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CLINICAL PATHWAYS RAWAT JALAN

POLIKLINIK: RESPIROLOGI ANAK SMF KESEHATAN ANAK, RSUP FATMAWATI, JAKARTA


2014 - 2016
.(ICD 10:)
KODE INA CBGs: .
Nama Pasien:

Aktivitas Pelayanan:
Kunjungan:

Umur:

Nomor Rekam Medis:


.

Rencana rawat jalan :


.. kali kunjungan dengan
antar waktu ..hari/minggu/bulan
Poliklinik Rawat Jalan: Respirologi Anak
Catan:
4
5
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Tanggal:

Utama
Penyerta
Komplikasi
Pemeriksaan DPJP:
Konsultasi:

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Pemeriksaan Penunjang (ICD 9 CM):



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Pendidikan dan Promosi Kesehatan (Hospial Health Promotion):



+/+/- +/+/+/
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Kode DPJP: . . . . . . . . . . . . ..
Diagnosis (ICD 10):

Tindakan (ICD 9 CM):




Obat Obatan::



Comparative Cost (dalam ribu Rp) per kunjungan:


Cost-Weight:
Unit Cost ... ... ... ... ... ... ... ... ... ... ... ...
Tarif RS ... ... ... ... ... ... ... ... ... ... ... ...
INA CBGs ... ... ... ... ... ... ... ... ... ... ... ...
Catatan Varians:
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Solusi Tindak Lanjut:

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