TIDAK L 0

LENGKA 1

IDENTIFIKASI PASIEN

NO NO RM NAMA
NAMA NO RM

1 00-06-01-03 SUNIL LAL ADWANI 1 1

2 00-06-01-00 SOLIHUN 1 1
3 00-05-92-20 WAGIMIN 1 1
4 00-06-00-68 LIAUW TIAN TJHU 1 1
5 00-06-00-05 ACHMAD DJUNAIDI 1 1
6 00-05-88-53 WARDI 1 1
7 00-05-99-04 ANWAR 1 1
8 00-05-29-89 HETTI 1 1
9 00-06-02-94 SUMARNI 1 1
10 00-06-01-99 AGUS 1 1
11 00-06-02-96 SUMARYATI 1 1
12 00-06-04-20 DIDI NOLDIANZAH 1 1
13 00-05-58-12 BET TIE 1 1
14 00-05-95-06 ELIES BUDIONO 1 1
15 00-06-04-21 NG HIAN TJONG 1 1
16 00-05-98-89 MAHPUDIN JAYADI 1 1
17 00-04-74-04 ARIEF MULYADI 1 1
18 00-06-06-06 JOHAN ADAM KASHOGY 1 1
19 00-06-04-26 B MANAHAN 1 1
20 00-05-98-97 AMBAR SUPRIYATI 1 1
21 00-05-97-20 PAINEM 1 1
22 00-06-04-73 SUMIYATI ABBAS 1 1
23 00-06-02-36 LIEM LIAN HOA 1 1
24 00-05-37-55 SANDI SUWARDI 1 1
25 00-05-34-88 MAMBRINEKE M SANGER 1 1
26 00-06-03-95 NUKMAN DAUD 1 1
27 00-06-04-14 AGUS S. LATUHERU 1 1
28 00-06-04-19 SUTEJO 1 1
30 00-06-04-72 WINARKO 1 1
31 00-06-03-93 O SUHARTO 1 1
32 00-06-04-28 PIETER DONI HELAN 1 1
33 00-06-05-84 PO SENG HOEI 1 1
34 00-05-77-49 BUSTOMI 1 1
35 00-06-05-62 RADIKTA FAQIH ALFARIZQY 1 1
36 00-06-00-04 SUPRAYETNO,M 1 1
37 00-06-04-23 DEVANO AZKA RAMADAN 1 1
38 00-06-06-47 SEPTIANDRI SUHARTO 1 1
39 00-05-76-95 KURNIATY DANUATMODJO 1 1
40 00-05-29-89 HETTI 1 1
41 00-05-78-86 USLI SENALI 1 1
42 00-05-77-23 HASAN DRAJAD 1 1
43 00-05-96-66 SUDIYONO 1 1
44 00-05-79-28 DONNY FALANTINO 1 1
45 00-06-04-71 MARINI IDAWATY PASARIBU 1 1
JML 44 44

OK
RI
JML
nama dokter
nama zr
ttd dok
ttd zr
IDENTIFIKASI PASIEN

LP. OPERASI CPP

TGL LAHIR/UMUR J.KEL
dok PAKAI
TGL JAM nama ttd TGL JAM
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 0 0 0 0 0 1 1 1
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 1 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 0 0 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 0 0 0
1 1 1 1 1 1 1 1 1 1
44 44 43 42 42 43 43 8 7 7
 ANALIS KUANTITATIF DRM
BULAN OKTOBER 2018

AUTENTIFIKASI PENULIS

CPPT CAT. PERAWAT

zr dok PAKAI
TDK PAKAI TDK PAKAI
nama ttd nama ttd TGL JAM nama ttd
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 0
0 0 0 0 1 0 0 0 0 0 1
1 1 1 1 0 1 1 1 1 1 0
1 1 1 1 0 1 1 1 1 1 0
0 0 0 0 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
1 1 1 1 0 1 1 1 1 1 0
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 0
0 0 0 0 1 0 0 0 0 0 0
1 1 1 1 0 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
1 1 1 1 0 1 1 1 1 1 0

0 0 0 0 1 0 0 0 0 0 1

1 1 1 1 0 1 1 1 1 1 0
1 1 1 1 0 1 1 1 1 1 1

0 0 0 0 1 0 0 0 0 0 1

0 0 0 0 1 0 0 0 0 0 1
0 0 0 0 1 0 0 0 0 0 1
1 1 1 1 0 1 1 1 1 1 1
8 8 8 8 20 7 7 7 7 7 19
 LIS KUANTITATIF DRM
ULAN OKTOBER 2018

