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SLEEDING SCALE

NAMA PASIEN :

NO. MEDREK :

DOKTER :

RUANGAN :

150 - 200 4 ui
201 - 250 8 ui
251 - 300 12 ui
301 - 350 16 ui
351 - 400 20 ui
>400 24 ui

Tanggal / Jam Hasil GDS Actrafid Perawat

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