LAMPIRAN 14 PEMANTAUAN TERAPI OBAT DATA PASIEN: Nama:_ ‘Tn $f. (UP), Tal. Lahir: ao [wag BB:__kg, TB: _em Alamat: No. Telp: ToL Masuk Rs: oF [or] tow Ruang Rawat: Condravesth KELUHAN UTAMA: RIWAYAT PENYAKIT SEKARANG; Mei Ag ad alae on chy, fetes duran Wtperatiant RIWAYAT PENYAKIT TERDAHULU: ec dagon {ijadltiomia Ab dd jut on GO, Nett, Hiren RIWAYAT KELUARGA: RIWAYAT SOSIAL: eee Ri \YAT PENGGUI 7 Vy Waiter Brean 0 (100 tg 2. Alofuhtel tab (oo taya Ci Bo = 4. co Meg Tes Novoragd fen (wo ju] = Joh To Byopie ak # of HASIL PEMERIKSAAN FISIK: Pemeriksaan | Nilal TOHA|gfox | TOU | Tatas [ox | Tal fc fu] Tl We fal | PAE Te] Biol normal 75-1 WT Popoewty | Bi [oc [Wa et _| alan | bo Tao [te Zee | tie 760 | i Fak bo -(cox]mtit_ Ao fia A 88 2 [o-sere 2a 40 te Spo Ko E 99. 4 HASIL PEMERIKSAAN LABORATORIUM: Pemeriksaan | Nilai Tgl., ‘Tg. Normal, 35 eke Veroriofin —|8-00- Fe (et Te uyodt, [4.000-logne tre] 12 400 1} 000 4 -52%| 4 46 ‘om Dos | Basogit. 0 Eosinogit z Peajrts Fata % & fost T: oft 2 ni it Siw. 36.4 tH Fiat 2St0 qeor B.0 vy Ter. 4 Ov 99 bo Wgenbias Att e_& =o. Bugeer [Ub “4 | Oe 3 1-Buatol\ 13 ‘Teo, \B. [ 9 | bes GOs Tow [at | Teer doll vane wah Oreo dom fa \ Cragin | 21 fa | atu | 6-149 autos WS -Si3 ne chewida | a-10F tgp ftHASIL PEMERIKSAAN DIAGNOSTIK? DIAGNOSIS: Sepals pel dd Abo oa CEQ = Segits seed PENGGUNAAN OBAT SAAT INI: ‘Nama Obat Regimen, Indikasi PEMANTAUAN (S.0.A.P) BAGIAN INI WAJIB DITULIS TANGANWome Ober Peepinen Remrtaton QGrk Now Purertern| Natrwur Qicarbovcl tab 3 xSo 4g Blebhretie Mogunvot Lx os us Aart Yigururtsersio, CaCos leageud BK lo My Aea& UMeor [Feec bet Bxdoo “p nk ovrsurin, BicoQuatol toe [XU ww Autti typertenge lop doarel bet lets 4g Araki Yloreles Pegtes fot \x Bo wey Bust Teretat uowolfet Seug Bete ag uxt ulcer Guckesorton babe l r@ ug Auk kigergenst Atesuostotin tote cas fast RBesterdension footw . \ x theater — Keokytsesteie ces Aa Morwditie, Romer tae \ x 2tese Aut Uapes ees Peqer'e_ tate | __ Le seo | flat tse Pemrberin, Ober Qoresrteves = Ovrepreaste tay 2 ¥4o 4B Aoi [terfioles Rerosumid way Lee ang Berd gerterse) Memparur wy BECO Freak faints: Nlee\ 23 MER Jaton NaCl oA, L¥ so “eq. raf Kupartrtete Peou Kein ws ort wt pm - | PREY Pedwe Stlester pes ope uh (pw Pat deere Guwinves usu Breer ot Kakt Aswrcortte ikouin le way 4 eto at ewnosterttls Becun Croueksomaore sa Kesriglateler [ew Rexenin by 2 Aaattiononic Comore 2 wrep Moerwuple Pentuninn’ Garon where | a] acl oo Sao! 20 Mer [fun Hektroth Aowoftud (0 4 whoo ug ElectMee Faum asus 2 7 Finding Fubueerig + Lomas Seine