Catatan Kesehatan Anak Anda

Dr. Edwin Tohaga. SpAPraktek :

RSUD RA Kartini JeparaRS Graha Husada Jepara

No : .......................................

Nama : ..................................

Catatan Kelahiran Buah Hatiku

Nama ....................................................................................................Jenis kelamin ........................................................................................Tanggal Lahir .......................................jam ..........................................Nama Orang TuaAyah .....................................................................................................Pekerjaan .............................................................................................Ibu ........................................................................................................Pekerjaan .............................................................................................Alamat rumah ......................................................................................

......................................................................................Telp ......................................................................................................

Riwayat Persalinan

Dokter Kebidanan ................................................................................Dokter anak .........................................................................................Jenis persalinan ................................Nilai apgar..................................Berat/ panjang badan ..........................................................................Lingkar kepala / dada ..........................................................................Golongan darah ...................................................................................Skiring laboratorium. Hb............HT...........T4.......................................

Riwayat Masa Neonatal

Ya TidakASI/Breast FedKuning / JaundiceKejang Defisiensi enzim G6PDInkompatabilitas ABOTerapi sinar / PhototerapiTransfusi tukarHipoglikemiaSindroma gangguan pernapasanCacat bawaanLain- lain.............................................................................................................................................................................................................Kadar bilirubin tertinggi....................................mg/dl waktu pulang .............................mg/dlPulang dari RS/RB tanggal .............................................................................................................Berat saat pulang..................grASI ........................................................................................................Susu Formula .......................................................................................Tanggal kontrol ....................................................................................

Skrining penyakit jantung bawaan kritikal

Dilakukan pada 24 jam usia persalinan dengan melakukan pemeriksaan saturasi oksigenasi pada keempat ektrimitas bayi.

Hasil pemeriksaan :

SaO2 tangan kanan ..........

SaO2 tangan Kiri ..........

SaO2 kaki kanan ..........

SaO2 kaki kiri ..........

Kesimpulan ..........................................................................................................................................................................................................................................................................................................................................

Pemeriksa

( .........................)

Jadwal Imunisasi anak anda

Jenis Rencana Pemberian

Tanggal Pemberian

Paraf

BCGHEPATITIS B

DPT

POLIO

CAMPAKHIB

PNEUMOKOKUS (PCV)

INFLUENSA (SETAHUN SEKALI)

MMR

TIFOID (DIULANG TIAP 3 TAHUN)

HEPATITIS A (2X INTERVAL 6 BULAN)VARICELA

HPV

MANTOUX

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