Noma 2 Kodo Dir Ow goypra Myon FANoaror rEatoss AGH FORM SOAP PHARMACEUTICAL CARE PATIENT PROFILE Tr./ Bis. Jenis Kelamin : \o\y, - \e Tel MRS =: AC Roystus, 00 Usia 254 Adnvtd TgLKRS : Tinggi badan : Berat badan Presenting Complaint: sen dowd Wuroma, Wot % MmEpy? Lacon Deren evatalWer CHMVEAN Aoee 2-41 Moly Gerrorte Rasen mranoelutr Kuk howbuns fae cor don oka oMgEMUD Diagnosa ea FDue Reval ur, GALES owe clon QE. cakks Diagnosa banding: \vbexnol Wemotthars ofade > Relewint Past Medical History: Migoreecwte dow QIGroearro ‘Drug Allergics + Tack monenma Arwovgt deve) dookTandetanda Viel Teel [ie ish tgl tgl tgl tgl ‘Tekanan darah Mo /4o | \LO/8 ‘Nadi Ro eg a 36.0 [362 RR i =LABORATORY TEST Test (normal range) tg gl WBC (4000-10000/mm) Wibb (te 7UD ‘Hb (L: 13-17 g/dL) wi C3 7 XV RBC (4-6x10'/mm') © (rot /ty ‘Het (40-54%) ery CF) PLT (150000-450000/mm') a8.F (eeVL) ‘Gula darah puasa (76-110 mg/dL) Qt Con (ALY ‘Gula darah 2 jam PP (90-130 mg/dL) te (ma fac) ‘Cholesterol (150-250 mg/dL) 28% Cog} dt) TG (50-200 mg/dl) are (mA sey Uric acid (3,4-7 mg/dL) @.5 (mal SL) ‘Albumin (55-50 g/dL) = SGOT (0-35 WL) = ‘SGPT (0-37 wi) = BUN (10-24 me/dL) IbB (org /AL) Kreatinin (05-15 mg/d) ORY Cong [SU] = ‘Natrium (135-15 mEq/L) ay (aac) Kalium (35-50 mEq/L) E38 Cong from), LED AD Cen dL) BOL bare Cong J acy Lou 1554 Come fA) DE = Eo = Be a ¥ Laks Sex aA Law ne Mo 2 No. Further Information Required Alasan rorcak odo’ Rosen Roragokow Lmepy Woden dow VAR MEARE IAS UPMO)| eegek Unkuk gogen Rrgpirenar ge She gover) RG HES REUSE GO WROD ° K admveorky goes Sent ek H Apokon Pes wos doce) OADASPAAOAS Juri MAMMA LAAQe Ope} Ragok UrSE goneSN, gokow goer cosy tromaptonens wut bon Curler AUER ONCDOSPUMONEN Lao ramtieown Bok aol dorann Vduror Sar QIN ny gethome Kolunne poser mavgplowms UD JAR Mahar buon LatoR’ Lecloor\ Bon sinkedy Lago vA Daen goon EN Mevekorsunty NSAD ALOE Trewloteownr Laroqugna, RawR UML sre goon pase Roylat H guionw] AEN ACETONE LOY Jamon ‘Bak YFTYSALAX Bon, he diner _ROeREN JAgovoln poe mony moor ho wsyornr daok Vdestro\ ARON AEAMAGON Leo Wao! You Suter LAOQ VALS gomen goon Gene monn Moves! oveUwe dook aomusck 7 Uaky MenLALVaN Lawes Lecco dow Saker lacogy uarue gomen Apolo GAG Soak Wes Seen] UAT EAGELCONEA EETOGY to Jankeokbop dara Owen omit dook REHM oubule mena. ose uate mavevutow Lory Leo aren Lagan gorier ‘suas lone oases eer doco ‘1 dan sanker Keregy west poserMedication ‘No. | Nama Obat Indikasi Dosis yang Dosis Terapi digunakan (literatur) Creak. Mertecrsvion L813. K Snot gods] Horus Smues Lundo\on 1 Racsgrcdode reas Rogier [Se Sow Mole Shuang Moc rotan ORO, Noe Se Ne) oe Mors Seto. och rocks 1 toh. gairon| fertake mangrues Dan ows ua] 2 [Lxrekes Nedagtsch WV copied - 1K Gthant Dowd, [Reka .B dow mmax 10 mg, | oe Anojreeielg REN [Lgacut secre gee Rows ettol 100-20] an Jer .Higarue reno, fay [Yost Wondon 3 Moshe [sdewndes menceopih = Sahows) S00 Yeo ) Reraencngon CoM) HAST «wordy owor ureik den vehsxor] noo apo wa, nat lunkuke marepkos| lusso > ALL Eeotcnel JAOwe Ypres Pero Vors sche 4 [Enkroskoe Nada &Neckotwun = Rieare Wor a SoBK Jaanogwy yor ros GN Per) uso. = kotdk shed Laneploolowy wa Xe Imax 6 keel 5 6 7 8Problem List (Actual Problem) Medical Pharmaceutical 1. Dioce 1. Extrortee a. . Dadrerdorno (uoteskes\) fa Lgitor %_ Asom urok Crrigermesemed [31 Dooce A. Pancotnac FL eck Onosgnore do PHARMACEUTICAL PROBLEM Subjective (syptan) “1684 = use SRR = eruryphe qemupha FEAVTHENA DALVLMD, - Dest Matos, WA 9. magy Leconte - Vek LecoaK vKamnows ae Sa, ny; OTOMY i Ypakendss lan odo eengeauys: = Objective (sign) . KOmAAVCR' CLO Lom comses gd Le B/G menomppukor hors sar Wees BESLIGKEGD ETOAVE ,Golow BohE COMES , MECWVA NeMoreor Bade \-2 Tonete -komde wisa\* FER owen docc\a ts = NCL /8 310 [40 A1B 1G 2 \L0/ BO* MORN. = 1 /BO RO -1FIB «Qe ATNQELAK + - CB 23g VE “BIB 226 PC fe Loy gernogoscnn t= tet /8 #18 & [enon Assesment (ith eden) = 1% + - W Rsow OR TTIG og TIL Tegel RAL Lokal 1183 orl A Creead ATA Regeoeddy i007 may! M Cher Plan (inducing primary care implicatiors) Monitoring © Efektivitas © Efek Samping Obat