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    Pharmaceutical Care Patient Profile: Nama: NIM / Kelas: Kelompok: Materi Kasus: Lampiran

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    Dewi Patni
    This document contains forms and templates for documenting a patient's profile, medical history, physical examination findings, lab results, medications, and a medication record and reminder for a pharmaceutical care case. It includes sections for patient identification, presenting complaint, diagnoses, past medical history, allergies, vital signs, physical exam findings, lab results, current medications, further information required, problem list, pharmaceutical care plan, and monitoring.

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    Pharmaceutical Care Patient Profile: Nama: NIM / Kelas: Kelompok: Materi Kasus: Lampiran

    Uploaded by

    Dewi Patni
    23 views17 pages
    This document contains forms and templates for documenting a patient's profile, medical history, physical examination findings, lab results, medications, and a medication record and reminder for a pharmaceutical care case. It includes sections for patient identification, presenting complaint, diagnoses, past medical history, allergies, vital signs, physical exam findings, lab results, current medications, further information required, problem list, pharmaceutical care plan, and monitoring.

    Original Description:

    soap sirosis

    Original Title

    Soap Sirosis

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    This document contains forms and templates for documenting a patient's profile, medical history, physical examination findings, lab results, medications, and a medication record and reminder for a pharmaceutical care case. It includes sections for patient identification, presenting complaint, diagnoses, past medical history, allergies, vital signs, physical exam findings, lab results, current medications, further information required, problem list, pharmaceutical care plan, and monitoring.

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    © All Rights Reserved
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    23 views17 pages

    Pharmaceutical Care Patient Profile: Nama: NIM / Kelas: Kelompok: Materi Kasus: Lampiran

    Uploaded by

    Dewi Patni
    This document contains forms and templates for documenting a patient's profile, medical history, physical examination findings, lab results, medications, and a medication record and reminder for a pharmaceutical care case. It includes sections for patient identification, presenting complaint, diagnoses, past medical history, allergies, vital signs, physical exam findings, lab results, current medications, further information required, problem list, pharmaceutical care plan, and monitoring.

    Copyright:

    © All Rights Reserved
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    of 17

    Nama :

    NIM / Kelas :
    Kelompok :
    Materi Kasus :

    LAMPIRAN
    FORM SOAP
    PHARMACEUTICAL CARE

    PATIENT PROFILE

    Tn. / Ny.

    Jenis Kelamin : Tgl. MRS :


    Usia :
    Tinggi Badan : Tgl. KRS :
    Berat Badan :

    Presenting Complaint

    Diagnosa kerja :
    Diagnosa banding :

     Relevant Past Medical History :

    Drug Allergies :
    HASIL PEMERIKSAAN FISIK

    Tanda – Tanda Vital Hasil Pemeriksaan Keterangan

    Tekanan Darah (mmHg)

    Suhu (oC)

    Heart Rate (HR) (x/menit)


    Respiratory Rate (RR)
    (x/menit)
    Keadaan Umum

    Kesadaran Kompos

    DATA LABORATORIUM

    Parameter Hasil Pemeriksaan Keterangan

    Bilirubin Total

    Bilirubin Direk

    Bilirubin Indirek

    SGOT

    SGPT

    BUN

    Kreatinin

    Albumin

    HbsAg

    HCV

    Pemeriksaan USG Abdomen


    MEDICATION

    MEDICATION

    Dosis yang Dosis Terapi


    NO Nama Obat Indikasi
    Digunakan (Literatur)

    10

    11

    12

    13

    14

    15

    FURTHER INFORMATION REQUIRED ( FIR )


    NO FIR Jawaban Alasan

    10

    11

    12

    13

    PROBLEM LIST ( ACTUAL PROBLEM )


    Problem List ( Actual Problem )

    No Medical No Pharmaceutical

    PHARMACEUTICAL PROBLEM
    Subjective (symptom)
    Objective (signs)

    Hasil Pemeriksaan Fisik

    Tanda – Tanda Vital Hasil Pemeriksaan Keterangan

    Tekanan Darah (mmHg)

    Suhu (oC)

    Heart Rate (HR) (x/menit)


    Respiratory Rate (RR)
    (x/menit)
    Keadaan Umum

    Kesadaran Kompos

    Data Laboratorium

    Parameter Hasil Pemeriksaan Keterangan

    Bilirubin Total

    Bilirubin Direk

    Bilirubin Indirek

    SGOT

    SGPT

    BUN

    Kreatinin

    Albumin

    HbsAg

    HCV

    Pemeriksaan USG Abdomen


    Assesment (with evidence)

    NO Nama Obat Indikasi Dosis DRP Keterangan


    Plan (including primary care implications)

    NO Nama Obat Indikasi Dosis Keterangan


    Monitoring
    • Efektivitas
    • Efek Samping Obat
    FORM MEDICATION RECORD

    ALERGI
    TANGGAL WAKTU OBAT TANDA
    NAMA NAMA DOSIS
    DIBERIKAN PEMBERIAN DAN TANGAN
    PASIEN OBAT OBAT
    OBAT OBAT REAKSI APOTEKER
    ALERGI
    MAHASISWA DOSEN
    FORM MEDICATION REMINDER

    Nama Pasien : Dokter Pemeriksa : Dr


    Umur : Apoteker : S.Farm.,Apt

    BULAN / TAHUN
    NAMA OBAT WAKTU (TANGGAL PEMBERIAN OBAT)

    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    BULAN / TAHUN
    NAMA OBAT WAKTU (TANGGAL PEMBERIAN OBAT)

    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    BULAN / TAHUN
    NAMA OBAT WAKTU (TANGGAL PEMBERIAN OBAT)

    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam
    Pagi
    Siang
    Sore
    Malam

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