Professional Documents
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No.
Pelayanan/ Tindakan
Nebulizer
Standar
Hasil
Analisa
Kegiatan
7 hari
10 hari
Tidak kontrol
20 menit
25 menit
Tidak diawasi
Mengetahui,
KEPALAUPTD PUSKESMASDTP ANYAR
Tanggal
: .....................................................................................
Waktu
: .....................................................................................
Kasus
: .....................................................................................
Daftar Hadir
: ..................................................................................... (terlampir)
Identitas Pasien
: .....................................................................................
Nomor RM
: .....................................................................................
Kronologis
: .....................................................................................
Masalah
: .....................................................................................
Evaluasi
: .....................................................................................
NO
URAIAN
Diagnosis kerja
Diagnosis Pasti
Terapi
SESUAI
TIDAK
SESUAI
KETERANGAN
Saran
: .....................................................................................
Kesimpulan
: .....................................................................................