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DataChecklistKriteriaMasukICU.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='5100px' 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 : khanzasoftmedia@gmail.com<br><br><font size='2' face='Tahoma'>DATA CHECK LIST KRITERIA MASUK ICU<br><br></font></td></tr></table>
</head>
<body>
<table width="5100px" 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>Cemas</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Firasat Buruk</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takut Pikiran Sendiri</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mudah Tersinggung</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Merasa Tegang</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Lesu</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tak Bisa Istirahat Tenang</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mudah Terkejut</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mudah Menangis</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Gemetar</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Gelisah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takut Pada Gelap</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takut Pada OrangAsing</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takut Pada Kerumunan Banyak Orang</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takut Pada Binatang Besar</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takut Pada Keramaian Lalu Lintas</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takut Ditinggal Sendiri</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sulit Tidur</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Terbangun Malam Hari</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tidur Tidak Nyeyak</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mimpi Buruk</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Bangun Dengan Lesu</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Banyak Mengalami Mimpi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mimpi Menakutkan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sulit Konsentrasi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Daya Ingat Buruk</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Hilangnya Minat</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Berkurangnya Kesenangan Pada Hobi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sedih</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Bangun Dini Hari</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Perasaan Berubah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sakit Nyeri Di Otot</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Kaku</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Kedutan Otot</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Gigi Gemerutuk</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Suara Tidak Stabil</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tinnitus</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Penglihatan Kabur</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Muka Merah Gejala Somatic</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Merasa Lemah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Perasaan Ditusuk</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Takhikardia</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Berdebar</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Nyeri Di Dada</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Denyut Nadi Mengeras</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Perasaan Lesu</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Detak Jantung Menghilang</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Merasa Tertekan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Perasaan Tercekik</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sering Menarik Napas</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Napas Pendek</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Bulu Berdiri</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sulit Menelan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Perut Melilit</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Ganguan Pencernaan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Rasa Kembung</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Nyeri Makan</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Terbakar Perut</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sukar BAB</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Muntah</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>BAB Lembek</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Kehilangan BB</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mual</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sering BAK</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tidak Bisa Menahan Kencing</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Menjadi Dingin</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Manorrhagia</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Amenorrhoea</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Ejakulasi Praecocks</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Ereksi Hilang</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Impotensi</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mulut Kering</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Muka Merah Gejala Otonom</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Mudah Berkeringat</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Bulu Berdiri Gejala Otonom</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Sakit Kepala</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Gelisah Wawancara</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Napas Pendek Wawancara</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Jari Gemetar</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Kerut Kening</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Muka Tegang</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tonus Meningkat</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Tidak Tenang</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Muka Merah Wawancara</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Total Skor</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Keterangan Skor</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>NIP</b>
</td>
<td valign="middle" bgcolor="#FFFAFA" align="center">
<b>Nama Petugas</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2023/05/29/000004
</td>
<td valign="top">
000006
</td>
<td valign="top">
SAKHA HAMIZAN AQILA
</td>
<td valign="top">
2017-08-03
</td>
<td valign="top">
L
</td>
<td valign="top">
2023-08-08 07:29:41.0
</td>
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<td valign="top">
159
</td>
<td valign="top">
Kecemasan Sangat Berat
</td>
<td valign="top">
123124
</td>
<td valign="top">
FREDIAN AHMAD
</td>
</tr>
</table>
</body>
</html>