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PEMERINTAH KABUPATEN SUMENEP

DINAS KESEHATAN SUMENEP

UPT PUSKESMAS SAPEKEN
KECAMATAN SAPEKEN
Jalan Raya Sapeken, Telp / Fax (0327) 511049
SAPEKEN

RESUME MEDIK
Nama : ............................................
Umur : ............................................
Alamat : ............................................
MRS : ............................................
KRS : ............................................
Dokter yang merawat : ............................................

I. ANAMNESA :
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
II. PEMERIKSAAN FISIK :
Tensi : ............................................
Nadi : ............................................
Respirasi : ............................................
Suhu : ............................................

III. PEMERIKSAAN PENUNJANG :

Laborat : ............................................
IV. DIAGNOSA :
...........................................................................................................................................................
V. THERAPY :
...........................................................................................................................................................
...........................................................................................................................................................
VI. PROGNOSA :
...........................................................................................................................................................
...........................................................................................................................................................
VII. KEADAAN KELUAR :
Sembuh
Berobat Jalan
Rujuk
Pulang Paksa
VIII. SARAN :
...........................................................................................................................................................
...........................................................................................................................................................

Sapeken ,...................2015
Dokter Yang Merawat

(............................................)

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