Dental Record PSMKGI
3
Rekam Medik Kedokteran Gigi PERSATUAN SENAT MAHASISWA KEDOKTERAN GIGI INDONESIA (Indonesian Dental Students Assosiation) Komisi C PSMKGI “Salam Pengabdian” No. File : ............... Data Pasien: Nama Lengkap (jenis kelamin) :_____________________________________________(L/P) Tempat, Tanggal Lahir :_________________________________________________ Agama :________________________________________________ _ Pekerjaan :________________________________________________ _ Status :__________________________________________ _______ Alamat Rumah :_________________________________________________ No kontak :_________________________________________________ Golongan Darah :_________________________________________________ Catatan perawatan : Tangga l Gigi Keluhan / Diagnosa Perawatan Paraf Rekam Medik Kedokteran Gigi PSMKGI | [email protected] | “SALAM PENGABDIAN”
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Transcript of Dental Record PSMKGI
Rekam Medik Kedokteran GigiPERSATUAN SENAT MAHASISWA KEDOKTERAN GIGI INDONESIA(Indonesian Dental Students Assosiation)
Komisi C PSMKGI Salam Pengabdian
No. File : ...............
Data Pasien:Nama Lengkap(jenis kelamin):_____________________________________________(L/P)Tempat, Tanggal Lahir:_________________________________________________Agama:_________________________________________________Pekerjaan:_________________________________________________Status:_________________________________________________Alamat Rumah:_________________________________________________No kontak:_________________________________________________Golongan Darah:_________________________________________________
Catatan perawatan :TanggalGigiKeluhan / DiagnosaPerawatanParaf
PEMERIKSAAN VitalKesadaran: __________________Nadi: ______/menitTekanan darah: __________________Pernafasan: ______/menitRiwayat Penyakit : penyakit jantung/hipertensi/hepatitis/Diabetes/alergi/hepar/lambung*Keterangan riwayat penyakit......................................................................................................
Anamnesis_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ EkstraoralTonus bibir : [ ] hipotonus [ ] Normal [ ] HipertonusTMJ : [ ] Normal [ ] ada kelainan .................................Kelenjar Limfe : [ ] teraba (sakit/tidak) [ ] tidak teraba
IntraoralKebersihan mulut : [ ] Normal [ ] sedang [ ] burukMukosa Bukal: [ ] Normal [ ] ada kelainan ..............Mukosa labial: [ ] Normal [ ] ada kelainan ..............Frenulum labii: [ ] Normal [ ] RendahLidah: [ ] Normal [ ] ada kelainan ..............Palatum: [ ] Normal [ ] DangkalTonsil: [ ] Normal [ ] ada kelainan ..............
Odontogram
Diagnosa_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Rencana Perawatan_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Operator pemeriksa:Tanggal pemeriksaan:Rekam Medik Kedokteran Gigi PSMKGI | [email protected] | SALAM PENGABDIAN
