65 th LBP
RM 86 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 18-Feb 87 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 88 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 89 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 19-Feb 90 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 91 08 015435 Ny. Sri indrawati P 40 th LBP
RM 92 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM 93 15 142388 An. Yaqda Rabha P 2 th DD
RM 94 15 129354 An. Ericha Octavia P 4 th CP
RM 95 13 102314 An. Azalea Kholiqo P 7 th CP
RM 20-Feb 96 13 100572 Ny. Tuminah P 55 th LBP
RM 97 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 98 13 100 117 An. Naura Aqila P 8 BL Bayi sehat
RM 99 15 0281 83 An. Ahza L 1 th Bayi sehat
RM 100 16 0327 16 An. Reynand L 2 th Bayi sehat
RM 101 14 0244 68 An. Ranu L 9 bl Bayi sehat
RM 21-Feb 102 16 0311 10 An. Salman L 2 th Bayi sehat
RM 103 13 102314 An. Azalea Kholiqo P 7 th CP
RM 104 15 127548 an. Adhysta Zaidan L 2 th DD
RM 105 15 145860 An. Zafran L 6 bl Bayi Sehat
RM 22-Feb 106 14 106073 Tn. Sukarwi L 47 th OA genu
RM 107 09 019139 Tn. Danawi L 55 th Post Stroke
RM 108 14 106996 Ny. Prapti Mulyani P 46 th myalgia
RM 109 15 141179 Tn. Masikan L 38 th OA genu
RM 110 15 147328 Tn. Otong Moehadi L 55 th Myalgia
RM 23-Feb 111 15 140611 Ny. Tayem P 48 th OA genu billateral
RM 112 14 108975 Ny. Subiyati P 61 th Trigger finger
RM 113 15 131014 Ny. Roeminah P 41 th OA genu billateral
RM 114 13 102314 An. Azalea Kholiqo P 7 th CP
RM 24-Feb 115 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat
RM 116 16 170947 Tn. Sutoyo L 65 th LBP
RM 117 16 163387 Ny. Anisfatun P 50 th LBP
RM 25-Feb 118 10 050387 Ny. Anita Susanti P 30th LBP
RM 119 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 120 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 121 16 155995 Ny. Zubaidah P 60 th LBP
RM 122 12 077759 Ny. Suntiati P 45 th Post Stroke
RM 27-Feb 123 17 173283 Tn. Suparman L 50 th LBP
RM 124 08 015435 Ny. Sri indrawati P 40 th LBP
RM 125 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM
RM
RM
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RAPI INDONESIA
FISIOTERAPI

Uraian Kegiatan
Bukti Fisik Verifikasi
Tindakan

IR, TENS, Exercise RM


IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
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IR, TENS, Exercise RM
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IR, TENS, Exercise RM
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Baby massage RM
Baby Massage RM
IR, NDT, Exercise RM
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IR, TENS RM
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IR, ES, Exercise RM
IR, TENS RM
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Baby massage RM
IR, US, TENS RM
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MWD, US, TENS RM
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Baby Massage RM
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IR, ES, Exercise RM
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Baby Massage RM
IR, TENS RM
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MWD, US, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa Tindakan
Periode STR : 2017
1-Mar 1 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
1-Mar 2 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
1-Mar 3 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
1-Mar 4 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
2-Mar 5 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
2-Mar 6 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
2-Mar 7 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
2-Mar 8 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
2-Mar 9 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA IR, TENS
3-Mar 10 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT
3-Mar 11 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
3-Mar 12 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
3-Mar 13 14 105853 Tn. Supomo L 60 th LBP IR, TENS
3-Mar 14 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
4-Mar 15 16 172122 Tn. Rujito L 70 th LBP IR, TENS
4-Mar 16 14 122530 Ny. Aminah L 60 th LBP IR, TENS
4-Mar 17 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
4-Mar 18 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
4-Mar 19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
4-Mar 20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
4-Mar 21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
6-Mar 22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
6-Mar 23 16 168044 Ny. Jumini P 50 th LBP IR, TENS
6-Mar 24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
6-Mar 25 09 019139 Tn. Danawi L 71 th LBP IR, TENS
6-Mar 26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
7-Mar 27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
7-Mar 28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
7-Mar 29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS
7-Mar 30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
7-Mar 31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
7-Mar 32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
7-Mar 33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
8-Mar 34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
8-Mar 35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
8-Mar 36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
8-Mar 37 16 172122 Tn. Rujito L 70 th LBP IR, TENS
9-Mar 38 14 122530 Ny. Aminah L 60 th LBP IR, TENS
9-Mar 39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
9-Mar 40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
10-Mar 41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
10-Mar 42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
10-Mar 43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
10-Mar 44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
10-Mar 45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
10-Mar 46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
10-Mar 47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
11-Mar 48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
11-Mar 49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
11-Mar 50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
12-Mar 51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
12-Mar 52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
12-Mar 53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
12-Mar 54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
12-Mar 55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
12-Mar 56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
13-Mar 57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
13-Mar 58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
13-Mar 59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
13-Mar 60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
13-Mar 61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
13-Mar 62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
14-Mar 63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
14-Mar 64 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
14-Mar 65 17 173283 Tn. Suparman L 50 th LBP IR, TENS
14-Mar 66 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
15-Mar 67 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
15-Mar 68 15 142388 An. Yaqda Rabha P 2 th DD IR, Exercise
15-Mar 69 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise
15-Mar 70 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
15-Mar 71 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
15-Mar 72 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
16-Mar 73 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS
16-Mar 74 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS
16-Mar 75 16 167885 Tn. Sutono L 45 th LBP IR, TENS
17-Mar 76 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
17-Mar 77 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
17-Mar 78 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
17-Mar 79 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
17-Mar 80 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
17-Mar 81 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
18-Mar 82 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise
18-Mar 83 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise
18-Mar 84 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
20-Mar 85 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
20-Mar 86 16 172122 Tn. Rujito L 70 th LBP IR, TENS
20-Mar 87 14 122530 Ny. Aminah L 60 th LBP IR, TENS
20-Mar 88 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
21-Mar 89 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
21-Mar 90 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
21-Mar 91 16 168044 Ny. Jumini P 50 th LBP IR, TENS
