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G.

CATATAN PERKEMBANGAN PERAWATAN LUKA (RECORD of PROGRESS)


Nama : No.Telp. :
Umur : Alamat :
Jenis Kelamin : L/P

Tgl Luka Stadium Luka Dasar Luka Cairan Luka Kulit Sekitar Rasa Sakit Ukuran Produk yang digunakan TTD
(Date) (Wound) (Wound Stage) (Wound Bed) (Exudate) (Surrounding Skin) (Pain) (Measure) (Sign)

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