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File: rujukan transfer eksternal 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; } @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:bold; font-style:normal; } #f6 { font-family:monospace; font-weight:normal; 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:279px; top:14px;"><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:299px; top:26px;"><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:275px; top:37px;"><span id="f2" style="font-size:9px;vertical-align:baseline;color:rgba(0,0,255,1);">www.rsaulia.com</span></div> <div class="txt" style="position:absolute; left:179px; top:49px;"><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:263px; top:60px;"><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:253px; top:72px;"><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:477px; top:17px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">No Form : FR.GD.16</span></div> <div class="txt" style="position:absolute; left:477px; top:37px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">No Rev : 03</span></div> <div class="txt" style="position:absolute; left:172px; top:122px;"><span id="f1" style="font-size:13px;vertical-align:baseline;color:rgba(0,0,0,1);">SURAT RUJUKAN/ TRANSFER EKSTERNAL</span></div> <div class="txt" style="position:absolute; left:60px; top:145px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nomor Surat Rujukan :</span></div> <div class="txt" style="position:absolute; left:60px; top:163px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Kepada Yth. :</span></div> <div class="txt" style="position:absolute; left:60px; top:178px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">TS</span></div> <div class="txt" style="position:absolute; left:60px; top:193px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Di</span></div> <div class="txt" style="position:absolute; left:60px; top:209px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Dengan hormat,</span></div> <div class="txt" style="position:absolute; left:60px; top:223px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Bersama ini kami kirimkan pasien</span></div> <div class="txt" style="position:absolute; left:60px; top:238px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Lengkap</span></div> <div class="txt" style="position:absolute; left:195px; top:238px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:60px; top:252px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tanggal Lahir</span></div> <div class="txt" style="position:absolute; left:195px; top:252px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:60px; top:267px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Jenis Kelamin</span></div> <div class="txt" style="position:absolute; left:195px; top:267px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">: Laki </span><span id="f4" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">– </span><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Laki</span></div> <div class="txt" style="position:absolute; left:60px; top:281px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Alamat Pasien</span></div> <div class="txt" style="position:absolute; left:195px; top:281px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:60px; top:296px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tanggal Masuk Rumah Sakit :</span></div> <div class="txt" style="position:absolute; left:60px; top:311px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Diagnosa Utama</span></div> <div class="txt" style="position:absolute; left:195px; top:311px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:60px; top:325px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Diagnosa Sekunder</span></div> <div class="txt" style="position:absolute; left:195px; top:325px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:294px; top:267px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Perempuan</span></div> <div class="txt" style="position:absolute; left:60px; top:346px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Alasan Dirujuk</span></div> <div class="txt" style="position:absolute; left:60px; top:360px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Alasan Klinis</span></div> <div class="txt" style="position:absolute; left:60px; top:375px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Alasan Non Klinis</span></div> <div class="txt" style="position:absolute; left:195px; top:360px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:195px; top:375px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">: NICU/ PICU Penuh Kamar Penuh APS</span></div> <div class="txt" style="position:absolute; left:226px; top:391px;"><span id="f1" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">RINGKASAN RIWAYAT PASIEN</span></div> <div class="txt" style="position:absolute; left:450px; top:375px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Lainnya :</span></div> <div class="txt" style="position:absolute; left:60px; top:410px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">1. Anamnesa</span></div> <div class="txt" style="position:absolute; left:78px; top:425px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Keluhan Utama</span></div> <div class="txt" style="position:absolute; left:198px; top:425px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:78px; top:439px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Riwayat Penyakit</span></div> <div class="txt" style="position:absolute; left:198px; top:439px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:78px; top:454px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Riwayat Alergi</span></div> <div class="txt" style="position:absolute; left:198px; top:454px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:60px; top:468px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">2. Pemeriksaan Fisik</span></div> <div class="txt" style="position:absolute; left:78px; top:483px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tanda </span><span id="f4" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">– </span><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tanda Vital</span></div> <div class="txt" style="position:absolute; left:198px; top:482px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">: Suhu : ____ </span><span id="f2" style="font-size:6px;vertical-align:super;color:rgba(0,0,0,1);">o</span><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">C</span></div> <div class="txt" style="position:absolute; left:296px; top:483px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Tekanan Darah : ____/ ____ mmHg</span></div> <div class="txt" style="position:absolute; left:202px; top:497px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">RR : ____ x/ menit</span></div> <div class="txt" style="position:absolute; left:78px; top:512px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Keadaan Umum</span></div> <div class="txt" style="position:absolute; left:198px; top:512px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:78px; top:527px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Kesadaran</span></div> <div class="txt" style="position:absolute; left:198px; top:527px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">:</span></div> <div class="txt" style="position:absolute; left:78px; top:541px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Temuan Pemeriksaan Fisik :</span></div> <div class="txt" style="position:absolute; left:60px; top:556px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">3. Hasil Pemeriksaan Penunjang yang Telah Dilakukan</span></div> <div class="txt" style="position:absolute; left:471px; top:483px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nadi : _____x/menit</span></div> <div class="txt" style="position:absolute; left:471px; top:527px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">GCS : E M V</span></div> <div class="txt" style="position:absolute; left:60px; top:585px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">4. Tindakan Medis yang Telah Diberikan</span></div> <div class="txt" style="position:absolute; left:60px; top:614px;"><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">5. Obat </span><span id="f4" style="font-size:11px;vertical-align:baseline;color:rgba(0,0,0,1);">– </span><span id="f2" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Obatan yang Telah Diberikan</span></div> <div class="txt" style="position:absolute; left:115px; top:642px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Nama Obat</span></div> <div class="txt" style="position:absolute; left:215px; top:642px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Dosis</span></div> <div class="txt" style="position:absolute; left:280px; top:635px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Rute</span></div> <div class="txt" style="position:absolute; left:266px; top:650px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Pemberian</span></div> <div class="txt" style="position:absolute; left:366px; top:635px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Jadwal</span></div> <div class="txt" style="position:absolute; left:357px; top:650px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Pemberian</span></div> <div class="txt" style="position:absolute; left:457px; top:635px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Waktu Pemberian</span></div> <div class="txt" style="position:absolute; left:479px; top:650px;"><span id="f1" style="font-size:10px;vertical-align:baseline;color:rgba(0,0,0,1);">Terakhir</span></div> <div class="txt" style="position:absolute; left:499px; top:822px;"><span id="f2" style="font-size:8px;vertical-align:baseline;color:rgba(0,0,0,1);">MED.038.0718.00</span></div> </body> </html>