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  • Formulir Serah Terima (Hand Over) Antar Shift Jaga

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    marlisa pinat
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    This document is a handover form used to transfer patient care responsibilities between shifts. It includes sections to document the patient's situation, background, medical diagnosis, vital signs, activities, risks, and recommendations for the morning, afternoon and night shifts. Nurses use this form to ensure continuity of care and awareness of each patient's condition when responsibility is transferred between shifts.

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    form hand over

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    This document is a handover form used to transfer patient care responsibilities between shifts. It includes sections to document the patient's situation, background, medical diagnosis, vital signs, activities, risks, and recommendations for the morning, afternoon and night shifts. Nurses use this form to ensure continuity of care and awareness of each patient's condition when responsibility is transferred between shifts.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    23 views2 pages

    Formulir Serah Terima (Hand Over) Antar Shift Jaga

    Uploaded by

    marlisa pinat
    This document is a handover form used to transfer patient care responsibilities between shifts. It includes sections to document the patient's situation, background, medical diagnosis, vital signs, activities, risks, and recommendations for the morning, afternoon and night shifts. Nurses use this form to ensure continuity of care and awareness of each patient's condition when responsibility is transferred between shifts.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 2

    FORMULIR SERAH TERIMA (HAND OVER) ANTAR SHIFT JAGA

    UNIT/RUANGAN :....................................................................... Nama Pasien : ..................................................................


    HARI, TANGGAL :....................................................................... Tgl Lahir : ..................................................................
    No. RM : ..................................................................

    PAGI SORE MALAM


    Situation :................................................................... Situation :................................................................... Situation :...................................................................
    ................................................................................... ................................................................................... ...................................................................................
    ................................................................................... ................................................................................... ...................................................................................
    Background :............................................................. Background :............................................................. Background :.............................................................
    .................................................................................. .................................................................................. ..................................................................................
    Dx. Medis :................................................................ Dx. Medis :................................................................ Dx. Medis :................................................................
    DPJP: dr.................................................................... DPJP: dr.................................................................... DPJP: dr....................................................................

    Assesment :.............................................................. Assesment :.............................................................. Assesment :..............................................................

    Kesadaran :.....................................GCS:................ Kesadaran :.....................................GCS:................ Kesadaran :.....................................GCS:................


    TTV : TD:......................mmHg Nadi :..........x/menit TTV : TD:......................mmHg Nadi :..........x/menit TTV : TD:......................mmHg Nadi :..........x/menit
    o o
    Suhu :............ C RR:...........x/menit Nyeri:................ Suhu :............ C RR:...........x/menit Nyeri:................ Suhu :............oC RR:...........x/menit Nyeri:................
    Oksigen:.............L/menit Infus :..............tts/menit Oksigen:.............L/menit Infus :..............tts/menit Oksigen:.............L/menit Infus :..............tts/menit
    Transfusi :..........tts/menit | Katheter:Y/T | NGT: Y/T Transfusi :..........tts/menit | Katheter:Y/T | NGT: Y/T Transfusi :..........tts/menit | Katheter:Y/T | NGT: Y/T
    Makan/Minum :......................................................... Makan/Minum :......................................................... Makan/Minum :.........................................................
    Toileting :.................................................................. Toileting :.................................................................. Toileting :..................................................................
    Aktivitas/Gerak :....................................................... Aktivitas/Gerak :....................................................... Aktivitas/Gerak :.......................................................
    Skore resiko Jatuh :.......................................................... Skore Jatuh :.......................................................... Skore Jatuh :..........................................................
    Recomendation :................................................... Recomendation :................................................... Recomendation :...................................................
    ............................................................................... ............................................................................... ...............................................................................
    ............................................................................... ............................................................................... ...............................................................................
    Pemberi Operan Penerima Operan Pemberi Operan Penerima Operan Pemberi Operan Penerima Operan

    (...............................) (...............................) (...............................) (...............................) (...............................) (...............................)

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