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DataPenilaianAwalKeperawatanRalan.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='1800px' 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 AWAL KEPERAWATAN RAWAT JALAN<br><br></font></td></tr></table>
</head>
<body>
<table width="1800px" border="0" align="center" cellpadding="1px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="middle" bgcolor="#FFFAF8" align="center" width="9%">
<b>PASIEN & PETUGAS</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="5%">
<b>I. KEADAAN UMUM</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="5%">
<b>II. RIWAYAT KESEHATAN DAHULU</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="9%">
<b>III. RIWAYAT TUMBUH KEMBANG DAN PERINATAL CARE</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="9%">
<b>IV. RIWAYAT IMUNISASI</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="10%">
<b>V. RIWAYAT TUMBUH KEMBANG ANAK</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="9%">
<b>VI. FUNGSIONAL</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="10%">
<b>VII. RIWAYAT PSIKO-SOSIAL, SPIRITUAL DAN BUDAYA</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="10%">
<b>VIII. PENILAIAN RESIKO JATUH</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="9%">
<b>IX. SKRINING GIZI (Strong kid)</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="9%">
<b>X. PENILAIAN TINGKAT NYERI</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="6%">
<b>MASALAH & RENCANA KEPERAWATAN</b>
</td>
</tr>
<tr class="isi">
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi2">
<td width="32%" valign="top">
No.Rawat
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
2020/10/06/000002
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
No.R.M.
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
000030
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Nama Pasien
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
SUJANTO A
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
J.K.
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
Laki-Laki
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Agama
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
ISLAM
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Bahasa
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
-
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Tgl.Lahir
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
-
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Cacat Fisik
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
0010-12-06
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Petugas
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
010101 KIKI SHAGIRAH
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Tgl.Asuhan
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
2020-10-11 10:49:44.0
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Informasi
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
Autoanamnesis
</td>
</tr>
</table>
</td>
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi2">
<td width="34%" valign="top">
TD
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
1mmHg
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
Nadi
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
2x/menit
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
RR
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
3x/menit
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
Suhu
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
4°C
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
GCS(E,V,M)
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
5
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
BB
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
6Kg
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
TB
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
7cm
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
LP
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
8cm
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
LK
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
9cm
</td>
</tr>
<tr class="isi2">
<td width="34%" valign="top">
LD
</td>
<td valign="top">
: 
</td>
<td width="65%" valign="top">
10cm
</td>
</tr>
</table>
</td>
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi2">
<td width="32%" valign="top">
Keluhan Utama
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
111111
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
RPD
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
13
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
RPK
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
12
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
RPO
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
14
</td>
</tr>
<tr class="isi2">
<td width="32%" valign="top">
Alergi
</td>
<td valign="top">
: 
</td>
<td width="67%" valign="top">
15
</td>
</tr>
</table>
</td>
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi2">
<td width="40%" valign="top">
Riwayat Kelahiran
</td>
<td valign="top">
: 
</td>
<td width="59%" valign="top">
Anak ke 16 dari 17 saudara
</td>
</tr>
<tr class="isi2">
<td width="40%" valign="top">
Umur Kelahiran
</td>
<td valign="top">
: 
</td>
<td width="59%" valign="top">
Cukup Bulan
</td>
</tr>
<tr class="isi2">
<td width="40%" valign="top">
Cara kelahiran
</td>
<td valign="top">
: 
</td>
<td width="59%" valign="top">
Spontan<br>18
</td>
</tr>
<tr class="isi2">
<td width="40%" valign="top">
Kelainan Bawaan
</td>
<td valign="top">
: 
</td>
<td width="59%" valign="top">
Tidak Ada<br>19
</td>
</tr>
</table>
</td>
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi">
<td width="70%" valign="top">
Nama Imunisasi
</td>
<td width="5%" valign="top">
Ke 1
</td>
<td width="5%" valign="top">
Ke 2
</td>
<td width="5%" valign="top">
Ke 3
</td>
<td width="5%" valign="top">
Ke 4
</td>
<td width="5%" valign="top">
Ke 5
</td>
<td width="5%" valign="top">
Ke 6
</td>
</tr>
<tr class="isi">
<td>
HIB
</td>
<td>
V
</td>
<td>
 
</td>
<td>
 
</td>
<td>
 
</td>
<td>
 
</td>
<td>
 
</td>
</tr>
<tr class="isi">
<td>
MMR
</td>
<td>
V
</td>
<td>
 
</td>
<td>
V
</td>
<td>
 
</td>
<td>
 
</td>
<td>
 
</td>
</tr>
</table>
</td>
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi2">
<td width="80%" valign="top">
a. Tengkurap, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
20
</td>
</tr>
<tr class="isi2">
<td width="80%" valign="top">
b. Duduk, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
21
</td>
</tr>
<tr class="isi2">
<td width="80%" valign="top">
c. Berdiri, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
22
</td>
</tr>
<tr class="isi2">
<td width="80%" valign="top">
d. Gigi pertama, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
23
</td>
</tr>
<tr class="isi2">
<td width="80%" valign="top">
e. Berjalan, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
24
</td>
</tr>
<tr class="isi2">
<td width="80%" valign="top">
f. Bicara Usia, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
25
</td>
</tr>
<tr class="isi2">
<td width="80%" valign="top">
g. Mulai bisa membaca, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
26
</td>
</tr>
<tr class="isi2">
<td width="80%" valign="top">
h. Mulai bisa menulis, usia
</td>
<td valign="top">
: 
</td>
<td width="19%" valign="top">
27
</td>
</tr>
<tr class="isi2">
<td width="100%" valign="top" colspan="2">
Gangguan perkembangan mental / emosi : 28
</td>
</tr>
</table>
</td>
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi2">
<td width="30%" valign="top">
Alat Bantu
</td>
<td valign="top">
: 
</td>
<td width="69%" valign="top">
Tidak<br>29
</td>
</tr>
<tr class="isi2">
<td width="30%" valign="top">
Prothesa
</td>
<td valign="top">
: 
</td>
<td width="69%" valign="top">
Tidak<br>30
</td>
</tr>
<tr class="isi2">
<td width="30%" valign="top">
Cacat Fisik
</td>
<td valign="top">
: 
</td>
<td width="69%" valign="top">
-
</td>
</tr>
<tr class="isi2">
<td width="30%" valign="top">
ADL
</td>
<td valign="top">
: 
</td>
<td width="69%" valign="top">
Mandiri
</td>
</tr>
</table>
</td>
<td valign="top" cellpadding="0" cellspacing="0">
<table width="100%" border="0" cellpadding="0" cellspacing="0" align="center">
<tr class="isi2">
<td width="50%" valign="top">
Status Psikologis
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
Tenang<br>31
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top">
Bahasa yang digunakan sehari-hari
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
-
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top" colspan="2">
Status Sosial dan ekonomi :
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top">
a. Hubungan dengan anggota keluarga
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
Baik
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top">
b. Pengasuh
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
Orang Tua 32
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top">
c. Ekonomi (Ortu)
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
Baik
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top">
Kepercayaan / Budaya / Nilai-nilai khusus yang perlu
diperhatikan
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
Tidak Ada<br>33
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top">
Agama
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
ISLAM
</td>
</tr>
<tr class="isi2">
<td width="50%" valign="top">
Edukasi diberikan kepada
</td>
<td valign="top">
: 
</td>
<td width="49%" valign="top">
Orang Tua<br>34
</td>
</tr>
</table>
</td>
</tr>
</table>
</body>
</html>