MR : SHKJ.

00-06-67-43
Name (Nama) : JULIA LUPOLO
DOB/Age (TTL/Umur) : 16 Nov 1959 / 64Y 5M 16D
Sex (Jenis Kelamin) : Female
Siloam Hospitals Kebon Jeruk Doctor (Dokter) : dr. Antono Sutandar, SpJP (K)
Jl. Perjuangan Jl. Kav. VIII, RT.14/RW.10, Kb. Jeruk, Kec. Kb. Jeruk, Kota Adm No. (No. Adm) : OPA2302070118 / 07 Feb 2023
Jakarta Barat, Daerah Khusus Ibukota Jakarta 11530 Payer (Payer) : PRIVATE
(021) 25677888

Created Date ( Tanggal Dibuat ) Modified Date ( Tanggal Diubah )

07 February 2023 09:41:31 07 February 2023 12:53:30

Medical Resume ( Resume Medis )

Section (Keterangan) Description (Deskripsi)
Anamnesis No active cardiac symptoms
(Anamnesa) Stable level of activity
Lab (03/11/2022): Hb 12.7, SGOT 24, SGPT 21, GGT 10, TC 224, HDL 73, LDL Vital Signs (TTV)
133 (Crestor 20 mg), TG 88, GDP 94, creat 0.72, uric acid 5.1, normal UL Blood Pressure (Tekanan darah): 142/75
Normal cvs exam mmHg
Brief USG: fatty liver Pulse (Nadi): 60 x/mnt
ECHO (02/2023): normal wall motion, LVEF 60%, DT 202 msec, dilated LA (LAV Respiratory (Pernapasan): - x/mnt
Physical Exam
35 ml/m2), E/E' 53/5 cm/s, trace MR SpO2: 98%
(Pemeriksaan Fisik)
ECG (02/2023): normal sinus rhythm Temperature (Suhu): 36.5°C
Coronary artery calcium scoring (2010) CAC score 246.4 Weight (BB): 58 kg
ECG stress test (05/2022): borderline Height (TB): 168 cm
Stress nuclear (06/2022): mild ischemia 5% stress defect in the distal to mid and Head Circumference (LK): - cm
anteroseptal walls
Non obstructive coronary artery disease, CAC score 246.4 (2010)
ECG stress test (05/2022): borderline
Stress nuclear (06/2022): mild ischemia 5% stress defect in the distal to mid and anteroseptal walls
=> intensive risk factors modification, LDL goal <70 mg/dL
Diagnosis
(Diagnosa) Hypertension
Dyslipidemia (Crestor 20 mg + Ezetrol 10 mg), LDL goal <70, to consider inclisiran (Leqvio) injection if goal not achieved

Fatty liver => diabetic diet (low glycemic index diet)

Easily bruises skin with clopidogrel => aspirin
Health Maintenance Issues (age >60):
- Colonoscopy/colon cancer screening 1x every 10 years
- Papsmear/ cervix cancer screening 1x every 5-10 years, mammography/ breast cancer screening 1x every 2 years (for
woman)

Health Maintenance Issues (age >65):

- Vaccination: pneumococcal vaccine 1x, shingles/cacar ular vaccine 1x, flu vaccine every 1 year
- BMD for osteoporosis screening

Advised for:
- LDL, Apo-B, LP(a)
- Family screening for lipid
Plan & Procedure
- LDL goal <70 mg/dL, GDP/FBS goal <110 mg/dL, HbA1c goal <6.5%
(Tindakan di RS)
- Home blood pressure monitoring (average BP goal <130/80 mmHg)
- Low glycemic index diet + exercise
- Low salt diet
- Follow up 6 months with labs + stress ECHO (STOP Herbesser 3 days before stress ECHO, switch to amlodipine 5 mg 1x1)
To consider inclisiran (Leqvio) injection if LDL goal not achieved
- Continue routine medications

MEDS:
Aspilet 80 mg 1x1 with largest meals (new)
Crestor 20 mg 1x1
Ezetrol 10 mg 1x1
Herbesser CD 100 mg 1x1
Procedure Result
-
(Hasil Tindakan)

Item (Obat) Qty (Jml) UoM (Unit) Frequency Dose (Dosis) Instruction Route (Rute) Iter (Iter) Routine (Rutin)
(Frekuensi) (Instruksi)

ASPILET 80MG 180 TABLET 1 X SEHARI 80 MG BERSAMA MAKAN ORAL 0 No

TAB TERBESAR 1-0-0
Printed By : HURI TRI MARDANTIE / Print Date : 02 May 2024 17:59 Dokumen ini ditandatangani secara digital
 MR : SHKJ.00-06-67-43
Name (Nama) : JULIA LUPOLO
DOB/Age (TTL/Umur) : 16 Nov 1959 / 64Y 5M 16D
Sex (Jenis Kelamin) : Female
Siloam Hospitals Kebon Jeruk Doctor (Dokter) : dr. Antono Sutandar, SpJP (K)
Jl. Perjuangan Jl. Kav. VIII, RT.14/RW.10, Kb. Jeruk, Kec. Kb. Jeruk, Kota Adm No. (No. Adm) : OPA2302070118 / 07 Feb 2023
Jakarta Barat, Daerah Khusus Ibukota Jakarta 11530 Payer (Payer) : PRIVATE
(021) 25677888

atau 0-1-0
CRESTOR 20MG 180 TABLET 1 X SEHARI 20 MG SESUDAH MAKAN, ORAL 0 No
TAB MALAM
EZETROL 10MG 180 TABLET 1 X SEHARI 10 MG SESUDAH MAKAN ORAL 0 No
TAB 0-0-1
HERBESSER CD 180 CAPSULE 1 X SEHARI 100 MG SESUDAH MAKAN ORAL 0 No
100MG CAP 1-0-0
AMLODIPINE 5MG 3 TABLET 1 X SEHARI 5 MG SESUDAH MAKAN ORAL 0 No
TAB 1-0-0 dimulai 3
hari sebelum
kontrol (pengganti
Herbesser CD 100
mg)

Dengan ini saya memberikan kuasa kepada Siloam Hospitals untuk menyimpan dan memberikan segala keterangan / catatan medis dan lainnya untuk
keperluan klaim kepada Perusahaan / Asuransi tersebut diatas sesuai kebutuhan polis / perusahaan. Saya bersedia membayar kepada pihak Rumah Sakit
pada saat :
1. Biaya Pemakaian saya sudah melebihi limit dan / atau tidak ditanggung di dalam polis / ketentuan perusahaan.
2. Belum ada jawaban resmi dari perusahaan / asuransi dan pelayanan bersifat emergency & urgent (life saving).

I herewith, authorized Siloam Hospitals to release all Medical Records and other data to Corporate / Insurance Company for claiming purposes in accordance
with the Insurance Policy or Company rule. I will pay the Hospital if :
1. The actual billing is over my limit and / or not borned in the Insurance Policy / Company's rule.
2. There is no official reply from Company / Insurance and I am really need Emergency & Urgent Medical Service (life saving).

dr. Antono Sutandar, SpJP (K)

Physician(Dokter) Patient(Pasien)

Printed By : HURI TRI MARDANTIE / Print Date : 02 May 2024 17:59 Dokumen ini ditandatangani secara digital