21-Mar 92 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
21-Mar 93 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
21-Mar 94 10 050006 Ny. Muktiyah P 62 th LBP IR, TENS, Exercise
22-Mar 95 10 04 9960 Tn. Muzayin L 71 th ischialgia IR, TENS, Exercise
22-Mar 96 14 105883 Tn. Subadar L 61 th ischialgia IR, TENS, Exercise
22-Mar 97 15 129697 An. Senditya Restu P 4 th CP NDT, Exercise
22-Mar 98 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
22-Mar 99 14 0204 36 An. Naufal L 7bl Bayi sehat Baby Massage
22-Mar 100 15 0281 83 An. Ahza L 1 th Bayi sehat Baby Massage
22-Mar 101 16 0327 16 An. Reynand L 2 th Bayi sehat Baby Massage
23-Mar 102 14 0244 68 An. Ranu L 9 bl Bayi sehat Baby Massage
23-Mar 103 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
23-Mar 104 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
23-Mar 105 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
24-Mar 106 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
24-Mar 107 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
24-Mar 108 17 173283 Tn. Suparman L 50 th LBP IR, TENS
24-Mar 109 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
24-Mar 110 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
25-Mar 111 10 050693 Ny. Rini Puji P 40 th OA genu billateral IR, TENS, Exercise
25-Mar 112 15 144451 Ny. Sumarni P 45 th LBP IR, TENS, Exercise
25-Mar 113 16 149293 Ny. Warti P 51 th Piriformis syndrome IR, TENS, Exercise
25-Mar 114 16 162829 Tn. Sukidjan L 49 th LBP IR, TENS, Exercise
27-Mar 115 13 097734 Ny. Anikmah P 45 th Frozen Shoulder IR, US, TENS
27-Mar 116 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
27-Mar 117 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
29-Mar 118 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
29-Mar 119 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
29-Mar 120 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
30-Mar 121 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Bukti Fisik Verifikasi Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa
Periode STR : 2017
RM 1-Apr 1 15 147328 Tn. Otong Moehadi L 55 th Myalgia
RM 1-Apr 2 15 140611 Ny. Tayem P 48 th OA genu billateral
RM 1-Apr 3 15 138948 An. Zahra Diva P 3 th CP
RM 1-Apr 4 13 102314 An. Azalea Kholiqo P 7 th CP
RM 1-Apr 5 15 140319 An. Rafa Nasron L 2 th CP
RM 3-Apr 6 15 144451 Ny. Sumarni P 45 th LBP
RM 3-Apr 7 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 3-Apr 8 16 162829 Tn. Sukidjan L 49 th LBP
RM 3-Apr 9 13 097734 Ny. Anikmah P 45 th Frozen Shoulder
RM 3-Apr 10 16 151074 Tn. Imam utomo L 61 th OA genu billateral
RM 4-Apr 11 16 162116 An. Evan Ardani L 3th DD
RM 4-Apr 12 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat
RM 4-Apr 13 13 094197 An. Elvina Nur P 3 th CP
RM 4-Apr 14 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 4-Apr 15 16 162221 An. Nathan Deniswara L 2 th Bayi sehat
RM 4-Apr 16 16 163197 An. Joana Lettysia P 7 bl Bayi sehat
RM 4-Apr 17 16 154287 Ny. Martik P 42 th ischialgia
RM 5-Apr 18 16 156832 Tn. Sukardi L 47 th OA genu billateral
RM 5-Apr 19 15 144455 Ny. Mariyam P 50 th OA genu
RM 5-Apr 20 16 159937 Ny. Karmini P 49 th OA genu billateral
RM 5-Apr 21 14 122172 Ny. Muntamah P 61 th LBP
RM 6-Apr 22 10 050006 Ny. Muktiyah P 62 th LBP
RM 6-Apr 23 10 04 9960 Tn. Muzayin L 71 th ischialgia
RM 6-Apr 24 14 105883 Tn. Subadar L 61 th ischialgia
RM 7-Apr 25 15 129697 An. Senditya Restu P 4 th CP
RM 7-Apr 26 13 100572 Ny. Tuminah P 55 th LBP
RM 7-Apr 27 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 7-Apr 28 16 162252 Ny. Munarsi P 47 th OA genu
RM 7-Apr 29 16 155995 Ny. Zubaidah P 60 th LBP
RM 7-Apr 30 16 167885 Tn. Sutono L 45 th LBP
RM 7-Apr 31 12 077759 Ny. Suntiati P 45 th Post Stroke
RM 8-Apr 32 17 173283 Tn. Suparman L 50 th LBP
RM 8-Apr 33 08 015435 Ny. Sri indrawati P 40 th LBP
RM 8-Apr 34 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM 8-Apr 35 10 050387 Ny. Anita Susanti P 30th LBP
RM 10-Apr 36 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 10-Apr 37 13 101787 Ny. Patemi P 30th ischialgia
RM 10-Apr 38 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 10-Apr 39 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 10-Apr 40 15 144451 Ny. Sumarni P 45 th LBP
RM 11-Apr 41 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 11-Apr 42 13 094197 An. Elvina Nur P 3 th CP
RM 11-Apr 43 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 11-Apr 44 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 11-Apr 45 16 162116 An. Evan Ardani L 3th DD
RM 11-Apr 46 16 166178 An. Aqsel Tristan L 3 th CP
RM 11-Apr 47 16 155995 Ny. Zubaidah P 60 th LBP
RM 12-Apr 48 16 167885 Tn. Sutono L 45 th LBP
RM 12-Apr 49 14 106073 Tn. Sukarwi L 47 th OA genu
RM 12-Apr 50 09 019139 Tn. Danawi L 55 th Post Stroke
RM 12-Apr 51 14 106996 Ny. Prapti Mulyani P 46 th myalgia
RM 13-Apr 52 15 141179 Tn. Masikan L 38 th OA genu
RM 13-Apr 53 16 172122 Tn. Rujito L 70 th LBP
RM 13-Apr 54 14 122530 Ny. Aminah L 60 th LBP
RM 13-Apr 55 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 14-Apr 56 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 14-Apr 57 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 14-Apr 58 16 162116 An. Evan Ardani L 3th DD
RM 14-Apr 59 15 140319 An. Rafa Nasron L 2 th CP
RM 14-Apr 60 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 14-Apr 61 16 168044 Ny. Jumini P 50 th LBP
RM 15-Apr 62 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 15-Apr 63 15 136876 Ny. Dartik Sri P 45 th LBP
RM 17-Apr 64 14 119723 Ny. Wuryanti P 55 th LBP
RM 17-Apr 65 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
RM 17-Apr 66 16 170947 Tn. Sutoyo L 65 th LBP
RM 18-Apr 67 16 163387 Ny. Anisfatun P 50 th LBP
RM 18-Apr 68 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 18-Apr 69 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 18-Apr 70 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 18-Apr 71 13 102314 An. Azalea Kholiqo P 7 th CP
RM 19-Apr 72 15 127548 an. Adhysta Zaidan L 2 th DD
RM 19-Apr 73 16 162116 An. Evan Ardani L 3th DD
RM 19-Apr 74 16 166178 An. Aqsel Tristan L 3 th CP
RM 19-Apr 75 13 094197 An. Elvina Nur P 3 th CP
RM 19-Apr 76 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 20-Apr 77 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 20-Apr 78 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 20-Apr 79 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 21-Apr 80 16 163958 Ny. Suparmi P 65 th LBP
RM 21-Apr 81 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 21-Apr 82 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 21-Apr 83 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 22-Apr 84 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 22-Apr 85 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 22-Apr 86 15 142388 An. Yaqda Rabha P 2 th DD
RM 22-Apr 87 15 129354 An. Ericha Octavia P 4 th CP
RM 22-Apr 88 13 102314 An. Azalea Kholiqo P 7 th CP
RM 24-Apr 89 16 167885 Tn. Sutono L 45 th LBP
RM 24-Apr 90 17 173283 Tn. Suparman L 50 th LBP
RM 24-Apr 91 08 015435 Ny. Sri indrawati P 40 th LBP
RM 24-Apr 92 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 24-Apr 93 16 172122 Tn. Rujito L 70 th LBP
RM 25-Apr 94 13 102314 An. Azalea Kholiqo P 7 th CP
RM 25-May 95 16 166178 An. Aqsel Tristan L 3 th CP
RM 25-Apr 96 15 140319 An. Rafa Nasron L 2 th CP
RM 25-Apr 97 16 162277 An. Ferdian gio L 8 bl Bayi Sehat
RM 25-Apr 98 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat
RM 25-Apr 99 16 161257 An. Hilmi zian L 1 th Bayi Sehat
RM 25-Apr 100 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 26-Apr 101 13 102314 An. Azalea Kholiqo P 7 th CP
RM 26-Apr 102 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat
RM 26-Apr 103 16 170947 Tn. Sutoyo L 65 th LBP
RM 26-Apr 104 16 163387 Ny. Anisfatun P 50 th LBP
RM 26-Apr 105 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 26-Apr 106 13 101787 Ny. Patemi P 30th ischialgia
RM 26-Apr 107 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 26-Apr 108 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 27-Apr 109 16 172122 Tn. Rujito L 70 th LBP
RM 27-Apr 110 14 122530 Ny. Aminah L 60 th LBP
RM 27-Apr 111 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 27-Apr 112 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 28-Apr 113 13 100 117 An. Naura Aqila P 8 BL Bayi sehat
RM 28-Apr 114 14 0204 36 An. Naufal L 7bl Bayi sehat
RM 28-Apr 115 15 0281 83 An. Ahza L 1 th Bayi sehat
RM 28-Apr 116 16 0327 16 An. Reynand L 2 th Bayi sehat
RM 28-Apr 117 14 0244 68 An. Ranu L 9 bl Bayi sehat
RM 28-Apr 118 16 0311 10 An. Salman L 2 th Bayi sehat
RM 29-Apr 119 14 0213 68 An. Arjuna L 2 th Bayi sehat
RM 29-Apr 120 13 0941 97 An. Elvina Nur P 3 th CP
RM 29-Apr 121 14 1071 26 An. Rasya yusuf L 2 th Bayi sehat
29-Apr 122 15 1293 54 An. Ericha Octavia P 3 th CP
ERAPI INDONESIA
FISIOTERAPI

