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DataPenilaianAwalMedisRalanGawatDaruratPsikiatri.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='5000px' border='0' align='center' cellpadding='3px' cellspacing='0' class='tbl_form'><tr class='isi2'><td valign='top' align='center'><font size='4' face='Tahoma'>RS SIMRS KHANZA</font><br>GUWOSARI, Pajangan, Bantul<br>Hp: 08562675039, 085296559963, E-mail : khanzasoftmedia@gmail.com<br><br><font size='2' face='Tahoma'>DATA PENILAIAN AWAL MEDIS RAWAT JALAN GAWAT DARURAT PSIKIATRI<br><br></font></td></tr></table>
</head>
<body>
<table width="5000px" border="0" align="center" cellpadding="1px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.Rawat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.RM</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Pasien</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tgl.Lahir</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>J.K.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kode Dokter</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Dokter</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tanggal</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Anamnesis</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Hubungan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keluhan Utama</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Gejala Menyertai</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Faktor Pencetus</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Penyakit Dahulu</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Riwayat Penyakit Dahulu</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Kehamilan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Sosial</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Riwayat Sosial</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Pekerjaan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Riwayat Pekerjaan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Obat Yang Diminum</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Faktor Kepribadian Premorbid</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Faktor Keturunan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Faktor Keturunan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Faktor Organik</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Faktor Organik</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Alergi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kesadaran</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>TD(mmHg)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>RR(x/menit)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Suhu(°C)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nyeri</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nadi(x/menit)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>BB(Kg)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>TB(Cm)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Status Nutrisi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>GCS(E,V,M)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kelainan Kepala</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Kelainan Kepala</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kelainan Leher</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Kelainan Leher</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kelainan Dada</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Kelainan Dada</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kelainan Perut</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Kelainan Perut</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kelainan Anggota Gerak</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Kelainan Anggota Gerak</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Lokalisata</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Kesan Umum</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Sikap Prilaku</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Kesadaran</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Orientasi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Daya Ingat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Persepsi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Pikiran</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Psikiatrik Insight</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Penunjang Laboratorium</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Penunjang Radiologi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Penunjang EKG</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Diagnosis/Asesmen</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Permasalahan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Instruksi Medis & Obat-obatan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Rencana Penatalaksanaan & Target Terukur</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Status Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Status Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Dirawat Di Ruang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Indikasi Ranap</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Dirujuk Ke</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Alasan Dirujuk</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pulang Paksa</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Pulang Paksa</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Meninggal Di IGD</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Penyebab Kematian</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kesadaran Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>TD Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nadi Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>GCS Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Suhu Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>RR Pulang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Edukasi</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2023/08/29/000001
</td>
<td valign="top">
000003
</td>
<td valign="top">
HAFIZ HARIYADI
</td>
<td valign="top">
1997-05-22
</td>
<td valign="top">
Laki-Laki
</td>
<td valign="top">
D0000004
</td>
<td valign="top">
dr. Hilyatul Nadia
</td>
<td valign="top">
2023-08-31 14:04:06.0
</td>
<td valign="top">
Autoanamnesis
</td>
<td valign="top">
1
</td>
<td valign="top">
2
</td>
<td valign="top">
3
</td>
<td valign="top">
4
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
5
</td>
<td valign="top">
6
</td>
<td valign="top">
Tidak Bergaul
</td>
<td valign="top">
7
</td>
<td valign="top">
Ganti-gantian Pekerjaan
</td>
<td valign="top">
8
</td>
<td valign="top">
9
</td>
<td valign="top">
10
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
11
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
12
</td>
<td valign="top">
13
</td>
<td valign="top">
Compos Mentis
</td>
<td valign="top">
14
</td>
<td valign="top">
15
</td>
<td valign="top">
16
</td>
<td valign="top">
Nyeri Tak Tertahankan
</td>
<td valign="top">
17
</td>
<td valign="top">
18
</td>
<td valign="top">
19
</td>
<td valign="top">
20
</td>
<td valign="top">
21
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
22
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
23
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
24
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
25
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
26
</td>
<td valign="top">
27
</td>
<td valign="top">
28
</td>
<td valign="top">
29
</td>
<td valign="top">
30
</td>
<td valign="top">
31
</td>
<td valign="top">
32
</td>
<td valign="top">
33
</td>
<td valign="top">
34
</td>
<td valign="top">
35
</td>
<td valign="top">
36
</td>
<td valign="top">
37
</td>
<td valign="top">
38
</td>
<td valign="top">
39
</td>
<td valign="top">
40
</td>
<td valign="top">
41
</td>
<td valign="top">
42
</td>
<td valign="top">
Kontrol/Berobat Jalan
</td>
<td valign="top">
43
</td>
<td valign="top">
44
</td>
<td valign="top">
45
</td>
<td valign="top">
46
</td>
<td valign="top">
Permintaan Pasien/Keluarga
</td>
<td valign="top">
Masalah Lokasi Rumah
</td>
<td valign="top">
47
</td>
<td valign="top">
= 2 Jam
</td>
<td valign="top">
48
</td>
<td valign="top">
Compos Mentis
</td>
<td valign="top">
49
</td>
<td valign="top">
50
</td>
<td valign="top">
51
</td>
<td valign="top">
52
</td>
<td valign="top">
53
</td>
<td valign="top">
54
</td>
</tr>
</table>
</body>
</html>