FORM MONITORING POKJA HPK

No Form HPK Januari - Maret 2019

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
1 GENERAL CONSENT 1 1 0 1 1 0 1 0 1 0 0 1 1 1 0 1 1 1 1 1 0 1 0
2 INFORMED CONSENT 0 1 1 1 1 0 1 1 0 1 0 1 1 1 0 0 1 1 0 1 1 0 0
3 LAYANAN ROHANI 1 1 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1 1 1 0 1 1 1
4 APS 12
5 MANAJEMEN NYERI 1 1 0 1 1 1 0 0 1 1 0 1 0 1 1 1 1 1 0 1 1 1 1
IDENTIFIKASI NILAI DAN
6 KEPERCAYAAN PASIEN 0 1 1 0 1 1 0 1 1 0 1 1 1 1 0 1 1 1 1 0 0 1 1
7 PENGKAJIAN TAHAP TERMINAL
FORM MONITORING POKJA HPK

Januari - Maret 2019 100%

24 25 26 27 28 29 30 31 TTL
1 1 0 0 1 1 1 1 21 67
1 1 1 0 1 0 1 1 20 64
1 1 0 1 1 1 1 1 27 87
5 41
0 1 1 1 0 1 1 0 22 70

1 0 1 1 1 1 0 1 22 70
 FORM

No Form HPK A
1 2 3 4 5 6 7 8 9 10 11
1 GENERAL CONSENT 1 0 1 1 1 0 1 1 1 0 0
2 INFORMED CONSENT 0 1 1 1 1 0 1 1 0 1 0
3 LAYANAN ROHANI 1 1 1 0 1 1 1 1 1 1 1
4 APS
5 MANAJEMEN NYERI 1 1 1 0 1 1 0 1 1 1 1
IDENTIFIKASI NILAI DAN
6 KEPERCAYAAN PASIEN 1 1 1 1 0 1 1 1 1 1 1
7 PENGKAJIAN TAHAP TERMINAL
 FORM MONITORING POKJA HPK

April - Juni 2019

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
1 1 1 0 1 1 1 1 1 0 1 0 1 1 1 1 1 1
1 1 1 1 0 1 1 0 1 1 0 1 1 1 1 0 1 0
0 1 1 1 1 1 1 0 1 1 1 1 1 1 0 1 1 1
15
1 1 0 1 1 0 1 1 1 1 1 1 0 0 1 1 0 1

1 0 0 1 1 0 0 1 0 1 1 1 1 1 1 1 0 1
 100%
30 TTL
1 23 76
1 21 70
0 25 83
7 46
1 23 76

1 24 80
No Form HPK
1 2 3 4 5 6 7 8 9 10
1 GENERAL CONSENT 0 1 1 0 1 1 1 1 0 1
2 INFORMED CONSENT 1 1 1 1 0 1 1 1 1 1
3 LAYANAN ROHANI 1 0 1 1 1 0 1 1 1 0
4 APS
5 MANAJEMEN NYERI 1 1 0 1 1 1 0 1 1 1
IDENTIFIKASI NILAI DAN
6 KEPERCAYAAN PASIEN 1 1 1 1 1 0 1 1 1 1
PENGKAJIAN TAHAP
7 TERMINAL
 FORM MONITORING POKJA HPK

July - September 2019

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
1 1 1 0 1 1 1 1 0 1 1 1 1 1 1 0
0 0 1 1 1 1 0 1 1 1 0 1 1 1 1 1
1 1 1 1 1 0 1 1 1 1 1 0 1 1 1 1
25
1 1 1 1 0 1 1 1 1 0 1 1 1 0 1 1

0 1 1 1 1 1 1 0 1 1 1 1 0 1 1 1
 100%
27 28 29 30 TTL
1 1 1 1 24 80
1 1 0 0 23 76
1 0 1 1 24 80
18 72
1 1 1 1 25 83

1 1 1 0 25 83