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  • Assesmen Pra Bedah

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    Zulaika asri nasution
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    This document contains forms for pre-operative medical assessment and surgical site marking for a patient undergoing a procedure. It includes sections for subjective and objective patient data collection, a pre-operative diagnosis, planned surgery, and the doctor's signature. A diagram of the human body is provided to mark the surgical site location. The patient or family must confirm the marked site is correct before the procedure.

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    ASSESMEN PRA BEDAH

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    This document contains forms for pre-operative medical assessment and surgical site marking for a patient undergoing a procedure. It includes sections for subjective and objective patient data collection, a pre-operative diagnosis, planned surgery, and the doctor's signature. A diagram of the human body is provided to mark the surgical site location. The patient or family must confirm the marked site is correct before the procedure.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    21 views2 pages

    Assesmen Pra Bedah

    Uploaded by

    Zulaika asri nasution
    This document contains forms for pre-operative medical assessment and surgical site marking for a patient undergoing a procedure. It includes sections for subjective and objective patient data collection, a pre-operative diagnosis, planned surgery, and the doctor's signature. A diagram of the human body is provided to mark the surgical site location. The patient or family must confirm the marked site is correct before the procedure.

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    of 2

    RM.17.

    5
    OK/AN
    LEMBAR PENGKAJIAN MEDIS PRE OPERASI No. Rekam Medis : ……………….……
    Nama : …………………… L/ P
    RUMAH SAKIT UMUM KOTA BANJAR DAN PENANDAAN OPERASI Tgl Lahir : ……………………
    Ruangan : ……………………
    Dokter : …………………….
    PENGKAJIAN PRE OPERATIF
    Jam : …………..WIB Tanggal :………………..
     Data Subjektif ( Anamnesis)
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
     Data Objektif ( Pemeriksaan Fisik )
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    ……………………………………………………………………………………………………………………………………………………..
    Diagnosis Pra operasi : Rencana Operasi :
    ………………………………………….. ……………………………………………….
    Tanda tangan Dokter Operator:

    Berikut tanda gambar sesuai dengan penandaan lokasi operasi pada tubuh pasien berikan penandaan pada tubuh pasien dengan tanda o

    Deskripsi singkat apabila tidak dapat dilakukan pada tubuh pasien :…………………………………………………………………………………………………………………………………………
    KLINIK PRATAMA
    KULON PROGO
    BANGUN SARI

    FORMULIR PENANDAAN AREA OPERASI


    Nama : …………………………………………………………….. Prosedur : …………………………………………………………….
    Umur : …………………………………………………………….. Tgl. Prosedur : …………………………………………………………...
    Nomor RM : ……………………………………………………………..

    PRIA WANITA
    Kanan Kiri Kiri Kanan Kanan Kiri Kiri Kanan

    Palmar (Anterior) Dorsal (Pasterior) Palmar (Anterior) Dorsal (Pasterior)

    Kiri Kanan Kiri Kanan


    Kanan Kiri Kiri Kanan

    Kanan Kiri Kiri Kanan Kiri Kanan

    Tandai dengan anak panah, gunakan spidol merah


    Saya menyatakan bahwa lokasi operasi yang telah ditetapkan pada gambar diatas adalah benar

    Pasien/Keluarga Operator,

    Nama Operator : ………………………..


    Nama Jelas / Tanda Tangan Tanggal : …………………………

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