Medical Faculty University of Sriwijaya a JiJendral Sudirman KM 3,5 Phone 62-0711-362423 Palembang Indoni Hemodialysis Center DR. Mohammad Hoesin General Hospital Division of Nephrology & Hypertension — Departement of Internal Medicine RSMH Palembang ‘Traveling Dialysis Patient Questionaire Patient's name (MARLIA MARGARETHA ‘Age: 35 years old Recent Address JUN Wetan Pasar , RT 02/07 WATES , kabupaten kulonprogo DIY Diagnosis and history = Chronic Kidney Disease stage V on Hemodialysis Hypertension How long has the patient been on dialysis: since 2022 Candesartan 1x 16 mg Clonidine 3x10,15 mg. Kreatinin : 5,31 mg/dl , Leukosit : 6840 /mt Recent Blood Pressure status : 154/96 mmhg Composition of Dialysate : Bicarbonate What Dialyzer and delivery system is the patient currently using : High Flux Known complication with dialysis runs : No Complication Does the patient have a shunt or fistula: brachialis sinistra ‘Type of heparinization used : maintenance heparin (5000 ui) Number of runt per week : twice a week How longperrun: 4-5 Hours TMP used mmHg. Positive pressure: mmHg Negative pressure HosAg : non reactive Anti HCV = non reactive Anti HIV hon reactive Date : August 2023 Diet No Allergies : No Patient's dry weight: 49 Kg oR “attached Palembang, 25 Rugust 20) the patient home trained or center dialyzer : RSUP Dr. Mohammmad Hoesin Palembang, South Sumatra What medication is the patient presently taking: folic acid 3x1 Calcium Carbonik (CaCO:) 3x1, Amlodipine 1x 10 mg Laboratory values over the past months : Hemoglobin 7.6 gi/di , Ureum Pre HD 90 mg/dl, mma