RESUME
INFORMED CONSENT
GENERAL CONSENT
dok dok
TGL isi TGL JAM nama ttd TGL nama
1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 0 0 0 0 0 0 1 1 1
1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 0 1 1 0 0 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 0 0 0 1 1 1 1 1
1 1 0 0 0 0 0 0 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 0 0
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1
1 1 0 0 0 0 0 0 1 1 1
1 1 1 1 0 0 1 1 1 1 1

1 1 0 0 0 0 0 0 1 1 1

1 1 1 1 1 0 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1

1 1 0 0 0 0 0 0 1 1 1

1 1 0 0 0 0 0 0 1 1 1
1 1 0 0 0 0 0 0 1 1 1
1 1 1 1 0 0 1 1 1 1 1
30 29 23 22 5 4 23 23 30 29 29
 CAT. YANG BAIK

CORETAN TERBACA TIPE-X BAGIAN KOSONG

dok
ttd
1 0 1 0 0
1 0 1 0 1
1 0 1 0 1
1 0 1 0 1
1 0 1 0 1
1 0 1 0 0
1 0 1 0 0
1 0 1 0 0
1 0 1 0 1
1 0 1 0 1
1 0 1 0 0
1 0 1 0 1
1 0 1 0 0
1 0 1 0 0
1 0 1 0 1
1 0 1 0 1
1 0 1 0 1
0 0 1 0 1
1 0 1 0 1
1 0 1 0 1
1 0 1 0 1
1 0 1 0 1
1 0 1 0 1

1 0 1 0 1

1 0 1 0 1
1 0 1 0 1

1 0 1 0 1

1 0 1 0 1
1 0 1 0 1
1 0 1 0 1
29 0 30 0 23
KET
TIDAK LENGKAP/TI 0
LENGKAP/ADA : 1

IDENTIFIKA

NO NO RM NAMA
NAMA

1 00-06-03-09 SAFIRA RAMADHINA 1

2 00-06-04-71 MARINI IDAWATY PASARIBU 1
3 00-05-76-95 KURNIATY DANUATMODJO 1
4 00-05-19-84 DESIRE CHRISYE THALIA WENZEN 1
5 00-06-04-52 CARNIVAL WIJAYANTO 1
6 00-06-03-76 STEVEN BUDI MULIA SIAHAAN 1
7 00-06-03-45 GE SU SIEN 1
8 00-05-73-14 ITI SUMIATI 1
9 00-06-03-06 LILIS WAHYUNI 1
10 00-03-17-83 JOKO SUMARSONO, IR 1
11 00-06-04-46 JOHANNES NAIBAHO 1
12 00-06-06-25 ANCILLA SUGIANTO 1
13 00-04-94-41 MOHAMAD HARRYS PRATAMA MAHINDRA 1
14 00-06-04-24 KAROLINA TANARTAH 1
15 00-06-06-10 FAUZHY 1
JML 15
 ANALIS KUANTITATIF DRM
BULAN OKTOBER 2018

IDENTIFIKASI PASIEN AUTENTIFIKASI PENULIS

CPPT
CAT. PERAWAT
NO RM TGL LAHIR/UMUR J.KEL
zr dok
TGL JAM nama ttd nama ttd TGL
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 0 0 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1 1
15 15 15 15 14 14 15 15 15 15 15 15
AUTENTIFIKASI PENULIS CAT. YANG BAIK

CAT. PERAWAT GENERAL CONSENT RESUME

CORETAN TERBACA

JAM nama ttd TGL TGL nama ttd dok

1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
1 1 1 1 1 1 1 1 1 0 1
15 15 15 15 15 15 15 15 15 0 15
CAT. YANG BAIK

KET
TIPE-X BAG KOSONG

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 1
0 1
 ANALIS KUANTITATIF DRM
BULAN FEBUARI 2019

