:

No. RM

LAPORAN OPERASI

Nama

OPERATION REPORT

Tgl Lahir :

L / W *)

Ruangan :
Ahli Bedah :

Asisten I :

Perawat Instrumen :

Surgeon

Assistant I

Scrub Nurse

Assistant II

Anaesthetist Nurse

Asisten II :

Perawat anesthesi :

Dokter Anastesi :

Jenis Operasi :

Elektif

Anaesthetist

Operations type

Elektive

Cito

Emergency

Diagnosa pra operasi :

Jenis Anesthesi :
Anaesthesia

Regional Block

Spinal

Sedasi

General

Golongan Operasi :

Pra operation diagnosis

Local

Operation's category

Besar
Large

Sedang
Medium

Kecil
Small

Diagnosa Post Operasi :

Bahan dikirim ke patologi :

Ya

Post operation diagnosis

Spesiment sent to pathology

Yes

Tidak

No

Nama / Macam Operasi :

Jenis bahan :

Operation

Nature of Speciment

Tanggal

Operasi Mulai

Date

Desinfektan :
disifectant

Insisi :
incision

Yang ditemukan :
Findings

Prosedur :
Procedure

Jahitan :
Closure

Time Started

Operasi Selesai
Time Ended

Kultur :

Ya

Yes

Jam :

Jam :

Tidak

Time

Time

No

Halaman 1/2

Penyulit :
Complications

Jumlah Kehilangan Darah :

The amount of blood loss

Status fisiologis intraoperatif :

Intraoperative Physiological Status

Tensi darah :
Blood Pressure

Stabil
Stable

Naik
Up

Turun
Down

Nadi :
Pulse

Stabil
Stable

Naik
Up

Turun
Down

Tingkat Pernafasan :
Respiratoy rate

Stabil
Stable

Naik
Up

Turun
Down

Instruksi Pasca Bedah :

Post Operative Instructions

Tanda Tangan & Nama Lengkap DoktTanggal :

Surgeon's Signature & Full Name
Date
Jam
:
Time
Halaman 2/2