CLINICAL PATHWA

RUMAH SAKIT UMUM DAERAH

PNEUMONIA
AMPANA
Nama Pasien : Umur : Berat Badan : Tinggi Badan: Nomor Rekam Medis :
……………… tahun ................. kg ....................... Cm
Diagnosis Awal : Kode : ICD 10 : ................................... Rencana Rawat : 5 hari
Ruang Rawat Tgl/Jam masuk : Tgl/Jam keluar: Lama Rawat : Kelas :
hari
Aktivitas Pelayanan Hari rawat 1 Hari rawat 2 Hari rawat 3 Hari rawat 4 Hari rawat 5

 Penyakit Utama 
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 Penyakit Penyerta
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Assesmen Klinis

Pemeriksaan Fisik

 Tekanan darah    
 Nadi    
 Respirasi    
 Suhu    
 Saturasi oksigen    
Konsultasi
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Pemeriksaan Penunjang

 DL, GDS, diff count 

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 Ur, Cr, sgot, sgpt
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 Na, K, Cl   
 EKG 
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 X-foto thoraks PA/AP
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 Sputum
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Medikamentosa

Antibiotik
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Obat-obatan lain

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Nutrisi
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Asuhan Keperawatan
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Edukasi
Kontrol
 Poliklinik
 Puskesmas
 Rujuk RS Lain
Jumlah Biaya .............

Nama Perawat: Diagnosis akhir Kode ICD 10

 Utama
Nama Dokter:  Penyerta
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Nama Pemeriksa Verifikasi