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RS KHUSUS MATA MEDAN BARUJl. Abdullah Lubis No. 67 Medan Telp : 6! " #$%&'& (a) : 6! " #$%*&*#

E+ail : +b+,.+a-a/ahoo.,o+

0ATATAN MED1S 2A3AT DARURAT

Accident Emergency Medical Record!. 4en5aian 4e8a9a- Nu8se Asse+en-

A. Da-a Sub;e-i< Sube,-i=e Da-a : Auto Anamnesa Allo Anamnesa

Riwayat Alergi / History Of Allergy : Tidak Ada Ada, .............................................

No es

Riwayat !enyakit "ulu / !ast "isease History :

B. Da-a >be-i< >be,-i=e Da-a :

#eadaan $mum : %aik &edang %uruk

'eneral (ondition 'ood )air %aik

Nilai n;e8i 4ain S,o8e : ?Tida ada n;e8i no pain " N;e8i San5a- be8a- pain

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Nurse

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0. Dia5nosa Ke8a 3o8in5 Dia5nosis :

................................................................................................................................................................

D. Dia5nosa Bandin5 Di

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=am / Time :

RS KHUSUS MATA MEDAN BARUJl. Abdullah Lubis No. 67 Medan Telp : 6! " #$%&'& (a) : 6! " #$%*&*#

E+ail : +b+,.+a-a/ahoo.,o+

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