8/18/2019 Mr. 4a Pengkajian Awal Terapi Wicara Pada Pasien Anak

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  RSUP. Dr. WAHIDIN SUDIROHUSODO MAKASSAR

PENGKAJIAN AWAL TERAPI WICARA PADA PASIEN ANAK 

A. Identitas

  Nama :…………………………

  Tgl Lahir :…………………………

  Jenis Kelamin : L / P

No Rekam Medis :……………………………

Tgl Kunjungan :……………………………

Jam :…………………………..

.Ri!a"at Kelahiran :

1. Pre Natal : Resiko Jatuh ( ) Demam Tinggi ( )Kelilit Tali Pusar ( )

2. Post Natal : Lahir : Normal ( ), S ( ), ! ( )

"enangis ( ) Ti#ak menangis ( )

$$ Lahir : %........ Kg P$ :%...%..&m

 

'. Natal : Demam tinggi ( ) keang ( )erna atuh ( )

#.Ri!a"at Kesehatan

Keluhan *tama :%%%%%%%%%%%....

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$. Ri!a"at Tum%uh Kem%ang :

1. Perkem+angan isik-"otorik

Tengkura :%%.%$ulan

"erangkak :.%%... $ulan

Du#uk :%%.%$ulan

$er#iri :%%.% $ulan

Jalan :%%% $ulan

2. Perkem+angan $ahasa /i&ara Taha 1 :

Re0leksi !o&alisation :%...%$ulan Taha 2 :

$a++ling :%......$ulan Taha ' :

Lalling :%...%$ulan Taha :

&holalia :%.%.$ulan Taha 3 :

True See&h :..%...$ulan

&.Tum%uh Kem%ang 'aat ini :

a. Perkem+angan isik -Psikomotorik%%%

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+. Perkem+angan $ahasa #an Kogniti0%%..%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

&. Perkem+angan so&ial - "ental %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

  MR.4a/TERAPI WICARA 

8/18/2019 Mr. 4a Pengkajian Awal Terapi Wicara Pada Pasien Anak

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Nama #an Tan#a tangan Terai /i&ara

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