TIDAK LEN 0
LENGKAP/A 1

NO NO RM NAMA

1 00-06-20-74 SUNTHERS JANUARTO

2 00-00-61-36 FAUZIAH MEDIASYARI
3 00-05-83-12 HERI SUPADMO
4 00-06-15-77 KARSONO
5 00-05-52-24 SUTINEM
6 00-06-18-58 LIM MEI ING
7 00-05-72-82 YULISMI
8 00-06-17-87 SUWIRYA
9 00-06-20-79 TYAGA DHAULAGIRI NUGROHO
10 00-06-21-32 DEWI ARISANTI
11 00-05-41-84 DENI ARDILA
12 00-06-20-75 BHUSHANT
13 00-06-17-47 TATI SURYATI
14 00-06-21-70 DJUSLI MS
15 00-06-21-76 ALCANDER GRACIO PALILING
16 00-06-22-16 AGUNG WIDODO
17 00-06-20-53 RUDY ALEXANDER
18 00-06-20-52 ABRAHAM TANUWIDJAJA
20 00-06-05-77 HERMAN SUBAGYO
21 00-06-00-23 SAMSUDIN
22 00-06-01-99 AGUS
23 00-06-20-78 BURHANUDDIN,DRS.H
24 00-06-18-87 JONI CHANDRA
25 00-06-21-62 DANIEL NATALISWANTO
27 00-06-24-16 SIM YENNYANTY
28 00-06-23-24 NURROCHMAN WIRABUANA
29 00-05-98-70 EMA ANASTASYIA
30 00-04-36-60 MERGIN SULINADI
31 00-06-21-75 SAKTI PANDHEGA MAWADIPTA
32 00-06-12-30 ZULARDI
33 00-06-22-11 DEDI SUPANDI
34 00-06-17-32 BONG SAUW TJUNG HARPINTO
35 00-06-25-36 NGALIMAN
36 00-06-21-94 MUHAMMAD ARKAN
37 00-05-97-20 PAINEM
38 00-06-04-71 MARINI IDAWATY PASARIBU

JML
 TANGGAL KEMBALI
DIAGNOSA TANGGAL KELUAR

2 X 24 JAM

POST LIPPOSUCTION 3-Feb-19 4-Feb-19 1

POST SC 6-Feb-19 7-Feb-19 1
FEBRIS, CKD ON HD 7-Feb-19 8-Feb-19 1
BATU GINJAL MULTIPLE 7-Feb-19 8-Feb-19 1
BATU GINJAL 7-Feb-19 8-Feb-19 1
BATU GINJAL MULTIPLE 7-Feb-19 8-Feb-19 1
CKD ON HD 7-Feb-19 8-Feb-19 1
CKD ON HD 8-Feb-19 9-Feb-19 1
TRAPPED PENIS 9-Feb-19 11-Feb-19 1
KEHAMILAN EKTOPIK TERGANGGU 10-Feb-19 11-Feb-19 1
POST PARTUM 10-Feb-19 11-Feb-19 1
BATU GINJAL 12-Feb-19 13-Feb-19 1
BATU GINJAL 12-Feb-19 13-Feb-19 1
HERNIA SEROTALIS DEXTRA 14-Feb-19 15-Feb-19 1
HIPOSPADIAS GRANULAR 14-Feb-19 15-Feb-19 1
BATU GINJAL 14-Feb-19 15-Feb-19 1
BATU GINJAL 14-Feb-19 15-Feb-19 1
BATU GINJAL 14-Feb-19 15-Feb-19 1
SOFT TISSUE TUMOR KNEE 15-Feb-19 16-Feb-19 1
BATU URETER 15-Feb-19 16-Feb-19 1
BATU GINJAL 15-Feb-19 16-Feb-19 1
BATU GINJAL SINISTRA 21-Feb-19 22-Feb-19 1
BATU DINJAL DEXTRA 21-Feb-19 22-Feb-19 1
KISTA PREPUTIUM/FIMOSIS 21-Feb-19 22-Feb-19 1
BA 22-Feb-19 23-Feb-19 1
POST OP ARTHROSCOPIC KNEE DEXTRA 23-Feb-19 25-Feb-19 1
POST SC 23-Feb-19 25-Feb-19 1
POST BA 23-Feb-19 25-Feb-19 1
UDT BILATERAL 23-Feb-19 25-Feb-19 1
BATU URETER MULTIPLE 24-Feb-19 25-Feb-19 1
BATU URETER 26-Feb-19 27-Feb-19 1
BATU GINJAL 26-Feb-19 27-Feb-19 1
BATU URETER 26-Feb-19 27-Feb-19 1
HIPOSPADIA 27-Feb-19 28-Feb-19 1
BATU MULTIPLE GINJAL 28-Feb-19 1-Mar-19 1
BATU GINJAL 28-Feb-19 1-Mar-19 1
 IDENTIFIKASI PASIEN

LP. OPERASI
KEMBALI

NAMA NO RM
TGL LAHIR/UMURJ.KEL dok

> 2X 24 JAM
TGL JAM nama
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 0 0 0 0
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1

