BAKTI SOSIAL

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BAKTI SOSIAL JAGE KASTARE FOUNDATION Lombok Tengah, 14 Juni 2014 LEMBAR ANAMNESIS Nama : Umur : Jenis Kelamin : Alamat : No.Reg : Tanggal : Anamnesis Keluhan Utama :___________________________________________ __________________________________________________ _______ Riwayat Penyakit :________________________________________ __ __________________________________________________ _______ __________________________________________________ _______ __________________________________________________ _______ Vital Sign Denyut Nadi :________x/menit Tekanan Darah :________mmHg Pernapasan :________x/menit Suhu :________ O C Diagnosis __________________________________________________ _______ __________________________________________________ _______ R/ Catatan : _________________________________________________ BAKTI SOSIAL JAGE KASTARE FOUNDATION Lombok Tengah, 14 Juni 2014 LEMBAR ANAMNESIS Nama : Umur : Jenis Kelamin : Alamat : No.Reg : Tanggal : Anamnesis Keluhan Utama :___________________________________________

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Page 1: BAKTI SOSIAL

BAKTI SOSIALJAGE KASTARE FOUNDATION

Lombok Tengah, 14 Juni 2014

LEMBAR ANAMNESIS

Nama : Umur : Jenis Kelamin :Alamat : No.Reg : Tanggal :

AnamnesisKeluhan Utama :____________________________________________________________________________________________________Riwayat Penyakit :_____________________________________________________________________________________________________________________________________________________________________________________________________________________Vital Sign

Denyut Nadi :________x/menit Tekanan Darah :________mmHg Pernapasan :________x/menit Suhu :________OC

Diagnosis __________________________________________________________________________________________________________________

R/

Catatan : _________________________________________________

BAKTI SOSIALJAGE KASTARE FOUNDATION

Lombok Tengah, 14 Juni 2014

LEMBAR ANAMNESIS

Nama : Umur : Jenis Kelamin :Alamat : No.Reg : Tanggal :

AnamnesisKeluhan Utama :____________________________________________________________________________________________________Riwayat Penyakit :_____________________________________________________________________________________________________________________________________________________________________________________________________________________Vital Sign

Denyut Nadi :________x/menit Tekanan Darah :________mmHg Pernapasan :________x/menit Suhu :________OC

Diagnosis __________________________________________________________________________________________________________________

R/

Catatan : _________________________________________________