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  • Draf Form Assesmen Awal Peserta Khitanan Massal - RSKB 2023

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    Yuvensius Dika
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    draf Form Assesmen Awal Peserta Khitanan Massal_RSKB 2023

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    4 views1 page

    Draf Form Assesmen Awal Peserta Khitanan Massal - RSKB 2023

    Uploaded by

    Yuvensius Dika

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    RUMAH SAKIT KHARITAS BHAKTI

    Jl. Siam No. 153 Telp.(0561) 734373 Fax. (0561) 768969 Pontianak

    SKRINING AWAL PESERTA KHITANAN MASSAL

    IDENTITAS

    Nama : ……………………………………………………………………………………
    Usia : ………………………………………………………………………………........
    ANAMNESA
    Keluhan : ……………………………………………………………………………………
    …………………………………………………………………………………….
    Riwayat medis : ……………………………………………………………………………………
    PEMERIKSAAN FISIK
    Kesadaran / KU : …………………………………………………………………………...............
    Nadi : ……………………………………………………………………………………
    Suhu : ……………………………………………………………………………………
    Tekanan Darah : ……………………………………………………………………………………
    Berat Badan : ……………………………………………………………………………………
    STATUS LOKALIS

    Kesimpulan : ……………………………………………………………………………………
    Oleh Dokter : ………………………………………………… TTD :

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