Uraian Kegiatan
Bukti Fisik Verifikasi
Tindakan

IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, US, TENS RM
IR, TENS, Exercise RM
IR, NDT, Exercise RM
Baby Massage RM
NDT, Exercise RM
Baby massage RM
Baby massage RM
Baby massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT RM
IR, NDT RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
NDT, Exercise RM
Baby massage RM
IR, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
IR, US, TENS RM
IR, NDT, Exercise RM
Baby Massage RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
NDT, Exercise RM
Baby Massage RM
NDT, Exercise RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan: Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa Tindakan
Periode STR : 2017
2-May 1 14 105853 Tn. Supomo L 60 th LBP IR, TENS
2 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
3 16 172122 Tn. Rujito L 70 th LBP IR, TENS
4 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
3-May 5 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
6 16 167885 Tn. Sutono L 45 th LBP IR, TENS
7 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
8 17 173283 Tn. Suparman L 50 th LBP IR, TENS
9 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
4-May 10 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
11 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
12 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
13 14 105853 Tn. Supomo L 60 th LBP IR, TENS
14 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
5-May 15 16 172122 Tn. Rujito L 70 th LBP IR, TENS
16 14 122530 Ny. Aminah L 60 th LBP IR, TENS
17 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
18 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
6-May 19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
23 16 168044 Ny. Jumini P 50 th LBP IR, TENS
24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
25 09 019139 Tn. Danawi L 71 th LBP IR, TENS
8-May 26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS
9-May 30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
10-May 35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
37 16 172122 Tn. Rujito L 70 th LBP IR, TENS
38 14 122530 Ny. Aminah L 60 th LBP IR, TENS
39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
12-May 41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
13-May 47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
15-May 50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
16-May 57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
17-May 62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
64 16 167885 Tn. Sutono L 45 th LBP IR, TENS
65 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
18-May 66 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
67 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
68 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
69 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
19-May 70 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
71 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
72 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA IR, TENS
73 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT
20-May 74 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
75 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
76 14 105853 Tn. Supomo L 60 th LBP IR, TENS
77 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
78 16 172122 Tn. Rujito L 70 th LBP IR, TENS
22-May 79 14 122530 Ny. Aminah L 60 th LBP IR, TENS
80 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
81 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
82 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
23-May 83 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
84 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
85 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
86 16 172122 Tn. Rujito L 70 th LBP IR, TENS
87 14 122530 Ny. Aminah L 60 th LBP IR, TENS
24-May 88 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
89 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
90 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
26-May 91 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
92 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
93 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
94 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
27-May 95 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
96 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
97 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
98 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
29-May 99 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
100 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
101 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
102 14 1120 61 An. Ibrahim raito L 10 th kelemahan lengan kanan IR, ES, Exercise
30-May 103 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
104 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Bukti Fisik Verifikasi Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa
Periode STR : 2017
RM 1-Jun 1 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 2 16 172122 Tn. Rujito L 70 th LBP
RM 3 14 122530 Ny. Aminah L 60 th LBP
RM 4 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 5 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 6 15 144451 Ny. Sumarni P 45 th LBP
RM 7 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 2-Jun 8 16 162829 Tn. Sukidjan L 49 th LBP
RM 9 13 097734 Ny. Anikmah P 45 th Frozen Shoulder
RM 10 16 151074 Tn. Imam utomo L 61 th OA genu billateral
RM 11 16 162788 Tn. Kasmari L 63 th LBP
RM 3-Jun 12 16 160930 Ny. Suwarti P 38 th LBP
RM 13 13 094197 An. Elvina Nur P 3 th CP
RM 14 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 15 16 162221 An. Nathan Deniswara L 2 th Bayi sehat
RM 16 16 163197 An. Joana Lettysia P 7 bl Bayi sehat
RM 17 16 154287 Ny. Martik P 42 th ischialgia
RM 5-Jun 18 16 156832 Tn. Sukardi L 47 th OA genu billateral
RM 19 15 144455 Ny. Mariyam P 50 th OA genu
RM 20 16 159937 Ny. Karmini P 49 th OA genu billateral
RM 21 14 122172 Ny. Muntamah P 61 th LBP
RM 6-Jun 22 10 050006 Ny. Muktiyah P 62 th LBP
RM 23 10 04 9960 Tn. Muzayin L 71 th ischialgia
RM 24 14 105883 Tn. Subadar L 61 th ischialgia
RM 25 15 129697 An. Senditya Restu P 4 th CP
RM 26 13 100572 Ny. Tuminah P 55 th LBP
RM 7-Jun 27 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 28 16 162252 Ny. Munarsi P 47 th OA genu
RM 29 16 155995 Ny. Zubaidah P 60 th LBP
RM 30 16 167885 Tn. Sutono L 45 th LBP
RM 31 12 077759 Ny. Suntiati P 45 th Post Stroke
RM 32 17 173283 Tn. Suparman L 50 th LBP
RM 8-Jun 33 08 015435 Ny. Sri indrawati P 40 th LBP
RM 34 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM 35 10 050387 Ny. Anita Susanti P 30th LBP
RM 9-Jun 36 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 37 13 101787 Ny. Patemi P 30th ischialgia
RM 38 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 39 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 40 15 144451 Ny. Sumarni P 45 th LBP
RM 10-Jun 41 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 42 13 094197 An. Elvina Nur P 3 th CP
RM 43 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 44 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 45 16 162116 An. Evan Ardani L 3th DD
RM 46 16 166178 An. Aqsel Tristan L 3 th CP
RM 47 16 155995 Ny. Zubaidah P 60 th LBP
RM 48 16 167885 Tn. Sutono L 45 th LBP
RM 12-Jun 49 14 106073 Tn. Sukarwi L 47 th OA genu
RM 50 09 019139 Tn. Danawi L 55 th Post Stroke
RM 51 14 106996 Ny. Prapti Mulyani P 46 th myalgia
RM 52 15 141179 Tn. Masikan L 38 th OA genu
RM 53 16 172122 Tn. Rujito L 70 th LBP
RM 13-Jun 54 14 122530 Ny. Aminah L 60 th LBP
RM 55 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 56 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 57 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 14-Jun 58 16 162116 An. Evan Ardani L 3th DD
RM 59 15 140319 An. Rafa Nasron L 2 th CP
RM 60 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 61 16 168044 Ny. Jumini P 50 th LBP
RM 62 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 63 15 136876 Ny. Dartik Sri P 45 th LBP
RM 15-Jun 64 14 119723 Ny. Wuryanti P 55 th LBP
RM 65 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
RM 66 16 170947 Tn. Sutoyo L 65 th LBP
RM 67 16 163387 Ny. Anisfatun P 50 th LBP
RM 68 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 69 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 70 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 16-Jun 71 13 102314 An. Azalea Kholiqo P 7 th CP
RM 72 15 127548 an. Adhysta Zaidan L 2 th DD
RM 73 16 162116 An. Evan Ardani L 3th DD
RM 74 16 166178 An. Aqsel Tristan L 3 th CP
RM 17-Jun 75 13 094197 An. Elvina Nur P 3 th CP
RM 76 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 77 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 78 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 79 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 80 16 163958 Ny. Suparmi P 65 th LBP
RM 81 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 82 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 83 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 19-Jun 84 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 85 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 86 16 167885 Tn. Sutono L 45 th LBP
RM 87 14 106073 Tn. Sukarwi L 47 th OA genu
RM 20-Jun 88 09 019139 Tn. Danawi L 55 th Post Stroke
RM 89 14 106996 Ny. Prapti Mulyani P 46 th myalgia
RM 90 15 141179 Tn. Masikan L 38 th OA genu
RM 91 13 100 117 An. Naura Aqila P 8 BL Bayi sehat
RM 92 14 0204 36 An. Naufal L 7bl Bayi sehat
RM 21-Jun 93 15 0281 83 An. Ahza L 1 th Bayi sehat
RM 94 16 0327 16 An. Reynand L 2 th Bayi sehat
RM 95 14 0244 68 An. Ranu L 9 bl Bayi sehat
RM 96 14 1071 26 An. Rasya yusuf L 2 th Bayi sehat
RM 97 15 1293 54 An. Ericha Octavia P 3 th CP
RM 98 16 1613 41 By. Tangguh L 4 bl Bayi sehat
RM 22-Jun 99 16 1487 05 An. Rifqi akmal L 1 th DD
RM 100 16 1551 02 By. Fitri Ajampiani P 4 bl Bayi sehat
RM 101 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 23-Jun 102 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 103 15 138948 An. Zahra Diva P 3 th CP
RM 104 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat
105 15 140319 An. Rafa Nasron L 2 th CP
106 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
24-Jun 107 16 168044 Ny. Jumini P 50 th LBP
108 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
109 09 019139 Tn. Danawi L 71 th LBP
110 15 147328 Tn. Otong Moehadi L 55 th Myalgia
111 15 140611 Ny. Tayem P 48 th OA genu billateral
112 14 108975 Ny. Subiyati P 61 th Trigger finger
113 15 131014 Ny. Roeminah P 41 th OA genu billateral
114 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
27-Jun 115 16 168044 Ny. Jumini P 50 th LBP
116 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
117 09 019139 Tn. Danawi L 71 th LBP
118 15 147328 Tn. Otong Moehadi L 55 th Myalgia
28-Jun 119 15 140611 Ny. Tayem P 48 th OA genu billateral
120 14 108975 Ny. Subiyati P 61 th Trigger finger
121 15 131014 Ny. Roeminah P 41 th OA genu billateral
122 10 050387 Ny. Anita Susanti P 30th LBP
123 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
29-Jun 124 13 101787 Ny. Patemi P 30th ischialgia
125 14 121218 Ny. Tuminah P 34 th OA genu billateral
126 14 0204 36 An. Naufal L 7bl Bayi sehat
30-Jun 127 15 0281 83 An. Ahza L 1 th Bayi sehat
128 16 0327 16 An. Reynand L 2 th Bayi sehat
129 14 0244 68 An. Ranu L 9 bl Bayi sehat
130 16 0311 10 An. Salman L 2 th Bayi sehat
ERAPI INDONESIA
FISIOTERAPI

