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    Status Mata

    Uploaded by

    tiara ananda

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    LEMBAR pemeriksaan

    Kepaniteraan Klinik Mata

    Nama : Nomor Medrec :


    Alamat : Umur : Sex :
    Paraf
    Ko-ass Penanggungjawab : ………………………..
    (………………………….)

    Anamnesis
    Keluhan Utama :
    Riwayat Perjalanan Penyakit :

    Riwayat Penyakit Dahulu : Hipertensi (…..), Diabetes Mellitus (…..), ……………………………

    Status Generalis
    Kes. : HR : RR : TD : T:
    Kepala : ………………………………….. Abdomen : …………………………………….
    Leher : ………………………………….. Hepar : …………………………………….
    Thoraks Lien : …………………………………….
    Cor : ………………………………….. Ekstremitas : …………………………………….
    Pulmo : ………………………………….. ……………………………………

    Status Oftalmologis

    ……………………………………………………. Visus …………………………………………………….


    ……………………………………………………. Koreksi …………………………………………………….
    ……………………………………………………. Gerakan Bola Mata …………………………………………………….
    ……………………………………………………. Tekanan Intra Okular …………………………………………………….
    ……………………………………………………. Palpebra …………………………………………………….
    Konjungtiva
    ……………………………………………………. …………………………………………………….
    Kornea
    ……………………………………………………. …………………………………………………….
    Camera Oculi Anterior
    ……………………………………………………. …………………………………………………….
    Angulus Irido Cornealis
    ……………………………………………………. …………………………………………………….
    Iris
    ……………………………………………………. …………………………………………………….
    Pupil
    ……………………………………………………. …………………………………………………….
    Lensa
    ……………………………………………………. …………………………………………………….
    Vitreous Humour
    ……………………………………………………. Fundus …………………………………………………….
    ……………………………………………………. DIAGNOSIS …………………………………………………….

    TERAPI

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