Form Review Rekam Medik

FORMULIR REVIEW REKAM MEDIK

  NA N AMA KSM / SMF

:

  RU RUANGAN

:

  MI MINGGU KE

:

  BU BULAN

:

  TA TAHUN

:

No.

Rekam Medik

1 2  ! " # $ % & 1' 11 12 1 1! 1" 1# 1$ 1% 1& 2' JUMLAH   Ke(e)a*+a*

DPJP

1

2



!

"

#

$

%

&

1'

11

12

1

1!

1"

1.

Ri*+ka,a* ma,0k da* ke-0a)

&.

S0)a( Ko*,0-(a,i / 3a4aa* ko*,0-(a,i

1$.

2.

Ed0ka,i

1'. S0)a( ke(e)a*+a* ,aki(

1%.

.

S0)a( e)*5a(aa* DPJP

11. S0)a( e)mi*(aa* eme)ik,aa* e*0*3a*+

1&.

!.

S0)a( Pe*+a-i6a* DPJP

12. 7a(a(a* K-i*i,

2'.

".

Pe*+ka3ia* a4a- medi, 87a)e -a* da* 7omi*e 7a)e P-a*9

1. Fo)m0-i( (e)*,e) i*(e)*a- / ek,(e)*a-

21.

#.

7a(a(a* Te)i*(e+)a,i

1!. S0)a( R030k Ba-ik

22.

$.

7a(a(a* Pe*+oa(a*

1". S0)a( ke(e)a*+a*

2.

%.

Pe),e(030a* Ti*daka*

1#. Re Re,0me Medi, Ra4a( I*a

2!.

1#

1$

1%

1&

2'

21

22