Uraian Kegiatan
Bukti Fisik Verifikasi
Tindakan

IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, US, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby massage RM
Baby massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT RM
IR, NDT RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
NDT, Exercise RM
Baby massage RM
IR, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
NDT, Exercise RM
Baby Massage RM
NDT, Exercise RM
Baby Massage RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
Baby Massage RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruang: Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa Tindakan
Periode STR : 2017
1-Jul 1 13 094197 An. Elvina Nur P 3 th CP NDT, Exercise
2 11 057337 An. Akbar Waldan L 2 th Bayi sehat Baby massage
3 16 162221 An. Nathan Deniswara L 2 th Bayi sehat Baby massage
4 16 163197 An. Joana Lettysia P 7 bl Bayi sehat Baby massage
5 13 094197 An. Elvina Nur P 3 th CP NDT, Exercise
6 11 057337 An. Akbar Waldan L 2 th Bayi sehat Baby massage
3-Jul 7 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
8 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
9 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA IR, TENS
10 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT
11 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
4-Jul 12 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
13 14 105853 Tn. Supomo L 60 th LBP IR, TENS
14 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
5-Jul 15 16 172122 Tn. Rujito L 70 th LBP IR, TENS
16 14 122530 Ny. Aminah L 60 th LBP IR, TENS
17 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
18 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
6-Jul 21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
23 16 168044 Ny. Jumini P 50 th LBP IR, TENS
24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
25 09 019139 Tn. Danawi L 71 th LBP IR, TENS
26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
7-Jul 27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS
30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
8-Jul 31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
10-Jul 35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
37 16 172122 Tn. Rujito L 70 th LBP IR, TENS
38 14 122530 Ny. Aminah L 60 th LBP IR, TENS
39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
11-Jul 41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
12-Jul 47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
13-Jul 52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
14-Jul 55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
15-Jul 59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
17-Jul 64 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
65 17 173283 Tn. Suparman L 50 th LBP IR, TENS
66 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
67 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
68 15 142388 An. Yaqda Rabha P 2 th DD IR, Exercise
18-Jul 69 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise
70 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
71 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
72 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
73 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS
74 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS
75 16 167885 Tn. Sutono L 45 th LBP IR, TENS
19-Jul 76 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
77 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
78 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
79 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
80 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
81 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
20-Jul 82 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise
83 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise
84 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
21-Jul 85 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
86 16 172122 Tn. Rujito L 70 th LBP IR, TENS
87 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
88 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
89 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
22-Jul 90 14 0213 68 An. Arjuna L 2 th Bayi sehat Baby Massage
91 13 0941 97 An. Elvina Nur P 3 th CP NDT, Exercise
92 14 1071 26 An. Rasya yusuf L 2 th Bayi sehat Baby Massage
24-Jul 93 15 1293 54 An. Ericha Octavia P 3 th CP NDT, Exercise
94 16 1613 41 By. Tangguh L 4 bl Bayi sehat Baby Massage
95 16 1487 05 An. Rifqi akmal L 1 th DD NDT, Exercise
96 16 1551 02 By. Fitri Ajampiani P 4 bl Bayi sehat Baby Massage
97 14 1120 61 An. Ibrahim raito L 10 th kelemahan lengan kanan IR, ES, Exercise
98 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
25-Jul 99 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
100 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
101 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
26-Jul 102 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
103 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
104 16 168044 Ny. Jumini P 50 th LBP IR, TENS
105 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
106 09 019139 Tn. Danawi L 71 th LBP IR, TENS
107 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
108 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
27-Jul 109 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
110 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
111 10 050006 Ny. Muktiyah P 62 th LBP IR, TENS, Exercise
112 10 04 9960 Tn. Muzayin L 71 th ischialgia IR, TENS, Exercise
113 14 105883 Tn. Subadar L 61 th ischialgia IR, TENS, Exercise
28-Jul 114 15 129697 An. Senditya Restu P 4 th CP NDT, Exercise
115 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
116 14 0204 36 An. Naufal L 7bl Bayi sehat Baby Massage
117 15 0281 83 An. Ahza L 1 th Bayi sehat Baby Massage
118 16 0327 16 An. Reynand L 2 th Bayi sehat Baby Massage
29-Jul 119 14 0244 68 An. Ranu L 9 bl Bayi sehat Baby Massage
120 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
121 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
31-Jul 122 16 168044 Ny. Jumini P 50 th LBP IR, TENS
123 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
124 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Bukti Fisik Verifikasi Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa
Periode STR : 2017
RM 1-Aug 1 15 138948 An. Zahra Diva P 3 th CP
RM 2 13 102314 An. Azalea Kholiqo P 7 th CP
RM 3 15 140319 An. Rafa Nasron L 2 th CP
RM 4 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 5 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 2-Aug 6 15 144451 Ny. Sumarni P 45 th LBP
RM 7 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 8 16 162829 Tn. Sukidjan L 49 th LBP
RM 9 16 162116 An. Evan Ardani L 3th DD
RM 3-Aug 10 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat
RM 11 16 162788 Tn. Kasmari L 63 th LBP
RM 12 16 160930 Ny. Suwarti P 38 th LBP
RM 13 13 094197 An. Elvina Nur P 3 th CP
RM 14 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 4-Aug 15 16 162221 An. Nathan Deniswara L 2 th Bayi sehat
RM 16 16 163197 An. Joana Lettysia P 7 bl Bayi sehat
RM 17 16 154287 Ny. Martik P 42 th ischialgia
RM 18 16 156832 Tn. Sukardi L 47 th OA genu billateral
RM 19 15 144455 Ny. Mariyam P 50 th OA genu
RM 20 16 159937 Ny. Karmini P 49 th OA genu billateral
RM 5-Aug 21 14 122172 Ny. Muntamah P 61 th LBP
RM 22 10 050006 Ny. Muktiyah P 62 th LBP
RM 23 10 04 9960 Tn. Muzayin L 71 th ischialgia
RM 24 14 105883 Tn. Subadar L 61 th ischialgia
RM 25 15 129697 An. Senditya Restu P 4 th CP
RM 26 13 100572 Ny. Tuminah P 55 th LBP
RM 27 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 28 16 162252 Ny. Munarsi P 47 th OA genu
RM 7-Aug 29 16 155995 Ny. Zubaidah P 60 th LBP
RM 30 16 167885 Tn. Sutono L 45 th LBP
RM 31 12 077759 Ny. Suntiati P 45 th Post Stroke
RM 32 17 173283 Tn. Suparman L 50 th LBP
RM 33 08 015435 Ny. Sri indrawati P 40 th LBP
RM 8-Aug 34 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM 35 10 050387 Ny. Anita Susanti P 30th LBP
RM 36 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 9-Aug 37 13 101787 Ny. Patemi P 30th ischialgia
RM 38 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 39 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 40 15 144451 Ny. Sumarni P 45 th LBP
RM 41 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 42 13 094197 An. Elvina Nur P 3 th CP
RM 10-Aug 43 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 44 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 45 16 162116 An. Evan Ardani L 3th DD
RM 46 16 166178 An. Aqsel Tristan L 3 th CP
RM 11-Aug 47 16 155995 Ny. Zubaidah P 60 th LBP
RM 48 16 167885 Tn. Sutono L 45 th LBP
RM 49 14 106073 Tn. Sukarwi L 47 th OA genu
RM 50 09 019139 Tn. Danawi L 55 th Post Stroke
RM 12-Aug 51 14 106996 Ny. Prapti Mulyani P 46 th myalgia
RM 52 15 141179 Tn. Masikan L 38 th OA genu
RM 53 16 172122 Tn. Rujito L 70 th LBP
RM 54 14 122530 Ny. Aminah L 60 th LBP
RM 55 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 56 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 14-Aug 57 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 58 16 162116 An. Evan Ardani L 3th DD
RM 59 15 140319 An. Rafa Nasron L 2 th CP
RM 60 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 15-Aug 61 16 168044 Ny. Jumini P 50 th LBP
RM 62 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 63 15 136876 Ny. Dartik Sri P 45 th LBP
RM 64 14 119723 Ny. Wuryanti P 55 th LBP
RM 65 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
RM 16-Aug 66 16 170947 Tn. Sutoyo L 65 th LBP
RM 67 16 163387 Ny. Anisfatun P 50 th LBP
RM 68 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 69 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 70 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 18-Aug 71 13 102314 An. Azalea Kholiqo P 7 th CP
RM 72 15 127548 an. Adhysta Zaidan L 2 th DD
RM 73 16 162116 An. Evan Ardani L 3th DD
RM 19-Aug 74 16 166178 An. Aqsel Tristan L 3 th CP
RM 75 13 094197 An. Elvina Nur P 3 th CP
RM 76 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 77 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 78 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 79 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 20-Aug 80 16 163958 Ny. Suparmi P 65 th LBP
RM 81 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 82 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 83 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 84 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 21-Aug 85 13 102314 An. Azalea Kholiqo P 7 th CP
RM 86 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 87 16 163958 Ny. Suparmi P 65 th LBP
RM 88 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 89 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 90 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 22-Aug 91 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 92 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 93 16 166178 An. Aqsel Tristan L 3 th CP
RM 94 10 050387 Ny. Anita Susanti P 30th LBP
RM 95 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 96 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 23-Aug 97 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 98 16 163958 Ny. Suparmi P 65 th LBP
RM 99 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 100 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 24-Aug 101 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 102 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 25-Aug 103 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 104 15 142388 An. Yaqda Rabha P 2 th DD
RM 105 15 129354 An. Ericha Octavia P 4 th CP
RM 26-Aug 106 13 102314 An. Azalea Kholiqo P 7 th CP
RM 107 15 140611 Ny. Tayem P 48 th OA genu billateral
RM 28-Aug 108 14 108975 Ny. Subiyati P 61 th Trigger finger
RM 109 15 131014 Ny. Roeminah P 41 th OA genu billateral
RM 29-Aug 110 13 102314 An. Azalea Kholiqo P 7 th CP
RM 111 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat
RM 112 16 170947 Tn. Sutoyo L 65 th LBP
RM 30-Aug 113 16 163387 Ny. Anisfatun P 50 th LBP
RM 114 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 115 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 116 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM
RM
RM
RM
RM
RM
RM
RM
ERAPI INDONESIA
FISIOTERAPI

