Name :An.

A
Chart
Room :Melati No:03-06-14

Date : 27-04-2020
Day to :1 2 3 4 5 6 7
Pulse Temp 6 12 18 24 6 12 18 24 6 12 18 24 6 12 18 24 6 12 18 24 6 12 18 24 6 12 1824 6 12 18 24
180 eratur
42

160 41

140 40

120 39

100 38

80 37

60 36

40 35

Interpretation
Teright
Dthe direction
BB&TB 16kg &110
Oral -
Parenteral -

Koh dear -
Throw up -

Diffection -
Berkih -

Nama : kintan monica

Nim : 1701011012
Tugas : bahasa inggris 2
RS. PIKES PANAKKUKANG MKS

Supporting investigation Name: An. A No. RM: 03 - 06 - 14

Medical
Age : 5 th L / P:

Date Name surety Responsible

Outcome of Lab Checks:

Hb : 11,0
Trombosit : 200.000
HCT : 40 %
Leukosit : 15.000
Sputum :The sputum contains the distinctive giant cell calibrated
 MR.8
Name: Ny.W Age: 27
Operations Report
Room : Melati No. RM : 303606

Surgeon Name: dr. Diki Assistant Name: dr. Ema Nurse Name: Salma

Anesthesiologist's name: dr. Wijaya Anesthesia Type:local anesthesia

Pro-Operative Diagnosis : pre eclampsia

Post-operative diagnosis : Caesarean Post pre eclampsia

Excised tissue Sent for inspection P.4.

YesNo

Date of Operation Operating Hours Operation Hours Duration of Operation

Start Completed
28 april 2020 06.00 WIB 10.00 WIB 3 hours

Operation Report: (If You Need To Be Continued On The Next Page)

The operation went well and smoothly without any problems

Signature of a Surgeon:
Circle accordingly
MR.9
 APPROVAL OF MEDICAL ACTION:
I, the undersigned below :
Name : Tn. J
Age/Gender : 30th/male
Address : Bintaro
Proof of identity / KTP: 123096782236

Hereby declare to have truly given

APPROVAL

For medical treatment consists of **Caesarean section

To myself * / wife * / husband * / my mother, * with
Name : Ny. W
Age /Gender : 27th/female
Address : Bintaro
Proof of identity / KTP: 123059587446
Treated at :delivery room
Medical Record Number: 303606
The purpose, nature, and necessity of the above mentioned medical treatment, as well as
the risks that can be caused by it have been explained enough by the doctor and I fully understand
it. Thus I make this statement mindful and without coercion

Makassar, 29 April 2020

Witnesses

Signatures Doctor’s that make statements

Medical paramedics signature

(SALMA) (dr. Diki) (JAKA)

2. Patient's family

(LUNA)

 Fill in the type of medical action taken

 Circle with another stroke

 DISCLAIMER OF MEDICAL ACTIONS

I, the undersigned below :

Name: Ny. I
Age/gender:34TH/female
Address : Bintaro
Proof of identity / KTP: 136474844848
Family relationship : Sister
Hereby declare to have truly given
REJECTION
For medical treatment consists of **Caesarean section
To myself * / wife * / husband * / my mother, * with
Name : Ny. W
Age /Gender : 27th/female
Address : Bintaro
Proof of identity / KTP:123059587446
Treated at :delivery room
Medical Record Number: 303606

I have also stated truthfully with no force that I am

a. Information and explanations have been given as well as warnings of hazards, risks and
possibilities that arise if no medical action is taken in the form of **Caesarean section
b. I have fully understood the information and explanation provided by the doctor
c. For my own responsibility and risk, I still refuse to take the medical action recommended by
the doctor.

Makassar, 29 April 2020

Witnesses

Signatures patients Doctor’s that make statements

Medical paramedics family signature

(SALMA) (Luna)(dr. Diki) (JAKA)

 Fill in the type of medical action taken

 Circle with another stroke

 SHEET CONSULTATION Name : An. A Age : 5 y.o
(sent to no status)
Room : melati MR number : 03-06-14

ihktiar clinic + lab. Short :

examination of Hb

consul requested :

check to find out whether or not

there is anemia

Doctor : Dr. Tirta

The date : april, 29 2020

the answer next door

 THE ANSWER

Invention :

after examination in patients obtained sugar levels of 11g / dl

diagnosis :

from the results that have been obtained patients stated suffering from anemia

advice :

1. often do routine blood tests.

2. multiply consume vitamin C, iron.
3. avoid the activity of blood transfusion to other people.
4. Avoid drinking coffee, tea or milk after eating

the date : April, 30 2020 consulent

(...........................................)