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Klinik Bhaksena Tragia: Jl. Bypass Ngurah Rai, Komplek Pertokoan Tragia Blok D21-22, Kuta Selatan Telp. (+62) 8113986396
Klinik Bhaksena Tragia: Jl. Bypass Ngurah Rai, Komplek Pertokoan Tragia Blok D21-22, Kuta Selatan Telp. (+62) 8113986396
Date :
Surname : First Name :
D.O.B : Address :
Sex/Gender : Attending Physician : dr. Andre Kristanto
Nationality :
Allergy:
Physical Examination:
Vital Sign
GCS Score : EVM VAS :
Blood Pressure : mmHg Respiration : x/min
o
Pulse : x/min regular Body Temp. : C
O2 Saturation : %
Physical Findings
Eye : Anemic (-/-), edema (-/-), pupil equals and reaction (+/+)
ENT : Tragus pain (-), tympanic membrane intact (+/+)
Thorax : Pulmo : Ves +/+, Rh -/-, Wh -/-
Cor : S1S2 single regular, murmur (-)
Abdomen : Distension (-), bowel movement (+) normal, pain in palpation RLQ (-),
hepatomegaly (-), splenomegaly (-)
Extremities : Warm, CRT <2”, numbness (-), skin turgor normal
Diagnosis:
Differential Diagnosis:
Treatment / Management:
Patient Monitoring:
Monitoring patient vital sign and symptom improvement/worsening.
Complication:
Is there any complication of disease found? YES / NO
If yes, please describe:
Bali,
The Attending Physician