LAPORAN PEMBEDAHAN

NAMA : NO RM
TGL. LAHIR :
JENIS KELAMIN : Lk. Pr.

Tanggal Tindakan Mulai Jam : Selesai Jam : Lama Pembedahan

:
Diagnosis Pra Badah : Jenis Tindakan :

.................................................................. Kecil Sedang Besar Khusus

.................................................................. Bersih Bersih Terkontaminasi
.................................................................. Terkontaminasi Kotor
.................................................................. Cito Elektif
.................................................................. Anestesi
.................................................................. Umun Regional Lokal

Diagnosis Pasca Bedah : ..........................................................................................................

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Tindakan Bedah : ..........................................................................................................
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Dokter

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