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  • RM BA 8 LAPORAN PEMBEDAHAN GA (Rangkap Dua)

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    RM BA 8 LAPORAN PEMBEDAHAN GA (rangkap dua)

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    RM BA 8 LAPORAN PEMBEDAHAN GA (Rangkap Dua)

    Uploaded by

    Mustopa Al Paris

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    DETASEMEN KESEHATAN WILAYAH 01.04.

    02 RM BA-8
    RUMKIT TINGKAT IV 01.07.03

    Nama : ……………………………………………………
    Tgl. Lahir : ……………………………………………………
    LAPORAN PEMBEDAHAN No RM : …………………………………….

    DPJP Bedah : …………………………… Operator I : ………………………. Asisten Operator : ………….


    DPJP Anestesi : …………………… Asisten Anestesi : ……………………..
    Diagnosis Pra Bedah : ………………………………………………………………... Tgl. Pembedahan :
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    Diagnosis Pasca Bedah : ……………………………………………………………... Lama Pembedahan :
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    Tindakan Pembedahan
    I. …………………………………………………………………….. ⎕ Emergensi
    II. ……………………………………………………………………..
    III. …………………………………………………………………….. ⎕ Elektif
    IV. ……………………………………………………………………..
    Jenis Pembedahan ⎕ Bersih ⎕ Bersih Tercemar ⎕ Tercemar ⎕ Kotor
    Operasi ke ⎕1 ⎕ Re-Do
    Profilaksis ⎕ Ya ⎕ Tidak
    Jenis Antibiotik ………………………………………….
    Waktu Pemberian ………………. Jam sebelum operasi
    URAIAN PEMBEDAHAN – Sesuai dengan instruksi
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    ( Bila perlu tambahkan formulir yang sama )
    Konsultasi Intra Operatif : ……………………………………………
    Jumlah Perdarahan : ………………………………………………….
    Jaringan ke Patologi Macam jaringan yang dikirim : Tanda tangan Operator
    ⎕ Ya : Tgl : ……………………. ………………………………………
    ⎕ Tidak ………………………... ………………………………………
    Label pasien sudah ditempel :
    ⎕ Sudah
    ⎕ Belum ( dr. ________________ )
    URAIAN PEMBEDAHAN :
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    Tanda tangan Operator

    ( dr. ________________ )

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