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<html>
<head><link href="file.css" rel="stylesheet" type="text/css" />
</head>
<body><table width='100%' border='0' align='center' cellpadding='3px' cellspacing='0' class='tbl_form'><tr class='isi'><td valign='top' width='20%'>No.RM</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>000011</td></tr><tr class='isi'><td valign='top' width='20%'>Nama Pasien</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>SETIYAWAN KRISTANTO</td></tr><tr class='isi'><td valign='top' width='20%'>Alamat</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>JL. DOKTER CIPTI RT 01/RW01, BEDALI, LAWANG, KABUPATEN MALANG</td></tr><tr class='isi'><td valign='top' width='20%'>Jenis Kelamin</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>Laki-Laki</td></tr><tr class='isi'><td valign='top' width='20%'>Tempat & Tanggal Lahir</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>MALANG 1990-02-21</td></tr><tr class='isi'><td valign='top' width='20%'>Ibu Kandung</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>JUMINTEN</td></tr><tr class='isi'><td valign='top' width='20%'>Golongan Darah</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>A</td></tr><tr class='isi'><td valign='top' width='20%'>Status Nikah</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>MENIKAH</td></tr><tr class='isi'><td valign='top' width='20%'>Agama</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>ISLAM</td></tr><tr class='isi'><td valign='top' width='20%'>Pendidikan Terakhir</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr><tr class='isi'><td valign='top' width='20%'>Bahasa Dipakai</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>INDONESIA</td></tr><tr class='isi'><td valign='top' width='20%'>Cacat Fisik</td><td valign='top' width='1%' align='center'>:</td><td valign='top' width='79%'>-</td></tr></table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr class="isi">
<td valign="top" width="2%">
1
</td>
<td valign="top" width="18%">
No.Rawat
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
2023/03/07/000001
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
No.Registrasi
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
001
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Tanggal Registrasi
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
2023-03-07 12:20:37
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Unit/Poliklinik
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
INT Poli Penyakit Dalam
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Dokter Poli
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
dr. Hilyatul Nadia
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Cara Bayar
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
UMUM
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Penanggung Jawab
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
-
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Alamat P.J.
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
JL. DOKTER CIPTI RT 01/RW01, BEDALI, LAWANG, KABUPATEN MALANG
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Hubungan P.J.
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
SAUDARA
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Status
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
Ralan
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Pemeriksaan Rawat Jalan
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr align="center">
<td valign="top" width="4%" bgcolor="#FFFAF8">
No.
</td>
<td valign="top" width="15%" bgcolor="#FFFAF8">
Tanggal
</td>
<td valign="top" width="54%" bgcolor="#FFFAF8" colspan="7">
Dokter/Paramedis
</td>
<td valign="top" width="27%" bgcolor="#FFFAF8" colspan="3">
Profesi/Jabatan/Departemen
</td>
</tr>
<tr>
<td valign="top" align="center">
1
</td>
<td valign="top">
2023-03-07 12:22:26
</td>
<td valign="top" colspan="7">
D0000004 dr. Hilyatul Nadia
</td>
<td valign="top" colspan="3">
dokter umum
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" colspan="2">
Subjek
</td>
<td valign="top" colspan="8">
: saasas
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" colspan="2">
Objek
</td>
<td valign="top" colspan="8">
: asasas
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
Suhu(C)
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
Tensi
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
Nadi(/menit)
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
Respirasi(/menit)
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
Tinggi(Cm)
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
Berat(Kg)
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
SpO2(%)
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
GCS(E,V,M)
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
Kesadaran
</td>
<td valign="top" width="8%" bgcolor="#FFFAF8" align="center">
L.P.(Cm)
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
Compos Mentis
</td>
<td valign="top" align="center">
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" colspan="2">
Asesmen
</td>
<td valign="top" colspan="8">
: asas
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" colspan="2">
Plan
</td>
<td valign="top" colspan="8">
: asas
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" colspan="2">
Instruksi
</td>
<td valign="top" colspan="8">
: asas
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top" align="center">
</td>
<td valign="top" colspan="2">
Evaluasi
</td>
<td valign="top" colspan="8">
: sas
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Diagnosa/Penyakit/ICD 10
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr align="center">
<td valign="top" width="4%" bgcolor="#FFFAF8">
No.
</td>
<td valign="top" width="24%" bgcolor="#FFFAF8">
Kode
</td>
<td valign="top" width="51%" bgcolor="#FFFAF8">
Nama Penyakit
</td>
<td valign="top" width="23%" bgcolor="#FFFAF8">
Status
</td>
</tr>
<tr>
<td valign="top" align="center">
1
</td>
<td valign="top">
I50.1
</td>
<td valign="top">
Left ventricular failure
</td>
<td valign="top">
Ralan
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Prosedur/Tindakan/ICD 9
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr align="center">
<td valign="top" width="4%" bgcolor="#FFFAF8">
No.
</td>
<td valign="top" width="24%" bgcolor="#FFFAF8">
Kode
</td>
<td valign="top" width="51%" bgcolor="#FFFAF8">
Nama Prosedur
</td>
<td valign="top" width="23%" bgcolor="#FFFAF8">
Status
</td>
</tr>
<tr>
<td valign="top" align="center">
1
</td>
<td valign="top">
02.07
</td>
<td valign="top">
Removal of skull plate
</td>
<td valign="top">
Ralan
</td>
</tr>
</table>
</td>
</tr>
<tr class="isi">
<td valign="top" width="2%">
</td>
<td valign="top" width="18%">
Biaya & Perawatan
</td>
<td valign="top" width="1%" align="center">
:
</td>
<td valign="top" width="79%">
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top" width="89%">
Administrasi
</td>
<td valign="top" width="1%" align="right">
:
</td>
<td valign="top" width="10%" align="right">
0
</td>
</tr>
</table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top" colspan="5">
Pemeriksaan Radiologi
</td>
<td valign="top" colspan="1" align="right">
:
</td>
<td valign="top">
</td>
</tr>
<tr align="center">
<td valign="top" width="4%" bgcolor="#FFFAF8">
No.
