Rm 17 Asesmen Medis Rawat Inap Neonatus

RM 17 Nama

RS PKU MUHAMMADIYAH MAYONG

: : :

No. RM Tgl Lahir/Umur

Jalan Pegadaian No. 12, Mayong - Jepara 59465 Telp Telp (0291) 4256500, Fax (0291) 4256556

(Tempelkan Label Identitas Pasien Jika  Tersedia  Tersedia)

ASESMEN MEDIS RAWAT INAP NEONATUS

     

Jeni !ela"in Tgl Ma#$   Na"a %PJP  Na"a PPJP &#ang &a'a !ela &a'a

Diisi olh Do!"r %am $

Ta#ggal Ta#ggal $

STATUS O&STETRI *"#r i+# i+#  P P  &i'ay &i'aya a +e +eri ri ....... ........... ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ...... *"#r $e/a"ilan $e/a"ilan ............. .................... ............... ................ ................ ................ ............. ..... !o"pli$ai ela"a $e/a"ilan ...................................... !o"pli$ai peralinan ................................................. ol. %ara/ 3+#      &/ol. %ara/ ya/ ya/      &/!! Pea/ a"  arna a rna  Jeni Par# ............................. .......................... ... 3ndi$ai ..........................................................

STATUS NEONATUS ay ayi la/ir a/ir angg anggal al  .... ...... .... .... .... .... .... .... .... .... .... .... ...... .... .... ...J .Ja" a" ... ..... .... .... .... .... .... Jeni Jeni !ela"i !ela"in n  !  P&   la/ir  ............... ....................... ................ ................ ................ ................ .......... .. P la/ir ............................ .......................... .... ing$ar !epala  77777777777777. ing$ar %ada  77777777777777. &e#iai (2 in#+ai inra inra ra/ea po"pa #dara +er#lang +er#lang )  ...................................................................................... ........................................................................................ ........................................................................................

P#ilaia# APGAR S'ORE ( Tida$ ada Tida$ ada e"a/ Tida$ ada ir#  p#i/

)

100 Tida$ era#r 8edang Meringi *#ng##ng +ir#

*

100 ai$ ai$ Menangi Mera/ a"+#

APGAR S'ORE %eny# an#ng Pernapaan Ton# Ton# oo Pe$a rangang arna Nilai "o"al

)+

,+

)(+

Ta#-a "a#ga# -o!"r

 STATUS STATUS NEONATUS LAN%UT Ta#ggal Ta#ggal $ ).PEMERIKSAAAN 0ISIK  A. Ka-aa# Umum

 Nadi !ean #"#" !#li  'arna T#rgor 8i$ap &e;le$  Moro Mengiap &. K1ala en#$  8##rae  Fonanella  Maa  >id#ng  '. Lhr D. Thora2 E. A3-om#

      



%am $

8#/#  Pernapaan  Pergera$an  Ton#  8#ara  (-)  "erini/ $era : Me"egang  <  - : Ton# le/er  <  - : =ap# #edane#" =ep/al /e"ao"

 <  -:  < - :

Telinga M#l#

 

$........................ .......................... ............................ .......................... .......................... ............... $ 'or $...................... ............................ .......................... .......................... ........................... Pulmo $.......................... ............................ .......................... .......................... ....................... $........................ .......................... ............................ .......................... .......................... ...............

RM 17 Hal. 1

0. G#i"alia

$ L $ Ts"is $ 4 / 5 6 P $ La3ia ma7ora $.................................................................................................................. G. A#us / r!"um $ 4 / 5 6 H. E!s"rmi"as $ ................................................................................................................................... I. Tula#g 1u#ggu#g $.................................................................................................................................... %. A#omali lai# $....................................................................................................................................

STEMPEL TELAPAK KAKI KANAN

KIRI

'AP %EMPOL TANGAN KIRI I&U

*. ASSESMEN 8. REN'ANA PENGELOLAAN

$..................................................................................................................................... $.....................................................................................................................................

Tanda angan %PJP

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Hal. 2

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