Rog Waris Tetra Socal geliay dam dag bila echt. OK ‘pk geliSal, i : Cora myoinan lan lain difonekel pag 2 eae (W)- Ody —* + Peueriisonn (cy Atongenmal /OF/0F (OW TURF TUK Man Cate) = elite TOU AL ath, rte 7 : ~ Ger + Agaric : Mine F Powtig + Gata) ~ Lev t 1 Wy -100 wun (tag ~ due + RoE E Chane) = tomnath Ole tQadeh) Wow = TORE (int) = Neuter = Obl, C cengacy ~ Gengorit : 4, “ + Fer wwnnkg(L — (Tuys') low (Wedal) (Unda) “oH yy (Camoring tat) He + Vor eumlly —( fuuctol| - \acos + LEH wana ZL ( Yura) - Gos FF mys (Tuga) = Keetoo Quen = ley Gen) = vm 2 Bh wy fal (tinge) —Cluminig Les way (SL Cay © Qurecivegom eee / OF los} wrr- Kins Tedycordia, Muocordio Ungenction » Legh Vantsicular Unfectroyny Porslnle leg aksiat Onletcyament © Pumesitetin thane (0%/ oF [rove Cordeomeneli 1 Bundurgan Perit neriigam LCA Alnatvan| TOAST Osfrte = 181/49 matty wormed) “Nadi M5 fos tune? 46% /tmmit—( \omal) ~ UW Ail effort x /wauit (Wormat) ~ SyOr Moro: oy *|., (Wormal) ~ Wh [fos + tad (Nan dah) ~ \wborit fos: (9.400 (tin9n} | ~ Hummaest /nfospores 35 (Qua dak) Vuutogil /osforfou: Bb‘ — (nan) Laue fofarirerr: 3° Lge ant) ~ WR fof osfore Fre C Ting) Yor Mo fostwrr VLe my en dat Or of orfwrre (od. g winlin ( Tita} RU fof OF f7eTL © (DD mmtale Ctrdan| (Wun J Wostwa s (FL ans at ( Mey ni} = Caeatietn MY os fra. LY wy ae ¢ Sivgny Yuurlyiad Wnacil Wink babe dar ugi # Dekoten + Ealmmnitin, CARO fox acim, evitleratin © Sussitits Gamat + Wasetolid © Were diate: MATIC oR Azole WeQeeam /13 fr fro OflerALin Oindangcin , (ofoxitin,Quan som FE /lo(s/ wr ~ SMUL Unoytr T Antetor Ianocardial imginetion Maker ioc Magtardinl Wakencerun ~ Two Dlonoctraity, * Yomritiom TWwrix - Cordin warali ~ Cloqaio din Hotigkas prour gutta = Burderner fom * GOS J) 06 row [wr] os | wr ~ Oh © (Yo ay / ~ O80 = Ur wy/ ae onda 2PE 8 4 o a Worm + Ug aw ous Be wag] ALC Trae ) wo.) Qe ~ [Aaa Fridae \ehecimen 1. | maieat tga Tidak Suir wrdigos Mondagat ka Font Terhyi % ) Yowsilitoa Dork pan Vowsigal r Levottotsaais , Hae Suid» euibyon That tyat TAS: Temee sowmor tayters, bapilet +OMR CHL, Aetty( gaktia eter wajues S| Dove Cony Tidne Hosig Terni Tepat 4. Genel Rucerion nak (evo Ho tSusiin » Pyare VU (for /r022) Quo lonten 5 | pone. Berle Tidne dda | Tak Ada TORE edible C. | Recess olvat bdo Nowigal , Ase, Hiagacin aj, WAVaikaw Folac , AMilion 4. | Wnlepegy Oat Ado Can arincton + Riso Qrolal 9- ee hae Hmulrorole , Acetyl gittuin tain -() Wane befa deh tanigir Son Carduotan Wey Remfat [ cseper yay sha Patritie (Acgd) bdein Wenghambae anaigehin Apuerjadt AKIN 2 gtanghan (AN at a) Reicha etrranege ANfiolsin 2 bektatan Maan teseptor fers punoon Acer kde aranhan hareha, pada jplorgan Ace \thih Wanyak tema Ofek souag fy tbordingban Selongan Ate ~ Sdoh ia sto AE Sgt Jor ocoran fae gates bot bert yay, ctynaea Hien ald Mok Karla aparoanta atta Uergiation forbid bons Vardasoban hac Salt ath nea ncaa, Wien ON, Cavin teshlen HAhada? levoflaadin . fol Wh Rengnca pl eth, fertcten AG Kelamb & dilabahan. Wotudian nil Seige fda atttjohle +) Forrsemid jy dengan fesakix qigal (tert cothon KineBa drval). " bre i Bacon ak fain cleo. borer Sipe Aithar da PMatalabcanpon aya fasten Biatetia (veNalom' anemia tomoity. PY fortsta aremnia Normosiky, ke tysobon Pada ojinjal Taha dietog ‘rai ahroyiin. Nhe caconya Clog Bosret Bsfilee don \efotn wei bebe wae taonaion dank. chivpn f : ae Hak Feohidan old Jattonry dan [eagi Siyar AyeMan coco Veg Mi bg a taut Joy Vantin \ eh Ao ogee 1 Asfllet fall dan hopin i) WOH hredoag laren tdhaneqne lehatyo Vetaovatg . Ksfle, don cloidogret wemiciys and Ybor foe ony Fe» Se eq ug Bt flats MONE fh 2) 5)Haier {lq My Hedoaed di Fen dt dguclan hag Onsinflatas fon Seysh . Yettan Seni ini fhe deat Veta, dagae bering. lanbany. G) oie uf Yetaniian daa (eefan oboe te do sot. lei, Ain ya diva (autaad ola aNtfrdorbea yay seu +) omagmie + ollot Atle Wa : tine Obnt LOMA (ehast : 7 y Gheas A (eros W los} e San tgs datgan Mal 4%, (9 La oO —— yee {he tc Mnatalen eo chetts $-Kalet dota , aai( HB YY tha Ons Kifedens, dary difakar adh —dolongn fee (on derortan dan ligt (Apdeaton ) ‘her ai aon hk Sd Mt ys, Sib Yio Hs testes ongbok Aetonbat Alaheban doy iets dillajon dot haf fenana Made teal sabi. Roar febithon {tapi antiog Yan Set fad fae 5) Fetoenia orto Wiest. detgon Asien thong dures henak halla. vats sfimmvlaktn . 4) Perguaal erbion digan rn Eltmpotica. soul yg se[iv 4 Vali! thingaw . 5) ohat porgaur datah Yay Aiakat ado dette to 2e My dn Vege 46). 6) etthan femipueat Minin dan aptlee . horn -Trandeytrat 4) Preparer oreprevte. Ahern » Mein Afkrg 4), SE Hee di dan fon cand Se lech or ion. °) en UA ae My pido Mdow hap Ve ta ot hs i BY Yenhciar omen “ry (aiba fate) 48% pet oo, Inpas W Pea! (fib fits) () fatananar fora dal Uitte Gye ser” bn!) 5) Fetratooae tule dauch (6% 4 Corp, (rep) 3) Yerartoon bsbaed (UL, To, \aecedt bin) 4) (erantcust Nua Cmagobin (uv) 8) Pehaniaaet FHtnhi Trvoy Ck, OP, sakuya Ohta) 6) Yetartouat ‘eaten doch 9) Yerantonan keryaan nsititias ofikaci antic ) nk Gifel Selhigga Yergaratan digang’ tga b)— fettantourt ete cing chat 9) Gdehad (0sen dow lulwogp fae