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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='7800px' 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 MEDIS IGD<br><br></font></td></tr></table>
</head>
<body>
<table width="7800px" border="0" align="center" cellpadding="1px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="middle" bgcolor="#FFFAF8" align="center" width="105px">
<b>No.Rawat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="65px">
<b>No.RM</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="160px">
<b>Nama Pasien</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="50px">
<b>J.K.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="60px">
<b>Tgl.Lahir</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="120px">
<b>Tanggal</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="80px">
<b>Informasi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Riwayat Peyakit Sekarang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Riwayat Penyakit Keluarga</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Riwayat Penyakit Dahulu</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="150px">
<b>Alergi Makan & Obat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="85px">
<b>Keadaan Umum</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="77px">
<b>Kesadaran</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="45px">
<b>T.D.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="30px">
<b>Nadi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="30px">
<b>R.R.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="30px">
<b>T.B.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="30px">
<b>B.B.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="32px">
<b>Suhu</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="87px">
<b>Submandibula</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="87px">
<b>Axilla</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="87px">
<b>Supraklavikula</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="87px">
<b>Leher</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="87px">
<b>Inguinal</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="57px">
<b>Oedema</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="57px">
<b>Frontalis</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="57px">
<b>Maxilaris</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="72px">
<b>Palpebra</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="72px">
<b>Sklera</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="72px">
<b>Cornea</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="100px">
<b>Buta Warna</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="68px">
<b>Konjungtiva</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="57px">
<b>Lensa</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="52px">
<b>Pupil</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="82px">
<b>Lubang Telinga</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="73px">
<b>Daun Telinga</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="112px">
<b>Selaput Pendengaran</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="90px">
<b>Proc.Mastoideus</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="70px">
<b>Septum Nasi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="80px">
<b>Lubang Hidung</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="50px">
<b>Bibir</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="60px">
<b>Caries</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="45px">
<b>Lidah</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="54px">
<b>Faring</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="45px">
<b>Tonsil</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="90px">
<b>Kelenjar Limfe</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="90px">
<b>Kelenjar Gondok</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="80px">
<b>Gerakan Dada</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="80px">
<b>Vocal Femitus</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="72px">
<b>Perkusi Dada</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="69px">
<b>Bunyi Napas</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="89px">
<b>Bunyi Tambahan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="72px">
<b>Ictus Cordis</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="79px">
<b>Bunyi Jantung</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="50px">
<b>Batas</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="50px">
<b>Inspeksi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="131px">
<b>Palpasi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="90px">
<b>Hepar</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="92px">
<b>Perkusi Abdomen</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="117px">
<b>Auskultasi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="87px">
<b>Limpa</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="80px">
<b>Costovertebral</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="70px">
<b>Kondisi Kulit</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="85px">
<b>Extrimitas Atas</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="143px">
<b>Keterangan Extrimitas Atas</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="93px">
<b>Extrimitas Bawah</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="153px">
<b>Keterangan Extrimitas Bawah</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Pemeriksaan Laboratorium</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Rongsen Thorax</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>EKG</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Spirometri</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Audiometri</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Treadmill</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="200px">
<b>Lain-Lain</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="120px">
<b>Merokok</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="120px">
<b>Alkohol</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="250px">
<b>Kesimpulan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="250px">
<b>Anjuran</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="90px">
<b>Kode Dokter</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center" width="170px">
<b>Nama Dokter Penanggung Jawab</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2022/05/18/000003
</td>
<td valign="top">
000001
</td>
<td valign="top">
WINDIARTO
</td>
<td valign="top">
Laki-Laki
</td>
<td valign="top">
1988-02-24
</td>
<td valign="top">
2022-06-08 05:56:36.0
</td>
<td valign="top">
Autoanamnesis
</td>
<td valign="top">
1
</td>
<td valign="top">
2 12121212
</td>
<td valign="top">
3
</td>
<td valign="top">
4
</td>
<td valign="top">
Baik
</td>
<td valign="top">
Composmentis
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Jernih
</td>
<td valign="top">
Isokor
</td>
<td valign="top">
Lapang
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Intak
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Lapang
</td>
<td valign="top">
Lembab
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
Bersih
</td>
<td valign="top">
Normal
</td>
<td valign="top">
T1-T1
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Simetris
</td>
<td valign="top">
Sama
</td>
<td valign="top">
Sonor
</td>
<td valign="top">
Vesikuler
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
Tidak Terlihat
</td>
<td valign="top">
Reguler
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Datar
</td>
<td valign="top">
Supel
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Timpani
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Tidak Membesar
</td>
<td valign="top">
Tidak Ada
</td>
<td valign="top">
Normal
</td>
<td valign="top">
Normal
</td>
<td valign="top">
1
</td>
<td valign="top">
Normal
</td>
<td valign="top">
1
</td>
<td valign="top">
2
</td>
<td valign="top">
3
</td>
<td valign="top">
4
</td>
<td valign="top">
4
</td>
<td valign="top">
5
</td>
<td valign="top">
6
</td>
<td valign="top">
7
</td>
<td valign="top">
8
</td>
<td valign="top">
</td>
<td valign="top">
1
</td>
<td valign="top">
2
</td>
<td valign="top">
D0000002
</td>
<td valign="top">
dr. Aisyah
</td>
</tr>
</table>
</body>
</html>