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DataChecklistPreOperasi.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='3500px' 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 : [email protected]<br><br><font size='2' face='Tahoma'>DATA CHECK LIST PRE OPERASI<br><br></font></td></tr></table>
</head>
<body>
<table width="3500px" border="0" align="center" cellpadding="1px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>No.Rawat</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>No.RM</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Nama Pasien</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tgl.Lahir</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>J.K.</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tanggal</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>SN/CN</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tindakan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Kode Dokter Bedah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Nama Dokter Bedah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Kode Dokter Anest</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Nama Dokter Anestesi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Identitas</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keadaan Umum</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Penandaan Area Operasi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Surat Ijin Bedah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Surat Ijin Anestesi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Surat Ijin Transfusi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Persiapan Darah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keterangan Persiapan Darah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Perlengkapan Khusus</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Radiologi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keterangan Radiologi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>EKG</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keterangan EKG</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>USG</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keterangan USG</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>CT Scan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keterangan CT Scan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>MRI</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keterangan MRI</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>NIP Ruangan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Petugas Ruangan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>NIP OK</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Petugas Ruang OK</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2023/06/10/000002
</td>
<td valign="top">
000005
</td>
<td valign="top">
ROBY ALAMSYAH
</td>
<td valign="top">
1986-07-20
</td>
<td valign="top">
L
</td>
<td valign="top">
2023-06-11 19:59:30
</td>
<td valign="top">
1
</td>
<td valign="top">
2 asasas
</td>
<td valign="top">
D0000003
</td>
<td valign="top">
dr. Qotrunnada
</td>
<td valign="top">
D0000004
</td>
<td valign="top">
dr. Hilyatul Nadia
</td>
<td valign="top">
Ya
</td>
<td valign="top">
Baik
</td>
<td valign="top">
Ada
</td>
<td valign="top">
Ada
</td>
<td valign="top">
Ada
</td>
<td valign="top">
Ada
</td>
<td valign="top">
Ada
</td>
<td valign="top">
3
</td>
<td valign="top">
Ada
</td>
<td valign="top">
Ada
</td>
<td valign="top">
4
</td>
<td valign="top">
Ada
</td>
<td valign="top">
7
</td>
<td valign="top">
Ada
</td>
<td valign="top">
5
</td>
<td valign="top">
Ada
</td>
<td valign="top">
8
</td>
<td valign="top">
Ada
</td>
<td valign="top">
6
</td>
<td valign="top">
12/09/1988/001
</td>
<td valign="top">
ANJASMARA
</td>
<td valign="top">
123124
</td>
<td valign="top">
FREDIAN AHMAD
</td>
</tr>
</table>
</body>
</html>