36 36 36 36 35 35 35 35
36 36 36 36 35 35 35 35
SI MARKING INFORMED CONSENT

dok dok

isi
ttd ttd nama TGL JAM nama ttd
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
0 0 0 0 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1

35 13 13 13 36 36 36 36 36 36
35 13 13 13 36 36 36 36 36 36
 PERSETUJUAN
D CONSENT
GENERAL Anestesi dan sedasi transfusi darah dan produk
CONSENT
pas saksi TTD

tgl tgl dok pas saksi

nama ttd nama ttd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 1 1 1 1 1 tdd
1 1 1 1 1 1 tdd tdd
1 1 1 1 1 1 tdd tdd
1 1
1 1

36 36 36 36 36 36 18 18 18 18 18 0
36 36 36 36 36 36 18 18 18 18 18 0
UAN DAFTAR TILIK KESELAMAT
transfusi darah dan produk darah CEKLIS CATATAN
PRE OPERASI ANASTESI
TTD
SIGN IN

tgl pj dr

1 1 1
1 1 1
1 1 1
tdd tdd tdd
tdd tdd tdd
tdd tdd tdd
tdd tdd tdd
1 1 1
1 1 1
1 1 1
1 1 1
tdd tdd tdd
tdd tdd tdd
1 1 1
1 1 1
tdd tdd tdd
tdd tdd tdd
tdd tdd tdd
1 1 1
1 1 1
1 1 1
1 1 1
tdd tdd tdd
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
tdd tdd tdd
1 1 1
tdd tdd tdd
tdd tdd tdd
tdd tdd tdd
 1 1 1
tdd tdd tdd
tdd tdd tdd

0 0 0 20 20 20
0 0 0 20 20 20
DAFTAR TILIK KESELAMATAN BEDAH DO
EDUKASI
PERENCANAAN REKONSULTASI
PASIEN PULANG OBAT
DOKTER
TIME OUT SIGN OUT

1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 tdd
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
tdd tdd 1 1 1 1 tdd
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 1 1
1 1 1 1 1 tdd
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
1 1 1 1 1 1 1
1 1 1 1 1 tdd
tdd tdd 1 1 1 1 tdd
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
1 1 1 1 0 1 tdd
1 1 1 1 0 1
1 1 1 1 0 1 1
1 1 1 1 0 1 tdd
tdd tdd tdd tdd tdd tdd tdd
1 1 tdd tdd tdd 1 tdd
1 1 1 0 0 1 tdd
1 1 1 1 1 1 tdd
1 1 1 1 0 1 tdd
1 1 1 1 0 1 tdd
tdd tdd 1 1 0 1 tdd
1 1 1 1 0 1 0
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
t tdd 1 1 0 tdd
 1 1 1 1 0 tdd tdd
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd

20 20 22 22 11 21 8
20 20 22 22 11 21 8
 AUTENTIFIKASI PENULIS

EDUKASI
ASESMEN INTERVENSI
RESIKO JATUH RESIKO JATUH
PERAWAT FARMASI GIZI

S I

I
OG
TE
AS

OL
AN

EK
N
A

GI
PR
tgl ttd zr tgl ttd zr

1 1 1 1 1 1 1 1 1
1 1 tdd 1 1 1 1 1 1 1
1 tdd tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd tdd 1 1 1 1 1 1 1
tdd tdd tdd 1 1 1 1 1 1 1
1 tdd tdd 1 1 1 1 1 1 1
tdd 1 tdd 1 1 1 1 1 1 1
1 tdd tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd 1 1 1 1 1 1 1 1 1
1 1 tdd 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1 1 tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd tdd 1 1 1 1 11 1 1 1
1 tdd tdd 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1 1 1
1 tdd tdd 1 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd tdd 1 1 1 1 1 1 1 0
1 tdd tdd 1 1 1 1 1 1 1 1
1 tdd tdd 1 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1 1 1
1 tdd tdd 1 1 1 1 1 1 1 1
1 tdd tdd 1 1 1 1 1 1 1
0 tdd tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
0 0 0 0 0 0 tdd
 1 tdd tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd

