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STATUS PASIEN

No. MR : Pekerjaan : Tanggal : Agama :Nama : Alamat :Kelamin :Umur :

DIAGNOSA:

1. ANAMNESA

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2. STATUS PRESENSSensorium : Frekwensi nafas : Tek.dara : Suu tu!u :Frekwensi nadi : KU"KP"K# :

3. STATUS LOKALISATA

A. TELINGADAUN TELINGA   KANAN K$R$   LIANG TELINGA  KANAN K$R$%isul : &uas :&uka : %enjolan :'airan : 'airan :N(eri tekan : )ara :Kelainan kongenital Nana :

•   Makroti : Serumen :

•   Mikroti : Krusta :

•   A**endage : Poli* :

•   Fistel : Fistel mastoid :

'or*us alineum :#ranulasi :

MEMBRAN TYMPANI: KANAN K$R$+arna

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•   Puti mutiara :

•   ,i*eremis :

•   )of -Suram :Re/eks 0aa(a :Atro1 :

%om!ering"!ulging :Perforasi :Retraksi :Penga*uran :

B. HIDUNG  RHINOSKOPI ANTERIOR   KANAN K$R$'a2um nasi :Sela*ut lendir :

•   Permukaan :

•   +arna :Konka :

•   $nferior :

•   Media :Meatus nasi :

•   $nferior :

•   Media :Se*tum nasi :

•   )e2iasi :

•   ,ematoma"a!ses"*erforasi :

Nana :)ara :Krusta :Poli* :'or*us alienum :Massa"tumor :

PARANASAL SINUS  Sinus Frontalis Sinus MaksillarisKANAN K$R$ KANAN K$R$

N(eri tekan Transluminasi

RONGGA MULUT TONSIL   KANANK$R$

A. %i!ir Permukaan :•   &uka : %esar :

%. #igi +arna :•   Karies : 3tter *ro* :

'. &ida Pli0a anterior :•   Sela*ut "!eslag: Kri*ta :

•   &uka : &akuna :

•   Pergerakan : Kel.limfe leer :). Palatum mole

warna :3. Faring

•   Sela*ut :

•   %enjolan :

4. LABORATORIUM

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•   )ara :

•   Urine :

5. PEMERIKSAAN PENUNJANG

6. RESUME______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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7. DIAGNOSA BANDING

8. DIAGNOSA SEMENTARA

. TERAPI

1!. USUL

 

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