MODUL 2

ADMISSION TO
A HOSPITAL
&
general assessment
 VOCABULARY
 Sure name
 Last name
 Family name : Nama keluarga di tulis
diakhir
 First name

 Given name : Nama kelahiran yang

diberikan diluar nama
kelarga , ditulis /disebutkan
di bagian awal

 Next of kin : Kerabat dekat

Civil state (be :marintal
status ) status pernikahan
 QUESTIONAIRE TO FILL IN
ADMISSION FORM

SURE NAME (IN BLOCK LETTER)

 What’s your name ?How do you spell it please ?
 Name please !
FIRST NAME (S)
 What’s your first name ? (your Christian names)
 How do You spell it ?
ADDRESS &TELEPHONE NO.
 Where do you live ?
 Are you on the phone ?
NEXT

DATE OF BIRTH
 When were you born ?

 Your date of birth please !

CIVIL STATE (Married, Single,Widowed or Other)

 Are you married ?

OCCUPATION
 What’s your occupation

 What’s his father’s occupation (in this case of child,

father’s occupation)
next
RELEGION
 What’s your relegion ? (Note : In some
states, it’s no oppropriate to ask this
question. It’s necessary to follow the culture.)
NAME & ADDRESS NEXT OF KIN
 Who’s your nearest relative ?
 Your next of kin
 Do you live at the same address?
 next
NAME & ADDRESS OF G.P*)
• Who’s your family doctor His Address ?
• What’s his address?
TELEPHONE NO.( if no phone, give a number where
messages may be sent. Add’ message only).
• Who can I give message ?
• Any contact person in emergency case ?
SURGEON OR PHYSICIAN IN CHARGE OF CASE
• Who is the doctor in charge of your case ?
• Do you know the doctor in charge of your case?
Study this conversation bellow,

 A casualty. A man got an accident; he was hit

by a motorcycle when he was crossing the
street. He is transferred to ER, by
ambulance. He is conscious. After a
roentgen. The doctor diagnoses that he has
fractures in his right leg
 NEXT
• Nurse : good morning Mr. Jake
• Patient : good morning Nurse
• Nurse : Excuse, Mrs. Jakes? The doctor diagnosed that you have a
fracture in your right leg. You need to have a couple of days of treatment. The
doctor suggests you to be hospitalize for the treatment. Now, I need to ask you
some question to fill in the admission form need to ask you some question
to fill in the admission form
• Patient : sure, please
• Nurse : what’s your sure name?
• Patient : my name is Mr. Jakes
• Nurse : how do you spell it ?
• Patient : J- a-k-e-s
• Nurse :When were you born ?
• Patient : I was born on July 17TH 1980
• Nurse : what’s you occupation
• Patient : I work as lecture at Hangtua
University
• Nurse : Are you married ?
• Patient : yes
• Nurse : Who’s your next of kin ?
• Patient : It’s my wife
• Nurse : whom should contact in this case?
• Patient : Just contact my
wife………….continues in details?
• Nurse : Well that’s enough Mr. jakes
 part I
Collecting demographic
data
Collecting demographic data
element
• Implementation step
Explaining what you are going to do
immediately
• It is time for me ….
• I just want to ……… interview you
• I would like to ……… asses your health
• I am going to condition
• I need to……….
 example
Well Mr. James i need to collect your personal data
I’m going to ask you some personal data

Certainly, nurse
 Question to colletc demographic elements
• Name
– What is your name ?
– What is your complete name ?
– What is your name ?

• Age
– How old are you ?

• Address
– What is your address ?
– Where do you live ?

• Phone
– Your phone number, please
– What is your phone number ?
– Do you have mobile phone number ?
 Continous
• Ethinic origin
» What is your ethnic origin ?
• Marital status
» Are you married ?
• Health insurance
» Do you have any health insurance ?

• Occupation & title

» What is occupation ?
» Do you have academic title ?
» What is your title?
» What do you do
• Next of kin
» Who is your next of kin ?
• Reason for contact
» What brings you in this hospital ?
» Who sends you to this hospital ?
» What makes you come to this hospital
 note
• In european and american countries,
this kind of question is recently
skipped
• Reason for contact : it is a reason
that makes you come to hospital. It
can be a complain, medical check up
organized by your company
 Part II
Current health and illness status

Assessment step
• Current health status
• What do you think about your health ?
• Would you tell me about your health
condition recently ?
• Example of Patient respon
• I’m usually healthy,have usual cold, and have to take
medicine for high blood pressure.
 Elimination pattern
• Would you tell me about your.........?
• How many times a day do you do
your ..........?
• Do you have problem with your......?
» Bowel motion
» Water work
• Is the stool formed or loose ?
• Is you waterworks sluggish ?
 Part 3
history of past health and
ilnessess
• This part helps you interview your
patient to gain information about
his/her past health illnesses
 Assesment step 1
• Asking common communicable diseases.
• Have you ever had + .......(a kind of disease)
• Respone :yes i have/ no i haven’t
• How old were you when you got it?
• Respone : i was about......years old
• Kinds of diseases : measles,chicken
pox,rubella,rheumatic,fever,diphtheria,sca
rlet fever,polio,infectious mononucleosis
 Assesment step 2
Asking about imunizations
• Have you ever been immunized
against + (a kind of diseasea) see
above
• Have you ever got .....+(a kind of
disease)......immunization
Example : have you ever got polio
immunizations ?
 Assesment step 3
• Asking about allergies
• Are you alergic to........(certain
food/medication)
• Example : are you alergic to
penicillin/ antibiotic)