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<html>
<head><link href="file.css" rel="stylesheet" type="text/css" />
</head>
<body><table width='100%' border='0' align='center' cellpadding='3px' cellspacing='0' class='tbl_form'><tr class='isi'><td valign='top' width='20%'>No.RM</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>000013</td></tr><tr class='isi'><td valign='top' width='20%'>Nama Pasien</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>PARAMITA RAMADANI</td></tr><tr class='isi'><td valign='top' width='20%'>Alamat</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>BANTUL, BELOPA, BANDA SAKTI, BANTUL</td></tr><tr class='isi'><td valign='top' width='20%'>Jenis Kelamin</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>Laki-Laki</td></tr><tr class='isi'><td valign='top' width='20%'>Tempat & Tanggal Lahir</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>- 1990-01-01</td></tr><tr class='isi'><td valign='top' width='20%'>Ibu Kandung</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr><tr class='isi'><td valign='top' width='20%'>Golongan Darah</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr><tr class='isi'><td valign='top' width='20%'>Status Nikah</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>MENIKAH</td></tr><tr class='isi'><td valign='top' width='20%'>Agama</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr><tr class='isi'><td valign='top' width='20%'>Pendidikan Terakhir</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr><tr class='isi'><td valign='top' width='20%'>Bahasa Dipakai</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr><tr class='isi'><td valign='top' width='20%'>Cacat Fisik</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr></table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="top" width="2%">
1
</td>
<td valign="top" width="18%">
No.Rawat
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
2023/11/20/000001
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
No.Registrasi
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
001
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Tanggal Registrasi
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
2023-11-20 13:17:50
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Umur Saat Daftar
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
33 Th
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Unit/Poliklinik
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
INT Poli Penyakit Dalam
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Dokter Poli
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
dr. Hilyatul Nadia
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Cara Bayar
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
-
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Penanggung Jawab
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
-
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Alamat P.J.
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
BANTUL, BELOPA, BANDA SAKTI, BANTUL
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Hubungan P.J.
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
SAUDARA
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Status
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
Ralan
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Biaya & Perawatan
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top" width="89%">
Administrasi
</td>
<td valign="top" width="1%" align="right">
:
</td>
<td valign="top" width="10%" align="right">
0
</td>
</tr>
</table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top" colspan="4">
Tindakan Rawat Jalan Dokter
</td>
<td valign="top" colspan="1" align="right">
:
</td>
<td valign="top">
</td>
</tr>
<tr align="center">
<td valign="top" width="4%" bgcolor="#FFFAF8">
No.
</td>
<td valign="top" width="15%" bgcolor="#FFFAF8">
Tanggal
</td>
<td valign="top" width="10%" bgcolor="#FFFAF8">
Kode
</td>
<td valign="top" width="41%" bgcolor="#FFFAF8">
Nama Tindakan/Perawatan
</td>
<td valign="top" width="20%" bgcolor="#FFFAF8">
Dokter
</td>
<td valign="top" width="10%" bgcolor="#FFFAF8">
Biaya
</td>
</tr>
<tr>
<td valign="top" align="center">
1
</td>
<td valign="top">
2023-11-20 14:03:52
</td>
<td valign="top">
RJ00861
</td>
<td valign="top">
Pemeriksaan Poli Spesialis
</td>
<td valign="top">
dr. Hilyatul Nadia
</td>
<td valign="top" align="right">
250,000
</td>
</tr>
</table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top" width="89%" colspan="2">
Total Biaya
</td>
<td valign="top" width="1%" align="right">
:
</td>
<td valign="top" width="10%" align="right">
250,000
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi">
<td>
</td>
<td colspan="3" align="right">
 
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
2
</td>
<td valign="top" width="18%">
No.Rawat
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
2023/11/19/000001
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
No.Registrasi
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
001
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Tanggal Registrasi
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
2023-11-19 07:52:38
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Umur Saat Daftar
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
33 Th
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Unit/Poliklinik
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
INT Poli Penyakit Dalam
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Dokter Poli
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
dr. Hilyatul Nadia
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Cara Bayar
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
-
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Penanggung Jawab
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
-
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Alamat P.J.
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
BANTUL, BELOPA, BANDA SAKTI, BANTUL
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Hubungan P.J.