20 3 4 23 23 23 23 33 23 23 11
20 3 4 23 23 23 23 23 23 23 11
 ASSESMEN RAWAT INAP

R
LA
SI

GI

CU
TE

I
O

TR

TR

H
F
AS

AK
S
OL

RA

DA
A

IA
VA
AN

L
KI

AN
EK

R
SA

DA
BE
IO

GE
PS
N
A

RD
GI
PR

KA

1
1
1
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
1
1
1
1
1
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
1
1
1
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
1
1
1
1
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd 1 tdd
1
1

1
1
1
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd
 1
tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd

3 0 0 0 0 19 0
3 0 0 0 0 19 0
ASSESMEN RAWAT INAP

GP DPJP GIZI NYERI

I
TR
M
H

AK
DA

TE
LA
AN

S
DA
BE

OB

nama ttd nama ttd nama ttd

1 1 0 0 0 1
1 1 1 1 0 1
1 1 0 0 0 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 1 1 1 tdd 1
1 1 0 0 tdd 1
1 1 0 0 tdd 1
1 1 0 0 tdd 1
1 1 0 0 tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1
1 1 1 1 tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 1 0 0 tdd tdd tdd 1
1 1 1 1 tdd tdd tdd 1
1 1 1 1 tdd tdd tdd 1
1 1 1 1 tdd tdd tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd 1 1 1 1 tdd tdd tdd 1
1 1 0 0 tdd tdd tdd 1
1 1 1 1 tdd tdd tdd 1
1 1 1 1 1 tdd tdd tdd 1
1 1 0 0 tdd tdd tdd 1
1 1 0 0 tdd tdd tdd 1
1 1 1 1 tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd
 1 1 1 1 tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd tdd

0 1 23 23 13 13 2 2 2 23
0 1 23 23 13 13 2 2 2 23
 CPPT

MENINGGAL zr dok

jam TGL JAM nama ttd nama ttd

1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
1 tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd
 1 tdd 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd
tdd tdd tdd tdd tdd tdd tdd tdd tdd

22 0 23 23 23 23 23 23 23
22 0 23 23 23 23 23 23 23
 RESUME

READ BACK CAT. PERAWAT

tgl jam ttd TGL JAM nama ttd

tdd 1 1 1 1 1 1
0 0 0 0 1 1 1 1 1 1
0 0 0 0 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
1 1 0 0 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
1 1 1 1 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd tdd tdd tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd 1 1 1 1 1 1
tdd 1 1 1 1 1 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1
tdd tdd tdd tdd tdd tdd tdd tdd tdd 1

7 7 6 6 24 24 24 24 24 36
7 7 6 6 24 24 24 24 24 36
 CAT. YANG BAIK

RESUME

dok CORETAN TERBACA TIPE-X BAGIAN KOSONG

TGL nama ttd

1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 0
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 0
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 0
1 1 1 0 1 0 0
1 1 1 0 1 0 1
1 1 1 0 1 0 1
1 1 1 0 1 0 0
1 1 1 0 1 0 0

36 36 36 0 36 0 19
36 36 36 0 36 0 19
KET
 ANALIS KUANTITATIF DRM
BULAN NOVEMBER 2018

TIDAK LEN 0
LENGKAP/A 1

NO NO RM NAMA

1 00-06-20-32 MEDIOL STIOVANNY YOKU

2 00-06-20-71 JOANNA MARY WILSON
3 00-04-31-75 RATNA SURANTI
4 00-06-20-61 DIAN TARISMA
5 00-06-16-64 ADITYA NIZAR LUTFIANSYAH
6 00-05-98-70 EMA ANASTASYIA
7 00-06-21-02 BAYI NY FAUZIAH
8 00-05-98-03 SUPRIYANTO TJONG
9 00-06-20-91 MURTI IRMA SYLVIANA
10 00-06-21-11 MAULANA IQBAL
11 00-06-17-07 PUTRI PERMATA SARI
12 00-00-44-85 ENTOL MUHAMMAD NAUFAL
13 00-06-21-22 FEBRYANNE MARISA
14 00-06-09-42 VERA RIA FRANSISKA
15 00-05-88-19 NUMAN RAYADI MANAF
16 00-06-21-66 AZZAM KHALIF PUTRA MAULANA
17 00-06-18-57 HILLARY CRISTY SIANIPAR
18 00-02-30-04 GITA ISDINAR OKTAVIA
19 00-06-13-00 HAGIA SOFIA KYNA RAHMAN A
20 00-02-24-49 MALLER RODNEY DAMIEN
21 00-05-03-83 ISFARIAL REIHAN RAISOLI
22 00-06-22-31 SITI SAMSIAH
23 00-06-22-57 ZARAH WAGINEM
24 00-06-22-63 KHAERUDIN SYAPRUDIN
25 00-03-46-24 LIN TJHIU LIAN
26 00-05-78-98 CHRISTIANINGRUM
27 00-06-23-05 YVETTE KIMBERLY A.M. SOES
28 00-06-23-16 MUHAMMAD RACHMANI
29 00-00-43-69 WIDYANTO RUSTIAN
30 00-06-23-64 IMADUDDIN ZUFAR ARIF
31 00-06-23-43 FETI FATIMAH
32 00-06-24-31 RINIKA DWI SEVIANA
33 00-06-23-97 SITI ELNASTA
34 00-06-03-23 VINCENTIUS WIJAYA
 35 00-05-85-14 SARI SUZANNA TUMANGGER
36 00-03-26-30 SEPTIYAN DWI PUTRA
37 00-06-24-62 SITI BADRIATI
38 00-06-10-36 MATHIAS SAMUEL
39 00-05-89-27 ANTON SUTANTO
40 00-05-69-75 GITA ROLINA SIAHAAN
41 00-06-24-88 MARSYA NURISSA
42 00-03-44-79 SATRIA IRSY
43 00-06-11-48 YUNIARDI
44 00-05-50-89 KHUSNUL KHOTIMAH

