diff --git a/assets/docs/therapy-protocol-1.html b/assets/docs/therapy-protocol-1.html new file mode 100644 index 00000000..1e3949d8 --- /dev/null +++ b/assets/docs/therapy-protocol-1.html @@ -0,0 +1,312 @@ + + + + + General Consent + + + + + + + + + + +
+ logo + +
+ PEMERINTAH PROVINSI JAWA TIMUR +
+
+ RUMAH SAKIT UMUM DAERAH Dr. SAIFUL ANWAR +
+
+ TERAKREDITASI KARS VERSI 2012 TINGKAT PARIPURNA +
+
+ Jl. Jaksa Agung Suprapto No. 2 MALANG 65111 +
+
Telp. (0341) 362101, Fax. (0341) 362110
+
Email: rsu-drsaifulanwar@jatimprov.go.id
+
Website: www.rsudsaifulanwar.jatimprov.go.id
+ 		+ logo +
+ +
+ +
+

+ Protokol Terapi +

+

Layanan Kedokteran Fisik dan Rehabilitasi +

+
+Terapi Ke

+{{ .Repalcable }} +
+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ No RM + {{ .Repalcable }}
+ Nama Pasien + {{ .Repalcable }}
+ Tanggal Lahir + {{ .Repalcable }}
+ Diagnosa + {{ .Repalcable }}
+ Permintaan Terapi + {{ .Repalcable }}
+ Frekuensi Terapi + + 2 x Per Minggu       + Evaluasi: 1 Bulan +
+ Target Terapi + {{ .Repalcable }}
+ Waktu Mencapai Target + {{ .Repalcable }}
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ NO + + Tanggal + + Dokter + + Fisioterapi + + Terapi Wicara + + Okupansi Terapi + + Ortotik Prostetik + + PSM + + TTD Pasien +
+ 1 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ 2 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ 3 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ 4 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ 5 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ 6 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ 7 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ 8 + {{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}{{ .Repalcable }}
+ + + + + + + + + + + +
+ Evaluasi + {{ .Repalcable }}
+ Rencana Selanjutnya + {{ .Repalcable }}
+ + + + + + + + + + + +
+ Malang,
+ Cap dan TTD Dr. SpKFR +
+ (........................................................) +
+ +
+ + + \ No newline at end of file diff --git a/assets/docs/therapy-protocol-2.html b/assets/docs/therapy-protocol-2.html new file mode 100644 index 00000000..b468bd43 --- /dev/null +++ b/assets/docs/therapy-protocol-2.html @@ -0,0 +1,217 @@ + + + + + General Consent + + + + + + + + + +
+ logo + +
+ PEMERINTAH PROVINSI JAWA TIMUR +
+
+ RUMAH SAKIT UMUM DAERAH Dr. SAIFUL ANWAR +
+
+ TERAKREDITASI KARS VERSI 2012 TINGKAT PARIPURNA +
+
+ Jl. Jaksa Agung Suprapto No. 2 MALANG 65111 +
+
Telp. (0341) 362101, Fax. (0341) 362110
+
Email: rsu-drsaifulanwar@jatimprov.go.id
+
Website: www.rsudsaifulanwar.jatimprov.go.id
+
+ +
+ + + + + + + + + + + + + + + + + + + +
+ No RM: + {{ .Repalcable }}
+ Nama Pasien + {{ .Repalcable }}
+ Diagnosa + {{ .Repalcable }}
+ Permintaan Terapi + {{ .Repalcable }}
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ PELAKSANAAN PROGRAM + + Tanggal + + TTD +
+ PASIEN + + DOKTER + + TERAPIS +
1. {{ .Repalcable }}{{ .Repalcable }}
2. {{ .Repalcable }}{{ .Repalcable }}
3. {{ .Repalcable }}{{ .Repalcable }}
4. {{ .Repalcable }}{{ .Repalcable }}
5. {{ .Repalcable }}{{ .Repalcable }}
6. {{ .Repalcable }}{{ .Repalcable }}
7. {{ .Repalcable }}{{ .Repalcable }}
8. {{ .Repalcable }}{{ .Repalcable }}
9. {{ .Repalcable }}{{ .Repalcable }}
10. {{ .Repalcable }}{{ .Repalcable }}
11. {{ .Repalcable }}{{ .Repalcable }}
12. {{ .Repalcable }}{{ .Repalcable }}
13. {{ .Repalcable }}{{ .Repalcable }}
14. {{ .Repalcable }}{{ .Repalcable }}
15. {{ .Repalcable }}{{ .Repalcable }}
16. {{ .Repalcable }}{{ .Repalcable }}
17. {{ .Repalcable }}{{ .Repalcable }}
18. {{ .Repalcable }}{{ .Repalcable }}
19. {{ .Repalcable }}{{ .Repalcable }}
20. {{ .Repalcable }}{{ .Repalcable }}
+ + + + + + + + + + + + + +
+ Tempat & Tanggal
+ Cap dan TTD Dr. SpKFR +
+ (.................................................) +
+ +
+ + + \ No newline at end of file diff --git a/assets/docs/therapy-protocol-3.html b/assets/docs/therapy-protocol-3.html new file mode 100644 index 00000000..6623fb9e --- /dev/null +++ b/assets/docs/therapy-protocol-3.html @@ -0,0 +1,241 @@ + + + + + General Consent + + + + + + + + + +
+ logo + +
+ PEMERINTAH PROVINSI JAWA TIMUR +
+
+ RUMAH SAKIT UMUM DAERAH Dr. SAIFUL ANWAR +
+
+ TERAKREDITASI KARS VERSI 2012 TINGKAT PARIPURNA +
+
+ Jl. Jaksa Agung Suprapto No. 2 MALANG 65111 +
+
Telp. (0341) 362101, Fax. (0341) 362110
+
Email: rsu-drsaifulanwar@jatimprov.go.id
+
Website: www.rsudsaifulanwar.jatimprov.go.id
+
+ +
+ +
+