Uraian Kegiatan
Bukti Fisik Verifikasi
Tindakan

IR, NDT, Exercise RM


IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, NDT, Exercise RM
Baby Massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby massage RM
Baby massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT RM
IR, NDT RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
NDT, Exercise RM
Baby massage RM
IR, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
Baby Massage RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruanga: Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th) Bukti Fisik
L/P Diagnosa Tindakan
Periode STR : 2017
2-Sep 1 14 122530 Ny. Aminah L 60 th LBP IR, TENS RM
2 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS RM
3 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS RM
4 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise RM
4-Sep 5 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS RM
6 14 119723 Ny. Wuryanti P 55 th LBP IR, TENS RM
7 14 122488 Tn. PB. Kartono L 67 th OA genu billateral IR, TENS RM
8 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS RM
9 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA IR, TENS RM
5-Sep 10 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT RM
11 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT RM
12 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage RM
13 14 105853 Tn. Supomo L 60 th LBP IR, TENS RM
14 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS RM
15 16 172122 Tn. Rujito L 70 th LBP IR, TENS RM
6-Sep 16 14 122530 Ny. Aminah L 60 th LBP IR, TENS RM
17 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS RM
18 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS RM
19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise RM
7-Sep 20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage RM
21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise RM
22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS RM
23 16 168044 Ny. Jumini P 50 th LBP IR, TENS RM
24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS RM
25 09 019139 Tn. Danawi L 71 th LBP IR, TENS RM
8-Sep 26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS RM
27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS RM
28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS RM
29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS RM
30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise RM
31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage RM
32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS RM
33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS RM
9-Sep 34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS RM
35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS RM
36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS RM
37 16 172122 Tn. Rujito L 70 th LBP IR, TENS RM
38 14 122530 Ny. Aminah L 60 th LBP IR, TENS RM
39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS RM
11-Sep 40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS RM
41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise RM
42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS RM
43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage RM
44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise RM
12-Sep 45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS RM
46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS RM
47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise RM
48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise RM
13-Sep 49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise RM
50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage RM
51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage RM
52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage RM
53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS RM
14-Sep 54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS RM
55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS RM
56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS RM
57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS RM
58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS RM
15-Sep 59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS RM
60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS RM
61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS RM
62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise RM
63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage RM
16-Sep 64 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise RM
65 17 173283 Tn. Suparman L 50 th LBP IR, TENS RM
66 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS RM
67 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS RM
68 15 142388 An. Yaqda Rabha P 2 th DD IR, Exercise RM
18-Sep 69 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise RM
70 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise RM
71 13 100572 Ny. Tuminah P 55 th LBP IR, TENS RM
72 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise RM
73 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS RM
19-Sep 74 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS RM
75 16 167885 Tn. Sutono L 45 th LBP IR, TENS RM
76 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS RM
77 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise RM
20-Sep 78 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS RM
79 15 141179 Tn. Masikan L 38 th OA genu IR, TENS RM
80 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise RM
22-Sep 81 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise RM
82 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise RM
83 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise RM
84 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise RM
85 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS RM
23-Sep 86 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS RM
87 14 119723 Ny. Wuryanti P 55 th LBP IR, TENS RM
88 14 122488 Tn. PB. Kartono L 67 th OA genu billateral IR, TENS RM
89 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS RM
90 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise RM
25-Sep 91 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise RM
92 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise RM
93 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise RM
94 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise RM
26-Sep 95 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS RM
96 16 172122 Tn. Rujito L 70 th LBP IR, TENS RM
97 14 122530 Ny. Aminah L 60 th LBP IR, TENS RM
98 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS RM
99 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS RM
27-Sep 100 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS RM
101 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise RM
102 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise RM
28-Sep 103 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise RM
29-Sep 104 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise RM
105 10 050693 Ny. Rini Puji P 40 th OA genu billateral IR, TENS, Exercise RM
106 15 144451 Ny. Sumarni P 45 th LBP IR, TENS, Exercise RM
29-Sep 107 16 149293 Ny. Warti P 51 th Piriformis syndrome IR, TENS, Exercise RM
108 13 094197 An. Elvina Nur P 3 th CP NDT, Exercise RM
109 11 057337 An. Akbar Waldan L 2 th Bayi sehat Baby massage RM
110 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage RM
30-Sep 111 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise RM
112 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise RM
113 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS RM
114 16 167885 Tn. Sutono L 45 th LBP IR, TENS RM
115 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS RM
116 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Verifikasi Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa
Periode STR : 2017
2-Oct 1 15 136876 Ny. Dartik Sri P 45 th LBP
2 16 154287 Ny. Martik P 42 th ischialgia
3 16 156832 Tn. Sukardi L 47 th OA genu billateral
4 16 170947 Tn. Sutoyo L 65 th LBP
5 10 050693 Ny. Rini Puji P 40 th OA genu billateral
6 15 144451 Ny. Sumarni P 45 th LBP
3-Oct 7 16 149293 Ny. Warti P 51 th Piriformis syndrome
8 16 162829 Tn. Sukidjan L 49 th LBP
4-Oct 9 13 097734 Ny. Anikmah P 45 th Frozen Shoulder
10 16 151074 Tn. Imam utomo L 61 th OA genu billateral
11 16 162788 Tn. Kasmari L 63 th LBP
12 16 160930 Ny. Suwarti P 38 th LBP
5-Oct 13 13 094197 An. Elvina Nur P 3 th CP
14 11 057337 An. Akbar Waldan L 2 th Bayi sehat
15 16 162221 An. Nathan Deniswara L 2 th Bayi sehat
16 16 163197 An. Joana Lettysia P 7 bl Bayi sehat
17 16 154287 Ny. Martik P 42 th ischialgia
18 16 156832 Tn. Sukardi L 47 th OA genu billateral
6-Oct 19 14 119723 Ny. Wuryanti P 55 th LBP
20 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
21 16 170947 Tn. Sutoyo L 65 th LBP
22 10 050006 Ny. Muktiyah P 62 th LBP
7-Oct 23 10 04 9960 Tn. Muzayin L 71 th ischialgia
24 14 105883 Tn. Subadar L 61 th ischialgia
25 15 129697 An. Senditya Restu P 4 th CP
9-Oct 26 13 100572 Ny. Tuminah P 55 th LBP
27 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
28 16 162252 Ny. Munarsi P 47 th OA genu
29 16 155995 Ny. Zubaidah P 60 th LBP
10-Oct 30 16 167885 Tn. Sutono L 45 th LBP
31 12 077759 Ny. Suntiati P 45 th Post Stroke
32 17 173283 Tn. Suparman L 50 th LBP
33 08 015435 Ny. Sri indrawati P 40 th LBP
34 12 083101 Ny. Sri Sularwati P 38 th ischialgia
35 10 050387 Ny. Anita Susanti P 30th LBP
11-Oct 36 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
37 13 101787 Ny. Patemi P 30th ischialgia
38 14 121218 Ny. Tuminah P 34 th OA genu billateral
39 10 050693 Ny. Rini Puji P 40 th OA genu billateral
12-Oct 40 15 144451 Ny. Sumarni P 45 th LBP
41 16 149293 Ny. Warti P 51 th Piriformis syndrome
42 13 094197 An. Elvina Nur P 3 th CP
43 11 057337 An. Akbar Waldan L 2 th Bayi sehat
13-Oct 44 16 159119 An. Calista agya P 7 bl Bayi Sehat
45 16 162116 An. Evan Ardani L 3th DD
46 16 166178 An. Aqsel Tristan L 3 th CP
47 16 155995 Ny. Zubaidah P 60 th LBP
48 16 167885 Tn. Sutono L 45 th LBP
49 14 106073 Tn. Sukarwi L 47 th OA genu
50 09 019139 Tn. Danawi L 55 th Post Stroke
14-Oct 51 14 106996 Ny. Prapti Mulyani P 46 th myalgia
52 15 141179 Tn. Masikan L 38 th OA genu
53 16 172122 Tn. Rujito L 70 th LBP
54 14 122530 Ny. Aminah L 60 th LBP
55 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
56 08 009687 Ny. Sulastri P 65 th OA genu billateral
15-Oct 57 16 159119 An. Calista agya P 7 bl Bayi Sehat
58 16 162116 An. Evan Ardani L 3th DD
59 15 140319 An. Rafa Nasron L 2 th CP
60 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
16-Oct 61 16 168044 Ny. Jumini P 50 th LBP
62 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
63 15 136876 Ny. Dartik Sri P 45 th LBP
64 14 119723 Ny. Wuryanti P 55 th LBP
17-Oct 65 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
66 16 170947 Tn. Sutoyo L 65 th LBP
67 16 163387 Ny. Anisfatun P 50 th LBP
18-Oct 68 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
69 15 128846 Ny. Ngadinah P 58 th OA genu billateral
70 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
71 13 102314 An. Azalea Kholiqo P 7 th CP
19-Oct 72 15 127548 an. Adhysta Zaidan L 2 th DD
73 16 162116 An. Evan Ardani L 3th DD
74 16 166178 An. Aqsel Tristan L 3 th CP
75 13 094197 An. Elvina Nur P 3 th CP
76 11 057337 An. Akbar Waldan L 2 th Bayi sehat
77 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
20-Oct 78 10 028857 Tn. Sholihin L 75 th OA genu billateral
79 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
80 16 163958 Ny. Suparmi P 65 th LBP
81 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
82 15 128846 Ny. Ngadinah P 58 th OA genu billateral
83 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
21-Oct 84 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
85 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
86 12 077759 Ny. Suntiati P 45 th Post Stroke
87 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
88 16 168044 Ny. Jumini P 50 th LBP
23-Oct 89 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
90 15 136876 Ny. Dartik Sri P 45 th LBP
91 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
24-Oct 92 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
93 16 159119 An. Calista agya P 7 bl Bayi Sehat
94 16 162116 An. Evan Ardani L 3th DD
95 15 147328 Tn. Otong Moehadi L 55 th Myalgia
96 15 140611 Ny. Tayem P 48 th OA genu billateral
97 14 121218 Ny. Tuminah P 34 th OA genu billateral
98 13 102314 An. Azalea Kholiqo P 7 th CP
99 15 140319 An. Rafa Nasron L 2 th CP
25-Oct 100 16 162277 An. Ferdian gio L 8 bl Bayi Sehat
101 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat
102 13 101787 Ny. Patemi P 30th ischialgia
103 12 083101 Ny. Sri Sularwati P 38 th ischialgia
104 15 142388 An. Yaqda Rabha P 2 th DD
26-Oct 105 15 129354 An. Ericha Octavia P 4 th CP
106 13 102314 An. Azalea Kholiqo P 7 th CP
107 13 100572 Ny. Tuminah P 55 th LBP
27-Oct 108 16 167885 Tn. Sutono L 45 th LBP
109 12 077759 Ny. Suntiati P 45 th Post Stroke
110 17 173283 Tn. Suparman L 50 th LBP
111 08 015435 Ny. Sri indrawati P 40 th LBP
28-Oct 112 12 083101 Ny. Sri Sularwati P 38 th ischialgia
113 10 050387 Ny. Anita Susanti P 30th LBP
114 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
115 13 101787 Ny. Patemi P 30th ischialgia
116 15 142388 An. Yaqda Rabha P 2 th DD
29-Oct 117 15 129354 An. Ericha Octavia P 4 th CP
118 13 102314 An. Azalea Kholiqo P 7 th CP
30-Oct 119 16 159119 An. Calista agya P 7 bl Bayi Sehat
120 16 162116 An. Evan Ardani L 3th DD
121 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
31-Oct 122 15 136876 Ny. Dartik Sri P 45 th LBP
123 14 119723 Ny. Wuryanti P 55 th LBP
124 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
125 16 170947 Tn. Sutoyo L 65 th LBP
126 12 077759 Ny. Suntiati P 45 th Post Stroke
127 17 173283 Tn. Suparman L 50 th LBP
ERAPI INDONESIA
FISIOTERAPI

