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RM : 6.

1
Nama Pasien : .................................. No. RM :

Jenis Kelamin : L / P Tgl Lahir : .....................................................................

Unit/Ruangan : ................................ Tgl Masuk : ................................................ Jam : ..........

OBSERVASI LANJUTAN (INTENSIF)


ASS / PENGKAJIAN RENCANA KEPERAWATAN

DIAGNOSA KEPERAWATAN DIAGNOSA MEDIS

NAMA& NAMA&
TGL JAM GCS SUHU NADI TD RR CAIRAN TTD IMPLEMENTASI TTD
PERAWAT PERAWAT

NAMA&
NAMA&TTD
TGL JAM GCS SUHU NADI TD RR CAIRAN IMPLEMENTASI TTD
PERAWAT
PERAWAT
Tgl/Jam Evaluasi ( SOAP ) Nama/TTD

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