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YAYASAN PELAYANAN KESEHATAN BALA KESELAMATAN

RUMAH SAKIT BALA KESELAMATAN “BOKOR” TURE


Jl. Jendral Achmad Yani No. 91 Turen – 65175 Malang
Telp. (0341) 824002, 824453 Fax. (0341) 823878
Rek. Mandiri Cab. Malang Dampit No. 144-00-1990009-8 a.n Pelayanan Kesehatan Bala Keselama
Check List Monitoring Pelaksanaan Asesmen Pra Aneste
Bulan : agustus
No Tanggal No. Reg Nama Pasien

1 8/1/2018 113967 NY. RIKE YOHANES


2 132302 NY. SUSANTI
3 132281 NY. NUR AZIZATUL
4 8/2/2018 132333 NY. WAHYUTI
5 8/3/2018 132267 SDR. AHMAD ROBY
6 132216 TN. SUKADI
7 132358 AN. AL NASIF
8 8/4/2018 128874 NY. NUR WISUDAWATI
9 131690 NY. KHOLISATUL
10 132392 NY. SULIHA
11 8/7/2018 132409 NY. SUWARNI
12 8/8/2018 123443 NY. NURUL H
13 8/9/2018 132493 NY. EMI LESTARI
14 131635 NY. SHINTA FEBRIAN
15 128401 NY. ULFA N
16 8/12/2018 132383 NY. NURUL H
17 132550 NY. SRI RATNASARI
18 132619 NY. GESTI M
19 8/13/2018 62384 TN. M. SHOLEH
20 6498 NY. TATIK
21 132411 NY. SURATIK
22 132397 NY. SUSIANAH
23 132448 NY. SARIYANI
24 8/14/2018 122643 NY. NARSIH
25 126336 NY. MARMI
26 132608 NY. HALIMATUS
27 130356 NY. NUR MASLICHAH
28 131617 NY. NUR AYATI
29 132678 NY. NUR HIDAYAT
30 8/18/2018 132707 NY. WIJI KASIANI
31 132702 NY. YUNAITI
32 8/19/2018 58441 NY. EMI YULIASTUTIK
33 8/21/2018 132793 KARIMATUN NIKMAH
34 132796 NY. ULFE PEBRIANI
35 132818 NY. YULIUS RIKA
36 8/23/2018 132800 NY. SUWATINI
37 132446 NY. NANIK
38 8/25/2018 132799 NY. EKA PRIMADANI
39 131777 NY. SULASTRI
40 8/27/2018 132272 TN. SUKARDI
41 132780 NY. EKA YULIATIN
42 127151 TN. SLAMET E
43 8/28/2018 132987 NY. NUR KHASANAH
44 8/29/2018 133037 NY. NURUL FATMAWATI
45 8/30/2018 133083 NY. INNANDARI
46 133081 NY. SRI WAHYUNI
47 132969 TN. NGATIMIN
48 8/31/2018 133099 TN. AGUS P
49 133112 TN. SUWIGNO
YAYASAN PELAYANAN KESEHATAN BALA KESELAMATAN
RUMAH SAKIT BALA KESELAMATAN “BOKOR” TUREN
Jl. Jendral Achmad Yani No. 91 Turen – 65175 Malang
Telp. (0341) 824002, 824453 Fax. (0341) 823878
pit No. 144-00-1990009-8 a.n Pelayanan Kesehatan Bala Keselamatan e-mail: rs_bokor@yahoo.com
Check List Monitoring Pelaksanaan Asesmen Pra Anestesi

Diagnosa Asesmen Pra Anestesi Keterangan


Ya Tidak
SC / KEPALA FLOATING √
SC / POST DATE √
SC / IUFD √
LAPARATOMI / CSYTA OVARI √
STT ABDOMEN / EKSISI √
HIL (D) √
V APP DORSUM PEDIS / DEBRI √
SC / POST DATE √
MYOMECTOMI / MYOMA UTERI √
CURET / BO √
CYSTA OVARI / LAPARATOMI √
CURET / RESTPLACE POST PARTUM √
SC / IUFD √
SC / HIGH MIOPI √
SC / BEKAS SC √
SC / GEMELI √
SC / OBESITAS √
CURET / BO √
HEMANGIOMA REGIO PUNGGUNG √
STT MANUS DIGITI 5 / EKSISI √
HEMOROID INT EKSTERNA √
HEMANGIOMA RETRO AURICAL / EKSISI √
ABSES DIPANTAT / DEBRIDEMEN √
SC / RIWAYAT MOLA √
BIOPSI / SUSP CA CERVIC √
SC / KPD + OLIGO √
SC / BEKAS SC √
BIOPSI / CA OVARIUM √
SC / DJJ MELEMAH √
SC / PLASENTA PRIVEA √
SC / BEKAS SC √
CURET / AB INC √
SC / BEKAS SC √
SC / BEKAS SC √
SC / POST DATE √
SC / POST DATE √
SC / POST DATE √
CYSTA OVARI / CYSTECTOMY √
SC / BEKAS SC √
HIL (S) √
GANGLION WRIST (D) / EKSISI √
HIL (D) √
SC / BEKAS SC √
CURET / SISA PLASENTA √
SC / POST DATE √
CURET / AB INC √
ABSES GENUO (S) / DEBRI √
OP FX PHALANX MANUS (S) / DEBRI √
RUPTUR TENDON / REPAIR TENDON √

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