HSAAS DOCUMENT | HOSPITAL SULTAN ABDUL AZIZ SHAH (HSAAS)

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HSAAS INTERNAL DOCUMENT

HSAAS DOCUMENT - DEPARTMENT OF MEDICAL

Borang Persetujuan Penerimaan Rawatan Risiko

Spirometry Test Form

Echocardiography Request Form

Holter Registration Form

Exercise Stress Test Form

Osptretinoin Treatment Consent Form

Patch Test Consent Form

Patch Test Form

Phototherapy Consent Form

Photography Consent Form

Phototherapy Form

Dermatology Life Quality Index (DLQI) Worksheet

Eczema Area And Severity Index (EASI) Worksheet

Psoriasis Area And Severity Index (PASI) Worksheet

HSAAS DOCUMENT - DEPARTMENT OF OTORHINOLARYNGOLOFY, HEAD AND NECK SURGERY (ENT)

Audiogram Form

Universal Neonatal Hearing Screening Form

Skin Prick Test Form

Pediatric Case History Form

HSAAS DOCUMENT - DEPARTMENT OF REHABILITATION MEDICINE

Borang Rujukan Servis Fisioterapi (Pesakit Luar)

Borang Rujukan Servis Fisioterapi (Pesakit Dalam)

Prosthetic & Orthotic Outpatient Referral Form

Speech Therapy Referral Form

Rehabilitation Medicine (Clinical) Referral Form

Occupational Therapy Referral Form

HSAAS DOCUMENT - DEPARTMENT OF PSYCHIATRY

Psychiatry Clerking Sheet

Patient Interview Form

Patient Information Checklist Form

Patient Consent Form (Teleconsultation)

Borang Laporan Guru Sekolah

Borang Keizinan Telekonsultansi

Borang Keizinan Mengeluar dan Bertukar Maklumat

Borang Arahan Pemerhatian Rapi

Borang Arahan Kekangan

Behaviour Chart

HSAAS DOCUMENT - DEPARTMENT OF RADIOLOGY

Copy of Radiological Examination Image/Report and Image Service Form Digitization

Borang Keizinan Menjalankan Prosedur Radiologi Yang Memerlukan Pemberian Kontras Media

Radiology Post Angiogram Orders and Hand-Off

Slip Persediaan Pesakit Pemeriksaan Bone MIneral Densitometry (BMD)

Slip Persediaan Pesakit Pemeriksaan Tomografi Berkomputer (CT Scan)

Hysterosalpingogram (HSG) Examination Preparation Slip

Mammography Examination Slip

Slip Persediaan Pesakit Pemeriksaan Magnetic Resonance Imaging (MRI)

Slip Pemeriksaan Ultasound (US)

Radiology Pre-Procedure Checklist

Radiological Examination Request Form

Breast Imaging Request Form

Special Consent of Patient With Implant For MRI Procedure

Slip Persediaan Pesakit Pemeriksaan Barium

HSAAS DOCUMENT - DEPARTMENT OF DIETETICS

Enteral Product_Feeding Bag Ordering Form

Borang Aduan Perkhidmatan Makanan

Dietetics Referral Form

Borang Persetujuan Bayaran Diet_Mother Accompanied Child

HSAAS DOCUMENT - PUBLIC HEALTH UNIT

Borang Kebenaran Suntikan Hepatitis B Anggota Kesihatan

Borang Kebenaran Suntikan Hepatitis B Pelajar

Borang Kebenaran Suntikan Tifoid Anggota Kesihatan

Borang Kebenaran Uijan Saringan Darah Anti HBs Anggota Kesihatan

Borang Pemeriksaan Tempat Pembiakan Nyamuk

Mantoux Test Referral Form

Notification of Occupational Accident and Dangerous Occurrence Form

Notification of Occupational Poisoning / Disease Form

Notification of Occupational Noise Induced Hearing Loss Form

Notification of Occupational Lung Disease Form

Notification of Occupational Skin Disease Form

General Assessment Form OMC

Spirometry Test Form

Tuberculin Vial Request Form

Pemeriksaan Premis Makanan RTE

Borang Pemeriksaan Pusat Pengumpulan Sampah

HSAAS DOCUMENT - COUNSELLING AND MEDICAL SOCIAL SERVICE UNIT

Borang Perubatan 1/09(T) Jabatan Perkhidmatan Awam Malaysia

Borang Rujukan Kaunseling

Borang Rujukan Bantuan Perubatan

Borang Pinjaman Peralatan Perubatan

Memo Permohonan Pesara Persekutuan

HSAAS DOCUMENT - CLINICAL RESEARCH UNIT

Arahan Kerja Pengurusan Perkhidmatan Klinik Konsultasi Penyelidikan

Borang Permohonan Menjalankan Penyelidikan Klinikal

Application to Conduct Research Project

Senarai Semak Permohonan Penyelidikan Klinikal

HSAAS DOCUMENT - NURSING MANAGEMENT UNIT

Borang Permohonan Credentialing and Privileging (Nursing)

Senarai Semak Permohonan Credentialing & Privileging (Nursing)

Garis Panduan Pengurusan Katil

Arahan Kerja Penyediaan Jadual Staf

Minit Mesyuarat Pagi

Ringkasan Laporan Atas Talian

HSAAS DOCUMENT - UNIT OF INFECTION CONTROL

Air Sampling Form

Case Monitoring Form

Infection Control Round Form

Inter Healthcare Infection Prevention Transfer Form

Particulate Count Form

Wound Surveillance Form

Contact Precaution Checklist for Multi-Drug Resistance Organism (MDRO)

Ward/Clinic Audit Report Checklist

HSAAS DOCUMENT - MEDICAL RECORD UNIT

Borang Permohonan Penggunaan Rekod Perubatan Pesakit (Untuk Penyelidikan, Rujukan dsb)

Borang Permohonan & Pemulangan Rekod Perubatan Pesakit Masuk Wad

Borang Permohonan & Pemulangan Rekod Perubatan Pesakit Temujanji Klinik

Borang Permohonan Laporan Perubatan

Garis Panduan Rekod Perubatan Pesakit

HSAAS DOCUMENT - QUALITY AND RISK MANAGEMENT UNIT

Patient Safety Incident Reporting (IR) Form

Patient Safety Incident Reporting Form_MIRCA Format

Root Cause Analysis and Action Report_RCA2 Form

100

Application for Renewal of Clinical Privileges Form

101

Credentialing and Privileging Application Form

102

Checklist for Credentialing and Privileging

103

Incident Reporting Prescription Slip

HSAAS DOCUMENT - SECURITY UNIT

104

Borang Akuan Penerimaan dan Penyerahan Kunci

105

Borang Permohonan Semakan Data Akses Keselamatan

HSAAS DOCUMENT - ISLAMIC AFFAIRS UNIT

106

Borang Khidmat Bimbingan Agama

HOSPITAL SULTAN ABDUL AZIZ SHAH (HSAAS)

Universiti Putra Malaysia
43400 UPM Serdang
Selangor Darul Ehsan

03 9769 5500

hsaas.contact@upm.edu.my