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
SAUDARA
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Status
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
Ranap
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Penilaian Awal Medis Rawat Jalan Paru
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top">
YANG MELAKUKAN PENGKAJIAN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="33%" border="0">
Tanggal : 2023-11-19 07:57:22.0
</td>
<td width="33%" border="0">
Dokter : D0000004 dr. Hilyatul Nadia
</td>
<td width="33%" border="0">
Anamnesis : Autoanamnesis, 1
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
I. RIWAYAT KESEHATAN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td colspan="2">
Keluhan Utama : 2
</td>
</tr>
<tr>
<td width="50%">
Riwayat Penyakit Sekarang : 3
</td>
<td width="50%">
Riwayat Penyakit Dahulu : 4
</td>
</tr>
<tr>
<td width="50%">
Riwayat Penggunaan Obat : 5
</td>
<td width="50%">
Riwayat Alergi : 6
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
II. PEMERIKSAAN FISIK
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="25%" border="0">
Kesadaran : Compos Mentis
</td>
<td width="25%" border="0">
GCS(E,V,M) : 14
</td>
<td width="25%" border="0">
TD : 7 mmHg
</td>
<td width="25%" border="0">
Nadi : 8 x/menit
</td>
</tr>
<tr>
<td width="25%" border="0">
Suhu : 9 °C
</td>
<td width="25%" border="0">
RR : 10 x/menit
</td>
<td width="25%" border="0">
BB : 12 Kg
</td>
</tr>
<tr>
<td width="50%" border="0" colspan="2">
Status Nutrisi : 11
</td>
<td width="50%" border="0" colspan="2">
Nyeri : 13
</td>
</tr>
<tr>
<td width="25%" border="0">
Kepala : Normal
</td>
<td width="25%" border="0">
Thoraks : Abnormal
</td>
<td width="25%" border="0">
Abdomen : Tidak Diperiksa
</td>
<td width="25%" border="0">
Muskuloskeletal : Normal
</td>
</tr>
<tr>
<td width="100%" colspan="4">
Keterangan Lainnya : 15<br>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
III. STATUS LOKALIS
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%" border="0" align="center">
<img alt="Gambar Lokalis" src="./gambar/LokalisParu.png" width="100%" height="400">
</td>
</tr>
<tr>
<td width="100%" border="0">
Keterangan : 16
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
IV. PEMERIKSAAN PENUNJANG
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%">
Laboratorium : 17
</td>
</tr>
<tr>
<td width="100%">
Radiologi : 18
</td>
</tr>
<tr>
<td width="100%">
Penunjang Lainnya : 19
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
V. DIAGNOSIS/ASESMEN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%">
Asesmen Kerja : 20
</td>
</tr>
<tr>
<td width="100%">
Asesmen Banding : 21
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
VI. PERMASALAHAN & TATALAKSANA
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%" border="0">
Permasalahan : 22
</td>
</tr>
<tr>
<td width="100%" border="0">
Terapi/Pengobatan : 23
</td>
</tr>
<tr>
<td width="100%" border="0">
Tindakan/Rencana Tindakan : 24
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
VII. EDUKASI
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%" border="0">
25 sasas
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Hasil Pemeriksaan EKG
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top">
YANG MELAKUKAN PENGKAJIAN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="50%" border="0">
Tanggal : 2024-01-05 09:17:39.0
</td>
<td width="50%" border="0">
Dokter : D0000004 dr. Hilyatul Nadia
</td>
</tr>
<tr>
<td width="50%" border="0">
Kiriman Dari : 1
</td>
<td width="50%" border="0">
Diagnosa Klinis : 2
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
HASIL PEMERIKSAAN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="50%">
Irama : 3
</td>
<td width="50%">
Laju Jantung : 4
</td>
</tr>
<tr>
<td width="50%">
Gelombang P : 5
</td>
<td width="50%">
Interval PR : 6
</td>
</tr>
<tr>
<td width="50%">
Axis : 7
</td>
<td width="50%">
Kompleks QRS : 8
</td>
</tr>
<tr>
<td width="50%">
Segmen ST : Tidak Normal
</td>
<td width="50%">
Gelombang T : Tidak Normal
</td>
</tr>
<tr>
<td width="100%" colspan="2">
Kesimpulan : tes y
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Catatan Persalinan
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top">
YANG MELAKUKAN PENGKAJIAN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="50%" border="0">
Mulai Persalinan : 2023-11-29 20:16:05.0
</td>
<td width="50%" border="0">
Selesai Persalinan : 2023-11-29 20:16:05.0
</td>
</tr>
<tr>
<td width="50%" border="0">
Dokter Penanggung Jawab : D0000004 dr. Hilyatul Nadia
</td>
<td width="50%" border="0">
Bidan/Perawat : 12/09/1988/001 ANJASMARA
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
CATATAN PERSALINAN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%" border="0" align="justify">
1 asasasas
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
KESIMPULAN POSTPARTUM
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="3%" align="left" valign="top" border="0">
1.
