[ Mini Kiebo ]
Server: Windows NT DESKTOP-5B8S0D4 6.2 build 9200 (Windows 8 Professional Edition) i586
Path:
D:
/
Backup
/
Data Shendy
/
Back up Shendy
/
Download
/
[
Home
]
File: pasien masuk ICU 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; } #f1 { font-family:sans-serif; font-weight:bold; font-style:normal; } #f2 { font-family:sans-serif; font-weight:normal; font-style:normal; } @font-face { font-family: ff0; src: url("0.ttf"); } #f3 { font-family:ff0,monospace; font-weight:normal; font-style:normal; } #f4 { font-family:monospace; font-weight:bold; font-style:italic; } #f5 { font-family:sans-serif; font-weight:bold; font-style:normal; } @font-face { font-family: ff1; src: url("1.ttf"); } #f6 { font-family:ff1,sans-serif; font-weight:normal; font-style:normal; } #f7 { font-family:monospace; font-weight:normal; font-style:normal; } @font-face { font-family: ff2; src: url("2.ttf"); } #f8 { font-family:ff2,sans-serif; font-weight:normal; font-style:normal; } @font-face { font-family: ff3; src: url("3.ttf"); } #f9 { font-family:ff3,sans-serif; font-weight:bold; font-style:normal; } </style> </head> <body> <img id="background" style="position:absolute; left:0px; top:0px;" width="595" height="841" src="page1.png"> <div class="txt" style="position:absolute; left:261px; top:9px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,175,80,1);">RUMAH SAKIT</span></div> <div class="txt" style="position:absolute; left:281px; top:20px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(255,0,0,1);">AULIA</span></div> <div class="txt" style="position:absolute; left:262px; top:32px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(4,98,193,1);">www.rsaulia.com</span></div> <div class="txt" style="position:absolute; left:162px; top:43px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Alamat : Jalan Jeruk Raya No. 15, Jagakarsa, Jakarta Selatan 12620</span></div> <div class="txt" style="position:absolute; left:246px; top:55px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Email : info@rsaulia.com</span></div> <div class="txt" style="position:absolute; left:227px; top:66px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Telp : (021) 7270208; 7866057</span></div> <div class="txt" style="position:absolute; left:451px; top:21px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">No Form : FR.RI.107-22</span></div> <div class="txt" style="position:absolute; left:453px; top:41px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">No Rev : 00</span></div> <div class="txt" style="position:absolute; left:158px; top:90px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">FORMULIR PASIEN MASUK INTENSIVE CARE UNIT (ICU)</span></div> <div class="txt" style="position:absolute; left:250px; top:102px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">IDENTITAS PASIEN</span></div> <div class="txt" style="position:absolute; left:61px; top:114px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Pasien</span></div> <div class="txt" style="position:absolute; left:185px; top:114px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">: ........................................................</span></div> <div class="txt" style="position:absolute; left:359px; top:114px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Ruang : .........................</span></div> <div class="txt" style="position:absolute; left:61px; top:125px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Tgl. Lahir/ Jenis Kelamin : ........................................................</span></div> <div class="txt" style="position:absolute; left:61px; top:137px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">No. RM</span></div> <div class="txt" style="position:absolute; left:185px; top:137px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">: ........................................................</span></div> <div class="txt" style="position:absolute; left:61px; top:148px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Alamat</span></div> <div class="txt" style="position:absolute; left:185px; top:148px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">: ........................................................</span></div> <div class="txt" style="position:absolute; left:33px; top:160px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Yth. Dokter Penanggung Jawab ICU :</span></div> <div class="txt" style="position:absolute; left:33px; top:172px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">dr. ....................................................</span></div> <div class="txt" style="position:absolute; left:33px; top:183px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Bersama ini kami hadapkan pasien dengan kondisi :</span></div> <div class="txt" style="position:absolute; left:33px; top:195px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">...............................................................................................................................................................................................................</span></div> <div class="txt" style="position:absolute; left:33px; top:206px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">...............................................................................................................................................................................................................</span></div> <div class="txt" style="position:absolute; left:33px; top:218px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Diagnosa Medis : ............................................................................................................ ......................................................................</span></div> <div class="txt" style="position:absolute; left:33px; top:229px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Mohon penatalaksanaan selanjutnya dapat dilakukan di ruang ICU</span></div> <div class="txt" style="position:absolute; left:197px; top:241px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Jakarta, ............................................. Jam .............