ANALISA DATA

Nama pasien : ………………….. Diagnosa Medis : ……………………………

Jenis kelamin : ………………….. No.Med Record : ……………………………
Kamar/Bed : ………………….. Hari/Tanggal : ……………………………

No Data Senjang Masalah Keperawatan Paraf

Perawat
MASALAH KEPERAWATAN

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DIAGNOSA KEPERAWATAN

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PRIORITAS MASALAH

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 NURSING PLANING
Nama pasien : ………………….. Diagnosa Medis : ……………………
Jenis kelamin : ………………….. Hari/Tanggal : ……………………
Kamar/Bed : ………………….. Shif : Pagi / Sore / Malam

No Diagnosa Jam SLKI SIKI Paraf

Keperawatan perawat
(SDKI)
 IMPLEMENTASI
Nama pasien : ………………….. Diagnosa Medis : …………………….
Jenis kelamin : ………………….. Hari/Tanggal : …………………….
Kamar/Bed : ………………….. Shif : Pagi / Sore / Malam

No Diagnosa Jam Implementasi Evaluasi Paraf

Keperawatan perawat