Professional Documents
Culture Documents
CM / Medical Record :
Nama / Name :
CATATAN MEDIS GAWAT DARURAT
Tanggal Lahir / Birth Date :
Accident Emergency Medical Record
Tanggal / Date : Jam / Time :
1. Triage
Prioritas Triage / Triage Priority : P1 (Merah) P2 (Kuning) P3 (Hijau) P4 (Hitam)
❑ Trauma ❑ Non Trauma
Cara Pasien Datang : ❑ Sendiri ❑ Diantar : ……………………………………………
The Patient Presented By Him/herself Come with
_________________________________
Tanda Tangan & Nama Lengkap Perawat
Nurse’s Signature & Full Name
Tanggal / Date : Nama Dokter : Tanda Tangan :
Jam / Time : Doctor Name Sign