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DataPenilaianKorbanKekerasan.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='3800px' border='0' align='center' cellpadding='3px' cellspacing='0' class='tbl_form'><tr class='isi2'><td valign='top' align='center'><font size='4' face='Tahoma'>RS SIMRS KHANZA</font><br>GUWOSARI, Pajangan, Bantul<br>Hp: 08562675039, 085296559963, E-mail : khanzasoftmedia@gmail.com<br><br><font size='2' face='Tahoma'>DATA PENILAIAN KORBAN KEKERASAN<br><br></font></td></tr></table>
</head>
<body>
<table width="3800px" border="0" align="center" cellpadding="1px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.Rawat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>No.RM</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Pasien</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tgl.Lahir</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>J.K.</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kode/NIP</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Pemeriksa</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tanggal</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Anamnesis</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Hubungan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Jml.Saudara</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kondisi Keluarga Inti</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Hubungan Orang Terdekat</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Jenis Kekerasan/Penganiayaan Yang Dialami</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tempat Kejadian Kekerasan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Lama</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Periode</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Seberapa Sering Mengalami Kekerasan / Penganiayaan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemicu Kekerasan / Penganiayaan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Yang Melakukan Kekerasan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Dampak Yang Terjadi Pada Korban Kekerasan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Tanda-tanda Yang Didapatkan Pada Korban Kekerasan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Memerlukan Pendampingan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Kelainan/Gangguan Jiwa</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Kepala</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Thoraks</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Leher</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Abdomen</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Genitalia</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Ekstrimitas Atas</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Ekstrimitas Bawah</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Pemeriksaan Anus</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2023/01/27/000002
</td>
<td valign="top">
000003
</td>
<td valign="top">
HAFIZ HARIYADI
</td>
<td valign="top">
1997-05-22
</td>
<td valign="top">
Laki-Laki
</td>
<td valign="top">
D0000003
</td>
<td valign="top">
dr. Qotrunnada
</td>
<td valign="top">
2023-03-10 18:03:09.0
</td>
<td valign="top">
Autoanamnesis
</td>
<td valign="top">
1
</td>
<td valign="top">
2
</td>
<td valign="top">
Broken Home
</td>
<td valign="top">
Tidak Ada Masalah
</td>
<td valign="top">
3 asasas as as as
</td>
<td valign="top">
4
</td>
<td valign="top">
5
</td>
<td valign="top">
Tahun
</td>
<td valign="top">
6
</td>
<td valign="top">
7
</td>
<td valign="top">
8
</td>
<td valign="top">
9
</td>
<td valign="top">
10 sasasas
</td>
<td valign="top">
Tidak
</td>
<td valign="top">
11
</td>
<td valign="top">
12
</td>
<td valign="top">
13
</td>
<td valign="top">
14
</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
<td valign="top">
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</td>
</tr>
</table>
</body>
</html>