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BKJ-BOR-PPK-12 Pind.

1/2018
BAHAGIAN KEJURURAWATAN
KEMENTERIAN KESIHATAN MALAYSIA
CUMULATIVE DATA COLLECTION FOR THROMBOPHLEBITIS

HOSPITAL :______________________________ SUKU TAHUN: _____________ TAHUN______________

ADULT ADULT
PAEDIATRICS NEONATES
Bil WARD (CONSCIOUS PATIENT) (UNCONSCIOUS PATIENT)
N D % N D % N D % N D %

JUMLAH
* To be filled in by Hospital Coordinator N - NUMERATOR D - DENOMINATOR Reviewed March 2018
* Data of Unconscious/ Paeds & Neonates patients are recorded for study purpose only but excluded from HPIA DATA collection

Disediakan oleh: Disemak Oleh:


_____________________________ __________________________________
(Penyelaras Hospital) (Pengarah Hosp/Timb. Pengarah Hosp)
Tarikh : Tarikh:

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