+ Lembar Formulir Rawat Jalan
Layanan Kedokteran Fisik dan Rehabilitasi +

+
+ +
+ + + + + + + +
I. Identitas PasienNo. RM: {{ .Repalcable }}
+ + + + + + + + + + + + + + + + + + + + + + + +
+ Nama Pasien + : {{ .Repalcable }}
+ Tanggal Lahir + : {{ .Repalcable }}
+ Aalamat + : {{ .Repalcable }}
+ Telp / HP + : {{ .Repalcable }}
+ Hubungan dengan Tertanggung + : + ☑ Suami / Istri +    + ▢ Anak +
+
+ + +
+ + + + +
II. Diisi oleh Dokter SpKFR
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
+ Tanggal Pelayanan + : {{ .Repalcable }}
+ Anamnesa + : {{ .Repalcable }}
+ Pemeriksaan Fisik dan Uji Fungsi + : {{ .Repalcable }}
+ Diagnosis Medis (ICD-10) + : {{ .Repalcable }}
+ Diagnosis Fungsi (ICD-10) + : {{ .Repalcable }}
+ Pemeriksaan Penunjang + : {{ .Repalcable }}
+ Tata Laksana KFR (ICD 9 CM) + : {{ .Repalcable }}
+ Anjuran + : {{ .Repalcable }}
+ Evaluasi + : {{ .Repalcable }}
+ Suspek Penyakit Akibat Kerja + : + ☑ Ya   ( {{ .Repalcable }} ) + +
+ ▢ Tidak +
+
+ + + + + + + + + + + +
+ TTD Pasien + + Tempat & Tanggal
+ Cap dan TTD Dr. SpKFR +
+ (........................................................) + + (........................................................) +
+ +
+ + + \ No newline at end of file