Form Rekam Kefarmasian (1)

7/18/2019 Form Rekam Kefarmasian (1)

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Blok Pengobatan Rasional 2015

Lembar Kerja Praktikum Skenario A, B, C, dan D

REKAM KEFARMASIAN FORM PELAYANAN KEFARMASIAN

1. DATABASE PASIEN

A. Demoga!Nama " #m$ "ta%$n

&enis Kelamin " Tinggi "'mBeat ba(an " kg

B. Kel$%an #tama

)

)

*. Se+aa% ,en-akit -ang (i(eita saat ini

)..

)..

D. Se+aa% Me(is te(a%$l$

Pen-akit Onset Membaiksemb$%

E. Ke,at$%an" Baik" ).. Se(ang" )).B$$k"..............

Komenta)))))))))))))))))))))))))))))))

F. Se+aa% alegi" Ya")) Ti(ak")).. Ti(ak(iketa%$i" )..

Ti,e"))))))))))))))))))))))))))))))))..

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DATABASE PASIEN




0. Se+aa% so'ial 0a-a i($, "Meokok" Ya").. Ti(ak"))Alko%ol" Ya").. Ti(ak")..

Pola Makan. Se+aa% Obat

1. A,aka% ,asien saat ini ata$ (alam 2akt$ 3 b$lan teak%imekons$msi obat ese,4

Ya). Ti(ak ).. 5

Bila -a seb$tkan5 (an +elaskan 6nama obat5 (osis5 egimen5lama ,emakaian (an keg$naan7

).

)8. A,aka% ,asien saat ini mekons$msi obat bebas 4

Ya ) Ti(ak )Bila -a seb$tkan5 (an +elaskan 6nama obat5 (osis5 egimen5lama ,emakaian (an keg$naan7

).

).3. Penilaian se+aa% obat"

Keti(ak,at$%an ,asien)))))))))))))))))))))))......Pengeta%$an tentang obat

k$ang))))))))))))))))))).*aa mengg$nakan obat ti(ak

bena................................................Kom$nikasi k$ang '$k$, (engan tenaga kese%atan

lainn-a.......... Reaksi e/ek sam,ing obat..............................................................

Masala% -ang be%$b$ngan (engan obat lainn-a)))))))).....

I. Re9ie2 SistemStat$s se'aa $m$m"

Tan(a:tan(a 9ital"e,a"Sistem Ka(io9ask$la"Da(a'%est"Ab(omen"K$lit"Ne$oMental"Stat$s 'aian"EENT"Komenta"





&. Laboatoi$m (Penyajian Data LaboratoriumSESA!KA" den#an kebutu$an akti%ita& '"!)*!"+oe$ AP)EKE*-

Data Satuan "iai"orma .arike/ .arike/ .arike/DA*A.

Eitosit +$tamikolite

;5< = >5<6P7;5> = >5>6L7

emoglobin

g(L 18 = 1;6P713 = 1?6L7

ematokit @ ;< = ><

6P7;> = >>6L7

Le$kosit mm3 ;.<<<:1<.<<<

Tombosit mm3 1>< : ;>< 1<3

it$ng &enisBaso!l @ < 5< = 15<Eosino!l @ 15< = 35<Batang @ 85< = ?5<

Segmen @ ><5< =<5<

Lim/osit @ 8<5< =;<5<

Monosit @ 85< = C5<La+$ En(a,Daa%

Mm+am 1> 6P7 1< 6L7

M*ER ,g 8 = 31M**KER

g(L 38 : 3?

M*ER C< : G?