Uraian Kegiatan
Bukti Fisik Verifikasi
Tindakan

IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, US, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby massage RM
Baby massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT RM
IR, NDT RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
NDT, Exercise RM
Baby massage RM
IR, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
Baby Massage RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
Baby Massage RM
Baby Massage RM
IR, TENS, Exercise RM
IR, TENS RM
IR, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
Baby Massage RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan: Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa Tindakan
Periode STR : 2017
1-Nov 1 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
2 14 119723 Ny. Wuryanti P 55 th LBP IR, TENS
3 14 122488 Tn. PB. Kartono L 67 th OA genu billateral IR, TENS
4 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
5 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
2-Nov 6 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
7 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
8 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
9 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA IR, TENS
10 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT
11 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
12 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
3-Nov 13 14 105853 Tn. Supomo L 60 th LBP IR, TENS
14 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
15 16 172122 Tn. Rujito L 70 th LBP IR, TENS
16 14 122530 Ny. Aminah L 60 th LBP IR, TENS
17 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
4-Nov 18 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
6-Nov 21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
23 16 168044 Ny. Jumini P 50 th LBP IR, TENS
24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
25 09 019139 Tn. Danawi L 71 th LBP IR, TENS
7-Nov 26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS
30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
8-Nov 33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
37 16 172122 Tn. Rujito L 70 th LBP IR, TENS
9-Nov 38 14 122530 Ny. Aminah L 60 th LBP IR, TENS
39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
10-Nov 43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
11-Nov 46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
13-Nov 51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
14-Nov 56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
15-Nov 59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
16-Nov 64 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
65 17 173283 Tn. Suparman L 50 th LBP IR, TENS
66 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
67 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
68 15 142388 An. Yaqda Rabha P 2 th DD IR, Exercise
69 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise
70 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
17-Nov 71 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
72 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
73 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS
74 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS
75 16 167885 Tn. Sutono L 45 th LBP IR, TENS
19-Nov 76 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
77 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
78 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
79 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
80 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
81 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
20-Nov 82 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise
83 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise
84 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
21-Nov 85 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
86 16 172122 Tn. Rujito L 70 th LBP IR, TENS
87 14 122530 Ny. Aminah L 60 th LBP IR, TENS
88 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
89 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
26-Nov 90 14 0244 68 An. Ranu L 9 bl Bayi sehat Baby Massage
91 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
22-Nov 92 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
93 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
94 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
95 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
96 17 173283 Tn. Suparman L 50 th LBP IR, TENS
97 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
98 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
23-Nov 99 10 050693 Ny. Rini Puji P 40 th OA genu billateral IR, TENS, Exercise
100 15 144451 Ny. Sumarni P 45 th LBP IR, TENS, Exercise
101 16 149293 Ny. Warti P 51 th Piriformis syndrome IR, TENS, Exercise
102 16 162829 Tn. Sukidjan L 49 th LBP IR, TENS, Exercise
103 13 097734 Ny. Anikmah P 45 th Frozen Shoulder IR, US, TENS
24-Nov 104 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
105 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
106 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
107 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
108 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
109 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
110 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
25-Nov 111 16 172122 Tn. Rujito L 70 th LBP IR, TENS
112 14 122530 Ny. Aminah L 60 th LBP IR, TENS
113 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
114 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
115 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
116 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
117 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
118 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
119 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
27-Nov 120 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
121 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
122 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
123 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
124 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
125 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
28-Nov 126 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
127 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise
128 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
129 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
130 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
131 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS
29-Nov 132 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS
133 16 167885 Tn. Sutono L 45 th LBP IR, TENS
134 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
135 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
136 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
30-Nov 137 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
138 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
139 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
140 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise
141 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Bukti Fisik Verifikasi Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa
Periode STR : 2017
RM 2-Dec 1 10 050387 Ny. Anita Susanti P 30th LBP
RM 2 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 3 13 101787 Ny. Patemi P 30th ischialgia
RM 4 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 5 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 6 15 144451 Ny. Sumarni P 45 th LBP
RM 4-Dec 7 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 8 16 162829 Tn. Sukidjan L 49 th LBP
RM 9 13 097734 Ny. Anikmah P 45 th Frozen Shoulder
RM 10 16 151074 Tn. Imam utomo L 61 th OA genu billateral
RM 11 16 162788 Tn. Kasmari L 63 th LBP
RM 5-Dec 12 16 160930 Ny. Suwarti P 38 th LBP
RM 13 13 094197 An. Elvina Nur P 3 th CP
RM 14 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 15 16 162221 An. Nathan Deniswara L 2 th Bayi sehat
RM 16 16 163197 An. Joana Lettysia P 7 bl Bayi sehat
RM 17 16 154287 Ny. Martik P 42 th ischialgia
RM 6-Dec 18 16 156832 Tn. Sukardi L 47 th OA genu billateral
RM 19 15 144455 Ny. Mariyam P 50 th OA genu
RM 20 16 159937 Ny. Karmini P 49 th OA genu billateral
RM 21 14 122172 Ny. Muntamah P 61 th LBP
RM 22 10 050006 Ny. Muktiyah P 62 th LBP
RM 23 10 04 9960 Tn. Muzayin L 71 th ischialgia
RM 7-Dec 24 14 105883 Tn. Subadar L 61 th ischialgia
RM 25 15 129697 An. Senditya Restu P 4 th CP
RM 26 13 100572 Ny. Tuminah P 55 th LBP
RM 27 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 28 16 162252 Ny. Munarsi P 47 th OA genu
RM 29 16 155995 Ny. Zubaidah P 60 th LBP
RM 30 16 167885 Tn. Sutono L 45 th LBP
RM 8-Dec 31 12 077759 Ny. Suntiati P 45 th Post Stroke
RM 32 17 173283 Tn. Suparman L 50 th LBP
RM 33 08 015435 Ny. Sri indrawati P 40 th LBP
RM 34 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM 35 10 050387 Ny. Anita Susanti P 30th LBP
RM 9-Dec 36 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 37 13 101787 Ny. Patemi P 30th ischialgia
RM 38 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 39 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 40 15 144451 Ny. Sumarni P 45 th LBP
RM 41 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 11-Dec 42 13 094197 An. Elvina Nur P 3 th CP
RM 43 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 44 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 45 15 144451 Ny. Sumarni P 45 th LBP
RM 46 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 12-Dec 47 16 162829 Tn. Sukidjan L 49 th LBP
RM 48 13 097734 Ny. Anikmah P 45 th Frozen Shoulder
RM 49 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 50 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 51 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 52 16 163958 Ny. Suparmi P 65 th LBP
RM 53 16 172122 Tn. Rujito L 70 th LBP
RM 13-Dec 54 14 122530 Ny. Aminah L 60 th LBP
RM 55 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 56 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 57 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 58 16 162116 An. Evan Ardani L 3th DD
RM 59 15 140319 An. Rafa Nasron L 2 th CP
RM 14-Dec 60 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 61 16 168044 Ny. Jumini P 50 th LBP
RM 62 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 63 15 136876 Ny. Dartik Sri P 45 th LBP
RM 64 14 119723 Ny. Wuryanti P 55 th LBP
RM 15-Dec 65 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
RM 66 16 170947 Tn. Sutoyo L 65 th LBP
RM 67 16 163387 Ny. Anisfatun P 50 th LBP
RM 68 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 69 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 16-Dec 70 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 71 13 102314 An. Azalea Kholiqo P 7 th CP
RM 72 15 127548 an. Adhysta Zaidan L 2 th DD
RM 73 16 162116 An. Evan Ardani L 3th DD
RM 18-Dec 74 16 166178 An. Aqsel Tristan L 3 th CP
RM 75 13 094197 An. Elvina Nur P 3 th CP
RM 76 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 77 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 78 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 79 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 19-Dec 80 16 163958 Ny. Suparmi P 65 th LBP
RM 81 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 82 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 20-Dec 83 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 84 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 85 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 86 16 162116 An. Evan Ardani L 3th DD
RM 87 16 166178 An. Aqsel Tristan L 3 th CP
RM 88 13 094197 An. Elvina Nur P 3 th CP
RM 21-Dec 89 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 90 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder
RM 91 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 92 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 93 16 163958 Ny. Suparmi P 65 th LBP
RM 94 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 22-Dec 95 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 96 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 97 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 98 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 23-Dec 99 15 142388 An. Yaqda Rabha P 2 th DD
RM 100 15 129354 An. Ericha Octavia P 4 th CP
RM 101 13 102314 An. Azalea Kholiqo P 7 th CP
RM 102 16 163387 Ny. Anisfatun P 50 th LBP
RM 103 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 104 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 26-Dec 105 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 106 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA
RM 107 13 102314 An. Azalea Kholiqo P 7 th CP
RM 108 15 127548 an. Adhysta Zaidan L 2 th DD
RM 109 15 145860 An. Zafran L 6 bl Bayi Sehat
RM 110 14 105853 Tn. Supomo L 60 th LBP
RM 27-Dec 111 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 112 16 172122 Tn. Rujito L 70 th LBP
RM 113 14 122530 Ny. Aminah L 60 th LBP
RM 114 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 28-Dec 115 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 116 15 142388 An. Yaqda Rabha P 2 th DD
RM 117 15 129354 An. Ericha Octavia P 4 th CP
RM 118 13 102314 An. Azalea Kholiqo P 7 th CP
RM 29-Dec 119 13 100572 Ny. Tuminah P 55 th LBP
RM 120 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 121 16 162252 Ny. Munarsi P 47 th OA genu
RM 122 16 155995 Ny. Zubaidah P 60 th LBP
RM 123 16 167885 Tn. Sutono L 45 th LBP
RM 30-Dec 124 14 106073 Tn. Sukarwi L 47 th OA genu
RM 125 09 019139 Tn. Danawi L 55 th Post Stroke
RM
RM
RM
RM
RM
RM
RM
RM
RM
RM
RM
RM
RM
RM
RM
RM
ERAPI INDONESIA
FISIOTERAPI

