Get Surat Keterangan Dokter

The Surat Keterangan Dokter, or physician's statement, is a crucial document for confirming a patient's medical condition, treatment, and history. This guide will walk you through the process of completing the form online, ensuring that you provide all necessary details accurately.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to acquire the form and open it for editing.
2. Enter the patient’s full name in the designated field labeled 'Nama Lengkap Pasien/Patient’s Full Name.' Ensure correct spelling to avoid discrepancies.
3. Input the patient's identification number under 'No. KTP/Passport No.' This is essential for identification purposes.
4. Provide the patient’s date of birth in the 'Tanggal Lahir/Date of Birth' section using the format (dd/mm/yy).
5. Record the hospitalization date in the 'Tanggal Perawatan/Date of Hospitalization' field.
6. Select the type of hospital room and service relevant to the patient's case under 'Jenis Kamar Perawatan /Type of Hospital Room' and 'Jenis Layanan/Type of Service.'
7. Indicate the first occurrence date of symptoms in the 'Tanggal gejala atau keluhan pertama kali diketahui oleh Pasien' field.
8. Fill in the date of the first consultation for the current condition in the 'Tanggal pertama kali konsultasi untuk penyakit yang diderita saat Ini' section.
9. Detail the symptoms of the condition in the 'Mohon jelaskan gejala penyakit' section.
10. Identify the primary and secondary diagnoses in the 'Diagnosa Utama/Primary Diagnosis' and 'Diagnosa Tambahan/Secondary Diagnosis' sections.
11. Explain the cause of the diagnosis in the 'Faktor Penyebab Diagnosa/Cause of the disease' field.
12. Record the date when the diagnosis was established in the 'Tanggal Diagnosa ditegakkan' section.
13. Document any treatments or surgeries performed in the 'Terapi atau tindakan bedah yang diberikan' field.
14. Enter the surgeon's name in the 'Nama dokter bedah/Surgeon’s name' section.
15. Provide the results of laboratory tests or radiology in the 'Hasil pemeriksaan laboratorium/Radiologi' section.
16. Indicate if the treatment was due to an accident and provide the necessary details if applicable.
17. Confirm whether the patient has had prior consultations or admissions for the same diagnosis and fill in the relevant fields.
18. Finally, declare the accuracy of the information provided by signing in the section labeled 'Nama Jelas & Tanda Tangan Dokter' and complete 'Tempat & Tanggal/ Place & Date.'
19. Once completed, you can save changes to the document, download it for printing, or share it as needed.

Begin filling out the Surat Keterangan Dokter online now to ensure timely and accurate medical documentation.