JML
 DIAGNOSA TANGGAL KELUAR

THYPOID FEVER 2-Feb-19

POST BA 2-Feb-19
THYPOID FEVER 4-Feb-19
F20 3-Feb-19
ANEMIA EC THALASEMIA 6-Feb-19
G1 P0 A0 + FEBRIS 6-Feb-19
BCB SMK 6-Feb-19
F20 7-Feb-19
F20 7-Feb-19
VERTIGO VESTIBULAR CENTRAL 7-Feb-19
F20 8-Feb-19
DHF 8-Feb-19
CERVICAL RADICULOPATHY 8-Feb-19
OBSTRUCKTIF JAUNDICE 10-Feb-19
GASTEROENTERITIS DEHIDRASI 9-Feb-19
NCB SMK 10-Feb-19
THYPOID FEVER 9-Feb-19
TYPOID FEVER 11-Feb-19
DIARE DEHIDRASI RINGAN 11-Feb-19
THYPOID FEVER 15-Feb-19
THYPOID FEVER 15-Feb-19
DHF 15-Feb-19
CKD, HHD, DM TIPE 2 16-Feb-19
DHF 17-Feb-19
BRONKITIS AKUT, DM2 18-Feb-19
ISK, DYSPEPSIA 21-Feb-19
PTSD, GANGGUAN KEPRIBADIAN AMBANG 21-Feb-19
BRONKOPNEUMONIA, HT 21-Feb-19
CHF 22-Feb-19
DHF 23-Feb-19
KOLIK ABDOMEN 23-Feb-19
FEBRIS 23-Feb-19
23-Feb-19
GEA 24-Feb-19
OBS DEMAM G2P0A0 25-Feb-19
MALE HYPO 25-Feb-19
THYPOID FEVER 26-Feb-19
THYPOID FEVER 26-Feb-19
F32 27-Feb-19
THYPOID FEVER 27-Feb-19
ERITEMA 27-Feb-19
THYPOID FEVER 28-Feb-19
PNEUMONIA, GEA, DM2, CKDS ON HD 28-Feb-19
G1 P0 A0 HAMIL; 6 MGG, SUSP ABORTUS IMMINUENS 28-Feb-19
 IDENTIFIKASI PASIEN
NAMA NO RMTGL LAHIR/UMURJ.KEL
GENERAL
TANGGAL KEMBALI CONSENT