Uraian Kegiatan
Bukti Fisik Verifikasi
Tindakan

IR, TENS, Exercise RM


IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, US, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby massage RM
Baby massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby Massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, US, TENS RM
IR, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT RM
IR, NDT RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
NDT, Exercise RM
Baby massage RM
IR, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
NDT, Exercise RM
Baby massage RM
IR, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT RM
IR, NDT RM
Baby Massage RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa Tindakan
Periode STR : 2017
2-Jan 1 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise
2 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
3 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
4 16 172122 Tn. Rujito L 70 th LBP IR, TENS
5 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
6 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
7 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
3-Jan 8 14 0213 68 An. Arjuna L 2 th Bayi sehat Baby Massage
9 13 0941 97 An. Elvina Nur P 3 th CP NDT, Exercise
10 14 1071 26 An. Rasya yusuf L 2 th Bayi sehat Baby Massage
11 15 1293 54 An. Ericha Octavia P 3 th CP NDT, Exercise
12 16 1613 41 By. Tangguh L 4 bl Bayi sehat Baby Massage
13 16 1487 05 An. Rifqi akmal L 1 th DD NDT, Exercise
4-Jan 14 16 1551 02 By. Fitri Ajampiani P 4 bl Bayi sehat Baby Massage
15 14 1120 61 An. Ibrahim raito L 10 th kelemahan lengan kanan IR, ES, Exercise
16 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
17 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
5-Jan 18 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
6-Jan 23 16 168044 Ny. Jumini P 50 th LBP IR, TENS
24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
25 09 019139 Tn. Danawi L 71 th LBP IR, TENS
26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS
9-Jan 30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
37 16 172122 Tn. Rujito L 70 th LBP IR, TENS
10-Jan 38 14 122530 Ny. Aminah L 60 th LBP IR, TENS
39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
11-Jan 43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
12-Jan 47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
13-Jan 57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
16-Jan 63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
64 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
65 17 173283 Tn. Suparman L 50 th LBP IR, TENS
66 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
67 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
17-Jan 68 15 142388 An. Yaqda Rabha P 2 th DD IR, Exercise
69 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise
70 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
71 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
18-Jan 72 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
73 16 162252 Ny. Munarsi P 47 th OA genu IR, TENS
74 16 155995 Ny. Zubaidah P 60 th LBP IR, TENS
75 16 167885 Tn. Sutono L 45 th LBP IR, TENS
76 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
77 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
78 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
79 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
19-Jan 80 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
81 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
82 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise
83 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
20-Jan 84 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
85 16 172122 Tn. Rujito L 70 th LBP IR, TENS
86 14 122530 Ny. Aminah L 60 th LBP IR, TENS
87 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
88 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
89 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
22-Jan 90 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
91 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
92 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
93 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
94 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
95 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
23-Jan 96 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
97 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
98 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
24-Jan 99 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
100 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
101 14 1120 61 An. Ibrahim raito L 10 th kelemahan lengan kanan IR, ES, Exercise
102 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
25-Jan 103 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
104 16 168044 Ny. Jumini P 50 th LBP IR, TENS
105 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
26-Jan 106 09 019139 Tn. Danawi L 71 th LBP IR, TENS
107 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
108 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
109 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
110 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
27-Jan 111 10 050006 Ny. Muktiyah P 62 th LBP IR, TENS, Exercise
112 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
113 14 105883 Tn. Subadar L 61 th ischialgia IR, TENS, Exercise
114 15 129697 An. Senditya Restu P 4 th CP NDT, Exercise
115 13 100572 Ny. Tuminah P 55 th LBP IR, TENS
116 14 0204 36 An. Naufal L 7bl Bayi sehat Baby Massage
117 15 0281 83 An. Ahza L 1 th Bayi sehat Baby Massage
118 16 0327 16 An. Reynand L 2 th Bayi sehat Baby Massage
119 14 0244 68 An. Ranu L 9 bl Bayi sehat Baby Massage
120 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
29-Jan 121 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
16 168044 Ny. Jumini P 50 th LBP IR, TENS
123 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
124 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
125 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
126 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
127 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
128 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
129 16 168044 Ny. Jumini P 50 th LBP IR, TENS
30-Jan 130 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
131 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
132 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
133 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
134 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
135 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
136 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
137 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruangan : Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Bukti Fisik Verifikasi Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa
Periode STR : 2017
RM 1-Feb 1 13 102314 An. Azalea Kholiqo P 7 th CP
RM 2 15 127548 an. Adhysta Zaidan L 2 th DD
RM 3 16 162116 An. Evan Ardani L 3th DD
RM 4 16 166178 An. Aqsel Tristan L 3 th CP
RM 5 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 6 15 144451 Ny. Sumarni P 45 th LBP
RM 7 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 8 16 162829 Tn. Sukidjan L 49 th LBP
RM 9 16 162116 An. Evan Ardani L 3th DD
RM 3-Feb 10 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat
RM 11 16 162788 Tn. Kasmari L 63 th LBP
RM 12 16 160930 Ny. Suwarti P 38 th LBP
RM 13 13 094197 An. Elvina Nur P 3 th CP
RM 4-Feb 14 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 15 16 162221 An. Nathan Deniswara L 2 th Bayi sehat
RM 16 16 163197 An. Joana Lettysia P 7 bl Bayi sehat
RM 17 16 154287 Ny. Martik P 42 th ischialgia
RM 18 16 156832 Tn. Sukardi L 47 th OA genu billateral
RM 19 15 144455 Ny. Mariyam P 50 th OA genu
RM 20 16 159937 Ny. Karmini P 49 th OA genu billateral
RM 5-Feb 21 14 122172 Ny. Muntamah P 61 th LBP
RM 22 10 050006 Ny. Muktiyah P 62 th LBP
RM 23 10 04 9960 Tn. Muzayin L 71 th ischialgia
RM 24 14 105883 Tn. Subadar L 61 th ischialgia
RM 25 15 129697 An. Senditya Restu P 4 th CP
RM 6-Feb 26 13 100572 Ny. Tuminah P 55 th LBP
RM 27 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke
RM 28 16 162252 Ny. Munarsi P 47 th OA genu
RM 29 16 155995 Ny. Zubaidah P 60 th LBP
RM 30 16 167885 Tn. Sutono L 45 th LBP
RM 31 12 077759 Ny. Suntiati P 45 th Post Stroke
RM 7-Feb 32 17 173283 Tn. Suparman L 50 th LBP
RM 33 08 015435 Ny. Sri indrawati P 40 th LBP
RM 34 12 083101 Ny. Sri Sularwati P 38 th ischialgia
RM 35 10 050387 Ny. Anita Susanti P 30th LBP
RM 36 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 37 13 101787 Ny. Patemi P 30th ischialgia
RM 8-Feb 38 14 121218 Ny. Tuminah P 34 th OA genu billateral
RM 39 10 050693 Ny. Rini Puji P 40 th OA genu billateral
RM 40 15 144451 Ny. Sumarni P 45 th LBP
RM 41 16 149293 Ny. Warti P 51 th Piriformis syndrome
RM 9-Feb 42 13 094197 An. Elvina Nur P 3 th CP
RM 43 11 057337 An. Akbar Waldan L 2 th Bayi sehat
RM 44 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 45 16 162116 An. Evan Ardani L 3th DD
RM 46 16 166178 An. Aqsel Tristan L 3 th CP
RM 47 16 155995 Ny. Zubaidah P 60 th LBP
RM 48 16 167885 Tn. Sutono L 45 th LBP
RM 49 14 106073 Tn. Sukarwi L 47 th OA genu
RM 10-Feb 50 09 019139 Tn. Danawi L 55 th Post Stroke
RM 51 14 106996 Ny. Prapti Mulyani P 46 th myalgia
RM 52 15 141179 Tn. Masikan L 38 th OA genu
RM 53 16 172122 Tn. Rujito L 70 th LBP
RM 54 14 122530 Ny. Aminah L 60 th LBP
RM 55 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 11-Feb 56 08 009687 Ny. Sulastri P 65 th OA genu billateral
RM 57 16 159119 An. Calista agya P 7 bl Bayi Sehat
RM 58 16 162116 An. Evan Ardani L 3th DD
RM 59 15 140319 An. Rafa Nasron L 2 th CP
RM 60 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 61 16 168044 Ny. Jumini P 50 th LBP
RM 12-Feb 62 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 63 15 136876 Ny. Dartik Sri P 45 th LBP
RM 64 14 119723 Ny. Wuryanti P 55 th LBP
RM 13-Feb 65 14 122488 Tn. PB. Kartono L 67 th OA genu billateral
RM 66 16 170947 Tn. Sutoyo L 65 th LBP
RM 67 16 163387 Ny. Anisfatun P 50 th LBP
RM 68 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 14-Feb 69 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 70 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 71 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 15-Feb 72 15 136876 Ny. Dartik Sri P 45 th LBP
RM 73 10 050006 Ny. Muktiyah P 62 th LBP
RM 74 10 04 9960 Tn. Muzayin L 71 th ischialgia
RM 75 14 105883 Tn. Subadar L 61 th ischialgia
RM 76 15 129697 An. Senditya Restu P 4 th CP
RM 77 13 100572 Ny. Tuminah P 55 th LBP
RM 16-Feb 78 14 0204 36 An. Naufal L 7bl Bayi sehat
RM 79 15 0281 83 An. Ahza L 1 th Bayi sehat
RM 80 16 0327 16 An. Reynand L 2 th Bayi sehat
RM 81 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 17-Feb 82 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 83 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 84 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 85 13 102314 An. Azalea Kholiqo P 7 th CP
RM 86 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 18-Feb 87 16 163958 Ny. Suparmi P 65 th LBP
RM 88 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 89 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 19-Feb 90 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 91 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 92 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 93 16 166178 An. Aqsel Tristan L 3 th CP
RM 94 10 050387 Ny. Anita Susanti P 30th LBP
RM 95 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis
RM 20-Feb 96 10 028857 Tn. Sholihin L 75 th OA genu billateral
RM 97 17 173832 Ny. Isbandiyah P 73 th OA genu billateral
RM 98 16 163958 Ny. Suparmi P 65 th LBP
RM 99 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder
RM 100 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 101 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 21-Feb 102 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder
RM 103 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA
RM 104 15 142388 An. Yaqda Rabha P 2 th DD
RM 105 15 129354 An. Ericha Octavia P 4 th CP
RM 22-Feb 106 13 102314 An. Azalea Kholiqo P 7 th CP
RM 107 15 140611 Ny. Tayem P 48 th OA genu billateral
RM 108 14 108975 Ny. Subiyati P 61 th Trigger finger
RM 109 15 131014 Ny. Roeminah P 41 th OA genu billateral
RM 110 13 102314 An. Azalea Kholiqo P 7 th CP
RM 23-Feb 111 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat
RM 112 16 170947 Tn. Sutoyo L 65 th LBP
RM 113 16 163387 Ny. Anisfatun P 50 th LBP
RM 114 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA
RM 115 15 128846 Ny. Ngadinah P 58 th OA genu billateral
RM 116 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder
RM 117 15 140319 An. Rafa Nasron L 2 th CP
RM 118 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 24-Feb 119 16 168044 Ny. Jumini P 50 th LBP
RM 120 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
RM 121 09 019139 Tn. Danawi L 71 th LBP
RM 122 15 147328 Tn. Otong Moehadi L 55 th Myalgia
RM 123 15 140611 Ny. Tayem P 48 th OA genu billateral
RM 124 14 108975 Ny. Subiyati P 61 th Trigger finger
RM 25-Feb 125 16 0327 16 An. Reynand L 2 th Bayi sehat
RM 126 14 0244 68 An. Ranu L 9 bl Bayi sehat
RM 127 14 1071 26 An. Rasya yusuf L 2 th Bayi sehat
RM 128 15 1293 54 An. Ericha Octavia P 3 th CP
RM 27-Feb 129 16 1613 41 By. Tangguh L 4 bl Bayi sehat
RM 130 16 1487 05 An. Rifqi akmal L 1 th DD
RM 131 16 1551 02 By. Fitri Ajampiani P 4 bl Bayi sehat
RM 132 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat
RM 133 15 138948 An. Zahra Diva P 3 th CP
RM 134 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat
RM 135 15 140319 An. Rafa Nasron L 2 th CP
RM 28-Feb 136 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral
RM 137 16 168044 Ny. Jumini P 50 th LBP
138 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder
139 09 019139 Tn. Danawi L 71 th LBP
140 15 147328 Tn. Otong Moehadi L 55 th Myalgia
141 15 140611 Ny. Tayem P 48 th OA genu billateral
142 14 108975 Ny. Subiyati P 61 th Trigger finger
143 15 136876 Ny. Dartik Sri P 45 th LBP
ERAPI INDONESIA
FISIOTERAPI

Uraian Kegiatan
Bukti Fisik Verifikasi
Tindakan

IR, NDT RM
IR, NDT RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, NDT, Exercise RM
Baby Massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby massage RM
Baby massage RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
Baby massage RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, ES, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
NDT, Exercise RM
IR, TENS RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
IR, TENS, Exercise RM
IR, TENS, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
MWD, US, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, Exercise RM
IR, NDT, Exercise RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
Baby Massage RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
Baby Massage RM
Baby Massage RM
Baby Massage RM
NDT, Exercise RM
Baby Massage RM
NDT, Exercise RM
Baby Massage RM
Baby Massage RM
IR, NDT, Exercise RM
Baby Massage RM
IR, NDT, Exercise RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IR, TENS RM
IKATAN FISIOTERAPI INDONESIA
LOG SHEET FISIOTERAPI

Nama Fisioterapi : Ika Nur Cahyanti, A.Md. Ftr


Institusi Pelayanan : RS Keluarga Sehat
Ruang Pelayanan : Poli Fisioterapi Dewasa dan Anak
Atasan Langsung / PJ Ruanga: Prasetyaningsih, AMF

