Admission to Hospital, Nurses
(Sumber/ Source: Pramudya, Leo A.2005. English for Professional Nurses. Jakarta: EPN.)
(Rewritten by Dimas Erda Widyamarta: www.ithinkeducation.blogspot.com)
Surname, last name, family name: nama keluarga, ditulis di akhir
First name, given name: nama kelahiran yang diberikan di luar nama keluarga, ditulis/ disebutkan di bagian awal.
Next of kin:kerabat dekat
Civil state (BE: Marital Status): status pernikahan
A) The Questionaire to Fill in the Admission Form
Dr Harjono Hospital Regency of Ponorogo
Hospital Reg. No:
SURNAME (IN BLOCK LETTERS)
>what’s your name?
>How do you spell it?
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?
DATE OF BIRTH
>When were you born?
>Your date of birth please
>Are you married?
(In the case of a chold, father’s occupation)
>What’s your occupation
>What’s his father’s occupation
>What’s your religion?
Note: In some states, It’s not appropriate to ask this question. It’s necessary to follow the custom
NAME & ADDRESS OF NEXT OF KIN
>who’s your nearest relative?
>Your next of kin?
>Do you live at the same address?
NAME & ADDRESS OF GENERAL PRACTITIONER
>Who’s your family doctor
>What’s his address?
(If no phone, give a number where message may be sent. Add “message only’)
>Whom 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?
B) Referral Letter
Note: A General Practitioner (GP) usually wirites a referral letter to a consultant (specialist) to admit someone to a hospital. Here is a sample of a Referral Letter written by dr. Wayan to Dr. Pranawa.
The nurse asks the patient: did you bring the referral letter with you?
The patient or a companion: yes. Here you are or (yes. My next of kin bring it with her)
Date, April, 25th 2013
Dear Dr. Pranawa
I would be grateful for your opinion and advice with regard to
(NAME) MARTA, DIMAS ERDA WIDYA
Please indicate in the box
A brief outline of history, symptoms and signs and present therapy are given bellow:
This 19 years old salesman had a severe attack of central chest pain six months ago which lasted 10 mins and was relieved by rest. This has recurred several times after exertion. His father died aged 90 of a coronary thrombosis. Physical examination was normal and i refer him to you for further assessment in view of his age.
Thank you for seeing him
If transport required plese state:
Stretcher/ Sitting case
Sitting case- twi man lift NO
Signature Dr. Wayan