DETASEMEN KESEHATAN WILAYAH 02.04.02 DETASEMEN KESEHATAN WILAYAH 02.04.

02
RUMAH SAKIT PEMBANTU 02.09.04 KERINCI RUMAH SAKIT PEMBANTU 02.09.04 KERINCI

Nama : …………………………………….. Ruangan : ……………………………… Nama : …………………………………….. Ruangan : ………………………………

Umur : …………………………………….. Alamat : ……………………………… Umur : …………………………………….. Alamat : ………………………………
FORMULIR PEMERIKSAAN FISIOTERAPI FORMULIR PEMERIKSAAN FISIOTERAPI
RUMKITBAN 02.09.04 KERINCI RUMKITBAN 02.09.04 KERINCI
6. NECK 1. LUMBAL-COXY
1. NECK 6. LUMBAL-COXY
o Hnp Cervical o HNP Lumbal o Hnp Cervical o HNP Lumbal
o Cervical Root Syndrome (CRS) o Low Back Pain (LBP) o Cervical Root Syndrome (CRS) o Low Back Pain (LBP)
o Tortikolis o ischialgia o Tortikolis o ischialgia
o Tension Type Headache (TTH) o OA Lumbal o Tension Type Headache (TTH) o OA Lumbal
o Spondilosis Cervical o Spondilosis o Spondilosis Cervical o Spondilosis
o OA Cervical o Spondiloarthrosis o OA Cervical o Spondiloarthrosis
o Vertigo o Pinformis Syndrome o Vertigo o Pinformis Syndrome
7. SHOULDER 2. PATELLA
2. SHOULDER 7. PATELLA
o Bursitis o ACL o Bursitis o ACL
o Tendinitis o OA Genu o Tendinitis o OA Genu
o Brachialgia o TKR o Brachialgia o TKR
o Capsulitis o Kista Deker o Capsulitis o Kista Deker
o Frozen Shoulder 3. ANKLE o Frozen Shoulder 8. ANKLE
8. WRIST & FINGER o Sprain Ankle 3. WRIST & FINGER o Sprain Ankle
o Tringer Finger o Calcaneus Spoor o Tringer Finger o Calcaneus Spoor
o Carpal Tunnel Syndrome (CTS) o Plantar Fascitis o Carpal Tunnel Syndrome (CTS) o Plantar Fascitis
o Dequair Vaim Syndrome 4. WAJAH o Dequair Vaim Syndrome 9. WAJAH
o Reumathoid Athritis o Bellspalsy o Reumathoid Athritis o Bellspalsy
9. CHEST FISIOTERAPI o Tic Fasclasis
4. CHEST FISIOTERAPI o Tic Fasclasis
10. STROKE
5. HEMIPARASE 5. STROKE
10. HEMIPARASE
Sungai Penuh, ……………………………..20
Permintaan Dokter Sungai Penuh, ……………………………..20
Permintaan Dokter

( )
( )