</span></div> <div class="txt" style="position:absolute; left:283px; top:252px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Dokter</span></div> <div class="txt" style="position:absolute; left:233px; top:287px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">...................................................</span></div> <div class="txt" style="position:absolute; left:231px; top:298px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Terang dan Tanda Tangan</span></div> <div class="txt" style="position:absolute; left:171px; top:310px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">PERSETUJUAN DOKTER PENANGGUNG JAWAB ICU</span></div> <div class="txt" style="position:absolute; left:35px; top:322px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">A. KRITERIA MAYOR</span></div> <div class="txt" style="position:absolute; left:218px; top:322px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">JALAN NAPAS</span></div> <div class="txt" style="position:absolute; left:402px; top:322px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">LAIN </span><span id="f9" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">– </span><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">LAIN</span></div> <div class="txt" style="position:absolute; left:33px; top:334px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Post Operasi kraniotomi, laparotomi,</span></div> <div class="txt" style="position:absolute; left:51px; top:346px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">torakotomi, multiple fraktur, total</span></div> <div class="txt" style="position:absolute; left:51px; top:357px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">tiroidektomi dan operasi jantung.</span></div> <div class="txt" style="position:absolute; left:33px; top:369px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Butuh Ventilasi Mekanik</span></div> <div class="txt" style="position:absolute; left:35px; top:381px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">B. KRITERIA MINOR</span></div> <div class="txt" style="position:absolute; left:35px; top:393px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">KESADARAN</span></div> <div class="txt" style="position:absolute; left:33px; top:405px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">GCS <8</span></div> <div class="txt" style="position:absolute; left:33px; top:417px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Kejang Umum</span></div> <div class="txt" style="position:absolute; left:33px; top:429px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Sopor / koma</span></div> <div class="txt" style="position:absolute; left:33px; top:441px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Sistem AVPU : hanya respon nyeri</span></div> <div class="txt" style="position:absolute; left:33px; top:453px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">SIRKULASI</span></div> <div class="txt" style="position:absolute; left:33px; top:465px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Hr >90 atau <50 x/menit dengan</span></div> <div class="txt" style="position:absolute; left:49px; top:477px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">pulsasi lemah.</span></div> <div class="txt" style="position:absolute; left:219px; top:334px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Ancaman/ gangguan patensi jalan</span></div> <div class="txt" style="position:absolute; left:233px; top:346px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">napas (stridor, gurgling, snoring,</span></div> <div class="txt" style="position:absolute; left:233px; top:357px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">hoarseness)</span></div> <div class="txt" style="position:absolute; left:219px; top:369px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Terpasang ETT</span></div> <div class="txt" style="position:absolute; left:218px; top:393px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">PERNAPASAN</span></div> <div class="txt" style="position:absolute; left:219px; top:405px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">RR >30 atau <10 x/menit</span></div> <div class="txt" style="position:absolute; left:219px; top:417px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Gerak otot napas tambahan (napas</span></div> <div class="txt" style="position:absolute; left:233px; top:429px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">cuping hidung, otot suprasternal, otot</span></div> <div class="txt" style="position:absolute; left:233px; top:440px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">intercostal, dan substernal)</span></div> <div class="txt" style="position:absolute; left:219px; top:452px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Kelelahan nafas (nafas cepat, dangkal,</span></div> <div class="txt" style="position:absolute; left:233px; top:464px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">keringat dingin, dan kelelahan).</span></div> <div class="txt" style="position:absolute; left:219px; top:476px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f8" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">SpO2 <92% dengan NRM ≥ 6 Lpm</span></div> <div class="txt" style="position:absolute; left:404px; top:334px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Pasca henti jantung (ROSC)</span></div> <div class="txt" style="position:absolute; left:404px; top:347px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Trombosit <100.000 dengan</span></div> <div class="txt" style="position:absolute; left:418px; top:358px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">ancaman perdarahan aktif.</span></div> <div class="txt" style="position:absolute; left:404px; top:370px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Kalium <2 atau >6 mEq/L (disertai</span></div> <div class="txt" style="position:absolute; left:418px; top:382px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">gangguan kardiovaskular)</span></div> <div class="txt" style="position:absolute; left:404px; top:394px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Natrium <120 mEq/L yang disertai</span></div> <div class="txt" style="position:absolute; left:418px; top:406px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">gangguan kesadaran.