FORM REKAP MEDIC UJIAN PRAKTEK

Hari, tanggal : …………………………………………………………………………………………………………………………

Nama Pasien : ………………………………………………………………………………………. usia ……….th. ( L / P )
Keluhan Utama : ………………………………………………………………………………………………………………………….
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Keluhan tambahan : ………………………………………………………………………………………………………………………….
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Riwayat Penyakit : ……..........................................................................................................................
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Hasil Pemeriksaan : ………………………………………………………………………………………………………………………….
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Kesimpulan Diagnosa : ………………………………………………………………………………………………………………………….
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Saran/Anjuran : ………………………………………………………………………………………………………………………….
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Titik Bekam yang digunakan :

Pemeriksa

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(nama peserta Ujian)
 RESUME TERAPI BEKAM

Hari, tanggal : …………………………………………….

Nama Pasien : ………………………………………………………………………………….......................................
Tanggal Lahir : ..................................................................................., Usia ..................... ( L / P )
Alamat : ............................................................................................................................
NO. HP : ............................................................................................................................
Keluhan Utama :

Keluhan tambahan :

Riwayat Penyakit :

Hasil Pemeriksaan :

Kesimpulan Diagnosa :

Saran/Anjuran :

Titik Bekam yang digunakan :

Pasien Pemeriksa
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