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LAMPIRAN
LEMBAR PENGAMATAN PASIEN
No. Rekam Medik :
Nama :

Umur <40


40-55


>55
Status Perkawinan Kawin


Tidak Kawin
Pendidikan Rendah (Tidak sekolah - SD)


SMP-SMA


Akademi / PT
Paritas 2


3-5.


>5
Keluhan Utama Perdarahan Pervaginam


Nyeri Perut Bagian Bawah


Keputihan


Sulit Buang Air Kecil
Stadium Ringan (Stadium 0 - lb)


Sedang (Stadium II)


Berat (Stadium III - IVb)