</td>
<td valign="top" width="15%" bgcolor="#FFFAF8">
Tanggal
</td>
<td valign="top" width="10%" bgcolor="#FFFAF8">
Kode
</td>
<td valign="top" width="26%" bgcolor="#FFFAF8">
Nama Pemeriksaan
</td>
<td valign="top" width="18%" bgcolor="#FFFAF8">
Dokter PJ
</td>
<td valign="top" width="17%" bgcolor="#FFFAF8">
Petugas
</td>
<td valign="top" width="10%" bgcolor="#FFFAF8">
Biaya
</td>
</tr>
<tr>
<td valign="top" align="center">
1
</td>
<td valign="top">
2023-03-07 12:21:38
</td>
<td valign="top">
ICU-01
</td>
<td valign="top">
THORAX AP/PA<br>
</td>
<td valign="top">
dr. Aisyah
</td>
<td valign="top">
ANJASMARA
</td>
<td valign="top" align="right">
180,000
</td>
</tr>
</table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top" colspan="3">
Gambar Radiologi
</td>
</tr>
<tr align="center">
<td valign="top" width="4%" bgcolor="#FFFAF8">
No.
</td>
<td valign="top" width="15%" bgcolor="#FFFAF8">
Tanggal
</td>
<td valign="top" width="81%" bgcolor="#FFFAF8">
Gambar Radiologi
</td>
</tr>
<tr>
<td valign="top" align="center">
1
</td>
<td valign="top">
2023-03-07 12:21:38
</td>
<td valign="top" align="center">
<a href="http://localhost:80/webapps/radiologi/pages/upload/polos1.jpg"><img alt="Gambar Radiologi" src="http://localhost:80/webapps/radiologi/pages/upload/polos1.jpg" width="450" height="450">
</a>
</td>
</tr>
</table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>
<td valign="top" colspan="5">
Pemeriksaan Laboratorium PK & MB
</td>
<td valign="top" colspan="1" align="right">
:
</td>
<td valign="top">
</td>
</tr>
<tr align="center">
<td valign="top" width="4%" bgcolor="#FFFAF8">
No.
</td>
<td valign="top" width="15%" bgcolor="#FFFAF8">
Tanggal
</td>
<td valign="top" width="10%" bgcolor="#FFFAF8">
Kode
</td>
<td valign="top" width="26%" bgcolor="#FFFAF8">
Nama Pemeriksaan
</td>
<td valign="top" width="18%" bgcolor="#FFFAF8">
Dokter PJ
</td>
<td valign="top" width="17%" bgcolor="#FFFAF8">
Petugas
</td>
<td valign="top" width="10%" bgcolor="#FFFAF8">
Biaya
</td>
</tr>
<tr>
<td valign="top" align="center">
1
</td>
<td valign="top">
2023-03-07 12:21:16
</td>
<td valign="top">
101-K.3
</td>
<td valign="top">
Hematologi Darah Rutin ( CITO )
</td>
<td valign="top">
dr. Hilyatul Nadia
</td>
<td valign="top">
FREDIAN AHMAD
</td>
<td valign="top" align="right">
185,000
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top" align="center" bgcolor="#FFFAF8">
Detail Pemeriksaan
</td>
<td valign="top" align="center" bgcolor="#FFFAF8">
Hasil
</td>
<td valign="top" align="center" bgcolor="#FFFAF8">
Nilai Rujukan
</td>
<td valign="top" align="right">
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Hemoglobin
</td>
<td valign="top">
3 g/dl
</td>
<td valign="top">
13.5-18.0
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Rhesus
</td>
<td valign="top">
3 g/dl
</td>
<td valign="top">
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Golongan Darah
</td>
<td valign="top">
3
</td>
<td valign="top">
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
LED
</td>
<td valign="top">
3 mm/jam
</td>
<td valign="top">
10
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
MCHC
</td>
<td valign="top">
3 %
</td>
<td valign="top">
32.0-37.0
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
MCH
</td>
<td valign="top">
3 pg
</td>
<td valign="top">
27.0-31.0
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
MCV
</td>
<td valign="top">
3 fl
</td>
<td valign="top">
82.0-92.0
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Erytrosit
</td>
<td valign="top">
3 juta
</td>
<td valign="top">
4.5-5.5
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Trombosit
</td>
<td valign="top">
3 u/L
</td>
<td valign="top">
150.000-440.000
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Hematokrit
</td>
<td valign="top">
3 %
</td>
<td valign="top">
40.0-48.0
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Gran%
</td>
<td valign="top">
3 %
</td>
<td valign="top">
50-70
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Mid%
</td>
<td valign="top">
3 %
</td>
<td valign="top">
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Lymph%
</td>
<td valign="top">
3 %
</td>
<td valign="top">
20-40
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Diffcount
</td>
<td valign="top">
3
</td>
<td valign="top">
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
Leukosit
</td>
<td valign="top">
3 /mm3
</td>
<td valign="top">
5.000-10.000
</td>
<td valign="top" align="right">
0
</td>
</tr>
<tr>
<td valign="top" align="center">
</td>
<td valign="top">
</td>
<td valign="top">
</td>
<td valign="top">
SDT/Malaria
</td>
<td valign="top">
3
</td>
<td valign="top">
negatif
</td>
<td valign="top" align="right">
0
</td>
</tr>
</table>
<table width="100%" border="0" align="center" cellpadding="3px" cellspacing="0" class="tbl_form">
<tr>