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File: observasi dan persetujuan restrain page 1.html
<html> <head> <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"> <style type="text/css"> .txt { white-space:nowrap; } #f0 { font-family:sans-serif; font-weight:normal; font-style:normal; } @font-face { font-family: ff0; src: url("0.ttf"); } #f1 { font-family:ff0,monospace; font-weight:bold; font-style:normal; } #f2 { font-family:sans-serif; font-weight:bold; font-style:normal; } #f3 { font-family:sans-serif; font-weight:normal; font-style:normal; } @font-face { font-family: ff1; src: url("1.ttf"); } #f4 { font-family:ff1,sans-serif; font-weight:normal; font-style:normal; } @font-face { font-family: ff2; src: url("2.ttf"); } #f5 { font-family:ff2,monospace; font-weight:normal; font-style:normal; } </style> </head> <body> <img id="background" style="position:absolute; left:0px; top:0px;" width="594" height="841" src="page1.png"> <div class="txt" style="position:absolute; left:107px; top:20px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Rumah Sakit Umum Aulia</span></div> <div class="txt" style="position:absolute; left:109px; top:32px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Jl. Jeruk Raya No.15 Jagakarsa, Jakarta Selatan</span></div> <div class="txt" style="position:absolute; left:108px; top:43px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Kotak Pos : 12620 Telp : (021) 727 0208</span></div> <div class="txt" style="position:absolute; left:445px; top:20px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">No Form : FR.RI.113-22</span></div> <div class="txt" style="position:absolute; left:441px; top:40px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">No Rev : 00</span></div> <div class="txt" style="position:absolute; left:379px; top:67px;"><span id="f3" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama</span></div> <div class="txt" style="position:absolute; left:451px; top:67px;"><span id="f3" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:379px; top:80px;"><span id="f3" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">No. Rm</span></div> <div class="txt" style="position:absolute; left:451px; top:80px;"><span id="f3" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:379px; top:94px;"><span id="f3" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">Tgl Lahir :</span></div> <div class="txt" style="position:absolute; left:379px; top:108px;"><span id="f3" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">Jenis Kelamin : L / P</span></div> <div class="txt" style="position:absolute; left:54px; top:159px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Ruang :</span></div> <div class="txt" style="position:absolute; left:54px; top:174px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Alamat :</span></div> <div class="txt" style="position:absolute; left:118px; top:139px;"><span id="f2" style="font-size:13px;vertical-align:baseline;color:rgba(0,0,0,1);">OBSERVASI DAN PERSETUJUAN TINDAKAN RESTRAINT</span></div> <div class="txt" style="position:absolute; left:54px; top:195px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Dokter harus di hubungi terlebih dahulu untuk mengisi aplikasi ini.</span></div> <div class="txt" style="position:absolute; left:54px; top:210px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tanggal Pengkajian</span></div> <div class="txt" style="position:absolute; left:175px; top:210px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:342px; top:210px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Oleh :</span></div> <div class="txt" style="position:absolute; left:54px; top:224px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tanda Tangan</span></div> <div class="txt" style="position:absolute; left:175px; top:225px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:54px; top:239px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Pengkajian Restrain</span></div> <div class="txt" style="position:absolute; left:175px; top:239px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:54px; top:253px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Dokter yang Merawat </span><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:54px; top:274px;"><span id="f3" style="font-size:0px;vertical-align:baseline;color:rgba(0,0,0,1);">Dihubung i</span></div> <div class="txt" style="position:absolute; left:175px; top:268px;"><span id="f3" style="font-size:0px;vertical-align:super;color:rgba(0,0,0,1);">: </span><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Ya</span></div> <div class="txt" style="position:absolute; left:261px; top:269px;"><span id="f3" style="font-size:7px;vertical-align:baseline;color:rgba(0,0,0,1);">Tidak</span></div> <div class="txt" style="position:absolute; left:97px; top:305px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tipe Restrain</span></div> <div class="txt" style="position:absolute; left:233px; top:306px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Lamanya Restrain</span></div> <div class="txt" style="position:absolute; left:382px; top:298px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Frekuensi Evaluasi Penggunaan</span></div> <div class="txt" style="position:absolute; left:380px; top:313px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Restrain (minimal setiap 24 jam)</span></div> <div class="txt" style="position:absolute; left:180px; top:394px;"><span id="f2" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">PERSETUJUAN OLEH DOKTER YANG MERAWAT</span></div> <div class="txt" style="position:absolute; left:54px; top:416px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Saya menyetujui tindakan pengekangan (restrain) berdasarkan