STATUS KEPANITERAAN ILMU BEDAH

FAKULTAS KEDOKTERAN UNIVERSITAS KRISTEN INDONESIA

Hari / Tanggal :

Rumah Sakit :

Nama Mahasiswa :

IDENTITAS

Nama Pasien :

Umur :

Jenis Kelamin :

Bangsa :

Pekerjaan :

Alamat :

Ruangan :

Tgl Masuk :

ANAMNESA

Keluhan Utama :

Keluhan Lain :

Riwayat Penyakit : ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….……………………………………………………………………………………………………………………………………………………

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Riwayat Keluarga :

Riwayat Masa Lampau

1. Penyakit Terdahulu : 2. Trauma Terdahulu : 3. Riwayat Operasi : 4. Sistem

a. Neurologi : b. Kardiovaskular : c. Gastrointestinal : d. Genitourinary : e. Catamenia : f. Riwayat Gizi :

5. Riwayat Psikiatri :

STATUS PASIEN

A. Status UmumKeadaan Umum : Keadaan Gizi : Kesadaran : Frekuensi napas: Suhu : Nadi : Tekanan Darah : Kelenjar lymph: Kulit : Wajah : Kepala : Telinga: Mata : Mulut: Hidung : Dada: Leher : Paru: Jantung : Inspeksi

Inspeksi PalpasiPalpasi PerkusiPerkusi AuskultasiAuskultasi

Abdomen : Ekstremitas :InspeksiAuskultasiPalpasi

Perkusi

B. Status Lokalis

C. Pemeriksaan Khusus Lain :

D. Resume………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

E. Diagnosa Kerja :

F. Diagnosa Banding :

G. Pemeriksaan Anjuran :

H. Terapi :

I. Prognosa

Ad Vitam :

Ad Fungtionam :

Ad Sanatinam :