</td>
<td width="97%" align="justify" valign="top" border="0">
Waktu Persalinan : Kala I + Kala II + Kala III = 2 + 3 +
4 = 5
</td>
</tr>
<tr>
<td width="3%" align="left" valign="top" border="0">
2.
</td>
<td width="97%" align="justify" valign="top" border="0">
Perineum : Episiotomi.    Jahitan Luar : 6 dg
7.    Jahitan Dalam : 8 dg 9
</td>
</tr>
<tr>
<td width="3%" align="left" valign="top" border="0">
3.
</td>
<td width="97%" align="justify" valign="top" border="0">
Anak : Perempuan.    Status : Hidup.    APGAR Score :
10.    BB : 11 gram.    PB : 12 cm.    Kelainan : 13
</td>
</tr>
<tr>
<td width="3%" align="left" valign="top" border="0">
4.
</td>
<td width="97%" align="justify" valign="top" border="0">
Ketuban : 14.    Placenta : 15.    Ukuran : 16
gr.    Tali Pusat : 17 cm.    Insertio : 18
</td>
</tr>
<tr>
<td width="3%" align="left" valign="top" border="0">
5.
</td>
<td width="97%" align="justify" valign="top" border="0">
Darah Yang Keluar : Kala I + Kala II + Kala III + Kala
IV = 19 + 20 + 21 + 22 = 23
</td>
</tr>
<tr>
<td width="3%" align="left" valign="top" border="0">
6.
</td>
<td width="97%" align="justify" valign="top" border="0">
Keadaan Ibu Post Partum (2 jam) :
<table width="99%" border="0" align="right" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%" border="0" align="justify">
Kondisi Umum : 24
</td>
</tr>
<tr>
<td width="100%" border="0" align="justify">
Tensi Darah : 25 mmHg.    Nadi : 26 x/menit.    RR
: 27 x/menit.    Suhu : 28 °C
</td>
</tr>
<tr>
<td width="100%" border="0" align="justify">
Kontraksi Uterus : 29
</td>
</tr>
<tr>
<td width="100%" border="0" align="justify">
Perdarahan Per Vaginam (PPV) : 30
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td width="3%" align="left" valign="top" border="0">
7.
</td>
<td width="97%" align="justify" valign="top" border="0">
Pengobatan : 31
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Transfer Pasien Antar Ruangan
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top">
YANG MELAKUKAN PENGKAJIAN
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="33%">
Tanggal Masuk : 2023-12-04 14:40:17.0
</td>
<td width="33%">
Tanggal Pindah : 2023-12-04 14:40:17.0
</td>
<td width="33%">
Indikasi Pindah : Kondisi Pasien Stabil
</td>
</tr>
<tr>
<td width="33%">
Asal Ruang Rawat : sasass
</td>
<td width="33%">
Ruang Rawat Selanjutnya : asas
</td>
<td width="33%">
Metode Pemindahan : Kursi Roda
</td>
</tr>
<tr>
<td width="100%" colspan="3">
Petugas / Perawat Yang Menyerahkan : 12/09/1988/001
ANJASMARA
</td>
</tr>
<tr>
<td width="100%" colspan="3">
Petugas / Perawat Yang Menerima : 123124 FREDIAN AHMAD
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
DIAGNOSA & PROSEDUR
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="50%">
Diagnosa Utama : asas
</td>
<td width="50%">
Diagnosa Sekunder : asas
</td>
</tr>
<tr>
<td width="100%" colspan="2">
Prosedur Yang Sudah Dilakukan : asas
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
OBAT & PEMERIKSAAN PENUNJANG
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%">
Obat Yang Telah Diberikan : asas
</td>
</tr>
<tr>
<td width="100%">
Pemeriksaan Penunjang Yang Sudah Dilakukan : asas
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
PERSETUJUAN KELUARGA
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="50%">
Peralatan Yang Menyertai : Oksigen Portable, sasas
</td>
<td width="50%">
Pasien/Keluarga Mengetahui & Menyetujui Alasan
Pemindahan : Ya
</td>
</tr>
<tr>
<td width="100%" colspan="2">
Keluarga/Penanggung Jawab Pasien Yang Menyetujui :
asasasa, Hubungan : Kakak
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td valign="top">
KEADAAN PASIEN SAAT PINDAH SEBELUM TRANSFER
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0px" class="tbl_form">
<tr>
<td width="100%" colspan="3">
Keluhan Utama : asas
</td>
</tr>
<tr>
<td width="66%" colspan="2">
Keadaan Umum : Compos Mentis
</td>
<td width="33%">
TD : asasas mmHg
</td>
</tr>
<tr>
<td width="33%">
Nadi : asasa x/menit
</td>
<td width="33%">