LEMBAR DATA KLIEN BEKAM SUNAH

Hari, tanggal : …………………………………………………………………………………………………………………………

Nama Pasien : ………………………………………………………………………………………. usia..........th. ( L / P )
Keluhan Utama : ………………………………………………………………………………………………………………………….
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Keluhan tambahan : ………………………………………………………………………………………………………………………….
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Riwayat Penyakit : ……..........................................................................................................................
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Hasil Pemeriksaan : ………………………………………………………………………………………………………………………….
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Kesimpulan Diagnosa : ………………………………………………………………………………………………………………………….
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Saran/Anjuran : ………………………………………………………………………………………………………………………….
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Titik Bekam yang digunakan :

Pemeriksa

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(nama peserta Ujian)
 RESUME TERAPI BEKAM

Hari, tanggal : …………………………………………….

Nama Pasien : ………………………………………………………………………………….......................................
Tanggal Lahir : ..................................................................................., Usia.......................( L / P )
Alamat : ............................................................................................................................
NO. HP : ............................................................................................................................
Keluhan Utama : ……………………………………………………………………………………………………………………………

Keluhan tambahan : ……………………………………………………………………………………………………………………………..

Riwayat Penyakit : …………………………………………………………………………………………………………………………….

Hasil Pemeriksaan : ……………………………………………………………………………………………………………………………..

Kesimpulan Diagnosa : ………………………………………………………………………………………………………………………………

Saran/Anjuran : ………………………………………………………………………………………………………………………………

Titik Bekam yang digunakan :

Pasien Pemeriksa

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