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Formulir Pemeriksaan Radiologi Formulir Pemeriksaan Radiologi

This document is a radiology examination form from PKU Muhammadiyah Purbalingga hospital. It contains the patient's information such as name, age, gender, room, and date of examination. It lists various body parts and imaging tests that can be requested, including non-contrast exams of the head, chest, abdomen, pelvis, and extremities as well as contrast exams like intravenous pyelogram and hysterosalpingography. The attending physician's name and clinical notes are included as well.

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57 views1 page

Formulir Pemeriksaan Radiologi Formulir Pemeriksaan Radiologi

This document is a radiology examination form from PKU Muhammadiyah Purbalingga hospital. It contains the patient's information such as name, age, gender, room, and date of examination. It lists various body parts and imaging tests that can be requested, including non-contrast exams of the head, chest, abdomen, pelvis, and extremities as well as contrast exams like intravenous pyelogram and hysterosalpingography. The attending physician's name and clinical notes are included as well.

Uploaded by

Martono
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PKU MUHAMMADIYAH PURBALINGGA

PKU MUHAMMADIYAH PURBALINGGA Jl. Kolonel Sugiri, Gandasuli, Bobotsari, Purbalingga 533353
Jl. Kolonel Sugiri, Gandasuli, Bobotsari, Purbalingga 533353 Telp 0281 758808 Email : pkum_pbg@yahoo.com
Telp 0281 758808 Email : pkum_pbg@yahoo.com
FORMULIR PEMERIKSAAN RADIOLOGI
FORMULIR PEMERIKSAAN RADIOLOGI No. RM : Tanggal :
No. RM : Tanggal : Nama Pasien :
Nama Pasien : Umur :
Umur : Jenis Kelamin :P/L
Jenis Kelamin :P/L Ruang Rawat :
Ruang Rawat : Tanggal Pemeriksaan :
Keterangan Klinis : Dr.
(..............................................)
Tanggal Pemeriksaan :
Keterangan Klinis : Dr.
(..............................................) NON CONTRAS ANGGOTA GERAK BAWAH
NON CONTRAS ANGGOTA GERAK BAWAH  Cranium  Pedis dextra/sinistra
 Cranium  Pedis dextra/sinistra  Sinus Paranasal  Ankle Joint dextra/sinistra
 Sinus Paranasal  Ankle Joint dextra/sinistra  Nasal  Cruris dextra/sinistra
 Nasal  Cruris dextra/sinistra  Thorax  Knee joint(Genu)
 Thorax  Knee joint(Genu)  Abdomen Ap dextra/sinistra
 Abdomen Ap dextra/sinistra  Abdomen 3 Posisi  Femur dextra/sinistra
 Abdomen 3 Posisi  Femur dextra/sinistra  Pelvis AP  Hip Joint dextra/sinistra
 Pelvis AP  Hip Joint dextra/sinistra ANGGOTA GERAK ATAS TULANG BELAKANG
ANGGOTA GERAK ATAS TULANG BELAKANG  Clavikula dextra/sinistra  Cervikal
 Clavikula dextra/sinistra  Cervikal  Scapula dextra/sinistra  ThoracaliS
 Scapula dextra/sinistra  ThoracaliS  Manus dextra/sinistra  Thoracolumbal
 Manus dextra/sinistra  Thoracolumbal  Wrist joint dextra/sinistra  Lumbal
 Wrist joint dextra/sinistra  Lumbal  Antebrachi dextra/sinistra  Lumbosacral
 Antebrachi dextra/sinistra  Lumbosacral  Elbow Joint dextra/sinistra USG
 Elbow Joint dextra/sinistra USG  Humerus dextra/sinistra  USG Abdomen
 Humerus dextra/sinistra  USG Abdomen  Shoulder Joint dextra/sinistra CONTRAS
 Shoulder Joint dextra/sinistra CONTRAS  BNO IVP
 BNO IVP  Colon In Loop
 Colon In Loop  OMD
 OMD  HSG
 HSG

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