ASSESMENT IGD

RS KHUSUS MATA MEDAN BARU Jl. Abdullah Lubis No. No. 67 Medan Telp Telp : 6! " #$%&'& (a) : 6! " #$%*&*# E+ail : +b+,.+a-a/ahoo.,o+ +b+,.+a-a/ahoo.,o+

Ases+en 12D!* 0ATATAN MED1S 2A3AT DARURAT Accident Emergency Medical Record !. 4en5aian 4e8a9a- Nu8se Asse+enA. Da-a Sub;e-i<  Sube,-i=e Da-a :

Auto Anamnesa

Riwayat Alergi / History Of Allergy :

Allo Anamnesa

Tidak Ada  No

Ada, ............................................. es es

%aik 'ood

&edang )air

Riwayat !enyakit "ulu / !ast "isease History : B. Da-a >be-i<  >be,-i=e Da-a :

#eadaan $mum : 'eneral (ondition

Nilai n;e8i n;e8i  4ain S,o8e S,o8e

*

+

!erna5asan / Res5iration :

: ?Tida ?Tida ada n;e8i  no pain pain " N;e8i San5aSan5a- be8abe8a-  pain


Tekanan "ara4 / %lood !ressure:

%uruk   %aik  

mmHg 6/mnt





0

1

2

3

+*

Nadi / 5ulse :

6/mnt

&u4u / Tem5erature

%erat 7adan / 8eig4t :

#g

&aturasi *  / &aturation :

Tanda Tangan  Nama ;engka5 !erawat

Tanggal / "ate : ............... ..............

:

o

( 9

Nurse
=am / Time

: ................ .............

RS KHUSUS MATA MEDAN BARU Jl. Abdullah Lubis No. 67 Medan Telp : 6! " #$%&'& (a) : 6! " #$%*&*# E+ail : +b+,.+a-a/ahoo.,o+

Ases+en 12D** Tan gg al / " at e

:

=am / Time

:

 Nama "okter /

:

"octer

Tanda Tangan : Name&ign

*. 4e+e8isaan Do-e8  Do,-o8 Assess+enA. Ana+nesa  Ana+nesis :

B. Da-a >be-i<  >be,-i=e Da-a :

 Normal #e5ala / Head Mata / Eyes Mulut / Mout4 ;e4er / Neck  "ada / (4est !erut / A7domen

=ika Tidak Normal, =elaskan ?f Not Normal, !lease E65lain

'(& : E ...... M ........ > .......

0. Dia5nosa Ke8a  3o8in5 Dia5nosis : ................................................................................................................................................................ D. Dia5nosa Bandin5  Di<
...................................................................................................................................................................

E. Tindaan " 4en5oba-an  T8ea-+en- " The8ap; :  

...................................................................................................................................................................

(. Tinda Lanu- : (ollo9 Up 2. Kondisi 4ulan5

:

0ondi-ion >< Dis,ha85e

Tanggal / "ate :

4ulan5

Ra9a-

4ulan5 4asa

Dis,ha85e

1npa-ien-

Re
Ruu Re
Menin55al Dea-h

=am / Time

:

RS KHUSUS MATA MEDAN BARU Jl. Abdullah Lubis No. 67 Medan Telp : 6! " #$%&'& (a) : 6! " #$%*&*# E+ail : +b+,.+a-a/ahoo.,o+

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