pada:</span></div> <div class="txt" style="position:absolute; left:66px; top:430px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Observasi</span></div> <div class="txt" style="position:absolute; left:176px; top:430px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Informasi/ komunikasi dengan perawat</span></div> <div class="txt" style="position:absolute; left:315px; top:448px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Jakarta,</span></div> <div class="txt" style="position:absolute; left:417px; top:430px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Komunikasi antar tim kesehatan</span></div> <div class="txt" style="position:absolute; left:426px; top:448px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">, 20</span></div> <div class="txt" style="position:absolute; left:483px; top:448px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Jam:</span></div> <div class="txt" style="position:absolute; left:537px; top:448px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">WIB</span></div> <div class="txt" style="position:absolute; left:129px; top:471px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Dokter</span></div> <div class="txt" style="position:absolute; left:446px; top:471px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Saksi</span></div> <div class="txt" style="position:absolute; left:67px; top:530px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">(</span></div> <div class="txt" style="position:absolute; left:242px; top:530px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">)</span></div> <div class="txt" style="position:absolute; left:84px; top:547px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Lengkap dan Tanda Tangan</span></div> <div class="txt" style="position:absolute; left:373px; top:530px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">(</span></div> <div class="txt" style="position:absolute; left:545px; top:530px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">)</span></div> <div class="txt" style="position:absolute; left:393px; top:547px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Lengkap dan Tanda Tangan</span></div> <div class="txt" style="position:absolute; left:194px; top:579px;"><span id="f2" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">PEMBERITAHUAN KEPADA KELUARGA</span></div> <div class="txt" style="position:absolute; left:54px; top:598px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Keluarga Sudah Diberitahu : </span><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Ya</span></div> <div class="txt" style="position:absolute; left:261px; top:598px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tidak</span></div> <div class="txt" style="position:absolute; left:54px; top:612px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama</span></div> <div class="txt" style="position:absolute; left:175px; top:612px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:54px; top:627px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Hubungan dengan Pasien </span><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:54px; top:641px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Kebutuhan untuk Restrain : </span><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Fisik</span></div> <div class="txt" style="position:absolute; left:261px; top:641px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Obat </span><span id="f4" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">– </span><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Obatan</span></div> <div class="txt" style="position:absolute; left:54px; top:656px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tujuan Restrain</span></div> <div class="txt" style="position:absolute; left:175px; top:656px;"><span id="f3" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:54px; top:671px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Saya sudah menerima informasi dan mengerti perlunya tindakan ini.</span></div> <div class="txt" style="position:absolute; left:315px; top:689px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Jakarta,</span></div> <div class="txt" style="position:absolute; left:426px; top:689px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">, 20</span></div> <div class="txt" style="position:absolute; left:484px; top:689px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Jam:</span></div> <div class="txt" style="position:absolute; left:537px; top:689px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">WIB</span></div> <div class="txt" style="position:absolute; left:93px; top:721px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Dijelaskan Oleh</span></div> <div class="txt" style="position:absolute; left:393px; top:721px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Yang Menerima Informasi</span></div> <div class="txt" style="position:absolute; left:60px; top:776px;"><span id="f3" style="font-size:7px;vertical-align:baseline;color:rgba(0,0,0,1);">(</span></div> <div class="txt" style="position:absolute; left:231px; top:774px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">)</span></div> <div class="txt" style="position:absolute; left:66px; top:788px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Lengkap dan Tanda Tangan</span></div> <div class="txt" style="position:absolute; left:374px; top:774px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">(</span></div> <div class="txt" style="position:absolute; left:543px; top:774px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">)</span></div> <div class="txt" style="position:absolute; left:383px; top:788px;"><span id="f3" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Lengkap dan Tanda Tangan</span></div> </body> </html>