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DataPenilaianPasienKeracunan.html
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DataPenilaianPasienKeracunan.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='3300px' 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 PENILAIAN PASIEN KERACUNAN<br><br></font></td></tr></table>
</head>
<body>
<table width="3300px" 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>Tempat Kejadian</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Tempat Kejadian</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keluhan Yang Dirasakan Saat Ini</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Penyakit Sekarang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Hamil</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Menyusui</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Perkiraan Penyebab Keracunan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Bahan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Jml Bahan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tipe Pemaparan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Tipe Pemaparan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tipe Kejadian</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Bau Bahan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Bau Bahan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pupil</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Pupil</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kesadaran</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tensi(mmHg)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nadi(x/menit)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>RR(x/menit)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Suhu(°C)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>SpO2(%)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Urine(cc/j)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pengobatan Sebelum Ke IGD</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Diagnosa</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Penunjang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Penatalaksanaan Yang Diberikan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tindak Lanjut</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2023/05/26/000001
</td>
<td valign="top">
000013
</td>
<td valign="top">
PARAMITA RAMADANI
</td>
<td valign="top">
1990-01-01
</td>
<td valign="top">
Laki-Laki
</td>
<td valign="top">
D0000003
</td>
<td valign="top">
dr. Qotrunnada
</td>
<td valign="top">
2023-05-26 07:10:48.0
</td>
<td valign="top">
Autoanamnesis
</td>
<td valign="top">
1
</td>
<td valign="top">
Tempat Hiburan
</td>
<td valign="top">
4
</td>
<td valign="top">
2
</td>
<td valign="top">
3
</td>
<td valign="top">
Tidak
</td>
<td valign="top">
Tidak
</td>
<td valign="top">
Suplemen Makanan/Vitamin
</td>
<td valign="top">
5
</td>
<td valign="top">
6
</td>
<td valign="top">
Sengatan
</td>
<td valign="top">
7
</td>
<td valign="top">
Tidak Disengaja
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
8
</td>
<td valign="top">
Unisokor
</td>
<td valign="top">
9
</td>
<td valign="top">
Compos Mentis
</td>
<td valign="top">
10
</td>
<td valign="top">
11
</td>
<td valign="top">
12
</td>
<td valign="top">
13
</td>
<td valign="top">
14
</td>
<td valign="top">
15
</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">
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</td>
<td valign="top">
Pulang Sembuh
</td>
</tr>
</table>
</body>
</html>