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Stiker identitas pasien

RINGKASAN PASIEN PULANG

Tanggal masuk : ................................................................................. Tanggal keluar : .........................................................................

Indikasi masuk : .........................................................................................................................................................................................

Diagnosa masuk : .......................................................................................................................................................................................

Ringkasan riwayat penyakit / keluhan:

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Pemeriksaan fisik :
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Pemeriksaan penunjang diagnostik :

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Terapi pengobatan selama di rumah sakit :

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Keadaan pasien waktu pulang :

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Tindak lanjut :
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Edukasi pulang :
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Terapi pulang :
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Diagnosis utama :
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Diagnosis sekunder : 1. …………………………………………………………………………………..

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Komorbiditas :
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Tindakan / Prosedur
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Yang menerima Penjelasan, Dokter Yang Merawat,

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Pasien / Keluarga Tanda tangan & nama lengkap