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  • GENERAL CONSENT RALAN-dirotasi

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    Admisi RS Sandi Karsa
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    8 views8 pages

    GENERAL CONSENT RALAN-dirotasi

    Uploaded by

    Admisi RS Sandi Karsa

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 8
    g RUMAH SAKIT SANDI KARSA & : Kantor : Jl. Abd. Dg. Sirua No.16A Makassar, Telp. (0411) 446343-0811446343 * ecmnail : rssandikersa@g ‘Nama Pasien No.RM/Jenis Kelamin ‘Tempat Tanggal Lait Alamat Pasien ‘No.Telepon/Hp_ .1 Q)Laki-Laki/Male — O Perempuan / Female ‘Nama Penanggung Jawab se ‘Sure Name. ‘Tenis Kelamin : OLaki/ Male O Perempuan / Female . Sex ‘Hubungan dengan pasien': DOrang’Tua Anak ()Suami/Isti OKelwarga OTeshan 0 Lain-lain ‘Relationship to Patient Alamat tempattingeal Residential Address Alamat KTP Pendidikan : O Tidak Sekolah OBelum Sekolah OTK Osp s2 Education OSLTP OSLTA Akademi OSL ‘Pekerjaan_ :O Pelajar/ Mahasiswa 0 Wiraswasta OPNS O Pegawai Swasta Occupation O Tidak Bekerja O Profesional O Pensiuna A. Kondisi General Condition of Service 1, Selama dalam perawatan di RS. Sandi Karsa Makassar pasien bersedia menerima informasi terkait dengan pemeriksaan dan tindakan medis, Keperawatan serta pemeriksaan penunjang lainnya, During hospitalization in Sandi Karsa Hospital, patient agree to examination and medical treatment, nursing care ‘and diagnostic examination. 2. Diunit pelayanan tertentu RS. Sandi Karsa Makassar, ada keterlibatan peserta di didampingi oleh petugas RS, baik dokter, perawat, maupun tenaga medis lainnya. In special units of Sandi Karsa hospital, will joint educate participant during hospitalization that willbe control by hospital employee such as doctors, nurses, and other medical staffs. ;Selama perawatan di RS. Sandi Karsa Makassar, pasien yang memeriukan tindakan medis invasive akan diberikan 1 penjelasan oleh tim medis yang merawat sebelum pasien menyatakan persetujuannya untuk’ dilakukan tindakan tersebut. During hospitalization in Sandi Karsa hospital, if patient need invasive medical treatment, medical team will give explanation Before patient declare to agree with the treatment. 4, Solama dalam perawatan di RS, Sandi Karse Makassar, pasien dianjurkan untuk tidak mengenakan atau menyimpan Darang Derbarga. Kebilangan ataupun Kerusaken bareng buken merupakan tanggung jawab RS, Sandi Karsa Makassar ik dalam pemberian pelayanan yang, During hospitalization in Sandi Karsa hospital, we actvice patient don’t use or bing valuable things, any damage or Tose of valuable things are not liability of hospital. 5. Pasien dan keluarga bersedia mengikuti peraturan dan ketentuan yang berleku di RS Sandi Karsa Makassar. Patient and their family are agree to follow the hospital rules and certainty of Sandi Karsa hospital. 6. Pasien dan kelusrga dapat memilih kelas ruang: perawatan yang tersedia di RS. Sandi Karsa Makassar, berdasarkan pola tarf_yang berlaku sesuai dengan hak perawatan yang ditanggung asuransi kesehatan. Patient and their family can choose bed type which available in Sandi Karsa hospital depend on bed type fee ‘appropriate o authority of health insurance or partnership system that patient use. Hal? a mR 2/RI/2019 7, Saya memahami informasi yang ada di dalam diri sayfa, termasuk diagnosis, hasil laboratorium dan,

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