2 X 24 JAM > 2X 24 JAM

4-Feb-19 1 1 1 1 1 1
4-Feb-19 1 1 1 1 1 1
6-Feb-19 1 1 1 1 1 1
4-Feb-19 1 1 1 1 1 1
7-Feb-19 1 1 1 1 1 1
7-Feb-19 1 1 1 1 1 1
7-Feb-19 1 1 1 1 1 1
8-Feb-19 1 1 1 1 1 1
8-Feb-19 1 1 1 1 1 1
8-Feb-19 1 1 1 1 1 1
9-Feb-19 1 1 1 1 1 1
9-Feb-19 1 1 1 1 1 1
9-Feb-19 1 1 1 1 1 1
11-Feb-19 1 1 1 1 1 1
11-Feb-19 1 1 1 1 1 1
11-Feb-19 1 1 1 1 1 1
11-Feb-19 1 1 1 1 1 1
12-Feb-19 1 1 1 1 1 1
12-Feb-19 1 1 1 1 1 1
16-Feb-19 1 1 1 1 1 1
16-Feb-19 1 1 1 1 1 1
16-Feb-19 1 1 1 1 1 1
18-Feb-19 1 1 1 1 1 1
18-Feb-19 1 1 1 1 1 1
19-Feb-19 1 1 1 1 1 1
22-Feb-19 1 1 1 1 1 1
22-Feb-19 1 1 1 1 1 1
22-Feb-19 1 1 1 1 1 1
23-Feb-19 1 1 1 1 1 1
25-Feb-19 1 1 1 1 1
25-Feb-19 1 1 1 1 1 1
25-Feb-19 1 1 1 1 1 1
25-Feb-19 1 1 1 1 1 1
25-Feb-19 1 1 1 1 1 1
26-Feb-19 1 1 1 1 1 1
26-Feb-19 1 1 1 1 1 1
27-Feb-19 1 1 1 1 1 1
27-Feb-19 1 1 1 1 1 1
28-Feb-19 1 1 1 1 1 1
28-Feb-19 1 1 1 1 1 1
28-Feb-19 1 1 1 1 1 1
1-Mar-19 1 1 1 1 1 1
1-Mar-19 1 1 1 1 1 1
1-Mar-19 1 1 1 1 1 1

44 44 44 44 44
44 44 44 44 44
 PERSETUJUAN
GENERAL Anestesi dan sedasi transfusi darah dan produk darah CEKLIS
CONSENT PRE OPERASI

TTD TTD

tgl tgl pas saksi tgl pj dr

1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd 1 1 1 1 tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd
1 tdd tdd tdd

44 0 0 0 0 1 1 1 1 0
44 0 0 0 0 1 1 1 1 0
 DAFTAR TILIK KESELAMATAN BEDAH
CATATAN PERENCANAAN
ANASTESI PASIEN PULANG

SIGN IN TIME OUT SIGN OUT

tdd tdd tdd tdd 1

tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1
tdd tdd tdd tdd 1

0 0 0 0 44
0 0 0 0 44
 EDUKASI
REKONSULTASI ASESMEN INTERVENSI
OBAT RESIKO JATUH RESIKO JATUH
DO
DOKTER PERAWAT FARMASI GIZI

tgl ttd zr
1 1 1 1 1 tdd tdd 1 1 1 1
1 1 1 1 1 1 tdd 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 tdd 1 1 1 1
1 0 1 1 1 tdd 1 1 1 1 1
1 tdd tdd 0 0 0 0
1 1 1 tdd 1 tdd tdd 1 1 1 1
1 1 1 tdd 1 1 1 1 1
1 1 1 tdd 1 1 tdd 1 1 1 1
1 1 1 tdd 1 tdd 1 1 1 1 1
1 1 1 1 1 tdd tdd 1 1 1 1
1 1 1 1 tdd tdd 1 1 1 1 1
1 1 1 1 1 tdd 1 1 1 1 1
1 0 1 1 1 1 tdd 1 1 1 1
1 tdd tdd 0 0 0 0
1 1 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 tdd 1 tdd 1 1 1 1 1
1 0 1 tdd 1 tdd 1 1 1 1 1
1 0 1 1 1 1 tdd 1 1 1 1
1 0 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 tdd 1 tdd 1 1 1 1 1
1 1 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 1 1 tdd tdd 1 1 1 1
1 1 1 1 1 1 tdd 1 1 1 1
1 1 1 1 1 0 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1
1 1 1 tdd 1 tdd tdd 1 1 1 1
1 1 1 tdd 1 1 tdd 1 1 1 1
1 0 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 tdd 1 tdd tdd 1 1 1 1
1 tdd tdd 1 1 1 1
1 1 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 tdd 1 tdd tdd 1 1 1 1
1 0 1 1 1 tdd tdd 1 1 1 1
1 1 1 1 1 1 1 1 1 1 1
1 0 1 tdd 1 tdd 1 1 1 1 1
1 0 1 tdd 1 1 tdd 1 1 1 1
1 0 1 tdd 1 tdd 1 1 1 1 1
1 1 1 tdd 1 1 tdd 1 1 1 1
1 0 1 1 1 tdd 1 1 1 1 1

