CLINICAL PATHWAYS

RSUP. DR WAHIDIN SUDIROHUSODO MAKASSAR

BAGIAN ORTOPEDI DAN TRAUMATOLOGI
2014 – 2015

Nama Pasien Umur: Berat Badan: Tinggi Badan: Nomor Rekam Medis

Diagnosis Awal: Kode ICD-10: Rencana Rawat: Hari

R. Rawat: Tgl/Jam Masuk Tgl/Jam Keluar: Lama rawat Kelas: Tarif/hari (Rp) Biaya (Rp)
Hari
Hari Rawat Hari Rawat Hari Rawat Hari Rawat Hari Rawat Hari Rawat Hari Rawat
1 2 3 4 5 6 7
Hari Sakit: Hari Sakit: Hari Sakit: Hari Sakit: Hari Sakit: Hari Sakit: Hari Sakit:
Diagnosis:

 Penyakit Utama
 Penyakit Penyerta
 ..........................................       
 ..........................................       
 Komplikasi
 Penyebaran Infeksi       
 Bony Ankylosis       
 Muscle wasting       
 Kerusakan tulang rawan       
 Kerusakan Vaskular       
 ..........................................       
 ..........................................       
 ..........................................       
Assessment Klinis:
 Pemeriksaan dokter       
 Konsultasi       
 Anestesi       
 Rehabilitasi Medik       
 Gizi       
 ..........................................       
 ..........................................       
 Pemeriksaan Penunjang
o Laboratorium
 Darah rutin       
 LED       
 CRP       
 BT/CT       
 HBsAg       
 CLINICAL PATHWAYS
RSUP. DR WAHIDIN SUDIROHUSODO MAKASSAR
BAGIAN ORTOPEDI DAN TRAUMATOLOGI
2014 – 2015

 HIV rapid test       

 Kultur dan Sensivitas       
o Radiologi
 Xray
 ......................................       
 ......................................       
 ......................................       
 ......................................       
 ..........................................       
 ..........................................       
 Tindakan
 IV Line       
 Urinary Catheter       
 Debridement       
 Irigation       
 Remove Implant       
 Arthrotomy       
 ..........................................       
 ..........................................       
Obat-obatan:
 Ceftriaxone       
 Cefazolin       
 Hypobac       
 Cetapain       
 Cernevit       
 ..........................................       
 ..........................................       
Pembiusan Umum Gas
 ..........................................       
 ..........................................       
Pembiusan Umum Injeksi
 ..........................................       
 ..........................................       
Pembiusan Regional/ Lokal
 ..........................................
      
 ..........................................
      
Nutrisi: ....................... Kkal/hari       
Protein: .......................mg       
Mobilisasi:       
 CLINICAL PATHWAYS
RSUP. DR WAHIDIN SUDIROHUSODO MAKASSAR
BAGIAN ORTOPEDI DAN TRAUMATOLOGI
2014 – 2015

Hasil (Outcome):
       
       
       
Pendidikan/Rencana Pemulangan
       
       
       
Varians
Jumlah Biaya
Perawat Kode ICD
Diagnosis Akhir Kode ICD-10 Jenis Tindakan
9-CM
DPJP  Utama

DPJP Anestesi  Penyerta  

 
 
DPJP Operator
 
 Komplikasi  
 
Verifikator  
 