Jenis Kelamin Uraian Kegiatan


Tanggal No. No. RM Nama Pasien Usia (th)
L/P Diagnosa Tindakan
Periode STR : 2017
1-Mar 1 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
1-Mar 2 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
1-Mar 3 16 172122 Tn. Rujito L 70 th LBP IR, TENS
1-Mar 4 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
2-Mar 5 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
2-Mar 6 16 167885 Tn. Sutono L 45 th LBP IR, TENS
2-Mar 7 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
2-Mar 8 17 173283 Tn. Suparman L 50 th LBP IR, TENS
2-Mar 9 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
3-Mar 10 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
3-Mar 11 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
3-Mar 12 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
3-Mar 13 14 105853 Tn. Supomo L 60 th LBP IR, TENS
3-Mar 14 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
5-Mar 15 16 172122 Tn. Rujito L 70 th LBP IR, TENS
5-Mar 16 14 122530 Ny. Aminah L 60 th LBP IR, TENS
5-Mar 17 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
5-Mar 18 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
5-Mar 19 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
5-Mar 20 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
5-Mar 21 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
6-Mar 22 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
6-Mar 23 16 168044 Ny. Jumini P 50 th LBP IR, TENS
6-Mar 24 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
6-Mar 25 09 019139 Tn. Danawi L 71 th LBP IR, TENS
6-Mar 26 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
7-Mar 27 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
7-Mar 28 14 108975 Ny. Subiyati P 61 th Trigger finger IR, TENS
7-Mar 29 15 131014 Ny. Roeminah P 41 th OA genu billateral IR, TENS
7-Mar 30 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
7-Mar 31 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
7-Mar 32 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
7-Mar 33 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
8-Mar 34 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
8-Mar 35 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
8-Mar 36 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
8-Mar 37 16 172122 Tn. Rujito L 70 th LBP IR, TENS
9-Mar 38 14 122530 Ny. Aminah L 60 th LBP IR, TENS
9-Mar 39 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
9-Mar 40 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
10-Mar 41 16 149009 Tn. Ruslan bin ngarijo L 62 th Post Stroke IR, ES, Exercise
10-Mar 42 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
10-Mar 43 16 159119 An. Calista agya P 7 bl Bayi Sehat Baby Massage
10-Mar 44 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
10-Mar 45 15 147328 Tn. Otong Moehadi L 55 th Myalgia IR, TENS
10-Mar 46 15 140611 Ny. Tayem P 48 th OA genu billateral IR, TENS
10-Mar 47 15 138948 An. Zahra Diva P 3 th CP IR, NDT, Exercise
10-Mar 48 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
10-Mar 49 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
10-Mar 50 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
12-Mar 51 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
12-Mar 52 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
12-Mar 53 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
12-Mar 54 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
12-Mar 55 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
12-Mar 56 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
13-Mar 57 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
13-Mar 58 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
13-Mar 59 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
13-Mar 60 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
13-Mar 61 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
13-Mar 62 16 162116 An. Evan Ardani L 3th DD IR, NDT, Exercise
14-Mar 63 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
14-Mar 64 16 167885 Tn. Sutono L 45 th LBP IR, TENS
14-Mar 65 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
14-Mar 66 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
15-Mar 67 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
15-Mar 68 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
15-Mar 69 15 145903 Ny. Nita Faradilla P 70 th ISCHIALGIA IR, TENS
15-Mar 70 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
15-Mar 71 16 167990 Ny. Surinah binti Harjo P 59 th OA genu billateral IR, TENS
15-Mar 72 08 015959 Ny. Sri Daulati P 61 th ISCHIALGIA IR, TENS
16-Mar 73 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT
16-Mar 74 15 127548 an. Adhysta Zaidan L 2 th DD IR, NDT
16-Mar 75 15 145860 An. Zafran L 6 bl Bayi Sehat Baby Massage
16-Mar 76 14 105853 Tn. Supomo L 60 th LBP IR, TENS
16-Mar 77 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
16-Mar 78 16 172122 Tn. Rujito L 70 th LBP IR, TENS
16-Mar 79 14 122530 Ny. Aminah L 60 th LBP IR, TENS
16-Mar 80 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
16-Mar 81 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
19-Mar 82 14 111731 Ny. Siti Munzaenafi P 61 th Frozen Shoulder IR, TENS
19-Mar 83 15 136876 Ny. Dartik Sri P 45 th LBP IR, TENS
19-Mar 84 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
20-Mar 85 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
20-Mar 86 16 172122 Tn. Rujito L 70 th LBP IR, TENS
20-Mar 87 14 122530 Ny. Aminah L 60 th LBP IR, TENS
20-Mar 88 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
21-Mar 89 08 009687 Ny. Sulastri P 65 th OA genu billateral IR, TENS
21-Mar 90 14 106073 Tn. Sukarwi L 47 th OA genu IR, TENS
21-Mar 91 09 019139 Tn. Danawi L 55 th Post Stroke IR, ES, Exercise
21-Mar 92 14 106996 Ny. Prapti Mulyani P 46 th myalgia IR, TENS
21-Mar 93 15 141179 Tn. Masikan L 38 th OA genu IR, TENS
21-Mar 94 10 028857 Tn. Sholihin L 75 th OA genu billateral IR, TENS
22-Mar 95 17 173832 Ny. Isbandiyah P 73 th OA genu billateral IR, TENS
22-Mar 96 16 163958 Ny. Suparmi P 65 th LBP IR, TENS
22-Mar 97 14 115477 Tn. Nazief Zainul L 67 th Frozen Shoulder MWD, US, TENS
22-Mar 98 15 128846 Ny. Ngadinah P 58 th OA genu billateral IR, TENS
22-Mar 99 14 123553 Ny. Khotik Hoang P 55 th Frozen Shoulder IR, TENS
22-Mar 100 16 155995 Ny. Zubaidah P 35 th Frozen Shoulder IR, TENS
22-Mar 101 16 162304 Tn. Moch Zainal L 65 th ISCHIALGIA IR, TENS
23-Mar 102 14 1120 61 An. Ibrahim raito L 10 th kelemahan lengan kanan IR, ES, Exercise
23-Mar 103 16 1558 73 By. Muh. Radika L 3 bl Bayi sehat Baby Massage
23-Mar 104 16 1635 35 By. Ida Bagus P 5 bl Bayi sehat Baby Massage
23-Mar 105 16 166178 An. Aqsel Tristan L 3 th CP IR, NDT, Exercise
24-Mar 106 15 140319 An. Rafa Nasron L 2 th CP IR, NDT, Exercise
24-Mar 107 16 162277 An. Ferdian gio L 8 bl Bayi Sehat Baby Massage
24-Mar 108 15 141687 An. Arsyfa Mutiara P 6 bl Bayi Sehat Baby Massage
24-Mar 109 16 161257 An. Hilmi zian L 1 th Bayi Sehat Baby Massage
24-Mar 110 14 11282 Ny. Rya Handayani P 35 th Frozen Shoulder IR, US, TENS
24-Mar 111 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
24-Mar 112 14 123926 An. Fathan Zidan L 5 bl Bayi Sehat Baby Massage
24-Mar 113 16 170947 Tn. Sutoyo L 65 th LBP IR, TENS
26-Mar 114 16 163387 Ny. Anisfatun P 50 th LBP IR, TENS
26-Mar 115 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
26-Mar 116 10 050387 Ny. Anita Susanti P 30th LBP IR, TENS, Exercise
26-Mar 117 16 162204 Nn. Anung anindita P 25 th LBP ec. Scoliosis IR, TENS, Exercise
27-Mar 118 13 101787 Ny. Patemi P 30th ischialgia IR, TENS, Exercise
27-Mar 119 14 121218 Ny. Tuminah P 34 th OA genu billateral IR, TENS, Exercise
27-Mar 120 10 050693 Ny. Rini Puji P 40 th OA genu billateral IR, TENS, Exercise
28-Mar 121 15 144451 Ny. Sumarni P 45 th LBP IR, TENS, Exercise
28-Mar 122 16 149293 Ny. Warti P 51 th Piriformis syndrome IR, TENS, Exercise
28-Mar 123 13 094197 An. Elvina Nur P 3 th CP NDT, Exercise
28-Mar 124 11 057337 An. Akbar Waldan L 2 th Bayi sehat Baby massage
28-Mar 125 15 142993 An. Arya Atyasa L 8 bl Bayi Sehat Baby Massage
29-Mar 126 12 077759 Ny. Suntiati P 45 th Post Stroke IR, ES, Exercise
29-Mar 127 17 173283 Tn. Suparman L 50 th LBP IR, TENS
29-Mar 128 08 015435 Ny. Sri indrawati P 40 th LBP IR, TENS
29-Mar 129 12 083101 Ny. Sri Sularwati P 38 th ischialgia IR, TENS
29-Mar 130 15 142388 An. Yaqda Rabha P 2 th DD IR, Exercise
29-Mar 131 15 129354 An. Ericha Octavia P 4 th CP IR, NDT, Exercise
29-Mar 132 13 102314 An. Azalea Kholiqo P 7 th CP IR, NDT, Exercise
Bukti Fisik Verifikasi

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SURAT PERNYATAAN

Yang bertanda tangan di bawah ini:


Nama : Prasetyaningsih, AMF
NIP/ NIK : KSH/ 3. 120
Pangkat/ Golongan :-
Unit kerja/ Instansi : RS Keluarga Sehat Pati
Jabatan : Kepala Ruang Fisioterapi

Menyatakan bahwa
Nama : Ika Nur Cahyanti, A.Md.Ftr
NIP/ NIK : KSH/ 3. 1243
Pangkat/ Golongan :-
Unit kerja/ Instansi : RS Keluarga Sehat Pati
Jabatan : Fisioterapis
Telah melakukan pelayanan fisioterapi pada periode 30 Maret 2016 sampai dengan 29 Maret 2017
Bulan Rawat Jalan Rawat Inap umum Rawat Inap khusus
April 0
Mei 0
Juni 0
Juli 0
Agustus 0
September 0
Oktober 0
November 0
Desember 0
Januari 129
Februari 125
Maret 121
JUMLAH 375

Demikian surat pernyataan ini dibuat untuk dipergunakan sebagai persyaratan registrasi fisioterapi ( Surat Tanda Registrasi)

Pati, 31 Desember 2017

Prasetyaningsih, AMF
KSH/ 3. 120
SURAT PERNYATAAN

Yang bertanda tangan di bawah ini:


Nama : Prasetyaningsih, AMF
NIP/ NIK : KSH/ 3. 120
Pangkat/ Golongan : -
Unit kerja/ Instansi : RS Keluarga Sehat Pati
Jabatan : Kepala Ruang Fisioterapi

Menyatakan bahwa
Nama : Ika Nur Cahyanti, A.Md.Ftr
NIP/ NIK : KSH/ 3. 1243
Pangkat/ Golongan : -
Unit kerja/ Instansi : RS Keluarga Sehat Pati
Jabatan : Fisioterapis
Telah melakukan pelayanan fisioterapi pada periode 30 Maret 2017 sampai dengan 29 Maret 2018
Bulan Rawat Jalan Rawat Inap umum Rawat Inap khusus
April 122
Mei 104
Juni 130
Juli 124
Agustus 116
September 116
Oktober 127
November 141
Desember 125
Januari 137
Februari 143
Maret 132
JUMLAH 1161

Demikian surat pernyataan ini dibuat untuk dipergunakan sebagai persyaratan registrasi fisioterapi ( Surat Tanda Registrasi)

Pati, 31 Desember 2018

Prasetyaningsih, AMF
KSH/ 3. 120

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