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DataPenilaianAwalMedisRalanGeriatri.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='5400px' 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 PENILAIAN AWAL MEDIS RAWAT JALAN GERIATRI<br><br></font></td></tr></table>
</head>
<body>
<table width="5400px" 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>Riwayat Penyakit Sekarang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Penyakit Dahulu</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Penggunakan Obat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Alergi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kondisi Umum</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>TD(mmHg)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nadi(x/menit)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Suhu</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>RR(x/menit)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tulang Belakang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kepala</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Kepala</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Thoraks</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Thoraks</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Abdomen</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Abdomen</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Ekstremitas</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Ekstremitas</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>In.Kebersihan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>In.Warna</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>In.Kelembaban</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>In.Gangguan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Lainnya</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kondisi Sosial</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Status Psikologis (GDS)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Status Kognitif (MMSE)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Status Nutrisi (MNA)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Skrinning Risiko Jatuh (OMS)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Status Fungsional (ADL: BARTHEL INDEX)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Laboratorium</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Radiologi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Diagnosis</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Diagnosis Banding</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Permasalahan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Terapi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tindakan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Edukasi</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2022/11/04/000001
</td>
<td valign="top">
000001
</td>
<td valign="top">
WINDIARTO
</td>
<td valign="top">
1988-02-02
</td>
<td valign="top">
Laki-Laki
</td>
<td valign="top">
D0000004
</td>
<td valign="top">
dr. Hilyatul Nadia
</td>
<td valign="top">
2022-11-04 15:10:35.0
</td>
<td valign="top">
Autoanamnesis
</td>
<td valign="top">
1
</td>
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</td>
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</td>
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</td>
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<td valign="top">
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</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
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</td>
<td valign="top">
9
</td>
<td valign="top">
10
</td>
<td valign="top">
Membungkuk
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
12
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
13
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
14
</td>
<td valign="top">
Tidak Diperiksa
</td>
<td valign="top">
15
</td>
<td valign="top">
Abnormal
</td>
<td valign="top">
Lain-lain
</td>
<td valign="top">
Lembab
</td>
<td valign="top">
Normal
</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
<td valign="top">
Skor Antara 5-9 Menunjukkan Kemungkinan Besar Depresi
</td>
<td valign="top">
24-30 : Tidak Ada Gangguan Kognitif
</td>
<td valign="top">
Skor 12-14 : Status Gizi Normal
</td>
<td valign="top">
Risiko Sedang Skor 6-16
</td>
<td valign="top">
12-19 : Ketergantungan Ringan (B)
</td>
<td valign="top">
18
</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
<td valign="top">
22 qwqwq qww
</td>
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</td>
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</td>
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</td>
<td valign="top">
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</td>
</tr>
</table>
</body>
</html>