7/23/2019 Anamnesis Obs

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ANAMNESIS OBS

IDENTITAS

Nama :____________________________ Umur/ Tgl.Lahir:_____________/_______________

Alamat :____________________________ Pekerjaan:_____________________________

BB/TB :____________________________ Rujukan :_____________________________Menikah_________ lama________ Alergi !"at :_____________________________

RPS#eluhan:

_________________________________________________________________________

Sakit $erut % & /' (:________________________________________________________

#eluar air $er)aginum % & /' (:______________________________________________

*erak anak % Baik / menurun /tia+a (:________________________________________

,P,T:_____________________________ TP:_________________________________ AN-:______________________________US*:________________________________ TU :___________ P:___________ D00:_____________

RPD

:______________________________________________________________________________

RP# :_____________________________________________________________________________

#B % 1a /ti+ak (:_____________________________________________2t3$_______"ulan/tahunAB!RTUS % 1a / ti+ak (

STATUS PRESENT

TD:________________ RR:____________ N:__________Suhu:____________

RI4A5AT !BSTETRI

ANAK 1 2 3 4 5 6J.KBBL

USIA KELAHIRAN

(ATERM/PRETERM/POST

ERM)TEMPAT LAHIR

7/23/2019 Anamnesis Obs

2/2

(RS/BIDAN)DILAHIRKAN OLEH

(DOKTER/BIDAN)JENIS LAHIR

(SPONTAN/SC/VAKUM/F

ORCEP)USIA SAAT INI

-3$1right A!"#$%#& Peri3+e 67.68.7869 7;.68.7869