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DataPenilaianPasienPenyakitMenular.html
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DataPenilaianPasienPenyakitMenular.html
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<html>
<head><link href="file2.css" rel="stylesheet" type="text/css" /><table width='2600px' 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 PASIEN PENYAKIT MENULAR<br><br></font></td></tr></table>
</head>
<body>
<table width="2600px" 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 Dokter</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Nama Dokter</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>Mengetahui Penyakitnya</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Penyakit Sama Serumah</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Kontak</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Riwayat Kontak</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Transmisi Penularan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keterangan Transmisi Penularan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Kebutuhan Ruang</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Keluhan Yang Dirasakan Saat Ini</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Penyakit Keluarga</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Alergi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Vaksinasi</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Riwayat Pengobatan</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Diagnosa Utama</b>
</td>
<td valign="middle" bgcolor="#FFFAF8" align="center">
<b>Diagnosa Tambahan</b>
</td>
</tr>
<tr class="isi">
<td valign="top">
2022/08/09/000002
</td>
<td valign="top">
000006
</td>
<td valign="top">
SAKHA HAMIZAN AQILA
</td>
<td valign="top">
2017-08-03
</td>
<td valign="top">
Laki-Laki
</td>
<td valign="top">
D0000004
</td>
<td valign="top">
dr. Hilyatul Nadia
</td>
<td valign="top">
2023-03-20 21:57:02.0
</td>
<td valign="top">
Autoanamnesis
</td>
<td valign="top">
1
</td>
<td valign="top">
Ya
</td>
<td valign="top">
Ya
</td>
<td valign="top">
Berkunjung Ke Daerah Endemik Dalam 2 Minggu Terakhir
</td>
<td valign="top">
2
</td>
<td valign="top">
Cairan Tubuh Lainnya
</td>
<td valign="top">
3
</td>
<td valign="top">
Ruang Rawat Biasa
</td>
<td valign="top">
4
</td>
<td valign="top">
5
</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
</td>
</tr>
</table>
</body>
</html>