ALT 6S0PT7 #L 83 6P7 3< 6L7AST 6S0OT7 #L 81 6P7

8> 6L7Alkalin/os/atase

#L 1> = ?G

00T6gamma0T7

#L > : 3C

Bili$bin Total

mg(L <58> = 15<

Alb$min g(L 35> = >5>

Keatinin g(L <5?:15>B#N mg(L C = 8>Nati$m mmolL 13> = 1;>





Kali$m mmolL 35> = >5<Kolesteol

Totalmg(L 1>< = 8<<

DL mg(L ;> = ?>6P73> = >>6L7

Tiglisei(a mg(L 18< : 1G<0l$kosa(aa%A'ak sesaat

mg(L 8<<

0l$kosa(aa%,$asa

mg(L C< = 11<

0l$kosa(aa% 8&PP

mg(L 1;< : 8<<

Asam $at mg(L ?5> 6P7 6L7*!"AL!S!S

Beat &enis 15<1> =15<8>

, ;5C = 5;Hana K$ning

+eni%Alb$min Negati/

Re($ksi0l$kosa

Negati/

Se(imen Negati/ Le$kosit L,b Negati/ Eitosit L,b Negati/

&am$ Negati/ Kistal Negati/ E,%itel Negati/ Baktei Negati/

K. asil Pemeiksaan Lain

...........................................................................................................................................................

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PROFIL PEN00#NAAN OBAT SELAMA MEN&ALANI RAHAT INAP 6Fom k%$s$s ,asien a2at ina,7

Nama Obat R$te,embeian

Dosis -ang(ibeikan

ai Ke: Pengg$naan Obat selama Men+alani Ra2at Ina,

1 8 3 ; > ? ...

• Bei tan(a 6J7 ketika obat masi% (ig$nakan ,asien bei tan(a 6 =7 ketika obat s$(a% TIDAK lagi (ig$nakan,asien

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*' )A'BA.A" ")K 'ELAKKA" DRUG USED STUDY PE"++"AA" A")!B!)!KA PADA PAS!E"*AA) !"AP

No &enisantibiot

ik

Dosis%aian6mg7

R$te6,o5 i97

&enistea,i

In(ikasi ai Pembeian Antibiotika6(im$lai (ai %ai ,etama

,asien men(a,atkanantibiotika7

1 8 3 ....

Nama Dokte -ang meese,kan antibiotik "1. Resi(en "8. S,esialis 6s$,e9iso ata$ kons$ltan7 "

Kon(isi ,asien saat kel$a $ma% sakit 6clinical outcome7 " 6lingkai sala% sat$71. Semb$%membaik8. P$lang atas ,emintaan sen(ii3. Meninggal ($nia

&enis tea,i 6lingkai -ang ses$ai7 " Em,iis 6E75 Eten(e( Em,iis 6TE75 De/eniti/ 6D75 Ti(ak (iketa%$i 6#7

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A&&e&&ment A3oteker K.SS tentan# Peniaian ke&e&uaian 3en##unaan Antibiotika Pada Pa&ien*a4at !na3 den#an metode +y&&en&

)i3etera3i

6eni&antibiotik

Do&i&(m#-

rek(7-

*ute

Dura&

i($ari-

)otaDo&i

&

Kate#ori +y&&en&

Sta

rt

Sto

3!

!! !!! !88 8!

(m (m A B * A B A B * D

Em,iis 6E75 Eten(e( Em,iis 6TE75 De/eniti/ 6D75 Ti(ak (iketa%$i 6#7

C | P o g a m S t $ ( i P o / e s i A , o t e k e # I I



L. Assessment A,oteke

No PoblemMe(ik

Data S$b+ekti/Ob+ekti/ ,en($k$ng

Tea,i -ang(ibeikan

&enis DRP (annon DRP

S$mbeLiteat$ -ang

Dig$nakan

asil *iti'alA,,aisal

6k%$s$s $nt$k,engg$naan

liteat$,ime+$nal7

1

8

3

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M. *ae Plan A,oteke

No Care Pan )era3i 6be(asakanDRP (an non DRP ,a(a Tabel L.7

*iti'al A,,aisal 6k%$s$s $nt$k,engg$naan liteat$ tesie+$nal7

(alam ,enent$an rekomenda&itera3i 9 :are 3an tera3i

*ae Plan Monitoing 6Monitoinge/ekti9itas tea,i5 ESO5 Inteaksi

Obat5 Toksisitas 5 (an monitoingke,at$%an7

1

8

3

bila (i,el$kan 6ses$aikan /akto isiko ,asien7

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N. *ae Plan KIE

Obat -ang (ibeikan In/omasi obat -ang (ibeikan Non:/amakotea

Peniaiandari )utor Praktikum

(0 ; 100-

)anda )an#an)utor Praktikum


Form Rekam Kefarmasian (1)

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