</span></div> <div class="txt" style="position:absolute; left:404px; top:418px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Hipokalemia dengan gangguan</span></div> <div class="txt" style="position:absolute; left:418px; top:429px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">kesadaran dan kardiovaskular.</span></div> <div class="txt" style="position:absolute; left:404px; top:441px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Anuria selama 12 jam disertai</span></div> <div class="txt" style="position:absolute; left:418px; top:453px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">peningkatan serum kreatinin >3</span></div> <div class="txt" style="position:absolute; left:418px; top:464px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">kali.</span></div> <div class="txt" style="position:absolute; left:404px; top:477px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Membutuhkan Continuous Renal</span></div> <div class="txt" style="position:absolute; left:33px; top:489px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">MAP <65 atau >150 mmHg</span></div> <div class="txt" style="position:absolute; left:33px; top:501px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Perdarahan >30% EBV</span></div> <div class="txt" style="position:absolute; left:33px; top:513px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Dehidrasi berat >15% BB</span></div> <div class="txt" style="position:absolute; left:33px; top:525px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Turgor kulit menurun</span></div> <div class="txt" style="position:absolute; left:33px; top:538px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">CRT >2 detik</span></div> <div class="txt" style="position:absolute; left:33px; top:550px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Produksi urine <0.5 ml/kgbb/jam</span></div> <div class="txt" style="position:absolute; left:219px; top:488px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Tidal volume <5 ml/kgbb</span></div> <div class="txt" style="position:absolute; left:219px; top:500px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">PaO2 < 60 mmHg</span></div> <div class="txt" style="position:absolute; left:219px; top:513px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">PaCO2 >50 mmHg</span></div> <div class="txt" style="position:absolute; left:268px; top:524px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">PaO2 / FiO2 <200</span></div> <div class="txt" style="position:absolute; left:418px; top:488px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Replacement Therapy.</span></div> <div class="txt" style="position:absolute; left:404px; top:500px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Penyakit terminal / vegetatif state</span></div> <div class="txt" style="position:absolute; left:418px; top:512px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">yang akan menjalani donor organ.</span></div> <div class="txt" style="position:absolute; left:404px; top:524px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Keganasan metastatik (komplikasi)</span></div> <div class="txt" style="position:absolute; left:404px; top:536px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">GDS >500 mg/dl yang memerlukan</span></div> <div class="txt" style="position:absolute; left:418px; top:548px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">titrasi insulin.</span></div> <div class="txt" style="position:absolute; left:33px; top:562px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Suhu >38.5 C atau <36 C disertai</span></div> <div class="txt" style="position:absolute; left:49px; top:574px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">pulsasi nadi lemah, cepat.</span></div> <div class="txt" style="position:absolute; left:33px; top:586px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Memerlukan obat vasoaktif / anti</span></div> <div class="txt" style="position:absolute; left:49px; top:597px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">aritmia kontinyu.</span></div> <div class="txt" style="position:absolute; left:33px; top:609px;"><span id="f1" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Keterangan : Indikasi masuk ICU jika memenuhi 1 Kriteria Mayor atau 5 Kriteria Minor</span></div> <div class="txt" style="position:absolute; left:49px; top:621px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Kesimpulan prioritas pasien masuk :</span></div> <div class="txt" style="position:absolute; left:51px; top:634px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Prioritas 1</span></div> <div class="txt" style="position:absolute; left:141px; top:634px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Prioritas 2</span></div> <div class="txt" style="position:absolute; left:223px; top:634px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Prioritas 3</span></div> <div class="txt" style="position:absolute; left:303px; top:634px;"><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Prioritas 4 </span><span id="f6" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);"> </span><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Tidak ada indikasi masuk</span></div> <div class="txt" style="position:absolute; left:33px; top:647px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Keterangan :</span></div> <div class="txt" style="position:absolute; left:218px; top:670px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Jakarta, ..................................... Jam ...........</span></div> <div class="txt" style="position:absolute; left:277px; top:683px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">DPJP Intensif</span></div> <div class="txt" style="position:absolute; left:236px; top:726px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">.......................................................</span></div> <div class="txt" style="position:absolute; left:241px; top:739px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Terang dan Tanda tangan</span></div> </body> </html>