44 22 41 18 40 13 15 42 42 42 42
44 22 41 18 40 13 15 42 42 42 42
 INTERVENSI
RESIKO JATUH

R
LA
SI

GI
TE

CU

I
O

R
F
AS

AT
OL

RA
VA
AN

KI
EK

R
SA
IO

GE
PS
N
A

RD
GI
PR

KA
tgl ttd zr
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1
1 1 1 1
wal kebidanan
0 post0partum, pengkajian awal kebinan bayi baru lahir)
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
wal kebidanan
0 post0partum, pengkajian awal kebinan bayi baru lahir)
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 0
1 1 1
1 1 0
1 1 1
1 1 1 1
1 1 1
1 1 1
1 1 1
1 1 1
1 1 1

42 42 39 0 1 1 2 6
42 42 39 0 1 1 2 6
 ASSESMEN RAWAT INAP

GP DPJP GIZI

I
I

TR
TR

TR

M
AH

AK

TE
LA
A

IA

D
KI

AN
R

S
DA
BE
I

OB
GE
PS

nama ttd nama ttd

1 1 1 1 1 0
1 1 1 1 1 0
1 1 1 1 1 1
1 1 1 1 0
1 1 1 0 0 0
1 1 1 1 0
tdd
1 1 1 1 tdd
1 1 1 1 tdd
1 1 1 1 tdd
1 1 0 0 tdd
1 1 1 1 1 tdd
1 1 0 0 0
1 1 1 1 1 tdd
1 1 1 0 0 tdd
tdd
1 1 1 0 0 tdd
1 1 1 1 1 tdd
1 1 1 1 1 1
1 1 1 0 0 tdd
1 1 1 0 0 tdd
1 1 1 0 0 tdd
1 1 1 0 0 0
1 1 1 0 0 0
1 1 1 0 0 tdd
1 1 1 1 tdd
1 1 1 1 1 tdd
1 1 1 0 0 tdd
1 1 0 0 tdd
1 1 1 0 0 tdd
1 1 1 0 0 tdd
1 1 1 0 0 tdd
tdd
1 1 1 1 1 tdd
 1 1 1 0 0 tdd
0 0 0 0 0
1 1 1 0 0 0
1 1 0 0 1
1 1 1 1 1 tdd
1 1 1 1 1 tdd
1 1 1 0 0 tdd
1 1 1 0 0 tdd
1 1 1 0 0 1

0 0 2 26 1 39 39 17 17 4
0 0 2 26 1 39 39 17 17 4
 CPPT

GIZI NYERI MENINGGAL zr

nama ttd jam TGL JAM nama

1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 1 1 tdd 1 1 1 1
1 tdd 1 1 1 1
0 0 1 1 tdd 1 1 1 1
0 0 1 1 tdd 1 1 1 1
tdd tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
0 0 1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 1 1 1 1
tdd tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
0 0 1 1 tdd 1 1 1 1
0 0 1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
tdd tdd 1 1 1 1
1 1 tdd 1 1 1 1
 1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
0 0 1 1 tdd 1 1 1 1
0 0 1 1 tdd 1 1 1 1
1 1 1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 tdd 1 1 1 1
1 1 1 1 tdd 1 1 1 1

4 4 41 40 0 44 44 44 44
4 4 41 40 0 44 44 44 44
CPPT

READ BACK CAT. PERAWAT

zr dok

ttd nama ttd tgl jam ttd TGL JAM

1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 0 0 0 0 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 1 1 1 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 0 0 0 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 0 0 0 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 0 0 0 1 1 1
1 1 1 1 0 0 0 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 0 0 1 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 tdd 1 1 1
1 1 1 1 1 1 1 1 1 1

44 44 44 16 11 11 12 44 44 44
44 44 44 16 11 11 12 44 44 44
 CAT. YANG BAIK

RESUME

AT. PERAWAT
CORETAN TERBACA TIPE-X
dok

nama ttd TGL nama ttd

1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 1 1 0
1 1 1 1 1 1 0 1 0
1 1 1 1 1 1 1 1 0
1 1 1 1 1 1 1 1 0
1 1 1 1 1 1 1 1 0
1 1 1 1 1 1 0 1 0

44 44 44 44 44 44 4 44 0
44 44 44 44 44 44 4 44 0
ANG BAIK

KET
BAG KOSONG

1
0
0
0
1
1
0
0
0
0
1
0
1
0
1
0
1
1
1
1
1
1
1
1
1
0
0
1
1
1
1
1
0
0
1
1
1
1
1
1
1
1
1
1

30
30