HAND OVER SHIFT – EMERGENCY ROOM CHECKLIST

TANGGAL : .................................. SHIFT ................................. DEFIB DAILY (AM) AMBULANCE WEEKLY AM

DOKTER JAGA : .............................................................................. SENIN MINGGU I
DEFIB MONTHLY (AM)
PERAWAT : INCHARGE ................TEAM .................................. SENIN MINGGU I EKG DAILY (AM)
MATERI BRIEFING: ..............................................................................
OXYGEN / SHIFT SUCTION DAILY (AM)
NEBU DAILY (AM) MONITOR DAILY(AM)
CHECKLIST
DEFIB DAILY (AM) AMBULANCE WEEKLY AM
SENIN MINGGU I JUMLAH PASIEN
DEFIB MONTHLY (AM)
BPJS RAWAT INAP
SENIN MINGGU I EKG DAILY (AM) UMUM RUJUK
OXYGEN / SHIFT SUCTION DAILY (AM) ASURANSI LAIN APS
NEBU DAILY (AM) MONITOR DAILY(AM) FREE OF CHARGE PULANG
LAIN - LAIN MENINGGAL
JUMLAH PASIEN
BPJS RAWAT INAP TEMUAN MASALAH / INFORMASI BARU
UMUM RUJUK .............................................................................................................................
ASURANSI LAIN APS ............................................................................................................................. ..............
FREE OF CHARGE PULANG .............................................................................................................
LAIN - LAIN MENINGGAL ............................................................................................................................. ..............
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TEMUAN MASALAH / INFORMASI BARU
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HAND OVER SHIFT – IN PATIENT DEPARTMENT I
............................................................................................................. ................................ TANGGAL : .................................. SHIFT .................................
............................................................................................. ................................................ PERAWAT : INCHARGE ................TEAM ..................................
............................................................................. MATERI BRIEFING: ..............................................................................
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............................................................................................................................. JUMLAH PASIEN
HAND OVER SHIFT – EMERGENCY ROOM BPJS RUJUK
TANGGAL : .................................. SHIFT ................................. UMUM APS
DOKTER JAGA : .............................................................................. ASURANSI LAIN PULANG
PERAWAT : INCHARGE ................TEAM .................................. FREE OF CHARGE MENINGGAL
MATERI BRIEFING: .............................................................................. LAIN - LAIN

TEMUAN MASALAH / INFORMASI BARU
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HAND OVER SHIFT – IN PATIENT DEPARTMENT I
TANGGAL : .................................. SHIFT .................................
PERAWAT : INCHARGE ................TEAM ..................................
MATERI BRIEFING: ..............................................................................
JUMLAH PASIEN
BPJS RUJUK
UMUM APS
ASURANSI LAIN PULANG
FREE OF CHARGE MENINGGAL
LAIN - LAIN
TEMUAN MASALAH / INFORMASI BARU
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HAND OVER SHIFT – IN PATIENT DEPARTMENT II
TANGGAL : .................................. SHIFT .................................
PERAWAT : INCHARGE ................TEAM ..................................
MATERI BRIEFING: ..............................................................................
JUMLAH PASIEN
BPJS RUJUK
UMUM APS
ASURANSI LAIN PULANG
FREE OF CHARGE MENINGGAL
LAIN - LAIN
TEMUAN MASALAH / INFORMASI BARU
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HAND OVER SHIFT – IN PATIENT DEPARTMENT II
TANGGAL : .................................. SHIFT .................................
PERAWAT : INCHARGE ................TEAM ..................................
MATERI BRIEFING: ..............................................................................
JUMLAH PASIEN
BPJS RUJUK
UMUM APS
ASURANSI LAIN PULANG
FREE OF CHARGE MENINGGAL
LAIN - LAIN
TEMUAN MASALAH / INFORMASI BARU
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HAND OVER SHIFT – OUT PATIENT DEPARTMENT
TANGGAL : .................................. SHIFT .................................
PERAWAT : INCHARGE ................TEAM ..................................
MATERI BRIEFING: ..............................................................................
JUMLAH PASIEN
POLI BPJS UMUM POLI BPJS UMUM
MATA SYARAF
PENYAKIT DALAM GIZI
BEDAH UMUM
ANAK RAWAT INAP
TEMUAN MASALAH / INFORMASI BARU
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HAND OVER
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HAND OVER SHIFT – OUT PATIENT DEPARTMENT
TANGGAL
PERAWAT
: .................................. SHIFT .................................
: INCHARGE ................TEAM ..................................
MATERI BRIEFING: ..............................................................................
SHIFT
POLI BPJS
JUMLAH PASIEN
UMUM POLI BPJS UMUM
IN PATIENT
DEPARTMENT I
MATA SYARAF
PENYAKIT DALAM GIZI
BEDAH UMUM
ANAK RAWAT INAP

TEMUAN MASALAH / INFORMASI BARU

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RS KARTINI
KUPANG
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 HAND OVER
SHIFT
IN PATIENT
DEPARTMENT II
RS KARTINI
KUPANG
 HAND OVER
SHIFT
OUT PATIENT
DEPARTMENT
RS KARTINI
KUPANG
HAND OVER
SHIFT
EMERGENCY
ROOM
RS KARTINI
KUPANG